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Home My WebLink AboutBuilding Permit #762-15 - 7 MILLPOND 4/6/2015I=` t BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: -e15 Date Received 1% Date Issued: IMPORTANT: Applicant must complete all items on this page gel 4P� 1, ;P �AR'CEL o - -- $ �ZO'NI,NG1��®ISTRIC � �t�=., ,bs •rte. 6 yes C4 ono: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Owe family [I Addition 2'fwo or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �- C7 ,5 *pFloes®tlplain �Wetlands.; 4Wa_ejrshed;iDistnct ❑°Water/Sewer ^^ s� UtSC:KIV 11UN VI- VYVK 11 v oc �rvRin�yl OWNER: Name: Address: Please Type or Print Clearly ,. �,i Phone: 125(- c-/ %-d 00 ---OlSak IA�cldress: 14114S��/1 v �^d ter- t�/ • .__# '.- Sup�nnsor&s�Construct�®nlLicense��° _ .fpr- �®afe: __ _, �. ._ . J. li 1Ex11:: omoKf.,A% i7q, ,a 1CG9 - / ` F ARCHITECT/ENGINEER Phone. Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSI-BASED ON $125.00 PER S.F_ Total Project Cost: $ -FEE: $. 0,D Check No.: 2 0 �2' Receipt,N - NOTE:- -Persons contracting with -unregistered contractors do not Oee,w s -to -the -g uaran - fun 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/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 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 o 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: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ .. TYPE' F SEWERAGE DISPOSAL P,,t, 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 PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted Planning Board Decision: Conservation Decision: Comments Comments yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 4 IFIRE ib PARTiMm _ ENT TepDumpso ion fsits 3no0 Street _ ter e ye %zrdbtedk5f1 124,INlain°Sf�eet iFa re$fDep�arfine nt�s�``.g n,� atu re,�/date Dimension Number of Stories: Total square feet of floor area, based on Exterio=r. ;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 Doc -Building Permit Revised 2014 k i Location No.:&g /S— Check #�'21— A 28613 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ Building Inspector o " O 2 Or O O rr CA N 0 _ CD r. 0 � m O� is- O- ' n— C c c rn W -- C 2)N e�rt �D W C' mO - O �. O CL O @ @ D O5 = O ^ cm N O N ♦ , O -% �' � n W I=D CDr— M CD ogCco -� vi - CL cl) Cc �(Q = -� c V CD= Dcn QQE �D N CDS o m N ��,C CLccn = Qom '= a Q. Z I CD ?CD O �C m * CD O cn rt c�® '`� :Z CD 1 ' CAO Cl) r— CD --I Z °I. -h tiCL 0 CD O CD O oo y CD CD C CDo �S s �,, v �c O C �rt 0 v_C C z '--IrD - cn O� CD rt v 3 O X-'"' fD 0 t N Z O W G O T 7 _OA 3 ?n O d L G f1 N A O (M =r T >' N W O M T O' d _7 m < O 00 O Oc C: N O Ln < G O O_ r) T M D z G) z H n q M m v � M'o M C G) H rl � W C H m 700 CD 3 3 W O = m = FROM :2685 -Kitchens FAX NO. :9789466421 Feb. 21 2015 07:39PM P1 Fsb 21 1510:55a aiohard I Madison �� 9782770685 KITCHEN lNST T—I0N ESTIMATE WORKSHEET A � c�-- "": NnrtwbNll: Carlene ludlc!jnl,97878-687.0200 ?12012015 Mom OWA'w Tema and Haut Away P,177.00 ✓ �'a #� i fsS s % i' $ :lectrical $^1,980.000ir lumbi»g w $1,740.00 ✓- FO Aif g.6,4 -,; I $ .aminate Flooring s1,00-ow""polls ii' gsTibi )rywall - $890.0061—P,0015 .al�irretryft ►IianCes i3,32Z40 SPO w2- jSq S j l6f p ldditional Charges / permits X675.00 j- �4 2- customer Signature: - pate: " .. I�ot�ciateSignature: 'PC Signaturo: �r -� i r Pate: r FROM :2685 -Kitchens DETAIL STARTS HERE FROM: THE HOME DEPOT STORE 2685: MErHUEN 72 PLEASANT VA. _LEY ST METHUEN, MA 01 344 FAX NO. :9789466421 Feb. 21 2015 07:39PM P2 FAX PURCHASE ORDERS Date: 02/21/2015 Page: 2 FAX: (978) 946-64.7 PHONE: (978) 989-9025 x.t. 420 ============(Use this number to invoice The Home Depot) P.O. Nbr 85457185======= For customer: IUDICIANI CARLENE======= 0000-282-627 KITCHEN POINT -NAT FROM MEASURE: 228050M01 MEASURE PO#: 85457029 INSTALLATION SITE: IUDICIANI, CARLENc PHONE: (978) 687-0200 Ext. 7 MILLPOND NORTH ANDOVER, MA 0-1845 TRIP CHARGE:. CUSTOMER NAME: CARLEVE IUDICIANI PHONE: (978) 687-0206 WORK (508) 380-7580 Ext ORDER: 227939 REF #: 03 No merchandise selected. MERCHANDISE WILL ARRIVE AT SITE VIA THE FOLLOWING: KITCHEN POINT -NAT CUSTOM WORK: 01 PO I OF 5; DMO AND HAUL AWAY OF EXISTING ITEMS AND CONSTRUCTION DEBRIS FROM 3ROJECT. Quantity: 1.00 JM: MR Price Ea.: $2,177.00 Extension: $2,177.00 SPECIAL INSTRUCTIONS: PO 1 OF 5; D --MO AND HAUL AWAY OF EXISTING ITEMS AND CONSTRUCTION DEBRIS FROM PROJECT. q, 0 U rJ 88 ;2 Zrt 9311 37j" -A 4 Of 7 --32111 23 ............. .... t 0 -I 23lot r4 911.