HomeMy WebLinkAboutBuilding Permit #511 - 49 ORCHARD HILL ROAD 1/30/2006i
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Permit NO:/
Date Issued: 1-13e 0
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
.14.9, - 200��
Date ReceiPPI�Qly '4� T"
I IMPORTANT: Applicant must complete all items on this pace
LOCATION -0�C t�
_ Print
PROPERTY OWNER
Print , /
MAP NO.: PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HIRTnUIC nPQTurr'r V c n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential ENon-
Residential
El New Building
❑ Addition
Alteration
G One family
G Two or more family
No. of units:
❑ Industrial
Commercial
G Repair, replacement
❑ Demolition
G Assessory Bldg
L Moving (relocation)
❑ Other
❑ Others:
D Foundation only
Utr A KIF 11UN UP W UKK I U BE PREFORMED -net,) iA- to d
Identification Please Tvve or Print Clearly)
OWNER: Name:
Phone:CM 4C. (h0%,& f
Signature
Address: 6^ O f24-#AAr-2-0 t1 % %.L, 2f7.
CONTRACTOR Name:_ ���� &A-VL5 'fit Phone:91&�/o 10c)
Address: l c1 k 41-1 911,0rx1%A C, Q 41 n A o. _ L _'� , rn _ . , ' n L .V1 1 A 1 _ n.t 0 -AA
Supervisor's Construction License:_ CCj DAC( S 1 �3 Exp. Date:
Home Improvement License: Exp. Date:
ARCHI'T'ECT/ENGINEER IMg=j1 w Se.A%Pf Name: Phone:
Address: _ -1
FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON S
$125.00 PER S.F. 0. C
Total Project Cost .$ j
`jCj (��� x10.00=FEE:$
Check No.: /? %%9 Receipt No.: 9 13-
1lv
TYPE OF SEWARGE DISPOSAL
Public Sewer L
Well
r -I
Private (septic tank, etc. L. '
Tanning/Massage/Body Art
Tobacco Sales
Permanent Dumpster on Site
Swimming Pools Ll
Food Packaging/Sales L.
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner" lOWAA,� - Signature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
❑ ❑
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer connection signature & date
Temp Dumpster on site yes no Fire Department signature/date
Building Permit Approved and Issued by:
PT C�
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NOTE'S and DATA — (For department use)
Doc: INSPECTIONAL. SERVICES DEPARTMPNTA PPORM05
Created RvIC hn._006
Building Department f a
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
❑ Debris Removal Form
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ Form U
❑ Surveyed Plot Plan
❑ Debris Removal Form
❑ 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)
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Form U
❑ 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
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:BPFOR:1105
7
Location
No. Date �J
MORTh TOWN OF NORTH ANDOVER
Of.•o ,•1ti
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Certificate of Occupancy $
�ss�cNustt
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # /,�/ 2l/
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No. Sl/ Date --? -
NORT#q
TOWN OF NORTH
ANDOVER
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$
s�CHus
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$
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$
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$
TOTAL
Check # /
2 G
C for
Building
In
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 511 X1/30/06) Date: March 20 2007
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 49 Orchard Hill Rd
MAY BE OCCUPIED AS Had—figap Lifer' IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE
BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: AAA Regional H,eadqua-den
North Andover MA 01845
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F f.� -- - — ✓lie t�7o7rvnzoouueaCtii o�:/�aaaaaeteuaella �
i..' BOARD OF BUILDING REGULATIONS ;
r License: CONSTRUCTION SUPERVISOR
I Number:._CS 049518
Birthdate 1212511.947
£k
Expires 12/2512007 Tr. no: 11099
Restricted '00
�w f
GARY A BELANGER
i. 4 MAYFIELD AVE '
METHUEN, MA 016'44( --
Commissioner
f -f
1Y
OFFICE OF BUILDING INSPECTOR
TOWN OF NORTH ANDOVER
CONSTRUCT
•N CONTROL
PROJECT NUMBER:
PROJECT TITLE: 1 F -+ ST
PROJECT LOCATION: 4-01 0 (2.e A W;> tH t t. L 7,o a 4
NAME OF BUILDING: AA
NATURE OF PROJECT: VA? L i f"T t N SMTP*-LLAN-TI a ,
IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,
IREGISTRATION NO.
BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I
HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS,
COMPUTATIONS AND SPECIFICATIONS CONCERNING:
ENTIRE PROJECT D ARCHITECTURAL STRUCTURAL 0 MECHANICAL
FIRE PROTECTION 0 ELECTRICAL OTHER (SPECIFY)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS,
COMPUTATIONS AND SPECIFICATIONS MEET THI_ APPLICABLE PROVISION OF THE MASSACHUSETTS
STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES.
AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE. AND OCCUPANCY.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B
EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT
THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING
PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0
1. Review, for conformance to the design concept, shop drawings, samples and other sues
which are submitted by the contractor in accordance with the mquirements of the construction
documents.
2. Review and approval of the quality control procedures for all code -required WA
A
3. With6Be present atI and ual oappropriate to the of Q� 04� f
stage constriction to become, famili
Preg quality the work and to determine, in general, if the s bBit7� W
performed in a.manner consistent with the � dD�erft CAMas12
PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS
TOGETHER WITH PERTINENT COMMENTS TO THE NORTH AN UILDI
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL PO AS O T
SATISFACTORY COMPLETION AND READINESS OF THE PR CT R f%
SUBSCRIBED AND SWQRM TO BEFORE ME THISDAY OF
C2� -
NOTARY PUBLIC MY COMMISSION
147/. -w ,�,
113
UtK I IH(A I t UI- LIAtSILITY MUKANUt 1 9/16/2005
PRODUCER
M. P . ROBE�2TS IPjS . AGENCY INC.
1060 OSGOOD STREET
NORTH .ANDOVER, MA 01845
978-683-8073
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED ANDOVER CONSTRUCTION CO., INC.
P.O. BOX 125
ANDOVER, MA 01810
INSURER A TETE PROVIDENCE MUTUAL FIRE INS CO
INSURER B: HANOVER INSURANCE COMPANY
INSURER C: THE PROVIDENCE MUTUAL FIRE INS CO
INSURER D: AMERICAN HOME ASSURANCE COMPANY
INSURER E:
COVERAGES
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
DD'_
asRo
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DDC E
POLICY
DA EYMMIDDm N
UMTS
GENERAL LIABILITY
EACH OCCURRENCE $ 1, 000 000
PREMISES UA AUE 'UEaoccurence$ ZOO OOO
X COMMERCALGENERAL LIABILTY
CLAIMSMADE Ex—I OCCUR
MED EXP (Any one person) $ 51000
PERSONAL&ADVINJURY $ 1,000,000
A
CPP 0058664 01
04/01/05
04/01/06
GENERAL AGGREGATE $ 2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY PRO- LOC
JECT
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$ 1,000,000
ANYAUTO
(Ea accident)
BODILY INJURY $
ALLOWNED AUTOS
X
SCHEDULED AUTOS
(Per person)
BODILYINJURY
B
X
HIRED AUTOS
AHN-6424027-03
04/01/05
04/01/06
X
NON-OWNEDAUTOS
(Peraccident) $
PROPERTY DAMAGE
$
(Peraccident)
GARAGE LIABILITY
I
I
AUTO ONLY -EA ACCIDENT $
OTHERTHAN EAACC $
ANYAUTO
I
I
AUTOONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE $ 1,000,000
X OCCUR CI CLAIMS MADE
AGGREGATE $ 11000,000
$
UMC 0050177 01
04/01/05
04/01/06
$
C
DEDUCTIBLE
$
X RETENTION $ 10,000
WORKERS COMPENSATION AND
I ORYL M TS X ER
EMPLOYERS' LIABILITY
WC 670-33-47
04/01/05
04/01/06
E.L. EACH ACCIDENT $ 1,000,000
ANY PROPRIETORlPARTN
E.LDISEASE- EAEMPLOYE $ 1,000,000
D
OFFICERIMEMBEREXCLUDED?
tfyes. describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
AAA MERRIMACK VALLEY REGIONAL HEADQUARTERS IS LISTED AS AN ADDITIONAL INSURED
IN RESPECTS TO GENERAL LIABILITY COVERAGE FOR WORK PERFORMED BY THE INSURED.
AAA MERRIMACK VALLEY REGIONAL
HEADQUARTERS
49 ORCHARD HILL ROAD
NORTH ANDOVER MA 01845
ACORD 25 (2001 /08)
GANUELLA
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 DO SO SHALL
IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. L�
(c) ACORD CORPORATION 1988