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Home My WebLink AboutBuilding Permit #122 - 200 SUTTON STREET 8/16/2006 Of ttORTH 1N TOWN OF NORTH ANDOVER '•�, APPLICATION FOR PLAN EXAMINATION 9SSACHUSE4 / 1 ]PROM-7 Permit NO: Date Received: 10 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 4; Print PROPERTY OWNER Print MAP NO.: PARCEL: 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 ❑ Alteration No. of units: ❑ Repair, replacement L/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: Signature Address: CONTRACTOR Name: y I L Phone: &D/ Address: � � —.7c— Al. Supervisor's Construction License: 62oo Exp. Date: Home Improvement License: Exp. Date: J/ za ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$A%W PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$12.5.00 PER S.F. Total Project Cost :$ _ w x4* EE:$ Check No.: ( D Y0 Receipt No.: Y Page I of 4 TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art ❑ Public Sewer Tobacco Sales Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site El Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaran fie Signature o g wner d f A 7ent/O ✓ Signature of Contract g 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 El Other COMMENTS�V c ffi nk ,c.->_ ATE REJECTED DATE APPROVED CONSERVATIO o ��'a- COMMENTS I CtVICA �a�5141SJ 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 Dempster on site yes_no_ Fire Department signature/date Building Permit Approved and Issued by: Page 2 ol'd 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 of 4 Doc:INSPECTIONAL SERVICES DEPARTMEN'I':nPFORM05 Created JMC.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 ❑ 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 Addition Or Decks o Building Permit Application ❑ 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) New Construction (Single and Two Family) o Building Pen-nit 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 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 DEPARTNIENTMFORNI05 Pine 4 of 4 Location ,-1yy ✓J f+b n Lr— No. t Dates MORTq TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ sJACMUSEt� Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #19364 l) Building Inspector Nt . IONAL GRANGE MUTUAL INS . CO . EDWARD E VIEL DBA Policy Number: MPI66885 VILLAGE KITCHEN & APPLIANCE Account Number: CAC I66885 Effective Date: 09/20/05 Agent: CHAS F HARTSHORNE & SON INC Producer Code: 200167 CONTRACTORS DECLARATIONS - COVERAGES APPLYING TO THIS LOCATION DESCRIPTION OF PREMISES - ADDRESSES Prems. Bldg . No . No . Address 2 1 9 OSGOOD ST LAWRENCE, MA 01840 ESSEX DESCRIPTION OF PREMISES - OCCUPANCY AND CONSTRUCTION Prems . Bldg . No . No . Occupancy Construction Protectior 2 1 CARPENTRY-INTERIOR FRAME 3 COVERAGES PROVIDED Prems. Bldg . Limit of No . No . Coverage Insurance Ded 2 1 CONTENTS-SPECIAL 11000 250 OPTIONAL COVERAGES Prems . Bldg . No . No . Coverage Limits 64-N18&19/00 09/08/05 RENEWAL MC NATIONAL GRANGE MUTUAL INS . CO . ;r EDWARD E VIEL DBA Policy Number: MPI66885 VILLAGE KITCHEN & APPLIANCE Account Number: CAC I66885 Effective Date: 09/20/05 Agent: CHAS F HARTSHORNE & SON INC Producer Code: 200167 CONTRACTORS POLICY DECLARATIONS - LIABILITY SCHEDULE LIABILITY COVERAGES PROVIDED Code Premium Advance Premiur Classification No . Basis Rate Prems/Op & Produci STATE - MASSACHUSETTS CARPENTRY-INTERIOR 74231 41725 32 . 227 1345 * PD DEDUCTIBLE = NONE PAYROLL ADDITIONAL INSURED 2 INCL BP0402 MANAGERS OR LESSORS OF # INSD Total Estimated Liability Premium 1345 * LIABILITY PROPERTY DAMAGE DEDUCTIBLE PER CLAIM 64-N188-2 9/00 09/08/05 RENEWAL MC NATIONAL GRANGE MUTUAL INS . CO . EDWARD E VIEL DBA Policy Number: MPI66885 VILLAGE KITCHEN & APPLIANCE Account Number: CAC I66885 Effective Date: 09/20/05 Agent: CHAS F HARTSHORNE & SON INC Producer Code: 200167 CONTRACTORS DECLARATIONS - COVERAGES APPLYING TO THIS LOCATION DESCRIPTION OF PREMISES - ADDRESSES Prems . Bldg . No . No . Address DESCRIPTION OF PREMISES - OCCUPANCY AND CONSTRUCTION Prems . Bldg . No . No . Occupancy Construction Protectioi COVERAGES PROVIDED Prems . Bldg . Limit of No . No . Coverage Insurance Ded OPTIONAL COVERAGES Prems . Bldg . No . No . Coverage Limits ALL ALL MECHANICAL ELEC & PRESSURE SYS BREAKDOWN INCLUDED GL AGGREGATE LIMITS APPLY PER JOB SEE BP0702 64-N188-19/00 09/08/05 RENEWAL MC NATIONAL GRANGE MUTUAL INSURED , INSURANCE COMPANY �s 55 West Street, Keene, NH 03431 Telephone: 1-888-646-7736 CONTRACTORS POLICY DECLARATIO " k NAM .. - w Named Insured and Mailing Address EDWARD E VIEL DBA Policy Number: MPI66885 VILLAGE KITCHEN & APPLIANCE Account Number: CAC I66885 200 SUTTON ST REAR BLDG NORTH ANDOVER, MA 01845 Agent: CHAS F HARTSHORNE & SON INC Producer Code: 200167 781 245 4300 POLICYHOLDER INFORMATION Named Insureds Business: CARPENTRY INTERIOR Entity: INDIVIDUAL Policy Term: 12 Effective: 09/20/05 (12:01 A.M. Standard Time at the address Expiration: 09/20/06 of the Named Insured stated above) In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. See the attached schedules for Description of Premises, Property Coverage, Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. BUSINESSOWNERS LIABILITY COVERAGE LIMITS OF INSURANCE Liability & Medical Expenses - each occurrence S 11000 , 000 Personal and Advertising Injury Limit 0 11000 , 000 Products-Completed Operations Aggregate Limit S 2, 000 , 000 General Aggregate Limit S 2, 000 , 000 Fire Legal Liability - any one fire or explosion $ 500 , 000 Medical Expense Limit - per person S 10 , 000 Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- ages reduces the amount of insurance we provide during the applicable annual period. Please refer to section DA. of the Businessowners Liability Coverage Form. For policies subject to premium audit: Annual Audit Applies. Estimated Annual Premium: S 1 ,368 TOTAL PREMIUM AND CHARGES S 1 ,368 Countersigned: By: 64-5470 (9/00) 09/08/05 RENEWAL MC ✓lc ie -Pomvnwouoea� o�✓�acic�aelld`'� Board of Building Regulations andItand" HOME IMPROVEMENT CONTRk;T0jt Registration.-., _132126 Expiration 11/22/2006 TYPe. .DBQ EDDIE VIEL'S CARPENTRY SERV 'f 9MARD VIEL JR. 55A PORTLAND ST p LAWRENCE,MA 01843 " `�`� Administrator g�4 �, ✓�n '(•r tiriat�ro�tlr+l2l�� n�: 1(A:i.lanJtfloe�.6 +4= BOARD OF BUILDING REGULATIONS `' " License: CONSTRUCTION SUPERVISOR s : Number: CS 000505 Birthdate: 09/27/1935 Expires: 09/27/2007 Tr.no: 4055.0 Restricted: 00 EDWARD E VIEL 55 PORTLAND ST G— LAWRENCE, MA 01843 Commissioner NORTIy , ovm Of : 4Andover O tiN:: :� 11% No. I'k-NQW-lbdower, Mass., 6 COCMICKEWICK AD'g?ATED A'P � `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............. ..................... t. ...S..t.... ......................................................... Foundation has permission to erect........................................ buildings on &.00........Sv .M.Q.ON........r.. ................. Rough to be occupied arl'W..6.......S*.'cds..........�..�i ..WA.Z.........................:. .... 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 30 rOW Final ! PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCST TS.. Rough Service _ 4rtmGj, 'ECTOR 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. FIESEE REVERSE SIDE Smoke Det.