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HomeMy WebLinkAboutBuilding Permit #436-2011 - 530 TURNPIKE STREET 11/19/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:—/ -10// Date Received Date Issued: �� (z) MPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER /l1e-6 Y Print MAP NO:_.2 s PARCEL: /2— 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 eptic� ®Well FRT Fl odp'laan� O�+Wetl r ds°�� f 0`�Watershed District= DESCRIPTION OF WORK TO BE PERFORMED: &49 d4[/&v X144��'� I(//y,� tc1 r� 4&1!x`—T Identification Please Type or Print Clearly) OWNER: Name: 470—e-- <6/6 Phone: '173 Address: i CONTRACTOR Name: 47J,6VJGIee 5VAOeelS Phone: 617413C Za) Address: ] Supervisor's Construction License: 2Z `t3 Exp. Date: �t/ z, Home Improvement License: Exp. Date: ARCHITECT/ENGINEERPhone: Address: Reg. No. FEE SCHEDULE.BULDING PERM! •$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7/ s06) FEE: $ 5;,o Check No.: ;S-5 / Receipt No.: j2-2 7 2 7 NOTE: Persons contract n �/i unregist ed contractors do not have access to the guaranty fund *zmwn 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 I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation 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 , 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 i I ® Notifiedpickup for icku - Date Doc:.Building Permit Revised 2008 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals fiat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording iust be submitted with the building application Doc: Doe-Building Permit Revised 2008mi Location No. L��� '"���� Date 40 MORTM TOWN OF NORTH ANDOVER 9 t s ° Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2372- 7 /Building Inspector ORTI-f Andover 0" O - - ~ O . •_= tip... ��. � . INo. _ _ -- (0 dover, Mass#P_////eF// Q '�-� LAK COCMICHEWICK V ADRATE D P`? C9 qS BOARD OF HEALTH i Food/Kitchen Septic System PERMD •�" BUILDING INSPECTOR THIS CERTIFIES THAT ` Foundation ..... .................: �ry....... has permission to erect..............:..a...................... buildings on .. . ....... �............................... Rough �— a �<M O.cJ G'✓►? C / /J'/'a' .... Chimney to be occupied as...............................� l . ��E�E v� /E/F.�........................................................................................../.� .................. ...... ... provided that the person accepting this permit shall in every respect conform to 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, Afteration and Construction of Buildings in the Town of North Andover. -S A If_=,A`/- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERM EXPIRES IN ,6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .................. ......... � �.......... ............ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. Smoke Det. SEE REVERSE SIDE i � IQ •o�P � ZU m FT 3 � O u F— a PARTIAL EXIST ELEVATION SCHEMATIC SITE PLAN Lo W� � Wo Y LL, a Z Z< 0o IO IIIM. LO Z WOT CIMNIIQ 01Q mK If�iO� Il�f LVf ILS MA FQ IO WMO OGQ IA Olw[V OIMa RYIt-�IOIm PARTIAL PROPOSED ELEVATION PARTIAL ELEV AND SITE PL A2 I i I. i F 7L I TOWNE architects PD am BI Z Bck*o"02115 781 BG 4M9 i A� CERTIFICATE OF LIABILITY INSURANCE 11ATE M �) � /2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Iris Sery Of MA, Inc PHONEFAX P 0 BOX 920444 AIC No Ext: AIC No: Needham MA 02492 A DRIESS: PRODUCER CUSTOMER ID#:COMMOBUI INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Liberty Insurance COT oration 42404 Commodore Builders Corp. INSURER B:Liberty Mutual Fire Insurance Coma 23035 80 Bridge Street Newton MA 02458-119 INSURERC:North River Insurance CompanV 21105 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1555905407 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DD WVD UB POLICY EXP POLICY NUMBER MMILDDNYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY TB7Z11259847090 1/1/2010 1/1/2011 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY PRO LOC $ B AUTOMOBILE LIABILITY AS2Z11259847100 1/1/2010 1/1/2011 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ C X UMBRELLA LIAB NX OCCUR 5530930011 1/1/2010 1/1/2011 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2Z11259847080 1/1/2010 1/1/2011 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT 1$1,000,000 OFFICERIMEMBER EXCLUDED? F_� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The following are listed as additional insureds as respects General Liability where required by written contract: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood Street North Andover MA 01845 AUTHORIZED REPRESENTATIVE I_ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD