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HomeMy WebLinkAboutBuilding Permit #52 - 18 MEADOWOOD ROAD 7/17/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:� Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION l45 N1f-��©fl -tJ PROPERTY OWNER STEMP 1N1 �� Print MAP NO: )-4" PARCEL: �. ZONING DISTRICT: Historic District yes Fn0dMachine Shop Village yes TYPE OF IMPROVEMENT o Residen ' Non- Residential New Building T �i eb T */ PROPERTY OWNER STEMP 1N1 �� Print MAP NO: )-4" PARCEL: �. ZONING DISTRICT: Historic District yes Fn0dMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Building nefamily Addition Two or more family Industrial Iteration No. of units: Commercial Others: Repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: NEw &oF R%9 oLp Rood' e)FF Identification Please Type or Print Clearly) OWNER: Name: RN -V-7 F Phone: fel W 35x&6 AdrirP-qs- CONTRACTOR Name: l C�ENj Phone: ( 33� - Address: ,47- Rn ri L e'.A- C -t. SAL&L' F1411 010247 Supervisor's Construction License. CS It iplk05 Exp. Date:, oja t_&2c31d Home Improvement License: 1N.<7 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: $Caocn, o c) FEE: $ Check No.: 2,605 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the guagnty fund nature of Agent/Owner Signature of contractor C. 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 Signature COMMENTS HEALTH Reviewed on Signature - COMMENTS L 40 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no 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 ❑ Notified for pickup- Date Doc.Building Permit Revised 2009 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 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 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 Revised 2008 Location ;/&�, No. Z 2 Date to TOWN OF NORTH ANDOVER .. s Certificate of Occupancy $ Building/Frame Permit Fee $"" Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # o? b 0 2222-6 ZY Building Inspector 07/17/2009 13:29 19786859460 HASBANY INSURANCY HAUL U1 ACORD CERTIFICATE OF LIABILITY INSURANCE rr D"TEIMMID°WY") 07/17/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hasbany Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 236 Pleasant St ALTER THE COVERAGE AFFORDED BY THE POLICIES • BELOW. GENERAL LIABILITY 987668 06/28/2009 Methuen, DW 01844 Phone N: 978-685-3188 Fax Ot 978-685-9460 INSURERS AFFORDING COVERAGE NAIC0 INSURED IWUWTIA•• Penn AMmica Insurance COIBpa Craig Cohen IULaugfn0 -State Insurance __...,••, _- 405 Waltham St.-' INgVRER C: Methuen, MA. 01844 LLCURER0: COVERAGES THE POLICIES OF INSURANCE LISTED QRI.OW 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 DESCRIOED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE 13FEN REDUCED BY PAID CLAIMS, LTR IHBND TYPE OF INBVNANCE POLICY NUMBER I DATE IM -EFFECTIVE. ..!SM DATE uMWOOM ON LIMITS A GENERAL LIABILITY 987668 06/28/2009 06/28/2016 EACINOCCURRENCE s1,000,000 X COMMERCIAL OFNf:11AL 1V181LITY bRFI1A% IEPcoTC� - PRFw49FS (EA oacuronool _ a 100,000 1 CLAIMS MADE I - I OCCUR MED EXP (Ary M. pe rj a 10 , 000 PERSONAL A ADV INJURY $1,000,000 - BFNFRAI AOomm $2,000,000 OCNt AOOREOATF. LIMIT ArrLIES PER: 52,000,000 PRODUCTS- COMPIOP AOO PRO- X POlcv LOC JECT .. -. .. AUTOMCBILe U ADILRY I COMRINFD SINOLE LIMIT ANY AUTO $ (FA ar.W"Q ALI. OWNED AVIW _ HOMLY INJURY I SrHEDULE0 AUTOS IPn penal a HIRFD AIITOS ^ DODII.V INJURY & NONIiWNEO AUTOS — leer AooldaHl - _ ... PROPERTY DAMAOF i (Per wmIonD GARAGE LUIBILITY AUTO ONLY • EA ACCIDENT S ANY AUTO OTHER THAN FA A(,Y; g AUTOONLY: ADO a EXCESSAIMDRELLA LIABILITY FACHOCCURRENCF S OrCIA n CII AIMS MADE AnOApAYE _ DFn[IrT9LE Y ( E _ RFTENTION S S IS WORAERG COMPENMTION AND WCMA87-319-09 06/28/2009 06/28/2010TORYiIMITs X EMPLOYEAVUABILITY •• -- - ER ANN PR(u`RIETOR/PnRTNFaFxErUTrvE r;,l„ EACIIACCIDF.NT $1,000,000 OFFICF.RIM[MPER EXCLUDEp7 F.I., DrCEASE • EA FMPI.OYEF F 1 , 000 , 000 S yM,,k,.rAD Unna x __ SPFCIAL PROVISIONS We. F.I. DISEASE - POLICY LIMIT 91,000,000 OTHER "SICRIPTION OF OPITRATIONB I LOCATIONS / VEHICLES I EXCLUSIONS ADDED ST ENDORSEMENT /SPECIAL PROVI[SIONB Opps:General Contractor CERTIFICATE HOLDER CANCELLATION building inspector SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BF, rANCELLED 11tFORE THE EIPIFAIL' Roan of No. Andover DATE THEREOF. THE ISBUINO INSURER WILL ENDEAVOR TO MAIL 10 DAYS W NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILUPE To DO So IMPOSE. NO OBLHIATION OR LIABILITY OF ANY XMe UPON THII INSURER, ITS AOENTS OR 1-603-898-9581 1 Eric o � uj z CL c% O O y w. C VO V CL c ev R O c ;= O Cc `o KJ c v' = m c C. EE o c O O .. "m Cm \mc E C : `m a CD Co m y y W c v�EcDm cc Amo CL. Co ; = p cm c Cm 0 0 o r m v y p G -00 Z ++ t c O C H m y d CD C �c Q : ti 3 0 = m CL N r N mCc W 00 w�L Co CZ W C Z ac 'ECm H o Ca a 5 = W m ` N �= Q " 2 O CM Ca O -0 'E m m CD 0 CD Z O� CD L O d o � C O O v J •O •O. C Z Q CL V CO) � C _ C C !O CO3 0 0 N LU U) 19 W LLI LLIW CA 0 A H a w w w � a w v � A � t� v Wv w 2 O i Co c a Sao '� v ,� O aai to p O Cd tz w � G 0 C � � .x O w Cf)w w U w" r�G w" w cn w' u: w cq cn cn o � uj z CL c% O O y w. C VO V CL c ev R O c ;= O Cc `o KJ c v' = m c C. EE o c O O .. "m Cm \mc E C : `m a CD Co m y y W c v�EcDm cc Amo CL. Co ; = p cm c Cm 0 0 o r m v y p G -00 Z ++ t c O C H m y d CD C �c Q : ti 3 0 = m CL N r N mCc W 00 w�L Co CZ W C Z ac 'ECm H o Ca a 5 = W m ` N �= Q " 2 O CM Ca O -0 'E m m CD 0 CD Z O� CD L O d o � C O O v J •O •O. C Z Q CL V CO) � C _ C C !O CO3 0 0 N LU U) 19 W LLI LLIW CA NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: A M (a0woo Rn js that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: sP1^14 N\A LL+5 ImPo5eL, (Location of Facility) Sig of Permit Applicant 0747 Loi Date .h R Licensed 6 Insured Member of Boston Better Business BureauV rjap jas a 1 Page No of Pages. COHEN� BROOKLINE MALDEN (617)73,14-9100 e _ * (781) 322.0822 FULLY LICENSED ROOFING SPECIALISTS FULLY INSURED 405 WALTHAM ST #356, LEXINGTON, MA 02421 PROPOSAL SUBMITTED TO PHONE DATE S"t I� ti 979 bc6Z Vt`15q I 0 C oq STREET JOB NAME 116 7_500,J6oC) R S i VStAL_Pi UAco , (cm CITY, STATE AND ZIP CODE JOB LOCATION Ncxr 0 C(ZM n C) S�L� A Mt ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates. Strip roof down to the boards, replace normal amount of boards. Maximum amount of boards to be replaced 75 feet at no charge. StX Put three. feet of Winter Guard on all bottom edges of roof, and existing valleys. Refer to Exhibit A. Cover entire roof with roofing paper. Install 8" aluminum drip edge on all edges of roof (color UA i counter flash chimney, new vent pipe flashing(s). Install a 68F I o,< 30 year roof. All roofs hand nailed. We DO NOT use nail guns. W�R't1�tiy?.WcGO All debris will be removed by Cohen Construction 12 year guarantee on Workmanship License 30 year guarantee on Materials #148746 CQT IN A RNb(af\)f-NII V -1A ..1 fn9Rc.vL0 \Iity i I L.-, i ic,r,-,J Be propIISe hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars `7 ayment to be made as follows: LF. All material is guaranteed to be as specified. All work to be completed in a workmanlike man- ' ner according to standard practices. Any alteration or deviation from above specifications Authorized r �' involving extra costs will be executed only upon written orders, and will become an extra Signature --- charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our Note: This proposal may be 30 workers are fully covered by Workman's Compensation insurance. withdrawn by us ff not accepted within days. Arreptttnre of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work Signature ! ��t� �l /^ 3--'t.m_ .•� as specified. Payment will be made as outlined above. Date of Acceptance: o�I O � / C_ V r ' L Signature