Loading...
HomeMy WebLinkAboutBuilding Permit #030-2011 - 51 MAYFLOWER DRIVE 7/2/2010 i BUILDING PERMIT Of NoeTh 1 TOWN OF NORTH ANDOVER 32 °`�t'' ` "6*° �0 APPLICATION FOR PLAN EXAMINATION * _ _ r ,�0 /1 . e.� Permit NO: Date Received ��SSACHUS���� Date Issued: 2 �� MPORTANT:Applicant must complete all items on this page LOCATION � 4 FLpu..r ;11 t n PROPERTY OWNER --art Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building S@e eem fljS dition y wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: ye iL $K�Sh�rc C. �ectg, �•�, T e6,t . Iden�f cation Please Type or Print Clearly) OWNER: Name: 1�e.� • we 1.L . Phone•1*2 108 3ltr.+j Address: 10 4e-e4 !coo CONTRACTOR Name: lk�46"11A ., C (QA-00tPhone i� Address: Col 1. e.. w.6 a og4 - o n Supervisor's Construction License: CS Z 3d-'). Exp. Date: It; 010 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 6SLUV �,-G', ' .hone: Address: Te4�'n.6. , KA 15, Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ ! 0,bo FEE: $ / Check No.: `7 �9 Receipt No.: `�d G NOTE: Persons contracting with unregistered contgactors do not have access to the guaranty fund Signature of A ent/Owner� -- _ _ __.g_ __ e Signature of contractor 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS t • a CONSERVATION Reviewed on Signature - , COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: VEjriance, Petition No: ..-Zoning Decision/receipt submitted yes f Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway-Permit �y 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.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 ❑ 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 i i ❑ 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) j ❑ 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:Building Permit Revised 2008 Location No. (7 —,�a // Date 7 �� MpRTIr TOWN OF NORTH ANDOVER -� 3? • �0 1 9 • Certificate of Occupancy $ ;�b',••° '<�' Building/Frame/Frame Permit Fee $ /yy ss�CHusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 1 2 3 0 6 Building Inspector O ,'O Tp, io M ° u ra`lq CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 030-2011 Date: July 27, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 51 Mayflower Drive, North Andover, MA, Lot 22 MAY BE OCCUPIED AS residential single-family IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Key Lime Inc. 10 Hepatica Drive North Andover MA 01845 Building Inspector Fee: $100.00 Receipt: 23183 Cf NORTH 7M 02 I• ~ 9 f ; • �r �SSACHUSE� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 030-2011 Date: July 27, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 51 Mayflower Drive, North Andover, MA, Lot 22 MAY BE OCCUPIED AS residential single-family IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Key Lime Inc. 10 Hepatica Drive North Andover MA 01845 Building Inspector Fee: $100.00 Receipt: 23183 NORTH TO" of6Andover No. / LAK o dover, Mass., O �. COCMICHEWICK V AD RA TED S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. :/.......... ................ ............................................................................. Foundation has permission to erect.........:.....:........................ buildings on .��—.. ... � I�...A.. . :........ Rough to be occupied as.............. ,`� .. ...y...�..�� �,%� cc ...../ 4�� / c� .. ' �`� h� ey provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Fina this office, and to.the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of �f 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 CONSTRUCTIONS TS .. ...�. ............. ..... ....firz'z�••••.... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. �Z Street No. Smoke Det. SEE REVERSE SIDE 7- 2-51�-- :iv F Tov' m Of : Andover . No. f _ dover, Mass., 7• ev " O -- LAKE 7. COC HI C ME WICK V AORA TED S BOARD OF HEALTH Food/Kitchen Sic;S+st in ? { 2 . )jPERMIT T D zV ' BUILDING INSPECTOR THIS CERTIFIES THAT ............ / .. Fot has permission to erect. buildings on T/.....fl*..vabw ..41.0ma ...a ot atRou to be occupied as....�j.�r. ,.... ..... ...... ....... .....Z... �./�....... .. ... nina�� provided that the person accepting this permits ail in every respect conform the terms of the ap icatio n file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 'fPLUMB114G INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ' d���h�d g y Z or PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TARTS , ELECTRICAL .......... ............ ............................ ....... ........ r`se ? BUILDING PECTOR 12 Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough il a Display n a Conspicuous Place on the Premises — Do Not Remove Fi� No Lathing or Dry. Wall To BeZ. Done FIRE DEPARTMEN Until Inspected and Approved by the Building Inspector. Street No. SEE REVERSE SID �. �� -7 ,) � Smoke Det. 51 i '1ORTH O " M a Tao ` `HuAPPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit# /5/ i� 03o -c;mr/ ADDRESS/LOCATION OF PROPERTY : �yE-"�c wife Map /67 Parcel am/Cs Lot Number oZal- SUBDIVISION 19,E_n S#tdhi DATE REQUESTED FILED/READY FOR INSPECTION -7 lr?obo CLOSING DATE ON PROPERTY: c�/a ♦a FIVE(5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Address SIGNED ROUTIN CONSERVATION PLANNING q17A711 � DPW. WATER METER SEWERIWATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW o L7 kv Signature Fite: Application for OC form revised Jan 2007 NORTH Town of 6 Andover No. ]( o dower, Mass. T O �' LAK . 1 1 COCMICMEWICK y1. ADRATE D 0`?���5 `S U BOARD OF HEALTH jPERMIT Food/Kitchen 1 T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. .. C:. ............................. . ..a-'. ............................................................................. Foundation has permission to erect.................:...................... buildings on , f ... � � A � - Rough �`°��'SG1 ! -� �! �i'�i�; G� Chimney to be occupied as �.� - - � �.. ��°' ...�` y .......... ............... ... .....:..... ....... ................................ ............................................. .. provided that the person accepting this permit shall in every respect conform o the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating 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 CONSTRUCTIONS TS Rough .......,, �...� :-'y'� .................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NORTH ® of 4Andover O No. _ ori dover, Mass., 07s 6 0 A� COC MIC ME WICK ��� ADRATED S BOARD OF HEALTH M D PER I T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........101�.. ...... ...`I.. .... ....,.............. ......... ........................................................ ............ Foundation has permission to erect........................................ buildings on � W. ►........... ..w ....t Z Rough to be occupied as....�j1.S'4..... . . . ..... �..2...I(.*.�.... � Chimney provided that the arson acce tin this ermit s all in eve respect conform tQthe terms of theAicatio n file inP P P g P ry P PFinal this office, and to the provisions of the Codes and By-Laws relating 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. �u ��lU���°9 i Final 42,01 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR OCJ UNLESS CONSTRUC TARTS Rough 1 av �BUILDING ... ............... ..................... ...... Service PECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final T No Lathing or Dry Wall I o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. iNlassachusetts- Department of Public Safeh Board of BuildingRei, ulations and Standards Construction Supervisor License License: CS 75302 Restricted to: 00 BENJAMIN C OSGOOD 69 OLD VILLAGE LANE NO ANDOVER, MA 01845 c-- J"�" 'y�/�` Expiration: 12/4(2010 (unmii..ioner Tr#: 6955 I, I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts NCCI NO 40959 (800)876-2765 POLICY NO. I WCC 5007581012009 PRIOR NO. WCC 5007581012008 ITEM 1. The Insured Key Lime Inc Mailing Address: 10 Hepatica Drive North Andover MA 01845 (No. Street Town or City County State Zip Code ❑ Individual ❑ Partnership ® Corporation ❑ Other FEIN 04-3311218 i Other workplaces not shown above: 2. The policy period is frorr109/15/2009 t009/15/2010 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident$ 1,000,000 each accident Bodily Injury byDisease $ 1,000,000 policylimit Bodily injury byDisease $ 1,000,000 eachemployee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change g by audit. Classifications Premium Basis Rates Estimated Per$100 Estimated Code Total Annual of Annual No. Remuneration Remuneration Premium INTRA 285896 SEE EXTENSION OF INFORf 1ATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 2,846.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 755.00 E] Annually ❑ Semi Annually ® Quarterly El monthly MA Assessment Chg. $2,419.86 x 7.2000% $174.00 08/25/2009 This policy,including all endorsements,is hereby countersigned by Authorized Signature Date GOV GOV KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP The Fairway Agency Inc MA 15645 123 1505 1 305 Forest Street Bridgewater,MA 02324 WC 00 00 01 A(11-88) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission.