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HomeMy WebLinkAboutBuilding Permit #462 - 16 SAMUEL WAY 2/27/2009 BUILDING PERMITo� NORTH A 06, TOWN OF NORTH ANDOVER F t APPLICATION FOR PLAN EXAMINATION „ ^^ �1/ Permit NO: Date Received q�R.tTeD•PP`•(� Date Issued: 2 T �SSACHISE� IM ORTANT: Applicant must complete all items on this page LOCATION ". Print ., PROPERTY- vOINNER ;Print m _ MAP NO. PARCEL ZONINGDISTRICT: Historic District yes no Shop rn -Machine _ -;:Yes TYPE OF IMPROVEMENT PROPOSED USE Resodpntinl 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 F.loodpta"n Wetlands *,WatershedFDistrict g UVaerlSewer y } f DESCRIPTION OF WORK TO BE PREFORMED: -(�uc.�C«t�l O' M1��.1 Yui-'► ������, c�a'�Z� -ri 1P Identification Please Type or Print Clearly) OWNER: Name:EEL;: �����'� Address: -z:zs-T A 4 CONTRACTOR ,Name: 1 "1)7 Phone: . �,G �.. Address. . Supervisor s Construction License; C.�` Exp :Date.: �� E~ III v r. Ni C Home lmprouernent::Lidense: :Exp,. Date F/ENGINEER Phone: 0)'­7 Address: '36 hfot4 U -� Reg. No. 4--!->o FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000-0 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ ; , FEE: $ Check No.: ��� Receipt No.: .2/,f`/7 NOTE: Persons contracting with u e e contractors do not have access t e g anty fund 5ignatute`°o -gen _ ,= R gr�ature-of contractor ILA 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 ho, COMMENTS CONSERVATION Reviewed on Si nature adv COMMENTS �,,j a. � y Or HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature&Dire--)/, Driveway Permit A DPW Town Engineer: Signature: ` Located 384 Osgood Street 'FIRE= Dimension Number of Stories: .J— 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 ❑ Notified for pickup Date Doc.Building Permit Revised 2008 t R I ± 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 Addition Or Decks ❑ Building Permit Application . ❑ Certified Surveyed Plot Plan_ ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses. ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products E NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ 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:Building Permit Application Revised 2.2008 I,� Location/ SG,tGI u� ly � / No. �/ �- Date �aRTM TOWN OF NORTH ANDOVER 41 /r U • s : , Certificate of Occupancy $ �ssACM <� Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ � Check# 2184. 7 Building Inspector NORTH c 0 of : Andover No. - �. o dover, Mass., O LAKE COCMIC EWICK 7,e ADRATE D S BOARD OF HEALTH Food/Kitchen Septic System PER M, ,.- IT IN INSPECTOR THIS CERTIFIES THAT woo ............. .......................................................................,.................................................,....... o atio )lq has permission to erect.........:..... ::...................... buildings on .,.���.. ...........,................. .......................................... rough !' to be occupied as �U` C G� Chimney provided that the person accepting this permit shall in every respect 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.INSPECTO...........R Final Occupancy Permit Required to Occupy 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. 4�1 'I l� i � _ .. __ _... ✓�ie �ominoouoeal,/,d o�'✓�ra�ae�zuael� BOARD.OF BUILDINGREGULATIONS 1 r License. CONSTRUCTION SUPERVISOR r ' Number CS 094621 I r ' Birtl��te'�07/0�f�1970 4 Ei� 0702610 Tr.no: 94621 � s � atestn d Yb0 � r COWL FISHER }f 30 JORDAN STREE��.,�` BEVERLY, MA 01915 r' Commissioner A '� RD CERTIFICAT't OF LIABILITY INSURANCC� DATE(MM/DDmYY) OP ID B WINDO-4 11/03/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McLaughlin Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 828 Lynn Fells Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Melrose MA 02176 Phone: 781-665-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Aspen Specialty Ins. Co. Windover Construction, Inc. INSURER B: United Specialty Insurance Co. Attn Karen Cochand INSURER C: One$eacon Insurance Group 13 Elm Street INSURERD: American Internatll Companies Manchester MA 01944 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. LTR NSRE TYPE OF INSURANCE POLICY NUMBER POLICYIEFFECTIVE fON DATE MM/DD/YY GATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000 000 A X COMMERCIAL GENERAL LIABILITY GL0005L74-01 01/01/07 01/01/09 PREMISES Eaoccurence) $]2000 000 CLAIMS MADE OCCUR . MED FXP(Any one person) $ CLUDED •s. y`7 PERSONALBADVINJURY $1,000 000 GENERALAGGREGATE $ OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (EaeCddent) $1,000,000 ALL OWNED AUTOS BODILY INJURY C X SCHEDULEDAUTOS FBIE07908 04/01/08 04/01/09 (Per person) $ X HIRED AUTOS BODILYINJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMSRELLALIABILITY EACH OCCURRENCE $5000000 B X OCCUR 0 CLAIMSMADE CXA4GS708 09/25/OB 01/01/09 AGGREGATE $500000Q $ DEDUCTIBLE $ X RETENTION $ WORKERS COMPENSATION AND rE.L.DISEASE Y LIMITS ER D EMPLOYERS'LIABILITY WC6967012 03 20 ANY PROPRIETOR/PARTNER/EXECUTIVE / /08 03/20/09H ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? If yes,describe under EASE-EA EMPLOYEE $500,000 SPECIALPROVISIONSbelow -POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Edgewood Retirement Community Renovation and Expansion, North Andover, MA Bank of America, N.A. , their subsidiaries, affiliates and parent companies; and their repective officers,directors,trustees,managers,members and employees are Additional Insured on all policies abover (except for WC & employers liability) for liability arising out of the operations of Windover CERTIFICATE HOLDER CANCELLATION EDGEW-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Edgewood Retirement Community NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Inc 57755 Osgood Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR N. Andover MA 01845 REPRESENTATIVES, AUTHORIZE PR NTA O ACORD 25(2001108) ©ACORD CORPORATION 1988 �� �. r j Construction, Inc. and its subcontractors are listed for liability arising out of the operations of the Construction Manager and its Subcontractors on this project.