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HomeMy WebLinkAboutBuilding Permit #732 - 69 SALEM STREET 6/11/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: to Date Recei Date Issued: P a (® IMPORTANT: Applicant must complete all items on this haae • MOL � t4 4` ��,'. `• ��,• a o� 41L li w 1• Argo ♦pP ��(�/ tam runt MAP NO: PARCEL: ZONING DISTRICT: District yes no Machine Shop Vtilla�gb Yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other ,,,Septic Floodplain Wetlands Watershed District er/Sewer DESCRIPTION OF WORK TO BE PREFORMED dentificatio Please Type or Print Clearly) OWNER: Na//me: C t Pho Address: CONTRACTOR Name: bPhone: Address: 140t�� Q ��Lt V1, 6 Supervisor's Construction 'License: adb Exp. Date: t C� Home Improvement License: Exp. Date:_ 6 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: $ �,�y� FEE: $ 02 CS Check No.: Receipt No.: c9 f 01 NOTE: Persons contractingwith unregistered contractors do not have access to the guaranty fund nature of Agent/Ownefn,r.r//�_.. Sitanature of 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 DEPARTMENT:BPFORM07 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 4\ CONSERVATION Reviewed on COMMENTS V V \ HEALTH Reviewed on Signature A.. COMMENTS_ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea 364 uS ooa. Street FIRE DEPARTMENT Temp Dumpster on site ,yes- no Located at 124 Main Street Fire Department signature/date 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 department use ❑ Notified for pickup - Date I ............. -......... _... - ---................ ................ --............................................. ---.......................................... -------..-...... ......._-...... _._............................................................................... -.._.... ........... :....... _.._ .._.... -_.... .......... _... Doc.Building Permit Revised 2008 Location �/' �Gl 4n S'7`""'" No. Date %/ D TOWN OF NORTH ANDOVER Certificate of Occupancy $ �— Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # as 05 Building Inspector Board of Building Regula ions and Standards One Ashburton, Place - Room 1301 Boston, Massachusetts 02108 Construction ,Supervisor License JOHN C RAITT 165 CYPRESS LN NASHUA, NH 03063 DPS-CA1 0 5OM-07/07-PC8490 „/IL6 TONliLI3tU97.UlP.lL(�Z 6�✓l�l��tlCdBlid Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrations_ 135031 4010000i 3?12010 Tr# 267016 Type Individual JOHN C. RAITT „ JOHN RAITT 165 CYPRESS LN NASHUA, NH 03063 - " Administrator License CS: 20567 Restriction: 00 Expiration: 5/20/2010 Tr# 24328 Update Ad96 and return card. Mark reason for change. ❑ Address F] Renewal ❑ Lost Card �ruu�• o�'.��uee�a 20567 Tr# 24328 Commissioner Li 1 a-auw wD F 1 a�cucwa� Li --paujum"t 1 1 auJaa.uju DPS -CAI is 50M-07/07-PC6490 iJ LJ LJ Z o Z 0D. ' * t_ :� i4 Q Q }F a 1.7 st Z Ui. CA (J1 O .ul �'-' 0 o \ \ \ CD « Nom• Z Z y 77 t. ,•S; kX r. ir CD cp Co <„m CD Co m CD CL Co IV MM.m y o �c 90 d o toL SF m co O CD CD n n mm o 0D. ' * m Q Q }F a Z Ui. CA (J1 O .ul �'-' 0 o \ \ \ CD « Nom• y A. •ter: /�M (7 CD CD � ;..co i r '.•� p w .'.� yy�.w� I iF G co 4jjy* PO7 fl l C Ir Z I ' .:n Z ,c :3 �._' r� m Co CL n i a 2'co z + o O Y � Q.X,. r �d 1 j N CD CD' CD :. CD 1 d 06 O.s Q 0. f r ' }n�a iv CD cp Co <„m CD Co m CD CL Co IV MM.m y o �c 90 d o toL SF m co O CD CD n n mm o 0D. ' * m 3 Z Ui. CA (J1 O .ul �'-' 0 o \ \ \ CD « Nom• y 0)-7- CDcn O .. d m �..� ,p O,aD � • ti c :Ic lu AA m CJ. ? n ' a' •Co CD �• CD [� 4 ii1 3 W.= fir, o * m c Z Ui. 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T CD fl I 700 2CD _c:`co C ='.W W •A C7 A o.cCD , nac co cm CL CD ann BUILDING PERMIT 3� dd`.:.:- ;.'� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _e Permit NO: Date Received; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building U One family Li Addition u Two or more family -J Industrial LJ Alteration No. of units: J Commercial U Repair, replacement U Assessory Bldg -J Others: U Demolition U Other i! Septic. ', U.Welt'. U Floodplain Wetlands . CJ,1Natershd district U 1NaterlSew r Identification Please Type or Print Clearly) OWNER: Name: --.M //U Phone: 9)f - M3, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $1200 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 11:5-.,336. .-- FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he guaranty fund 5ig'nature of NNW— er Signature of';coritracor �;� LJ' L=9.83' R= 775.00' PROPOSED POOL LOCATION PLAN 69 SALEM STREET NORTH AiVDO VER, MA. SCALE: 1" = 50' I DATE: JUNE 5, 2008 S88 0735 "L- SALEM E SALEM STREET DANA F. PERKINS, inc. Consulting Engineers & land Surveyors 1049 EAST STREET TEWSBURY, MASSACHUSETTS 01876 PREPARED FOR: MAUREEN & MICHAEL PAYNE 69 SALEM STREET NORTH ANDOVER, MASSACHUSETTS JOB N0. 51358 SHEET 1 OF 1 I HERE15Y GERrIPY THAT 77-E EX15rlNG DWELLING IS LOCATED A5 5M1 M HEREON. kE �I 00 L=9.83' R= 775.00' PROPOSED POOL LOCATION PLAN 69 SALEM STREET NORTH ANDO TIER, MA. I SCALE: 1" = 50' 1 DATE: JUNE 5, 2008 S8810 755'E SALEM STREET DANA F. PERKINS, inc. Consulting Engineers & Land Surveyors 1049 EAST STREET TEWKSBURY, MASSACHUSETTS 01876 PREPARED FOR: MAUREEN & MICHAEL PAYNE 69 SALEM STREET NORTH ANDOVER, MASSACHUSETTS JOB NO. 51358SHEET 1 OF 1 1 HEREPY CERTIFY THAT T71E EXISTING DWELLING /S LOCATED AS. SHOWN HEREON. m m m m y m m v y C � W y Cl) CD n Z tI3 Q. r 0 FMM• c 0. = y CD CDCL o Q� =r CD CDo c CDCD V� CL O CO) co CD v CO2 O -o Z CD O CD O C 0 I F cn n cn V 0 cn C_ O O 0 CD 0 a m 0 C co com 0 0 CLrr y c?�o =r__ N Q EO E4, ® � CO) =a CD A A m CL w cn ro aor- CL m m O O y y O O = r m •O O � 1 � .r .ACD w 1O O x Z�•A O LA. A O O ? :3'M: n , ..... c =r_ m y 0 C -)m CD�. CA d y .L Q W a CD H y mCD St �C �C y ~' A 0 0 CD sn Go 'O O CDCD r► C m CD N .� CD o t, C2 CD m o+ n� moo: o ~" cn o 77, d cnp7 ° 7�dy \ y �n w w G� w cn ro aor- Hn M l O :v w 19 0 � °�'— n �� ` ro r9. Z 0to z � � cn �CL y r1 1O O x c :.4 0 H 0 9 9L O C CD ►Y I I� N W 0 1 0 0 e 2 0 0 3 \I 1 Z s a O ACORA, CERTIFICATE OF LIABILITY INSURANCE 04/08/2 s' PRODUCER (603)224-2562 FAX (603)224-8012 The Rowley Agency, Inc. 139 Loudon Road P.O. Box 511 Concord, NH 03302-0511 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 Quality Design Nor'Easter Pools Inc. 106 Perimeter Road Nashua, NH 03063 INSURERA: Acadia Insurance Company 31325 INSURERB: Maine Employers Mutual Ins Co 0008 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INS MED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER'156 ME WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBF.D HN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY,P 'iq_'c AIMS. INSR AODT INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM1DD1YY POLICY EXPIRATION DATE (MWDD[YYI LIMITS GENERAL LIABILITY CPA01783I 04/18/2008 04/03/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 250,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 5,000 A X C20001 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY T PROJECT El LOC AUTOMOBILE X LIABILITY ANY AUTO CAA017918412 04/18/2008 04/03/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 A X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY $ (Per accident) X PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA017918612 04/18/2008 04/03/2009 EACH OCCURRENCE $ 3,000,000 X OCCUR a CLAIMS MADE AGGREGATE $ 3,000,000 $ A $ $ RXDEDUCTIBLE RETENTION $ 0 WORKERS COMPENSATION AND 3102800889 04/03/2008 04/03/2009 - WC STATUORY "M - I OTHER B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? OVERAGE APPLIES IN MA E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ S00,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER _F DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS overing operations of the insured during the policy period. Commonwealth of Massachusetts 600 Washington St. Boston, MA 02111 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, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Christine Holman/CHH ACORD 25 (2001/08) ©ACORD CORPORATION 1988