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Home My WebLink AboutBuilding Permit #10 - 30 CHARLOTTE WAY 7/2/2009 BUILDING PERMIT GF "oRT" q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * 0 Permit NO: Date Received -� ��SSACHUS bate Issued: / C MPORTANT:Applicant must complete all items on this page LOCATION =�- � ..�+ Print PROPERTY OWNER iZ`J Print I MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine'Shop Village yes_ o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: — Commercial Repair, replacement Assessory Bldg Others: Demolition Other e tic Well Floodplain .Wetlands Watershed District I Water/Sewer I ff DESCRIPTION OF WORK TO BE PREFORMED: of ti Al NE" rl> Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: 11'��\Affj;2- - C -C12i. .j Phone Address: Fi> fE� ' MN Supervisor's Construction License: C a -- Exp.; 'Daae: "7- [ - 2y C Home Improvement-License: Exp: Date; ARCHITECT/ENGINEER-Or `..•Ci4f% r> Phone: ")-)b 371 - Address:_ F-1 oAuMEN ( SQ e "41 Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $'' ?7��` Z` FEE: $ t �I Check No.: //D� � Receipt No.: a- N NOTE: Persons contracting with unregistered contractors do not have access t e g ty fund ignature of Agent/Owner Signature of contractor ..: Location y 3 o cilia ,-c,�� /F (,!)e No. f 0 Date i NQRTN TOWN OF NORTH ANDOVER 3?.. o� • � ; , Certificate of Occupancy $ � aay �' �O�•no.A.. cHustt� Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / 22178 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATEAPPROVED PLANNING & DEVELOPMENT I f' 1,� t COMMENTS CONSERVATION Reviewed on Signature COMMENTS (E HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 1� Water& Sewer Connection/Si nat &Dat Driveway Permit DPW Town Engineer: Signature: K� + Located 384 Osgood Street FIRE DEPARTMENT Temp Dun ter on site yes 17 no Located at 124 Main Street Fire Department signature/date Sf COMMENTS I� Dimension Number of Stories: JTota square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use) A ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified 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) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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 Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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:Building Permit Application Revised 2.2008 NQRTH Tovm Of ` 4 Andover C V0� - L / 4 Y,y. No. O o dover, Mass., �- 2�A COCHICMEWICK`y1 ' 0RArE D ApP �5 �`s E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...........�r- ... ..f..��-!4..�"� F�� . �� . .... �(��.. Foundation has permission to erect........................................ buildings on ..:,:Z.y .......................................... Rough to be occupied as.... ... ... ... ... ... . . . .. /'�•....... .. Chimney p r ..:........ .... ..... ...... ................................. 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough �L ................. ..................... ............ 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. SEE REVERSE SIDE Smoke Det. s. Q ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID BS DATE(MMIDDIYYYY) WINDO-4 03/18/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McLaughlin Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 828 Lynn Fells Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Melrose MA 02176 Phone:781-665-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Onited specialty Insurance Co. INSURER B: Ohio Casualty Group M . Juu INSURER C:rsT Construction, Inc. American Internat l companies Mr. Justin Bellivea 13 Elm Street INSURER D: Manchester MA 01944 INSURER I-- COVERAGES 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. LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDDNY E POLICY EXPIRATION MIDD TION LIMITS GENERAL LIABILITY EACH OCCURRENCE $110001000 A X COMMERCIAL GENERAL LIABILITY CR0946109 01/01/09 01/01/10 PREMISES Eaoccurence $50,000 CLAIMS MADE FX]OCCUR MED EXP(Any one person) $EXCLUDED PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP ACG $2,000,000 POLICY�{ PRO- LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED ctnt)INGLE LIMIT $1,000,000 ALL OWNED AUTOS BODILY INJURY $ B SCHEDULED AUTOS BA00953558225 11/01/08 11/01/09 (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EAACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILTTY EACH OCCURRENCE $5000000 A X I OCCUR E�CLAIMSMADE CXA4GS709 01/01/09 01/01/10 AGGREGATE $5000000 DEDUCTIBLE $ X RETENTION $10000 $ TATU OT WORKERS COMPENSATION AND X I TORY LIMITSI JOT ER C EMPLOYERS'LIABILTTY WC6967012 03/20/08 03/20/09 E.LEACH ACCIDENT $500 000 ANY PROPRIETOR/PARTNERfEXECLTTfVE r C OFFICERIMEMBEREXCLUDED? WC009399316 03/20/09 03/20/10 EL DISEASE-EA EMPLOYEE $500 000 Byes,describe under SPECIALPROVISIONSbelow E.LDISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Edgewood Retirement Community Renovation and Expansion, North Andover, MA Edgewood Retirement Community, Inc. and Trident Building,LLC; Bank of America, N.A. their subsidiaries, affiliates and parent companies; and their respective officers, directors, trustees, managers, members,building committee members and employees are additional insureds on all policies CERTIFICATE HOLDER CANCELLATION EDGEW-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Edgewood Retirement Community NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Inc 575 Osgood Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR N. Andover MA 01845 REPRESENTATIVES. ;Vc o ACORD 25(200'f/O8) �� :,.:�`�}:.i.,„.�.w«,:z.°:.''b°...,.rs�.. ` :'�'�.,.�`�z'�,�, a�,,,.w:>:.,, ``s -'' �”��k €✓w.,:..a.y4,.,,sa�,."^`�t.`+��'`-s'��`.:9 :' �'�"�aCM��'�� .S u......as.��TE HI�Qk.7�:.. above {except for Workers Compensation and Employers Liability Coverage) for liability arising out of the operations of Windover Construction, Inc. and its subcontractors are listed for liability arising out of the operations of the Construction Manager and its Subcontractors on this project. J --- -- — 4 BOARD OF BUILDING REGULATIONS r License: CONSTRUCTION SUPERVISOR NumbeyCS+ 094621 f Bid a j 970 0 Tr.no: 94621 r i CORY E FISHER r 30JORDAN STREET � ,fe BE1/ERLY, MA 019 �� C Commissioner