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HomeMy WebLinkAboutBuilding Permit #760 - 62 WILLOW RIDGE ROAD 5/26/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received `� � cocwwwcwr.c• TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Others: Repair, replacement Assessory Bldg Demolition Other Septic Well, Floodplain ` Wetlands Watershed District Water/Sewer tbUKIV 1 IUN Ur wUKK TO BE PREFORMED: ()V ry)c _ a tcW l'rdaws l r)s-�a 11 Y auj a�-P lct kyru4- Identification Please Type or Print Clearly) OWNER: Name: Phone: ArlrlrAcc• 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. Total Project Cost: $ C�aO FEE: $ / Check No.: `7 I Receipt No.: Z 1j01 /y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 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: 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 2010 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) A" o 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: Building Permit Revised 2008 Location ✓'f j ?/ / -/ No. Date < Ad NORTIy TOWN OF NORTH ANDOVER OfV•'o ,�,�•C • • OR O? F S Certificate of Occupancy $ 0 (�' Building/Frame Permit Fee $ — Foundation Permit Fee $ �- Other Permit Fee $ TOTAL $ Check # S 2 3.2 Building Inspector m m m m m y m C2 C � CO) Cl) 10 CD CD n Z y CD O 'tz CL r- � � O d CA O CD C� O Q "C CO CD CDo CD C CD CA �. CD CLO y O I CD S v y O � Z CD .Ot O CD O CCD 0 W— F cn n 0 cn O O 0 m O m O 00 c a cc CD coc 0 co) CL0 N N m 03 g -c C• H C r N »® R m 'E C-5 c. C, • s'fl N =r CL co m H p O m m gr O -p G n O 0 O y' C9 ' y m a m�: � o, C2 CD O N C7'fl CDCD H d y ads c m-• a �m C y HCD QC2 m 0 V w N =mci v co !o CD o � w CD s: cn CD CDH �C dm: CL nC so ;-� C0: gym: 2 z CO2 O O . m M T T C042 2 cn o d cn o to:3? 071 '� o?? ro H E G rte,, n b �? y :n o b tz n? y n �' ` 71 G x 'n G 0'tz C) M cn 'n 0 O o tx E" y 0 9 0 c Board of.IiniYieg Re=sla&n+ and Standards 1 Corestrua*m Supervisor Ucense License: CS 96835 6lrtlrdafe; . fll15/1977 t Expro om *ismo Tr* 9805. PAUL PELLERIN Com. 5 TINAAVENUE 1'S~L+iAM, NH MD76 = ConnsiosidUl ; , r I'd 9182868E09i 2utptg uivalled dea:aT OT 9? aeW Visit Our Showroom At: Irl LIUMN Famous Brand Names 354 N. Broadway VINYL SIDING Certainteed Salem, NH 03079 Mastic Weds. - Fri. 12 - 4 , , Alcoa Sat. 9 - 12 ;Olnc. •Andersen Tel. (603) 898-2259Harvey Fax (603) 898 - 2816 Therma-Tru Proposal - Agreement PROPOSAL SUBMITTED TO PHONE DATE STREIET JOB NAME CITY, STATE 61ZIP CODE j� JOB LOCATION All We hereby propose to furnish all materials and labor necessary for the completion of the following products in accordance with the specifications and drawings - S b/ Cl 4 s� Ll� y+2 u✓Gs�-l` — -e4", G-✓% Gam-.. ,, Ls h� s - ( CZ L� �S LL-� 4:i ' • /%%�: • ^" ` �"' t�o%WO,) F/4✓6 t� j2+vi.✓i l+/:v. G�i3w 6t..�(�t LL`Y✓ L'Ylt4j /"' �.�Cyt otal contract price is --,(—;Y j cZc - 14L dollars AYMENTS TO BE MADE AS FOLLOWS: _L MATERIAL IS GUARANTEED TO BE AS SPECIFIED. ALL WORK O BE COMPLETED INA AUTHORIZED 'ORKMANLIKE MANNER ACCORDING TO SPECIFICATIONS PER STANDARD PRACTICES SIGNATURE JY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COST WILL = EXECUTED ONLY UPON WRITTEN ORDERS AND WILL BECOME AN EXTRA CHARGE JER AND ABOVE THE ESTIMATE. CC EPTANCE OF PROPOSAL -THE ABOVE PRICES. SPECIFICATIONS AND CONDMONS ZE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS 3ECIFIED. PAYMENTS WILL BE MADE AS OUTLINED ABOVE. USTOMER HAS THE RIGHT TO CANCEL THIS CONTRACT UP TO THREE (3) DAYS AFTER kTE OF ACCEPTANCE. ATEOFACCEPTANCE SIGNATURE SIGNATURE Date: 5/26/2010 Time: 10:39 AM To: @ 8931009 kesideO Page: 001-002 ACOR �» CERTIFICATE OF LIABILITY INSURANCE os/is/2 0 PRODUCER (603)432-3666 FAX (603)432-6076 Lakeside Insurance Agency, Inc. One Wall Street Windham, NH 03087 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 Pellerin Vinyl Siding & Replacement Windows, Inc. 3S4 N Broadway Salem, NH 03079 INSURER/: Cincinnati Insurance Cos. INSURERB: AmGuard Insurance Co. INSURER C: INSURER D- INSURER E. OVERAGES 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 ADD1 TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTIVE POLICYEXP1RATi0N LIMITS GENERAL LIABILITY PAC33102S7 10/28/2009 10/28/2010 EACH OCCURRENCE $ 1' OOO O X COMMERCIAL GENERAL LwrurY DAMAGE TO RENTEO $ 500,00 CLAW MADE � OCCUR MED EXP (Anyone Person) $ 10 100( A PERSONAL & ADV INJURY S 1,000,00( GENERAL AGGREGATE $ 2, OW, GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,00( POLICY n M n LOC AUTOMOBILE LIABILITY COMBAdED SINGLE LW1IT ANY AUTO (Es ecddeM S ALL OWNED AUTOS BODLY N.1l1RY SCHEDULED AUTOS (Per Person) $ FARED AUTOS BODLY INJURY $ NON -OWNED AUTOS (Per acciderA) PROPERTY DAMAGE $ (Per accident) GARAGE UABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S _ AUTO ONLY: AGG S EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FI CLANISMADE AGGREGATE S S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND PEWC01S109 06/29/2009 06/29/2010 X I TORYLUITSCSTATLI T EMPLOYERS' LIABILITYER E.L.EACHACCIOENT $ SOO,000 B ANY PROPRIETORIPARTNER/EXECUTTVE OFFICERlMEMBER EXCLUDED? El- DISEASE - EA EMPLOYEE $ 500, OO SPECIAL A s, describe under E.L. DISEASE - POLICY LIMIT $ SOO ,000 PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEAAENTI SPECIAL PROVISIONS Covering work performed by the Named Insured during the policy period. orker's Compensation statutory coverage is provided for New Hampshire. Officers have elected to be excluded under Worker's Compensation coverage. Kathy Green 62 Willow Ridge Road North Andover, MA 0184S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL —J,(L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Edwin Duvall/LYNN ACORD 25 (2001108) ©ACORD CORPORATION 1988 La >10 T SS:O ETS2SE9 juag xed eLS:TT SZ ReW ,4Tnsaa s83ed uot4euna uot4eotjt-4uapI adRl awtl a-4ea uotioesueul isel e8S:TT OTOZ SZ ReW 9T8E868E09T 3utptS ulJaTTad uoj 301 uauueoS/uazd03/xed/ua4utud TeuosJad OTSS sa'Jas 009S 4afaotJJ0 dH