HomeMy WebLinkAboutBuilding Permit #832 - 240 RALEIGH TAVERN LANE 6/21/20060.4 14ORTFI
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Pennit NO: yo e;, Date Received:
Date Issued: to, ?"I - D (P -. -
IMPORTANT: Applicant must complete all items on this page
r
LOCATION_ -� lio -OVN�) 1.-Qnc-
Print
PROPERTYOWNER FAWOOrAo R
Print
MAP NO.: PARCEL: ZONING DISTRICT:
� A �T� WTVIr d -Mr "IrTTY "TXTI�
tT1QTnD1C nKYRICT WN n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
-A One family
[I Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
L%Repair, replacement
El Assessory Bldg
0 Commercial
Demolition
—0
Moving (relocation)
0 Other
D Others:
—0
L-1 Foundation only
I :
DESCRIPTION OF WORKTO BE FKt1,UKMt1) -Lc LAI QTT v 'd I d I I I "
C4 10 A * 0A 7-7—
(C \N , 7 c� Hw-c F(W (M-cn�
Identification Please Type or Print Clearly)
OWNER: Name:
Address:
V
CONTRACTOR- Name:-uft Tri -
�) no
Address: 0-1-/
Supervisor's Construction License:
Home Improvement License: H7
Y r rl)
M- e,- F "
0
Phone.
4*A, " z 0)
-w --4*
Exp. Date:
Exp. Date: LQ 7
ARCH ITECT/ENGIN EER Name: Phone:
Address:
�Reg. No
FEE SCHEDULE: B ULDING PERMIT. $ 10. 00 PER $ 1000. 00 OF THE TOTAL ESTIMA TED COST BASED ON $125. 00 PER S. F.
Total Project Cost 000 —x I 0.00=FEES
Check No.:- Receipt No.:
Page I ot'4
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art L
Swimming Pools
Public Sewer n
Well
Tobacco Sales El
Food Packaging/Sales E
Private
Permanent Dumpster on Site
(septic tank, etc.
Electric Meter location to
project
IN " 1 r; reffolls colitractitig with wiregistered cotitractors do tiot have access to the raittv fmid
Signature of Agent/Owner Signature of
Contractor �k 3; P
Plans Submitted Plans Waived 0 Certified Plot Plan 0 Stamped Plans
El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition N
DATE REJECTED
1� F]
E]Water Shed Special Permit
El Site Plan Special Permit
El Other
DATE REJECTED
r]
DATE REJECTED
11
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
-T
DATE APPROVED
DATE APPROVED
El
I
DATE APPROVED
Conservation Decision:
Building Setback ( .)
Front Yard Side Yard Rear Yard
Required Provided Required' Provides _.Require Provided
& Sewer connection signature & date
Temp Dumpster on site y;Xno_ Fire Department signature/date
Building Pennit Approved and Issued by:
Page 2 of 4
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:_
NU I LS and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMEN'r:BHORM05
OcatcdJMC. Jan.2006
Water
1:� /z--/ A/ 6
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)
L3 Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
• Building Permit Application
• Certified Proposed Plot Plan
Li 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: INSPEc'rIONAL SERVICES DEPAUNI EN,r:BPFORM05
Page 4 of 4
UNITED
'HOME
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United Home Experts &
United Painting Co., inc.J,
,�A 200 Butterfield Dr. Suite I
lq331 Ashland, MA 01721
1 t0408-881-8555 FAX 508-881-5584
Www.unitedpainting.net
PROPOSAL lk ff X PAGE 1
Material
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Dumpster
Phone #:
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Attn:
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Project:
Bid Date:
Phone #:
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Attn:
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Company:
Work #-
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Address:
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Email:
City, St. Zi
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Heard of us by:
Base proposal as per attached scope of work:
Alternates: Any additional customer requested car—penti!y work will 4e bbilfidaf
per hour + materials.
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Prices good for 30 days
PAYMENT: A non-refundable deposit of 1/3 of the accepted proposal item(s) (ell &10
amount is due upon authorization in the amount of $__J (/I :Z f'
with 1/3 due upon half of completion in the amount of
alld "u, Uduuwd due upon completion in the amount of $__ 1 " -7 ( . + any customer options
DISCLOSURE: State law requires us to inform you of contract liens. A4iy contractor, supplier, or subcontractor
may lien your real property if you or the general contractor fail to pay for goods or services delivered or installed at
the work location. Some contractors and suppliers automatically send letters of notification similar to this notice.
