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HomeMy WebLinkAboutBuilding Permit #548 - 700 CHICKERING ROAD 4/21/2009Permit NO: Date Issued: �(k /A 7 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 711 7 0� y ,fit �,cv "6' ry� O 4.. qq �ecw`rt.uwcc v. ' IMPORTANT: Applicant must complete all items on this page LOCATION �ti'14{✓ PROPERTY OWNER ,lt tM�vJ . riPrint MAP NO: 10 � PARCEL: ZONING DISTRICT: Historic District yesA�o Machine Shop Villa9e Yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Oa � t dist` Addition wo or more farm Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO E PREFORMED: I Identification Please Type or Print Clearly) OWNER: Name: 12a,1ck 16�r zk ` 45�d cl vtv Ce, Phone: i 37V —67oo Address: .6 Vi kktr��n S 5-E-►*e��- Q,) t 11 -0 5 e 1`l�� • 62 o CONTRACTOR Name: " V1C, Phone: SuT 50 -351 Address; r` _ ' (4 Supervisor's Construction License: 2_'1 • I Exp. Dater L/17 12010 Home Improvement License: 1 Z I Exp. Date: //?a 17-0 11 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. en 1/` 1" - Total Project Cost: $ /©8, 0 C) © 00 . FEE: $ ! Check No.: 6P" Receipt No.: NOTE: Persons contracting wit un egistered contractors do not have access to the guaranty f did Signature of AgentJOwner r _ Signature of contractor __ Location No. Date r � NORt1y TOWN OF NORTH ANDOVER Oi,,,•o '',�00 • L A Certificate of Occupancy $ s�cNust Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check # 2i5�u Btlilding Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 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 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 No 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 E ❑ 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 071.�✓f� Board of Building Regulations and Standards Construction Supervisor License License: CS 72791 Expirati6n 4{97/2010 Tr# 22409 Restcistion 0<3', DONALD E DONAHUE JR 401 CENTRAL ST MILFORD, MA 01757 Commissioner =- HOME IMPROVEMENT CONTRACTOR Registration: 127874 Expiration: 1/20/2011 Tr# 279146 Type: Private Corporation J + D HOME IMPROVEMENT, INC. DONALD DONAHUEJR 401 CENTRAL STREET,.•. MILFORD, MA 01757 Administratoi J ACORD. CERTIFICATE OF LIABILITY INSURANCE DA 4/14/2009 ' PRODUCER (508) 473-0556 FAX: (508) 478-6709 Karl A. Bright Ins. A g gy • 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 6 Congress St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 424 Milford MA 01757 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA The Travelers Indemnity 25658 INSURER B: Liberty Mutual Insurance 944 J & D HOME IMPROVEMENTS, INC. INSURER C: 401 CENTRAL STREET INSURER D: . INSURER E: 4)DN � U MILFORD MA 01757 OVERAGES 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 H MAY HAVE BEEq REDUCED BY PAIP CLAIMS. INSR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY (EM EFFECTIVE PDAATE MMMIDD TION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PA MI E S DENTED occuffence)$ 300,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR 1-660-6756LO4-6-IND-08 9/24/2008 9/24/2009 MED EXP one emon $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMWOP AGG $ 2,000,000 PRO LOC X I POLICYFI AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS - BODILY INJURY $ (Per pemon) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA A $ AUTO ONLY: AGG $ ANY AUTO EXCESSIUMBRELLA LIABILITY H OCCURRENCE $ AGGREGATE $ OCCUR 0 CLAIMS MADE $ $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERMIEMBEREXCLUDED? Assigned Risk Policy Certificate to follow from Liberty Mutual 10/6/2008 10/6/2009 X WC STATd OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE$ 100,000 5001 000 E.L. DISEASE -POLICY LIMIT $ i If yes, descnbe under SPECIAL PROVISIONS below -T OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RMX Northeast Inc listed as additional insured. (508)902-0244 Benchmark Assisted Living LLC 40 Williams Street Wellesley, MA 02481 ACORD 25 (2001108) INS025 (otwpaa SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE Peter Ellis/KIM_.�� r Anon t`nDDnoATinm ioAR Page 1 of 2 October 16, 2008 BENCHMARK ASSISTED LIVING LLC 40 WILLIAMS ST, STE 350 WELLESLEY, MA 02481 - RE: Certificate of Workers Compensation Insurance Insured: T & D HOME IMPROVEMENTS INC 401 CENTRAL ST MILFORD, MA 01757 Policy Number: WC2-31S-369439-018 Effective: 10/6/2008 Liberty Mutual Group P.O. Box 9090 Dover, NH 03821-9090 Telephone (800)653-7893 Fax (603)-245-5330 Expiration: 10/6 /2009 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability (Limits Bodily Injury By Accident: $100,000 Each Accident Bodily Injury by Disease: $ 100,000 Each Person Bodily Injury by Disease: $ 500,000 Policy Limits Sole Proprietor/Partner Coverage Election: As of this date, the above -referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions, and is not altered by any requirement, term or condition of any or other documents with respect to which this certificate may be issued. 1l its certificate is issued as a matter of informa6on only and confers no right upon you, t -he certificate holder. This certificate is not an insurance polity- and does not amend, extend, or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date, Liberty Mutual will endeavor to notify you of such cancellation. AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as inspects such insurance as is afforded by those companies. cc: Insured: Producer of Record: I & D HOME IMPROVEMENTS INC KARL A BRIGHT INS AGCY INC 401 CENTRAL ST P O BOX 424 MILFORD, MA 01757 MILFORD, MA 01757 ul/ 16/ztxls L 4 c o I" o Uw" a a�' w x w � aa U w a cn w O a ,r w w .. w o z U) V) 4 o o H c o I" w Z r 1. o 1: - Q G ,r �N �o o o H O E ■ O v Z o o. O y D � O cm co I C W Q y 0> �g m m CD 0 CD as o 0 Ca o a �Q CD cc c v .5.0 fl. O C Z � V y c C C C _cc C. 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