HomeMy WebLinkAboutBuilding Permit #Exception - 40 PEMBROOK ROAD 5/1/2018 day 28 13 07:20a Surfside Po Ambrnptny 978 735 4381 p.2
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BUILDING PERMIT 3r dt;f•_ o`
TOWN OF NORTH ANDOVER n
APPLICATION FOR PLAN EXAMINATIO * o ,
Permit NO: Date Received ATOO
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION r7 &,q(3 R-M k �
Print
PROPERTY OWNER-J U S T I m P- L o eb< w
/ Print
MAP NO: OZ[ PARCEL:P�ZONING DISTRICT: Historic District yes
Machine Slop Village yes One
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building :1 One family
❑ Addition Two or more family E Industrial
❑ Alteration No. of units: G Commercial
❑ Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition &Other St., Pcrzlt—
E Septic ❑ Well D Floodplain ElWetlands El Watershed District
ateriSewer
ave (-r . AJo sw1&,AAINE PO L /2 )( 171
Identification Please Type or Print. learly)
OWNER: Name: UJk t--0kA-kl(W Phone: S Ot- y 7 y
Address: 10
CONTRACTOR Name: Phone: 97oc- a-TO-6
dv►2r'Sli�� PQdc t9o:
Address:
/37 LUNEN3wflJ-,- SF f- 1*Gy d u24
Supervisor's Construction License: oS o 3 139-2- Exp. Date:
Home Improvement License: �a I Exp. Date:
ARCH ITECTIENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ i�
FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiord
Signature of Agent/Own Signature of contractor
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
IPROFERTY GINNER
,y. ®Itl Structure yes ani
P.nnt ;00 YYear p
I1II�APN�O _-; PA�RCEL� IN--
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--�� bMachinShoVilla a esu tno
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
® Septic Well ®9'FI o plaice s ° ®�Netl nds ®1 Wa hed Dis N a`
�$V1%ater/Sewer `
DESCRIPTION OF WORK-TO IBE PERFORMED:
• • � 1
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
NTR6ACT®R kName.. _ _ - Phone
t _
_ ._ ___ -
- - ,
Su er�vlso�'s Coristruc__tion�lLicense _ _- - � NE�xp r®ate ��..� � ¢�,
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
;Signat'u`re of Agent/Owner r; "...;:. . .., Signature of contractor r .r. .r... . ;.
Plans Submitted ❑ Man`s Waived ❑ Certified Plot Plan ❑ Stamper';ran ❑
�+..
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
i
CONSERVATION Reviewed on 3 Signature
COMMENTS
HEALTH Reviewed on Siqnature
COMMENTS
1
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
FTE DEPARTIt91'ENT - Temp Dumpster on site yes no
Located at,124 Main Street
Fire Pep arb-petit signature/date
COMMENTS �
i
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
i
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 de artment use
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Notified for pickup - Date
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Doe.Building Permit Revised 2010
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Building Department a
The folowing 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
o 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
DOTE: 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 apn>al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submated with the building application
Doc: Doc.Bui!ding permit Revised 2012
I
Date./ 1p—Ir-
f. ... ..
NORTH
3j y` 0
4. TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLA ION
�9SSACMUSEtSy
This certifies that . . . ��. ? . ,!- ./. . . . . . . . . . . . . .
_ has permission for gas installation . . . . . . . . . . . . . . . . . . . . . .
in the buildings of . .e..(' �,���-. .�. . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . .1� � . . P& . . . . . . . . . . . . .. North Andover, Mass.
Fee. .3.0. . . . Lic. No.).?.:'.f.: . . s . . .� .. .� .-�. . . . . . .
AS INSPECTOR
Check# / 3-�
5850
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Sk 1157V P0136 #12304
05-06-200v a 03 = 220
rASSMHUSETTS STATE EXCISE TAX
Essex Wth R"istrk
Once. 05-06-2009 0 0302"
Ct1Q= 292wt. 123D4
Fee: $10566.36 Conss •343.500.00
()U CLAIM DEFD
We, Michael R. Cushing and Dawn M.Cushing
of Newton,New Hampshire
For consideration paid and in full consideration of Three Hundred Forty-Three Thousand Five
Hundred and 00/100($343,500.00)Dollars
Crrant to Justin Elderkin and Kerry Elderkin, Husband and Wife as Tenants by the Entirety
of40 Pembroke Road,North Andovcr, Essex County,Massachusetts
With QUITCLAIM COVENANTS
A certain parcel of land, with the lir t` croon. situated in North Andover in said Essex
County,being parts of lots numbered 14 .:J 15 on a plan of land entitled: "Plan and Profiles of a
Portion of Mifflin Park,Nortb Andover, tic:s:>s.,dated December 1946",and recorded writh North
Essex District Registry of Deeds as Plan No.k 7'08, S"i d Prf.'mises being bounded and described as
follows:
NORTHERLY by land now of s:.r :;, . font? Su-mmerS, about 118 feet;
? EASTERLY by part of Lot nij:3ibGrc t1 13 ons. plan, 76.50 feet;
SOUTHERLY by land now or fcj-r11c:; o�.otc e. j.clwell, about 115 feet; and
WESTERLY by the easterly line of embrook !wad, 86.78 feet.
