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Home My WebLink AboutBuilding Permit #664-14 - 42 MOLLY TOWNE ROAD 3/27/2014Permit N0: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ATANT: Applicant must complete all items on this LOCATION r ► "a -c(` I_�TG�c.� .r't +` (r"a— Print PROPERTY OWNER ` ��c. �'�Q�.� � ' r Print 100 Year 018 Structure yes rnoMAP NO: PARCEL ZONING DISTRICT: � Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building JOne family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Assessory Bldg ❑ Commercial ❑ Repair, replacement ❑ Others: ❑ Demolition ❑ Other- ther-❑ ElSeptic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO ERFORMED: Type OWNER: Name: Arlrlracc- I CONTRACTOR Name;_ , C zy f c I / Phone: Address: Supervisor's Construction License: C's 6-35 c'> Exp. Date: 7 Home Improvement License: (_C C.. 5c 3 Date: 7Nf 15 ARCHITECT/ENGINEER 1 r -J n c -ASS- Phone: (e �? - AILL- c)i V y:S Reg. No. "'), -) 7 6--*� L4 -2F,3? FEE SCHEDULE: BUY -DING RERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSWON $125.00 PER S.F. Total Project Cost: $ �dt 0 00 FEE: $ Check No.: 3 Z-10 Receipt No.: Z -T & NOTE: Persons contracthig with junrggistered contractors do not have ac c s to the guaranty fund Signature of Agent/O ner Slg�ature of contra Plans Submitted L�J Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans - Plans Submitted 0 ..'Plans Waived -0 .: ;_Certified Plot Plan ❑ Stamped Plans ❑ TYPIJ OF--SEWEIAGE_DiSP-0 Public Sewers Tanning/Massage/Body Art El. Swmm�g a �. `.,� "' Well ❑ Tobacco.Sales Q-,�� : � '+�� •', ..•Food Packaging/Sales Private {septic tank, etc:_ ❑ -: = . Permanent Mmpster on Site ❑ THE.FO.LLOWING SECTIONS FOR -OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 'DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS .CONSERVATION COMMENTS HEALTH COMMENTS DATE :APPR-OVED Reviewed on - Signature Reviewed on Signature . Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Com Water & Sewer Connection lSignature Date Driveway Permit DPW 'Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTIUI;ENT': -. Temp Dumpster on site yes_ no Located-at.124iMair, Street:-- #' - Fire rtmefit sigh cepa ature/date 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; rriast-or service drop requires approval of Electrical Inspector - Yes .. No DANGER.Z®NE LITERATURE: Yes No MGL -.Chapter 166.Section 21A =F and G min.$10041000.fin.e NU I t5 and UA I A — (l -or aepartment use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following i8"4—list of the' required forms to be filled out for: the appropriate. permit to`.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ B,uilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. AndlG( G.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 o 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) W n a 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 o issuance o Bldg—Perm 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 apw} al 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 42- HcA,I--k- Pa. N o. Date Check 4t�?o TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL B ild�inglnsp�ector � AI r N CA LL O In O m N +v \ O O LL N m Ln >. U a aJ (n Z Z -1 C: O "O 3 O LL t :3 O d' C t U _ O C LL z Z J a L � O d' _ Fa C LL O F - (A Z -j U LU L O d' U _ O ul _ O C I.L O W IL Ln Z ..0 O d' _ co C LL W �' oa. w LU LL N L O D] O �.+ v V) i ai ) O (n FM 0 W CL U) z 0 m i za 0z Z N W Ii�JrvA+ LLJ O V W LLJ -j CL z LF 4 C7 1v N E O z O 0 01- E .- Q �E m m - W wWO + O O C a. Q t Q Os a = Co v J �CL O D C,w W O CL VY^/ Q L • N � C � 0 cC � w v O .