Loading...
HomeMy WebLinkAboutBuilding Permit #769-11 - 65 LINDEN AVENUE 5/13/2011BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received /I Date Issued: f IMPORTANT: Applicant must complete all items on this page iLv---T gin 11 OR 160b o a RT, WK7E-R'-- Kenn&%--- I' ZONING DISTRICT R Hiis i - M "J—P-A 0, n %Iftb49hop-Vi L16 g 0 "gRADRATED tog TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building )9,One family 11 Addition El Two or more family 0 Industrial El Alteration No. of units: El Commercial XRepair, replacement El Assessory Bldg 0 Others: 0 Demolition 0 Other EI -Septic, IM0611; e DESCRIPTION OF WORK TO BE PREFORMED: Delmole,xc&\)(k, pou'r Lv\CW-e-, v:bQ+1vx(A , Par cov\cv�e V--rost/ Px-iain wA-1 I ,����e- g+� i lr� � Xg D:ec� wi`� Stai rS � re,►m.�ve, � Cwa.�,+? Pic�� W iV�.JLJ, ft "d P" in s,divxq1 rcp4/repo�ntckimne,4 A-6,troakrie', ldentifkation Please Type or Print Clearly) OWNER: Name: KtA f\ exv� I kwkvam Phone: 01"79-390-0093 A4 Address: -N, f IT "OR N '- ;PA. csu ii"AW IR te oo L �AL4'pKqyeTra_ ,, LDt ARCH ITECT/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. 0 Q0 Total Project Cost: $ 3ii3G - 10 FEE: $ Check No.: 7 -T— Receipt No.: 12 �xe NOTE: Persons contracting with unregistered contractors do not have access to , the guaranty fund -ge FSnaturewofcontractor 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: INSPECTIONAL SERVICES DEPARTMENTMITORM07 Revised 2.2008 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 n CONSERVATION Reviewed on ��/3�j1 Signature ;�'-�� GaAj�- COMMENTS Aj () I i,,^- (C70� HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments t 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 Doc.Building Permit Revised 2008 Location 6 1-�' -4 �Uf No. ; 669- ) Date TOWN OF NORTH ANDOVER ° _ L 9 Certificate of Occupancy $ CNUst<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit, Fee $ TOTAL $ Check # 7,� 24154 /Building Inspector G S,. O O as o w° a°�° cin w a C w2 w�' v U `� w o w w�' w a. w W � cn �' w a O :Jo w z w rA z cn - Q cn 0 _. L O O v Z o a O y � C cm ca 0 'a h O O '- m m O O CL CD O� .o O CD L cc o a E: Qf Q ca o_ cc� c vcv J .O a o D c Z CD V ca O C W m U) OG W LU 19 LUW 0 �aC ev ev �_ Z r.+ .r C is E E O o cx Z U U -IV p " I m c ,! c. �. N evm E �O �..� O �jmm L. U N m cm CD -9 ,r,n CA • ref N C/) N A E y CO 'v W O a� •i► `i m. m0 C U HOS Cf) CM c C, 12 m o 'C C3 P-4 V env CD �a _ O y m C :m=3 C N a`� O a.+ N O nCO)pH D o W y.r -cc -W 'Cos M5— CIO dt 5 C3 V Z 0 C.D C3 4D C402 d O 2 O :0 _ cc =.0mISm> 0 _. L O O v Z o a O y � C cm ca 0 'a h O O '- m m O O CL CD O� .o O CD L cc o a E: Qf Q ca o_ cc� c vcv J .O a o D c Z CD V ca O C W m U) OG W LU 19 LUW 0 Gerald A. Brown Inspector of Buildings Please print DATE: JOB LOCATION: b TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Number IiOMEOWNER VtV%Y\& 1 Name PRESENT MAILING ADDRESS I0 City Town jeo 0 -\[ c - Street Address Home Phone Telephone (978) 688-9545 Fax (978)688-9542 Map/Lot 9?8-380 -oa9 3 Work Phone Zip Code. The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) . DEFINITION OF HOMEOWNER Person(s) who gwns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements.. HOMEOWNERS APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE/DD 01/1414/2011011 PRODUCER (978) 686-2266 NORTH ANDOVER INSURANCE AGENCY INC. M.J. FOSTER INSURANCE SERVICES 163 MAIN STREET NORTH ANDOVER MA 01845-2508 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 F.P. RE ILLY & SONS, INC. 206 ANDOVER STREET STE. 11 ANDOVER MA 01810- INSURER A: ACADIA INSURANCE CO. EFFECTIVE DATE MWDD/YY) INSURER B: TRAVELERS LIMITS INSURER C: X INSURER D: CPA0193900 INSURER E: 10/20/2011 COVERAGES 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 LTR ADD'LlPOLICY INSRD TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE MWDD/YY) POLICY MM%IDD TION LIMITS A X GENERAL LIABILITY CPA0193900 10/20/2010 10/20/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 250,000 PREMISES Ea occurrence $ X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FXI OCCUR / / / / MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LA GGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X JEF7 LOC A X AUTOMOBILE LIABILITY ANY AUTO MAA0193901 10/20/2010 10/20/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY $ (Per person) X ALL OWNED AUTOS SCHEDULED AUTOS / / / / X X HIRED AUTOS NON -OWNED AUTOS / / / / BODILY INJURY $ (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO / / / / AUTO ONLY: AGG $ A X EXCESSIUMBRELLA LIABILITY X OCCUR 7 CLAIMS MADE CUA0193902 10/20/2010 10/20/2011 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DEDUCTIBLE / / / / $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY NY PROPRIETOR/PARTNER/EXECUTIVE WCA0336827 06/03/2010 06/03/2011 X IT WC TATU- T LIMITAER E.L. EACH ACCIDENT $ Soo, 000 E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 • OTHER INLAND MARINE CPA0193900 10/20/2010 10/20/2011 LIMIT 650,000 EQUIPMENT DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RATTE CONSTRUCTION CO., INC. IS AN ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION V' ( ) - (978) 682-4982 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Kenneth R. Markham, Dir. Of Op EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT RATTE CONSTRUCTION CO . , INC. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 33 WALKER ROAD INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ```` \ �'��\J BLDG. 1, UNIT 2E NORTH ANDOVER MA 01845- N V/r_ �[` ACORD 25 (2001/08) INS025 plw),m 0 ACORD CORPORATION 1988 Page 1 of 2 AcoRa' CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) `.� 14113111 PRODUCER Cowan Insurance Agency, Inc.ONLY �OU�GU �- 359 Main Street W Haverhill MA 01830 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 Hoffman Concrete Construction LLC 203 Jones Avenue Dracut MA 01826 INSURER A: Employers Mutual Casualty Company INSURER B: Associated Employers Insurance Company INSURER C: INSURER D: INSURER E: COVERAGES THEPOLICI ES OF INSURANCE LISTED BELOWHAVE BEEN ISSUEDTOTHE INSUREDNAMEDABOVE FORTHE POLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS Phone:AUTHORIZED Fax: GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY OD53419 07119110 07119111 DAMAGE TO RENTED $100,000 MED EXP An one person)$ 5,000 CLAIMS MADEFX OCCUR PERSONAL & ADV INJURY $ i,000,000 x Blanket additional insured GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 A ANY AUTO OZ53419 07119110 07119111 (Ea accident) BODILY INJURY $ ALL OWNED AUTOS X SCHEDULED AUTOS (Per person) BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 A 7 OCCUR E CLAIMS MADE OJ53419 07/19110 07119/11 AGGREGATE $ 2,000,000 $ DEDUCTIBLE S X RETENTION $ 10,000 WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 B ANY PROPRIETOR/PARTNERIEXECUTIVE WCC5003639012009 11119110 11119111 OFFICER/MEMBER EXCLUDED? I? I E.L. DISEASE - EA EMPLOYE $ 500,000 (Mandatory in NH) Ifyes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 978 682 4982 All parties as required by contract are listed as additional insureds on the general liability insurance policy. Concrete construction. Philip Hoffman has not elected to be covered by the worker's compensation policy. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULDANYOF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE EXPIRATION Ratte Const. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 33 Walker Rd Suite 2E NOTICE THE CERTIFI LDERNAMEDTOTHELEFT,BUTFAILURETODOSOSHALL IMP O O WGATION OR LIABILIT Y KIND UPON THE INSURER, ITS AGENTS OR North Andover, MA 01845 REPRESENTATIVES. REPRESENTATIVE Phone:AUTHORIZED Fax: ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -20m!j vq"A sQ. N 00 N _. x N N c5 c�'Isk� ° h W- - .*