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HomeMy WebLinkAboutBuilding Permit #066-14 - 29 HEPATICA DRIVE 7/18/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: "'` Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION #ee#111-11'cil 11Ci`tla �o _ Print PROPERTY OWNER_Xe Print 100 Year Old Structure yes MAP NO: 1076- PARCEL:ovy16 ZONING DISTRICT: Vie Historic District yes Machine Shop Village yes .TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ` R,6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration '° ' ' { No of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: , ❑ Demolition ❑ Other ` Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District RoWater/Sewer DE CRIPT N OF WORK TO BE PERFORMED: --de S:4&fie )Proyw,GY 11,9-we Identification Please Type or Print Clearly) OWNER: Name: /4(s!1 4 of e. tc. // Phone: 9�8- �-3163 Address: 10 Ne-A4A'c,* bQi yd-v IVeek 6.$ Loves Vh i4- Vlsfa CONTRACTOR Name: � � 4 $y'►j n C- �IX-Bts oPhone: S 08-3.78 -4(A;o Address: (o`'t ©hd- rV U*QX d-wek o je 4,4 ede+P Supervisor's Construction License: CS-073.30 . Exp. Date: 13/oq(l�o/i( Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 6)SvLL;V*'t 19 EAQ �c-T5 I;c.Phone: 78/-- 13?- Address: 13? -Address: 580 M41-61 eB�-. KV-48,4& _Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ bd Check No.: ( �2— Receipt No.: o NOTE: Persons contractingwith unregistered contractors do not have access to the uaran un g g ryf aSignature�of,,Agent/Qwn ; C Sigature of contracto Plans Submitted � PI ns Waived ❑ Certified Plot Plan IStmped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGEDISPOSAL 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 ❑ I 7 �i- 5 COMMENTS yeyl (,lI GL/ CONSERVATION Reviewed on Si nature 1 COMMENTS dr MAA�- HEALTH .:�:�,.�• - . .� Reviewed on Sig nature OMMENTS •• 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 ToivA Engineer: Signature: Located 384 Osgood Street FIRE DEPARTI HENT =Temp Dumpster on siteyes no Located at*124.Main'Strdet Fire Depai4ii ilsl ignature/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 .e �. JLO-� El 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 Li Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L: Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li 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 ,fa L3 Certified Surveyed Plot Plan r r $I ❑ Workers Comp Affidavit Li Photo Copy of H.I.C. And-C.S1.- Licenses ,r o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Calculations (If Applicable) Hydraulic o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cask if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the api)e al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Bui?,-1ing permit Revised 2012 I I Location No. Date t . - TOWN OF NORTH ANDOVER' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 'Uv Other Permit Fee $ TOTAL $ Check# J-11 .* C. J U J J �/ Building Inspector � NORTF� Town of t E ndover C LA h , ver, Mass, A- coc M.c Hew.C. y1. 7tls gi1TE0 P'Lf 5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ` /,,,. BUILDING INSPECTOR THIS CERTIFIES THAT ....... . ...hof,e:. •:• :......... .......................... ..................................... Foundation has permission to erect.......................... buildings on .a 1,�6 rZmC...X1.4.............................. Rough tobe occupied as ............ ...: °` .4?: Q! '..® � ................................................................. Chimney provided that the person accepting this permit shall in every spect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ............... .... .........INSPE.............TO...... Final BUI CR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin-e 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. Smoke Det. SEE REVERSE SIDE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supetlisor - License: CS-075302 BENJAMIN C OSOOOD 69 OLD VILLAGE LANE s NO ANDOVER MA 01945 Expiration Gomrnissioner 12/04/2014 I .Aco /24/201 F CERTIFICATE OF LIABILITY INSURANCE 6 ' 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 pollcy(ies)must be endorsed. If SUBROGATION IS WANED,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 Ileu of such endorsement(s). CONTACT PRODUCER NAME: M P ROBERTS INS AGCY INC PHONE (978)683-8073 (978)683-3147 No Ext: fVC No 1060 Osgood Street D IlAIL North Andover, MA 01845 ADRESS: INSURER(S) AFFORDING COVERAGE NAICp INSURER A:ESSEX INSURANCE CO INSURED KEY LIME INC INSURER 8: 10 HEPATICA DRIVE INSURER C:HANOVER NORTH ANDOVER, MA 01845 INSURER 0: 978-683-3163 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. ILTRR TYPE OF INSURANCE NeD WV0 POLICY NUMBER MM/DD/WYY IMMID LIMITS X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 CLAIM8-MADE OCCUR PREMISES Ee occurrence $ 50,000 MED EXP(Any one person) $ EXCLUDED A 3DD9812 06/15/13 06/15/14 PERSONAL&ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY C�PRO- LOC PRODUCTS-COMPIOP AGO $ EXCLUDED JECT OTHER: $ AUTOMOBILE LIABILITY Ea accident $ ANYAUTO BODILY INJURY(Per person) s ALL OWNED SCHEDULED BODILY INJURY(Per socident) $ AUTOS AUTOS -RTOPSM DAMAGE NON-OWNED Peraccideni $ HIRED AUTOS AUTOS $ UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVENIA - E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NN) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C HANOVER INSURANCE IHN221,11111405 11/16/13 11/16/14 Fire Builders Risk DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be atteched if mare space is required) PROPERTY LOCATION: 8+ 6 10+ ACRES ON TURNPIKE STREET NORTH ANDOVER, MA 01845. PROPERTY LOCATED MAYFLOWER 6 HEPATICA DRIVE NORTH ANDOVER, MA 01845. NOTE 400,000 EACH HOUSE TOTAL VALUE 1.2 MILLION/ ENTERPRISE RANK LISTED AS MORTAGEE AND CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION Enterprise Bank 6 Trust PO Box 5203 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Norwell, MA 02061 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV �R. ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013104) The ACORD name and logo are registered marks of ACORD i