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HomeMy WebLinkAboutBuilding Permit #91 - 75 JOHNSON CIRCLE 8/8/2006Permit NO: I Z Date Issued: — ^ 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received a 1 I . IMPORTANT: Applicant must complete all items on this pate LOCATION �J J C) ci t\ +—cA c Print PROPERTY OWNER _�v\ �`-�,s Print MAP NO.: PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition 0 Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial 0 Repair, replacement 0 Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Please IvD or Print Clearly) OWNER: Name: �p.� `� � �'S Phone: 69 � oZSg-y7,3$* Address: 5 aj 0 k, KrJ rx ",-- J k CONTRACTOR Name: Address: C-1 f-r,0r\+..S't =M °10wrA Aa 01-75-7 Supervisor's Construction License: 150000—.)— Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. z 7 -c),) tib FEE SCHEDULE: BULDING P MIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ C.#o (J FEE:$% - Check No.: 025s, -- Receipt No.: 15Y-5 2 -- Page 1 of 4 TYPE OF SEWERAGE DISPOSAL Art ❑ Swimming Pools ❑ g Public Sewer F1Tanning/Massage/Body Well F1Tobacco Sales ❑ Food Packaging/Sales [I Private ❑ lPermanent Dumpster on Site (septic tank, etc. Electric Meter location to project INUIVI: Persons contracting with unregistered contractors do not have access to the guara y un 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION s COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Deci DATE REJECTED []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED 11 DATE REJECTED I Comments Comments Q C DATE APPROVED DATE APPROVED DATE APPROVED Water & Sewer connection/Signature & Date Driveway Permit Temp Dumpster on site yes) no_ Fire Department signature/dateE& O.L Building Setback (ft.) Front Yard Side Yard Rear Yard Required EProvided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: IvuIt.) ana vA1A—(ror Page 3 of 4 Doc: INSPECTIONAL SER Created JMC. 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 u 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 u 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 Pane 4 n4`4 Location 75*- TOA /7-/ 0 ?'7 Ctd No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 15,332 Building Inspector PROPOSAL & C� Z, V, PROPOSAL N4. T C' o.t, % i vc�� +"� �'1�rp� �'r1Cn#' SHEET NO. �' 1!'LX`� t / _ `q • 11 5 � �� i i� : { DATE tai V Ppnpn.gAi CI IRMITTim Tr). 'A.Pi:-■Q ME! MC nMhAr NAME ADDRESS 5 /V. PHONE N0.-1 ¢ ` LP5 r 914 f i DATE OF PLANS ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of o r,+rK r W . k' 5tr; 1 < 0.r, 0�rA Pt -e x(:a n-4- r i it e -r +t'r-c cA t1 r Wilk cls /.\i9 PSC0Cpct -n0 /� j t�'�r~cacTt 4.uf 1 L CAti h 1 =`"rte F t �G r y[G\r"LaT &l4 e„ _iiiy (r% +j r`° \ CC ,is FOIL -_r— +,ALV4.ry 0.i rG.� L C>.J1 A t r1t t 1 /00 sq. S +A r n c. t - �- C qc`. rc cS� _` {ti4 {ttT 4t� t`'.+ \ r- ;V t' W 0. {' pati / +°. f rr G i tC'rJ, C34 U "- )"c. f il < y 11Lii fi {` cy.n ((tf`�f+tG c lV \(nnu at`1 + r'C C4 a 4 f`Cal�TGG t cnn V c t.fc t" 4 r S'�,.120 kcr"0' r_ t e_LtVZ'gc!4 k. _11 •'Act Jac. Imo '3 by c All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of ..3 i)< 10 �.+ s y ok, Dollars ($ _ C0000 . ()0 with payments to be made as follows. .:;r >,,� � Grp � �t� PC�O� Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agrtrle t� s c . tingent upon strikes, ac - 'dents it ¢ lKs b and our control. CC��i� 1�.� l oe ]hh Note—This proposal may be withdrawn - _ -_ by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted, You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date _ P ) l 0 6r Signature :.� NC 3818-50 PROPOSAL board of RuildiAg Regulations and Standards HOME IMpROVEMENT CONTPACTOR Registration: 150082 Expiratloft: 3i612008 Type: DBA License or registration valid for individu use 041tv before the expiration date. If found retu "lo: Board of Building Regulations and -Ston(AT115, One Ashburton Place RM 1301 Boston, ma. 02,08 CLINGAI--,H1 CONSTRUCT"ON FRONT STREET IST FLOOR Not valid without 'i9"A1L'rc t -Alt FOR0, MA 01757 AAminislrator a CERTIFICATE OF LIABILITY }-,:CER (508)473-2030 FAX (S08)473-2834 - Hickey Insurance Agency, Inc. Main Street YA , C lmm,,.w , , , . , INSURANCE o3�i872 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. 0 Box 427 `i!�r�. MA 01757 i'_ w, Juan Cungaciai DBA 7 Cungachi Construction 28 Front St. Yl,i ford, MA 01757 INSURERS AFFORDING COVERAGE ' NAIC IF INSURERA: Western World HTBO18 INSURER B: INSURER C: 1,000 PERSONAL 8 ADV INJURY INSURER D: INSURER E GENERAL AGGREGATE ;E °Ot .C:ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD -7EQLIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH ! , 'ES �GGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADO"L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS :c.co Y TYPE OF INSURANCE - - -_ ^ - - � _'' RRENCE S 1 OOO OQ GENERAL LIABILITY Y OMMERC WL GENERAL LIABILITY --" J CLAIMS MADE � OCCUR c: +L AGGREGATE LIMIT APPLIES PER: I P -- —, RO- =OUT n CY� _E,LCC AUTOMOBILE LIABILITY _— >NY AUTO >LL OWNED >UTOS SCHEDULED AUTOS -i;RED AUT_S ',,,N-CVvNEC -:..TOS 3ARAGE LIABILITY >NY AUTO =-xCESSIUMBRELLA LIABILITY -" R J CLAIMS MACE 'EDL'CTELE RETENTION S NPPI0113 EACH OCCU , , DAMAGE TO RENTED $ S0,00 MED EXP (Any one person) S 1,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE 5 2 '000,00 PRODUCTS - COMP/OP AGG S 1,000,000 COMBINED SINGLE L41T S (Ea accident) BODILY INJURY $ (Per person) BOCILY INJURY S (Per accident) — _ PROPERTY DAMAGE TS (Per accident) AUTO ONLY 'EA ACCIDENTEA S OTHER THAN ACC 5 AUTO ONLY: AGG S EACH OCCURRENCE S AGGREGATE S S S 5 CRKERS COMPENSATION AND T `APLO'rERS' UABILITY E.L. EACH ACCIDENT 5 " 4;;PRIETOiLPARTNERIEXECUTIVE E.L DISEASE - EA EMPLOYEEI MEMBER EXCLUDED? scree under E.L. DISEASE - POLICY LIMIT $ "' =_ 0RCVISICNS De.ow - . �CRTIC N OF OPERATIONS r LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS EIP iiKz S COMPENSATION CERTIFICATE HAS BEEN REQUESTED AND THE CARRIER WILL ISSUE DIRECTLY. FRT:F: STURDY HOME IMPROVEMENT 34 FRONT STREET SPRINGFIELD, MA 01151 ACOGD 25 (2001/08) FAX: (413)543-3200 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MNL DAYS WRIT TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MNL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. RS AGENTS OR REPRESENTATNFS. AUTHORIZED REPRESENTATIVE AV— Robert Mulrev/7FHMA1 ©ACORD CORPORATION 1988 Location 5 rj > 6 No. !3AQ Date f , /,�- Check # / , . 2 -'-�'.05 2 7 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector S G'k7iv veU //-y -/5 r � � The Commonwealth of Massachusetts FOR i Board of Building Regulations and Standards MUNICIPALITY Massachusetts State Building Code, 780 CMR, 7th edition 6 g USE Building Permit Application Revised August, 2012 • This Section For Official Use Only Building Nrmit Number:�j (� (a _ (� l Date Applied: 115 Signature: Building Inspector Date SECTION 1: SITE INFORMATION Residential Commercial ❑ Other Description: 1.1 Property Address: 1.2 Assessors Map & Parcel Number�_��,Z Map Number Parcel Number 1.1 a Is this an accepted street? yes no 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sq ft) Frontage (ft) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public ❑ Private ❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Commercial- Service Size Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owpper' of Record: �^ sk,'e i 1, ►� A92, /�c i� % 5 L/O �i So t��`✓`c �(%< 41111 .11((14 Address for Service: Name (Print),, // See �� � c�" 70-- 5/5-2r Me Signature Telephone E -Mail Address SECTION 3:.DESCRIPTION OF PROPOSED)YORK2 (check all that apply) New Construction Existing Building Owner -Occupied Repairs(s) Alteration(s) Addition ❑ Demolition c Accessory Bldg. ❑ Number of Units I Other ❑ Specify: -`7 J ?A Y110 Brief Description of Proposed Work: eq i IGr2 Cyt%` SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only Y 1. Building $ S 1. Building Permit Fee: $ 2• Indicate how fee is determined. ❑ Standard City/Town Application Fee 2. Electrical $ ��' ® 3. Plumbing $ ��_ -� ❑ Total Project Costa (Item 6) x multiplier x 4. Mechanical (HVAC) $ 3. Other Fees: $ List: 5. Mechanical $ (Fire Suppression) Total A . 6. Total Project Cost: $ oz Y 000 e. Check Check Amount: Cash Amount: