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HomeMy WebLinkAboutBuilding Permit #683 - 700 SALEM STREET 4/24/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION /o',�t�eo ,°.•rye t Permit NO: Coed Date Received - 39s +,T.o CHI Date Issued: U IMPORTANT: Applicant must complete all items on this page 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: 11Demolition ❑ Other _ y { q ��b a a '^' #a �S�t�' y ': C *; `1,11-1,✓ n'' fR .e�'� °:. £ " ^' b' J6r" y� z �'p� �t4znrlhr�tl E 4. t" s'stt � nFSCRIPTION OF WORK TO BE PREFORMED: 5111fx"e s - Co vGdz '4.1 G s�r�lr o� /=/,lsGl/� v� �c��% s 04 4!0�242s Identification Please Type or Print Clearly) OWNER: Name: Phone: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PErrR((S.F. Total Project Cost: $_ �� �7�� d FEE: $ epx Check No.: ,3�oReceipt No.: a o 13 NOTE: Persons contractinexith unregistered contractors do not have access to the guarantyfund 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o Certified Surveyed Plot Plan o 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) o Building Permit Application o 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) o 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 2.2007 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 CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ■❑ DATE REJECTED DATE APPROVED a 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 Located at 384 Osgood Street rFIRE DEPryAATt�ME�+NT.:, .4., emp Int; - (+or+4��i17C�t F�IreD�ptrtment srghature/date s, 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 2 1 A —F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date ................. ......................... _......... _........... ....... ...._...................................................................................... ......... _....... ........... _..................................... _... ............................................. ........... ....................... _.............................. .......................................... Doc.Building Permit Revised 2007 Location No. Date a TOWN OF NORTH ANDOVER y Certificate of Occupancy $ Ss Mus Mu ,�� Building/Frame Permit Fee $ Foundation Permit Fee $ —— Other Permit Fee $— TOTAL $ Check #� 20) 5) Building Inspector 04/24/2007 13:24 6034324700 wHi I ItmUKt 1NnL.1MW1f1,t rw�ar- U4 DATE (101100 YYYY) OP ID S CERTIFICATE OF LIABILITY INSURANCE M I-1 04 24 07 �CORa,. IS ISSUED AS A MATTER OF INFORMATION THIS CERTIFICATE NO RIGHTS UPON THEC TIFICATE PRODUCER ONLY AND CONFFRS ODES NOT AMEND, EXTEND OR I{pLDER. THIS CERTIFICATE BY THE POLICIES BELOW - Whittemore Insurance Whittemore ALTER THE COVERAGE 501 MaMoth Road Londonderry NH 03053INSURERS AFFORDING COVERAGE NAIC 0 Phone: 603-432-2577 S`ax:603-432-4700 Concord Genera�l Mutual wBURCDNew IIBUsiERA Hampshire _ INSURER B: NCCImo. .� INSURER C: . H . L Martin LLC 6544 INSURER D. — pp Box ManchestCV NH 03109 INSURERE: COVERAGES FOR THE OTHER DOCUMENT WITH RA ES�PECT TO WHICH TTMS CEATIIFICAT - MAYBE ISSUED OR DWG OF SUCH ANY REQU�EMENT, TERM OR CONDITION Of ANYONTRACTOR DESCRIBED HEREIN IS SUBACTTO ALL THE TERMS Ii7cCLUS10N9 AND CONDIT{ONS MAY PERTAIN, THE INSURANCE AFFORDED BY THE pOUCIES POLICIES. AGGREGATE LIMITS SHPAID CLAIMS.— OY HAVE BEEN REDUCED 8Y — •• UM1T$ TYPE uRANCE POLICY NUMBER DATE MW OIW E MMtD EACHOCcuRRENCE s 1000000 LTR NS O&NERALUAOILITY ... 5 500000 07/16/06 07/16/07 PREMIses Ea«�Nrenca)- — A X COMMERCIAL GENERAL 1;262679-3 MEOEAP (Anyone oofsonj $5000 _ CLAIMS MADE OCCUR PER SONAI.SADVINJURY 61000000 GENERALAGCREGATE s2000000 PRODUCTS-CQMPiOP AGG %2000000 GEN'L AOQREGATE LIMIT APPLIES PER: POLICY P CT Lac CDMBINEOSINGLELIMIT g AUTOMORILEUABILITf (E.+ ecddent) — _ ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per P^son) SCHEDULED AUTOS BODILY INJURY 3 HIRED AUTOS (Per Pccldenq r NON -OWNED AUTOS PROPERTY DAMAGE S - _ (Pot ettldenl) AUTO ONLY - EA ACCIDENT 0 OARAGBLWBIUTY EAACC i _ ANY AUTO AUTO N ONILYYA00 E EACH OCCURRENCE S ••' I C$WUMBREI-LALIABILITY AGGREGATE i _ OCCUR CLAIMS MADE i F — DEDUCTIBLE F RETENTION A TORY LIMNTs EJt WORKERS COMPENSATION AND EMPLOYEWLIABILITTAPPLICATION STATUS 04/25/07 04/25/013 E.L. EACH ACCIDENT $100000 11100000 8 ANY RROPRIETORJPARTNERr5XECUTIVE E. L. DISEASE •EAEMPLOYEE OFFK:ERMEMBEREXClUDEOT fE.LDISEASE -POLICY LIMIT 5500000 MOW niynR69V SI IONS below I I !SCRIP ON OF PORKTIONS I LOCATIONS I VEHICLES 1 Carpentry DIOL Toon of North Andover Brian Leathe 1600 Osgood St North Andover MA 01845 �HOIILD ANY OF THE ABOVE DESCRIBED PoUon BE OAHCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENOCAVOR To NAL 10 DAYS WRITTEN NOTKE To THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE MD OSLIOATION OR lWBLL1 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRGSRNTATIVEs. T14ORIZED 0 ACORD CORPORATION 1988 m m m m vI m y mm D F 'O C � yCl CD n az y CO n. . C =� d= y n� �o d o CD CDCL o Q d CD Sr o C CD y CD =cz 0 y CD S v H O C z a oCD O CCD 0 0 I z r� cn a m : 'zf a� O m 0 ?J ° N? m m 0 o m z r� cn a m : 'zf a� ^rl a m � c ?J ° �-C m phn o o Q z cn o � a E cn H q V o� �z O t CD s cn s m : 'zf a� ^rl a qd a ?J ° �-C rELM x o a 0 Q om cn cn 91 'zf g, ^rl a qd a ?J ° 7C o m z x o a 0 Q � � z H.L. Martin, LLC ROOFING) WINDOWS) DOORS) SIDING PO Box 6544, Manchester, NH 03108 Hots. (603)623-8978 Fully Insured NO CONTRA . CT Date — 20-0-4C I (we), the undersigned; hereby accept your proposal to finish Labor and Material to perform the following work on premises located at the following address: No. %0 S.9/G 4!�I 6: ? Owner's Name ,��i%Y v�L-'GiZAB�'Tb� Ge%.Q/(-.�� Tel7 fl' -' G� �'"^ ©� S Address In accordance with specifications given below: SPECIFICATIONS OF CONTRACT i0ro� /-'L.4ly';7o' -e tvi 7 Gi' /�'pV ,QAoe,4 /� A — LI1l v� /,►�i.d � l�� ��/1 5 �.. T CA �ASGIA c>` w/��� u• S % a/d _lIC12 � ew oAle Ile d4 �� Y w<:ylJ�? cue 'Ow � 76 ©A; s -- 1.7e6<r-).4- n CASSl u i!�' -- L_ D cG e vl-" & 0/-" ro- / /' G- �}S a/L 7-0 /✓Ay /=�le o f /J I-ee ,' e A Y 44- fflTf �c c For the sum of Additional work at A5!- 4, j 114- 7 -rel - Deposit $ 4 The undersigned property owner agrees upon completion of said work, to pay cash (if any) $ Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has. (have) hereunto set his (their) hand(s) the day and year first above written. Buyer(s) Acknowledge Receiving a Completed Legible Copy of This Contract. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. S THE ATTACHED , TICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. By .(A orized Agent) of H.L. N, LLC owner orproperty to or L.S. _ 91te � Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 154043 Type: individual Expiration: 2/5/2009 HERMEL L. MARTIN HERMEL L MARTIN 850 WELLINGTON ST. MANCHESTER, NH 03104 Update Address and return card. Mark reason for change. i-CAi 0 SOM-05/06-PC8490 Address Renewal � Employment [:]Lost Card ✓lW, -CJO�IfUIlLDJ7.C!/PdAUL o�✓//(,(I�1Q(z!�LCl6P,�6 + _ — -- Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR � - Registration: 154043 Expiration: 2/5/2009 Tr# 254097 Type.: individual 1ERMEL L. MARTIN 1ERMEL L MARTIN 150 WELLINGTON ST.,,� AtNCHESTER, NH 03104 Administrator Tr# 254097 License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature