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HomeMy WebLinkAboutBuilding Permit #209 - 57 BOXFORD STREET 9/20/2006 i J TOWN OF NORTH ANDOVER VtORTH Ii APPLICATION FOR PLAN EXAMINATION 3?0�t b;�tioL j Permit NO: - Date Received llrr -zo •Z)coop + f 7 4p�A%ro p Date Issued: 9SsgcHus�� IMPORTANT: Applicant must complete all items on this page '� LOCATION 2 +U UX J of Print PROPERTY OWNER 1�?o kn' JQ cJ/ Qn 1 Pnnt MAP N PARCEL: 6 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building [YOne family ❑ Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: 19-4epair,replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑ Other 57L ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification M.Please Type or Prin learly) OWNER: Name: o Phon 9) F- Address: S,7 Ank InazV+ CONTRACTOR Name: ,UqMes �yPG�/, l� Phone( 9-�e) Address: �` -1 S/�''�� /0hc, � Supervisor's Construction License: O'&6-S,;�CJ Exp. Date: %Z// 0 4 Home Improvement License: / 6 7 Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATE ST BAS D ON$125.00 PER S.F. Total Project Cost :$ as FEE:$ Check No.: v�a� Receipt No.: ! / Page Iof4 Location,S'4 6" No. U Date , �T r. NaRTM TOWN OF NORTH ANDOVER Cf, �•o .•,h � 9 ' Certificate of Occupancy $ sNUs t� Building/Frame Permit Fee $ Foundation Permit Fee $ F Other Permit Fee $ TOTAL $ Check # 19594 Building Inspector i TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art ❑ , Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales El❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to proj ect NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contracto Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ { THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ 1 I I COMMENTS i, DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED I HEALTH ❑ ❑ COMMENTS J � 1 FIRE DEPARTMENT - Temp Dumpster on site yes no 4� ' Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature&Date Drivewav Permit r I i f Building Setback (ft. Front Yard Side Yard Rear Yard Re wired Provided Required Provides Required Provided 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) r i Page 3 of'4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 r 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 ❑ 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) o Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 --4 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 • ,§ PRODUCT 118 a MUNRO GRAPHICS (978)682-0699 ----- r������ Page No. of Pages J & J Roofing Specializing in All Types of Roofing - Ventilation - Carpentry 978-683-2968 603-898-1058 i PROPOSAL S61111EI TO PHONE DP.TE STREET JOB NAME IV CITY.STATE and ZIP CODE JOB LOCATION i Av N r)Jc,,l e< 6-� o Yg 5 � ARCHITECT r DATE OF PLANS JOB PHONE I We hereby submit specifications and estimates for: C;,r d +f-A t'1......�.Gc ( .... t�ly t•.wcc;c la j u rm t s7 u M C t'.�..�).. _�'. .�. fir ..� .��.c ..�7�i't_vvA +..e.s kL .Y... ........ .... .... .. ............ rckce- t ceC, eCAve- rcx;- enc( 'S 7L �� c k / �� - i, I� i' Ir 1'ie' JOr05Y Hereby to furnish material and labor— complete in accordance with above specifications, for the sum of: Payment to =�made as follows: i— -y� /��+ _ dollars($ 7 O( '6 l _). rt ;i r.Ii material is ��arant,ed to ce as s e ifs d. A — . ranne accordin to st nasri ces.An I 'rook to be completed in a workmanlike 5 `c` Y altG'ratio A horized r,volving extra costs will be axecuted onrr up�r n or deviation from above specifications Signature cn=rge cver ani above ah- astimate. A11 ag F �'nhen orCers. and will become an extra P Ements contingent upon strikes. accidents or relays oey nc our crntroi. O:Her to carry firE tornado ani other necessary insurance. ote:This proposal mallbe Our wcrkars are sully covc-reo by VvorKman's Y v ompensaiion Insurance. withdrawn by us if not accepted within days. ) raptance cif j3raptn41 —]-he abode prices, specifications conditionsaro to do thewo k as specifiea rPay entree lleYeby accepted. You are authorized Signature—_ II be made as outlined above. --- I Date of Acceptance:_ Signature i NORTfy Town of No.C907 T �O - LAKE o dover, Mass., COCHICHEWICK IST P'PG �15 Ill 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........... �..�.�. ............. a..V.�... ....h...%................ Foundation has permission to erect.. buildings on.. .. ......... ... r ....X.Irw Rough to be occupied as , • ............... .. .... ..... .1 ................................................... Chimney .(.2.4 provided that the person accepting this per lt shall in every respect conform he 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �— PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR O TARTS Rough Service DIN 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. 1 II I fie -Co�m�r,Yuyxureaur" vy,��,••�•••�.•.---- �_ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 126777 Expiration: 7/19/2008 Type: Individual JAMES P.FREDERICK ' j JAMES FREDERICK 352 ISLAND POND RD. 'S" DERRY,NH 03038 Deputy Administr j ✓1Ze V047Z41209ZU��LL/Z 4�✓I�G�SCCCItCCd6i BOARD OF BUILDING REGULATION License: CONSTRUCTION SUPERVISOR Number: CS, 065870 Birthdate: 12/17/1974 Expires: 12/17/2006 Tr.no: :6659.1 Restricted: 00 JAMES P FREDERICK 352 ISLAND POND RD DERRY, NH 03038 Commissioner I ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MMIDD/YYYY) J&JRO-2 08/30/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB International New England HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 299 Ballardvale St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington MA 01887 Phone: 978-657-5100 Fax:978-658-9185 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Western World Ins. Co. INSURER B: Argonaut Ins. Co. J&J Roofing INSURER C: Travelers Insurance Co. 352 Island Pond Rd. INSURER D: Derry NH 03038 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ON LTR NSR TYPE OF INSURANCE POLICY NUMBER DATCY EM/FECTI%IVE POLICY MM/DDS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY NPP1012021 04/04/06 04/04/07 PREMISES(Ea occurence) $50000 CLAIMS MADE X❑OCCUR MED EXP(Any one person) $ 1000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 1000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1000000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ B ANY AUTO BA6302622 05/22/06 05/22/07 (Ea accident) ALL OWNED AUTOS BODILY INJURY $lOOOOO X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ 300000 X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 100000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER C EMPLOYERS'LIABILITY 6KUB611OB70106 01/28/06 01/28/07 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Residential Roofing 1997 Ford F350 PK UP 1FTHF36H9VEC84867 i CERTIFICATE HOLDER CANCELLATION ROBIN-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Robin Sauigni IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 57 Boxford St N Andover MA 01845 REPRESENTATIVES. AUTH PRE EN IVE` ACORD 25(2001/08) ©ACORD CORPORATION 1988 i