HomeMy WebLinkAboutBuilding Permit #743 - 425 JOHNSON STREET 5/15/2009Permit NO:
Date Issued:
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LOCATION '12
PROPERTY OA
MAP NO:9kA
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received 5'-t I ` d �–
IMPORTANT: Applicant must complete all items on this page
Print
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
)� One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Others:
❑ Repair, replacement
❑ Assessory Bldg
emolition
❑ Other
0 Septic 0 Well �
0 •Floodp a� - � QWjatiands ;,�
�!Uatershed gisf'iq-
Ca Water/Sewert
UcaVrcIr 11UN Ur VVUKK I U tit F'KEFUKMED:
vv o Gil S1�rt \ 1 TUu d -r- l i aJ L fy -
OWNER: Name:
M
CONTRACTOR Name:
Address: /33 A ki w
Supervisor's Construction Li'
Home Improvement License
ARCHITECT/ENGINEER
Phone:
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: $ �-000 FEE: /00
Check No.: `/gTt Receipt No.: .? 62- D -A
NOTE: Persons contracting with unregistered contractors do not have access cess to the guaranty fund
Signature of A ent/Own ,
g Signature of contractor
I
n
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 Packagifig�Sale�,y -Tj
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATIO
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
TE REJECTED
11
DATE APPROVED
DATE APPROVED
KW YA07—
DATE REJECTED DATE APPROVED
❑ ❑
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
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.$10041000 fine
Doc.Building Permit 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 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
❑ 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 DEPARTMENT:BPFORM07
Revised 2.2007
Location j
/
No. 7 `� . Date
TOWN OF NORTH ANDOVER
. - s
Certificate of Occupancy $
Building/Frame Per Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL
Check # e r"C7
202uk"S
/Building Inspector
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
j Number: CS O40870
Birthdate: 07/01/1950
EXPIrss: 07/01/2007 Tr. no: 14501
Restricted: 00 '
JOHN J HASHEM ,IR136 KARA Da
;
N ANDOVER, MA 01845 C '`
Commissioner
I
�n <_n"!n_ ^,n I1 11 1 G 7 Q 6.=.n_1J1(n L -LCR• rill') IF nnf
��D, CERTIFICATE OF LIABILITY INSURANCE
05/01/200
PRODUCER 603-742-1452 FAX
Brown & Brown of N H, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
93 Washington St
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
EFFECTIVE
A
I
Dover, NH 03820
INSURED Onway Construction LLC
INSURERS AFFORDING COVERAGE
INSUREP,.. National Grange Mutual Ins.
NAIC #
14788
INSL:RERB American Home Assurance Company
06/01/2006
79 Newfields Road
N,0.1R'EP C
DPNAGE TO RENTED $ 50 000
Exeter, NH 03833
IPJ3'vFEP D
COMt icF' I�.L GEfcEPP Li�B"CITY
II.S !F CF't.
1L-UVaMAU1=Q
THE POLICY PERIOD INDICATED. NOTWITHSTANDING
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TR
DD'LPOLICY
INSR
TYPE OF INSURANCE POLICY NUMBER
EFFECTIVE
A
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
MP064041
06/01/2006
06/01/2007
EACH OCCURRENCE $ 1,000,000
DPNAGE TO RENTED $ 50 000
COMt icF' I�.L GEfcEPP Li�B"CITY
MED EXP (Any one person) $ 5,000
NX
CLAIMS MADE CCCLIR
PERSONAL & ADV INJURY $ 1,000,000
A�F—
GENERAL AGGREGATE $ 2,000,000
GEN'L .<-GRE,--ATE LIMIT APPLIES PER
PRODUCTS - COMP!OP AGG $ 2,000,000
:
POLIC17PFIEY C''}_; n
AUTOMOBILE
X
LIABILITY
ANY AUTO
B1064041
06/01/2006
06/01/2007
COMBINED SINGLE LIMIT
(Ea accident) $
1,000,000
BODILY INJURY
(Per person) $
A
ALL OWNED:'UTOS
SCHEDULED AUTOS
HIF'ED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE $
AGGREGATE $
OCCUF• n CLAA11, MADE
$
$
DEDUCT'BLE
$
F ETENT I OI I
WORKERS COMPENSATION AND
8963094
06/21/2006
06/21/2007
TOR LIMITS OER
E L EACH ACCIDENT $ 500, 000
B
EMPLOYERS' LIABILITY
ANY PROPPIET_F%F'AF'TNEF'EXE-_LITi,,E
OFFICER/MEMBER EXCLUDED'
j
E L DISEASE - EA EMPLOYEE $ 500,000
If des, describe under
SPECIAL PROVISIONS beL•w
E.L. DISEASE -POLICY LIMIT $ 500,000
OTHER
I I
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Hashem Construction Inc
133 Main St
North Reading , MA 01864
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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Gail Durgin/GAIL
ACORD 25 (2001108) FAX: (978)664-1450 OACORD CORPORATION 1988
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P. 0. Box 1025 State Road, Stow, MA 01775
PERMIT Date:
North Andover Permit No Dig Safe Num er
(City of Town) (If Applicable)
In accordance with the provisions of M. G.L.14 8 Chapter as provided in section 57 7 (M R 34 Start Date
This Permit is granted to: a���C
Full name of person, Firm or Corporation
Pennissionto locate dumpster for construction/renovation/de.molition of building
Comments: dumpster must be. 25' from structure if unable to place with required
Restrictions: clearance dumpster must be covered with plywood or tarp end of work -day
at _ t -/-L Se— I Li
( Give location by street and no., or describe in such manner as two pK�ied adequate identification of location )
Fee Paid$ 50.00 Fire Chief
This Permit avill expire Signature of offical granting permit) Offical granting permit ( Title )
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APP. -26-2'� 10 7 17: 4-� BELL ATLAHT I C.
Town of North Andover
Bullding Department
27 Charles Street
North Andover INA 01846
Tel- gig -688-9545 Fax: 978-688-9542
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Town of North Andover NORTI'�
Building Department °b �t�`° 86
27 Charles Street
North Andover MA 01845 ti o
Tel: 978-688-9545 Fax: 978-688-9542
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DEMOLITION OF BUILDING AFFIDAVITIt °114roo ►�" 4°�
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DATE 2-0-0 7
OWNER'S NAME & ADDRESS 14S#&� /ol G
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LOCATION OF PROPERTY TO DEMOLISH�✓� �/O H��% S o �� S-77
DESCRIPTION/��'t ��M • 1�/G�Q 1� �iiE' A�
CONTRACTOR'S NAME & ADDRESS
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DEPARTMENT SIGN -OFFS
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DUMPSTER - ON/OFF STREET Ca FF) M I L -i -ex Wts-re �rvQ %l%�r�p�erv.✓
DIG SAFE NUMBER Y-- 2-007 IS�V 4%%3- -
DATE REC'D BLDG. INSPECTOR