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HomeMy WebLinkAboutBuilding Permit #283-13 - 45 HEPATICA DRIVE 10/10/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION i Permit N0: Date Received Date Issued: 0 y IMPORTANT:Applicant must complete all items on this page LOCATION / o 02 7 2 _ 'Print PROPERTY OWNER l/EV V . 4-Pf I Unit# o 7 _/C7 6 Print MAP NO:A/a PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 11 Other �tS�e tic- �W Ili y - i�-�- _��Floodpla�®Wetlands¶-�f is 0 W�atershed�Dist'rict� ��Water/Sewers _ DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: a)� r01 4y7G Phone:7;e-4 3110.-3 Address: /o /{ep��i c�. �9 v��1 - 10�` ��oe�G . t t¢ m���� CONTRACTOR Name: C'- 64e0 R Phone: s -A-18 -4�n Address: to {�'�(,tll t� �*r-y Supervisor's Construction License: ;7S-30i-- Exp Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 6)Tua;V4 Ate-46 t,,fs Phone: A? Address: A?u� '��.6r A4 0. Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Ilk 1 Total Project Cost: $ /0 FEE: $ /dC� Check No.: 6,?r7 Receipt No.: 'V�ICF613 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty and S�nature of�Agent/O_ wne 9ri to of do -- • i` M Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F1 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 ❑ l THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ �] j I COMMENTS t CONSERVATION Reviewed on D O / Si nature COMMENTS q _ J 3 3.7 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes PlanningBoard Decision: Comments - Conservation Decision: Comments Water & Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/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, 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 NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi r i 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks o Building Permit Application o Certified Surveyed.Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2008mi i Location No. �(�' ��3 Date 1011,6L.- • - TOWN OF NORTH ANDOVER • ��T'TLI�D p�4�` 1 • Certificate of Occupancy $ Building/Frame Permit Fee $ � ^ ,` Foundation Permit Fee ' �µ � t Other Permit Fee $ TOTAL $ • Check#- 25803 EI it6ing Inspector ,I NORTH Town o - � 6 ndover p No. _' t ' h ver, Mass, o z A- COC NIC Nt WICK y1. 7�Q�a�TED r.PP�,�S S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT ....... ..... -.7-W................................................................... BUILDING INSPECTOR has permission to erect ....... buildings on ..�J lJ.. ., �� ... �}c�.E .......... Foundation I ................... ....... . ........ ..... ............ / Rough to be occupied as ,......::.�G "" ••�• �P...... 0,v. Chimney provided that the person accepting this permit shall in every respect co orm to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws r ating 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 CONSTRUCTI TARTS Rough ........'•.• Service ..... ... . . ................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE uhlic s r �tas.a� utccF� cRe� � c sts �c�nd SU.n<l:►r t. .-. Board of Buildim-F ecYisar License co"Stfruction sub? _- L.iceose: CS 75302 13FNjAMIN C GSGOOE 6S OLD Vtt1A LANE NO ANDOVER,MA 41845 121412012 6267 (7efit[ii1S�t<ISicE Accwbr DATE(MM/OD/YYYY) ..�- CERTIFICATE OF LIABILITY INSURANCE F3/2/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE$ 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 on this certificate does not confer rights to the certificate holder In lieu of such endoreement(a). PRODUCER M P ROBERTS TNS .AGCY INC NHMNE FAX 1060 Osgood StreetAIc No Exl: 978 683--8073 (A/C,No):(978)683-3147 AODRESs:mike@mprobertsinsurance.com North Andover, MA Q1$45 INSURER(S) AFFORDING COVERAGE r7NAIC# INSURER A: INSURED CENTER REALTY TRUST INSURER B: INSURER C: P.O. BOX 876 INSURER D: ZURICH NORTH .ANDOVER, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATENUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE LTR 1NSR D POLICY NUMBER (MM/DD/YYYY) (MM/DDM/YY) LIMITS GENERAL LIABILITY i EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE 10RENIE PREMISES(Es occurrenos) $ i CLAIMS-MADE �OCCUR MED EXP(Anyoneperson) $ i PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY JET LOC AUTOMOBILE LIABILITY $ Ea accident $ _ ALLOWNENYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NONAWNEDPROPER AUTOS (Per accident)AMAG $ ;DED ELLA LIAB OCCUR EACH OCCURRENCE $ SS LIAR CLAIMS•MADE -- AGGREGATE S RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN C TRY LIMITS ER ANY PROPRIETORIPARTNER/EXECUnVE WC005095106 02/10/12 02 10 D OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) If yes,descdbe under E.L.DISEASE-EA EMPLOYEE S 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,I morespaoe is required) CERTIFICATE HOLDER CANCELLATION SAMPLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©9988-2010 ACORD CORPORATION.All rights reserved. ACORD25(2010!05) The ACORD name and logo are registered marks of ACORD