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HomeMy WebLinkAboutBuilding Permit #429 - 61 UNION STREET 12/4/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: Z 0 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: PARCEL: O� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial _ Iteration S' No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTIOR-OT WORK TO BE PERFORMED: l (�2f Identification Please Type or Print Clearly) OWNER: Name: _ �,bf,? Phone: Address: CONTRACTOR Name: Phone: '3 9 —a d23 Address: �jP rC CfC Supervisor's Construction License: Exp. Date: cX / gf3i Home Improvement License: Exp. Date: , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. —� :C . z, � Total Project Cost: $ , 2 p FEE: $ 7 G 3 �2 7,G Check No.: �S Receipt N�.. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty d Signature of Agent/Owner Signature of contractor 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 r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: g Located 384 Osgood Street FIRE DEPARTMENT - Temp Dempster on site yes 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 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 ❑ 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 ❑ 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 ❑ 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 ❑ 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: Doc.Building Permit Revised 2008 Location (JiJ•U No. C�'� Date NORTq TOWN OF NORTH ANDOVER 3?O�,f`•O !•,h0 t * ; ; Certificate of Occupancy $ CMust Building/Frame/Frame Permit Fee $ �SSA Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 96 s_3 .� Building Inspector NORTH TONM of � �. �.... __ - _ ,� 0� �`Y zCO, = dover, Mass., LAKE ^� COCMICMEWICK ADRATE D S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......(l ,.a.�.�r c7` .�s�"'�` ......................................................................................................... Foundation has permission to erect........................................ buildings on ...... ..................................................................................... Rough l f. h' �(%�i Lt° � r IJ.'i/�'fs' Chimney to be occupied as.............................�.f/�./...� 1................. ............ ................................................................................... provided that the person accepting this permit shall in every respect conform to the 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 CONSTRUCTION... TARTS Rough ............. ....... r�?'F t'fr�.. .. ................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. �lze �o-m�:naawea/,l/i o�',/�aa�ac/ucae�.a � Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registmil6r 114134 \ Expiratipn25876f 009 Tr# 132915,E PRA i Salem Vinyl}Siding, GLENN-:.C-CTE.,. 46 HERRICK'CI13CL1✓ PEL6iAM, NH.03f37i?':; Adminl,tratox .{..i C K BOARD OF BUILDING REGULATIONS CONSTRUCTION SUPERVISOR t NumbeF``CS 035152 , Q312 Q09 Tr.no: 2819.0 GLENN C COTEjJj_ - f�} 46 HERRICK CIRCt4 ` l� PELHAM, NH 03076:? ; i Commissioner Page1ofI Date:9129=09 12:22 PM Pagel of 1 �R CERTIFICATE OF LIABILITY DATE(MWDDIYYYY) INSURANCE s�,�2 09/28/09 Santo Insurance - Salem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 224 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Salem NH 03079 ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL Phone:603-890-6439 Fax:603-890-0315 INSURERS AFFORDING COVERAGE INSURED NAIC# INSURER A: Nationwide Companies 23787 Salem vinyl Siding LLC INSURER B: St Paul Travelers Glenn Cote INSURER C: Pr ressive Insurance Co an 46 Herrick Circle Pelham NH 03076 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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. JA TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MMroD/YYYY) W LIMITS NERAL LIABILITY CE $1,000,000 COMMERCIAL GENERAL LIABILITY ACP5403886208 05/20/09 05/20/10 ccurence) $100,000 CLAIMS MADE OCCUR _ _ - e person) $5,0 0 051AC1066793002 05/20/08 05/20/09 V INJURY $j QQQ QQQGREGATE $2,000,000 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,00O,000 POLICY PEO. LOC OMOBILE L'SUTYANWAUTO 08421148-4 01/19/09 01/19/10 COMBINEDSINGLELE LIMIT $500000 (Ea accident) ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY $ (Per person) X HIREDAUr05 X NON-OWNED AUTOS BODILY INJURY (Per ecddent) $ PROPERTY DAMAGE $ (Per ecddert) GARAGE LIABILITY ALIT 0ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABLI TY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABLITY X TORY LIMBS ER B ANY PROPRIETDR/PARTWPJEXECUTIVE 0 7403899805 03/24/09 03/24/10 E.L.EACH ACCIDENT $100,000 OFFIGER/MEMBEREXCLUDED? It yes. torybeun) 7403899805 03/24/08 03/24/09 E.L.DISEASE-EA EMPLOYEE $100,000 It yes,describe under SPECIAL PROVISIONS below OTHER E.L.DISEASE--POLICY LIMIT $550,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Janice Melanson & Casandra Czarnieeki 22 Wild Rose Dr North Andover NH 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOyNNpN DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Bldg Dept REPRESENTATIVES. 400 Osgood St AUTHORMEDREPRESENTATIVE North Andover MA 01845 James A Santo ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD � EM vINt SALEM VINYL SIDING LLC GLENN COTE 46 HERRICK CIRCLE Show this Purchase Order Number IN PELHAM,NH 03076 on all correspondence,invoices, 1349 SainB& jpd° (603)893-8043 shipping papers and packages. DATE REQUISITIO"O. — l4 TO i SHIP TO Ai6vft�e REQUISITIONED BY WHEN SHIP SHIP VIA F.O.B.POINT TERMS QTY. ORDERED QTY. RECEIVED STOCK NO.IDESCRIPTION UNIT PRICE TOTAL s ZL y 1 r .; as s r 1.Please send copies of your invoice. 8 2.Order is to be entered in accordance with prices, U � delivery and specifications shown above. 0 3.Notify us immediately if you are unable to ship N as specified. I AUTHORIZED