The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #512-15 - 8 MAYFLOWER DRIVE 12/1/2014TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer // _DESCRIPTION OF ORK TO BE PERFORMED: OlUnD4f•`o,? foe 3 ae/� I'� Identification - Please Type or Print Clearly OWNER: Name: Ke N k m e4 .LYr c Phone: Address: /d He -M Accit ) RN/ Contractor Name: -&(4- �&000 Phone: �;'09 -346 -,q(,30 Address: Lo �P �� L FFG Ny AA dojee0, Supervisor's Construction License: (2 s 07 336 2_- Exp. Date: ISL I4L 16 Home Improvement License: Date: ARCHITECT/ENGINEER) . C,6V W, C. 65 Phone: Address: Reg. N FEE SCHEDULE. BULDING PERMIT. • $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /Of Ozlt7 FEE: $ /a?O, - - I Check No.: e")e01 Receipt No.: pEsi NOTE: Persons contracting with unregistered contractors do not have access to h uaranty fun Signature of Agent/Ow ignature of contractor 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 PLANNING & DEVELOPMENT Reviewed On Ili "'' � Signature_ li&�iF COMMENTS CONSERVATION Reviewed on /'a 1A4 Si nature; COMMENTS HEALTH Reviewed on Signature COMMENTS N L 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 ,DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NU I t5 and UA I A — (For department use ❑ Notified for pickup Call Ema Date Time Contact Name Doc.Building Permit Revised 2014 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 o 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/Cross Section/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 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 Doe: Building Permit Revised 2014 Location ► 1 t �Ovv No. 512- Check Z Check # Q 0 1 c. Lo, J Date'.) 1 1 ) 4 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee_ oundation Permit F-9 $ Other Permit Fee $ TOTAL �� 7 Building Inspector 3 0 ENO W, WD WS N O 2 LL O m C t y Y LL +a)+ T N u Ln cc p N Z O Z p J_ m O + fa v LL t d' T N c V LL 0 H LU Z O z m J d t w LL (A Z Q U oC W t K N Ln LL ac 0 LU CL Z H t OC LL z a W LU LL v CO O z +' t% +� N u In NW w a w W CL F; N w 1-- s 00 O CL CL cm Q _ 'a J � O /d Z CL Y//\ i IE \ _. _ y .. ...._.._..._. ..__.-......_ .. _.___.. _ _. _.._... . _... .......... ..._. ......._... .... � _. ... - -.._ __.- !' u a p Z g i44�i o�Qf w J ap d 10 3F —Oo g $a za o� w ° m, �gwzZ LLQ�00 r w�7 wYgZ 00-0 O OO P.0 g 0 J n o Z ZU Q Z z z o m NO o WW E d F § U Q) �) �{ V 1: '�'� 0> az=wFpa saW 00 m a al d � !\I LV b- = ' _ - -� U gD W ]� G= W p N �0 m 0 e LL m as Hill, $ap ��fi C N N s [ a � - r r O � c O_ I. � c �a o m o o O U7w N w T ro J w o ¢ ¢y N Q c �mCl) > g3�� $E m` 5 L. i m� to WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. WCC -500_5007651 2014A� PRIOR NO. _WCC-500=b007b81-2013A ITEM 1. The Insured: Key Lime Inc DBA: Mailing address: 10 Hepatica Drive FEIN: "_••`1218 North Andover, MA 01845 Legal Entity Type: Corporation Other workplaces not shown above: 2. The policy period is from 09/15/2014 to 09/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ _ 1,60Q000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. ......................... -- iassifications Premium Basi --s Rates _ Code Estimated Per $100 Estimated No. Total Annual Of Annual _Remuneration Remuneration Premium INTRA 285896 INTER SEE, CLASS CODE ...—...__......... Minimum Premium $575 Total Estimated Annual Premium $4,217 GOV j GOV Deposit Premium $1,086 STATEICLASS mA 5645 MA Assessment Chg. ------- – $3,778.00 x 3.4000% $128 r This policy, including all endorsements, is hereby countersigned by �' -""`-��7 07/31/2014 Authorized Signature Date Service Office: M P Roberts Insurance Agency 54 Third Avenue 1060 Osgood Street Burlington MA 01803 North Andover, MA 01845 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission.