Loading...
HomeMy WebLinkAboutBuilding Permit #596 - 24 HIGHLAND TERRACE 3/27/2006 Ot NORTI{1ti p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 9SSACMUSF4 PermitNO: QJ /l- Date Received: 3' 0' o6 Date Issued: 3 'a �7-U�J IMPORTANT: Applicant must complete all items on this page LOCATION 0�'f A,4troJ kV Pri t PROPERTY OWNER W7 D- 4�; Print MAP NO.: ° 4,1 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 ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) 8' her ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED ✓ 1— Qc�n� l:dentification Please Type or Print Clearly) OWNER: Name: Ly��� Phone: Si ature Address: 014 CONTRACTOR Name: Lm�-t— Kmo Phone: 60 7 a6,21 f ` Address: a9 CorT- J Qr► Supervisor's Construction License: Exp. Date: 0-7o$ o?60 6 Home Improvement License: Or S 3 IV) Exp. Date: 3 ag ax, ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$115.00 PER S.F. Total Project Cost :$ sr, x10.00=FEE:$ Check No.: Receipt No.: Page 1 of 4 TYPE OF SEWARGE DISPOSAL i wmmn SiPools ❑ ❑ Tanning/Massage/Body Art ❑ g Public Sewer Well 11Tobacco Sales ❑ Food Packaging/Sales 11 Permanent Dumpster on Site ❑ Private(septic tank, etc. F1 Permanent Meter location to proj ect NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of Contractor a I'A. 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: f Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection sig ature&date Temp Dumpster on site ye _no_ Fire Department signature/date Building Permit Approved and Issued by: Page 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.I: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 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 ❑ 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 Page 4 of 4 r F Location No. � � Date NpRTM TOWN OF NORTH ANDOVER 41 A Certificate of Occupancy $ SsMu9 CHU'•t� Building/Frame/Frame Permit Fee $ � st Foundation Permit Fee $ Other Permit Fee $ TOTAL $ . Check # 15; 1y �j t � 91 , '" / / Building Inspec V MA Construction Supervisor#082056 Home Improvement Contractor#135385 ROB FARRELL ROOFING,SIDING& REPLACEMENT WINDOWS FULLY FREE --_. ESTIMATES 978-682-9449-�o.Andover 603-378-0515 Hampstead 603-247-4668 Cell INSURED 29 Cortland Rd, E.Hampstead,NH 0382 6 Uwe,the owner(s)of the below mentioned premises,hereby contract with and authorize you as a contractor to supply all materials, labor,and perform all workmanship in accordance with the following specifications,terms,and conditions on premises below. Owner's Name Phone Job Address_ � lit City ( N�01�� State no!� SPECIFICATIONS tJOIA �L 4 f0614� /No 6Aw5- E ( �T S C'e. + # WATT M �� ?"a ,4i t'T T o 2 S 1.5' ur►� I T L'O M�'j, ;j LQ', ►-c,1Ikx o i� 1v u w� t 00M i v.�J eQ.14en e.T u a ,CoA T �•; ��. SL�. —�`'. C2 + W AM-6- SL i X16 TP VA 11#- -5 11dx nk AUT T.ri + r0.7rA 11 IQ. 1)vSit�. R A,cc.4,;aL ,5 Y K, W06,KMLA-P µjAapk►l �_ GJJT"/CAGT►t� t Materials and labor to cost$ 1;) Payments to be made as follows Q� will 1) 0-T 00 Options: Additional cost$ Additional cost$ II The above costs,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Owner has 3 days from date signed to withdraw ithout any consequenc / Respectfully Submitted: Signa C_Date. O er � kThisprosal may be ithdrawn by us if Signature Date j not accepted within _days. Owner ,. i. 4 NORTH Town of Andover No. '- zs HI1A E dover, Mass., 3 •, ••a COC CHEWICH y�. ADRATED P' �� S BOARD OF HEALTH PERMIT Food/Kitchen Septic System j BUILDING INSPECTOR THIS CERTIFIES THAT n.... ..... ...... .... ............... ::::: Foundation has permission to erect...................... ............. buildin o ... .................... ...... Rough to be occupied as ...................................................... Chimney provided that the person accepti is permit shall in every respect conform to the terms of the application on file in Final this office, and to the provision f 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 CONSTRUCUON S TS Rough ............................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR DRough isplay 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. i SEE REVERSE SIDE Smoke Det. 1 N ORTH Town of : Andover No. �s- - dover, Mass.,- (0 T O L A E co LA V 7��0RATED P'Pa\ 7�7 BOARD OF HEALTH PERMIT - Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................... .�.............. ... a..... ............................... ..... Foundation has permission to erect.............efth. ............. buildin on...�d/...... ... ....... ................................... .............. Rough to be occupied as ................... Chimney . . . .. . . . . .. . . .. .. . . . . . ................................................................ provided that the person acceptpermit shall in every respect conform to the terms of the application on file in Final this office, and to the provisionCodes and By-Lawsrelating 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 CONSTRUCTJON S TS Rough ........ ................................................................. ....................... ... Service BUILDING 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. i SEE REVERSE SIDE Smoke Det. I r t BOARD_OF.BUILDING REGULA'T'IONS * . ' License: CONSTRUCTION SUPERVISOR Number CS 082056 ` Birthdate: 07/08/1966 Expires: 07/08/2006 Tr.no: 82056 i Restricted: 00 ROBERT J FARRELL i 29 CORTLAND RDS HAMPSTEAD, NH 03841 Administrator .-%,e (�omrirrra'�zcuea�� a�✓liG�ddac�uidC� Board of Building Regulations and Standards IN- HOME IMPROVEMENT CONTRALTO ' Registration: 135385 - :: Expiration: 312912008 Type: DBA ROBERT FARRELL ROOFING+SIDING ROBERT FARRELL ^ 29 CORTLAND RD. HAMPSTEAD,NH 03826 Administrator 1 FROM PHONE NO. : 603 432 6096 Dec. 27 2005 03:45PM P1 —•------••-----..____..____._.........._........ ............._.. _..-SSSS_._._SSSS__—._. ACORN, CERTIFICATE OF LIABILITY INSURANCE P _ DAi(( MMfDwYYO1Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RICUTS UPON THE CERTIFICATE Pallaek Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND;EXTEND OR 12 Rarmafttar Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Loadondarry NH 03053 Phone: 603-432-2011 Fax:603-432-6096 INSURERS AFFORDING COVERAGE NAIL .-- -- . INSURED INSURER At Nantorn Nvr:d incurana 4v. NSURER B: Th8 Travelars Ccm anial Robert J. rarreldl NSURERC; ��J.,,.... ,� Hampstead NHR91$26 NSURERD: INSURER E: COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BERN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WYTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE I.USURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 19 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAiD CLAIMS. ,.........,.:...... LTR NSR TYPE OF INSURANCE POLICY NUMBER LIQY EFFECTIVE OA M 1 LIMTS GENERALLUI1WTV r:ACH OCCURRENCE _ $500,000 A IX COMMERCIAL GENERAL LIABILITY NPP9168211 10/17/05 10/17/06 PD F=M"�sEs�eccNWrence) $50,000 CLAIMS MADE ®OCCUR MED EXP(Any wepomon) $5 DOO PERSONAL 6 ADV INJURY a rj00 r 000 GENERALAGVEGATS E 1 0001,000 GEN'LAGOREGATSLIMIT APPLIES PER: PRODUCTS•COMPIOPAG6 $1 OO- POLIGY JECT LOC "o-0-0-11�—.W. AUTOMOMLE LIARILITY COMBINED SINGLE LIMIT ANYAUTO ge6dfird) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY 3 ( P—) Y HIREDAUTC8 NON-OWNEDAUTOS BODILY INJURY (Per mi;lanl) PROPERTYDAMA.GE $ TV accJdm) L.GARAGE LIABILITY" - AUTO ONLY.EA ACCIDENT S ANYAUTO OTHER THAN EA ACC S AUTO ONLY; AO© S EKCESSIUMBRELLA LIABILITY EACH OCCURRENCE g OCCUR CLAIMS MADE AGGREGATE S DEOUCTGLE S RETENTIQN $ $ WORKERS COMPENSATION AND 7C TORY LIMITS : ER k3 EMPLOYERS*LIABILITY 62zUB3$44B9SOOS 11/O4/OS 11/OA/G6 E.6 EACHAC010"T $100000 OFFICRER/MEhtT9ER 6CLLUDW�TIVE EMPLOYEE a100000 E.L.DISEASE-EA EMPdescn �beurtda �IAL PROVISIONS bdIOw E.L.DISEASE-POLICY LIMIT S500000 OTHER DESCRIPTION OF OFERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROV161ONS Roofing - ROSidontial CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSWNG INSURER YJILL ENWIAVOK TO MAIL. 10 DAY$WRITTEN NOTICC TO TMC CERTIPICATC HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL David C3$ riaOn® Roofing & SidingIMPoaE NO OBLIGATION OR LIABILITY Or Y KIND UP M!IN3URlR,ITSAOtrMYS 01t 200 Sutton Street REPRESENTATIVES, North Andover MA 01845 AUTHORIZED REPRESENTATIVE I Stahl H. Pollaek IV ACORD 25(2001108) ACORD CORPORATION 1988