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HomeMy WebLinkAboutBuilding Permit #207 - 717 WAVERLY ROAD 9/19/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION p`t%ORoT 6 quo 2 'e p L �I Permit NO: Date Received ��` 1# a" 0,9 M A°gArgo APP,�'�� h Date Issued: •0 SSACHUS� i IMPORTANT: Applicant must complete all items on this page LOCATION '7/ 7 — 7191 Lr// Print PROPERTY OWNER E 3-/ Z o, o Print 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 �,?�- -r 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 ❑ ❑ i COMMENTS DATE REJECTED DATE APPROVED I 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) I I F i Page 3 of 4 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 i - Install New IKO Cambridge Charcoal Gray roof shingles over the old roof I 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) $ I (GARAGE LIABILITY ' I 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