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Home My WebLink AboutBuilding Permit #868 - 41 ROYAL CREST DRIVE 7/3/2007 J BUILDING PERMIT NORTH q 6'0 TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ��SSACHUs��y Date Issued: d 7 IMPORTANT: Applicant must complete all items on this page ft t T LOCAL ION Ph PROftRTY OWNER Pant ' MAP NO � PA �, RCEL Zt}N1NG DISTRICT HiSTO ,IC DISTR!`CT yes, <.no 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 )a Other er 11 Septic :I�t/eII z` Ffovcp air eia'r�ds [Jr Vl/atershed Dtrrct Water/Sew r DESCRIPTION OF WORK TO BE PREFORMED: a 1 s Ba-L,y /re ,Eici,,M c�ps^ �., sac- �- CG-� e� �(�Cc�oc ti•,�. C9F ��w�.ra��un _502 zy3 -3Z4Z . Identificatio lease Type or.Print Clearly) OWNER: Name: -- Phone: �n Address: 7� �l� - /�CIY � c�2.0 % 0/ova"_ . . . CONTRACTOR Nome one, Address: ,'" io Su ervisor's UCtaConstro Licenser `: z Ow HomWR e hi provement:eticense , p. Date ARCHITECT/ENGINEER QJ- t ,A' Phone: 50Y 7 Z I-7&c)-o Address: 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: $ FEE: $ Check No.: /vF9� Receipt No.: ,��3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agenfib7 n'er ` Signature of contractor ' 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 E REJECTED DATEAPPROVED CONSERVATION COMMENTS DATE REJECTED DATE A PROVED HEALTH z 2Z12_ ell COMMENTS )-I,, f 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 Located at 384 Osgood'Street 01 tE ,EPA TMENTV Tem Dum sten on site es nak 'p p e; Y Locaie 124 Main Street Fire Department SA, atu>reldate_o g .. r. f COMMENTS , 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.$100-$1000 fine NOTES and DATA— For department use rl-2-v ❑ Notified for pickup - Date i Doc.Building Perniit Revised 2007 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 PP Permit Application ❑ Certified Surveyed Plot Plan Li 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 DEPARTMENTMFORM07 Revised 2.2007 i NORTH Town of Andover /7 2 dover, Mass.,. 0 � C) LAKE COCHIC MEWICK ,A?4 \- OC:) E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. ..PXW.10...Ky.......................... Foundation has permission to erect........................................ buildings on ...ex 0 ...................... Rough to be occupied as........................ 7 06.. ........ ... .. ..... . Chimney ................................................ 06�1 =74 provided that the person accepting this permit shall in every respect conform o ft terms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUTARTRough ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. BOARD OF BUILDING REGULATION' i. I Y. � License: CONSTRUCTION SUPERVISOR I Number: CS 077853 i Birthdate: 11/1 8/1957 i Expires: 11/16/2007 Tr. no: 9499. Restricted: 00 KENNETH E SALSMAN 2 ADAMS STREET t, W ESTBORO, MA 01581 �c � Commissioner � s ✓fie '�oomvrrLcyyu{realt✓i `7" ��,aas�u,�.usef Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 149914 Expiration: 2/2112008 Type: Private Corporation i TREELINE CONSTRUCTION,INC. KENNETH SALSMAN 130 WESTBOROUGH STREET MILLBURY, MA 01527 Administrator . � ff�'�, �ri y� V ✓'JLF ZJ(i?Yl/IY,I092f1 c�'✓//[l7/JJCI.