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HomeMy WebLinkAboutBuilding Permit #627-2011 - 315 SOUTH BRADFORD STREET 3/22/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: RTANT: Applicant must C f Date Received all items on this Print MAP NO:,1a-'I' C PARCEL: /Z ZONING DISTRICT: Historic District yes Machine Shop Village yes 1100, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ di ion ❑ Two or more family Industrial Iteration No. of units: ,❑ 9Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D S pt1c ®Well {jjj s -:i 4 _i� �S 2�3� } S.t ®jFloodplain _ ® Wetlands T - , �` Watershed Districtz-'n S A . � DESCRIPTION OF WORK TO BE PERFORMED: v Print CIearly) Address: / j �d ��� G� ✓ dL �c 7 — CONTRACTOR Name: � �� � a A ( Phone: Address:40- Supervisor's Construction License: �S r-717 G Exp. Date: ;2— j Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phon Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F. Total Project Cost: $ ��� T� FEE: $ lc el • ©J Check No.: 9 / fir. Receipt No.: 01?,3 9 7 NOTE: Bersons cgntngctiA4g h unregistered contractors do not have access to t#,e gugranty u l Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS 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 ; r 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 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 o Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location N e; ;? 7 o. Date - 1 -- Check# 56 k 23978 F(uilding Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - 1 -- Check# 56 k 23978 F(uilding Inspector WD WD cd W z o 0 a m C 0 a O O 0 wx a � Z a O � O w I O_ O "0 G - O W E " o w° a CO m m 0 - i .�.1 CD L _ U w '-� R" a�' m w U w on�i w°' CO co w C7 :L O +•+ y w k+ N r� z ,� cn v Q se p cn W z •A ON J O F. 2' o m C O O cs Z a O � y C I O_ O "0 G H V V m m � CD L CiG CD R W m G e_cv Cl a :L O +•+ y ca CO c O CD = c cc v J .� .EL :E¢ CO2 C C3 CD • L co c CL y O a C _ v CL — r y � t O CD G O O v� N N L 3 N. Of On A Q H C cc O O Ca. =moo 1 C a N CZ C t 3 c3 '� N t5` CO Ci O m � N C = O C F— s.. W G �Cm ze _ y O• •d C W •E n •o SO N C3 O O ® E C y CL m3 0:5 CL•=.r CD •A ON J O F. 2' LLI v♦ LLI ca W W 19 W N O O O cs Z a O � y C I co cm O "0 03 H m m � CD L yr CD O03 e_cv Cl a CL ca CO = c cc v J .� .EL O CO2 C C3 CD CD V CL y O C C CL 0 � LLI v♦ LLI ca W W 19 W N 3/22/2011 8:48:36 AM 8740 ® 03/03 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY) 03/22/2011 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(iss) 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 Perry Insurance Agency LLC 522 Chickering Rd, Rt 125 North Andover, MA 01845 CONTACT SAKE: PMONE PAr (At . Na. Ext): (A/`. Ha): EMAIL ADDRESS; PRODUCER COST ONE R IDtl. INSURED IS) AFFORDING COVERAGE RUC 0 INSURED Steve Smolak 762 Dale Street North Andover, MA 01845 INSURER A: A.I.M. Mutual Insurance Co INsuReR e: INSURER C: 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 TIDY HAVE BEEN REDUCED BY PAID CLAIMS. T"r Ltr TYPE OF INSURANCE POLICY NUMEER POLICY EFF ,aR/nn/rrrr, POLICY ERP am/an/rrTr) LII7IT5 GENERAL LIABILITY EACH OCCURANCE 6 nCCMMERCIAL GENERAL LIABILITY ��CLAIMS MADE OCCUR ❑ GEN'L AGGREGATE LIMIT APPLIES ER: DAMAGE To RENTED ssence) 6 MED ERP (My one Person) 6 PERSONAL 6 ADV INJURY 6 GENERAL AGGREGATE 6 PRODUCTS - COMP/OP ANO B ❑ POLICY PROJECT ❑LOC 6 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT lea accident) 6 ANY AUTO BODILY INJURY (Per Deraan) 6 ❑ALL -..D AUTOS BODILY INJURY(Per accident) 6 ❑SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) 6 NON -OWNED AUTOS 6 6 ❑ UMBRELLA L UB F] OCCUR EACH OCCURRENCE 6 F]EXCESS LIAE C-] CLAIMS MADE AGGREGATE 6 ❑ DEDUCTIBLE 6 RETENTION 5 6 WORKERS COMPENSATION AND EMPLOYEES LIABILITY ® mirYt*s Brx- ER E.L. EACH AccinexT g 100,000 THE PROPRIETOR/PARTNERS/ EXECUTIVE OFFICERS ARE A ❑ incl ® eXcl 6002880012010 12/27/2010 12/27/2011 E.L. DISEASE -POLICY LIMIT 6 5500/000 E.L. DISEASE - EA EMPLOYEE 6 100,000 COMMENTS DESCRIPTION OF OPERATIONS OR LOCATIONS: STEVE SMOLAK IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 120 MAIN STREET POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE