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Home My WebLink AboutBuilding Permit #058 - 203 MIDDLESEX STREET 7/31/2006 TOWN OF NORTH ANDOVER NORTF/ APPLICATION FOR PLAN EXAMINATION 0 'T"° 16 q�o o m � t � Permit NO: 0_5;/5 Date Received ? e� Date Issued: 23-J • 2,67 �9SSACHl1`''��9 IMPORTANT: Applicant must complete all items on this page LOCATION 67 103—vZO'JJ® Print PROPERTY OWNER ✓O S- r,671 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 1.,Two or more family ❑Industrial ❑Alteration No. of units: P Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ' ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Ide t' ication Please Type or Print Clearly) OWNER: Name: Tv pati o f/�/7 /a/J� /1'� Phone: 971 1(,,J,17� f.2-& �d Address:�o29 s®/rJSi'�(i� �7�i'�iofy� i°Gdf, Wf zy4�rzq CONTRACTOR Name: Cg za ha17 -- Phone: Address: LZ Supervisor's Construction License: j� /Q 112ih1I Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 9i O� x12.00=FEE:$ Check No.:� Receipt No.: a� Page I of 4 i Building Department i 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 ❑ 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) ❑ 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 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 DEPARTMENT:BPFORM05 Pa-e 4 of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body ❑ g F1 Art Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales 11❑ 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 ❑ ❑ []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/Si nature&Date Driveway Permit 4,---T--emp Dumpster on site yes . no_ Fire Department signature/date I Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Totals square feet eet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) i �I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPART'MENT:BPFORM05 Created JMC.Jan.2006 LocatioA3 No. Date hpRTly TOWN OF NORTH ANDOVER + ; , Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s,+cMust 9 � Foundation Permit Fee $ Other Permit Fee $ L` TOTAL $ Check # J/6 19295 Building Inspector SENT BY: NORTH ANDOVER 8 FOSTER INSURANCE;9786A66410; JUL-31 -06 12:1APM; PAGE 1/1 ACOR_D„, CERTIFICATE OF LIABITY INSURANCE 07 .312006 THIS CERTIFICATE.15 133UI?D AS A MATTER OF INFORMATION PMODLIM ONLY AND CONFERB NO RIGHTS .UPON THE CERTIFICATE NORTH ANDOVER INSURANCZ A(ZNCY, INC HOLDER OTD E THE THIS COVERAGE DOED40 8Y TO'HE MEND, BE ND OR 9 FIAVERLY ROAD INSURERS AFFORDING COVERAGE NORTH ANDOVER MA 01945-2415 INSURER A:FIANOwER INSZ7RANL"E COMPANY INSURED Csllahan Air Conditioning 6 Heating INGURER&ATLANTiC CHAR ZR 91 Belmont street INSURER C: ER North Andover MA 01845- INsURERE: COVERAGES BELOW RTHE POLICIES EQUIREMENToT TERM ORICONDITION OF NY CONTRACT R OTHER R DOCUMENT WITO THFINSOAFTH RESPECT MED TO WHICH MAY INDICATED. OR MAY PERTAIN, THE THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOrt10NS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED eBMIPAN lit CLAIMS. ParICY P!>:TIVE POL(clr M PIRATKIN USITB NBR TYPE OF IN UR&H� 2,000,000 Ourm GEN&RALUABILITY / / / j EACH OCI:URRENCE / 300,000 FIRE DAMAGE OMtMe e, X COMMERCL&OENERALLV161UTY 15,000 A CLAIMS MADE 9X OCCUR OomG613330 09/25/2005 09/25/2406 MED EXP One e PERSONAL 6 APV INJURUR Y / GERAL AOOREGATE e 4,000,000 NE PRODUCTS-COMPIOP AGO 0 GEN'L ADORE;ATE LIMIT APPLIES PER: / POLICY PR LOC AUTOMOBILE LLAES.ITY . / COMBIt�D SINGLE LIMB 500,000 (Ee wdaenq / ANY AUTO A X ALL OWN£DAUTOS ANN6511421 09/25/2005 09/35/2006 BODILYINJURV (Per Porten) e X SCHEOVLEDAUTOS X HIRED AUTOS BODILY INJURY (Per socW"Q / NON-OWNED AUTOS PROPERTY OAMAOE PMI awdani) !'- AUTO ONLY-EAACCIDETR 1 ARA6E LIABILITY OTHHAN EA AC 1 ANY AUTO / / / / AAUTTO ONT A00 0 UMS613793 09/25/2005 09/'25/2006 EACH RRe 1 2,000,000 A w=sB uAmLm / 2,000,000 X)OCCUR FICLAMS MADE 1 DEDUCTIBLE RETF71T10N i VVMWRB OOMPOMTION AND / / I / X M E H SUrLOVERV UAWLm/ 500.000 E.L.EACH ACCIDENT 0 500,000 1PCI00018901 09/25/2005 09/.25/2006 ELDISEAW-CA EMPLOYE a 500,000 E.L.DISEASE-POLICY LMrT OTHER DEBCRtPTIDN OF OPNIATiO &j=ATIONBNENIOLX&=0LLWON9 ADDED BY BMNDORSO OPECIAL PR"WO"B CERTIFICATE HOLDER AODrnoNAl INsuRED•INS RSR LCTTER CCSHOULD ANYTIOPr)T1IE ABOW DCBCRIBsia POuctEs OE C1LNOiLIlP EiFORe THE UPIRATION OATS :TH Mr' TILE WtfUINA NISURBR WILL ENDEAVOR TO MAIL 010 DAY*WRrTTEN NOTICE TO THE CERTIFICATE NOLlD&R NAMED TO THE LEFT,BUT TOMN Of NORTH ANDOWR FAILURE TO DO SO 0:HALL IMPOSE NO OBLISIATiON OR LIABILITY 01 ANY IDND UPON THE 1600 OSGOOD STREET nBAa®ITeoRRE TIVBs rAUUZORZKD REPRPSRNTATNE NORTH ANDOVER MA 01845- VA 0 CORPORATION 1969 ACORD 25.8(7/97) Pews 1 d 2 INS02N("10),01 ELECTRONIC LA6ER FORMS,INC.-(WO)3274W t NORTI, oWn 0Andover INTO. O �" �LA o '� dover, Mass., �'��• lS I� CoCHICHEWICK ADRAT E D P? �C) `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT S �"�. t��, k/ 1.�..... Foundation has permission to erect.... ................................... buildings on ... .� .A.raw c........Jl '............... Rough % to be occupied as.......(3. 01O ... ..... ...... t..�.. ��. . .. .......464A..1 /. Chimney C e provided that the person accepting this permit shall In everyect conform tot a terms of the applical6n on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 CONSTRU . STAR S. Rough . . ... . ...... . . . Service G 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. Ne a ' Board of Building Regulations One Ashburton Prace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE..:,;;; Birthdate: 04/08/1951 Number: CS 073584 Expires: 0410812C96,--'>l--' Restricted To: 00 JOSEPH K CALLAHAN 91 BELMONT ST ,r NORTH ANDOVER, MA 01845 m � f .. Tr,no: 22173 Keep top for receipt and change of address notification. 3-CA1 5OM-04/05-PC8698