Loading...
HomeMy WebLinkAboutBuilding Permit #451-2017 - 69 OLD VILLAGE LANE 10/27/2016 BUILDING PERMIT ttLeo NORTH 16�t•� (� VY TOWN OF NORTH ANDOVER o2 APPLICATION FOR PLAN EXAMINATION 0 70 Permit No#: -9017 Date Received I ® • a? - a-Oi (0 o P ^en �/ 'ZJ,9 A RwrEo SSACHUS� Date Issued: 1OLi2--1016 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 43CW 6-v0 0 Print 100 Year Structureyes no MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial K-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: -po o es �D Pee 6�v /�jIOGS/� Identifi tion- Please Type or Print Clearly OWNER: Name: -ZAi 1,9v Phone: Address: Ce &,4 i Contractor Name: 6-,�o O Phone: Email: t��•� �/ O cam, C�an�dS /(�c f' Address: t¢4 ©,C,�� �/'L ��„•� Supervisor's Construction License: Exp. Date: 14 AI P _ Home Improvement License: 1.*6-/8(P Exp. Date: 101711-:0' 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: $ c2., 60 FEE: $ 23 0 Check No.: 39 Receipt No.: 3 / 0 9 NOTE: lPersons conte ' g wit registered contractors do not have cess to the ;antyfiund i �. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ I'maing/Massage/Body Art ❑ Swumning 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH-- . , , Reviewed on Signature COMMENTS 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 DEP R - .. �._..� �AaTMENT T;empDumpsterto esu on�si ,y ___ q Fire�Department=,signature/date;. ._ __ -_ �____,_ _ . --___ � .__�m•__._�..� __n _-.-_--�. -- - = - C®MM'ENTM S I 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 department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Buildi-ug Permit Revised 2014 i 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 OTE: 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/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) I 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 2012 IECC Energy code 4, Engineering Affidavits for Engineered products OTE: 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 m ust be submitted with the building application I Doc:Building Permit Revised 2014 I %AORTFHt Town of t 1, 6Andover O - � ' 1 No. � �1 z o�h ver, Mass, / ' 7 • a o 1 b COC NICN.WKK S U BOARD OF HEALTH Food/Kitchen PERMIT. T LD Septic System THIS CERTIFIES THAT BIJ..........0.$IQa BUILDING INSPECTOR Foundation has permission to erect buildings on ....... ..9 OL ...... .. �!...... .... .... ..... Rough to be occupied as ............ ����.....:� .�.«�/��............. . ............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the 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 CONSTRUCTIO STARTS Rough .............. Service ..........dw..�... .. ..... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. Smoke Det. �® A� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD'YYW)10/5/16 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 policy(ies) must be endorsed. 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). PRODUCER CONTACT M.P. Roberts Insurance Agency NAME' AMY ROBERTS PHONE 978 683-8073 FANo: {978) 683-3147 1060 Osgood Street E-MAIL North Andover, MA 01845 ADDRESS: AMY@mprobertsinsurance.com INSURERS)AFFORDING COVERAGE NAIC# — - - _ INSURERA:ESSEX INSURANCE. INSURED ---- KEY LIME INC ----- INSURER B:Associated Em to ers Insurance 10 HEPACTICA DRIVE INSURER C: NORTH ANDOVER, MA 01845 INSURER D: 1 NSU RER E: I NSU RER 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. INSR _ —— ADDL SUER -- POLICY EFF_ POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD/Y I MM/DDIYYYY LIMITS A GENERALLIABILITY 3EE0820 6/15/16 6/15/17 EACH OCCURRENCE $ 1'000'000 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I P MIS Ea $ 50,000 CLAIMS-MADE X OCCUR MED EXP(Anyone person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE L IMIT APP LIES PE R POLICY PRO _ LOC PRODUCTS-COMP/OP AGG $ EXCLUDED AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ Ea accident $ ANY A UTO ALLOWNED SCHEDULED BODILY INJURY(Per person) $ � AUTOS 'AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS _AUTOSERTY DAMAGE Z $ r accident) UMBRELLA LIAB � OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WCC50050075812016A 9/15/16 9/15/17 WCSTATU- OTH- TIVE OFFICER/ME ER ANY BER EXCLUDED? N/A E.L.EACH ACG DE NT $ 1,000,000 (Mandatory in NH) Ifyes,describeunder E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DE SCRIPT ION OF OPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 1,000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renerks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN SAMPLE CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ks MICHAEL P ROBERTS ©1988 AC CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks ofACORD j Phone: Fax: E-Mail: i r, t,0;:r inr.:uPe'7 l rj�"%(<r.1.;C• in,tlf; Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporation before the expiration date. If found return to: '~ =' Registration Expiration Office of Consumer Affairs and Business Regulation 186786 10/07/2018 10 Park Plaza-Suite 5170 Boston,MA 02116 Key-Lime,Inc benjamin Osgood _ 10 Hepatica Drive North Andover,MA 01845 Undersecretary Not valid without Ognature Massachusetts -Department of Rubiic Safety. Board of Building Regulations and Standar s Construction Supervisor License: CS-075302 BENJAMIN C OS��O 69 Old Village I.a�e od North Andover NfA 0l 5fi� -�• Expiration Commissioner. 12/04/2016 Location l0 9 OC No. 900 Date 16 ' d 7-o1al �p • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 4 Other Permit Fee $ Y TOTAL $ F Check# cit �; ! U 9 4 ✓ Building Inspector