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Home My WebLink AboutBuilding Permit #434-2011 - 16 DUFTON COURT 11/19/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � —)-0 It Date Received Date Issued: t( l� IMPORTANT:A licant must com lete all items on this page LOCATION 16 DQ tj 0—A 0 5—� P.-in tJ R PROPERTY OWNER 6C Print MAP NO: O "o PARCEL ZONING DISTRICT:_ Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ❑'Septic ❑Well Floodplain [1W- etlands 0 Waters `e ,G istnct . DE PTION OF WORK TO BE PERFORMED: �� Identifif at�ionPlease Type or Print Clearly) OWNER: Name ��L�"72- /—'�'W�� Phone: i Address: Ph CONTRACTOR Name: onf 7I-'/7� ��Z I Address: 'j�3 .� "' 4 h Supervisor's Construction License:Cf 3 s Z Exp. Date: I Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �' FEE: $ Check No.: 13 Receipt No.: ��7 NOTE: Persons contractin with u e istered contractors do not have access he guarantyfund I 4 - nature of contractor Signafure_ofAgent/OWne __ _ _ e..— -- Location 1,6 No. 7 3 y .2 0/i Date /1 NORTM TOWN OF NORTH ANDOVER O F . 9 Certificate of Occupancy $ �,ssACMUS t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 7) Check # 23725 Building nspector J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature j COMMENTS i r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Locatedno384 Osgood Street Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use 1 a ® Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application i o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi ORTH F ' Tovm of Andover 0 No. 3 - o dover, Mass.,0 LAK COCHICHEWICK ORATED P `S BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT Cti ............. .... ....�......................�?.�.d.'.y.......................................................................................... Foundation has permission to erect..............: c ' ......................... buildings on , �...� .... .." .... C..G�. ................................. Rough to be occupied as...................�. ...1:�..�?......... .......1.�.G��... ..F................................................................................. Chimney provided that the person accepting this permit shall in every resp�ct conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the- Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and.:Approved by the Building Inspector. Burner. Street No. SEE REVERSE SIDE Smoke Det. Bollr'd of Kuildin; Rc,� ublic ti; Construction "ll inn.-S ; rfet� Supervisor rrtd .4inndardx License: CS License 36852 JOSEPH LOW R WATSON 43 T RD ANDOVER, MA 018811 00 11171.1-11,,,, Expiration: 5/26/201♦ 2 Trµ: 28949 I 11/2/2010 9:25 AM FROM: HOWE INSURANCE AGY HOVE INSURANCE AGENCY TO: 1-978-475-0413 PAGES 001 OF 001 -7 ACORDTmCERTIFICATE OF LIABILITY INSURANCE DAT;ro2M1I j PRODUCER Phare: (978)4750400 Fax: (918)4752171 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION THE HOWE INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 PUNCHARD AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ANDOVER MA 01810 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURERA: Travelem Insurance J W WATSON JR EXCAVATING INC INSURER B: Travelers Insurance 43 LOWELL JUNCTION ROAD INSURER C: MWCARP ANDOVER MA 01810 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR ADDIJ INSRTYPE OF INSURANCE POLICY NUMBER POLICY EFIDM FECTNE POLICY IXPMAT DATE MMA)DIYY ATE MMDONY LIMITS GENERAL LIAW Y 6806445P311 02/03M 0 02/03111 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY PRE T ERENTED ce $ 300,000 CLAIMS MADE X❑OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 POLICY 7 JEPRa LOC AUTOMOBILE LIABILITY BA5872R700 10/21MO 10/21M1 COMBINED SINGLE LIMIT ANY AUTO (Ea aocidanl) S 500,000 ALL OWNED ALTOS BODILY INJURY X SCHEDULED ATOS (Per person) S B X HIRED ALTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per acdderlt) GARAGE LIABILITY ALTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS IUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 7 CLAIMS MADE AGGREGATE $ S DEDUCTIBLE S RETENTIONS S WORKERS COMP04SATION AND WC601324801 12/10/09 12M0/10 Toai�ETm`� oTM EMPLOYERS'LUBIUTY C MY►ROFRIETORRAfflWM 7?CYRYE E.L.EACH ACCIDENT S 500,00() OFF ICEWMEMWREXCUIOEDt E.L.DISEASE-EA EMPLOYEE S 500,000 YON,d"em"under weaLcPmy mswwrr E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCA IONS/VEHICLES/EXCLUSIONS ADDED BY INDORSEMENT/SPECIAL PROVISIONS TOWN OF ANDOVER AS ADDITIONAL INSURED. PROPERTY LOCATION:16 PEARSON STREET ANDOVER MA 01810 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, ;MORIZEO REPRESENTATIVE *ChstinerangeJ. O ACORD CORPORATION 1988