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Home My WebLink AboutBuilding Permit #569-12 - 53 HEPATICA DRIVE 1/27/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: J 6 9, 2 Date Received Date Issued: . IMPORTANT: Applicant must com Tete all items on this page LOCATION _53 /'S'emk,¢ 1>eya- 11 Print PROPERTY OWNER Z T 4 !Z 2 10a /e At Unit# Print MAP NO:/4Z-3 PARCEL: /6 ZONING DISTRICT: R Historic District yes Co Machine Shop Village yes 100 year-old structure yes no 1-1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ' ❑Two or more family ❑ Industrial ❑Alteration, No. of units: ❑ Commercial e air replacement ❑Assessory Bldg El Others: p ❑ Demolition ❑ Other ❑ Septic ❑ Well, 0 Floodplain, O.Wetlands, 0 .Wate_rshed'District le'lCter/Sewer, DESCRIPTION OF WORK TO BE PERFORMED: o (Identification Please Type or Print Clearly) OWNER: Name: A4 912 so, e- Phone: Address: 5C3 �i�e/,¢,4'c be 61 t CONTRACTOR Name: tre,/ 1, ns G ,(zC . Phone: `174f-4,83 -3/&_4 Address: jo Supervisor's Construction License: CSS 7S.3o3- Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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: $A7, ova - c4 eaa FEE: $ 9�; -®o ' Check No.: J3s/J Receipt No.: 9 ,1/�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ovvner Signature of contract C Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL I Public Sewer F1Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales U •...,: •. 1 -`tip -•c•• Private,(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i♦y, THE FOLLOWING SECTIONS FOR OFFICE USE ONLY c v� INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED F PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS • ' , 4 ��; : `1 r;t. Zoning Board of Appeals:variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Comarvation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit 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 A 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 Z uilding Permit Application Porkers Com Affidavit Photo p Co of H.I Copy.of .C. And/Or C.S.L. Licenses 94— Copy of Contract /iia- Floor Plan Or Proposed Interior Work V4- Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit E Addition or Decks o Building Permit Application o Certified Surveyed Plot lot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report a 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: Doc.Building Permit Revised'2008mi Location___J�.3 f4 �1 G 4 No. ( Date 9//� 7 7— MORT1y TOWN OF NORTH ANDOVER 3? • O 10. R :F A I }�o Certificate of Occupancy $ ;�s""'O'•tt' cwust Building/Frame Permit Fee $ �� Cs� F Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 4 24962 Building Inspector k P{ NORTH T0VM Of Andover, . No. dover, Mass., 2 7// T O LAKE T I)I COC MIC HE WICK y1• I DRATED 1III 77 f� BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT......... ........ ...... ................................... .............. ..... .......................................................................... Foundation _ E�ftI G G "�J ' ..... buildings on Rough has permission to erect...:............................... ..�..... .. ....... ........................... ../...�.....f..................... 1 + to be occupied as.......................... .s�'.....I(.- ..... �E.r?....� ��a� Chimney provided that the person accepting his permit shall in every respect conforn:i#dthe 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 I VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EMPIRES IN 6 MONTHS ELECTRICAL INSPECTOR, UNLESS CONSTRUCTITcmptyyy TS Rough - �:::: ....................... service Final Occupancy Permit Required t® lding 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--Budding Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. i WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue,Burlington,Massachusetts 01803 (800)876.2765 NCC1 NO 40959 POLICY NO. WCC 5007581012011 PRIOR NO. WCC 5407581012010 ITEM i The insured Key Lime Inc Mail Address: 10 Hepatica Drive North Andover MA 01845 Street No. Town or City County State Zip Code FEIN xxxxx1218 []individual ❑Partnership ®Corporation []JointVenture ❑Association ❑other Other workplaces not shown above: 2. The policy period is from 09/15/2011 to 09115/2012 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 by Disease $ 1.000,000 policy limit Bodily Injury by Disease $ 1.000.000 each employee C. Other States Insurance:Coverage Replaced By Endorsement=20 03 06A D. This policy includes these endorsements and schedules:SEE SCHEDULE i 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 by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium i INTRA 285896 SEE E TENSION OF INFORMATIC N PAGE i I I Minli-num premium$ 500.00 Total Estimated Annual Premium $ 4,426.00 As indicated interim adjustments of premium shall be made: Deposit Premium $ 1,165.00 ❑ Aninualiy ❑ Semi Annually ® Quarterly ❑ Monthly MAAssessment Chg. $3,983.19 x 5.9000% �J $235.00 This policy,!'eluding all endorsements,is hereby countersigned by . 07/08/2011 Authorized Signature Date GO V GOV KIND PLACING CLAIM NAME SAFETY M P Roberts Insurance Agency STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Inc, MA 5645 14 505 1060 Osgood Street North Andover,MA 01845 INC 00 00 011 A(7-11) Includas copyrighted material of the National Council on Compensation Insurance, used vith Is permission. i i !<l:tssachusetts- Departm Board of of'PLlalic Sal'et3 Building Re, and nd Standar Construction s pervisor License d license: CS 75302 BENJAMIN C OSGOOD 69 OLD VILLAGE LANE NO ANDOVER;MA 0184 ('ur'rmi,4irrcr 6XPiration: 12/ 4/2012 Tr#: 6267 . ... i II 7Q U1RICE It.MAP7i.+N P.E. 198 EAST MAIN STREET GF,ORG TOWN,MA 01833 9'7WS24LI1�p8y fu�p/y978-3,32-2558 eali 9 t�502-5921 Oetoba 31,2412 Mr, ft#amm, Osgood fax to 975.685-1,099 Key Lime Inc. 10 Heptica Drive North Andover,MA. 01845 RE:Unit"If',Lot 3 cold Salem Village,North Andover Dear Mr. Osgood As you requested I visited the site 1451112 to review the installation of the Engineend Materials consisting of L VI,3 WAMs utilized in the fhMing of the terve project.Ttwse are shown on plaits blared by O'Sulliv=A c'hitects Dated 6-8-09,with the framing sleets certified by me 6114109. bused on the above site"'V-4 it ai d l ,u what'I could visibly see; 1 can Certify that to the best of my lmowlO die is lmon'iprof I s and Steed Beam members utilized in the ftming as shown on the,,br wng.s',am installed properly and meet the loading conditions of the'�b Edition 6f the Massachusetts State Building Ladle for 1&2 Fancily Residences. All other framing requirements of the dtauda�and code,including but not limited to u?ata ials,nailing schedules,blocking,corrections,manufactures requirements and other deails erre the responsibility of the licensed constructionsupervisor responsible for the project. Should you have any questions please do not hesitate to call. Yours mealy, a� Law IH, Ogden D.E, StricWral 27765" ��i►P4��4P ISTD IVAt 6% i I