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HomeMy WebLinkAboutBuilding Permit #292 - 660 GREAT POND ROAD 10/12/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ; a Print- PROPERTY rint PROPERTY OWNER v fi Print MAI' PARCEL: ZONING DISTRICT: Hiist8ijbDistrict :yes no tt � Maclaine Shop'Village Y nog ; es TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alterati No. of units: Commercial epair, replace Assessory Bldg Others: emo i ion Other Septic Well y Floodplain Wetlands Watershed t)istrict WrSewer � L. .'�4 m F 2 L DESCRIPT ON OF WORK TO BE PERFORMED: Lamy-, a Shy ^,& 1 (A-U w� 3o 00 thPly ��jy 9 ettJ 3 l6 AAI W_,� Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: COIT,F, ACTOR Name: Ph ode. g sae �.� '.. Address: Vit" t��r' d, t 4 Supervisor's Constructicna license /0�6 3 Exp Date: Norrie triarovement.License: exp $,]Pate: Mid ARCHITECT/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. Total Project Cost: $ �3w FEE: $ 7z- -- Check No.: a 6Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t guaranty fund Signatureµ!of Agent/Ouurier . _. "`3Signature of contacto '� 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature A COMMENTS a 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumster on site yes no Locatedat 1.24-Main Street F� a Daf tmen#signaturelclate ep ..i . ; 1"6COMMENTS ' Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i i I 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 NOTES and DATA— For department use ' Ill fly I 1 ' I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department { The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I 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) o 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: Doc.Building Permit Revised 2008 1 Location No. � '"` Date ,.oR•M TOWN OF NORTH ANDOVER o.t.... :•rya Certificate of Occupancy $ b+A �- cHuBuilding/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ { TOTAL $ Check # lWo,� 22521 wilding Inspector NORTH Town of L Andover . O `"I,w_ 1'x'••1•• 'Y v,•,e�. ,,• No. a �� LAKE dover, IVMass. • /A COCMIC NE WICK y�. ADRATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �� BUILDING INSPECTOR THIS CERTIFIES THAT...... ....� .... ....A-is ....... F ...... ... ......... ' "" Foundation has permission to erect.........�............................ bu' ' gs on ........111P e Rough to be occupied as..... .W� ,j.... ......... ....Aft..........................:................................. Chimney provided that the person this permit shall tl'ery resp nform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws rel ti o 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS STARTS Rough ..... ......... ....................... Service OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Do Not Remove Rough Final No Lathing or Dry albyl To BeDone FIRE DEPARTMENT Until Inspected and Approv d the Building Inspector. Burner •' ' Street No. SEE REVERSE SIDE Smoke Det. Proposal FULLYINSUR.ED FREE EMAIATES IMGHT GUTTERS Specializing in Seamless a All Colors Available 350 BERRY ST. a NORTH ANDOVER, MA 01845 TELEPHONE 978-687-2247 PROPO�iS�AL SUBMITTED TO ((//�}JJ (// ���p�(�y�PHONE rT DATES} �v/-u,? STREET ;4�/ ' JOB NAME/LOCATION CITY,STATE AND DP CODE JOBSTART DATE All', r+ � ��r, ✓ rl (��v latf r K° ka .S`.�i s n . � :� l�cz.r- o'1 1 " Cko t C.9 , l-"�. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:$��,�c 1'� �'�✓ Payment to be made as follows: All material is guaranteed to be as specified.All work to be completed in a workmanlike "'Authorized �✓j/ f�__f manner according to standard practices. Any alteration or deviation from above Signature specifications involving e)Qra charge over and above the estimate.All agreements contingent T upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and 1/ other necessary insurance.Our workers are fully covered by Workmen's Compensation NOTE: This proposal maybe Insurance. withdrawn by us if not accepted within days. or Acceptance of Proposal - The above prices, specifications 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 Massachusetts - Delriu-tment of Public Safety Board of Buildin- Re-ulations and Standards Construction Supervisor License License: CS 102663 _................. Restricted to: 00 SCOTT WRIGHT . 350 BERRY ST NORTH ANDOVER, MA 01845 �--�— ! Expiration: 8/12/2011 ( unmi,.i mir Tr#: 102663 BblY` df Bilfki1tiaSrs A�i1dtlledR „NCY�f�NIN �VN'!'Cb�it'RA�"1'C� w. xpiratron 4/14/2011` Tr# 282754 Type. "DBA vilk(w M'(TiotS 356 MMM. K10.AOOVEk,MA 01845Apdmin ter ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MM/DD/YYYY) WRIGSC2 1 10/ 3/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE T. A. Sullivan Ins. Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 344 S. Union St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lawrence, MA 01843 Phone: 978-683-4700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Mass.Workers Comp.Assigned INSURER B: Worcester Insurance Company Scott Wright INSURER C: 350 Berry .tit INSURER D: N.Andover MA 01845 INSURER E: 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. 1Nb AWL)'LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE(MMIDDfMN LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 B X COMMERCIAL GENERAL LIABILITY CB 3M6760 12/01/08 12/01/09 PREMISES(Eaoccurence) $ 300000 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $50000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 71 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER A EMPLOYERS'LIABILITY WC 004460069 09/30/09 09/30/10 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER B Commercial ApplicaCB 3M6760 12/01/08 12/01/09 B Property Section DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Installation of gutters CERTIFICATE HOLDER CANCELLATION TOWNOFA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF NORTH ANDOVER IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR NORTH ANDOVER MA 01845 REPRESENTATIVES. AUTHORIZE PRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988