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HomeMy WebLinkAboutBuilding Permit #694 - 555 TURNPIKE STREET 5/2/2006CNUg�4 Permit NO: Date Issued: 5 '" LOCATIO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: s'�S #4 PROPERTY OWNER MAP NO.: PARCEL: TVDE' ANI" 1JQr nr Ri1T1 T%TVV- icant must Print Date Received: `( d� all items on this Ig/if-u -P-� e/t y— 6 t Print ZONING DISTRICT: 1111CTnR1r n[WRIf T VFS fl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Addition Alteration G One family jwo or more family No. of units: ❑ Industrial Repair, replacement Demolition ! Assessory Bldg j ommercial Moving (relocation) ❑ Other 0 Others: Foundation only 24 L DESCRIPTION OF WORK 10 BE PKE✓ UKMEIJ -I r tl, ( OWNER: Name: Address: CONTRACTOR Name: Address: r( Identification Please Type or Print Clearly) r. Phone: CD c/ CD /, Lr1C Phone: Supervisor's Construction License: 0SJy!zCl4 Exp. Date: o Home Improvement License: L/7 Z 17 0 Exp. Date: ARCHITECT'ENGINEER Name: Phone: ,address: Reg. No. FEE SCHEDULE: BULDLXG PERMIT: S/0.00 PER $1000.00 OF THE TOTAL ESTIJI I TED COST BASED ON $125.00 PER S.F. Total Project Cost x10.00=FEE:$�,� b� Check No.: d1)©% iw. �4 Receipt No.: Page I of 4 TYPE OF SEWARGE DISPOSAL _ Public Sewer - Tanning/Massage/Body Art i_. i Swimming Pools !_� Well i J Tobacco Sales 1- Food Packaging/Sales r 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 guaran fund Signature of Agent/Owner Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St ped Plan ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & 'DEVELOPMENT COMMENTS CONSERVATION COMMENTS DATE REJECTED ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes— Planning es_ Planning Board Decision: Conservation Decision: Water & Sewer connection signature & date Comments Comments Temp Dumpster on site yes_ no Fire Department signature, date Building Permit Approved and issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total land area, sq. ft.: NO I ES and UA I A — (hor department use Pa,e 3 ul' l )oc_ INSPec rIONAL SERVICES DI PAR mated .f A'. J an '(A'o Total square feet of Floor area, based on Exterior dimensions. 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 ❑ 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) 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 copy and proof of recording must be submitted with the building application Dor: I\SPECFIONAL SERVICES DEPARTMEN'rMFORSI05 11age 4 ol'4 .r+..r Location ..7 6J T(wo oe 44. 1tt No. 14 Date 4f I TOWN OF NORTH ANDOVER s Certificate of Occupancy $ T A,..„5 t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Y'006�5 $ TOTAL $ "Zz , Check #%O—?—Lr- `' (P 4D -(Vr 695 1911 6 7 Building Inspector m. i �n. CERTIFICATE OF LIABILITY INSURANCE °a/ a o0em' PRooucER (9T8)459-2101 Ext. Daigle Company, Albert A. 313 Wi I lard Street Dracut, NA 01828-5099 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. INSURERS AFFORDING COVERAGE NAIC !! INSURED Georgoulis Construction Inc. 96 Arlington Ave. Dracut, MA 01826 INSURER A:LIOyds London INSURERS American Now Assurance INSURER C: INSURER D: INSURER E: rnvice er_c� 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 POUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LIR WIN I TYPE OF INSURANCE POL{C.Y NUMBER POLICY EFFECTNE A POLICY EXPIRATION LIMBS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 DAMAGE T PREMISES £aaccurence IS X COMMERCIAL GENERALLIABIUTY LOL059893 02/15/2006 02/15/2007 MED EXP (Any one Person) $ 6,000.00 CLAIMS MADEI OCCUR PERSONAL& ADV INJURY $ 1,000,000.00 A GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 1,000,000.00 POLICY PRO LOC AUTOMOBILE UABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S BODILY IWURY (Par person) S ALL OWNED AUTOS SCHEDULED ALROS BODILY INJURY (Per accident) S HIRED AUTOS NON -04YNED AUTOS PROPERTY DAMAGE S (Per awidenl) I GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO H AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE S OCCUR U CLAIMS MADE S S DEDUCTIBLE S RETENTION $ WC STATU- TH- COMPENSATION AND LINT EL. EACH ACCIDENT S 100 000.00 B EMPLOYM' UABILITY ANY PROPRIETDAMARTNERIEXECUTIVE OFFICEFVMEMBER EXCLUDED? `782_66_24 09/25/2005 09/25/2006 — E.I_ DISEASE - EA EMPLOYEE S 100 000.00 H yes, "I3-4--8 eSCnbe under SPECIAL PROVISIONSbebw E.L.OtSEASE- POUGYUMIT $ 500 ON. 00 i OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISKMVS i CERTIFICATE HOLDER CANCELLATION Property Management of Andover, { nc . SHOULD ANY OF TOW ABOVE OESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION Chestnut Creen DATE THEREOF, THE ISSIANG INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 555,565, & 675 Tur np I ke Rd, NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL Andover MA 01810 IMPOSE NO OBLIGATION OR LW OFA KIND UPo4;r@ tNSURER, ITS AGENTS oR ACORD 25 (2001108) 1988 1 ��e �iamv�nan+uea.�! n�,/i�,QeaaciivaelA Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration -4 117870 Expiration: 12/12/2006 Type: Private Corporation GEORGOULIS CONSTRUCTION, INC. 19' .SCOTT GEORGOULIS 96 ARLINGTON AVEC DRACUT, MA 01826 Administrator . ��C! �!'CII/JJ1 C: il!/Jt.'[Il�/J cr�• +�n1NIC'!tf!.if'�(.S BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR to t Number: CS 058498 Birthdate: 10/2-1/1966- {f Expires: 10/21/2007 Tr. no: 5948.0 �-' Restricted: 00 SCOTT C GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Commissioner a