HomeMy WebLinkAboutBuilding Permit #813 - 50 ROCKY BROOK ROAD 6/20/2006NORTH
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Permit NO
t13
Date Issued: , 2-a- ,g`/
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: O
IMPORTANT: Applicant must complete all items on this page
LOCATION 5b 'Zoe
Print
PROPERTY OWNER �� G-
Print
MAP NO.: 90A PARCEL: 3'�
TVPF. ANTI TTCF. (nF RiT i nmq.
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
'Addition
❑ Alteration
XOne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED crgx,\J t> YboL —yi NV 1
Identification Please Type or Print Clearly)
OWNER: Name: \ ,V-cr 9' Ul� b��P-0 Phone:
Address: JSD Z0cl-i
CONTRACTOR Name: `�tiCst^c�S P�o� @��;� a'b!::�s CO3Z.\r- Phone: �CU— (� %'`��G
�-
Address: I,rb �W.idZcQ e_ S4T)ee+ PAA
Supervisor's Construction License:
Date:
1 �s
Horne Improvement License: / /3 15-6 Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BAS D ON $125.00 PER S.F.
Total Project Cost :$ 5WVVx10.00=FEE:$_
Check No.: 02 f / Receipt No.:
Page Iof4
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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:BPFORM05
Page 4 of 4
TYPE OF SEWARGE DISPOSAL
Public Sewer ❑
Well ❑
Nk
Private (septic tank, etc.
Tanning/Massage/Body Art ❑ Swimming Pools k
Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
Electric Meter location to
project
N V TLS' : Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner — Signature of Contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan Stamp Tans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED
❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
El
CONSERVATIO;i; _x
COMMENTS
HEALTH
DATE REJECTED
DA TE APPROVED
J
11
❑ ' S `� p
once, reumon iv
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Com
Com
Water & Sewer connection signature & date
Temp Dumpster on site yes_no K Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required
Provided Required
Provides Required
Provided
vi vi 1V S VN
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NO I ES and DATA — (For department use)
Page 3 of 4
DOC: INSPECTIONAL SERVICES DFPARI'MFNT RPFORM05
Created 1MC. Jan.2006
Location AA //
No. Date ,
TOWN OF NORTH ANDOVER
TOTAL $
Check # t C
19437 - 0-----1-4.-
Building Inspector
Certificate of Occupancy
$
orb+,. �,`' •
rsSAC►1USEt�
Building/Frame Permit Fee
$`
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL $
Check # t C
19437 - 0-----1-4.-
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APR -27-2006 03:42P FROM: TO:17817443098 P.1
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Board of Building Regula la ions and Standards
One Ashburton Place - Room 1301
I' Boston. Mappchusetts 02108
Home Improvemeztractor Registration
Registration: 113956
m Type: Private Corporation
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Expiration: 7/22/2007
+'+ ROGERS POOL PATIO & TOY n.6 'N = i
GARY ROGERS
150 MIDDLE ST
LOWELL, MA 01852
bAi A 60M-04/04.0101218
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Expir . ton 72007
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ROGERS POOL" T1 I��TOY .' O INC
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150 MIDDLE ST
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LOWELL, MA 01952 Administrator
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idate Address and return card. Mark reason for change.
Li Address ❑ Renewal L_j Employment L_j Last Card
License or registration valid for Indlvldul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ms. 02108
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MAY -30-2006 01:12P FROM:
..-.-PRODUCT 91------------------_.
TO:17817443098 P.1
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ROGERS POOL, PATIO & TOY CO., INC.
150 Middle Street
LOWELL, MA 01852
(978) 454-5517 1.800.698.7946
www.rogerspools.com 0 www.rogerstays.com
OVER 60 YEARS OF QUALITY SALES & SERVICE
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APR -27-2006 03:43P FROM:
STPAUL
TRAVELERS
TO:17817443098 P.2
W it r-% v
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (7PJUB-3972B30-7-06 )
RENEWAL OF (7PJUB-3972830-7-05)
INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
INSURED:
ROGERS POOL PATIO & TOY
COMPANY INC
150 MIDDLE ST
LOWELL MA 01852
NCCI CO CODE: 13579
PRODUCER:
POPOLIZIO INS AGENCY
175 LITTLETON ROAD
WESTFORD MA 01886
Insured is A CORPORATION
Other work places and Identification numbers are shown In the schedule(s) attached.
2. The policy period Is from 02-28-06 to 02-28-07 12:01 A.M. at the Insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:,
MA
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state Ilsted In
Item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident: $ 100000 Each Accident
Bodily Injury by Disease: $ 500000 Polley Limit
Bodily Injury by Disease: $ 100000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, If any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A
D. This policy Includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
The premium for this policy will be determined by our Manuals of Rules, Class Ificatlons, Rates and Rating
Plans. All.requlred Information Is subject to verification and change by audit to be made ANNUALLY .
DATE OF ISSUE:. 01-30-06 WC
OFFICE: DIRECT ASSIGNMENT 701
PRODUCER: POPOLIZIO INS AGENCY
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ST ASSIGN: MA
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