HomeMy WebLinkAboutBuilding Permit #76 - 72 WAVERLY ROAD 8/4/2006TOWN OF NORTH ANDOVER NORTH
APPLICATION FOR PLAN EXAMINATION ttUE° b q'u'o
3? a ,, ..
�O t
Permit N0: lkp Date Received -�? l
Date Issued:
4d
�9SSAC HUs���y
IMPORTANT: Applicant must complete all items on this page
LOCATION � to'
,2;7`'' � Pnn
PROPERTY OWNER Tames
Print
MAP NO.: PARCEL: ZONING DISTRICT:
♦ I TT\ -nC . AT TITTTT TTl►T/"'�
U1QTnuTr ' niQT1D'1 T VF.0 F1
1 11 lL AL L --- v
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Assessory Bldg
Repair, replacement
❑ Commercial
❑ Demolition
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK IU 13t VKtVUKIVItIJ
,a X . ,
OWNER: Name:
Address:
CONTRACTOR Name:
Identification Please Type or Print Clearly)
ila ^�
0 ✓,
97S' 31 y 70Y2,
Address: I7 `s.5�'�P
Supervisor's Construction License: 3 /S Exp. Date:
Home Improvement License: f d �) 90 Exp. Date:T/�/
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. N
FEE SCHEDULE: BULDING PERM! . $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BA D ON $125.00 PER S.F.
Total Project Cost :$ �� On 6 x12.00=FEE:$
Check No.: %02. Receipt No.:IF
%
Page 1 of 4
i
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Public Sewer ❑
Well
Tobacco Sales ❑
Food Packaging/Sales 11❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
Electric Meter location to
project
11 v it r.: rersons contractin with unregtstere co . ractors do not have access to the guarantyfund
;Signature of Agent/Owne Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
r COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition N
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE REJECTED
0
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
❑17
Comments
Comments
LE
DATE APPROVED
Water & Sewer connection/Si2natu/re & Date Driveway Permit
Temp Dumpster on site yes_�o Fire Department signature/date G//tiles, ` jz'< ;'e'
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NOTES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTM ENT:BPFORM05
Created IMC. Jan.2006
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
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)
IN 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
Pave 4 of 4
AlLocation7Y a ���
No. / Date
TOWN OF NORTH ANDOVER
s
Certificate of Occupancy $
Building/Frame Permit Fee $ 166
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 7x=—
f . / Building Inspector
r.
W
z
0
w
w
a
H
U
z
0
U
M�
W cm
I 0
O
CD
L,* cD
m m
CD 0=
CL
��
�3
CD
O
CD 0 L
M O d
y C 'fl
c c
C.3 .ca
i.0
CODCLC
V v2
cc c
C
C
_c
d
CO2
Y/
19
W
W
19
UlW
N
Cd
o
a
C t
a
0
`
c
O y
x
w
a
c�
U
o
w
a:
U
x
W
o
C2
X
W
a
a:
cqi
Cd
G%
a
a
w'
w
z
as
c�
cn
z
0
w
w
a
H
U
z
0
U
M�
W cm
I 0
O
CD
L,* cD
m m
CD 0=
CL
��
�3
CD
O
CD 0 L
M O d
y C 'fl
c c
C.3 .ca
i.0
CODCLC
V v2
cc c
C
C
_c
d
CO2
Y/
19
W
W
19
UlW
N
C t
0
`
c
O y
C
SO
•nom
`
ac
c
c
is
0 p.
5
Aci)0
0
tscm
C
S
d0 i:+
y �
�
o � � y
MA
.0
cm
y0
E
0
o -,.o
.
_amo
y
t = O
0
pl
COQ
y
y
w C =
00�
im
N
te.1 Z
O
GO ID
a
ca
�C
_
`0
0 G
O ZL. 0
N .
,,,
1yy1
L
�.
vi
�E
a z
v ~ s .y
O
LU
C.3
L.
a m�0�
cm
g.
m = �
�
0
_
z
0
w
w
a
H
U
z
0
U
M�
W cm
I 0
O
CD
L,* cD
m m
CD 0=
CL
��
�3
CD
O
CD 0 L
M O d
y C 'fl
c c
C.3 .ca
i.0
CODCLC
V v2
cc c
C
C
_c
d
CO2
Y/
19
W
W
19
UlW
N
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State
Fire Marshal
P. 0. Box 1025 State Road, Stow, MA 01775
PERMIT Date: 7` r?/ o c
North Andover Permit No
(City of Town) ( If Applicable) Dig Safe Number
In accordance with the provisions of M. G.L.144 8 Chapter1Q as provided in section 5 2 7 ('. M R 34 Start Date
This Permit is granted to:
Full name of person, Firm or Corporatio
Permission to locate dumpster for construction/renovation/demolition of building.
