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Home My WebLink AboutBuilding Permit #296 - 200 Marblehead Road 10/16/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O tNORT#1 O L A Permit NO: Date Received1VL Date Issued:—L °R,r,° �SSHCHU`�E� IMPORTANT: Applicant must complete all items on this page LOCATION �00 MetIIJ I e Rr�cF' Print PROPERTY OWNER 6 (�C f L� • �� f�J/ Print MAP NO.:03 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building /One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ,*Iepair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) O WNER: Name: �>a,, (<- 4 .0 , Phone Address: 200 Mg q�1w � CONTRACTOR Name: Phone:Al Address:�0 �� Supervisor's Construction License: 6,tl,'G f ( Z Exp. Date: o7 r Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$100200 OF THE TOT,4L EST/MATED COST BASED ON 5125.00 PER S.F. Total Project Cost :$ FEE:$ 11/1 00,Check No.: C9 Receipt No.: Page W4 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit 0 Photo Co Of Copy H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks o Building Permit Application o Surveyed Plot Plan o 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) New Construction (Single and Two Family) o Building Permit Application Li Certified Proposed Plot Plan ❑ 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) ❑ 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:INSPECTIONAL SERVICES DEPARTNIEN'rMFORN105 Page 4 of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools El Art L, Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ � Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric 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 ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS e FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes <7 Plannm�Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature& Date Driveway Permit 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) Page 3 f4 Doc:INSPECTIONAL SERVICES DEPARTMENT:1311fORM05 Ocaled JMC.J:m._006 ` Location ` No. e Date 16 . �_d 1� �j NORM TOWN OF NORTH ANDOVER Certificate of Occupancy $ 'IS ACM*Area. t Building/Frame Permit Fee $ -70 J Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19689 Building Inspector e r .. i 1t��H'e�"� •. �tei d of 1i"ril+di �1> t1omIMPR 2 ,'Z TMs a wtsl SITAdriilei .._� gpLEftil. `! � ✓� -CJG�11�/I�IY� �✓4ladJal� , >' BOARD OF REGIdEAT101VS - ; License: CONSTRUCTION SUPERVISOR ° NurnlserCS. 060112 Birtclater"x`08%04l�956 t Expir sc~09104/2008 Tr.no 28784 Re�'strfc�'r�"00 - THOMAS T DOYLE 8 WEST ST ` c SALEM, NH 03079 g Commissioner Page of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 rvyx IL 0wa0N. _R-00F" ING (978)691-1355 Shingles= ACORD,. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY) 07/26/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pelham Insurance Services NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services, Inc.. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 Bridge Street Pelham NH 03076 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Nautilus Thomas Doyle dba INSURER B:Associated Industries Thompson's Construction Roofing INSURER C. 8 West St INSURER D: Salem NH 03079 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. ILTR NSRD TYPE OF INSURANCE POLICY NUMBER DTE(MM/DD/YY)EFFECTIVE POLICY DD/YYDAEXPIRATION TE MM/DDIYY) LIMITS A GENERAL LIABILITY NC 532152 04/15/2006 04/15/2007 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED occu ante $ 50,000 CLAIMS MADE D OCCUR MED EXP(Any oneperson) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 PRO- POLICY JECT LOC 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 FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND AWC7012214012006 04/21/2006 04/21/2007 x CRYLIMTS oR TORY LIMITEP, EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? EGL.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Various Construction CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL V40RTH Town of 0 No. Z _P�J*j A IS E = dover, Mass., COCMICKEWICK V SRATED C3 BOARD OF HEALTH PER' MIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT �.�. .........� ,... . ..A.�.......................................................... ......................... Foundation has permission to erect........................................ buildings on 61.0.0.......fA.wr..b.(A....P-ApA....... ... . • Rough to be occupied as........................... .. . .... .1. �....4...... . .. .....................tital Chimney .......................................... ...provided that the person acceptin his pe it shall in every respect nformtothe 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 CONS TR N STARTS Rough Service rk.*�., D VECTOR 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.