HomeMy WebLinkAboutBuilding Permit #675 - 32 LISA LANE 4/21/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: to %�5_
Date Issued: b 7
Date Received
o•tS�.tO 6 Q
to
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
0 Two or more family
❑ Industrial
0 Alteration
No. of units:
❑ Commercial
Repair, replacement
0 Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
p"Septic 0 x.; ell
Cl llain D Wett nds
C Vlfatershed District
D',W'.ter/Sewer
,Ae
�m
DESCRIPTION OF WORK TO �B PREFORMED: �f
:e Ge U4r/ P-7 C/
ll
Identification Plea Typ or rint Clear ffy
OWNER: Name: C, 4 Phone:
Address:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1900.00 OF THE TOTAL ESTIMATED COST BASED
ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to r�a'n`ty
Signature of Agent/Owner Signature of contra
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
PLANNING & DEVELOPMENT ❑
DATE REJECTED DATE APPROVED
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
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
Located at 384 Osgood Street
FIRE' DEPARTMENT =- Terri Dur? fern tem
p� p y .� no
Located at 124 Maim Streef
Fire- Departm6nt signature/date
COMMENTS .
a,
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
❑ Notified for pickup - Date
.........................................................................................................................................................................................................................................................................................................................................................................................
......................................................................................................
Doc.Building Permit Revised 2007
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
jik 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)
Li 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
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
Location 3 2 4r4 A1,V
No. 16,2 Date
NORTH TOWN OF NORTH ANDOVER
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Certificate of Occupancy $
��''',••°''t�' Building/Frame Permit Fee $
SswcNusE
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
20 1 ,-0 1
/Building Inspector
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NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: G " C't 14 is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
Also, note Permits are required under Fire Prevention laws. -Chapter 148 Section
10A.
The debris will be disposed of in:
(Location o
Fire Department Sign off:
Dumpster Permit
�C_la 4--'o .�
acility)
Signature of Permit Applicant
Date
04/20/2007 13:41 FAX 7812721362 W—GOCHIS INS AGENCY INC 1&01
LHO
%pLiberty
Mutual.
Ap v i i, 2m
TOWN OF N. ANDOVER
1600 OSGOOD, ST.
N. ANDOVER, MA 01845
RE, r 'erGGcate of Workers C.`onrpensataa tmaMranrc
lnattrod: ALAN r SAB knNO DBA A R J SE.RVICrS
PO BOIL 464
BYi'Iiii.l1, MA 0191,2
Liberty Mutual Group
PO IMtx 7202
Pcm'tst 0,1111, NH 03802.7202
Telepbone (800) 653 789.1
Fax (603) 4J 1 ••5693
PoiicvNumbcx: W0,11S-)19747.046 I',('i%ive, 7';10,006 Uxpimliow 79/7007
Coveragtaflbrded under Wnrkrrs Cnropcnsolina l.awortbefnllowing stialcjs): MA
am-1019PUL
&)dl1ylnjllryByAccidml: I 100,000 iachAccidcnl
lltxlity Injury by t)iseaci S 10(1,000 Fach Persnn
LAxtily lnjtlry by 1>isr�tsr:
$ X00,000 I Mics l.irnlis
.1s ofibis dale., the abiwc.-roka- iced pnlicyboldor is ins iml by l.ibatt,VA4uma1 Fire Ltsltrancc Cu unrkx the
pcdicy listed above,
'1110 insureaca othwded by floc list.xl policy is subject to Al Ihr. (a7ns, exclusions and co ililioas and is not
aNtYvtl try any regtrirtsn�l, 1crrp m candilmn ofnny or olhcr dn"I'm lis with respecl to which this certiticale.
may be.. issued,
This curtilicnlr is issuc-tii as a mailer orinfivinalion only mail uoutims alt)right upon yu% the ccrliGcalc. holder.
This cnutificata is nal an iosurmnco lmlicry and docs not anumd, attend, m• altar the coverage aQitrdcd by lho
policy listed above.
Mills policy is cancelled berorr the statM texpintieta dole, Liborly Muhlal will eadeuvor nl notify von orsuch
catrcrllnlion. N—M '
AUfHOI IZEl1 RI?i'RE41 N ,AI'1vk
i.IJiEATY MUTUAL lt4SURAWE CdIOUP
IN, t:4Naai!arw tweyLniriK'1'WNUIY:N.INWlKNN:EfiK77llf•.snnMrhw.hiinnwec.e'h 1balodAylh—e Mpll
cc: Insured:
ALAN F SMIAt'INO DHA A & J 81;RVIMS
F0 BOX 464
HYFIELD, MA 01Y22
A 11 /INTI
Producer ofRoaord:
W GUCHIS INSURANCE nCh:NC'Y
111 C'AMBRf #T, STRTiFT
BURLINGTON, MA 01803
1
APR 20,2007 01:07P A * J ServicesBuilding C 19782552951 page 1
AcK.1 Services Building Contractors
.18soll Sal?atillo `
P.O. Box 931
Bylicld, MA 01922
978-465-149-') office
979-463-0819 r i.
