HomeMy WebLinkAboutBuilding Permit #207 - 717 WAVERLY ROAD 9/19/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION p`t%ORoT 6 quo
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Permit NO: Date Received ��` 1# a"
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Date Issued: •0 SSACHUS�
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IMPORTANT: Applicant must complete all items on this page
LOCATION '7/ 7 — 7191 Lr//
Print
PROPERTY OWNER E 3-/ Z o, o
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MAP NO.: Oq- PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building ❑ One family
❑ Addition ❑Two or more family ❑Industrial
❑ Alteration No. of units:
❑Repair, replacement ❑Assessory Bldg ❑Commercial
❑Demolition
❑ Moving(relocation) 1 ❑ Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: I7 /QYIV4-' 4- ,IF T I z l o Phone:
Address: 2 :2- tyL= T 5 4/0 2 L: i�/� +.�/��I� I-(,4 M A/ C/
CONTRACTOR Name: 7"41 D ti/A IV b co 2 Phone (G o.32 �S"5�4?3 t
Address: .' 7 1'11-:'g R Y 44, if,/fF 5'h/ C1 H N P o o d a
Supervisor's Construction License: 0 2 d Exp. Date: zy/ezo 5:—
Home
Home Improvement License: /o S'o�-E l Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ 2 7a FEES �,?�-
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Check No.:� Receipt No.:--1-7S 7
Q/S7,
Page I of 4
TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑
❑ Tanning/Massage/Body Art ❑ i
Public Sewer
Well
Tobacco Sales ❑ Food Packaging/Sales ❑
❑
Permanent Dumpster on Site ❑
Private(septic tank,etc. ❑ Electric Meter location to
proj ect
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING& DEVELOPMENT ❑ ❑
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COMMENTS
DATE REJECTED DATE APPROVED
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CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
FIRE DEPARTMENT - Temp Dumpster on site yes no
r' Fire Department signature/date
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
Building Setback(ft.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA— For department use)
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Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.J.3n.2006
Building Department
artment
,
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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:BPFORM05
Page 4 of 4
� NORTIy
Town of Andover
No. �407T.P
_
ui = dover, Mass.,
49' 6
7 O - _ LAKE
coC M"C.E.CK
RATED
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
/ ' ZI-P
7/ 7 ,
BUILDING INSPECTOR
THISCERTIFIES THAT....... ..... ..N.... /..................................................................................................... Foundation
has permission to erect........................................ buildings on ..7. .. .�g......Oty .....�.'....... Rough
to be occupied as........... ..0.....QV..4/`........��ir....�Q� �............ Chimney
.........................................................
provided that the perso accepting this permit shall in every resp conform'to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
3 Z PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU=O Rough
.............................................. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
TED'S HOME IMPROVEMENTS
27 PERRY AVENUE
NASHUA,NH 03060
TELEPHONE (603) 889-4736
FAX(603) 889-7362
Dianne Letizio 05/15/06
22 West Shore Road
Windham,NH 03087
I will do the following work at 717-719 Waverly Road in N. Andover, MA
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- Install New IKO Cambridge Charcoal Gray roof shingles over the old roof
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I will guarantee the roof for 1 year against any workmanship on my part and against any
leaks under normal circumstances. I will not warrantee against acts of God such as high
winds, falling trees, ice back ups,which could cause leaks.
For the total amount of
$ 2700.0 0, which includes labor and material.
Payments are to be made in the following manner. $1,350.00 at the start of the job, and
final payment of$1,350.00 to be made at completion of job.
Thank you,
Home Ow r Date �-
Contractor Date /
��— ✓ire �anvincmarealCf- o�'✓t�a�sac�.asel7d
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
'O:ml Registration: 105881
�.. : Expiration: 7/21/2008
Type: Individual
THEODORE G.VANDOORNE
Theodore VanDoorne
27 Perry Avenue
Nashua,NH 03060 Deputy Administrator
f} '�` .:/he �anvmaancvealf.� o�J�a�sccc�ruaell,:
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 020889
Birthdate: 04/16/1948
L Expires: 04/16/2008 Tr.no: 21469
Restricted: 00
THEODORE G VANDOORNE ..
27 PERRY AVE —J
NAS!!UA, NH 03060
Commissioner
CER'.TIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY)
04/28/2005
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM"LATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Foy Insurance Agency LLC DOES NOT ANIEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
350 Main Street POLICIES BELOW.
Nashua, NH 03060 COMPANIES AFFORDING COVERAGE
INSURED
Theodore G Van Doorne Jr (COMPANY A.I.M. Mutual Insurance Co
dba Teds Home Improvements LETTER A
27 Perry Ave
Nashua, NH 03060
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NO T Wr(HSTANDING ANY RE-QUIREMLNT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE.Ml:-1Y BE ISSU IED 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 CLAIiMS.
R 'TYPE OF INSURANCE POLICY NUNIBER i POLICY EFFECTIVE POLICY EXPIRATIO\ LIMITS
DATE(NIM/DD/YY) DATE(MM/DD/YY)
GiNE1L\L LLULILTI'1' I 'GI:NF:RAI.AGGREGATE I $
! 1CONINI1 RCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $
—�CLAINIS MADE( OCCUR( i PERSONAL&ADV.INJURY S
OWNER'S S CONTRACI OR'S PROT. EACH OCCURRENCE $
(FIRE DAMAGE-(Any one tire) S
MEEXPENSE(Any one person) $
�AUTOMOBILE LIABILITY i !
----
COMBINED SINGLE
!ANY AUTO i (LIMIT $
-_-- li\LL UWNLU Alit VS !
(BODILY INJURY $
HSCHEDULED AUTOS Per person)
HIRED AUTOS BODILY INJURY
jNON-OWNED AUTOS (Per accident) $
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(GARAGE LIABILITY '
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PROPERTY DAMAGE $ ,
EXCESS LIABILI'T'Y EACH OCCURRENCE $
r_ 1UMBRELLAFORM AGGREGATE $
PTI IER THAN UMBRELLA FORM
WC TATUTORY OTHER
:1\"OIt6ER'S CONIPIiNSA'I'lON AND X I IT
J'NIPLOYIiRS'L1.11i1LITY !
7013701012004 108/20/2004 ;08/20/2005 IEL EACH ACCIDENT $ 100,000
A)FHE PROPRIETOR/ INCL
EL DISEASE--POLICY LIMIT $ 50O 000
IL'r\RTNERS/EXECUTIVE —�
PFICERS ARE IX F_XCL I IEL DISEASE--EACH EMPLOYEE $ 100,000
OTHER
� I
!
DISCRIP'110N OF 019�:1tA'I'IANS/LOCATIONS/VIilIICLES/SPECIAL ITEMS
Workers Compensation Coverage applies to Massachusetts Employees Only..
The Insured's Projects are in the Commonwealth of Massachusetts
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
THEODORE G VAN DOORNE, JR EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
dba TED'S HOME IMPROVEMENTS LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
27 PERRY AVENUE LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
NASHUA, NH 03060