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Home My WebLink AboutBuilding Permit #801-16 - 254 GREAT POND ROAD 1/12/2016BUILDING PERMIT NORTH pF �t Lem l6 yq�d TOWN OF NORTH ANDOVER 3� bid• •_ h, 6 APPLICATION FOR PLAN EXAMINATION y� T tl Permit No#: -R [ Date Received �Q"CRATE, (11 rgSSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 4 ( LW4 (L"(/ yyA r is P, t PROPERTY OWNER 11) --� Print loo is Year structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'One family ,KAddition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: . emolition ❑ Other _ ®;Septic 0, 1Ne11 ❑=Floodpla ❑ WetlanFds ❑ 1%Vater�shedFlsinct w� A OWNER: Name: Address: ri W DESCRIPTION OF WUKK i U tit rtKruruvitu: ific ion'- P71 ase Type or Print Clearly Phone Contractor Name: kallelbPhone: Email: G) ti tie Address: Supervisor's Construction Licenser �� Exp. Date: Home Improvement License:///3 FF5-�S< Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. _ FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. �a Total Project Cost: $ FEE: $ -3a Check No.: �6 ,p Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarant1f#nd ,, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f 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 r' PLANNING & DEVELOPMENT Reviewed On j 1 b Signature_ A� COMMENTS Lis -f--eN -ltt r t► U)5' zy &k CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature 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 r DPW Town Engineer: Signature: C= 1 Located 384 Osqood Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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 Doc.Building Permit Revised 2014 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 4. Workers Comp Affidavit 4, Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products TE: 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/Cross Section/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 . OTE: 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) 4. Copy of Contract 4, 2012 IECC Energy code Engineering Affidavits for Engineered products DTE: 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 Revised 2014 Location �,J--- No. Date ^ Check# - 4 C TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ " Other Permit Fee $ TOTAL $ C Building Inspector S LL OO cr.0L m u Y "p O LL N N er+ CL N N cl: O U LU tan z zZ m c O C O LL OA0 O K N C L U C LL cc O W 0. N z J a OD p K C LL cc O W N Z u � LL bD t p0 or N U (A C LL cc O u w tai► Z ..0 '� d• C Il z W Q Lay � 6L N m Z i.+ v VI a3 Y O In Cc 0 c )Q - •-� c o= M V Q. 00p, W CD �•1-.A.' rn i C C �! C cc o CD(„i L C 3 � J .o CD OX°� 0'0 c V _ a .� ,E c .a 0 oZ CL - y c o A � moi ao � L F+ Q, Qi 4 i •a: Q v O C a i m a CL d co N O N W.2 m +=.' uj wLL •2 d N C P: I N CL t o W .E U�� L 0 (D � U Q o a) N to M •> -*. O 2 R o c O s O CL 0 U LS w 0 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: P is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: (Location of Facility) Sig lure of Permit Applicant Date D rf, kn i �� 044W 4 ree AC<> i)r (hK 11F1(:A i t UI- LIMSILI I Y INZWKAMA: 01108/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ACT PRODUCER 04066-001 NAME: Branch 4066-1 Fabri & Rourke Insurance A��Nd, E (978) 352-4990 AIC. No.: (978) 352-4991 2 Central Street 1st Floor EMAIL Georgetown, MA 01833 A DRESS: I OJBIIo=o a • A.I.M. Mutual Insurance Company INSURED Seven Star Builders Inc 211 Seven Star Road Groveland, MA 01834 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: r IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, USIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE /NSR SVWU POLICY NUMBER MMIDDnYY MM/DDIY1'YY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F� OCCUR EACH OCCURRENCE 5 DAMAGEPREMISESS ( Ea occurrenRENTED ce S MED EXP (Any one person) 5 PERSONAL & ADV INJURY 5 GENERAL AGGREGATE S EN'L AGGREGATE LIMIT APPLIES PER: --]POLICY ECT OC PRODUCTS - COMP/OP AGG S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON OWNED AUTOS i I COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE Peraccident) $ S UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE S $ A yy�RKDEERDg p�pERNJEEWTIIONN.S AND EMPLOCYA LIABILITY AONYIPROPRILZ WMJUSWECUTIVE Y I N a date MMEErvmtnH) t�c�L �y �(ffMandatory in NH) D( RIPTfON OF OPERATIONS below NIA VWC-100-6018531-2015A 5/18/2015 5118/2016 yy� X TORY LIMITS i ER E.L. EACH ACCIDENT S 100,000.00 E.L. DISEASE - EA EMPLOYEE 5 100,000.00 E.L. DISEASE - POLICY LIMIT S 500,000.0( i i i UESCKIPTION OF OPERATION51 LOGATIEMb I VMMU S (Atracn AGUM) iui, Aaaiaonal KL-marKs scneaure, at more space is required) AC"R o CERTIFICATE OF LIABILITY INSURANCE 1/7/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Heidi Shea PHONE (978)352-4990 No:(97B)352-4991 Fabri A Rourke Insurance Agency, Inc. 2 Central St., 1st Floor EMIL INSURERS AFFORDING COVERAGE NAIC S EACH OCCURRENCE $ 1,000,00( INSURERA$sses Insurance Company Georgetown MA- 01833 INSURED INSURER B : INSURER C: Seven Star Builders, Inc. INSURER D: 211 Seven Star Road INSURER E: AUTOMOBILE INSURER F: Groveland NA 01834 COVERAGES CERTIFICATE NUMBER14aster 15-16 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY YY MM/uDO EXP LIMITS A A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 3EB6694 9/17/2015 9/17/2016 EACH OCCURRENCE $ 1,000,00( PREMISES Ea occurrence) $ DAMAGE TO RENTED 100, 00( MED EXP (Any one person) $ 5,00( PERSONAL & ADV INJURY $ 1,000,00( L AGGREGATE LIMIT APPLIES PER: POLICY F-]jE O -FLOC MOTHER: GENERAL AGGREGATE $ 2,000,00( PRODUCTS - COMPIOP AGG $ 2,000,00( $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE $ P $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YEN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NSA PER OTH STATUTE ER E.L. EACH ACCIDENT is E.L. DISEASE - EA EMPLOYEd S E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aiWched'd more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE tr Iwilliam Fabri/HSHEA Road ' O 1988-2014 ACORD CORPORATION. All rights reserved aA ` ne and logo are registered marks of ACORD 2 � a 211:SEVEN STAR RQ GROVELAND, iNA 0183M2309 bA �l 5 0 D 10-97.2D13 Rev 07.15.2009 ,q V �C �(JfG9i(•)itG91.(C1P-C(ll� Gf�C%I��LG,liC(.CJf(lSCff Office of Consumer Affairs & Business Regulation T OME IMPROVEMENT CONTRACTOR egistration: .138835 Type: xpiration:,-;,5/21/2017.; Individual KEVIN F. CUNNIFF KEVIN CUNNIFF =- 211 SEVEN STAR RD _--- GROVELAND, MA 01834 Undersecretary M1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards i.l3:Z�t?tfL (fit-7LI;)C fS iSii t' License: CS -069599 KEVIN F CUNN" �s 211 SEVEN STAT -RD' GROVELAND MA 0183 �.�6C�. " Expiration .f••�•� Commissioner 09/29/2016