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HomeMy WebLinkAboutBuilding Permit #604 - 36 EVERGREEN DRIVE 4/12/2010Permit NO: 6 aC/ Date Issued: 41/112/ld .BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION !U Date Received . v'•ct''�D '6��N0 41 \7a p�AATeo �Pp �.�y TYPE OF,IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alte No. of units: Commercial e air, re lacen'ent Assessory Bldg Others: Demolition Other Septic V1/ell Floodplain Floodplain 1lUetlands : Watershed District Ka teriSewer A10 r— OWNER: Name: UESURIPTION OF WORK TO BE PREFORMED: 4— >eic� e g rJ Identification P Aq 0— � Type or Print Clearly) Address: r «/ d /� Phon ARCH ITECT/ENGINEER ±- �/vgc.,GiivP one: (if -7 Address: e2161 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: $ /Z, er69 y FEE: $ Check No.: Receipt No.: �( NOTE: Persons contracting with unregistered c?p1ractors do not have access to thh aranty fund Location A No. Date T#q TOWN OF NORTH ANDOVER 0 Certificate Occupancy $ 7 st of 14 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 2 9 6 Building Inspector Plans Submitte Plans Waived Certified Plot Plan Stamped Plans P 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 HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR�.MENT -.Temp Dumpstern site: eyes °' .no . } _Located_ t 124"N�ain— treet s Fire Department:signatureldate - COMMENTS x .. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: Z 7 0 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) s ❑ Notified for pickup - Date ...... -.._....................................................... -_-.._.................................................. ...... ---....... _...... _............... _...................................................... _.... ---................................................... _............ ---.-....... _._.......................................................................... -- -..............:........................................ Doc.Building Permit Revised 2010 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: Building Permit Revised 2008 -1 � CERTIFICATE OF -LIABILITY INSURANCE OP ID CRB TE(MM/DD/YYYY) 1704/09/10 FLCS-01 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PRODUCER J. E . D. Insurance & Financial Service Agency, Inc. 38 Mechanic St., Ste 204 THIS CERTIFICATE IS.ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Foxboro MA 02035 POLICY NUMBER Phone:508-543-1067 Fax:508-543-3278 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A* Essex Insurance FLCS INSURER B: Travelers Insurance 19038 INSURER C: Sean Mindes 32 Old Coach Road Atkinson NH 03811 INSURER D: INSURER E: a Wvcr "Ca 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. 5H ku NSR TYPE OF INSURANCE POLICY NUMBER POLI Y E FE TIVE DATE MM/DDIYYYY POLI EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 rA X COMMERCIAL GENERAL LIABILITY -I 3DC2698 08/06/09 08/06/10 PREMISES(Eaoccurence) $ 50000 CLAIMS MADE F OCCUR MED EXP (Any one person) $ 1000 PERSONAL &ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENT AGGREGATE LIMIT APPLIES PER, PRQDUCTS-COMP/OPAGG $ 2000000 POLICY JE O- LOC - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS ' BODILY INJURY NON-0WNEDAWTOS y (Per accident) $ PROPERTY DAMAGE $ a ` 04, (Per accident) GARAGE LIABILITY • Y•� } r"1 AUTO ONLY -. EA ACCIDENT $ ANY AUTO" / 7 j4'� •� ` OTHER THAN EA ACC $ AUTO ONLY: AGG $ (EXCESS /UMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE ," AGGREGATE $ DEDUCTIBLE $ �_*� ' $ RETENTION $ - /- WORKERS COMPENSATION • �, AND EMPLOYERS' LIABILITY YINJ TORY LIMITS ER E.L. EACH ACCIDENT $ 100000 B ANY PROPRIETOR/PARTNER/EXECUTI 9949M49609 08/13/09 O8/13/1:Oy OFFICER/MEMBER EXCLUDED? (Mandatory In NH) + + � E.L. DISEASE - EA EMPLOYEE $ 1000000 If describe . '. �'d_ yes, under I •, -POLICY LIMIT $SQOQOQ SPECIAL PROVISIONS belowDISEASE OTHER -- - --• � J DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 4 vcnr 11.- c nWLWQM VANIaLL-AIIUN Herb and Maria Meyer 36 Evergreen Drive N. Andover MA 01845 ACORD 25 (2009101) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MEYERHE , DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR E. Dustin, CPCU, CLU RIe ACORD name and logo are registered marks of ACORD All rights reserved. n 'FL'CS 5y PO.Box 131 Atkinson, NH 038.11 Name / Address Herb and Maria Meyer 36 Evergreen Dr N.Andover, MA 01845 Estimate Date Estimate # 4/3/2010 2010-48 Project Deck -10 Description Qty Rate Total 270 sq ft deck, 4' stairs and landing to grade, composite decking, rails and trim. All specification are to approved plan and per Mass building code. All debris to be removed. building permit- N Andover 12/1000 12 12.00 144.00 Demo- Dismantle and dispose of existing deck and stairs 1 600.00 600.00 Site Work- footings- 24' tapered sonotube footings 5 75.00 375.00 Site Work- footing- 8" sonotube footings 2 50.00 100.00 Concrete -cut and patch concrete pad to accommodate footing as per 3 35.00 105.00 plan (*excludes concrete paint finish) Deck Framing 270.83 5.00 1,354.15 Stair Framing 1 250.00 250.00 Decking and Rails 69 25.00 1,725.00 Exterior Trim 1 250.00 250.00 Materials- see attachment 1 7,432.00 7,432.00 Mass sales tax 6.25% 1 464.00 464.00 Repeat customer discount 2.5% -310.00 -310.00 Terms 1/3rd on contract 1/3rd on commencement Balance on completion Please visit us at FunctionalLivingcs.com Total$12,489.15 e CERTIFICATE OF LIABILITY INSURANCE OP ID CRM FLCS-61 DATE(MM/DD/YYYY) 1 04/09/10 PRODUCER J.E.D. Insurance & Financial Service Agency, Inc. 38 Mechanic St., Ste 204 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Foxboro MA 02035 NSR Phone:508-543-1067 Fax:508-543-3278 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Essex Insurance FLCS INSURER B: Travelers Insurance 19038 INSURER C: Sean Mindes 32 Old Coach Road Atkinson NH 03811 INSURER D: INSURER E: EACH OCCURRENCE $ lOOOOOO Vwvm wmC 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. —POLICY LTR NSR ' TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ lOOOOOO A X COMMERCIAL GENERAL LIABILITY -I 3DC2698 08/06/09 08/06/10 PREMISES (Ea occurence) $ 50000 CLAIMS MADE F OCCUR MED EXP (Any one person) $ 1000 PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 POLICY ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY _ AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR F—I CLAIMS MADE DEDUCTIBLE RETENTION $ - $ WORKERS COMPENSATION_ AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER E.L. EACFIACCIDENT 1000000 B ANY 9949M49609 08/13/09 08/13/10 OFFICER/MEMBER EXCLUDED7ECUTIV� $ (fyes,dorybeun In E.L. DISEASE - EA EMPLOYEE $ 1000000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CONI 1 OTIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MEYERHE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Herb and Maria Meyer 36 Evergreen Drive REPRESENTATIVES. N: Andover MA 01845 AUTHORIZED REPRESENTATIVE John E. Dustin, CPCU, CLU ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD - - --7— Board E Board of'BuildingAegulations;and Standards HOME IMPROVEMENTCONTRACTO:R Registration':153699 Expuaiion 1%3/2009'. TO 253254 , Type Lfd Liability Corporation r FUNCTIONAL LIVING CONSTRUCTION SER, LLC. ADAM DOMANSKI, ,zy 43 NEWBURGH NASHUA, MA 03062. Administrator (' j Massachusetts -De rtrtment uf• Pul)lic Safet� Board of Building Re Construction Supervisor License nd �tnd.u'tis License: CS 64759 Restricted to: 00 SEAN C MINDES �r 3' , PO BOX 647 BEDFORD, MA 01730 rrrmiissi ner Expiration: 7/14/2010 Tr#: 420 a Page 2 of 3 4/12/2010 Ei Li W W D J w O LLI z o m c c c s C2 ` C N • C7 C �� d �. 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