HomeMy WebLinkAboutBuilding Permit #66 - 65 COURT STREET 8/2/2006Ot HORTIM
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a TOWN OF NORTH ANDOVER
'• �,' ,>• : APPLICATION FOR PLAN EXAMINATION
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Permit NO:(116 Date Received::Z- (9 -
Date Issued:
I IMPORTANT: Applicant must complete all items on this pa#:e I
LOCATION GS- _ � 7 C, U v (q
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PROPERTY OWNER TO e- 1 a V) N 6 Lc v 1�
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MAP NO.: PARCEL: ZONING DISTRICT:
TVPF. AND ITSF OF BUILDING
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Addition
Alteration
i One family
f-1Q`wo or more family
No. of units:
C Industrial
D Repair, replacement
Demolition
❑ Assessory Bldg
i_i Commercial
J Moving (relocation)11
Other
❑Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED V V ►� 1 •P X Ken/ rn
P i, Lu G r w -,J'S 4-
0
CONTRACTOR Name:
Address: / (co �� St n l • tit Vida Vti- tz & 6 te Y�5-
Supervisor's Construction License: Q 2 6 & S / Exp. Date:
Horne Improvement License: ! G � 77 2- Exp. Date:
ARCHITEC'-c/ENGINF.F.R Name: Phone:
7Y�2
Z& I?
Address: Reg. -No.
FEE SCHEDULE: BOLDING PERMIT. 510.00 PER $1000.00 OF TH TOT��TLV,?,E COS BASED 0A,
512.. 0/l t'E R S. F.
S ;� J _
Total Project Cost :$ e�� 0 U x =-FEE.$ �' Jl Z 7tCPO
Check No. Receipt No.: ��'
Location q
No. 40 Date
. I%
-1 A- I! -o TOWN OF NORTH ANDOVER
Certificate of Occupancy $
=�-. 1� 00
Is I... I Building/Frame Permit Fee $
IMU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# 3qj?-
9 3tJ 5 k
Buifing Inspector
TYPE OF SE\1 ERAGE DISPOSAL
Public Sever
Private (septic tank t
Tanning, Massage Body Art
Tobacco Sales
Permanent Dumpter on Site
Swimming Pools
Food Packaging Sales
Electric \Icter location to �
proiect
<) I E: Persu►rs cu►rlrucli►rg with unrezfislered c•anlr ►rc rh► ►uN have access h► //te /;►u►rv►►►lt %und
Signature of Agent Owner
Signature of contractor
Plans SUbmltted— —
Plans Wak ed _ Certified Plot Plan Stamped Plans
THE FOLLO%ING SECTIONS FOR OFFICE I:SE ONLY
INTERDEPARTMENTAL SIGN OFF - L FORM
PLANNING & DEVELOPMENT
CO1••IMENrTS
DA TE REJECTED
_Water Shed Special Permit
Site Plan Special Permit
_ Other
DATE APPROVED
D. REJECTED DATE �PPRO�'ED
CONS ERVAT[Ot
COMMENTS
DATE REJECTED
HEALTH
COMMENTS
Zoning Board of .Appeals: � ariance. Petition No:
1 _C- ipt : u+ 111W d ci
I:uuiin . 13onrJ Decision: — ----- -r- ,nnme1w
Atw o !UCci;-i,;n: .:nunUIth:
DATE APPROVED
!cr ._ ..c,w:r c •nrccrion. `'t?n,�ture & mate
), rrnit
-------.._..---------------
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Pr(-),, ided Required Protides R.epired Provided
Dimension
Numbcr of Stories: Total square feet of floor area, based on Exterior diinensions.
Total land area, ,,q. ft.:
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
❑ Debris Removal Fonn
❑ 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 Permit Application
❑ Form U
❑ Surveyed Plot Plan
u Debris Removal Form
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o 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 -
❑ Form U
❑ 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 DEPAR'rN4EVT:RPF0RNIII5
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HOME IMPROVEMENT CONTRACTOR
Registration: 103772
Expiration: _:-7/9/2006
Type: 1pdividual
JOSEPH G. LEVIS,-
Joseph Levis
65 Salem St
Lawrence, MA 01842
Administrator
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rin 1301
Boston, Ma. 02108
Xvalid out signat re
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Numbers .CS 030651
Birthdate,01/0711954
ii',Exp_lres:,Q.1./07/2008 Tr. no: 14186
R0StrIcted:tUU_./
JOSEPH -,G -LE
160 PLEASANT
N ANDOVER, MA 0"14'5
Commissioner
91te 'Commowaveaa
Board of Building Regulati ns and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement.'Contractor Registration
JOSEPH G. LEVIS
JOSEPH LEVIS
160 PLEASANT STREET
NORTH ANDOVER, MA 01845
DPS-CA1 Co50M-05/06-PC8490
,per �lae �o-�r�nooau�ea�/ a�,/Liaaaaciivaelld
�-\ Board ol Building Regulations and Standards
HOME IMP R2,VEMENT CONTRACTOR
Registration 103772
E'x`p ration x/9/2008
_Typendiv�idual
JOSEPH G. LEVIS
JOSEPH LEVIS
160 PLEASANT STREET��
NORTH ANDOVER, MA 01845 Deputy Administrator
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Run 1301
Boston, Ma. 02108
Not valid w' to gnature
Reqistration: 103772
i'
Type: Individual
Expiration:
7/9/2008
Update Address and return card. Mark reason for change.
Address Renewal �1 Employment Lost Card
�_-�
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Run 1301
Boston, Ma. 02108
Not valid w' to gnature
ACORD CERTIFICATE OF LIABILITY INSURANCE
TMIC f FRTIFIrATF IS I
Michaud, Rowe And Ruseak Ins.
198 Massachusetts Ave
North Andover MA 01845
Phone., 978 688 8829 _Fax: 978 557 2130
INSURED ,
Levis Campanies Inc.
Joseph Levis
160 pleasant Street
North Andover DBA 01845
COVERAGES COVERAGES
Y
OP 10 C DATE (UMMOly"
_ IZVIS-1 03/03/06
RCED AS A MATTER OF INFORMATION
) EIGHTS UPON THE CERTIFICATE
:A-' E DOES NOT AMEND, EXTEND OR
AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVI=RAGE MAIC # .
�INSURERA; Safety Insurance Company 33618 _
' INSURER 8: Guard Iasurar. =i� Group
WSURERC Essex Insurar.:e Cozan,y 39020 _
FINSuaER D: Zurich Small 3usiness
INSURER I --
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PgUC.'Y PERIOD INDICATED. NOTWIT HS TANU)NCA
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS .:ERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCI JSIONS AND CONDITIONS OF SUCH
....rte en�eer_are mare lHr1WN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INTR
POCfC�EFFECTID�TPOLICY ERWRA7I0?�—
POLICY NUMBER - DATE MMlDDlYY DATE MMlDO
—
LIMITS
— -
NSR
TYPE OF INSURANCE
EA' 4OCCURREN�E
S 1000000
GENERAL LIABILITY
1
3CPS208 I 10/26/051 10/26/06
�SII.iAT FIO RERT'[T—
PRI M§F-S (r=g 0=4mn )
S 50000
C
X CCMMERCfALGENERAL LIABILITY
CLAIMS MADE U OCCUR I
I
ME - EXP (Anyone Dereon)
10
51000000
I
I
fffEO ALSAOVINJURY
-
I
GEIERALAGGREGATE
02000000
Ij
I1
L--�
PR( DUCTS - COMP/OP ACG 151000000
OENt AGGREGATE L9MT APPLIES PER:
I
POLICY I IJER LDC
AUTOMOBILE
LIABILITY
CCt•BINED$!NGLELIMT
3
821254
01/01/06 I
01/01/07
�' ocident)
A I
ANY AUTO
I
—
_
ALLOWNED AUTOS I
I
6CC LY INJURY I
(Per wmn)
$ 500000
I
X
SCHEDULED ALTOS
I
— ....
g
X
WIRq ALTS I
NON-OWNEOAUTCS
I
BOC LYINJURY
(Pm m6denf)
3500000
I
PRCRERTY DAMAGE .
5250000
.
(Per .00ldenD
AUT CNLY_EA ACCIDENT
' S
ILITY
O
I
CTH• R THAN
iAQT
I
, ONLY'
S
EAC I OCCURRENCE
f
REllA LIA8ILRY
I
I
S
EANCLAIMS MADE
I
4C{C :ELATE
IIBLE
4 5
WORKERS COMPENSATION AND
EMPLOYERS* LIABILITY
LEWC701295 -
02/27/06
I
I 02/27/07
ORY UMTS ER
EL. ACWACCIOEMT
2100000
S 100000
$
ANY PROPRIETCR/PARTNER1EXEV-MVEE
L : 18EASE • EA EMPLOYE
OFFICERIMEM6ER F-XCLUCE07
E. L.I ISGASE• POLICY LIMIT S 500000
I
If dCSCrlbe (Ifldor
' SXe=, A PROVISIONS below
OTHER
10
Property Section
IBR61934784
07/14/05
I
07/19/06
I
VEMCLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CESCRIPTION OF OPERATIONS! LOCATIONS!
fn 1,111Cf 1 ATIAIu
HOLL)tK
Town of North Andover
Department of Public Works
384 Osgood Street
North A=dover ISL 01645
NORTH -13 SHOULD ANY OF THE ABOVE OESCRIBED'Pt:UCIE3 BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF• THE ISSUING INSURER WIU ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMI *0 TO THE LEFT. BUT FAILURE TO DO 50 SHALL
IMPOSG NO OBLIGATION OR LIABILITY OF Al lY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATrvEB.
AUTHo REPRESENT _,- ,:�
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