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HomeMy WebLinkAboutBuilding Permit #784 - 37 BRADSTREET ROAD 6/12/2006TOVN'N OF NORTH ANDOVER e ,APPLICATION FOR PLAN EXAMINATION Permit NO: --�—w Date Received: 6P 7 (v 6 Date Issued:, tlMZ WI IMPORTANT: Applicant must complete all items on this LOCATION :32 �' Print PROPERTY DA"NER / 0VW edkrLI Print MAP NO.: 3 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE OWNER: Name:_ 0 i'1'1 ° Residential Non- Residential = New Building Addition Alteration One family = Two or more family No. of units: -- -- Industrial Repair, replacement = Demolition = Assessory Bldg _ Commercial Others: = Moving (relocation) - Other = Foundation only - DESCRIPTION OF WORK TO BE PREFORMED cr C' Wo<3 1p ,4 ', Ay Identification Please Type or Print Clearly) OWNER: Name:_ 0 i'1'1 ° Phone: lf Address: /X e- e CONTRACTOR Name: o .y/ r T address: ��� // AV C {� %t t 5 k v` Phone. 3 J e7� U r-- A'oss e9 Supers isor's Construction License:_ Exp. Date: Home ImproNement License: F L /'a— Exp. Datta: ARCHITECT. E \CENEER \.tmc: Phcne: kddress:. Reg. No. FEE SC'HE'DL LE: B DI NG PE'RVIT. S1 .i" PFR St 100.00 AGF TL E TJT. tL `�T�.Gl.1 ?6D re�ST 3. ISED �,', 51- „`IO PER .S.l�: Total Project Cost :$ - f '�Q x 10.00= FEE:$ 23d (_'heck N o.: Receipt No.:1.9 Y o Pa;w h44 Q o Q n Z c O Q 69 69 GH 69 69 «• _ CD L m cr c w O 0 a E ti Z � 8 := 0a E a� 0 0 E a Z 2 L o E c cc a O �, a ~ v m' ,° o 0 OOJER o �. c v O • • b U Ae o ti .�° �� Z MOl ••w V TYPE OF SENVARGE DISPOSAL Public Seiner Well •k Tanning '%lassage Body Art _- Tobacco Sales Permanent Dempster on Site S� i iming Pools Food Packaging Sales Private lSept ic tan , etc. _ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have rrcc•ess to the guaru tY fund Signature of .Agent, O-vrner Signature of Contractor Plans Submitted �' Plans Waived Certified Plot Plan Stamped Plans _ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH C01l_�IEITS DATE REJECTED DATE APPROVED ❑Water Shed Special Permit C1 Site Plan Special Permit J Other DATE REJECTED DATE APPROVED El El DATE REJECCED DATE APPROVED Zoning Board of Appeals: % ariance. Petition No: Zoning Decision receipt submittcd :,es ":rnnini, 8•rrrd Decision: rscr�:U: n f?cci::ion: _---..—..------�-Ontntents ',:A; -ncc �r tp Dumpster .:n i c ;.c – -'tu =ire Dcpartrtent iq�rnr<tur,: Jaw _ p � P1 �� �� J C �. GtL- S kTT 2'1� S�i1 r► fi' - BUilding 0(urrnit .1ppro%ud and [5suud by: Building Setback (ft.) Front Yard Side Yard Rear Ward Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: c 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 Addition Or Decks Building Permit Application ------ - - -- -- --- .- ----------- Surveyed ---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 Hydras Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two .Farr ily) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit ❑ TW -O' Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board o Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one cop3 ant proof of recording must be submitted with the building application tiliR\'i('['S OFT � R' ME s '':314`011`165 Cpl CA CA Cd r w° Cf)w° Q cd a U w 94 O a°G w rL —CISCIS w UW °D n°' w a 90 U) o cn z u C/) WE TIT P4 CD CM CD ca CD O in AO CD OCD 4D O � O O � O W O CL C< co C V O D c CD 0 CLCO3 e CL C a® C t0 � COP) �50 o : cy O C vV d c R ea O c O � m Ea O V ;� ; 0 C. VJ O w ". C2 00 m c 11O N o O y y 4D�3p w:& C O . :. m 0 O O av o h m � � a _ r:caZo � 0 CL a Q o c m c c = o N t+ :ago co W CO y"• CD :5 �- 'fa c •- A O F. oc 'E dt C w o H o v o o c g VO CL • O fl = A LO LON C O.= COO i z u C/) WE TIT P4 CD CM CD ca CD O in AO CD OCD 4D O � O O � O W O CL C< co C V O D c CD 0 CLCO3 e CL C a® C t0 � COP) �//kms / �. � \ \ k / �. � \ \ k ACORD- CERTIFICATE OF LIABILITY INSURANCE D/YYY ATE(MM/DDY) PRODUCER -L/24/2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pelham Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 960 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 122 Bridge Street All THE COVERAGE AFFORDED BY THE POLICIES BELOW. - Pelham NH 03076 INSURED Thomas Doyle dba Thompson's Construction & 8 West St Salem NH 03079, INSURERS AFFORDING COVERAGE INSURER A: Nautilus INSURER B: Associated Industries INSURER C: NAIC # COVERAGES THE REQUIREMENT, THE AGGREGATE INSR LTR A POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER X GENERAL LIABILITY NC 532152 COMMERCIAL GENERAL LIABILITY C LAWS MADE ❑X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ECT LOC VJUKtK C: NAMED ABOVE WITH RESPECT TO ALL THE POLICY EFFECTIVE DATE GLIM/DD/YY) 04/15/2006 FOR THE POLICY TO WHICH THIS TERMS, EXCLUSIONS POLICY EXPIRATION DATE (MM/DD/YY) PERIOD INDICATED. NOTWITHSTANDING ANY CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, AND CONDITIONS OF SUCH POLICIES. LIMITS 04/15/2007 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person $ 1,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY OCCUR � CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below AWC7012214012006 04/21/2006 04/21/2007 WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE S 100,000 E.L. DISEASE -POLICY LIMIT S 500,000 OTHER DESCRIPTION Job: OF OPERATIONS/LOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL Various Roofing and Construction PROVISIONS CERTIFICATE HOLDER rAMrrl I A'rl^kl Carl Schoene 50 Turtle Lane Andover, MA 01810 ACORD 25 (2001/08) INS025 (0108).07 AMS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 REPRESENTATIVES. AUTHORI7�ED EPRESENTATIVE VMP Mortgage Solutions, Inc, (800)327-0545 © ACORD CORPORATION 1988 Page 1 of 2