HomeMy WebLinkAboutBuilding Permit #881-11 - 284 BRENTWOOD CIRCLE 6/21/2011 TOWN OF NORTH ANDOVER G/ APPLICATION FOR PLAN EXAMINATION Permit N0: 0 ( Date Received Date Issued: /Ll/ IMPORTANT:Applicant must coin Tete all items on this page LOCATION Eq wb GI PROPERTY OWNER Print Print MAP N0: _pARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ', �,-�❑+ Water/Sewer s;# '��,,� , �,.� 1,. `�-'s��`��� �=' '� .;,�"C-.y �g ��-q,. � �,, �#-,s' - .....' 'S�,_:f#{- "•. ��sa�:•--:*' +z+rs�,� � t-a# � ,..` ,� � k.�.� ^'.ir`. �i'�,v'*p�i. i` YC� i DESCRIPTION OF WORK TO BE PERFORMED: Ski -e�ci 5+in o`� ha.I-� hip 1e5 �d � 1CLoe . (Identification Please Type or Print Clearly) OWNER: Nair�e: l 1 C'1 eQ L F Y-,rj t j , 11 I van Phone: CP 1 '�-• oZ G Fs' l �f Address:_ CONTRACTOR Name: j�-, om G C(�s( �i fir- �l^ Phone: C> > Co 3� ���- �q 7 7 Address:_ 'Dr �- Supervisor's Construction License: Qq D��Exp. Date: _ a.' a C)f Home Improvement License: i (o q Exp. Date: (oz./ a[>/' 3 ARCHI T ECT/ENGINEER Phone: Address-------- Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ -, & (� J. — FEE: $_ I heck No.: S 7 ' Receipt No.: VOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of AgentlOwner `"� ignature of contractor, _. �`,( �/ Location...?1'S' �/ ecu do �i rCJ No. (�/— '/ Date �5 f' NORTH TOWN OF NORTH ANDOVER -� �? p C I a � ` ` ; • certificate of Occupancy $ CMU;sBuilding/Frame Permit Fee $ Foundation Permit Fee $ 1 Other Permit Fee $ TOTAL $ Check # 24L _ a ui ding Inspector I it x Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE 0'P:-SEWERAGEDiSPOSAL" Public Sewer ❑ Tanning/MassageBody Art ❑... Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food PackagingfSales ❑ 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 Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes-.. Planning Board Decision: Comments Conservation Decision: Comments Water &Sewer ConnectioniSianature&Date Driveway Permit APV6T Tow;-, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM� . -Temp Dumpster on site yes.. no Located*at 124 Main Street Fire Departmeritsigriatureldate 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 I tified for pickup - -Date- No - - I Doc:.Building Permit Revised 2008mi 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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 u 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) u 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 2014 VAO H ® of O = „., r 11% No. o , dover, Mass., I� COCMICHEWICK DRATED P'V *`� BOARD OF HEALTH Food/Kitchen rwERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........]".1 �i !, !'1................................................................................................................. Foundation ion has permission to erect........................................ buildings on ...a '... ... � . Rough to be occupied as..... �"r� �.... E ... 2s�' ..... Chimney . . .. . . . . .. . ...................................................................................... provided that the person accepting this permit shall in every respect 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 MONTHS 7p �7-p T T T ^ ELECTRICAL INSPECTOR UNLESS�1 L.ESS CONS 1 R CT10 TARTs7 Rough Tey,T ,.................................. 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. The Commonwealth of Massachusetts • x Department of Industrial Accidents i Office of Investigations Ri TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction,alteration, renovation, repair,modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building"be done by registered contractors, with certain exception,along with other requirements. Type of Work: ,o t Est. Cos `— Address of Work o9 Sy Bmmuiocd Lr- Owner irOwner Name: M I a ( * Ka+ sU i l k/o fl Date of Permit Application: (o( 1 7 L10 II I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other(specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: I �MCAS �7 CarlSL a9-I Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name CORMTHI OP ID:JN ACORO" DATE(MM/DD/YYYY) `...� CERTIFICATE OF LIABILITY INSURANCE 06/17111 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(les)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 603-673-7228 c0NTACT Beard 8 Boyd Insurance AgencyPHONE FAX 8 Main Street 603-673-7290 A/c No Ezt: (A/C,No): Amherst,NH 03031 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 9 INSURERA:The St.Paul Travelers INSURED Thomas Cormier INSURER 8: 5 Mahogony Or Nashua,NH 03062 INsuRERc: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. RDDL INSR TYPE OF INSURANCE POLICY NUMBER MMOIIDD EFF MPnO�LICY EXP LIMITS LTR GENERAL LIABILITY 1 000,00 DAMAGE TO RENTED EACH OCCURRENCE $ � A COMMERCIAL GENERAL LIABILITY 6802A354167 05/26/11 05/26112 PREMISES Ea occurrence $ _ 300,00 li CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ 5,00 X Business Owners PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY PRO- LN $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea a-dent $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS UTOS NON-OWNED PPROPEERa DAMA E $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR)PARTNER/EXECUTIVEYNIA UB5282N340 05104111 05/04/12 E.L.EACH ACCIDENT $IN 100,00 OFFICERWEMBER EXCLUDED? 100,00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ H es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 PROPERTY 6,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATME ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD License or registration valid for individul use only Ofiiee of Consumer Affairs&Busi ess Regulation Y ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ,163297 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 piration: _ / f2(33 Individual Boston,MA 02116 THO ICORMIE, =� /ar 'y ,1 THOMAS CORMIER`,`QQ 5 MAHOGANY DR. NASHUA,NH 03062 `"'` `K' - Undersecretary Not valid'without si ure /. �o��cr�lfz e ✓L�aeeat uaelt'a Board of Building Regulations and Standards 1 Zonstruction Supervisor License License: CS 99057 • Expiration: 312/201.2 Tilt 99057 Restriction.• 00 d THOMAS CORMIER JR s �5 MAHOGANY DR NASHUA,NH 03062 Commissioner M