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HomeMy WebLinkAboutBuilding Permit #035-14 - 68 MAYFLOWER DRIVE 7/10/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ilf"_< I/ Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION { ,Print PROPERTtY�OWNERt Pnnt 100PYear,Qld;Structure yes:. no MAP,NO`. D/ 7� PARCEL:dW/4 ZONING".DISTRICT:_ , istoric=Disthbt.' yes, n Machine Shop Village yes, no TYPE OF IMPROVEMENT PROPOSED USE R�ily Non- Residential ew Building ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑::Septic; 0 Well ❑ Floodplain, ©Wetlands ❑.Watershed District, water/Sewer - DSC /RIPT N OF WORK TO BE PERFORMED: I IdentificationPlease Type or Print Clearly) ��� 1 OWNER: Name: Ke- .��`Wt# _ e- / Phone: Address: /P h4e 4 aQid4 9 Pee,4 CONTRACTOR Name: C-��A Phone: �- 4&30 Address: tOr2 ©�� ll�t-6 � Kms, /�r�e i l�W410,Pne, W* Supervisor's Construction License: e5'e)733a� Exp: Date: /a 10 l41 4001 Home Improvement License: Exp. Date.: HITECT/ENGINEER1�&146 Vig ��CcN,1`�c TS.Zyc Phone: 7,0/ y3q'��4G y ARC / Address: s8o !��<<n .� . � � C4-� IMS Reg. No. t'y0/D FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. T otal Project Cost: $ FEE: $ A20. w Check No.: 13� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ovune ,� Ignature of contractor v •�•� Plans Submitted PI s Waived Certified Plot Plan [V Stan4ped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer �'J 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 ❑ � 7 /b l3 L COMMENTS /roVeaf1jL ldkelC e CONSERVATION Reviewed on J Si nature i COMMENTS HEALTH Reviewed on - Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments' Conservation Decision: Comments Water & Sewer Convection/Signature Date Driveway Permit DPW Tower ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTIVI IST - Temp Dumpster on site yes no Located at'U4 MainStreet Fire Department signatureldate COMMENTS 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 NOTES and DATA— (For de artrnent use ® Notified for pickup - Date Doo.Building Permit Revised 2010 Building Department The fol owing is a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building pp Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) v� Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit V' Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ROTE: 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 app:al 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.Bui?,fiing Permit Revised 2012 Location No. � Date i i • - TOWN OF NORTH ANDOVER a o µ Certificate of Occupancy $ F - Building/Frame Permit Fee $ ?: t Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# iW i2 i; Builng Inspector NORTH Town of 2 t E ndover :. O No. t - LANE h . ver, Mass, 71i411_3 A- COCHIC hl WICK 1• 7�ARRA TE O S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT /hl :i.F:. �.:....................................................................... yBUILDING INSPECTOR T ' Foundation has permission to erect.......................... buildings on ... . ... .��r. �..../.lf'L. ,�.,....,.,,,,..... / Rough to be occupied as ................. © °... Q....�� 1................=.....�! l�.l .. .::G`.:..' .................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of t application Final on file in this office, and to the provisions of the Codes and By-Laws relating to 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 CONSTRUCTION TARTS Rough ....SPEC'...OR...... Service BINTFinal NG GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6/24/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WANED,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). CUNITCT- PRODUCER NAME: N P ROBERTS INS AGCY INC PHONE (978)683-8073 (978)683-3147 No Ext' PJC No 1060 Osgood Street ADDRESS: North Andover, MA 01845 INSURERIB) AFFORDING COVERAGE NAICq INSURER A:ESSEX INSURANCE CO INSURED KEY LINE INC INSURER B: MMU10 HEPATICA DRIVE INSURER C: �'R NORTH ANDOVER, MA 01845 INSURER D: 978-683-3163 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR ADVILTYPE OF INSURANCE D a eR POLICY NUMBER MMIDD/YYYY MM UD/YYYY LIMITS LTR INBMAID X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Es occurrence $ 50,000 MED EXP(Arty one person) $ EXCLUDED A 3DD9812 06/15/13 06/15/14 PERSONAL&ADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY E]PRO- Cf LOC PRODUCTS-COMPIOP AGG $ EXCLUDED IEC T OTHER: $ COMBINED biffarEffr— AUTOMOBILE LIABILITY Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED A $ HIRED AUTOS AUTOS Per elddeni $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X fPER - AND EMPLOYERS'LIABILITY YIN STATUTE_ ER ANY PROPRIETORlPARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEPASER EXCLUDED? �I (Mendatory In NH) - - E.L.DISEASE-EA EMPLOYE•$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I C HANOVER INSURANCE IHN221411405 11/16/13 11/16/14 Fire Builders Risk DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more speoe Is required) PROPERTY LOCATION: 8+ & 10+ ,ACRES ON TURNPIKE STREET NORTH ANDOVER, MA 01845. PROPERTY LOCATED MAYFLOWER & HEPATICA DRIVE NORTH ANDOVER, MA 01845. NOTE 400,000 EACH HOUSE TOTAL VALUE 1.2 MILLION/ ENTERPRISE BANK LISTED AS MORTAGEE AND CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION Enterprise Bank & Trust PO Box 5203 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Norwell, MA 02061 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f 01988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD i 1. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisar License: CS-075302 , BENJAMIN C OSGbOD 69 OLD VRI AGE LANE NO ANDOVER NIA 01845 Expiration Commissioner 12/04/2014