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Home My WebLink AboutBuilding Permit #127 - 210 CANDLESTICK ROAD 8/17/2006 TOWN OF NORTH ANDOVER NORT1y APPLICATION FOR PLAN EXAMINATION o`tt•E° "tio O � Permit NO: _ �y Date Received ° Date Issued: r ,, s ��SSACHU5� IMPORTANT: Applicant must complete all items on this page LOCATIO PROPERTY OWNER Print MAP NO.: Print — PARCEL: ZONING D STRICT: TYPE AND USE OF 11U ILD OF IMPROVENTD MEING HISTORIC DISTRICT YES ❑ PROPOSED USE EI New Building Residential Non- Residential El Addition % .One family ❑ Alteration 0 Two or more family ❑ Industrial iekepair, replacernent No. of units: ❑ Demolition 0 Assessory Bldg ❑Commercial ❑ Moving(relocation) ❑ Foundation onl ❑ Other ❑ Others. DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Na _,c_ Phone: 1� Address: �-+,-4 Supervisor's Construction License: Exp. Date: I Home Improvement License: % Glc� Exp. Date: ARCHITECT/ENGINE ER Name: Phone: Address: Reg.No. FEE SCHEDULE:B Total Project Cost PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Check No.: f Receipt No.: Page I of 4 r IF k - Location Q No. Date 40RT#q TOWN OF NORTH ANDOVER �?o't„'o •,hoc ,+' F p { Certificate of Occupancy $ ��°',•� '��' Building/Frame/Frame Permit Fee $ Ss�CHust 9 ; Foundation Permit Fee $ 7f Other Permit Fee $ TOTAL $ Check # tf-- =Building Inspector FTYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art ❑ Sewer ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site F1Private(septic tank,etc. Electric Meter location to � p prod ect 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 ❑ i 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 E Y' 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 Driveway Permit Temp Dumpster on site yes no_ Fire Department signature/date ' I I 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.: i NOTES and DATA—(For department use) i 1 F I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.Jan.2006 Building Department ro 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 I 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 i P a9 d�f d M %,sir / t" i:r/ % f^ �. / ( o STARR PAINTING BRYAN INTERIOR & EXTERIOR BRYAN 800-630-4948 HAVE RH I LL Roofing * Gutters 374-4948 Pressure Washing * Textured Ceilings FREE ESTIMATES -* Registered Insured I herewith submit Specifications and Estimate for: loe C � 011 f •Q 1 f� 16, The entire job is to be done in a neat and substantial manner by first grade workmen. Contractor covered by Compensation, Public Liability and Property damage insurance. Any alteration or deviation from the specifications herein agreed upon involving extra cost of labor and material will be executed, and will become an extra charge over the sum mentioned in this contract.Agreements made with mechanics not recognized. I hereby propose to furnish and install the above complete in accordance with the above specificatiops for the sum of Dollars ($ Payments to be made: ! Date Signed -�-- I ACCE NCE OF ESTIMATE The foregoing terms, specifications and conditions are satisfactory, and the same are hereby accepted and agreed to, and hereby authorize you ou to execute the same. Date Signed This Contract is void 10 days from date unless signed and returned to bidder. ✓1ze �anvnw7uuea� o�'��faoJuc� � _ Board of Building Regulations and Standards i HOMEIMPROVEMENT CONTRACTOR Registration: 144769 Expiration: 111812006 Type: DBA STARR PAINTING 4 i BRYANT RAYCR AFT � 12 GRAND AVE HIAV'ERHILL,MA 01930 Adininistrator IIS 1 MEMM :RANfTE STATE INSURANCE COMPANY 71050-0000 WC - 874-16-2 ------------------------------------------- 013-66-0306-00 PENNSYLVANIA I JAMES FLANAGAN F BRYAN RAYCRAFT 12 ' PAND AVE Member Companies of 1AVERH I LL, MA 01830-0000 04MAmerican International Group EXECUTIVE OFFICES: :EE NAME AND ADDRESS SCHEDULE - WC990610 70 PINE STREET, NEW YORK, N.Y. 10270 MA UI COWWORKERS COMPENSATION AND EMPLOYERS 359 INSURANCE AGENCY WORKERS MAIN ST LIABILITY POLICY INFORMATION PAGE HAVERH I LL, PIA 01830-4000 i f4SURED IS --- . .. - --- - 'A R T N E R.S H I P PREVIOUS POLICY NUMBER IRENEWAL 008728393 )THER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC 0610 iTFM 2 ( POLICY PERIOD 12:01 