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HomeMy WebLinkAboutBuilding Permit #705 - 33 WOODCREST DRIVE 4/4/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received M OWNER: Name: DESCRIPTION OF Identification Please Type or Print Clearly) f � V P✓►n ,l Ok l son __ Phone: 47Y - 20,'--715� ARCHITECT/ENGINEER .Phone: Address: 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: $ s Check No.: G A—rv, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/IVlassageBody 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 I�ANNING & DEVELOPMENT COM \ENTS DATE REJECTED DATE PPOVED ❑ MG '0--r '� DATE REJECTED DATE APPROVED CONSERVATION Ti � 3)z �;k ~ COMMENTS Ni -)o` ?n_„ i ""a !--A ','HE'ALTH " COMMENTS DATE REJECTED DATE APPROVED 0 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Drivewav Permit Located at 384 Osgood Street 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 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 ❑ 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) ❑ Building Permit Application Li 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 DEPARTMENTMITORM07 Revised 2.2007 Locatiop,5 W No.� Date r • TOWN OF NORTH ANDOVER Certificate of Occupancy $ y. Building/Frame Permit Fee $c- `� Foundation Permit Fee $: Other Permit Fee $ TOTAL Check #Uvea" 25155 Building Inspector From:Davis Clark Latham 781 944 6360 04/03/2012 07:42 #565 P.001/001 CERTIFICATE OF LIABILITY INSURANC DATE(MM/DDfYYYY) E 4/3/12 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 T THE ER THS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE BY AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyites) 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 endorsemen s). PRODUCER CONTACT Davis, Clark & Latham Ins Agen PHONE One Pleasant St (781) 944-6171 FAx N (?Bi) 9q4-6360 ADDRESS: kc@dclatham. com Reading, MA 01867 INSURE S AFFORDING COVERAGE NAIC # INSURED INSURER A: Nautilus Insurance Co S & G General Contractors, Inc INSURER B: c/o Glenn Drane INSURER C : 17 Mineral Street INSURER D: Reading, MA 01867 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 VSR ...... .... .. _ . A GENERALLIABILI NM137772 6/2/11 6/2/12 COMMERCIAL GE NE RA L LIAB ILITY CLAMISAMADE D OCCUR AGGREGATE LIMIT APP LIES PER AUTOMOBILE LIABILITY ANYAUTO ALLOWWO SCHEDULED AUTOS AUTOS HIREDAUTOSNON-OWNED _ AUTOS UMBRELLALIAB OCCUR EXCESSLJAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTVE OFFICERIMEMBEREXCLUDED? N rM w,vls.tr..v to uur DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Adc itional Remarks Schedule, K more space is requi red) LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED PRE $ MEDEXP Anyoneperson) $ PERSONALS ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ BODILY INJURY (per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ er accident EACH OCCURRENCE $ AGGREGATE S Pool installation job location: Renee Ohlson, 33 Woodcrest Rd., N. Andover, MA 01845 WORKERS COMPENSATION CERTIFICATE WILL COME DIRECTLY FROM CARRIER ctrl IIHGAFE HOLDER CANCELLATION Town of North Andover Building Inspector 1600 Osgood St North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE$ENTATVE ©1988 2010 ACORD CORPORATION. ACORD 25 (2010/05) The ACORD name and logo are regist@red marks of ACORD phone: Fax: E -Mail: reserved. DATED/vY 04!03/2012 TIFICATL OF LIABILITY INSURANCE HOLDER T8Z9 CERTI$ CLQ y10 RIGHTS UPON TIME OERT161CATE THIS CERTZFiCATE OF OF INgOgZlATION ONLY AND CON9ERS 8Y THL ypLICIES BELM>w. OCER, ACID THE I9B1IE� 11 A6 .11 A 1+DATT pa-AukO OR ALTER THE COVERAGE AAFFO�Z D RE,BENTATIVC OA PROD THIS CERTIFICATE IS IV6LY Ap�ND, DOES NOT AFFIRDOLTIVELY OR NEGAT T D'VXTN THE IBSMIING INSMIM ), VED, aubjei INSURANCE DOES NOT CONSTITM7T$ A CONTRAC rood, i£ 808R06ATION IS a not 6VR£Dr the pollCyli°e) moat be endo him c°rtitieate doo CERTSFICa►TE HOLDER. n ADDITIONAL IN OEe an endor■aHwnt. A Statmont on t I£ the eeetitioeto bo der is a certain ➢olioi°e IaaY !°�' It2ORTANT: cDndiyionv of the pD1icY• nt(a). to the torma and O=TALY confer r1 hte to Eha cartificaE° hold°= in lieu e! euah or TAT VsaaucL■ yHatt (A/a. nal : Clark & LathaID InBuz'apCA INC, ttLl: Davis t2D IL Agency Inc ArDtsu. otwve>eu ea:e aDeTelat ID! . 7 5 1 pleasant street 33 iReading, ���° °°�'"'°_ MA 01867 rf�itual insurauco Co iaeutta a A.T.M. 'NS°per ° Contractors Inc • sae1� t' S & G General C INevam C: 17 Mineral Street LMouyn D: Reading, MA 01967 Ia.utaIL si TR: �VI$I17¢1 tA1DB CERTIGICATS NIJMbERI CiOVERAGEB NT I TLTBF¢CT TO WILTCE THIS c�TIONB oP SUCN POLICIES, LIe2OR 49 SNDLMN xEY THAT TEE pDLxCIE6 OP xNSUHANCE LIS'T'ED E41.OW HAVG BE£N ISBVILD TO T- INSURED NAD�D WHICH EOR THE DDLiCY pERxOD IND THIS Ie T'O CERT CANTFN+T OR OTHER DOCUME ExCI,VY10Ne AND COND TERM OR CONDITION OF ANY s SuBjECT TO A" THE Tem ' NOTWITHBTANIIIND ANT R'0UW'F pDZD G POLICIES DCSCRIBCD MEHEIN I FYRTAIN , THC INet1RANCE AFFORDED BY TH PO LItdITB NKY HAVE EN REDUCED BY PAID eI1.IM8. POLICY IMP POLICY CFP Oorroonwn POLICY g"&R 0 tAaY pOcOlANCL zn" 'TYPE OF INSURANCE wr DAMAOZ %O ��° 0 ho.) 6FNEp,AL LIABILITY f,pdo 0 IA -y on. ■.r•oal p[0{pY.DGTa. cENEpAi. LIABILITY LLL�--��I MD tx9 ypto %L c ADV INJVAV 0 1 1pcL1zM6 MADE t300WA 0 L� ptz�ILAL AOOD■oA'R e yAnvCT° - aoNP/ov AOO a Ac00.[cATE LIMIT APPLIES °Ai °BHrL �PPo]LOT nLOC n ZJMLZ LIMIT 0 POLICY Inn noaLenncl LIA6LLITY BODILY INJVt= (F'- Pcronl AUTOIIOBILE DANT AUTO too,,, I,jjp,,jpw Loeilo°e) 0 GALL OWNI'o AVT09 "ovary DAfOL� 0 {0•` wasdu,Ll aNCHEDULED AV709 0 aNZAE° AVToe p ANON-DNNLD ADTOD 0 oL0■ oCCOA)Vla� 0 UmDAELLA LIAR 0[cVP 0 p rV((;699 LIAD Q CNIML MAD[ 0 DEDUCSiOLt 'Tx_ •L<d yLMiq• µ 100,000 ENTION �PEIs t,L, pea AOCinLHT e ypRM�RS ()Ol/FENSATION LIABILITI LT�T 500 000 AN6t�LOYECS D 7OR/PppTNEAS/ t.L, D1!■*et •pLICL IiPRO BXECuTIVE OFFICRRS ARE � 05�19�2011 05/19/2012 ■ L D:.tl+t - vL Lew"° ° 100,000 0 incl excl 7021201012011 CMCELI,ATION BE BOLDER 13HOUID ANY OF THE ABVn DSBCRIMD ROLICIE DQ cELIZD RQ LI� CERTIY'ICATEIt, FM CE NITN THE. E%FIRATTOV DATE THEAEO11 NOTICe WILL ifow Or NORTH ANDOVER POLICY pRWISIONS. ATTOI bUlLMDING TNSP&CTOR 1600 OSGOOD ST NO ANDOVER, MA 01845 MCI 1/1 'd 1868 'ON 33NUMNI 031VIOOSSd WdLl: [ Z[H '8 'add