Comments: dumpster must be 25' from structure if unable to place with required
Restrictions: clearance dumpster must be covered with plywood or tarp end of work day
at
( Give location by street/and no., or describe in such manner as to provied adequate identification of location )
Fee Paid$ 50.00 �Fire Chief
This Permit will expire Z6 - %O L ( Signature of offical granting permit) Offical granting pemut ( Title )
' TNIC PERMIT MI ICT FBF r'r)MCPlr l Ir)l ICI V Pr)CT;=n I IPM1 TNF PPPUMPC
08/02/2006 08:03 9786820713 R C LAFOND PAGE 01
DATE (MWDD/Y)
ACORD CERTIFICATE OF LIABILITY INSURANCE xzMVC i YYY0a 01 06
PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
C. La£ond Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
396 Andover Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Andover MA 01845 NAIL#
Phones 978-686-3B26 £'ax:978-682-07]3 INSURERS AFFORDING COVERAGE
INSURED INSIRERA_�American International CO.
INSURER B:
iti 's construction, Inr'. INSURER C:
Frank Ru110 Ih Dennis Pinet
14 Stone post, RoadINSURER D:
Salem NH 030'r9 1 iNCtIRFRE:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOH THE I-VUUT m"IVU rvun.n �
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE A
MAY PERTAIN, THE INSURANCE AFFOF DED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND
POLICIES. AGGREGATE LIMITS SHOWA MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!_ .__ .....�..eweneeune POLICY NUTUN
MBER DATe MM/DD/YY DATE MMIDDlYY
GENERAL LIABILITY
COMMERCIAL GENERAL LABILITY
CLAIMS MADE C] OCCUR
G EEN'L AGGREGATE LIMIT AP'LIES PER
y
1 POLICY n JECT 17 LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESSfUMBRELLA LIABILrfY
OCCUR 7 CLP IMS MADE
DEDUCTIBLE
RETENTION S
WORKERS COMPENSATION AND
A EMPLOYERS' UABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFcmMEMBER EXCLUDED7
It yea, describe under
SPECIAL PROVISIONS below
OF
CERTIFICATE HOLDER
b
WC 874-26-59
0
Town of North Andover
BY
04/3b/061 04/30/07
°D, NOTWITHSTANDING
AY BE ISSUED OR
IONDITIONS OF SUCH
LIMITS
EACH OCCURRENCE
S
PREMISES Es aecurenec
5
MED EXP (Any one PefW)
$
PERSONAL A ADV INJURY
S
GENERALAGGREGATE
S
PRODUCTS - COMP/OP AGG
S
COMBINED SINGLE LIMIT
$
(En accident)
BODILY INJURY
5 "
(Poe person)
GODILY INJURY
5
(Per accident)
PROPERTY DAMAGE
$
(Per accidenl)
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
AUTO ONLY: AGO
S
EACH OCCURRENCE
S
AGGREGATE
5
S
S
S
X I TORY LIMITS ER
E.L. EACH ACCIDENT
5100,000
El, DISEASE - EA EMPLOYEE
$100,000
E.L. DISEASE -POLICY LIMIT
$500,000
SHOULD ANY OF THE ABOVE OESCRIBED POUCWS 8E CANCELLED BEFORE THE EXPIRATIO
DATE LHEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICIIE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMP05E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001108) C ACORD
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 100290
Expiration -6/15/2008
>IType Private Corporation
RULLO CONSTRUCTION CO; INC.
Frank Rullo
14 Stonepost Rd�'�
Salem, NH 03079 Deputy Administrator
$,OARD'QF BUILDING REGULATIQ_NS'
i' License. C.ONSTRUCTI`ON SUPERVISOR
Number'C 043956
BIr€F14ate 04KUMS57
Se
4007 Tr. no: 10307
�1�011�5 Ct�on�:L^�i dDD y r
FRANK RULLO
14.S,TONEP_OST
/�—
:• SALEM 1VN;
' Gominlssfoner
i
3)
l
Phone: 508-269-9308
pa m
F/1/06
Kim's Construction, Co. Inc.
14 Stone Post Road
Salem, NH 03079
Fax: 603-894-4761
E7� M
oZn� -n R 0 NL
%ee i� #� legA ale, o e s
30 DDD, D O
a h":;/
l i ire `s CoNsTf�c77a N
e