A.M.standard time at the insured's ( mailing address FROM 03/26/x6 TO 03/26/07 ITEM 3 I A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: a MA i i— E B. Employers Liability insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1 ,000,000 � each accident + Bodily Injury by Disease $ _ 1 000,000 policy limit { Bodily Injury by Disease $ 1 .000 000 each employee I C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A _ I _ TEM 44 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. i All information required below is subject to verification and change by audit. i Estimated Total I Rate Per Estimated Classifications Code dumber Remuneration $100 OF Re- Premium L Annual 0 3 Year muneration a Annual 3 Yea SEE EXTENSION OF INFORMATION PAGE - WC7754 '/ES/ASSESSMENTS/SURCHARGES $64 IFN,E CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $204 MA . ......PREMIUM .$500 MA TOTAL ESTIMATED PREMIUM C made-r%1 --o below, interi rn dd)ustments of premium shall be -Annually Quarterly Monthly DEPOSIT-PREMIUM IlGpRSEMENT5(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 +/05/06 ASSIGNED RISK 66 Issuing Office Authorized Representative WC 00 00 01 't3 q ORDrm CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNM) 0811612006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cowan Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 359 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill MA 01830 1. INSURERS AFFORDING COVERAGE NAIC# INSURED James Flanagan and Bryan Raycraft dba Starr Painting INSURER A: Em to ers Mutual Casualty Company 12 Grand Avenue INSURER B: Haverhill MA 01830 1 INSURER C: 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. INSR DD' TYPE OF INSI]RANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION �GENERAL LIABILITY I EACH OCCURRENCE LIMITS 1,000,000 A I X COMMERCIAL GENERAL LIABILITY 13DO2174 0111212006 0111212007 DAMAGE TO RENTED $100,000 ` CLAIMS MADE X I OCCUR _2R ISES MED EXP An one erson $5,000 i PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMP/OP AGG $2,000,000 X POLICY LOC AUTOMOBILE LIABILITY COMBINED A ANY AUTO 3ZO217406 0111212006 0111212007 (Ea accidentSINGLE LIMIT $1,000,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY $ (Per person) X HIRED AUTOS I X NON-OWNED AUTOS BODILY INJURY $ (Per accident) I PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ I OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000 A I X OCCUR CLAIMS MADE 3JO217406 0111212006 0111212007 AGGREGATE $ 1,000,000 DEDUCTIBLE X I RETENTION $10,000 $ WORKERS COMPENSATION AND $ EMPLOYERS'LIABILITY WC STATU- OTH- LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If es,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Paint'n l contractor. The worker's com ensation insurance certificate will be issued direct) b the com an Granite State. CERTIFICATE HOLDER II CANCELLATION Brian Eddy SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 21 ENDEAVOR DATE THEREOF,THE ISSUING INSURER WILL 10 0 Candlestick Lane OR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL No Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 4C6RO 25(2001AUTHORIZED REPRESENTATIVE }� /08) ` ©ACORD CORPORATION FSK I% NORTfy 'g 4Andover Town o l� ,ff - o o dover, Mass.,'L+LA 0 COCMICMEwICK AERATED P'P�\ ,�5 `S BOARD OF HEALTH PERMIT T D Food/Kitchen i Septic System - BUILDING INSPECTOR i THIS CERTIFIES THAT........ /!►......... .. .....Ok...7......................... Foundation has permission to erect........................................ buildings on . ....��.Q.............C4A .s..� .�.►.i�... Rough to be occupied as �►. ' 11,► �. ...... Chimney . .................................................................................. .. ........ .......... .................. provided that the person accepting this permit shall in every pect 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 _ PERMIT EXPIRES IN MONTHSFinal UNLESS CONSTRUC ELECTRICAL INSPECTOR Rough I ..... .................................. Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough 01splay in a Conspicuous dace on the Premises — Do Not Remove Final No Lathing or Dry Wall To DeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. I