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HomeMy WebLinkAboutBuilding Permit #751 - 429 WAVERLY ROAD 6/5/2006Permit NO:—ff�— Date Issued:_��_O LOC.XTION TOWN OF NORTH ANDOVER ,APPLICATION FOR PLAN EXAMINATION Date Received: IMPORTANT: Applicant must complete all items on this page Print PROPERTY OWNE ti.I,XP NO.:PARCEL: ZONING DISTRICT: rTio�r�nr� nrerr" rel r vse n 1 T rr, AMU Garr yr Da - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family - - Z Addition = Two or more family =Industrial Alteration No. of units: 104 Repair, replacement = Assessory Bldg - Commercial = Demolition r Moving (relocation) Other Others: = Foundation only DESCRIPTION Or WUK& i tt tst Mt-IMKNMU. Q OA'NER: dame: [+I Address: a's1 4 CONTRACTOR Name r f S ;address: Exp. JM 4rii/1 `l l�e_ 1, ✓ 9 l XI VA, Identification Please Type or Print Clearly) If T00,710 <l (OW,cit Date: Home ImproNement License: Exp. Date: ARCHITECT E\CINEER \.ame: 11hcne: Wdress: Reg. No. FEE SCHEDL LE: SC LDL ERMIT. 51O.J0 [ER ;; TYPE OF SENVARGE DISPOSAL � _ Tann ingAlassage: Body Art t. SHimmin� Pools Public Sewer _ — Well _ Tobacco Sales Food Packaging Sales — Permanent Dempster on Site Private (septic tank. etc. _ Electric Meter location to project NOTE: Persons contracting Signature of .Agent Owner. Plans Submitted PLANNING & DEVELOPMENT COMMENTS CONSERVATION (to not /tmwe access to the guurunty.Jund — Signature of Contractor Certified Plot Plan Stamped Plans "G SECTIONS FOR OFFICE USE ONLY EPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED ❑Water Shed Special Permit Site Plan Special Permit J Other DATE REJECTED DATE APPROVED COMMENTS DATE REJECTED DATE APPROVED HEALTH CONIMENTS Zoning Board of Appeals: � ariance. Petition No: Zoning Decision: rccript submitted ,es I":utnini, _ 15u1'latl n Duct -,Iain: C_onlnlents ��:�tCi .":; Jiilr :crncalon �!�tlatl:rl: & t!atL _I��p Dempster cn =i,c ye=_ no y ;=ire Department JL n: Building Setback (ft.) Front Yard Side Yard Rear Yard Required Prop ided Required Provides Required Provided DIMENSION Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. r 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 C, -."- a Building Permit Application �� 5 Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract o Floor Plan Or Proposed Interior \Kork Addition Or Decks ---Buiildi ng -Permit Application Surveyed Plot Plan o Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydrauli Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract zi Mass check Energy Compliance Report 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 'nc; 1\til'Ll"I.ION lL SERN'1('E!i OFT R•fII "!:iJl'I OR,115 Ix,c1rll ___j_._—. ___ -- .. ._ - ACORD,M CERTIFICATE OF LIABILITY INSURANCE CSR 04 DATE(MM/DDIYYYY) 1 HANSO-1 06/02/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSR LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Norwood Ins. Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 293 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Groveland, MA 01834 Phone: 978-372-5921 Fax: 978-521-0242 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Grange Mutual $ 1000000 INSURER B: COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—I OCCUR INSURER C: Norman Hanson/Pul 1/06 23 Downing Ave. Haverhill MA 01830 INSURER D: MED EXP (Any one person) INSURER E. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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 LTR I NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYY POLICY EXPIRATION DATE MMIDDIYY LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1000000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—I OCCUR PENDING UAIVIIAUA PREMISES Ea oRocccureence) $ 500000 MED EXP (Any one person) $ 10000 X Business Owners 06/02/06 06/02/07 PERSONAL &ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 POLICY ECT RO JPLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT_ ANY AUTO OTHER THAN EA ACC $ $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE OCCUR ❑ CLAIMS MADE $ DEDUCTIBLE $ --- $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE NONE TORY LIMITS ER ---- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? If yes, describe under — E.L. DISEASE - POLICY LIMIT ------- $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS I.CK I iriuiA i C r1ULUtK C:AN(;tLLA 11UN BAKERST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI( DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Steve Baker IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ftE`rR_E`5CNTATIVES. 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