The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #353 - 55 DAVIS STREET 11/1/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o�t NO4ORT1y f°- 'A Permit NO: Date Received Date Issued: Are nP'�g5 SSACHUS� IMPORTANT: Applicant must complete all items on this page LOCATION 55 7+►v S S"1 Print PROPERTY OWNER _,9!, „.1„ M NdE Nw,,)1e ti Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 5(One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: iX Repair, replacement ❑ Assessory Bldg ❑ Commercial Demolition Moving(relocation) ❑Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identifieation Please Type or Print Clearly) OWNER: Name:_Tow. a.io R a,1 E N w,.a t'e!3 Phone (118 ) togs- S V Address: -55 'b,4,;,3 s T CONTRACTOR Name: y f AA cn c4 Qu, Idc ry Tac. Phone.• ct 72 X(6 N__68(a 13 Address: �I. o . a'3 d� �3 Lu.4r..J 6U,, A%64 o►y 6 Z Supervisor's Construction License: C S 05%4315 Exp. Date:. 5--10 -02 Home Improvement License: I a&.9 S t Exp. Date: 8-1.2 - 08 ARCHITECT/ENGINEER Al /4 Name: Phone: .Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.812.00�;ER 81000.00 OF THE TOTAL ESTIMATED COST BAS ON,8'125.00 PER S.F. Total Project Cost :$�� fe�y.ao FEE:$_ ? Check No.:-151)qReceipt No.: Page lot'4 i Location �� Gf cJl No. Date f +" I NORTh TOWN OF NORTH ANDOVER 0 • a 09 Certificate of Occupancy $ ` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -2 3 19754 Building ns ec or i TYPE OF SEWERAGE DISPOSAL Swimming Pools G Tanning/Massage/Body Art Public Sewer Tobacco Sales ❑ Food Packaging/Sales Ell Well I 'J I� Permanent Dumpster on Site Private(septic tank,etc. ._.J Electric Meter location to project NOTE: Persons contracting wid inregistered contractors do not have access to the guaranty fund Signature of Agent/Owne ignature of contractor Plans Submitted ❑ Plans Waived ❑ Ce ' ted Plot Plan ❑ tamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision,receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer connection/Sip-nature& Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided I o w Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use) Page 3 of-4 Doc:INSPECTIONAL SERVICES DEPARTMENT 13PFORMO> Oeated JNIC Jan-'006 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 o Building Permit Application ❑ Workers Comp Affidavit o 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 ❑ Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses L3 Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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 a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan An Hydraulic Calculations (If Applicable) d ❑ Copy of Contract a 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 copy and proof of recording must be submitted with the building application Doc:LVSPE('TIONAL SERVICES DEPAR'1'.NEN'f:BPFOR NIIIS i I i i Page 4 of 4 i Town of -:u ,- Andover No. S� C' LAKE 10 " dower1 Mass., COCHICHEWICK%V * ArED C5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT..... 44 6o BUILDING INSPECTOR ......................................[u%17................................................................................ Foundation has permission to ere A....................................... UildingS on ...............SV....... ...... ..... Rough & Chimney .. ........ to be occupied as.... ..6-hAIA.........%. . ...os-L4.,t.x....................................... provided that the pe on accepting this permit siaii'm every respect conform to the ternis 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 1sop� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUTS S Rough - ......... Service ..... ........... .... BUILDING H*4SF%FUWR 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. , ✓/ie 70bsleo�uireau� 0T✓��4dl�uada Y.. BOAl��J i?i~.BUtLaIW'Cy RGU.LA'f 10N fi License: CONSTRUCTION SUF�HRUI$bR.` ' NumtSeirS 0543`75 F a Sir! Q 1 ?1965 i YF Bf Oli{1� '8 Tr.nt. 246n ` Re ri l f da- SCOTT SCOTT J PEA' t' 53 HIGHLAND LUNEN$URG, 4 co nmkiiCner ��ie �omrmzdruural!/� a��/�aaaac�utaef� __..-. Board of Building Regulations and Standards HOME IMPRr OVEMENT CONTRACTOR t' Registration:; 126959 Epkatipn 6/12/2008 Tr# 124708 SCOTT JAMES PEAbr- SCOTT PEACOCK 53 HIGHLAND ST. LUNENBURG, MA 01462 Administrator Ito S yX Y �os,— $� aq Ic s5 oy Ce.