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Home My WebLink AboutBuilding Permit #639 - 50 SANDRA LANE 4/11/2006Of NORT anti •_'..a O n TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 'fi pOr�r.° PrP"q9 9SSACHUSEt Permit NO:6sz� Date Received: $ Date Issued: l I/M�PORTANT: Applicant must complete all items on this page LOCATION //�� Print PROPERTY OWNERC � Wuo 'Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Res ential Non- Residential ❑ New Building ❑ Addition ❑ Alteration One 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 S S1. Identification Please Type or Print Clearly) OWNER: Name: 0- Sigqq tur4 Address: UU h t�t j rn ,� CONTRACTOR Name: V F / / V°G- Phone: %� ��(; Address: . (J�l/e / �l��C'�� , 0/ y wl Supervisor's Construction License: d- D (5,J2 Exp. Date: % Home Improvement License: O'K 3 Exp. Date: ARCHITECT/ENGINEER 52T es - JQJ ! H'Name: Phone: Address: , 7 /` sine 's �- Reg. No. FEE SCHEDULE: BULDING PER T: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ f�j) --r x10.00=FEE:$ Check No.: S16:7-7 'r"N :\ ,.. Receipt No.: Page I of 4 Y{� TYPE OF SEWARGE DISPOSAL Art ❑ Swimming Pools El Public Sewer Well Tobacco Sales El Food Packaging/Sales 11❑ ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the gu anty fun Signature of Agent/Owner Signature of Contract Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑. ' tamped PlanV ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTHEl COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Water & Sewer connection signature & date DATE REJECTED DATE APPROVED ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED DATE REJECTED Comments Comments DATE APPROVED El DATE APPROVED Temp Dumpster on site yes_no_. Fire Department signature/date Building Permit Approved and Issued by: e c44,0"` 6,,,, Page 2 of 4 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. NOTES and DATA — (For department use) i Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan2006 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 Location TO - No. 14, Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 19 .7 Building/Frame Permit Fee $ .2 CHUS Foundation Permit Fee $ 1 ID 47 q-' 0 Other Permit Fee IAI $ TOTAL s Check # 19121 Building inspector m m m X CA mm COO Cl) 10 0 CD n Z y CD O "0. r � � O O. = CO) O CD CD o CL cr WC v CD v CD 0 CD C CD y �. CD d O y �Q CD � v CA O 'O Z CD O CD O c y cn O cn c t� tvZ �n N G Q M 0 p G M G w. p pGp 55►► G p O rLS 00 ^ r " CCD p Q 9 G x H 0 0 c m m X m N F) :ZJ H d C co o d O C o CD d O 1. C O c CO) CD O !D CD CA CD CO) y 0 CD Z CD O to O C U2 m m C 7 CO) CLH rr VJ ff o y y CLCD U2 C I, - G CO7 O fl1 N o CCL Fn - CD mN "« y O ?m W = O Clan , O C. 1O CA CL CD m CA C m G '+ CD H d C=4 1� d • Q c a SD A N m 4 dt m 00 moi H 45 m O nCD d = N CD p1 �Ow CD d m CL . C-) ci 0 0; o zhey w o G7 rA po m o rA w o O w x o X 81 r �1 r, T h o .ate rt` C oW O O o W 2) W y 0 9 0 c 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 OTI IER DOCUME ' T WITH RESPECT T O 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. IfLINSR R DD' TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MPI45232 06/10/2005 06/10/2006 EACH OCCURRENCE $ 1,000,00, X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,001 CLAIMS MADE T OCCUR PRPMlqr-,q (Fa ncclirenCe�_ MED EXP (Any one erson) $ A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY Fj PRO- JECT F7 LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY 7 ANY AUTO EXCESSIUMBRELLA LIABILITY —1 OCCUR FICLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER P 1U, 000 ON PERS IAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ TIFICATE TO BE ISSUED 05/17/2005 05/17/2006 WC STATU- OTH- DIRECTLY BY CARRIER. E.L. EACH ACCIDENT $ CERTIFICATE TO FOLLOW E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ )ESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ertificate is issued in the interest of the named insured and Certificate holder listed below. ertificate is subject to company conditions and exclusions. 1'own of Salisbury Attn: Building Department Town Ball Salisbury, MA 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. AUTHOR IZED REPRESENTATIVE n� 11/23/2005 11:43 FAX 617 488 6501 Cunni/nnq tom_•- _ I i s n �x ';x (�F ACORDIF�AT,r`1N51AN�CE�� _ ct F r 4 K� «a; n�a. •_. c t:. f Is-er .,7fr ,'.yt 9.rY"d•:.rx r ' tils:s 3� t sr s s + I 11/23/2005 �t a yt? �. ,., t..l._..i�:... ,.., ...-:..� `.,,a l.i._i.� rr ll(,'. t,, F �. -- -' �,,,!.,. 