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HomeMy WebLinkAboutBuilding Permit #769 - 50 WILLOW RIDGE ROAD 6/24/2008Permit NO: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION S13U L k l 4k? <-'- c� �R- PROPERTY OWNER PA'0Cv k N _ Print 0�t LQC ib*'NO\ / Print MAP NO:! 9% PARCEL: ZONING DISTRICT: Historic District yes no :Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCR TION OF WORK TO BE PREFORMED: Type or Print Clearly) OWNER: Name: Address: Jd O t t�45W W\� CONTRACTOR Name: .60- 9 03 91 t -W04 - NO Address; Supervisor's Construction License: Exp. Date; Home Improvement License: I lc, ARCHITECT/ENGINEE Address: Phone: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASEED' ON $125.00 PER S.F. Total Project Cost: $ -cc FEE: $ (� Check No.: 67 o Receipt No.: 2 y NOTE: Persons contracting with unregistered contractors do not have access to -Me guaranty fund Signature of Agent/Owner Signature of contractor_ f� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION 4 COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on . Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FERE DEPARTMENT Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street yes no 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 No 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified 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) ❑ 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 ❑ 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 ❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location , No. Date 2 611""? - TOWN OF NORTH ANDOVER S Certificate of Occupancy $ \sA .ISt<Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4 A 2 L 7 Building Inspector r Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Cvontractor Registration -` Registration: 137193 Type: Supplement Card Expiration: 10/15/2008 'r BAY STATE ROOFER INC. ROBERT O'KEEFE �` f 240 PARK ST. " e' ,�, �.... Update Address and return card. Mark N. READING, MA 01864 reason for Address E] Renewal Employment LostCard DPS-CA1 io 50M-05/06-PC8490 a a N s. n. x A p w OU z Cd -5 C a .G G x AG O W p n: G ii AG O W W U a LU x p w uu�w y cn C w H U O r.4 G w W A v as z U) cn co O E C L O V Z CD C= O H � COw+ C tm I O O gco) CD m m CD 0 CD .0-/ CD co o O d C! Q c o � eacc v —J -0 O C Z CD �..� CO)CL c C C CO) 0 uj Y/ W 09 W W W N o c� o ` C 4- C2 O C= C A W CD C ;t O EQ o V ID 0 CL Q - N \�\ Ec O V Cf O 3 _ C C � m � ca �yo c I --ca -v V \^ �L N m 4:D,. m 12 05 O cm CM o -Q CL 0.2 r- m H O C-1ca 200 Z O r c �' O C ~ O. m i m C •O Q = m C W W ca ev m O 'O "re MD yam,,, O CO d= C .E r o •y fl Z O W w v CM ca O Q COD D. O � O 'O = CDH O _ =.-a�m� co O E C L O V Z CD C= O H � COw+ C tm I O O gco) CD m m CD 0 CD .0-/ CD co o O d C! Q c o � eacc v —J -0 O C Z CD �..� CO)CL c C C CO) 0 uj Y/ W 09 W W W N N 8 (MMIDD ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID S3 DAT 4/22 08 BAYSTI4 04 22/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MacIntyre Fay & Thayer Ins Agy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norwell MA 02061 Phone: 781-261-2000 Fax:781-261-2099 INSURERS AFFORDING COVERAGE NAIC#_ INSURED INSURER A' National Union Fire Insu_rance_- INSURER 8: J' Bay State Roofers Inc. 'INSURER C: PO Box 189 ( INSURER D: North Reading MA 01864 ---- —�' ---` 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 ont ­rQ A!]rSGPreTa t IWTR cwnVM MAY NAVE- BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM DDYY i DATE MIDDmO� LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -UAMAGE70 RENI-EU-- PREMISES {Ea oec irence) —._.. $ MED EXP (Any one person) $ CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ ( I GENERAL AGGREGATE I$ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG ` $ _- POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS I t HIRED AUTOS ` ( BODILY INJURY (Per accident) $ ( f NON -OWNED AUTOS -- - PROPERTY DAMAGE (Per accident) $ --- GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $- ANY AUTO ---- - $ I EXCESSfUMBRELLA LIABILITY EACH OCCURRENCE $ — _ AGGREGATE $ --- -- I (—� OCCUR C 4 J CLAIMS MADE o --- $ -- DEDUCTIBLE -•-- ---- RETENTION $ A WORKERS COMPENSATION AND • EMPLOYERS'LiABILITY531-5167 ANY PROPRIETORIPARTNERIEXECUTIVE i OFFICER/MEMBEREXCLUDED? 04/03/08 04/03/09 TORY LIMITS ER_ - E.L. EACH ACCIDENT $ 500000 - ' E.L. DISEASE -EA EMPLOYEE $ SOOOOO E.L. DISEASE - POLICY LIMIT $ 500000 j if yes, describe under i SPECIAL PROVISIONS below ` 1 OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of WC insurance for Insured while acting in the scope of their normal operations. CERTIFICATE HOLDER EVOFINS Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI01 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. OACORD CORPORATION 198 ACORD 25 (2001108) Glientiv tsui*4 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE Dmrv) I 04121108 PRODUCER CAD -Commercial Insurance HUB INTL New England, LLC PO Box 9146 Norwell, MA 02061-9146 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 Bay State Roofers, Inc. P.O. Box 189 North Reading, MA 01864 INSURER A: Nautilus Ins. Co. INSURER B: Safety Insurance Company INSURER C: INSURER D: 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. LTR A NSR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR POLICY NUMBER NC584521 POLICY EFFECTIVE DATE MMIDDIYY 10/24/07 POLICY EXPIRATION DATE MMIDDNY 10/24/08 LIMITS EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $50 000 PREMISES (Ea occurrencel MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2 000 000 PRODUCTS - COMP/OP AGG s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT E LOC B AUTOMOBILE LIABILITY 2433055 10/24/07 10/24/08 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS ' PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WIRY C STATU- OTH- TLIMITS IR WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS As respects operations normal to insured .04 Bay State Roofers, Inc. P.O. Box 189 North Reading, MA 01864 ACORD 25 (2001108) 1 of 2 #514UUZ3IM14uu1y WOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION )ATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0DAYS WRITTEN JOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL MPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE c ro n ACORD CORPORATION 1988