()LU�d�I., 4:u DEPARTMENT OF Pl1BLIC SAFE Y s License: HOISTING ENGINEER LICENS Numbef:HE 063460 Birthdatq 14/18/1957 Eicpire8 1311'8)2607 Tr.no: 8546 Restricted; 1A,2A,4A I KENNETH E SALSMAN I' 2 ADAMS'ST WESTBORO, MA 015$1. Commissioner i CERTIFICATE OF LIABILITY INSURANCEoPiD JA IpIIJIMIU11 TREEI,I5� .0413P/07 PRODUM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER.THIS CERTIFICATE DUES NOT AMEND,EXTEND OR 1558 Otis St. , P.O. Box .1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Northboro MA 01532 I I Phone. 508-393-7744 Fax:508-393-6983 INSURERS AFFORDING COVERAGE NAIC# INSURED INSU ERA NAUTILUS INSURANCE COMPANY I INSURER B: Hanover Insurance Group _ 22292 Traeli>nO Qon$t XVC1joV Inc• INSURER C: Amriaai Roma nrsausa:roa co, 130 WQzttyoro Strut INSURER D: Millbury MA 01527 I _ COVERAGES _ THE 00AICIE6 OF INSURANCE LISTED BELO-HAVE BEEN tSSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTYJITHSTANDING ANY RE(OUIHEMEN1,TEWA 0.,CONDITION OF ANY CONTRACT OR OTHER DOCUMENT vMTH RESPECT 7U WHICH THIS CERTIFICATE MAY BE 18sUED OR MAY PER i'AIN,?HQ(NaVRANCE AFaGROEO EY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUS104S AND CONDITIONS OF SUCH POLICIES.AGGREGATE-IM i SHOWN MA1 HAVE BEEN REDUCED BY PAIC CLAIMS. LTR INS R IYoE OF INSURANCE POLICY NUMBER — DATE M1VD I DgT'E MnroD11M UNIT$ �+ GENERAL LIABILITY EACH OCCURRENCE S 1000000 A X COIW„tERL^IALOENERALLIABILrY I NC659999 04/21/07 04/21/08 !!PRrOEMSEstEIIe�uence) $1.00000 _ CLAIMS MADE X i OCCUR+ I ) I MED EKP(Any*ns Perm1$ 5000 PERSONAL&ADV INJURY $ 1000000 13EN6RALAG3REU A': $2000000 GEN'L AiGFEGATE LIMIT APPLIES PER: ;12000000 I POLICY I—; 1507 1 1 LOC AUTOM001L£LIABILITY COM6WEDSINOLELIMIT ? F 1000 000 F3 ANY AUTO AFN'83870240Q 07/27/06 07/27/07 Ea:u den" i r- I ALL O'MJEDAUTOS I I BODILY INJURY � S X SCHEDULED AUTOS I I I ',Per owson) $ MIRED AUTOS I I B4�DILY INJURY £ X! NON•OWNEDAUT05 i(Peraemiaanl) i PROPERTY DANIAGE 5 L .� _ _RAGE LIABILITY I I AI;T)ONLY EA ACCIDENT ' E I ANY AUTO HOTHER THAN EA ACG IUTD]NLYN� ACG`S ms'sFXC"ESSIUMBRELIALI!ABILITY i �I EACH OCCURRENCE I F OCCUR CLAIMS MADE ACZGREGATE AGGREGATE6 �— DEOUCTIBLE RETENTION WORKERS COUPENSATION ANU x TORY LIMITS R EMPLOYERS'LIABILITY G i WCB979703 1.2/24/06 I 12/24/07 E.L.EACH ACC!DENT $1000000 ANY FROP?IETOfZFAR7NFRIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L,DISEAS4-EA EMPLOYEEt S 1000000 N yas,daSetihb linrlar aPF('IAL PROVISIONS DeYJW� _� W E.L.OI$EA8C•PULIGY LIMIT K 1QQQ000 QYHF-R DESCRIPTION OF OPERATION$(LOCAT1ONS i VEHICLES i EXCLUSIONS A00E0 BY ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION W ANAOVE2 SHOULD AWbF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATI:•7HERECF,THE ISSUING INSURER YVILL.ENDEAVOR TO MAIL 20 GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TKE LEFT,BUT(A1URE TO DO SO SHALL TOWfl Of Andover IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Attn: Building D®pt. Bartlett :Street REPR NTATIVES. Azdovor M 01810 RUTH6gWDREPRESEN WE ACORD 25(2001108) _ 9 ACORD CORPORATION 1988