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HomeMy WebLinkAboutBuilding Permit #422-2011 - 27 HEPATICA DRIVE 11/17/2010 BUILDING PERMIT11ORT#i� q a°tt�eO.�°�6�00 TOWN OF NORTH ANDOVER o _ APPLICATION FOR P 1/IINA ZION * a Permit NO: 2--.20110 „, « --._1,—a Received, Date Issued: �� 0 �SSACHUS�� IMPORTANT:Applicant must complete all items on this page r LOCATION ' S '-'..' �c , °.Cal Print PROPERTY OWNER_ A-e Zt'"vA*- . -40yG ' PrintMAP 210 , PARCEL: d O ZONING DISTRICT:V9 Historic District yes n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District titer/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: f e `tis c , Phone: 7 Cc3 ..,3 !a Address: �� �/�iQhG� J,e�`vi� o��l'L #oa�,qr-Ae m�W ,'ane: CONTRACTOR IVarne:_�y � ,..f�,-��: ,��/. yti`�L�, Phone: 5 04f-,.-.W-Ovi� Address: �,i'� 4a w/� &4tkv .r2, 491 ' '' i Supervisor's Construction License: '.Ss-&0.2. Exp, Date: 14 Xpdta._ Home Improvement License: Exp. Date: -� ARCHITECT/ENGINEER©.�ylli �AVC4� � G S �ircphone: 725'/-�c39�Co/�!Q Address: 8 i¢ O1`y V7' eekd.i nG- 9� Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I Total _Project Cost: $ FEE: $ l'-0 a Check No.: �'a Receipt No.: ,2370S' NOTE: Persons contracting x ith unregistered contractor l have access to the guaranty fund Pig nature ©f..Agent/Owner jSiigna ure 0f'c0ntra6t6r 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 DATE A PROVE PLANNING & DEVELOPMENT 5 A0 COMMENTS CONSERVATION Reviewed on U 116 Signature t COMMENTS t HEALTH Reviewed on -Signature COMMENTS Zoning Board of•Appeals:-Variance, Petition No: Zoning'Decision/receipt submitted yes Planning Board Decision: Comments a - Conservatiori becision:* Comments ` Water &•Sewer Connection/Signature&Date ' ` ' Driveway'Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 'COMMENTS Dimension Number of Stories: Total 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 ❑ Engineering Affidavits for Engineered products j 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 ❑ 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 Revised 2008 UcatlenoL� j No. �l`a/` 9°/i Dateof NORT#f TOWN OF NORTH ANDOVER - P •4 Certificate of Occupancy' • P Y $ s''••°';<� Building/Frame Permit Fee $ MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Syo 1 23767 f ilding Inspector � ORTIy 0 o oAndover ZQ =_ .LAKE over, 1Vlass., COCHICMEWICK 7dSDRATE D PP���S 77 S BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System THIS CERTIFIES THAT �� �lV�. BUILDING INSPECTOR .... ............................................................................................................................. Foundation has permission to erect........................................ buildings on -p ........................................................ Rough to be occupied as............................ ........ f Chimney provided that the person accepting this permit shall in every respect conform 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 - UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Massachusetts- Department of Public SAO% Board of Buildin- Regulations and Standards Construction Supervisor License License: CS 75302 BENJAMIN C OSGOOD 69 OLD VILLAGE LANE NO ANDOVER, MA 01845 5 Expiration: 12/4/2012 ('ummisiuner • Tr##: 6267 M.P. ROBERTS INSUIMCE AGENCY, INC. 1060 OSGOOD STREET NORTH ANDOVER, MA 01845 EMAIL: MPRInsurancei@AOL.COM P (978) 683-8073 F (978) 683-3147 September 112010 Key Lime Inc 10 Hepatica Drive North Andover Ma 01845 Re: Workers Compensation #WCC 5007581012010 Effective 9/15/2010 - 2011 I am pleased to enclose your Workers Compensation Insurance Policy issued by Associated Employers Insurance Company. The policy has been issued with the following coverages', limits and payroll exposures scheduled: $1,000,000 - Bodily Injury by Accident, each accident $1,000,000 - Bodily Injury by Disease, policy limit $1,000,000 - Bodily Injury by Disease, each employee Carpentry-Detached 1 or 2 $48,990 Clerical Office $34,446 Please review the policy. If you have any questions or if revisions are required, please contact our office to ensure the policy is corrected. I would like to take this opportunity to thank you for letting our agency be of service. Thank you. Sincer ly, Pa t 08/02010 13:10 9786833147 PAGE 05/05 AeO O CERTIFICATE OF LIA11811-ITY INSURANCE m-m 8 9 1Q TM CERTIFICATE I$ AS A MATTER OF:MORMATION ONLY,AND CONFERS NO RIGHTS UPON THE CERnFICATE HOLDfSZ. 'f�iii S CERTIFICATE D= NOT AFF1TaMA'f1VEMOR NB6ATIVRY A11111804E>LiEND OR ALTER THE COVERAGE:AFFORDED BY TIS POLIGM BELLOW. TM CMiTMCATE OF MURAL M DOES NOT OON3'1i1UiiT:A CONTRACt BETWEEN TME ISSUING MURER(S), AUTWRIMD REFIRESENTATIVE OR PRODUCIM AND 7M tT�CJITEHOtDER:' ;:: . VAFOIKTAN - Ifthees as . = must be end n IS VvAIIf37,s t0 fka tma. and ccn+ ftm of ttietion poceras* poNelas may MOM aP�ae7doLaa+tl -du A sbftmeM on fids oertl#icatt dohs not oonfar rim IO Me eorti5ca�hold"Tei lieu of aosh '' PROOU M M.P. Roberts It><aaraace Agcy:': ,iptvm978 683-8073 tTJ7s� 683-3147 1060 Osgood Street: IToxt$ ial over, M 018451 T fiiasnrass 61@ao1.cosy AMOMM COMAGE _ NAMA °ate ;gam+ s As iwMA:Risk Placement Services, Inc. I T. ,IIQC 3Yu t11rtee a �' Inc. 10 REPACTICA ARIVS TAT& AIMOY R, bM 01845 1 E- COVERAGES CERTIRCATE NU111MM REVISION NUIIIBEFL^ T RIS IS TO CEF TiFY THAT THE POLICIES OF NVJRPJVCE UMD MON HAVE BEEN 155UED TO THE INSURED IVAM®ABOW FOR THE POLICY PU�W INDiGATED HOTWTHSTANDNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TMS CERTIFICATE WY M ISSUED OR MAY PERTAIN,THE INSURANCE AFFOFDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE 1I CIMS, EXCLUSIONS AND CONCI TIONS OF SUCH POLICES.LIMBS SHOWN MAY HAVE BEEN R®UC®BY PAID CLAMS. L TYPE OF INSURANCECUL MM POLICY go ��uryyEVim `:. EACH OCCUFREMCE s 11000,000 CCMSRERCKMWERALLMLITY ,_. OANi4GETVRENTcU g 5O 000 A MA(Ja 46oE OCCUR 3DD9812 6/15/10 6/15/11 MEDEW ori Isar 6 0 PERSOH6LAA0V1KjgRY E �Q00 000 GENERAL AOOREGATE $ 2 OOO- OOQ CWLAGGtEGATELfi11TAPPUE3PERMODUCr3-COAFK)PACiG S POLICY LOC i`. S AU1Ui70BgEL1A89riY j.,..:. CONBNEDSIMGLELIM 6 MNYAVM BODILY t1VJUPY(Per pearan) S ALLOWN RO AMS SCHEOIILEDAlJT03 50DILYNJM(For emlaem) S P�a MAAiS ; HUMAUTCO ) non.Owrrro Avros : Igo e UMM=AUAS O=R *L EACH OCCUMENCE F,F,40NAB CLAJMSaftmS RETINTION S WRFUM COMEN=10N _ t WC STATU- OTH- Af10B6PWYEiiS'UABMY B AXf �MWERIExEculm W0050075810120. 9 9/15/09 9/15/10 EEAOHAcaaEHr $ 1,000,000 eoxuomt NIA L. FLOMEAM-FAMmum a 1,000,000 MOM EL,DISEAM-POLICY LUrr S Z 000 000 j . nEsi uPnoN OFOPewmoraa�Lnra�grls r vada� 5-1-K4 Ao0RA t01.Adirer t Re, sdndw.wmms apes Iseeq "* CERTHWATE HOLDER i.CANCELLATION SHOULD ANY OF IM ABOVE DESCRIBED POUCES BE CANCIB.Lno BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DEUVERM IN AWOROANCI[WrM 7HE POL(+rY PROVIMNS. AU710 9MfATNE + I- 0 1909WO ACORA CORPORATION. All rigtft reserve ACORD T.6(Mal The ACORD mom and logo registered marks of ACORD