HomeMy WebLinkAboutBuilding Permit #510-2011 - 27 MAIN STREET 12/29/2010TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 0 f
Date Issued: 12zlof/a
Date Received
I 'IMPORTANT: Applicant must complete all items on this page
_LOCATION — Z I vl si-re--e-�-
Print
PROPERTY OWNER 144 n rlt 9 U
Print
MAP NO: 02F, D PARCEL: C101 (o ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
Ateration
No. of units:
Ytommercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
QSeptic ®Well
oodplairi q�Wetl`arid's,;
�; WatershedDistncf
DESCRIPTION OF WORK TO BE PERFORMED:
!yt w h a yc wu vI 4 Wr n' _f' , w a s✓ a c s X 0 0 ✓S , n1 c w s
2 K k /l 0✓ do o it i, /VC, v✓ a Ak7 w/ .t of a w s� A RA
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Identification Please Type or Print Clearly)
OWNER: Name: Ann Inor/ ic Akv / Phone: 977-6,P7- 2703
Address: 2 S A4 /o b Al.,,- 41- - A -r, d a ve ✓, Al 4
CONTRACTOR Name: M o doy-h Co o d k1,ci7o t1 i✓i u Phone: &giF Sok- YO
73 °,9
Address: Or /M c If 0 4 ol, Al o /� �& wove r r M A- o l of V -r
Supervisor's Construction License:
Home Improvement License:
92257
Exp. Date:
G 3 toy 7 Exp. Date:
9L2P,1yZ
�7
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.
Total Project Cost: $ o? D e-0 o • fD FEE: $ i2 eta f
Check No.: /3A','- /,- Receipt No.:
NOTE: Persons contracting yh*unregistei eld contractors do not have access to -the gi
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑Swimming
Art ❑
Pools El
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
Reviewed on Signature
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
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.$10041000 fine
NOTES and DATA — For department use
® Notified for pickup - Date
L I
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
❑ 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
❑ Engineering Affidavits for Engineered products
VOTE: 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
:hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording .
nust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location _.;2 !r- .;2
No. d — o // Date 1:24 f
TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
Building/Frame Permit Fee $ 4", —
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # -
2 3 b`4 4 'Building Inspector
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*=, Massachusetts - Depas-tment of Public Safety
Board of Building Regulations and Standards
.Construction Supervisor License
License: GS 92297
DAVID W PAUL'
91 ELMCREST RD•
NORTH ANDOVER, MA 01845 , t
Expiration: 9/24/2012
Commissioner Tr#: 3195
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Registratron: 163647 Office of Consumei Affairs:and Business :Regulatim
10 Park P,laz9 $uife 5170
Expiration 7/8/2011. Tr# 28608'.
.. # . Boston, MA 02116
Type: LLC :.
MODERN CONSTRUCTION SERVICES
DAVID PAUL
91 ELMCREST RD
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Construction Supervisor License
License: CS 92297
DAVID W PAUL
91 ELMCREST RD -
NORTH AND*OVEa, MA 01845
Expiration: 9/24/2012
Commissioner Tr#: 3195
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License: CS
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DA\jID W PAUL
91 SLMCREST RD p1845
NORTH ANDOVER MA
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Expiration 912412010
'( r#-. 3595
12/28%2010 17:21
NO. 310 D01
CERTIFICATE OF LIABILITY INSURANCE OP ID CR DATE(MWZ130"'"
PAODUCBR MODER—$ 12/28/1()
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
Durfee Buf finton In&. Agcy, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, WEND OR
377 Second Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Fail River MA 02721
Phone: 508-679-6486 INSURERS AFFORDING COVERAGE
INSURED NAIC #
INSURER A: Nr.etern Ii'Orld InnuraQ.c Ca.
INSURER B:
Modern Construction Services L INSURER C:
91 Elmcrest Road
NO AndaVer MA 01845 fNSURER0:
I INSURER E.-
COVERAGES
:COVERAGES
THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP 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 OA
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOnIONs OF SUCH
POLICIES, AGGREGATE GMfTS SHOWN MAY HAVE BEEN REDUCED W PAID CLAIMS,
LTR Sp p TYPE OFINSURANCB PGL(CYNUNBER DATE
DEIICRIPTION OF
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SHOULD ANY OFTHE ABOYB OESCRIBIED POLICIES BE CANCELLED BEFORE THE EXPIRATfo
NOANDOV DATE THEREOF, THE I$$UINQ INSURIA WILL ENDEAVOA TO MAIL 10 DAYS WRITTEN
TmmNOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Buil of NDepartment
aAndovertment IMPOSE NO OBLIGATION OR LIABILR'V OP ANY HIND UPON THE INGUAER, ITS AGENTS OR
Building I]elrartment
RfiPRESENTATW94,
NO ArLdover MA AU 110 R E YE
I
ACORD 25 (2009/01) m 1980.2009 ACORD CORPORATION. All rights reserved.
The ACOn D name and F090 aro roglatered marks W ACORD
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GeNERaLLtApfLYTY
DATE N p
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A S COMMERCIAL GENERAL LIABILITY
CLQ M?AD X� OCCUR
NPP120SS46
01/21/10
01121/11PREMISES
OCCURRENCE 6500'.000
ERaceurU E5U,000
MED EXP Otis pefdpn) $5,000
PERSONAL & ADV INJURY $ 500, 000
GENERALAGGRECiATE S1-000,0QQ
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NOANDOV DATE THEREOF, THE I$$UINQ INSURIA WILL ENDEAVOA TO MAIL 10 DAYS WRITTEN
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aAndovertment IMPOSE NO OBLIGATION OR LIABILR'V OP ANY HIND UPON THE INGUAER, ITS AGENTS OR
Building I]elrartment
RfiPRESENTATW94,
NO ArLdover MA AU 110 R E YE
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ACORD 25 (2009/01) m 1980.2009 ACORD CORPORATION. All rights reserved.
The ACOn D name and F090 aro roglatered marks W ACORD
12/28/2010 17:21
NO. 310 D02
-'RDFCERTIFICATE OF LIABILITY INSURANCE OPID cR I
DATE(Ma '
PRODUCER MODER— 4 12/2g
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATIDIV
Durfee 8uffinton Ins .A t Inc DN LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
37 7 Second Street Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EX`rFAD OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES $SLOW.
Fall River MA 02721
Phone. 508-679-6486 INSURERS AFFORDING COVERAGE
RUENAIC 0
INSUAERA; Travelers Insurance Co.
INSURER e:
Modern Construction Services L INSURERC:
91 Elmcrest Road
No Andover MA 01845 INSURER D;
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COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED AEICV$ FOR THE POLICY IMOD INDICT
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E. L.DISF,AsE - EA EMPLOYEE $ 140000
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EKPIRATIGI
NOAt3riDV DATE THEREOF,714C ISSUING INSURER WILL ENDEAVOR TO MAIL 10 GAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SMALL
Totem o f No , r IMPOSE NO DBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENT$ OR
Building DepaartmenrtMent
REPRESENTATIVES.
NO Andover MA Av HOp�E E
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D 25 (2009101) C 1888-2009 ACORD CORPORATION_ All rights reserved.
The ACORD n8m0 and (Ego arta registered marks of ACORD