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Home My WebLink AboutBuilding Permit #304 - 19 WAVERLY ROAD 10/17/2006 f NOR7N 1 - 3? ° TOWN OF NORTH ANDOVER "•�'t �-. ": APPLICATION FOR PLAN EXAMINATION ,'SSACHUS�' Permit NO: V Date Received: Date Issued: `b �? b IMPORTANT: Applicant must complete all items on this page 1.00ATION1I Gil/ k AQ • Print PROPERTY OWNER 44 i ] Print MAP NO.: ! 9 PARCEL: O ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential `❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial a N(Iteration No. of units: repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition + ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: Phone: z� `� 4 Address: CONTRACTOR Name: -&/941� Phone: ?S7 Address: Lam/ ��t�Q ��; �_/ Supervisor's Construction License: 4�74 7560 Exp. Date: Home Improvement License: /.3 Exp. Date: 6 ARCHITECT/ENGINEER — Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00'OF THE TOTAL ESTIMATED COST BASED.-ON$125.00 PER S.F. Total Project Cost :$ a 6S4)-0 x10.00=FEE:$_ OD ' Check No.: Receipt No.: 7/ Pa,,e I of 4 TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well F1 ❑ Permanent Dumpster on Site Private(septic tank,etc. F1 Permanent Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of Contractor ? / Plans Submitted ❑ Plans Waived �� Certified Plot Plan ❑ Stamped Plans �/❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ' ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS �► DATE REJECTED DATE APPROVED HEALTH ❑ ❑ . . - 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 Temp Dumpster on site yes -'<o Fire Department signature/date Building Permit Approved and Issued by: Paso 2 of 4 Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) e I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENTWFORM05 Created 1MC.Jan.2006 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 v/,Building Permit Application /'/ Vorkers Comp Affidavit �4hoto Copy Of H.I.C. And/Or C.S.L. Licenses ' py o of Contract Floor Plan Or Proposed Interior Work Addition Or Decks " ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit J ❑ 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) 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 f ❑ Two Sets of Building Plans (One To Be Returned) to Include SprinklAr Plan And Hydraulic Calculations.(If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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:INSPEC'r10NAL SERVICES DEPAR'rN,1EN'1':RPFORi�105 Page 4 of Location _tj r P No. 0 '4 Date j0 ,r TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ CMUSE<� Building/Frame Permit Fee $ �e Foundation Permit Fee $ L_ t- Other Permit Fee $ TOTAL $ Check # 1/17 p l 19697 Building Inspector cut The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.O.Bos 1025 State Road,Stow,MA 01775 PERMIT Date: Z0 7-0� North Andover Permit No Dig Safe Num er (City of Town) (If Applicable) In accordance with the provisions of M.G.L.14 8 Chapter_JD_as provided in section 5 7 7 CMR 34 Start Date This Permit is granted to: Full name of person,Firmor Corporation Permissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be . 25 ' from structure if unable to place with required Restrictions: clearance//_''dumpster must be covered with plywood or tarp end of work _ day at r411A) V r•C..1 L �L (Give location by street add no.,or describe in such manner as toArovied adequate identification of location) FeePaids 50.00 1/11'41VOZ, Fire Chief This Permit will expire 7-04- (Signature of offical granting permit) Offical granting permit (Title) OCT 05 2006 4:38PM HP LASERJET 3200 �tP.5 A ORD CERTIFICATE OF LIABILITY INSURANCE OP IDIID °A�'MM'°°" ' PROD TWOL810105/06 THIS 0 45 06THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Davis, Davis & Moody HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 40 Kenitra Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill tom► 01830 Phone: 978-373-1347 Faa:978-556-0285 INSURERS AFFORDING COVERAGE NAICA INSURED IN$URERA: Arbella Protection Ineuranpe INSURER B: TWOB3e1r & 3n aS@ Contracting In INSURERC' Northh Andover VIA 01845 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTVVITHSTANDING ANYREQUIREMENT,TERM OR CONDITION OF ANY CONTRACT DRCTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL.THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS GROWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. InamPOLICY LTR NS TYPEOFINSURANCE POUCYNUMBER D MNIDDIY' DATE MM/DDVYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $],,000,000 A $ COMMERCIALGENERALLIABILITY 8500012700 06/22/06 06/22/07 PREMISES CE9ocaaanca $100 000 CLAIMS MADE 7 OCCUR NEDEXP(Any one parson) $5,000 PERSONAL SADV INJURY S 1 004 000 GENERAL AGGREGATE S2,000,000 GENL AGGREOATE LIMB APPLIES PER: PRODUCTS-COMP(OP AGO $2 OOO 000 POLICY JECI- LOG AUTOMOBILE LIABILITY COMBINED SINGLE LINT ANY AUTO (Ea accident) $ A'_L OWNED AUTOS SCHEDULED AUTOS (Per PersoN ILYIN) S Per HIRED AUTOS BODILYIWURY S NON-CVVNED AUTOS (Per accident) PRO PERTY DAMAGEri $ (Per accident) GARAGELMIBILITY AUTO ONLY-EAACCIDENT 6 ANYAUTO EA ACC 6 OTHER THAN AUTOONLY: AGG $ EWESUM13RELLALIASIUTV EACHOCCURRCNCE $ OCCUR El CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE S. RETENTION $ $ VERKERSCOMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY ANY PROPWETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT 6 OFFICERIMEL48EREXCLUDED? E.L.DISEASE•EAEMPLOYE $ Yt rras,desarlbo under BPEGIAL PROVISIONS below E.L DISEASE-POLICY LIMIT 6 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT?SPECIAL PROVISIONS WORlMRS COMPENSATION CERTIFICATE TO FOLLOW SHORTLY. CERTIFICATE HOLDER CANCELLATION NORTH A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFORE THE EMRA71ON DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITIIEN TOWN OF NORTH ANDOVER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 0060 SHALL FAX #978-688-9542 IM POaE NO OB LIGATION O R LIABILITY OF ANY KIN D UPON THE INSURER,ITS AGENTS OR 27 CHARLES STREET - NORTH ANDOVER MA 01845 REPRESE AT1 S. AUTT+o seNTa ACORD 2612M1108) 0 10 ACORD CORPORATION 1988 1ALr2u4ra.& liviulunt) 1VfU/ZVV0 0:V4 vpkut Vil/Uli tax Server A4h PRODUCER THIS CEFRUUTIF- TF IS ISSUED AS A MATTF; ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DAVIS DAVIS & MOODY INS HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 40 KENOZA AVE ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. PO BOX 949 COMPANIES AFFORDING COVERAGE HKVERHILL MA 01831 COMPANY 286XP A TRR TRAVELERS INDEMNITY COMPANY INSURED COMPANY TWOMEY & LEGARE CONTRACTING B INC COMPANY PO BOX 366 NORTH ANDOVER MA, 01845 c COMPANY D 6-6 =, .VEl=-EW*'*."'"'l"'- THIS 13 TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE POLICY EXPIRA710M LIMITS LTR DATE(MDMYT) DATE(MMOVYY) GENERAL LIABILITY GENERALAGGRM7E COMMERCIAL GENERAL LIABILITY PROOUCTSCOMPIOFAGG. CLAIMS MADEF__j OCCU R. PEWNRL&ADV.INJURY OWNERS&CONTRACTORS PROT. EACH OCCURRENCE RRE DAMAGE(Any one fire) MED.EXPENSE(Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE GARAGE UABIL11Y AUTO ONLY-EA ACCIDENT S ---------- ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE UMBRELLAFORM AGGREGATE OTHERTHAN UMBRELLA FORM WORKER'S COMPENSATION AND A STATUTORY umrrs EIMPLOYER'S LIABILITY (UB-5647C42-2-06) 09-18-06 09-10-07 THE PROPRIETOR! EACH ACCIDENT PARTNERWEXECUTIVE RINCL DISEASE-POLICY LINT mm —ts--500.000 OFRCERSARE: — X EXCL DISEASE-EACH EMPLOYEE OTHER 019CRIPTION OF OPEUrIONSILOCA'nONI�EFICLESIROFMCYIONSSPEaAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED,TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN H0710E TO THE CERTIFICATE HOLDER NAMED TO THE TOWN OF N ANDOVER LEFT, BUT FAILURE TO MAIL SUCH NOTICE WALL IMPOSE NO OBUGATION OR 27 CHARLES ST UABRJITV OF ANY END UPON THE COMPANY,ITS AGENTSOR REPRESENTATIVES, N ANDOVER MA 01845 7 AUMOOZED PWAME a .. ... ....... . ............ ........ .............1 ......... . .......... ...... .......... ........ o . ✓die�io�arT�u»uuue+a/,f/o�.��a� Board of Building Regulations and Standards License or registration valid for mdividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date, if found return to: Reg_iSh"t t', 136779 Board of Building Regulations and Standards rattori� One Asbburbou Place Rm 1301 8116f2008 Boston;Ma.02108 Lyp . Partnership TWOMEY+LEGARE CONTRACTING SHAWN TTWOMEY. 61 PATRIOT ST. N.ANDOVER,MA 01845 Administrator Not vahlrwithout s4zature —_ - BOARD OF BUILDING R License: CONSTRUCTION S Number: CS 067560 , Birthdate .10/25(1966 Expires:10/292007 Restricted: 00 SHAUN M TWOMEY 61 PATROIT ST c� N ANDOVER, MA 01845 Commissioner rrasgav�aa TWOMEYLEGARE CONTRACTING Professional Building /Remodeling P.O,Box 366 Shaun Twomey No.Andover,MB 01845 Doug Legare 978-685-7447 978-556-1547 NAME OF OWNER ADDRESS OF JOB Z( (/l/j vele-L i Ad r &o IrA , TEL. DATE: to ?-p T ® �' We hereby submit estimates for. , ELST/All- e- ST/All- '4:SA Ale- C7` /VMhi t/1� etti 5�'�!/atvc� /f A- C-0,06- I,-zr &-1 04 We Propose hereby to furnish material and labor.-complete in accordance with above specifications,for the sum of: dollars($ `3j /y� ' ) PaymeW to be made as follows: � .� _ ,h 6 ac©, — 2 qoa o-�- •tet-�- 3 e- 7 Authorized Signature NOTE:This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature Date of Acceptance: Signature NORTH Town of �_ � Andover NAZI.. No. 3� A dover, Mass.,-Z- V//7/�'A COCMICMEWICK �d A0RATE D % BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT........... /A ........................... .�... .�pclal*ov. ..I. ............ Foundation has permission to erect........................................ buildings on .. ........... Rough to be Occupied as.................. �.. ......it.... y .. ...... ................................... Chimney provided that the person acre ng this permit shall in every respect con to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to t e 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 CONSTRUCTT START Rough ... . . .. .. .. . . ......... ........... Service PECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done RE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Proposal TWOMEY & LEG E CoNTRAcTiNG Professional Building /Remodeling P.O.Box 366 Shaun Twomey No.Andover,MA 01845 Doug Legare 978-685-7447 978-556-1547 NAME OF OWNER -5 LISA,hj ADDRESS OF JOB TEL. DATE: O b 6 We hereby submit estimates for: S ans 67o 57U., �04,o. W g .� t�.h ` V e H4- V,4f L� 6" v We Propo8e hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: pip lars Payment to be made as follows: ✓ CAC d� OS, T L 000 e-� Ccmwltke, r-r— v 0 L eor- S Authorized Signatur _,:�7 -A-*e NOTE:This proposal may be withdrawn by us if not accepted within days. ACCepUmee of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signa t ' G/ Date of Acceptance: Signature