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HomeMy WebLinkAboutBuilding Permit #889-11 - 34 MILLPOND 6/17/2011Permit NO: 0 v // Date TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received EIPORTANT: Applicant must complete all items on 'this LOCATION 3/ m1714,) Z Al Print n '7.- i MAP NO: 9-:rM—PARCELZONING hit TYPE OF IMPROVEMENT 0 New Building 0 Addition 0 Alteration *Repair, replacement 0 Demolition PROPOSED USE Residential One family ❑ Two or more family No. of units: 0 Assessory Bldg 0 Other Historic District yes no Machine Shop Village yes no Non- Residential 0 Industrial 0 Commercial ❑ Others. .. iv Septic O Welly , 4` 'v , ®i loodplain� i p Wryetlands�, 'p DESCRt-P TION OF WORK TO BE iii ORJNCjD: libA:rkza�l<SLA-1101Y A"/ 4..A? .-.1, OWNER: Name: --UL Type Or Print Clearly) ►ne: Address: ZYt o,/ CONTRACTOR Name: Phone Address: 6/y Supervisor's Construction License: " � �� Exp. Date: a - a 0 ^;L,113 Home Improvement License: �6 ��� Exp. Date: 9(-0'1C) De / 3 ARCHITECT/ENGINEER Phone: Address: Req. No. ` FEE SCHEDULE: BULDING PERMIT., $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ /d ,o -&t _ FEE: $ /V '— Check No.: 19S7� Receipt No.: NOTE: Persons contracting with n egistered contractors do not have access to tAg my fund 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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Pen 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 Contrac ❑ Flo or/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 Perry New Construction (Single and Two Family) ❑ 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 "OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Perrr 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 Doe: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Ari ❑ 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 COMMENTS DATE REJECTED 711 DATE APPROVED 0 CONSERVA T ION Reviewed on Signature COMMENTS HEALTH' Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board'Decision: Comments V , 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 COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: 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 2008mi 39 Location No. <T&2! Date /Z 2 Z// TOWN OF NORTH ANDOVER J6. Certificat e of Occupancy $ Building/Frame Permit Fee $ /,�r 0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 242bl Building inspector CA m m m x CO) m D y C � 'O O CD C7 Z CO) CD O CL r � � � c CO) O v CD CD o CL cr CD CD CD vo w C CDCD NJ d O y co CD I v y O 1CD Z n CD CD a G CD C_ C S� p m = O S vi O CT d! O. O S O :/� Co ® m o Cos ma� s O ...rCL •Im O► O N 17 Mn =r CD n m CA m --I O O COD p O =' m CD a `N m cli CD O a�► O O y O �m Er r^^ VJ m m H �ic �0CDCL V n d m /V cn C V, m \ + „yh e� f n ? V�CAO nMCD O d to CD .CD cl ON O s' O o ,V ® W O cn Z HCD • cn m Fcn y CD oq tb : cl C C..3 O �o d o w � �? e � tsi 9 GOD �? a. t"'tz b M �? el. n OQ -ri : wcn r d cn ° �n A. x � Cd 7� H 0 0 c S o►�m co D co ' 0 CZ7r C, m N � m x v O N W...:. .. 1 r n n OD a) w z O UN -17-2011 01:10 PM BEACON.INS.AOENCY 9782513185 P.01 •' VCR IrIL.ANI C Vr LIl1117IL.I I 1 111%J%JF% %1\VG 6/17/11 FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS rER"IIFICAIE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES HS 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 policypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A stallemert on this certificate does not confer rights to the certificate holder in lieu of such endorsernen s . PRoaucleR Beacon Insurance Agency, Inc. NCOAna Deborah Grimshaw E - 1 78 251-2882 FAX ry : (978) 251-3185 Al Fi;01Ess; 22 Middlesex Street N. CHELMSFORD, MA 01863 PDUCER 2129 INSURER(S)AFFORDING COVERAGE NAICM INSURED INSURER A:Hartford Insurance Company ---....... Eric Pintal INSURER B: NAUTILUS INSURANCE CO. INSURER c :......__-......_..-•---.-__-_-'-----_....._.....-__-- Pintal Flooring 28 Burdette St INSUR°;D Dracut, MA 01826 INSURER E: -- NED EXP (Ary one person) INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE PCUCES 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 ANDCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- AEUI SU—SR --- -- ..-... POLE EFF POLICY EXP — - - -- - LTR TYPE OF INSURANCE JIM121an POLICY N IMSER (MMIMIVYYYI IDDI LIMTS GENERALUASILRY NORTH ANDOVER MA AUTHORED REPRESENTATIVE DEBORAH GRIMSHAW EACH OCCURRENCE S 1,000,090 B X COMMERCIAL GENE ML NN117642 5/20/11 5/20/12 DAANAGETO RENTED PE3EAAlSF.S(E9 _ _ CLAIMS -MADE l_7 OOCUR NED EXP (Ary one person) S 5,000 _._. PERSONAL& ADV INJURY $ -1.,..000000 I' GENERAL AGGREGATE, S 2, 00,000 _ PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY PRO JECT F-1 LOC $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ (Ea accident) 1 ANYAUIO BODILY INJURY (Per person) S ----- ALL OWKE D AUTOS S - BODILY INJURY (Per accident) SCHEDULEDAUrOS ------ PROPERTY DAMAGE - $ HIRED AUTOS (P er s ocident) NONOWNED AUTOSj t S $ UMBRELLA LIAS OCCUR EACH OCCURRENCE,-..---.-- $ AGGREGATE $ EXCESS LIAR CLAIMSAAADE DEDUCTIBLE 1 $ RETENTION A WORKERS COMPENSATION 0487N31 5/11/11 5/11/12WCSTATU- OTH IORY. AND EMPLOYERS' LIABILITY ANYPROPRIE10WAR7NER/EXECU7NE YIN EMPLOYEE ONLY POLICI - - - -- - -- $ 100,000 E.L.EACHACCICENT OFFICEPA IF 'MR EXCLUDED? (Mandabry In NH) NIA E.L. DIS EASE - EA EMPLOYEE $ 100,000 If yes. describe under DESCRIPTIONOFOPERATIONSbelow ------.._,-- E.L,DISEASE- POLICYLIMR _...._._------__---- 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aitch ACORD 101. Additional Renarks Schedule, if more space is required) Floorinq CERTIFICATE HOLDER CANCELLATION © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The AC ORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT NORTH ANDOVER MA AUTHORED REPRESENTATIVE DEBORAH GRIMSHAW © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The AC ORD name and logo are registered marks of ACORD PINTAL FLOORIN 28 BURDETTE ST. DRACUT, MA 01826 (978) 423-6985 Lk 4f11 11 Work Performed At: � /��.f � r; ,i ,�i� rte,,,.• 1 t.,.Gr2 l�i�t�r rJ (i / { (i S ' i 0 ri f J r U II material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications "ovided for the above work and was completed in a substantial workmanlike manner for the agreed sum of: Total: 0 U Deposit: Balance:j WHITE - CUSTOMER COPY YELLOW - CONTRACTOR COPY PINTAL FLOORING 28 BURDETTE ST. DRACUT, MA 0 1826 (978) 423-6985 Work Performed At: A-1,4) DESCRIPTION OF WORK PERFORMED 6 - 6A /7'd -A /1�" Z ,�71 /,1- <- A 4 V All material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of: Total: Deposit: Balance: WHITE - CUSTOMER COPY YELLOW - CONTRACTOR COPY