� C d ca_. Qi ci i v N o N v E Qaw FM 0 W CL U) z 0 m i za 0z Z N W Ii�JrvA+ LLJ O V W LLJ -j CL z LF 4 C7 1v N E O z O 0 01- E .- Q �E m m - W wWO + O O C a. Q t Q Os a = Co v J �CL O D C,w W O CL VY^/ Q L • N � C � d N � w O AM 0E O �@ 0 ci i v N CL J L m • � L U) � O O � U � N Q t ,mew = s E o ...: O z m` CL _0 N O O • � 'N O �. 3 =O L Q. CL (0j:5 (� 0 N (� O O C m ai Q. (D -,s c d .v m O y d �, •=,= C E L v i V O = O QO •a �.L+ 0 '0 = N O t Zo CL00 FM 0 W CL U) z 0 m i za 0z Z N W Ii�JrvA+ LLJ O V W LLJ -j CL z LF 4 C7 1v N E O z O 0 01- E .- Q �E m m - W wWO + O O C a. Q t Q Os a = Co v J �CL O D C,w W O CL VY^/ Q 12/0412013 11:24 9786833147 PAGE 01/01 AC R& CERTIFICATE OF LIABILITY INSURANCE YI 12/9 013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OF! PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the- certificate holder is an ADDITIONAL INSURED, the poiley(les) must be endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require an endorsement:. A statement Dn this certificate does not confer rights to the certificate holder in lila of such 0n4or3em$r1t(s)- PRODUCER M P ROBERTS INS AGCY INC 1060 Osgood Street NorthAndover, MA 01845 NAME: PHONt {J7g 683-8073 P 978)683 -.?147 CINo Ex' ADDRESS:sandf ft robertsinsurance . com INBURER(81 AFFORDING C0V9AA0e NAICS INSURER A.: ASSOCIATED EMPLOURS INS CO INSURED NORTH ANDOVER REALTY CORP. 66 SPRING HILL ROAD NORTH ANDOVER, MA 01845 INSURER 9: INSURER C: INSURER D: INSURER t: INSURER F: COVERAGES CERTIFICATE NUMBER: RFVI.RION NIIMRFR, THI$ IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN CATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CE TIFICATE MAY BE: ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND 0014DITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN5R LTR TYPE QF N$VRANCE UL INaO SUOR wv0 POLICY NUMBER POLICY EFF MMJDD/YYYY POLICY EXP (MMIODNYYYI LIMITS COMMeRciAL FFNIIRAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE D OCCUR _ PREMISES Me Occurrence $ MED EXP (Any oneperson), $ PERSONAL & ADV INJURY $ G.N'L AGGREGATE LIMIT APPLIES PER: POLICY 11 PRO. ❑ ACT LOO GENERAL AGGREGATE S — PRODUCTS - COMPlOP AGG $ $ OTHER; I AUTOMOBILE LIABILITY COMBINE6 SINULF LOT—$ ER aaaident BODILY INJURY (Per person) S ANYAUTO ALL OWNED gCHPOLJLF.O AUTOS AUTOS BODILY INJURY Par accdantl $ NON -OWNED HIRED AUTOS AUTOS Per accident S S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMSAIADE (AGGREGATE $ DED I RETENTION $ I $ WORKERS COMPENSATION R H- A AND EMPLOYER$' t.IAFtILrrYSTATUTE ANY PROPRIETORIPARTN@R/EXBtUTIVE YIN OFFICER/M@MDrR E%CUXEW NIA WCC5010734012013 03/13/13 03/13/14ELEACNACDID>NT ER $ 500,000 E.I., DISEASE - FA EMPLOYE $ 500 , 000 ;Mandatory In NH) Dyas daacrlbe er DE94`RIPTION ION OFOP OPERATIONS below E. I. DISEASE -POLICY LIMIT s 5OO 000 I DESCRIPTION OF OPERATIC NS J LOCATIONS J VEHICLES (ACORD 101, Additional Remarks Schedule, may be erleehed if mora npaca in mglalmd) 978-655-4760 e'•L'if rr,+nrr- ,int .., ,.. I TOWN OF NORTH ANDCrVER 1600 OSGOOD STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE . DELIVERFO IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH 'ANDOVER, MA 07.845 AUTHORIZED REPRESEN TIVE k . � A ORD25(2013/04) i W_Iatln-lui�AGORi7GQRPORATiON, All rights reserved. The ACORt) name and 1090 are re91$ter0d marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -063503 JAMES V CARRO,tL 21 JOHNSON CIRCLE North Andover NfA 01845 914- Jy�. " —Expiration Commissioner 07/19/2015 i Office of onsumer�ars & u mess Regulation HOME IMPROVEMENT CONTRACTOR —; Registration: ,.171245 Type: E ; Expiration: 3%.1/2014 Individual CA OLL V. JAMES Y_ CARROLL JAMES , 21 JOHNSON CIRCLE NO. ANDOVER, MA 01.$45: g —> Undersecretary