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HomeMy WebLinkAboutBuilding Permit #340 - 185 SUTTON HILL ROAD 5/1/2018 BUILDING PERMIT "°RrM q ttt`"ab• �O TOWN OF NORTH ANDOVER 0� °: - - °p APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ,TEo gSSACHUs�� Date Issued: IMPORTANT:Applicant must complete all items on this.page .LOCATION ' 5�1� nir Print PROPERTY OWNER Alp z4 .� C r� print MAP NO: PARCEL: 7b ZONING DISTRICT, Historic District .yes no 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 Wetlands Watershed District Water/Sewer 11 DESCRIPTION OF WORK TO BE PREFORMED: Identificationlease Type or Print Clearly) OWNER: Name: ' C a�arL Phone: Address: ,gyp CONTRACTOR Name: tk 6e rql � Phone: 417^rg' 7 Address 4 �' r # �C"- .�-t d Supervisor's Construction License: 3 ` 4 'Pp Exp. Date: /o/• s-,/� Home Improvement License: e n S'!;r-a73 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: $ 7.6 cJ FEE: $ z— Check No.: �.3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc he guaranty fund i nature of Agent/Owner—, Signature of contrac o 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 4 DATE REJECTED DATE APPROVED + PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 Durnpster on site yes no Located at 124 Main Street Fare 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 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 ❑ 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 Application Revised 2.2008 I 1 Location �� ' No. b Date NQRTITOWN OF NORTH ANDOVER •. pL � A 9 } °z ; . Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ ��7 s,K,a,sr. 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 � � , �} Buildirig Inspector ` NORTH TO" of :_� Andover O ~ l w..Y...,` V" No. C� ,.,..x , 4 o �` dover, Mass., �'�z' COCMICHEWICK A0RATE0 `S BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ ....rte 'r.f./ .... ... ?/a./y........................................................................... ......,. /� """"' Foundation has permission to erect........................................ buildings on ..... a``�. ?rY.../1.J.... /... ...................... Rough tobe occupied as................................. 'fil'��,�....... ....... c`:.. . . .�z.�a.. ................................................................. 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 ART Rough ... Service BUILDING INSPECTOR 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. OP ID 1K2:10/01/08 TE(MMIDDIYYYY) ACoRD CERTIFICATE OF LIABILITY INSURANCE BERUB-1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE TD Banknorth Ins Agcy Inc (MT) HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR One Griffin Brook Dr, S#100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. iMethuen MA 01844-1865 ' Phone: 978-688-4667 Fax:978-682-9037 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Charter oak Fire Insurance Co. 25615 INSURER B: Raymond Berube INSURER C: Ray�and Berube 36J. Chlckering Wa INSURER D: No Andover MA 01845 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. POLICY EFFECTIVE POLICY EXPIRATION LIMITS IN5RLTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE MMIDDIYY EACH OCCURRENCE $500000 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ 300000 CLAIMS MADE OCCUR MED EXP(Any one person) $5000 A X Business Owners I6806242B353 12/15/07 12/15/08 PERSONALBADVINJURY $500000 GENERAL AGGREGATE $1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $lOOOOOO POLICY PE LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $. EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE E.L.DISEASE-EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER PROPERTY 1124 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS This certificate is subject to policy terms and conditions. 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 Scott Theleman IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P.O. Box 83 REPRESENTATIVES. Lawrence MA 01842 AUTHORIZED REPRESENTATIVE ITD Banknorth Ins. Agency, Inc. ©ACORD CORPORATION 1988 ACORD 25(2001108) { I --.. — --r.....—._--- - — -- —...---.._—.__--.. -----.n.._----- ... — art .ij �i ' Page# of pages i `II Propont Proposal Submitted To: Job Name Job# I Address Job Location Date / -7a te of Plans i Phone# Fax# Architect e t > =herebybmit specifications and estimates for: ..... . ... i ._.. .. _ _ ..... ._.. _ _..__._ _._._..__... e I I i s _ .......... v _........ I We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ 7D011ars with payments to be made as follows: I r Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. i 2cceptance of Propool The above prices,specifications and conditions are satisfactory and are Signature, hereby accepted.You are authorized to o the work as specified. Payments will be made as outline I' / e� Date of Acceptance �7 J Signature ! NC3819 �+- ._ ✓fie-1�uvei /,oo��.�' �,fau��ta,.k. Board of BulationS an _Standards i Gontruction,Supiso ervr License License; CS' 35867 a" Explrefion�X215/2009 Tr# :8995 RAYMOND V BEfltg I 361 CHICKE 'ING N.AND01/ER,MA 01845 Commissioner i Board of:Building ui uilding Regulations and Stam NOME IMPROVEMENT CONTRACTOR Registraio,n`,, 105523 Ezpiratian 7/17/2010 Tr# 27075 T,., . rhdMdual �,AYMOND.V BERUBE , I:aymond Berube :.61 Chickering Rd �""�' um� 0 1845 Ad. ti ttir s ACORD OP ID 1K DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE BER -1 10/01/08 - PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE TD Banknorth Ins Agcy Inc (MT) HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR One Griffin Brook Dr, S#100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Methuen MA 01844-1865 Phone: 978-688-4667 Fax:978-682-9037 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Charter oak Fire Insurance Co. 25615 INSURER B: Raymond Berube Raymond Berube INSURER C: 361 Chickering Wa No Andover MA 01815 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. INZIK TYPE POLICY NUMBER` POLICY EFFECTIVE POLICY EXPIRATION LIMITS _. LTP. NSR TY.E-OF-INSURANCE — DATE MM/DD/YY----DA4? MM/DDM-GENERAL LIABILITY EACH OCCURRENCE $500000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ 300000 CLAIMS MADE F1 OCCUR MED EXP(Any one person) $5000 A X Business Owners I6806242B353 12/15/07 12/15/08 PERSONAL a ADV INJURY $500000 GENERAL AGGREGATE $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1000000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS I ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ \ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER PROPERTY 1124 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS This certificate is subject to policy terms and conditions. i 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 Scott Theleman IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P.O. Box 83 Lawrence MA 01842 REPRESENTATIVES., AUTHORIZED REPRESENTATIVE 1TD Banknorth Ins. Agency, Inc. ACORD 25(2001108) ©ACORD CORPORATION 1988