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HomeMy WebLinkAboutBuilding Permit #414 - 28 ROCK ROAD 11/15/2011 t TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received i Date Issued: IMPORTANT:A_ licant must complete all items on this page LOCATION8) p .Print PROPERTY OWNER a V(� tV Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yTno Machine Sho Villa e p g y100year-oldstructure y ' TYPE OF IMPROVEMENT PROPOSED USE e Residential Non Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ `r©F_ ' ® ,..,ell r ' {; ; ®� lo5 Xrl odp r y ®Wetlan s r r t® Wa er sti c� .�" ..J C •1 . 'k ` 4j r . Y j r ` ... ®_ r/Sew r __. DESCRIPTION OF WORK TO BE PERFORMED: qa (Identification Please �e or Print Clearly) OWNER: Nama e: qq Phone: Address: t?UC�_ O CONTRACTOR Name: �� - Phone: q78 " 3 sZ_8 176 Address: c 'Dox ( (.C Supervisor's Construction License: CS3_(4-44(p Exp. Date: Home Improvement License: 1 t S 6 Exp. Date: ( ? 12,0 172— ARCH ITECT/ENGI NEER ZARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0(), Uc-) FEE: $ 7-� Check No.: Receipt No.: NOTE: Persons contracting ivith unregistered contractors do not have access to the guaranty and +�'. Si�nature,ofiAgent/Ownerx � aEnSignature_ofrcont[actor _., r e 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) a 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 Doe: Doe.Building Permit Revised 2008mi ' I 1 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 APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature N COMMENTS HEALTH Reviewed on Signature COMMENTS 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 i 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 p 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 2011 June/mi Location No. — Date ! J NORTH TOWN OF NORTH ANDOVER O 0 ALR + ; : Certificate of Occupancy $ MusE 9 Buildin /Frame Permit Fee $ s�c Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2481 �` Building Inspector NORTH ® ® Andover 0 No. In o , '� dower, IVlass., U- COCHICHEWICK l,9S0RATED � �C� D BOARD OF HEALTH Food/Kitchen Septic System r. RMIT T . BUILDING INSPECTOR THIS CERTIFIES THAT........... .. .. ....., . ..... ................................................................... Foundation 4 #% ....E� . has permission to ere buildings on ... .... ... ............. ....... gh to be occupied as ... .f. ....... -r .....1,. v�..'. '�.....-r- Chimney ..... ' ... .. .. . . . . provided that the person accep ng this permit shall in every Nspect conform to 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 NTHS ELECTRICAL INSPECTOR UNLESS CONS TRI.3 ONS ARTS 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 SLIDE Smoke Det. Massachusetts- Department of Public Safety Board of Building Regulations and Standards v Construction Supervisor License I License: CS 34446 Restricted to: 00 4# ROGER S LEBLANC SPO BOX 160 , ',BOXFORD, MA 01921 Expiration: 4/20/2012 x` (•onunissioner TW: 21918 �o ✓/ze Zia»ro> r.�ae¢�/�✓��G�¢c�a«�1s116`. 1 01ce olCoasumerAhZeirs R srnessRe alation �' License orregi slr br" r HONE/NPROMENENTCONTRACTOR hefare the erpitstioo dw,, /f Registration ,,�=111356 Type: Office ofConsumer AfWrt 10 Park Plaza-Suite 5170 Expiration 1 %17/2012 DBAa RE , Boston,MA 02116 ROGER LEBLANC.,CARP-ENTRY " + �. ROGER LeBLANC f l 13 ROYAL CREST DR S' N ANDOVER„ MA 01245 _! ` Undersecretary' {# j No valid without signature :1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYY) T� 08/16/2010 PRODUCER (978)887_4900 FAX (978)887-2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 16 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfiel d, MA 01983 INSURERS AFFORDING COVERAGE NAIL# INSURED Roger S. LeBlanc Carpentry INSURER A: Nautilus Insurance Co. P.O. Box 160 INSURERB: Safety Insurance Company 39454 Boxford, MA 01921 INSURERc: Associated Employers Ins. Co. INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION LTR NSR DATE MMIDD/YYYY DATE MM/D LIMITS GENERAL LIABILITY NC855130 03/02/2011 03/02/2012 EACH OCCURRENCE $ 12000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 50,000 CLAIMS MADE 1-i-1 OCCUR MED EXP(Any one person) $ 51000 A PERSONAL&ADV INJURY $ 1,0002 OO GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 21000,000 POLICY ECT LOC AUTOMOBILE LIABILITY 6201823 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ 1XXX SCHEDULED AUTOS (Per person) B HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION C - AND EMPLOYERS'LIABILITY WCC5006432012011 07/03/2011 07/03/2012 TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE� E.L.EACH ACCIDENT $ 100,000 C OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ S001000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 36 Bartlett St. REPRESENTATIVES. Andover, MA 01810 AUTHORIZED REPRESENTATIVE Robert Sennott ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD