The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #735 - 35 EVERGREEN DRIVE 5/21/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ZZZ"'— Date Issued: ///0 IMPORTANT: Applicant must LOCATION- - e -r - Prnr PROPERTY OWNER -,Inv, ;; kyyJ MAP NO: PARCEL: ZONING Date Received complete all items on this - l�Kl tl )]STRICT v tt�eo 86'6 O\ �o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Others: Repair, replacement Assessory Bldg _/. T h -f' Demolition Other Septic .Well Flciddplan Wetlands Watershed District's Water/Sewer . ��. uE5GRIPTION OF WORK TO BE PREFORMED: a 3 D 'X yS 1e11'7D0,ei iL li 77,;H-/- OWNER: Name: ;76A n om}, Address: 3S: br/PK 4e CONTRACTOR Name:re-&K S E Please Type or Print Clearly) Gt 2 Phone ARCHITECT/ENGINEER Phone: hone: 7c?G P/l. ff) ►rnuo:= _ l 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: $ $ 7S^ o -o FEE: $ 30 • 60 Check No.: Receipt No.: 2 NOTE: Persons contracting ith unregistered contractors do not have access to the guaranty fund Location No. Date ZAd TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� d6 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r. Check #/ 7.?3 2.3 't /1 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 COMMENTS CONSERVATION Reviewed on Signature COMMENTS f' HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:. Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 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 COMMENTS CONSERVATION Reviewed on Signature COMMENTS NHEALTH r Reviewed on Signature COMMENTS Zoning Board of Appeals:. Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Dimer'-sion 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 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 Li 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) ❑ 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 2.2008 0 of WD WD P, w o A c x o w u v U) O z0 z a o I -v o w -C o aG G. x u cd a x � P4 a a o w c w a `� w w -� o w cn rlw U o cG a w �. Ow A a W a W z cn v O 0 o cn 8 O 5 a 2 6 O O O O � O o v Z O. O CO) 0 c CO) p 'O O A* O O 'E m m CL _0 CD CD O� .O O �CD CD 0 0 eca o a a c< c c -W cc C.3 �v .O. O CO2C Z O C CL C.7 CO) O � C C _c CZ COD uj LLI W LLI W U) "Neu, - (j!' public B(III(lin,-,Re-ula tions and Sul 11(la [.(Is Construction Supervisor License License: CS 60219 Restricted to. 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4127/2011 Tr#: 14425 Client#: 635556 PETERPAR2 ACORD,u CERTIFICATE OF LIABILITY INSURANCE �INFR TE(MMlDCNYYI� PRODUCER /10 USI Ins Sery of NIA, Inc I THIS CERTIFICATE IS ISSUED AS A MATTER OF O6IAT ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O Box 920444 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Needham, MA 02492 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. f INSURERS AFFORDING COVERAGE INSURED NAIC # Peterson Party Center Inc INSURERA: Hanover Insurance Company 22292 139 Swanton St INSURERB: Liberty Mutual Insurance Company 23043 Winchester, NIA 01890 INSURER C: INSURER D: COVERAGES NSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .TR NSRT nt TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIABILITY _6 MM/DD DATE MM/DDlYY LIMITS ZBN6482025 10/09/09 10/09/10 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY $1 000 000 DAMAGE TO RENTED CLAIMS MADE a OCCUR P qpc t` $300 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FXJ PRO- JECT X LOC A AUTOMOBILE LIABILITY AMN6398554 ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NON -O VNED AUTOS GARAGE LIABILITY ANY AUTO A EXCESSAIMBRELLA LIABILITY UHN6482021 X OCCUR a CLAIMS MADE DEDUCTIBLE RETENTION S None B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY , ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? tt yes, describe under SPECIAL PROVISIONS below OTHER WC2Z11259617029 10/09/09 110/09/10 10/09/09 110109/10 MED EXP (Anyone person) S5 000 EGENERALAGGREGATE NAL 8 ADV INJURY $1 000 000 $2 000 000 PRODUCTS-COMP/OPAGG $2,000,000 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 " BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG S EACH OCCURRENCE $5000000 AGGREGATE $5000 000 S S 10/09/09 10/09/10 X WC STATU- OTH- E.L. EACH ACCIDENT 5500 E.L. DISEASE - EA EMPLOYEE 5500 E.L. DISEASE - POLICY LIMIT 5500 "ESCR!PTION OF OPERATIONc / LOCATIONc I %-HICLES / Pyr( USIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSUF!-Vn LL ENDO Ap.; -�fl_ NOTICE TO THE CERTIFICATE HOLD -. NAMED TO THE LEFI, .: _ - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 252001/08 � ) 1 of 2 #S4312552/M4063373 BJECG o ACORD CORPORATION 1988 The Continoit wealth of 3fassach usetts t, Department of Industrial Accidents _ Offce of In vestigatioits 600 Washington Street Boston, . 1A 02111 -� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Mlicant Information Name (Business/Organization;lndividual): Address: City/State/Zip: eJ 7�-4 Are you an employer? Check the appropriate box: l lam I M ease Print LeQibl Phone #: 7Q/- -7ag_ �/&rzr-o a emp oyer with 4. ❑ I am a general cont employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t -actor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5 ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' oom Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 1 1.❑ Plumbing repairs or additions 12.❑ Roof re airs _ p. insurance required.] 13 i�Other �� f *Any applicant that checks box #1 must also fill out the section below showing their workm, compensation policy information. t Homeowners who submit this affidavit indicating they, are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the same of rhe sub-contraetors and their workers' comp. affidavit Policyin iica tng Such. . ! am an etnrloyer that is providiAg workers' contpensatton Insurance or nt a to ees. Below is the o! information, L j f y mp i' p Icy and fob site Insurance Company Name: ��PK,'1 V ,1%l fin l Policy # or Self -ins. Lic. C, o? Svr°,C n Expiration Date:DJob Site Address: City/State/Zip U.,c Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date) . 1 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER an Of up to 5250.00 a day against the violator. Be advised that'a copy of this statement may be forwarded to a Investigations of the DIA for insurance coverage verification. the Office of d a fine I do herebt, certif under thePains �and penalties ofperfurr that the information prortded SionaturP above is true and correct / /l L 2/0_z9 - /era -o Offl`clal use onlr. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector up c p��E�� 5 5 5 5 Z5 5 o o LU LU 5 5o E Z ca o � ZF, L Z 5 5 °� �M �" 00� =5 5 a: o -a , -a •� •� L Z 5 o . cc ... � L) �-a5 9 CU ° ° :