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Home My WebLink AboutBuilding Permit #703 - 66 SPRING HILL ROAD 4/24/2006NORTH � O �t.ao •aa •y0 r' s��•oa o �`,�g� ,SSACHUSt1 Permit NO: Date Issued: LOCA TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: PROPERTY OWNER r(A CA -I r MAP NO.: PARCEL: VITT ♦ 1 771 W !1 T'. DTTiT ilfl d- Applicant must i nil Print/ Date Received: 'Jr all items on this ZONING DISTRICT: ATCTnRTC ntgTRICT VFC fl ■ 1 1 JJ A TYPE OF IMPROVEMENT — — PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial BAlteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF W UKK 1 U t5t PK V Uxi«t Q Identification Please Type or Print Clearly) J t,> OWNER: Name: AU n �nI l Phone: 972 ea9325a- Address: (��c �S � n na CONTRACTOR Name: M LH Co f-6� Phone: Address: J Supervisor's Construction License: Exp. Date: ✓Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE. BULDIVG PERMIT. 510.00 PER 51000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$, /a0, 000 x10.00=FEE:$_ Check No.:�'y Receipt No.: Page Iof 4 I TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art I _ _I Swimming Pools 13 Public Sewer Well ❑ Tobacco Sales Food Packaging/Sales 171 Permanent Dumpster on Site �_ Private (septic tank, etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund/ Signature of Agent/Owner Signature of Contractor.4 Plans Submitted ❑ Pans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT - U - _ _-- - -- - - -❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS CONSERVATION1-1 COMMENTS HEALTH —� COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: DATE REJECTED DATE REJECTED El Comments Comments J DATE APPROVED DATE APPROVED DATE APPROVED Water & Sewer connection sijnatureSe\date wTemp Dumpster on site yesj no Fire Department signature/date Building Permit Approved and Issued by: Page 2 of=t Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. NOTES and DATA — (For department use) Page 3 01'4 Doc: INSPECTIONAL SERVICES DLPARTMENT HKORMOi Created AW.Jan 'Oob 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 Permit 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) ❑ 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 DEPARTNIENTMFORS105 Page 4 of d k If Location & 6- 12-41. No. -)63 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ -ff Foundation Permit Fee $ w Other Permit Fee $ TOTAL $ Check# (q 0q- 9 8 Building Inspector m m m m y m m CD y d C .0 � d 10 O CD n Z y CLO n� CL = co) > CO CD o v CD CD O CL Cr =r CD CDo C CD CCDO) O CA COD C2 CA O '0 Z CD O CCD O t CD �' V J n O cn y n m M m CA --1 :c �q C/) Ego O • OEpO A O CL H coo rrt c O Nnd�i �• N O .. tea" a O a d ti o OI ...r m O O =�O n m O •r 0 ea. � � �O : W C =r O a ao o o CO ?� CD O N CD c O 0: c d d 1 O H � O M y H d = : Q c. C O W — a CO)CL m C O H hH O H 0 CD oCIA: mo -o o CD moCD: D Im CL's: nc i to c o O � • � CD y n m M m CA --1 :c �q C/) cncn . Oil tTl x G r z b rt rD O a d 7d z w y 0 O C HpRTM TOWN OF NORTH ANDOVER OFFICE OF 1 40 p BUILDING DEPARTMENT 400 Osgood Street �,q �D'�'�TRD +`PP,�•(y North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: &q 23 Z W(o JOB LOCATION: &Y Number I StreeVAddres! HOMEOWNER Paw �,Lj u C( SS f Name Home Phone PRESENT MAILING ADDRESS�n Q City Town State Map/Lot -8Sal 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) The Co.m.monweaith of Massachusetts Department of Fire Services Office of the State. Fire Marshal P. O. Box 1025 State Road, Stow, MA 01775 PERMIT s-- �� 3 ,�, North Andover Date: ermst No. ( City of Town) (If Applicable) erg Safe Number In accordance with the provisions of M. G.Ld 4 8 Chapter 10 asrovided in section 5 - 7 f: MR 34 . This Penvit is granted to: 'j-6,rl C, It, /�� S£ Start Date L Full name ofperson, Firm or Corporation Permission to locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be 25' from structure if unable to lace with re wired Restrictions clearance dumpster miust/�be covered with Plywood or tar end of work day ( Give location by stwx t and no., or describe ve in such manner as to provied adequate td cation of location ) Fee Paid $ 50.00 / //� , Gv i/ Fire Chief This Permit will aspire — — c2C ( Signature of offical granting permit) Ofiical granting permit �(Title) DATE (MMIDDtYYYY A� CERTIFICATE OF LIABILITY INSURANCE 05/10/2006) PRODUCER (603)669-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Infantine Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 5125 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manchester, NH 03108 Kathy Pettit INSURED M L M Construction DBA: Michael Oleson PO Box 155 Chester, NH 03036 r+nveonr±Ce INSURERS AFFORDING COVERAGE I NAIC # INSURERA: Peerless Insurance 24198 INSURER B: INSURER C: INSURER D: INSURER E: 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. NSR I TR DD' NAR TYPE OF INSURANCE POLICY NUMBER POLICY TI EFFECVE POLICY EXPIRATION LIMITS North Andover, MA 01845 GENERAL LIABILITY CCP9501426 07/01/2005 07/01/2006 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICYFXJ PRO JECT r X LOC AUTOMOBILE LIABILITY BA9099150 07/01/2005 07/01/2006 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 500,000 BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) A 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/UMBRELLA LIABILITY CU9501826 07/01/2005 07/01/2006 EACH OCCURRENCE $ 1,000,000 X OCCUR FICLAIMS MADE AGGREGATE $ 1,000,000 A $ $ DEDUCTIBLE X RETENTION $ 10,00 $ WORKERS COMPENSATION AND WC9098250 07/01/2005 07/01/2006 X I WCSTATU- I OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 100,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCPTIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS E: Kitchen renovations. rGRTIGIrATG WrIl nGIP rAMrFI I ATInK1 ACORD 25 (2001108) ©ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Paul & Judy Cl ssel BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 66 Springhill Road OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZEDREPRESENTAT North Andover, MA 01845 ACORD 25 (2001108) ©ACORD CORPORATION 1988 t. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)