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HomeMy WebLinkAboutBuilding Permit #389 - 575 OSGOOD STREET 12/9/2008 NORTFI BUILDING PERMIT crob TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7D � � e Permit NO: Date Received ��SSACHUS���� Date Issued: IMPORTANT:Applicant must complete all items on this page '.LOCATION �- 'print PROPERTY OWNER :: " '.° Print MAP NO: PARCEL: ZONINGDISTRICT;; Historic District' yes no _ Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Xffd TM on Two or more family. Industrial I, Alteration. No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well', Floodplain Wetlands `: Watershed District Water/Sewer H III DESCRIPTION OF WORK TO BE PREFORMED: 1 a Identification Please Type or Print Clearly) OWNER: Name: — ' � `� Phone:")'7B 77 Address: CONTRACTOR Name: ' Phone: Address: Supervisor's Construction License.: Exp. ;Date: ° yAL ARCHITECT/ENGINEER Phone: l� �� 32 Z Address:_'J C1�i�, �i'i>r_S� Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: 7Receipt No 7 5 NOTE: Persons contracting wit unr is r d contractors do not have access to the guaranty fund li signature of�rgn Signature of contractor 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 o 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 j ❑ 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract j ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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:Building Permit Application Revised 2.2008 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments is Conservation Decision: Comments Water & Sewer Connection/Signature&,Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Oumpster on site yes r 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 t' I' Location G� No. ! Date ZJ // � �o�TM TOWN OF NORTH ANDOVER � Certificate of Occupancy $ Building/Frame Permit Fee $ z, Foundation Permit Fee $ /(q e-1 C. Other Permit Fee $ TOTAL $ Check # 90-76 s uilding Inspector to TH c Tovmof NO. O dover, Mass. 0 te- T = LAKE ' ' � � COCHICHE w ICK A. C ADRATED PPa\ � `s E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System l j�� ` BUILDING INSPECTOR rJ , THIS CERTIFIES THAT......... ... G ... .!-e,�Q�( ....... . nek Foundation has permission to erect........................................ buildings on....... ...��....c,���.0V...e1f............................. Rough to be occupied as......... ... .G�f:f. - . � ...............� � �/1s'.:¢.:....a�/'/ ................. Chimney provided that the person accepting this per mit shall in every respect conform to tl�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. H Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIO STARTS 1 Rough ............... ..... ....... . . ...... ............................... Service B G INSPECTOR;. Final' Occupancy Permit Required to Occupy Building GAS INSPECTOR Rou Display in a Conspicuous Place on the Premises — Do Not Remove >~inagh No Lathing or Dry Wall To Be Done ` Until Inspected and Approved by the Building Inspector. z; w FIRE DEPARTMENT >. ,w Burner,._ Street No. SEE REVERSE SIDE Smoke Det. iBAffui ungegulatio�and Standard Construction Supervisor License i License: CS 98240 Expiration-8/9/2011 Tr# 98240 ff , �Restricti&n 00'; DANIEL BOLDUC� 282 HAMPSTEADROAD ' �-G— DERRY,NH 03038 '~{ "f Commissioner~ _ U ACORD CERTIFICATE OF LIABILITY INSURANCE 10/08/2 DATE MM s) PRODUCER (603)224-2562 FAX (603)224-8012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Rowley Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 139 London Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 511 Concord, NH 03302-0511 INSURERS AFFORDING COVERAGE NAIC# INSURED Eckman Construction Co., Inc. INSURER A: Firemen I s Ins Co of Wash. DC 00373 84 Palomino Lane INSURERB: Acadia Insurance Company 31325 Bedford, NH 03110 INSURER C: INSURER D: 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. INSR ADDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPA012120114 09/01/2008 09/01/2009 EACH OCCURRENCE $ 1,000,00 X COM X C0MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 250,0001 �CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,00 A 0001 PERSONAL&ADV INJURY $ 1,000,000 X CG2503/CG2504 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRC7 X LOC AUTOMOBILE LIABILITY CAA012120314 09/01/2008 09/01/2009 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OW N E D AUTOS BODILY INJURY $ A SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per.accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA012120414 09/01/2008 09/01/2009 EACH OCCURRENCE $ 10,000,00 X OCCUR CLAIMS MADE AGGREGATE $ 10,000,00 B $ HDEDUCTIBLE $ X RETENTION $ 0 $ WORKERS COMPENSATION AND WCA013120715 09/01/2008 09/01/2009 X I WC STATUS OTH- ER EMPLOYERS'LIABILITY 3 A STATES: NH, VT, ME, E.L.EACH ACCIDENT $- 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? KA, CT. E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 OTHER CPA012120114 09/01/2008 09/01/2009 Limit of Liability- $200,000 ased/Rented A uipment Deductible- $1,000 ACV Applies DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS e: Edgewood Retirement Community, North Anodver, MA. Edgewood Retirement Community Inc., and rident Building LLC, their subsidiaries, affiliates and parent companyes, and their respective fficers, directors, trustees, managers, building committee members and employees are added as dditional insureds on all policies listed above except workers compensation for liability arising ut of the operations of Eckman Construction Co., Inc. on this project CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Edgewood Retirment Community Inc. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 575 Osgood Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, HA 01845 AUTHORIZED REPRESENTATIVE Christine Holman/CHH :w l ACORD 25(2001/08) ©ACORD CORPORATION 1988 I - I s �I r � IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08)