- C=) ............ Nala C,1 Pl- 11. m A I HW I Alff . ..... ..... bb CY) C-4 V. 'R Maio HOETZA Ila NOEM i! 100zM CP V0. S J� r, 1 cm'4 ;�j.. VA ic, � 9NI.,+ •UAU atJJ96ZuG Na I- W at 200 d; tu) 0 m AD, C-) 11 bl p 4 bn to, '80 -bLD V. r cu CLI 4- AQ1. J .1 Cc. Ln LL 54 :g e. C IJ c *JD 42 CU 15 r4 cc 10 E3 cu "m M E pi 2- —2 L0 "n I q, 0 U rJ 88 ;2 Zrt 9311 37j" -A 4 Of 7 --32111 23 ............. .... t 0 -I 23lot r4 911.- C=) ............ Nala C,1 Pl- 11. m A I HW I Alff . ..... ..... bb CY) C-4 V. 'R Maio HOETZA Ila NOEM i! 100zM CP V0. S J� r, 1 cm'4 ;�j.. VA ic, � 9NI.,+ •UAU atJJ96ZuG Na I- W R d; tu) 0 cc C-) 11 bl p bn to, '80 -bLD V. r cu (10 it w lu 15 Le -5 48P tu V—j eJ 54 :g e. *JD 42 CU 15 ;f Id 10 b E pi 2- —2 L0 "n I 12 A q, 0 U rJ 88 ;2 Zrt 9311 37j" -A 4 Of 7 --32111 23 ............. .... t 0 -I 23lot r4 911.- C=) ............ Nala C,1 Pl- 11. m A I HW I Alff . ..... ..... bb CY) C-4 V. 'R Maio HOETZA Ila NOEM i! 100zM CP V0. S J� r, 1 cm'4 ;�j.. VA ic, � 9NI.,+ •UAU atJJ96ZuG lip 0 N l bl p bn to, '80 -bLD 5. tjo W th 0 U %:I V ca w , (6 v 41 tu Eq 471 *JD 42 CU 15 ;f Id t4 S_0 <u CL M 2- —2 L0 "n I (u An T-- CU y Al d) v 0 ;'.2 lip 0 ZTd WdTV:LO STOE TZ 'qad TEV99V6BL6: 'ON XUA sual-PITA-Sa9z: W08A N V E t4 —2 too tZ T-- CU y Al d) ;'.2 JD < RIO CP ZTd WdTV:LO STOE TZ 'qad TEV99V6BL6: 'ON XUA sual-PITA-Sa9z: W08A rttYsePubiic "afeiY � �«�,iVla,�saivhtis�jts S.�p� I u� "3oar rxs.rt! iic`egul,at�rrak►E tanc�ats ,�: " (�tlmk�.�tttnn"Supci� ��,r. + ��• ;}n l�►t'se CS -030000 C� RI J,�1ib30N 3 AjADI$ON AVEC a ' 0834*7 , GROV /E@ A ,t �. 6 �J�-�"�`t �✓y�; � rit'�`�*g 4;,. ��Pif�ttvh A t Copne:[ 671ieponvrrco�aus o�Caclur�eCYa Office of Consumer Affairs & Business Regulation MWE'OME IMPROVEMENT CONTRACTOR egistration: !,1.185og Type: as �. .•. =Expiration: 3129/20'17= DBA R.J. CONSTRUCTI&A' t" RICHARD MADISON 3 MADISON AVE`_i GROVELAND,. MA 01834 Undersecretary License or registration valid for indiviilul'iise only before the expiration. date. Iffound return to: Office of Consume r` Affairs and Business Regulation 10 Park Plaza -Suite 5170 r Boston, MA 02116 Not Sali thout signature, AC" /or CERTIFICATE OF LIABILITY INSURANCE DATE 4/6/2015YYY) 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 NAME: A & K Fowler Insurance 200 Park St PRONE . (978) 664-0366 ac No: (978)664-2209 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # North Reading MA 01864 INSURER A:Hartford Insurance Co. INSURED INSURER B: R J Construction INSURERC: 3 Madison Ave INSURER D: INSURER E: /28/2014 Groveland MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1451505466 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 LTR TYPE OF INSURANCE ADDL U R POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MMIDDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I—XI OCCUR D8SBANF7078 /28/2014 /28/2015 DAMAGE TOR TED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO 7LOC $ AUTOMOBILE LIABILITYO CE,A aBINEDtSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS 68SBANF7078 /28/2014 /28/2015 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N / A 8WECGQ0160 /30/2014 /30/2015 I E.L. EACH ACCIDENT $ 100,000 -- E. L. DISEASE - EA EMPLOYE $ 100.00QI E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. Town of North Andover 120 Main St. North Andover, MA 01845 Mvvrw L.7 (LV IV/V.71 INS025 (201005).01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Orlanzo/NMO V 19t3t3-2070 AGORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD