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HomeMy WebLinkAboutBuilding Permit #688 - 64 COCHICHEWICK DRIVE 4/25/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION TYPE OF IMPROVEMENT PROPOSED USE i Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Others: I "epair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other OWNER: Name: Address: is q Identification PleaseXTe or rant Clearly) -- 1`7 -S i� �"Zv S' 1'�+4� Phone: '?78- /- 97-S'A4 i C'elGk ARCHITECT/ENGINEER Phone: Address: 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: $ 000.06 FEE: $ 10a Check No.: Receipt No.: NOTE: Persons contrac unregistered contractors do not have access to e uaran fund Signature ofAgen#ldwn r Signature of contractor *i Location ,�;Y No. Date TOWN OF NORTH ANDOVER 9 { Certificate of Occupancy $ A�t Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 201k5 Building Inspector 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS -. DATE REJECTED DATE APPROVED HEALTH ElEl COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street t=1tE ,tpTMENTh Temp Durrister." Qrt sl#a4° yeses n� Located at 14 AAetrrf feet ` a .I`Ire=Departmeni�ia"natur�aldate� Dimension Dim Number of Stories: Total square feet of floor area, based on Exterior dimensions.. ry 5 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 i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained 1 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 dump ster permits require sign off from Fire Department prior to issuance of BldgPermit 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-permitsrequire 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 Blda 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 0O z s? x w x v o w � z A • a w � a a � � w a � A i I I u w +' cn ►a 0 w w U w w w o �G w" c� w w a� rA o cn j o cn ui CL c c C `1 O � C � h O C 1.2 CL C O to O C �Z O_ O N 22 E Q C v� V m� i • L � N ro— E= O �o vy E mm Cz3 m cm N m 0.3 N h-�1 Cc cc N w or— CD + � N N O :CLm� c :�z o c`a e o � w o pct m • Ci N Z O a : CZ 02 cm oc a 5 Q o ::� o C •o = o a4 -o N t c �+ W •E wouc o h ID d •� t10 s m4 Z W .0 •Go � r 8awm F I� a E L Z a O CO) Q C � c cm o•— y40Q 'C di mm CD as L Cc o a cmQ cac ev R .30 CL 0 ca C Z 15 V y O C C— •� C c CO) 0 ACORDM CERTIFICATE OF LIABILITY INSURANCE I DATE 04/24/2007' PRODUCER (800)333-7234 FAX Eastern Insurance Group LLC 233 West Central Street Natick, MA 01760 Jr, Joseph Carroll 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 Scott L Dindo DBA: S L D Associates 19 Roberts Road Wilmington, MA 01887 INSURERA: National Grange Mutual E INSURERS: Granite State Insurance Co. INSURER C: INSURER D: INSURER E: i a�uvrec �ai�ra I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. ILT R INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE (MM/DDIYYI POLICY EXPIRATIONDATE DATE IMM/DD1YY1 LIMITS GENERAL LIABILITY MP023823 09/03/2006 09/03/2007 EACH OCCURRENCE $ 1 000 000 X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500 } 000 CLAIMS MADE Fx_1 OCCUR MED EXP (Any one person) $ 10 000 A PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY 7 PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ i NON -OWNED AUTOS (Per accident) s PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F] CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC2247128 04/06/2007 04/06/2008 WC S=OTH- i EMPLOYERS' LIABILITY TORY E.L. EACH ACCIDENT $ 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,90 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Property location - 64 Cochichewick Dr. No. Andover, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Town of North Andover OF ANY VAD UPON THE INSURER, ITS AGENTS OR North Andover, MA 01845 AUTHORIZE EPRESEATI ACORD 25 (2001/08) / / ir *--J ©AORD CORPORATION 1 VJ C: � or- CO O--� M �T- 00 75 E CO O U (t3 � O O � .