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Home My WebLink AboutBuilding Permit #199 - 63 FRENCH FARM ROAD 1/19/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION NORTF� 0-0t bo 1614, 3? 4.. •, 6 OL Permit NO: Date Received t4C ecmc nc wn'`1. Date Issued: 0 60 ,SSA USEt�h IMPORTANT: Applicant must complete all items on this page LOCATION Zj �G�/ Ql,Q�_ Prin PROPERTY OWNER r L%n Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential G New Building tKOne family Addition ❑Two or more family E Industrial Alteration No. of units: !7� Repair, replacement ❑ Assessory Bldg E Commercial Demolition --' Moving(relocation) Ll Other Others: C Foundation only DESCRIPTION OF WORK TO BE PREFORMED 0w - Identification Please Type or Printf Clearly) OWNER: Name: ,�/g/i ��'. a,'l a //V Phone: Address: ��-e/f(�� m 8Q CONTRACTOR Name: ke ��el? C f J �� Phone: MV 5- Address: FO 66 Supervisor's Construction License: e C! Exp. Date: Home Improvement License: Exp. Date: ARCHITECT,'ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERYIIT.512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ -7 710 0 FEE:$�� Check No.: 10 Receipt No.: I Pape IoP•1 Location No. Date p � ,ORTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ s' Mus<�'+ Building/Frame Permit Fee $ C I Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # d�_ Building Inspector TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art r j Swimming Pools Lj Public Sewer _ Well Tobacco Sales U Food Packaging/Sales F0� Permanent Dumpster on Site Private(septic tank,etc. i Electric Meter location to project NOTE: Persons contracting eth nregis7F7=e access to dee guar n fund Signature of Agent/Owner of contractor Plans Submitted ❑ Pla Waived ❑ Certified Plot Plan ❑ Stan ed Plans El 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 ❑ ❑ 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 Temp Dumpster on site yes_no__ Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Re uiredProvided 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) Doc INSPUC HONAL SERVICES DEPnRTMEN F:1311FORM05 Cremed MC Jun 20U6 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 ❑ Building Pen-nit 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) ❑ 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) j 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 cope and proof of recording must be submitted with the building application Doc:INSPEC I'IONAL SM'I('F.S I►I?P�K"1'\I I:YI':BPF(1K111115 09/19/2006 08:13 9787443575 GERALD MCCARTHY INS PAGE 02 A� DATE 091191 orvrvvl TM. CERTIFICATE OF LIABILITY INSURANCE osr+912000 r o R PFanb (9Ta)744-6-433 •■: (eTe)744-3576THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GERALD T MCCARTHY INSURANCE AGENCY,INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 92 NORTH ST HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 839 SIR THE20MMLMFORWD By SALEM MA 01970 INSURERS AFFORDING COVERAGE MAIC 0 INSURED 04SUROR A: SAFETY INSURANCE COMPANY LAWRENCE LEBLANC INSURER e: 3219tY InoMnnw COMPanry P O BOX 3399 INSURER C: _ HAVERHILL MA 01835 nNsuRERo „ INSURER E: COVERAGES POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUE TO THE INSURED NAMED ABOVE FOR THE POLICY INDICATED, N wt AIDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 199AD OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES MSCRIBEO HEREIN 19 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCT1 POLICIES, AGGREGATE LIMITS SHOWN#/AY HAVE BEEN REDUCED BY PAID CLAIMS. TY►EOl<INSURANCE P011CYNUMSFJi •OUCYt�CTrA POU6110IPMAT M UMIT3 LTR YA9 ATEDATE 91111111111110") GENERAL LIANUTY BP000030Q1 0010310Q OOM107 EACH OCCURREN_s€ COYIMERCIALGENERALLIABILITY PIftMIIlElT(E Xbaarbllob) t 100,000 CLAIMS MADE�X OCCUR MED,EXP(Any brn P—) S 10,000 A .... PERSONAL 4 ADV INJURY s 1000.400 GENERAL AOGRfGATE S 2r000A00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG. t II,000.D00 ~ POIICv r PRO LOC AUTOMOBILE LW91LRY 311Ql89 tOH3f05 10113/OQ COMBINED SINGLE LIMIT a ANY AUTO ALL OWNED AUTOS BOO LY INJURY (P•r pp•bn) t 1001000 X SCHEDULEDAVTOS B T HIRED AUTOS 600 LY (Per•oGONNI t 300,000 NON-OWNED AVTOS PROPERTY DAMAGE s 100,000 Per accident GARAGE LIABILITY AUTO ONLY-FA ACCIDENT a ANY AUTO OTHER THAN EA ACC a AUTO ONLY: AGG s 9XCM I UMBRELLA_LIABILITY EACH OCCURRENCE t OCCUR ( J CLAIMS MADE A09REGATE a a ' s 09DUCTIIILE RETENTION a a c u• oT1Ysb WORKERS COMPENSATION ANP rorty LttArtti EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S AMY PIM"1ETORIPARTN1 INKNUM Albac"UnIeEllomiuroaot E.L.OiSEASE•EAEMPLOYEE s N ys,dwcnbr vnM E.L.DISEASE•POUCY LIMIT' S w4rom FROMlt011d bN•M OTHER: DESCRIPTION OF OPERATIONSILOCATIONSIVENICLESIEXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS SIDING,GUTTERS,DOWNSPOUTS INSTALLATION CERTIFICATE HOLDER CANCELLATION TOWN OF NO ANDOVER SHOULD ANY OF TNk ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 1400 OSGOOD STREET WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO NO ANDOVER,MA DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE iN3URLIt,IT'S ATTN: BRIAN AGENTS OR REPRESENTATIVES. AUTHORIZEDREPRESENTATIVE /*/-e/d60bdh Atbntlon: T ACORD 25(2001108) Certificate 111 1675 0 ACORD CORPORATION IBM ORTH Town of O0% No. 919 = _ z lover, Mass., T 0 LA E ^, COCMICMEWICK V ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT .......... ..q.h ......t .............................................................................. Foundation Sias permission to erect................... .................... buildings o ...... 11..x!. ......1;.N.rV,0 ....... Rough • Chimney be occupied as... ........ tia wt ..................... provided that the person accepting thisermit 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 2 "_ PERMIT EXPIRES IN 6 TNTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC1719N ST ARTS Rough ................ ... ......... ... service ... . ... .. .. ......... .. ... BUILDING ECTOR 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. 09/19/2006 08:13 9787443575 GERALD MCCARTW INS PAGE 01 Gerald T. McCarthy Insurance Agency, Inc, P.O.Box 839--92 North Street,Salem,MA 01970 978.7446433 -Fax 978-7443575 September 19,2006 Town of North Andover 1600 Osgood Street Andover,MA Re: Lawrence LeBlanc•Liberty Mutual Pol#WC231S352562015 Dear Sir: Enclosed please find a certificate of insurance as evidence of liability coverage for the above mentioned. By law,certificates for workers'compensation insurance must be issued by the assigned insurance carrier;therefore,we have faxed a request to the above mentioned company to issue a worker's compensation certificate of insurance which they will mail directly to you. In the meantime,please be advised by us that this coverage is,in fact,presently active for the period of 9/28/05-06. 1 hope you will fund everything in order,and if you have any questions,please feel free to call. Sincerely, �/""/ ;"G"'.-V Deborah Tournas dt ✓ne TOammzanurra i a��G , 1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 090414 Birthdate: 01/28/1959 Expires: 01/28/2008 Tr.no: 90414 Restricted: 00 LARRY J LEBLANC 21 WINGATE ST#704 HAVERHILL, MA 01832 Commissioner ,�� .%fie (eo-na�rza�uuect�� a��_l�asra��ueP,(�d Board of Building Regulations and Standards `i HOME IMPROVEMENT CONTRACTOR J 4'f r Registration: 135829 Expiration: 5/14/2008 Type: Individual I LARRY LEBLANC LARRY LEBLANC 21 WINGATE ST.#704 HAVERHILL,MA 01831 Deputy Administrator e ® ® ® Page No. of Pages PROP pySUBMITTED TO / / l. ,f /f�� lPIN� rl D9 � STFkIET,r I' JOB NAME CITY,STAT; JOB LOCATION 00 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: /I// � l/r/J!/ Gar, �,%��r L �-�.� �c f 1��,• ' I ��.('.� /f•`%/�''`•"' ��N � fel ✓,-i✓moi��'"�.1 S We Propose her y to furnish m n I and labor—complete)q auordarwe with above specifications, for the sum of: r-- "' r 00 f/�i�O�i /i /t !i/%!�:'� r�1✓1/ •�1 �L. dollars($ POrhent to be made as follows: All material is guaranteed to be as specified. All work to be completed m a n anlike i ^ manner according to standard practices. Any alteration or deviation from above eecifications Authorizd I/ /^/ s y involving extra costs will be executed only upon written orders, and will becdme an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our Note:Thist posal may be workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted with days. Acceptance of Proposal —The above prices,specifications n _and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature — work as specified.Payment will be made as outlined above. Date of Acceptance: Signature rif o-