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Home My WebLink AboutBuilding Permit #729 - 54 PERLEY ROAD 5/22/20064` Permit NO: Date Issued: TOWN OF NORTHANDOVER APPLICATION FOR PLAN EXXMI'NATION Date Received: R INIPORTANT: Applicant must complete all items on this LOCATION— �JG /Z L X /Z D _ ,Print PROPERTY OW,'NER L T l Z/ o Print MAP NO.: rJ PARCEL: I t TYPE AND USE OF BUILDING TYPE OF IMPROVEMEN'l New Building Addition Alteration ✓Repair, replacement F Demolition Moving (relocation ZONING DISTRICT: HISTORIC DISTRICT YES ❑ PROPOSED USE Residential Non- Residential LE One family Two or more family No. of units: Industrial L Commercial Assessory Bldg J Other j Others: Foundation only SiI/ o o DESCRIPTION OF WORK TO BE PREFORMED R y T o /V 011 iv L- a lid c"—p Identification Please Type or Print Clearly) O) NER: Name: L 651— ! ^ 2/'a Phone• (G o -x) 13�ya- Address: :Z 2 1.✓ C'S' T -91Z a !� A R l7 w / ND h' A M m. H, CONTIUCTOR Name: A/ lj0v A. p Address: 1 7 P E A IL Y /41/. IV A s f'/ `T A- Al Supervisor's Construction License: Exp. Date: Home Improvement License: yo 6` ori' 5"/ Exp. Date: ARCHi-rECT.'F,NGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BCLDIAG PERMIT. ,510.00 PER $1000.00 OF THE TOT. IL ESTIMATED COST BASED ONS125-00 125.00 PER S• F. Total Project Cost :$_ 9 12 a el x10.00= FEE:$ 9Q _ Check No.: 7f/ -&Receipt 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 Addition Or Decks ❑ Building Permit Application • Surveyed Plot Plan o Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract o Floor/Cf Contract levation Plan Of Proposed Work With Sprinkler Plan And Hydrauli Calculations (If Applicable) o 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 cope and proof of recording must be submitted with the building application S)or: I1tiPF:("1'11)\,\l. 5ER%'I('LS DF,I' 1R'I'11EVIAPFOV105 Px—e 4 1'.t -t 4 TYPE OF SE KARGE DISPOSAL — Tanning/Massage!Body Art _ _ Stiimmin�l Pools Public Sewer Tobacco Sales — Food Packaging'Sales Well J - 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 guaranty fund Signature of Agent/Owner Signature, of Contractor a�� Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans J THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM PLANNING & DEVELOPMENT CONINIENTS CONSERVATION COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ❑ Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED HEALTH h - COMMENTS Zoning Board of Appeals: Variance. Petition No: Zoning Decision receipt submitted yes Planning Board Decision: -__— ___ _ Comments Conscruticn Decision: Comments `,Fater 6� Seater connection si nawre & date i-emp Dumpster en site yes_ no Fire Department signature date _ Building Permit Appro%cd and issued by i.e 2(.r4 Building Setback (f.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided r�ru rr. �.e�.i-.�• l/l..\JI%j Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NU I Eli and DA L\ —(For de artment use) 3,11 L:nc : ,SPEC r r; N,tL SERA ICES AIa \R I".iL 14 !' L:PI ORNIO . (LV i ail- .1.1.::.".. Location y' �% �� 61 12W - i No. 5� Date Z F TOWN OF NORTH ANDOVER Certificate of Occupancy $ cNuBuilding/Frame Permit Fee $ -3y s�st Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19,198 Building Inspector m X m m m y mm v y d C � � d 'v O co az y CL �• r C � � C d 5 CO) o CD o p CDCL o c� d CD CD C CD y —• CD FL, C2 y —• O CD � v CO) O CD CD Z O CD O CD rC C ? 0 O O = G A �yOC M ao m =� m C.)n0 m CA H CL .. ao �O m y 0 y N� O IE m O a 7 = con ; n O olj O y Cl m r� C a N . � Nil n o _ O Sr U)m �O�Q n y o m y f 7 A N CL0 _ A Q cn a 1 J N U m .19 -0 fA -� ti ;' _ 1 wC o C.) V1 n CD, o co): CD r' = m _ CL's 0. 5' cn o� M ITI 71 qa n � -M ro n w Co G �- w z y cn al \ CD d :d )nq 0 9 0 c J14 el.� Board of ByilcLug Regulations and Standards HOME IMPROVEMENT CONTRACTOR.. Re 11 R 105881 lfoomm 1/2006'. t • =� .� *� Ii�e f viduai THEODORE G. NDp Ali r Theotfore 27 Perry Avenue Nashua, NH 03060 �_. . Administrator /ze'omvnwouuca/�/a N�Utn`b�r 02088'9 T.r. no 21469 THS 27 P<ERY AUE p 4'i G- ` NASHLaA, NM=:0360 ',` Gommtssioner 00-3� 5 Opp cf:ericlosed:�space (MGL C 112 S:60L) IA - Masonry.only I G -1 & 2 Family Homes Failure to possess a -current editiomof the Massachusetts State -Building Code is cause for revocation of this license. OIG -E CALL CENTERt (888) 344J233 y CERTIFICATE OF INSURANCE04/28/2005 ISSUE ;:PRODUCER Foy Insurance Agency LLC 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. 350. Main Street Nashua, .NH 03060 COMPANIES AFFORDING COVERAGE INSURED Theodore G Van Doorne Jr dba Teds Home Improvements COMPANY LETTER AA.I.M. Mutual Insurance Co 27 Perry Ave Nashua, NH 03060 COVERAGES 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 RESPECTTO 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY) POLICY EXPIRATION. DATE(MM/DD%YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ tERCIAL CLAIMS MADE�CCUR PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ 'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one lire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ SCHEDULED AUTOS -.. .. BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM 0 KER'S COMPENSATION AND X w A T Y HER LIMITS A MPLOYERS' LIABILITY HE PROPRIETOR/ INCL ARTNERS/EXECUTIVE 7013701012004 08/20/2004 08/20/2005 EL EACH ACCIDENT $ 100,000 EL DISEASE --POLICY LIMIT $ 500,000 EL DISEASE—EACH EMPLOYEE $ 100 000 FFICERS ARE X EXCL I. OTHER DESCRIPTION OF OPERAI'IONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Workers Compensation Coverage applies to Massachusetts Employees. Only.. *The Insured's Projects are in the Commonwealth of Massachusetts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE THEODORE G VAN DOORNE, JR EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE dba TED'S HOME IMPROVEMENTS LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 27 PERRY AVENUE LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE NASHUA, NH 03060 TED'S HOME IMPROVEMENTS 27 PERRY AVENUE NASHUA, NH 03060 r TELEPHONE (603) 889-4736 FAX (603) 889-7362 Dianne Letizio 05/15/06 22 West Shore Road, Windham, NH 03087 I will do the following work at 56 Pearly Road in N. Andover, MA - Install New IKO Aristocrat Charcoal Gray roof shingles over the old roof - Install a new Rig Vent I will guarantee the roof for 1 year against any workmanship on my part and against any leaks under normal circumstances. I will not warrantee against acts of God such as high winds, falling trees, ice back ups, which could cause leaks. For the total amount of $ 2,800.00, which includes labor and material. Payments are to be made in the following manner. $1,200.00 at the start of the job, and final payment of $1,600.00 to be made at completion of job. Thank you, Home Owl—T 01 Date" d;(� Date Contractor 7 ,L , �� l%