� = m� O 4Q O -0 Q� W L C cMMa O W 74, Liam= � I����III�IIIIIIIIIIIIII�� Ilm�lll(Illlllllllliiiulll�"' . w U z w O U N LoN O w C. j W U) z O m N U U') D o U) z O U ai C E J2 m Z r- 00 00 0 d O Q�z QW� O Pa' a U rn cn C O U w O C N H `1 'O lC w O N C f0 L L) CCL � V N Lo o 0 a o c a m m H Y Results Page 1 of 1 I Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number ! Select Search type: Search Results AND OR Search Applicant Street City 1State Zi Name Title Ez iratic SCOTT L. SCOTT 109035 19 Roberts Rd. Wilimgton [MAj01887 Dindo Scott, OwnerDIND 9/1/200f 199 AD 137289 BUILDERS WHEELWRIGHT HAMPSTEAD NH 03841 JDEFFREOY OWNER 10/24/20( RD. Total of 2 Records matched. Back to Home Page BBRS Privacy Statement httn-//rih. ctatP.ma.ivw%hrc/hir,_nl 4/74/7(1(17 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv�tw` 600 Washington Street Boston, MA 02111 .4/0 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information / Please Print Le ibl Name (Business/Organization/Individual): S'(f D G— / L2 14a Address: �% ao 6 t_,- �� 9 City/State/Zip: (Jc I Vt, v�j , �� , c 'Ane #: 9 "'7CA.,•J 8 6 65,-�c Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2g& am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. T�_Remodeling 8. ❑ Demolition 9. ❑ Building addition I 10.❑ Electrical repairs or addition's 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -nny appncam mat cnecKs nox tt l must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:�_-e Policy # or Self -ins. Lic. #: v I 6 Expiration Date: a I Job Site Address: 7 /' 6) 4, 'i , /% City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the.form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerh/y der t ns e s of perj that the information provided above is true and correct. Si nature:Date: -` ;2 -0 7 Phone #: s Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ F Permit Fee $ �oundpion -/LaQfPermit Fee $ Sewer Connection Fee Water Connection Fee TOTAL 304 $ 56, S -U Building inspector 59.50 PAID Div. Public Works I PER311T NO. 3qb APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 1 MAP i-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION rJ - //J (� PURPOSE OF BUILDING r� M r %//Clr OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME / % % SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS I IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ' IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED NJ) APPPRR/pCVjEDD BY BUILDING INSPECTOR DATE FILED ��L �/ 7 CY SIGNATURE9i/DWNER OR AUTIRORIZED AGENT PERMIT GRANTED ,g 3 3 PROPERTY INFORMATION , LAND COST 1 EST. BLDG. COST EST. BLDG. COST PER SQ. FT. �' 1 I EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. { 4 APPROVED BY 1 NUILDINO INSPECTOR OWNER TEL. # ` CONTR. TEL. # I CONTR. LIC. # c:2 5-L= H.I.C. # I OCCUPANCY SINGLE FAMILY S'ORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION CONCRETE � 8 INTERIOR B PINEHARDW D— PLASTER — DRY WALL UNFIN. FINISH 1 2 13 — CONCRETE SL K. BRICK OR STONE PIERS 3 BASEMENT AREA FULL FIN. B M AREA '/. 1/7 1/. FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING _ HARDNu D COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD I I HIP BATH (3 FIX.) TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 10 1 Td—1 ELECTRIC NO HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. COMMONWEALTH OF MASSACHUSETTS EXPIRATION DATE 05/20/1997 RESTRICTIONS NONE z a PFPnRTMFNT OF PUBLIC -SAFFT'y ONE ASHBORTON PLACE BOSTON, MA 02108 'y II LICENSc CONSTR SUPENViSOR r IEFFECTIVE DATE LIC -N0. Y 06/30/1994 05163; IL o { T:1OMIriS J SAY':RS SS 4 020-26-7402 � GROVELAN��!�AO!�1 ST m � PHOTO (BLASTING OPR ONLY) FE f OC, 00VALID �:. BY LICENSEE AND OFFIC HEIGHT: NOT SSTAMP DU ORL S GNANTIDTURE OF THE COMMIISSIONERY DOB: X5/29/ 9' ryJ: • „Er !� THIS DOCUMENT MUST RG CARRIED ON THE PERSON OF THE HOLDER WHEN EN OTHERS- RIGHTIHUMB PRINT GAGED IN THIS OCCUPATION. OF LICENSEE S .. Ti , FREE ESTIMATE FULLY INSURED GUTTERS, INC. Siding, Decks, Roofing 31 Union Street Haverhill, Massachusetts 01830 Tel. 508-372-4088 In MA 1-800-552-0030 Outside MA 1-800-966-9238 DATE jt/ ' y a19 OFFICES OF: APPEALS BUILDING CONS ERVA`I'ION HEAL"I'H PLANNING °F yORiN1 Town of Q m a e <:: NORTH ANDOVER �SS,cHUS DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON. DIRECTOR A 1t O Maih Street North Aridover. Massachusetts O 1845 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit A,,fplicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. w. A O GQ v o w° cn uu a co w z z A a o U° °7° U cz w w L'' :1 m a `.' U W °�° C2 cn m w a °�° a�' m u. 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