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HomeMy WebLinkAboutBuilding Permit #491-2011 - 27 HEPATICA DRIVE 12/20/2010xe014 t(-- f-1--0.0/1 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / oy0�� Date Issued: IAIX0/D Date Received I IMPORTANT: Applicant must complete all items on this baize LOCATIONt/i `cr4 St 100, Print PROPERTY OWNER_ E)/' �r' r TC: - Print MAP NO: PARCEL: ZONING DISTRICT:y 1 Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildinOne fa Addition wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District a er ewer DESCRIPTION OF 1NORK TQ BE PREFO QOow*' i4i�'4C4'e� '2- 644- OWNER: Name: Address: 10 d a"� c )n Please Type or Print Clearly) &, wic . Phone: 778-&S'- V/X, 10 a� r%• �� vac , M 4- 6> 1 15 CONTRACTOR Name: m;4M;* Phone: Sa '` -44-150 Addre )Joe k mA*4"A- =1) Supervisor's Construction License: G!�; 7.5-3 -0 7-- Exp. Date: !.I JY /I Home Improvement License: Exp. Date: < ARCHITECT/ENGINEERfi(A h ©SuLC� Vow geAt� �F�Afone: 1. Address: 1MA.v r1, 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: $ 3S 6 �'� S� FEE: $ 3 0 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund , gnature of Agent/Owner Signature of contra '� C Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL ZblicSewer 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 APPROVED PLANNING & DEVELOPMENT COMMENTS 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: Conservation Decision: Water & Sewer Connection/Sig DPW Town Engineer: Signature: _Comments t Comments- 17 ommen Located 334 Usgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate 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 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 2008 No 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 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) uilding Permit Application �Prop Pro osed Plot Plan Certified of H.I.C. And C.S.L. Licenses orkers 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 -27 �Ff.;G'//c4 �rf , Location No. 71��- .?o tt Date f2 h 0 d Check # -�-76F/ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y� d 23bGG Bu"ng ng Inspector M w cc ?O L C3 C.3 O H ti yr c F� CL c m cc 'A Cc C2 E e CD CO C CDH V; y c cm o Ih� v CL �1• �` h L � � � U { Cti Ty a V� H ���1��3 ccm ca p� o s �� _ cn CA \ N � C z o �m QwcmO. N m Cf) CoC* — Q O O J fl c v w CID CD 0 r V H O O to 210 Z O .■.. Cf L c Q m m e O _ m CL. 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D ._m rAs - cONt �, z O p o o xV�� Nag �� Q 1 Dc Z o m p- t�m N .0 O O o S s _ `m >++ �- � O D Irm+ - Q m. .: ; . \' - o ID'' I � .SARs o Bea $ _ �����44 ? $� 3� 3 p •r � � < a m �OO . � x - - _�': n .�, � __ m �" (Q Q W 3 m 3 p&Fq$ o m r C- cep C' ® Iwo, F:IJ-' 1, o 't ��16r _N . �c �_-D .3. �a o Z Nlassachusctts - Department of Public Safctl Board of Building Regulations and Standards Construction Supervisor License License: CS 75302 BENJAMIN C OSGOOD ' 69 OLD VILLAGE LANE NO ANDOVER; MA 01845 r c- �.G- Expiration: 12/4/2012 ('ununissiuner -, _- Tr#: 6267 08/09/2010 13:10 9786833147 PAGE 05/05 AcoKLYCERTIFICATE OF LIABILITY INSURANCE 1 °�'� a/'°°""�' 10 TMS CERTIFM*m is ISSUED AS A MAT MR OF: WOR3NAnON Oi'L AND CONFERS NO RIMM UPON 11M CEKI FICATE HOLDM TM CERTi M7E DOES NOT AFFpMAii MLy'OR NEGATNEi if AuGi) IEXTEND OR ALTER THE COVEME *TOROED 8Y THE POUCH Figow. 7m CEzinFICATE OF ROMANCE DOES NOT COtdMnM A CONTRACT BETWEEN 7Vm ISSUING MURERp), AITWFCM NiA'iTVE ' - OR E�RODiICER. AND aNE.�TRC.ATE HOLDER..;- if:.�.. . 9d PORTANT: if the cecider e3 ster EXCLUS aG AND C ONDTIIONS OFOUCH POL"M LM M SHOWN MAY HAVE MEN M=ED BY PAID OLAM3. 1 Tm or INB wcc Pdl1C'1 B}f as must be end -n i1 wl swww to ft teases and coti+BtEom of the po ft oettsliin poftlea mw vequire oa A ets*metd on this certificaft does not eonfa: riga lb die certificafe hold" en New of such PRO06VM i M. P. Rabat s Issauxaace Ageacq. FAX 1060 Osgood Street; :i 978683-8073 (970) 683-3147 i rg,�rce1@aol. corn X COMMERCIALOMMMuTyDAMGETO iia tti'.T 7d6ro xr HA 01845 2316 RENTED20 a 50 0_00 A MAfflllMDE OCCUR w w 6/l5/10 v AFS COVERAGE NAlClk t erwfFaa!6A: 6AQVINAMY E 11-9-0-0-J00 _ _ itiSk Placement Services, Inc. L� : i.aw s W�'•:L.{, p, 1E � Cf+ :�` � flW.�e��. 10 iMPACTICA AFCIVT; y 1 a aaREOATe s 2 OOO�OQ Et c- IgDRM AMOVERF Mk 01845: C�NLAGC�2iGHTELGITAPPLIE3PER E ' COVERAGES wIMMUeu-' �;�;t:,. .x,.rof.,.. u.Mf:e�.,. THIS IS TO CRIT( THAT THIE POLICES OF iN9URANCE UME) BEI -OW HAVE BEEN ISSUED TO THE MiSURED NAM® ABOVE FOR THE POLICY PU;PW MT rAT®. NOTWTHSTANDNG ANY REQUF EMEN T, Tull OR CONDITION CF ANY CONTRACT OR OTHER DOCUMeiT WITH RBSPECT TO WHICH THIS CITE MAY M ISSUED OR MAY PERTAM, THE MISORANCE AFFORDED BY THE POLICIES DESMUM HSN IS SUBJ-EGT TO ALL THE Tim, EXCLUS aG AND C ONDTIIONS OFOUCH POL"M LM M SHOWN MAY HAVE MEN M=ED BY PAID OLAM3. 1 Tm or INB wcc Pdl1C'1 B}f rwmmwyym ui m AEt*IpUeEI? S�1'fATNE (�@l6iALL1ABNJiY EACH o1cIE a 1 000 000 R X COMMERCIALOMMMuTyDAMGETO RENTED20 a 50 0_00 A MAfflllMDE OCCUR 9DD9812 6/l5/10 6/15/11 w-om one Bean a 0 6AQVINAMY E 11-9-0-0-J00 aaREOATe s 2 OOO�OQ C�NLAGC�2iGHTELGITAPPLIE3PER -COwPnPMIG s E C DD ED POLC3Y SRO LOC a AUiLE LJA8Rir1f . SR1GtElAAfT s f�RY RoeomAM )ASi7Atl (Per pow" a URYIPereccaenq s ONRCEHMDAU`M 4 { NOiV-01Mi'ED AUTOS s ULLACEA9 OCCUR F. EACH2CtY1RRBQCE DR 93LIA8 LLAMA IN DIAwregnm VYC ST ATU- Olii WORMS COEENMTf01V ANO 8 PLOVE V IJAEaUTY H YJN AmrPRoPRtttaraPJ >a TMEa OFFICER ` 'yFg W=0075810120j4 9/i5/09 9/15/16 EL.EACHACCIDEW s 1,000,000 ECLLDED7 e�s,ae w 1.. 1 : EL.DISEASE.EAE31P : 1 000 o00 EL DIS PA— -PomLuir a 1,000,000 OEI TiONOFOMPATIONSbebw aESCRIP11pMaFVPERImoNa J LOr7 MM JvEeM M f a AD=101.A*Nmat Rs sldudra,wn"apeas ig"eeai i ACORD 25 (2009JrO1 The ACORO ranw and �aao,aeam AWM a�VKrVICAI IVN. All ngnrs reserree. foga " registered marks of ACORD JIMULD ANY OF IM ACOVE CESCMBED PCUCIES BE CANCEILPD BEFORE THE OgRRATION DATE THEREOF. NOTICE VoLL BE DELIVERED IN ACCORDANCE W I IME POLY PROVISIONS. AEt*IpUeEI? S�1'fATNE ACORD 25 (2009JrO1 The ACORO ranw and �aao,aeam AWM a�VKrVICAI IVN. All ngnrs reserree. foga " registered marks of ACORD