HomeMy WebLinkAboutBuilding Permit #561 - 6 ANDREW CIRCLE 3/7/2006 O�NO°T!1 1
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TOWN OF NORTH ANDOVER
� . ,r•' APPLICATION FOR PLAN EXAMINATION
SSACNUSE
Permit NO: Date Receive ` ',0&
Date Issued: Ok
IMPORTANT: Applicant must complete all items on this page
LOCATION �N D(Z (,r� C(t4
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PrintPROPERTY OWNER �nj 1 P L P- -C- n
) ' Print
MAP NO.: LI� PARCEL: L4 ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building , One family
❑Addition ❑ Two or more family ❑Industrial
❑Alteration No. of units:
' Repai replacement ❑Assessory Bldg ❑ Commercial
❑Demolition
❑Moving(relocation) ❑ Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
F.40 C AC F l� r&M01,05
Identification Please Type or Print Clearly)
OWNER: Name: 61,,1 r.oNjMR Ac T Phone: 9-79 - 9-2S1(032
Signature
Address:
CONTRACTOR Name: Phone:
Address: �J its C;MEENwoai7 4�-i L0c CFS-rFfz-
Supervisor's Construction License: Exp. Date:
I Home Improvement License: t 2 Co q-75 Exp. Date:
i ARCHITECT/ENGINEER Name: Phone:
Address: Reg.No.
FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEI"N$125.00 PER S.F.
Total Project Cost :$ 2 , DO x10.00=FEE:$ .3a
Check No.: Receipt No.: 19016
16
Page 1 of 4
I
Location
No. ' l Date
NORTIy TOWN OF NORTH ANDOVER
0 w
a
} °1 Certificate of Occupancy $ s
s Buildin /Frame Permit Fee $
JACMus 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19 ( , o
Building InspectoL/
TYPE OF SEWARGE DISPOSAL Swimming Pools F1
Public
Art L1Public Sewer
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
F1Permanent Dumpster on Site ❑
Private(septic tank,etc.
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner ftl (p v,iQ.4c r Signature of Contractor
Plans Submitted ❑ 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 ❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ 0
COMMENTS
Zoning Board of Appeals: Variance,Petition No:
Zoning Decision/receipt submitted yes
�I
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection signature&date
Temp Dumpster on site yes no_ Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
L.
Building Setback(ft.)
Front Yard Side Yard Rear Yard
Required 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)
III
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I
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Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan.2006
J
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
❑ BuildingPermit Application
pp cation
❑ Surveyed Plot Plan
o 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
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
,tA0RT#j
Town of Andover
No.
,01
LA E
dover, Mass., %3 0,6 COCHICHEWICK A.
0RATED 0"? Cl
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..............lio........... .
..................................... ..................................... ............
00000mak Foundation
has permission to erect........................................ buildings on .....6......... .........111 ... .................................. Rough
0
Chimney
to be occupied as...... ............ ............V........ ...............................................
provided that the person acc ting-this permit shall in every respect conform to the terms of the application on file in Final
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this office, and to the provis ns 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 CONSTRUCTION ST ' TS Rough
..................................... .......... ............... ............. Service
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous -Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspertpl, end Approved by the Building Inspector.
L SEE REVERSE SIDE Smoke Det.
Mar 07 06 10:38a Michael Bedard 1-401 -246-2868 p. 2
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• .,:I.e Depot reserves ih:.r.ht 1.,clinics .. .: t• ;•cn c , u.:au.
c.nnot perf0t.m it,obGl::l ons die al a zn•• hrral 1 fable,:
a;llcte the i0b was out is_luded is:hc b;,•:S'Met ,r C::
f:,acl•, to M:,u..
.:0NTRACTA OI .,
�3 "LESS DEPos:1'
SALANCE 1;
ON COWEJETION
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f:aser agrees that,Imil, ;tle1 :On c^.i:''.9!;v C.+;::?hai. ::the)rt:;}.- .. ,t: .•.. •:c !a,8 C
;:ity any balance due. ;..:.Las -: o ac;:: s to t v jointiy a:d>):veral!}o::i!::ue. ha:1. 1,•I Inder.
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firc,ceen t to p les and cat:: tl be:.:tended c:niod:Qed un ttss is�critin�iu a o-e,ar.= :zr_:::,e:.: ;Red
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11n alt i1p this contrild bet—r y0o r•-+d it. Y-1.m rnNllcd ton :•,^.:de[tly fi li,J-in. .4f 11•t'a•r'r !nl tl::
is :, protect your rights. ::•, not --.n a C.r••q,icti•,n I:ortifi,'+• a lu•tnhl lhiN pr:r•.:t is co a : s„• 1..
n„�u•,Ictarit from requoMing or ucctl•.i1;n C'ompltti.•n Csrltnt A)r.i�unl by N,r q»nrr i.r:..r ar.i . all sue..
In•I•erformed under the contepct.
Yon may c#Reel this frunincel...of n.• [inu prb.r t„ .Wnl1•,ht of!`ir tnlrc[leuriuvs,n., ,• r Ihr.:+r.: This c.•.
(::,ncYflPtloA for an elplennt' 'of[ Y tight. -f1)n'r will 1M n t-•,••'iar.chart,•r Yy,:xl•In�:5%of tt, )'trues -
cm..�ctkd by Purchaser API't:=:tbs t rd hn,b::ea,1e1".
3?Y;31YlOUttSIGNATl1RBliGLOW,'WL'AC,.3Lc'fUnI:L10Uu1:'iIYTHE'f1:R+3xQt:'inl�r-n;:�.;, -f- >,�.'
1:I?cr•.IPT OFA COPY OF TIPrCO ;:tAC1'Aon TWCI COMPI.E rZD LOPIGs OF'fitl:N011C?:.OI : YCEI.:.
I(-IIY %(Y/QUR SIGNATURE i,sLQN. (AVE UNDERSTANI)THAI THF.AGREENIF•t,r iS S:-. 'Fe.. TO
HISTORY AND FWt _AU'I'!iORWE??Clue DEIN*yf'I'n\'F,:'i1FY.,tNp Rr\•' M17•;: !:, tUD11 .
IN11iPF.NDENT C`i(li T P-.'ORI N AGr-.NCY AND RE[LASH THEM VV,0%l ALL a LITY
lti:\I)YL'RTFNT 'MI . N O E :c0 S. DONOTSIGNTMJCON .Cf.lf fl1^REAW'_. -'f 'LAN%-
Si Tli.MITTE
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Ku,�„wwne:
NDTIC[,Ab=Illott 6TBIL'i�.COM%'TIUKSA`ju WARRANr1LSARQ.I7A7'rMOKTItYnC"FN'/gtlflg,,71)AI.1 AUTO'
VY6Rc-DtAxh Elle Ydlw-L>•.lonxr Pln1c-S•la Cam•:::•,:,
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AT-HOME Installed
�,�'1 R 0,COSM Siding and Windows
T
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration:. 126893
;r-Expiratron �=g/312006
j�
7.ype Supplement Card
2
THE Home DepaZA, me Sery e
®UNROEUN CHHOUI� f J
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3200 COBE GALLERIA t?K1NY#20 � ,�
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ALTANTA,GA 30339 Administrator
Proudly sold,furnished and installed by RMA Home Services, Inc.,a Home Depot authorized contractor.
345 Greenwood St.Unit 2-Worcester,MA 01607-508-756-6686-Fax 508-756-2859-Toll Free 800-657-5182
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
Fire Department Sign off
Dumpster Permit
�— -7 6
Date
MARSH CERTIFICATE'OF INSURANCE CERnFICATENUMBER
.._ -
.:,. ATL 00091590711
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PRO"DED IN THE
ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
MAYA MCGLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN.
TAMI ROUSE(404)995-31430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE
3475 PIEDMONT ROAD,SUITE 1200 - -
ATLANTA,GA 30305 COMPANY
00492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY
INSURED COMPANY
THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY
DBA THE HOME DEPOTAT-HOME SERVICES,INC. —
HOME DEPOT USA,INC. COMPANY c
2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY
BUILDING C-8
ATLANTA,QA 30339 COMPANY
D AMERICAN HOME ASSURANCE COMPANY
COVERAGES w _1 F►i>;eertlCiaxe supersedes and reptaeas any previously issued certificate for the p4ticy pgnod noted:below. 3
THIS IS TO CERTIFY THATPOLICIESOF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOI DICATED....,,..
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE I-I ;OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIE j. ,REGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MMIDD/YY) -
A GENERALLU►BWTY IPR 3757 608-01 03/01/06 03/01/07
' GENERAL AGGREGATE $ - - 4,000,t)QQ-
XPRODUCTS-COMP/OPAGG $ 4,000,000
COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS'
CLAIMS MADE ®OCCUR 'OF SIR:$1,000,000 PER OCC' •` PERSONAL&ADV INJURY _$ 4,000,000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4;000,000
FIRE DAMAGE Any one fire $ 1.000,000
WED EXP(Any oneperson) $ EXCLUDED
B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03,/01/06 03,/01/07
COMBINED SINGLE LIMIT $ 1;000,000
ANYAUTO
ALL OWNED ADIOS BODILY INJURY
SCHEDULED AUTOS -(Per person)
HIRED AUTOS BODILY INJURY $NON-OWNEDAUTOS - (Per accident)
X ..ELF-INSURED AUTO
PROPERTY DAMAGE $
HYSICAL DAMAGE
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT $
ANYAUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE . $ - -
OTHER THAN UMBRELLA FORM
G WORKERS COMPENSATION AND 661099$(AZ,ID,MR,VA C STA OTH --
EMPLOYERSLIABILITY ) 03/01106 03/01/07 X TORY LIMITS ER _
C 6610995(AOS) 03/01/06 03/01/07 EL EACH ACCIDENT $ 1;000,000
OTHE PROPRIETOR! X INCL 6611326(OR) 03/01/06 05101/Q7 EL DISEASE-POLICY LIMIT $ 1.000.000
1. PARTNERSA ECUTNE — -
E OFFICERS ARE: EXCL 6610999(NY,W q 03/01106 03101107 EL DISEASE-EACH EMPLOYEE $ 1,000.0r.j
OTHER WORKERS
E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07
D 6610996(CA) 03/01106 03/01/07
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION'.'
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE FXI,: r,,N DATE THERE.F,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAL--- a DAYS w, I:-N NOTICE TO I�,
FOR INSURANCE PURPOSES ONLY - CERTIRCATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IM, a0 G+L.GATI(^ .R
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITSAGENTS OR RE, .'HTATNES,OR HE
ISSUER OF THIS CERMFICATE.
MARSH USA INC.
BY: Walter Gilstrap 4441r=
_ .
MM7(3/02) . VALID AS OF: 0"._ /0