Tile Soutbwedsterly comer of the premiscs is at a point in ts�e said easterly lint of Petnbrook Road
distant 90.5 feat northerly from a stone bound set in the said line of said street near the
intersection of Mifflin Drive.
26. Said pranism an Conveyed subject to the restrictions set forth in a deed dated October 17, 1944
and recorded in said Registry, Hook 668,Page 75;and also subject to two easements W the
Lawrence On and Electric Company both dated February 23, 1946 and recorded with said
Registry.Boole 684,Pages 381 and 382 respectively;all in so far as the same may now be stilt in
force and applicable.
y 28 13 07:19a Surfside Pool Company 978 735 4381 p.1
SURFSIDE POOL COMPANY Phone:978 250 0106
7 SUMMER ST. Fax: 978 735 4381
CHELMSFORD MA 01824
FAX
To: c . r � ! From:' Surfside Pool Co
ATTN: G�!L�/h1(r /N 5/��C.�"Oi2— Pages:_Rof
L` Includes cover sheet
Faxed to: DATE: ���b3
Our phone: 978.250.0106 Our E-Mail: 'c07-7-/d Plf 4ZCOt-(PA�J`�Cd
RE:
ljb
Please reply with: Estimate: Confirmation No._ #
Comments:
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REGISTER OF DEEDS
May 28 13 07:30a Surfside Pool Company 978 735 4381 p.8
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Interstates
Interstate
—Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
Roads Meters Data Sources:The data for this map was produced by Merrimack
AORTM Valley Planning Commission(MVPC)using data provided by the Town of
t,t Easements pf r`ao q� North Andover.Additional data provided by the Executive Office of
O MVPD Boundary O
�' r e�a O Environmental Affairs/MassGIS.The information depicted on this map is
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❑Parcels for planning purposes only.It may not be adequate for legal boundary
._,
O P definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
e9 ry P
lt" 9 MAKES NO WARRANTIES EXPRESSED OR IMPLIED,CONCERNING
t •
THE ACCURACY COMPLETENESS,RELIABILITY,OR SUITABILITY
L OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
.y91o�,�,p'vo Sty THIS INFORMATION
SACHUS�
1"=60 ft
SURF OL COMPANY
139 Lunenburg Street 33 Boylston Street Summer Market Plac 111 Rte.101A 551 Nagog Mall 738 North Main St.
Fitchburg,MA 01420 W.Boylston,MA 01 Chelmsford,MA 0 Amherst,NH 03031 Acton,MA 01720 Leominster,MA 01453
(978)342-7362 (508)835-4886 250-0106 (603)889-3100 (978)263-5144 (978)537-7332
TO. J 11SPIAf 6�Pftl!LJQ PHONE. O d2 " ,
yU ESTIMATE BY:
IV& �~'�� '' � DATE:
POOL MODEL S'
SIZE s-
LINER
PUMP/MOTOR UJ cS� t�'CJ
SKIMMER
Jl�iLl
VACUUM f� -
LADDER U101u,6U /
MEDIA
TEST KIT
CHEMICALS
T l��
WINTER COVER
SOLAR COVER
POOL PACKAGE �S"e
INSTALLATION/LABOR
TAX
TOTAL
PROPOSED PAYMENT PLAN:
p Delivery: a� 9 3�l -_
Deposit: $ Delive .f LTZ�� � $ � Final: $
***NOT INCLUDED IS THE COST OF THE PERMIT,ELECTRICAL,WATER,FILL REMOVAL AND ADDITIONAL GRADING
North Andover MIMAP May 28, 2013
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—Rail Line `w Wetlands Zoning
Interstates C'Exempt Lands a Busine s 1 District
Interstate Busine 5 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
—Major Roads O Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack
Busine s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of
Roads O Genera Business District Of «�c q1, North Andover.Additional data provided by the Executive Office of
[r Easements G!Planne Commercial Dev ? e<< rs�b 00 Environmental Affairs/MassGIS.The information depicted on this map is
Corrido Development Dist 3 Z. for planning purposes only.It may not be adequate for legal boundary
C3 MVPC Boundary 0 Corrido Development Dist O —•- A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
❑Municipal Boundary O Corrido Development Dist � p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
-.7 Industri I 1 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
Zoning Overlay # +{
F Industri 12 District
B Adult Entertainment # i� ,^ Y OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
C3 Downtown Overlay District
G Industri 13 District # u9 �0 41 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
®Industri I S District
Historic District go��1...F"ty THIS INFORMATION
Reside ce 1 District
®Water Protection t:Reside ce 2 Dislricl 9S ES
❑Parcels as R_idei ce 3 Dislricl SACMUS
C!Hydrographic Features e ce l
Streams 1" 60 ft etlde ce 4 4 DisDislricl
ricl -
de ce 6 District
��age a idential District
May 28 13 07:21 a Surfside Pool Company 978 735 4381 p.5
w� Office of Consumer Aff ' and Business Regulation
10 Park Plaza - Suite 5170
Boston, N assachusetts 02116
Home lmprovernent Contractor Registration
Repistration: 101005
Type: Supplement Card
Expiration_ 6/24/2014
FITCHBURG SURFSIDE POOLS,-INC.. ..-
RICHARD
OOLS,- INC.RICHARD HAJJAR -- —------ ----"-___ __.
139 L-unenburg Street
Fitchburg, MA 01420
Update Address and return card.Mark reason for change.
Address Renewal Employment `- Lost Card
OF--CAI s Sotos-04roaG101216 - — — --
.�. ase�ooir�no9aurealda o�;.-�laoad�a
0fram of Consumer Affairs&Business Regulation License or registration valid for iindividul use oily
., .:`% before the expiration data If found return to:
i IOME ti11lPROVEMENT CONTRACTOR Office of Consumer Affairs and BusinessRegulationR Registration:r gid:: S 101005TYRE= 10 park Plaza-Suite 5170
Supplement Card Boston,MA 02116
FITCHBURG SURFSIDE POOLS;INC.
RICHARD HAJJAR ,.:_;
139 LunenbuT Street
Fitchburg,MA 01420 (��J� --�-----__.._.._—
Undersecretary No`Cva without signature
Massachusetts-Department of pudic Safety
Board of Building Regulations and Standards
Construction Supervi%or"
License:CS-031352
t�tr�
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do Surfside -
139 anaenbulg;5tre
VdxhburgMAr0142 ::.
Commissioner 02J.22=14
May 2813 07:24a Surfside Pool Company 978 735 4381 p.6
Rpr 12 2013 4: OOPM Surfside Pool Company 19793451956 page 1
�1 FITCSUR41 MENA
A4�ORD" DATE(WMWWM
�- CERTIFICATE OF LIABIL11Y INSURANCE 411012013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON.TNE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORIDED BY THE POLICIES
BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT"BETWEEN THE ISSUING-INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cortiflcale holder is an ADDITIONAL INSURED,the policy(les)must be endorsed- If SUBROGATION IS WAIVED.subject to
the(arms and conditions of the polic)6 certain policies may requlre an endorsement. A statement on this cWtiflcats does not confer rights to the
certificate holder In IlOu of such ondorsement(s.
°D (508) 852.8500 NAME:
Protector Group Ins.Agency PWAE VAX
100 Front 3tnvet,Suite BDONe:
Worcester,MA01608.1435 A
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INSURW FltchbUrg Surfsido Pools Inc. imLlRaRa:Massachusetts S Insurance Company
dbaSurfs Ids Fence' IkURERC:Associated Ernpl6yers Co
113 Lunonburg Street ` INsuRERD:The"Hanover Insurance Co an -
FltchbuFg,-MA 01420 IWSUF"E:
INSURER F
COVERAGES CERTIFICATE NUMBER:- REVISION NUMBER:
'THIS IS TO.CERTIFY THAT THE POLIC S OF INSURANCE LISTED BELOW HAVE BEEN ISSUED-To THP-WSURED t*mED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTMiiTHSTAN011\G ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCl1MENT.WrrH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,.n4E INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
-EXCLUSIONS AND CONDITIONS'OF SUCH POLICES.LIMITS.SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS.,
POUCY EFF PIDUCY E"
LTR rVPE OFMgURANCE•. ' POLICY NUMBER M LENTS
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CERTIFICATE HOLDER CANCELLATION .
SHOULD ANYOF THSABOVE DESCRIBED PoLICIESSE CANCELLED BEFORE
Fitchburg Surfside POOIS Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL, 13E (DELIVERED IN
113 LUnenlbufg St ACCORDANCE VATH THE POLICY PRCMS10NS.
FItcllburgl,MA 04420- AUTHORIZIEDREPREaFkTAT(VE.
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.. ®1188.2010 ACORD CORPORATION_ . Ali rights reserved.
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