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Home My WebLink AboutBuilding Permit #560-14 - 39 HEPATICA DRIVE 1/27/2014 TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit N0: _ Date Received I i Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION / Pram., PROPERTY OWNER Ke V 4 o 44,e-- � Print 100 Year Old Structure yes MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family P�(ddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PEORMED: �-- I Identification Please Type or Print Clearly) OWNER: Name: 1�&y kc`-Ke- Llr- Phone: 97�•G83 -3063 Address: /o 14e-P 'c4. R 1 L) 65 CONTRACTOR Name: �59n, n - G v o n, le: Address: U5- Q[A V1 Lil &q 0(va - Supervisor's Construction License: C S Q7 30 Exp. Date: /x I yl / y Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: I Address: Reg. No. s FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /LPUSD. FEE: $ Q�U Check No.:—Z& � 5 Receipt No.: NOTE: Persons ons contracting with unregistered contractors do not have access to the guaranty fund Slgnafureof>AgentlOw �� idnature of contractor Plans Submitted ❑ P s Waived Certified Plot Plan ❑ Stam ed Plans ❑ i Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plad§-F] TYPE OF`.SEWERAGE DiSPOSAL Public Sewer Tanning/MassageBodyArt ❑. . Swimming Pools ❑ Well ❑ Tobacco Sales 11 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 ❑ F! COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS w 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 To-wo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street= '' Fire Departmerfsignatiareldate`' _ � C0MMENTS 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 No MGL Chapter 166 section 21A-F and G min.$10041000 fine NOTES and DATA— (For department use El Notified for pickup - Date I Doc.Building Permit Revised 2010 i I Building Department I The foh's. wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Li 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) j ❑ Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 Location No. ( Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee $1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .y Check# 1 � :. r :if . `- 4 " `' `) Building Inspector i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 10,000.00 m $ - $ 120.00 Plumbing Fee $ 15.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 15.00 Total fees collected $ 250.00 39 Hepatica Drive 560-14 on 1/27/2014 Finish Basement i NORTH Town Of t EAndover ver, Mass, COC NIC Ill WICK 1• U BOARD OF HEALTH Food/Kitchen PERI T LD Septic System THIS CERTIFIES THAT .....6'Y.4.e........ BUILDING INSPECTOR Foundation has permission to erect ........................... buildings on .....3 ...... .. .1�.,/4.w�..................... ;.C.k.w Rough to be occupied as ..J;Y.% .........101.0.ru M!1�........!�!N.... rA.. !4��1 Chimney provided that the person accepting this permit shall in respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final Ia� PERMIT EXPIRES IN 6jAqNNTjS ELECTRICAL INSPECTOR UNLESS CONSTRUCT TS Rough Service ........... ..... ............ ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 40959 POLICY NO. WCC-500-5007581-2013A PRIOR NO. I WCC5007581012012 ITEM 1. The Insured: Key Lime Inc DBA: Mailing address: 10 Hepatica Drive FEIN:**-***l 218 North Andover,MA 01845 Legal Entity Type: Corporation Other workplaces not shown above: 2. The policy period is from 09/15/2013 to 09/15/2014 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two�of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two.are: Bodily Injury.by Accident $ 1,000,000 each accident Bodily.lnjury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States insurance: D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 285896 INTER SEJ CLASS CODE SCHEDU E Minimum Premium $575 Total Estimated Annual Premium $4,470 GOV GOV Deposit Premium STATE CLASS MA 5645 MA Assessment Chg. $169 This policy,including all endorsements, Is hereby countersigned by � 07/23/2013 Authorized Signature Date Service Office: M P Roberts Insurance Agency 54 Third Avenue 1060 Osgood Street Burlington MA 01803 North Andover, MA 01845 WC 00 00 01 A(7-11) includes copyrighted material of the National council on compensation insurance, used with Its permission. Massachusetts -Department of Public Safety Board of Building Regulations and Standards i ( Construction Supen-icor License: CS-075302 ' BENJAlV N C OS0OO 69 OLD VII,LAGE LAME NO ANDOVER AMA 7 d i r Expiratior Commissioner 12/04/201 d i