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HomeMy WebLinkAboutBuilding Permit #12 - 34 CHARLOTTE WAY 7/2/2009 BUILDING PERMIT "°oT"e�ti TOWN OF NORTH ANDOVER o t APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received � ATED AV �SSACHUSES�� Date Issued: ' ? /01 IMPORTANT:Applicant must complete all items on this page LOCATION S4 c4h- ,P, 1(251T - '1�, Print PROPERTYOWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re ' ential Non- Residential New Building One 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 a er ewer': DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clea OWNER: Name: ���L- x^� 9F_-TtrZr�rly) ( Phone: Address: x CONTRACTOR Name: WJ=C, . "-1M1x1LJP hone: 1-76 Address: .t- `-�( � 7 - - C.C� 76 lea Supervisor's Construction License: Exp. Date: a Home Improvement License: Exp. Date- ,,ARCH M4,1 t4y:�R ':iSCMtn Phone: "76 37I 7 I Address: 30t-101NLj 0 t '30 . CcAetxz_g Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ SCP 1 FEE: $ 4 �� Check No.: Receipt No.: ;z NOTE: Persons contracting with unregistered contractors do not have access o t etv and ignature of Agent/Owner Signature of contractor Location J 7 No. Date NORTH TOWN OF NORTH ANDOVER O� «ao ,a,h0 0 9 ' Certificate of Occupancy $ /00 ��s+"^°•Eta Building/Frame Permit Fee $ wcMus Foundation Permit Fee $ / 00 Other Permit Fee $ TOTAL $ C2 Check # — i 221 60 Building Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT `710 9' d COMMENTS CONSERVATION Reviewed on ; '"- 1� � Dignature I f r COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments &-ZZ- Water& Sewer Connection/Si nature U /7 A',C Vwl--Drivewav 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 COMMENTS Dimension �II Number of Stories: J. Total square feet of floor area, based on Exterior dimensions. I 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 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 ❑ 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) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li 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 DEPARTMENTMFORM07 Revised 2.2008 r10RTF1 ONM of : 4Andover 0 No. ..�. y o dover, Mass., T Q - LAKE COCKICME WICK y �70 RATED 7 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... ... .Gt �. .......... ". �.`.F . co 4P 4P . ...Nt.�. .......... �' � Foundation has permission to erect........................................ buildings on3. ...Flo.......1 ! -•........�0'. ..........4`.... . ...... .... ..... Rough to be occupied as ............ f ..... a. .,.. .. t,...ff-61P-;x- provided la.................. himn y C e that the person accepting this p r d Mall ievery respect conform the terms oftation on file in Final this office, and to the provisions of the Codes and By-Laws relating to the I pection, 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough Service BUILDING IN CTOR 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 f Street No. SEE REVERSE SIDE Smoke Det. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID B DATE(MMIDDNYYY) WINDO-4 03/18/09_ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McLaughlin Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 828 Lynn Fells Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Melrose MA 02176 Phone:781-665-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER United Specialty Insurance co. INSURER B: Ohio CasualtyGroup M . Justin Construction, Inc. INSURERC: American Internat-1 Mr. ustin Belliveau companies 13 Elm Street INSURER D: Manchester MA 01944 INSURER E COVERAGES 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 BYTHE 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. lNbKLTR NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE EFFECTIVE DATE MMIDDIYY GENERAL LIABILITY EACH OCCURRENCE $1 OOO OOO AMA A X COMMERCIAL GENERAL LIABILITY CR0946109 01/01/09 01/01/10 PREMISES Eaoecurence $50,000 CLAIMS MADE FX�OCCUR MED EXP(Any one person) $EXCLUDED PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG s2,000,000 17 POLICY X PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ B SCHEDULED AUTOS BA00953558225 11/01/08 11/01/09 (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $5000000 A X OCCUR CLAIMSMADE CXA4GS709 01/01/09 01/01/10 AGGREGATE $5000000 DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND X OR STAT - TH- TORYLIMITS ER C EMPLOYERS'LIABILITY WC6967012 03/20/08 03/20/09 El.EACH ACCIDENT $500,00.0 ANY PROPRIETORIPARTNER/EXECUTIVE C OFFICER(MEMBEREXCLUDED? WC009399316 03/20/09 03/20/10 E.L.DISEASE-EAEMPLOYE $500 000 N yes,descr be under SPECIALPROVISIONSbelow E.L.DISEASE-POLICYLIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Edgewood Retirement Community Renovation and Expansion, North Andover, MA Edgewood Retirement Community, Inc. and Trident Building,LLC; Bank of America, N.A. their subsidiaries, affiliates and parent companies; and their respective officers, directors, trustees, managers, members,building committee members and employees are additional insureds on all policies CERTIFICATE HOLDER CANCELLATION EDGEW-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Edgewood Retirement Community NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Inc IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 575 Osgood Street N. Andover MA 01845 REPRESENTATIVES. ACORD 25 2001108 , ', HOLDERCODE EDGEI+7-2ry 5�ND0� � PAGE �e�� `� ��' I�YS1112ED S NAME,,"W3riL9oVer�, "On�S�"ruGta.bri I31c �,�� '' �OP�IDs�$ ` �`� 1111TE 3-/a��8 g,9s�k above (except for Workers Compensation and Employers Liability Coverage) for liability arising out of the operations of Windover Construction, Inc. and its subcontractors are listed for liability arising out of the operations of the Construction Manager and its Subcontractors on this project. ��ze v/anvnw,uuvr�z o�./�aaabr/u�6ad BOAR©OF BUILDING REGULATIONS License. C--ONS TRUCTION SUPERVISOR Nwmbe � 094621 ' Bird 970 tis q0 Tr.no: 94621 CORY E FISHER< q 30 JORDAN BEVERLY, fVIA 01915 �J Commissioner