11 Illtlil 18521f�dllllQ .Cl±.COillCif5t.I1Gl
Owl
APR 20,2007 01:08P A * J ServicesBuilding C 19782552951
A & %J SERVICES
BUILDING CONTRACTORS
P.O. 93 1, BYRELD, MA O 1922
9713.465.1493
Customer Name and Address
1 Job Descripfiorl
page 2
Proposal
Date
The following proposal is good
for 30 days from the above date.
/7/
/( LZ /
t /�> O `j
Aar -20. 2007-11:13AM No•2146 P• 2
....
AQM. CERTIFICATE OF LIABILITY INSURANCE o4�20ID2007 ,. rMMroaYwY)
+RODUCER (781)438-5000 FAX (781)438-5028 THIS CERTIFICATEWIISSUED ASA MATTER OF 1 FORMA ON
Int! ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
New England Heritage Insurance Agency Group, In
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
33S Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Stoneham, MA 02180
INSURERS AFFORDING COVERAGE "AIC tl
NsuR�D'A b'•J Services Building Contractors INSUIRERA: National Grange Mutual 14788
Jason Sabatino DBA iNSUNERP;
P 0 Box 931 INSURER r
Byfield, MA 01922 INSURER D:
Yv •
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM DR 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.
TY►E OF INSURANCE POLICY NUMBER PDUC'Y'EXPIRA UMRS
LTR DATE MMtpOKY DATE MMrDDm
•
EXPIRATION DATE TNEREOF. TNfi ISSUING INSURER WILL ENDEAVOR TO MAIL
GENERAL LIABILITY
MP098983
02/03/2007
02/03/2008
EACH OCCUNW-NCE
; 1,000,000
AUTHORIZED REPRESENTATIVE
r
North Andover, MA 01845
--•
X COMMFRCIALRENERALLIABILITY
William Kell RTW
TJCA>N_.
PRAE'70NET'EO'"*__.
EMISES l I*ED*
5..._.
„• ,,,,, , OO,OO
_„
MFD FNP (Any nne. prr:.)n)
CLAIMS MAOG a OCCUR
; 10.61-
0 00A
PERSONAL 6 ADV INA IRY
; 11000,000
A
P—.
GENERAL AGGREGATE
S 2,000,000
PRODUCTS - COMP/Or AGG
S 2,000,000
AWKLOATE LIMI1 APPLIES PEk
POLICYX JFR El LOC
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
IFP acudcr'I)
S
BODILY INJURY
l Pte)
S
•_......._-._..
ALL OWNED AUTOS
SCHFDUI,FI) AUTOS
BODILY INJURY
(Pep accident)
-- HIREDAUTOS
NUN•UWNEUAUT US
A
y
--•--_......_.._. _
PROPERTY DAMAGE
(Per w6aenq
GARAGE LIABILITY
AUTO ONLY - CA ACCIDENT
;
OTHER THAN EA ACC
S
ANY AUTO
_
AUTO ONLY; — AGG
S -
EXCESSAIMBRBLLA LIABILITY
FACII OCCI)RRENI;F
$
AGGRCGATC
;
OCCUR CI AIMS MADF
4 ~
UEOUCTIBLE
;
RETENTION ;
WORKERS COMPENSATION AND
TA
TORY LIMITS 'FR
EMPLOYERS! UAOIUTY
EA. EACH ACCIDFNT
$
ANY PROPRIFTORIPARTNFR/FXF.CUTIVF
F.L.. DISEASE • EA EMPI.OYFF
S
Ofrr-CRIMCMBCR EXCLUDED?
yye�ts,,
W.tc dmiunder
SPECIAL F'NUVISIONS E.I.
._.._....,....,, .._ .. .... ..........
F..I.. DI$EASE. POI.ICY I IMIT
;
OTHER
OESCR► N OF OPCRATIO146 ILOGAYIONS / ENICLE I EXCLU6I0 ADDED GY ENDORSEEMENT I SPECIAL PRC VI IONS
arpentry Contractor - Subject to the Terms, Conditions, Endorsements and Exclusions of the policies.
ACORD 25 (2001!08) FAX: (978)688-9542 WAGVKU IL URYVI(AIIV@T TODD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
•
EXPIRATION DATE TNEREOF. TNfi ISSUING INSURER WILL ENDEAVOR TO MAIL
Town of North Andover
10_ DAYS WRITTEN NOTICE TO THE CERTIFICATE "OLDER NAMED TO THE LEFT.
Attn! Building Dept
1600 Osgood Street
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIADILIYY
Building 20, Suite 2-36
OF ANY KIND UPONT"EINSURER,ITSAGENTSORREPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
r
North Andover, MA 01845
William Kell RTW
ACORD 25 (2001!08) FAX: (978)688-9542 WAGVKU IL URYVI(AIIV@T TODD
BOa�. 01 6 1 1 1��118IIUOY 8��'a3
HOME IMPROVEMENT CONTRACTOR
Registratibil ,,136095
ExpiratiOn:` 6/7/2008 a.
Type:': Individual
JASON A. SABATIN43
JASON SABATIN0.^"
23 FATHERLAND NmV '; -= % ��i,•, „_
BYFIELD, MA 01922De u
!
p ty Administrator
i