At your request, we will provide original lien release documents from anyone who provides said mate . rials or
service. Please call if you have any questions regarding liens.
ACCEPTANCE: The signature on this proposal reflects acceptance of the proposal as per the attached scope of
work, authorizes commencement of the work, and hereby guarantees payment as outlined above. Any atnounts not
paid within thirty days of invoice are subject to service charges of 1 '/2% per month (I 8%APR). All costs of
collection, including reasonable attorney fees�� are to be paid by the customer.
'AMERICAN
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Contractor signature =at Customer�ignature Date
'VISA BBB
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__ Great People, Quality Service, Fair Prices, That's United!
11
54
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11:56 APR 14, 2006
U-4.4.,270CIN
IINITF
#19482 PAGE: 2/3
ACORDT. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/14/06
PRODUCER
Herlihy Insurance Agency, Inc.
65 Elm Street
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, E)CrEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Worcester, MA 01609
kDD'L
INSRC
508 756-5159
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A. Acadia Insurance Company
United Painting Company, Inc. and
INSURER B. American International Group
United Painting Company, LLC.
200 Butterfield Drive, Unit I
Ashland, MA 01721
INSURER C;
INSURER D.
INSURER E;
r1-IVI:PAr.;:-q
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNTHSTANDING
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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
kDD'L
INSRC
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFE T E
DATE (MMIDDIYYI
P L
DATE (MM/DDNY.L
LIMITS
A
GENERAL LIABILITY
CPA011338712
04115/06
04115/07
EACH OCCURRENCE_ $1,000,000
DAMAGE TO RENTED
. 'SES We occurrence) $250,000
PRFM
MMERCIAL GENERAL LIA131LITY
MED EXP (Any on person) s5,000
CLAIMS MADE 5-10CCUR
PERSONAL & ADV INJURY $1.000.000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER�
PRODUCTS - COMP/OP AGG $2,000,000
--] POLICY M- JERC0j E-1 LOG
•
AUTOMOBILE
LIABILITY
AUTO
MAA01 1338812
04/15/06
04115107
COMBINED SINGLE LIMIT
(Ea accident) $1,000,000
BODILY)NJURY
(Per person) $
rANY
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per accident)
X
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
X
Drive Other Car
1
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
•
EXCESSAJIMBRELLA LIABILITY
CUA01 1339112
04115106
04/15107
EACH OCCURRENCE $1,000.000
AGGREGATE $1,000,000
X1 OCCUR EICLAIMS MADE
$
$
�DEDUCTIBLE
X RETENTION so
CONTPENS;V, ION AND
!WC4300883
—
108/15/05
08/15/06
WC ITATU- OTH-
j
E.L. EACH ACCIDEN-i
"I"' �- �LIAAEM? i'R ',XOf UDFD�
E.1- DISEASE -EA EMPLOYE, -.1
If yes, describe under
SPECIAL PROVISIONS below
1E.1. DISEASE -POLICY LIMIT $ik6o'o
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
r-=DTiCIrAT= ur%i npD rANrFI I ATIntd
ACORD 25 (2001/08) 1 of 2 #26801 ERV @ ACURD UUKFUKAIIUN W66
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION
United Painting Company, Inc and
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 110 DAYS WRITTEN
United Painting Company, LLC.
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
200 Butterfield Drive, Unit I
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Ashaldn, MA 01721
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #26801 ERV @ ACURD UUKFUKAIIUN W66
J67 Ite o
Board of Building Regu
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
UNITED HOME EXPERTS INC.
JONATHAN STEWART
200 BUTTERFIELD DR. STE. I
ASHLAND, MA 01721
DPS-CA1 0 50M-04/05-PC8698
Board ol Buildi., Re,ulalion, and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 147685
Expiration: 8/1/2007
Type: Supplement Card
UNITED HOME EXPERTS INC.
JONATHAN STEWART
200 BUTTERFIELD DR. STE. I
ASHLAND, MA 01721 Administrator
Reqistration: 147685
Type: Supplement Card
Expiration: 8/1/2007
Update Address and return card. Mark reason for ch
E] Address [:] Renewal [:] Employment E] Lo
License or registration valid for individull use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
,00' No-5Wwithout signature
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Location,;)qo Tc( u 6o, 6; "k
No. �-3 2, Date � -,--21 0
,40RTPI TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # I 0� ��
1 �456 Building Inspector