HomeMy WebLinkAboutBuilding Permit #812 - 35 PENNI LANE 6/7/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: 12.,-- Date Received
DESCRIPTION OF WORK TO BE PREFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: No MA LO CH WIANIV Phone: 99'7-692-2164
Address: 3 5 Pewit/ LANZ
ARCHITECT/ENGINEER Phone:
Address: Reg. No. 0.00-0
,.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
140
Total Project Cost: $ G, °% 200 FEE: $ go Co
Check No.: L4 0-70 Receipt No.: ao
NOTE: Persons contracting with unregistered contractors do not have access to the guargty 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
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
❑ 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
Plans Submitted V 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+6FF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
F _
DATE REJECTED "t' DATE'APPROVED"
HEALTH' " ❑ _ F• -, ❑
COMMENTS
M
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
S
Planning Board Decision:
Comments
a
Conservation Deoision,: Comments
Water & Sewer Connection/Signature & Date Driveway 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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
i
Doc.Building Permit Revised 2007
No
Location3S- P -C n n: 1.1'��
No i )-- Date
NORTH TOWN OF NORTH ANDOVER
O�t�o
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Certificate of Occupancy $
Building/Frame Permit Fee $ _ST
AGMUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # d -d
a
Building Inspector
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Gerald A. Brown
Inspector of Buildings
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TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
ROMEO , LICENSE EXEMPTION
nnTE:(,�� 47.
Telephone (978) 688-9545
Fax (978) 688-9542
JOB LOCATION: -Z5 F uN N I Ltav ive
Number Street Address M*Lot
HOMEOWNER
Name - Home Phone ql 12- 69 7.21 e, 4 Work Phone 56 & 76 4, ') x'27
PRESENT MAILING ADDRESS 3S toF/N.Av I L i9Al A"
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the
owner ads as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which tyre is, oris intended
to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned `°homeowner" assunnes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
its. yy
HOMEOWNERS SIGNATURE_ oL
APPROVAL OF BUILDING OFFICIAL
Rwiud 10.200s
Form Homwwftn Exww ion
BOARD O F 1PPF:V.S 688-95-41 CONSFRVArm, 688-9530 I4G.u'f11688-9540 PL.Lv\'1NG 688-9535
FROM DJ Builder PHONE NO. : 603 458 5079 Jun. 05 2007 08:36PM P1
DJ BUILDERS
USTOM HOMES
NORMA LOCKMANN
35 PENNI LANE
NORTH ANDOVER; MA.
DEMO:
KITCHEN:
420>0'7
♦ REMOVE ALL FLOORING AND KITCHEN CABINET'S
♦ REMOVE ALL SHEETROCK ON FIRST FLOOR EXCLUDING THE
LIVING ROOM, BATHROOM, AND ENTRANCE
♦ REMOVE BRICK FIREPLACE FACE
♦ REMOVE ALL DEBRIS
♦ FRAME TO PLAN
♦ WIRE TO CODE W/UNDER CABINET LIGHTS AND 6 RECESSED
CANS
♦ INSTALL PLUMBING TO NEW KITCHEN SPECIFICATIONS
♦ INSULATE ALL AFFECTED AREAS
♦ SHEETROCK WITH SMOOTH CEILINGS
♦ REPLACE WINDOW OVER SINK W/TRIPLE PELLA CASEMENT
♦ REPLACE FRENCH DOOR W/PELLA
♦ REPLACE ALL AFFECTED TRIM
FAMILY ROOM
♦
FRAME TO PLAN
♦
REMOVE WOOD BEAMS AND REPLACE W/STEEL I BEAM
♦
INSTALL 2 LIGHTS OVER MANTEL
•
SHEETTROCK W/SMOOTH CEILINGS
♦
INSTALL MANTEL TO PLAN
♦
REPAIR HEAT LOOP LEFT OF MANTEL
♦
REPLACE ALL AFFECTED TRIM
'A pliamv IS:an%iK . nwwraV Nw nangR s pwnNC Ana >qA QCia, . FAY rn:LARR FP170
2007-06-05 20:02 APOSTOLOFF DAVI 603 458 5079 Page 1
FROV DJ Builder PHONE NO. : 603 458 5079 Jun. 05 2007 08:36PM P2
Vr.✓nY�...F ry....sewru�.-+r+�a�.
DJ BUILDERS
CUSTOM HOMES
DINING ROOM:
♦ FRAME TO PLAIN
♦ ADD 4 RECESSED LIGHTS W/DIMMER
SHEETROCK W/SMOOTH CEILINGS
♦ REPLACE ALL TRIM
PAINT:
♦ PAINT ALL DISTURBED AREAS ($3000.00 ALLOWANCE)
♦ 2 COATS ON TRIM AND 2 COATS ON WALLS
HARDWOOD FLOORS:
♦ ENTIRE FIRST FLOOR EXCEPT BATH W/3 1/4 RED OAK SANDED
AND SEALED (3 COATS)
MISCELLANEOUS:
♦ SMOOTH CEILING IN ENTRANCE AND LIVING ROOM
TOTAL COST: $67.200.00
PAYMENTS: $25,000.00 PRIER TO START DATE
$25.000.00 AT COMPLETION OF SHEETROCK
$17,000.00 AT COMPLETION
ANY UNSEEN PROBLEMS OR CHANGES ARE
CUSTOMER a q BUII
AL.
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2007-06-05 20;03 APOSTOLOFF DAVI 603 456 5079 Page 2
FROM : DJ Builder PHONE NO. 603 458 5079 Jun. 06 2007 09:21PM P1
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APOSTOLOFF DAVi 603 458 5079 Page 1
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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID TPDATE(MM/DDNYYY)
1
D&JBU-1
06/05/07
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
TYPE Of INSURANCE
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
OBREY INSURANCE AGENCY
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1 E COMMONS DRIVE UNIT #27
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
LONDONDERRY NH 03053
GENERAL LIABILITY
Phone: 603-432-3883 Fax: 603-425-6769
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: NATIONAL GRANGE
INSURER B:
D & J BUILDERS
INSURER C:
DAVID APOSTOLOFF
3 BUSBY GROVE
DERRY NS 03038
INSURER D:
INSURER E:
MED EXP (Any one person) $5,000
LVIVAV a if -,M mT.1
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.
NSR
LTR
ADD'L
NSR
TYPE Of INSURANCE
POLICY NUMBER
pRATION
ATEYMM DD/1'IYVE
POLICY
MMIDD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1000000
PREMISES(Eaoccurence) $ 50,000
A
]C COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
TBI
06/05/07
06/05/08
MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2000000
POLICY PECTRO- LOC
J
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
(Ea accident)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per person)
HIRED AUTOS
NON OW NEO AUTOS
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
ITORY LIMBS ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE $
OFFICER/MEMBER EXCLUDED?
ff yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
NORMALO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
NORMA LOCBMAN IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED
Arnnn 43c imn4mai
CORPORATION 198