4i ,,.,i '^ I• t i -_ :. , `.' '� •�.i +- ''t'>��a?E 1- ''rlay:�r, Lid #•-' ti P.RODUCER .:. ........ ..,tu ei. .7,`.' -�. _.�.... 11i,. :, . .,ta)�`ys, b .a- H: 15 153UED AS Al tF-K OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeAngelis Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 283 Mi ack Street erERAGE ALTER THE COV AFFORDED BY THE POLICIES BELOW. Methuen, MA 01844 INSURERS AFFORDING COVERAGE COMPANY A Atlantic Charter Insurance Company VDAC INSURED James Gallagher g B COMPANY 352 Howe Street C Methuen, MA 01844 COMPANY D e..,, - v:%M uT.,.♦.r�i xcn+r .�rJ.: w,i. �.,,�', ... 1. ...!I'!' _ • .. S.:�sn w.... �� -. -wi 'tn�,. _.' YJ, -r? d 7�'Ca'�::,aa Y:.: • ` _ .. x ; 'r� THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED _'�� y' 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 POLICIES.. AGGREGATE LIMITS SHOWN MAY HAYS BEEN REDUCEp BY PAID CLAIMS. OF SUCH INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MMIODIYY) DATE (MM/DD/YY) (In Thousands) GENERALIJABILITY CC�•ILY OCC r COMPREHENSIVE FORM BODILY INJURY AGG $ PREMISES/OPERATIONS PROPERTY DAMAGE OCC $ UNDERGROUND PROPERTY DAMAGE AGG $ EXPLOSION & COLLAPSE HAZARD BI & PD COMBINED OCC S PRODUCTSICOMPLETEDOPFR BI&PO COMBINED AGG E CONTRACTUAL. PERSONAL INJURY AGG $ INDEPENDENT CONTRACTORS 'BROAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBILE LIABILITY - BODILY INJURY ANY AUTO (Perporson) E ALL OWNED AUTOS (Pdrdte Pass) BODILY INJURY ALLOWNEDAUTOS (PeraedCent) S (O(her than Prh ate Passenger) HIRED AUTOS PROPERTY DAMAGE $ NON•OWNED AUTOS BODILY INJURY &- GARAGE LIABILITY PROPERTY DAMAGE COMBINED $ EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM - S WORKERS COMPENSATION AND - X I STATUTORY LIMITS A EMPLOYERS'LIABILITY WCV00131904 5/17/2005 5/17/2006 EACH ACCIDENT s 100,000 I DISEASE - POLICY LIMIT Is 500,000 DISEASE • EACH EMPLOYEE $ 100,000 . OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!SPECIAL ITEMS - v! .v c rs tk. 2.a„ �,^ • -t� � c i ::+... • r L�r .Te�LY.J",sstQ t�^tr '' s r�.!' y Y ',,-r I p I'� eY 5;j''a`L-',4* 4AIVtt '' t �'A'd4i�4.... i ♦ ' ,.rrc P t ,,T T•isp5.: b}. .#`t C'h, 4. ... .1 r+.. dJl,., i.. •, ,awP, ... r .. � t j' .. 3 i:.•I'. •4' 3. a,M'1 1 �.aa'.�54'.6'-e etrd. � ITyv yt .P� Y "i':TeT I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Salisbury EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town Hall 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Salisbury, MA 01952 BUT FAILURE TO DO S SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TV INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT E " MeEf >' POE>A .I CERTIFICATE BOLDER COPY t PROPOSAL SUBMITTED TO ! STREET CITY„,STATE AND ZIP C01 ARCHITECT Proposal JIM GALLAGHER CONSTRUCTION 352 Howe Street METHUEN, MASSACHUSETTS 01844 (978) 686-8163. rf 1 DATE OF PLANS PHONE JOB NAME JOB LOCATION Page No. of DATE ,,•, / i JOB PHONE Pages hereby submit specifications and estimates for.: , / . ............. h 1 1 r �, c� / .........../ 1r. ............................ .................................................. ......._........_ ............. F.� '?.f�� . .........._'r.._...... i I............ , ......................... ................................... ....................... ................................ p f ropoo r hereby to furnish material and labor — complete in accordance with above specifications, for the sum OT: t/� L� dollars ($ � r � 1 � • All material is guaranteed to be as specified. All work to be completed in a workmanl alteration or deviation from above speike Authorized % • . manner according to standard practices. Any cifics• B Si nature tions involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents (Vote: This proposal may be or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. withdrawn by US it not accepted within days. our workers are fully covered by Workmen's Compensation Insurance. Acre patine pfrp D8id—The above prices, specifications Signature and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature i a C 0 � y c y F - V 'O - o R V n F- co O O W y ri W _ C 0, a c .2"Zm- W �.t.�. i- ° o o O ::oaf m O � e w h a, p IX v 00 Mg;< ;od <W �+ a o1 JQ a �: W cow L:i•fi� �', I i .aa i a � O c y F - V m D Z - o R V n F- co O cn�.!i`� W _ C 0, a c .2"Zm- W �.t.�. i- ° o o O m e w h a, p IX v 00 Mg;< ;od <W a JQ a �: W M N W L:i•fi� �', I i Q LO '7 e'7 c7 � I 0 M N D#} m D Z - J .; cn�.!i`� m ;od tb U)> e 0 G o' O` 0 0 ` s 0 00co in J O a) 4QI Z 3 w cm inOD 0