�T E,ti -36 1-4 2X2' �E1�( isrtrs q" O.C. STAw,At APPLICATION FOR A PERMIT TO INSTALL FURNACES, BOILERS, ' ROOF TOP UNITS, AIR CONDITIONERS, EMERGENCY GENERATORS 19 TO,THE NORTH ANDOVER INSPECTIONAL SERVICE DEPARTMENT The undersigned applies for a permit to install the following at: Location Owner of permises Address Name of mechanic Address Building occupied for Material of building Kind of fuel Chimney No. of flues Size Chimney Thickness Lining If steel stack location Diameter Height DESCRIPTION OF HEATING APPARATUS Kind of heater How many Make BTU Input Location in building Protected against fire as required How protected See the State Code (Pertaining to Chimneys, smokestacks and heating apparatus). ROOF TOP UNITS OR EMERGENCY GENERATORS Make Weight Dimensions Length Width Height Location in buiding How supported Size of roof timbers Material of roof timbers Span of roof timbers Distance on center Protected against fire as required How protected AIR CONDITIONS Kind of apparatus Make HVAC FORM REVISED 3/6/98 S.!J. COCK BUILDERS, INC. Contract P. 0. Box 631 Lunenburg, MA 01462 Date contract# (978) 582-0708 Office/Fax 9/10/2006 443 BUILT WITH PRIDE Name/Address Tom & Anne Hawley 55 Davis Rd North Andover, MA 01845 Location Description Total Quote to replace front steps and railing on existing farmers porch: 6,400.00 -Provide all permits necessary to complete work -Remove and dispose of existing stairs and railings -Install new railing similar to existing -Install new wood stairs and railings to match existing -Remove all excess building materials and debris Note: Price with vinyl railings is $7,800. We thank you for your business. Scott J. Peacock Total $6,400.00 Acceptance Signature //JW Fax Server 11/1/2006 10:30:56 AM PAGE 2/003 Fax Server DATE(MM/DD/YYYY) A CORD TM. CERTIFICATE OF LIABILITY INSURANCE 1110112006 PRODUCER Phone: (781)933-3100 Fax (781)933-9048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SALEM FIVE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOYLE INSURANCE SERVICES HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 445 MAIN ST BOX 806 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WOBURN MA 01801 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: ACADIA INSURANCE COMPANY S J PEACOCK BUILDERS INC INSURER B: COMMERCE INSURANCE COMPANY PO BOX 631 INSURER C: AMERICAN INTERNATIONAL GROUP LUNENSURG MA 01462 INSURER D: INSURER E: COVERAGES THE PCLfCIES 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.AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIR SRADULI TYPE OF INSURANCE POLICY NUMBER OL EYEFFECTNE P��EXFIRA710N LIMITS RGIROGENERALLIABWTY CPA015955910 11120105 11/20;'66 EACH OCCURRENCE $ 1,000,060 DAMACOMMERCIAL GENERAL LIABILITY PREMISES EO $ 250,000 PREMISES Es oceuerCe CLAtMSMADE®OCCUR M ED.EXP(Arty one person) $ (how A PERSONAL&ADV INJURY $ 1,000,OOO GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATELIMR APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 PRO- POLICY JECT LOC AUTOMOBILEUABIUTY WY0465 04115106 04115107 COMEINEDSINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ 500,000 X HIRED AUTOS BODILY INJURY X NON-OWNEO AUTOS (Per accident) $ 601)'m PROPERTY DAMAGE - $ 500,000 (Per accident GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F]CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE is RETENTIONS y WORKERS COMPENSATION AND WC8959205 04/01106 04101107 ORr LIMITS DT"�" EMPLOYERS'LIABILITY C ANY PROPMETORIPARTNERIEXECUrNE E.L.EACH ACCIDENT $ 500,002 OFFCERrMEWFREXCLUDED? E.L.DISEASE-EA EMPLOYEE 8 500,000 eyn,dn ib.urd.r SPECIAL PROVISIONS MI.. E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS job:55 David Road North Andover CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1800 OSGOOD ST EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE NORTH ANDOVER MA 01845 TO DO SO SHALL IMPOSE NO CSUGATION OR LIABILITY OF ANY KIND UPON THE ENSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: BRIAN LEATHE Gerard F B Jr ACORD 25(2001108) Certificate# 7025 C ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02,111 www.mass.b'ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): (� �C-i4COC4 Address: I� b ' fax 3 City/State/Zip: ill 4 Phone #: 78J a 6r— 6g C S Arean employer?Check the appropriate box: Type of project(required): 1.ff I am a employer with 4. ❑ 1 atn a general contractor and 1 6. ❑ Ne onstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.F] Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'coin pen sat ion policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in formation. Insurance Company Name: l�irtri,�n.� in/Te i/V A ��••J`► Policy#or Self-ins. Lic. #: &1e 09-5- 9 abs Expiration Date: /•—a 7 Job Site Address: 5J P A City/State/Zip: (Q A a)J6 c. n>A ( y 5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby certify under Nue pains and penalties of perjury that the information provided above is true and correct. Si.nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: