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HomeMy WebLinkAboutBuilding Permit #743-13 - 71 WINTERGREEN DRIVE 5/8/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: I PORTANT: A licant must cpm Tete all items on this age LOCATION 21 JAI! ..•j` �.� �r�� _ Print PROPERTYQWNER - -- - -- -- -- Pnnf 10QiYear,0ld Structu[e ye= . nc- hh PARCEL] ZONING DISTRICT: Historic District- y, s no MAP NO: w Machine Shop. Village y_e, no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition ❑ Two or more family 11 Industrial Alteration No. of units: El Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑ Well. ❑ Floodplain, ❑ Wetlands, 0 Watershed',District, 0 Water/Sewer OWNER: Name: Address: DESGRIPTIUN Ur v11UKK i u t9t rtKrummir-u. Identificatiipn Please Type or Print Clearly) IQ �e_ IT 't c" 6+'.i'Coc 51/ e_c-w tke -97 ?yo F, CONTRACTOR Name.:. / 040 Address � �-`7'�n"1/�-r� Jrf - Supervisor's Coristruction- License: U0 �7 Date. -� - Home. Improvement` License,: - . Exp. Date: i / y ARCHITECT/ENGINEER a N :IPI Df +16e,^ r Phone: (? 7 r"'i_ Address:/6- 0d 0,r600c(ST 1-d-101 Reg. No. ail i FEE SCHEDULE: BULDING PE(MIT- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $�� lFEE: $� Check No.: Receipt No.:� NOTE: Persons contracting with un ister d contractors do not have accesstot r fund Sture of O Agent/vvner Signature of ignacontractor -x k«-._ ... ... .. Nz. plane 1A/nivari ❑ I^PrtifiPri Pint Plan R Stamped Plans ❑ 0 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 specialpermit 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 i Doc: Doc.Building Permit Revised 2012 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION CN COMMENTS DATE APPROVED Reviewed on `f 0 /%3 Sianature P -1v a qo--C S 7 `f, � ` HEALTH Reviewed COMMENTS _ - . --4. Zoning Board of Appeals: Variance, Petition N C Planning Board Decision: b Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Sign rimy- Ur -FA t i ivitN i = I emp uumpster on site yes Located at'124.Main"Street Fire Department pignatu"reldate COMMENTS Located 384 Osgood Street no 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 WOTFS and DATA — (For department use) No 6'1 —� P t ! oldl A 1 AA V& ® Notified for pickup - Date , E E Doc.Building Permit Revised 2010 - C -w -C3:- 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 flan ❑ PhQto 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: Doc.Building Permit Revised 2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION nn Permit N0: Date Received U Date Issued: �10RUAI NT: Applicant must complete all items on this page LOCATION �� IA/I.�j`�•� S✓`�-�^� CP = - - - Print; PROPERTY OWNER lhh Pnnt' _ 10QiYearO.ld Structure ye -no. MAP NO: / V PARCEL. ZONING DISTRICT:. HistoncDistrict y no - - Mac_hine Shop Village ye , no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial Alteration No. of units: El Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 0 Demolition ❑ Other (I Septic: ElWell. D Floodplain? ❑ Wetlands: D Watershed District 11 Water/Sewer c/o —I—, OWNER: Name DESCRIPTIUN Ul— WUNK I u or- rtrcrummau. Identificati n Please Type or Print Clearly) Zv � J /a �n Address: .�e ku 2��- Phone: 9% FI -T f `?- /1 CONTRACTOR Name: _ � .. 171 Address:' ,�'Cnya-r✓ `�'� - - _ �y Supervisor's Construction License;p: Date:. ,2 Home.ImprovementLicense: �y- : = Exp. Date a ,-, ��pi tt' 1J2� Phone: (' 7 f'" ARCHITECT/ENGINEER Address:/Cod O GO °C(�� .S"�-+ /� / a� AI�rY-� Reg. No. Lijo� i FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �� lFEE: $ Check No.: Receipt No.:� J� NOTE: Persons contracti%with,un inter d contractors do not have access to r fund ;Signature of Agerit/Owner Signature�of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan R Stamped Plans ❑ . Location No.-7,�, — Check # 26368 Date `1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3?DD Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Buildirfg Inspector ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) �+ 11014112 PRODUCER Cowan Insurance Agency, Inc. 359 Main Street Haverhill MA 01830 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 Ray Parkhurst 44 Bateman Street Haverhill MA 01832 INSURER A: Providence Mutual Insurance Company INSURER B: Associated Employers Insurance Company INSURER C: INSURER D: INSURER E: COVERAGES 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' lNqR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE fMM1DDjYY) POLICY EXPIRATIONLTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CP006426004 0911112012 0911112013 PRE MISESDAMAGE TO RENTED occur $ 50,000 CLAIMS MADE X❑ OCCUR MED EXP An one person) $ 51000 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 I POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—I CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X WC STATU- OTH- B EMPLOYERS' LIABILITY WCC5006506012010 0912812012 0912812013 E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? Yes E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Carpentry contractor. Sole proprietor is not included on the worker's compensation coverage. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) _ fes/ ©AaCOR CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Bldg 20 Suite 2.36 IMPOSE NO OBLIGALIABILI NY KIND UPON THE INSURER, ITS AGENTS OR North Andover, MA 01845 EPRESENTATIVES. AUT IZED REPRESENT VE ACORD 25 (2001/08) _ fes/ ©AaCOR CORPORATION 1988 Enter construction cost for fee cal - NOYth Andover Fee Calculation Construction Cost $ 33,100.00 m $ - $ 397.20 Plumbing Fee $ 49.65 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 49.65 Total fees collected $ 596.50 71 Winteer reen 743-13 on 5/8/13 Screen and enclose 1422 Deck Loi t w L c) -T t l LOT t2 EXtSTtNCx isLpC, 'TA, t,4 v- D�3oX � 'C-XtSTtNCa- LE 2 E N E ----� i .. 15 a Q -O r \iVI NTERC-2EEN D VE L- oT l I (/50) X = /50 - _ .......................... . DESIGN EL EvIdT/ON,4T. , ......STOP OF 57ONE) _ EXI5TIM E"LE/4TION 4T ......... 2EQUi2E0 F/LL = ................. . ELEV..4T/ON,5 DES/ N .4.5 BU/LT INI! P/PE OUT OF, -/OUSE INI/. PIPE INTO T4NX' INV P/PE OUT OF 74NIY 13�.No IZ9.69 INV PIPE INTO D BOX t�,.00 126.72 INV PIPE OUT OF D. BOX , j l za,67 INV END OF PIPE I z a, I o t3av5o IZ-8// 3 zg.so ' tZB,oq t z� a Iz�310 WW-LcIC EZE1 4TIOIV NONE Arizu,s .4 VE2�44E STONE DEPT// ,47 /',eOBE NOTE. T //S PLAN /5 NOT ,4 W,4,e/e41VT)1 OF TIE SYSTEM BUT ,4 VE2/F/C,1T/ON OF T,yE LOC,4TION OF 71VLc Lcxl.5TI/V(:� ST�2UCTU2ES. 4 ZH YANSEN v 28895 P", I.��SrER�° AI E�G� 9% CLC D/SPO.54L SYSTEM /N NO2TN A.t�11�o V t 2 F02 WILLIAM FAL(,UN SZALE: �=40� 04TE: 11I -Ls I87 C'1�/,e/ST�4NSEN ENG/NEM/NC,, INC //4 KENOZ.4 .4 VE., ,y,4yE.P1//LL, MA. .fi t GUiNTE,2� S .S/EREBY CE.eT/FY 70 Tye T/TZ.E 1A1SU.PO.P ANO TO THE B.4AW TygT T.yEOb'EGG/.a6 /S GOC.4TE0 O.c/ T.S/E COr f -I 5AV,'V.t/ ANO Tf/AT/T-la6ws CO.(/FO.PhJ MllTl/T,yE r^w-`' OFNO. A.✓oc�� �zON/�trG PEGvcar1v,(1s R66AR0/.UG GOT ONES. N 1 F!/.eTif�E.P GE.PT/FY T//•9T TiY/S OiY'ELL/iY6 /S -t/OT LO4C4TE0 /A/ TiYE FEOE.PAG F,0000 ff.92A.P0 .4.?6.4. SHd vN O/V Ffit�.q ' N T y ,�.s v« 00 z 50098 00/08 - RTE- 6 -is -o3) :s 47Z'- �L. S. p A' .2Ae PG O T RL Ait/ /N z2a 7?//S PLAN Fo ,�PvePOSES - �f/OT FO.P � Boavo.Py GETE _ BDUNOAJeY /.f/FORi1/ �E.P.P�iyl�lG� E".tiG/.dEE.P/.f/6 SE.PY��'ES ATjOf/ TA.C�E.Sr ' F,Potil EX/STjNG .PECo,Pps, . 6 � �,q,P,Y ,sT.PEET 4PIrnnndal 01000ptance Of propai I —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature work as specified. Payment will be made as outlined above. Date of Acceptance: Signature RAY PARKHURST REMODELING Q HAVERHILL, MA 0 No Job Too Small - MA Lic. #CS087229 Tel. 978-521-7512 MA Lic. #142387 Cell. 978-609-5473 PROPOSAL/SUBMITTED TO ( PHONE (Al DATE Aa ,/ STRLTT ` JOB NAME CITY, STATE AND ZIP CODE JOB LOCATION rY ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: ..... .... ... . .... tJ �:. /....1_/ ._. ..�. S _;!....7..� ... ..../ '..�!' 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C..L.t............�...tf.�...... .......L...i.l....�..`..._f...1.................c..._'..!...(.`..'...!....r..{.................................._..................-...�^�......................... t ........f .............. !` t..r. .......... ..+............................................................................................................................................................................................................................................................................... ( t. (....:..r.... ....................................... .......... ;.................. ........... ............................................................................................................................... ................................................. ........................... P. ... > ......-.......... "... .............c........... ......�'a.....,..... ....... .... ........................ ............................... ....................... ............................................................................................... t.�...._...,f..(....... r ...... ........................................................ ...... .... ............................................................... . .......... .f ..r.................................................................................. VC 3propOZC hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: 3,(' , f 4 f - - . t j" { � . 7 1 r 1 1 e - I dollars ($ �� �, t a ✓ a v�. Pa ment to be made as follows: P All material is guaranteed to be as specified. All work to be completed in a workmanlike manner Authorized according to standard practices. Any alteration or deviation from above specifications involving Signature extra costs will be executed only upon written orders, and will become an extra charge over and ` above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our workers are fully cov- Note: ered by Workmen's Compensation Insurance. This proposal may be withdrawn by us if not accepted within days. 01000ptance Of propai I —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature work as specified. Payment will be made as outlined above. Date of Acceptance: Signature .- '',� �1e ((�on�marnaulca.�/� o�C/f�,ta.f.tac�u.teliN , - - Office of Consumer Affairs. & Business Regulation P'ME IMPROVEMENT CONTRACTOR gistration: 142387 Type: piration: 4/1/2014DBA RAY PARKHURST REMODELING RAYMOND PARKHURST 44 BATEMAN ST. ��-�— HAVERHILL, MA 01832 - Undersecretary, 9 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cunstructiun Suimr% isur License: CS -087229 i g RAYMOND GS�ARi RST .�•��r 44 BATEMAN ST;,`. rr HAVERHM k, MA 01832 11 "If 912, --&f`14`"� Expiration Commissioner 02/14/2014 CA m m m m y m y m < n O 'a -I O O O O 2 < m N v =CDQ-O CD 0 _ O �C'C 3 m O�� -n CO_O .ten m �< CCD 00 n O y o N N r-. - C CD = �• CLU) N CCD D O= O -� CL U3 to 0 C'1 W S O O fmIL U) CD 0-0 Z 'fl O. O Sa �O b cn to OWN --w Q. 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