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HomeMy WebLinkAboutBuilding Permit #327 - 871 FOREST STREET 10/23/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O 1"D 6;�tio .'J'� 4.. •_ 6 0 O 's o it Permit NO: Date Received k-06 +� ? e +' ° At ,� m. _ ,> X1,9 w Date Issued: ' SSACHus� IMPORTANT: TANT Applicant must complete all items on this age LOCATION 9 r/` l" �'l� /� 5' �/ /Y 0 •/i"A1 bO fi Print PROPERTY OWNER Z AN Print MAP NO.:j6 4 a PARCEL: 7 7 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building �A One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: K Repair, replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED E' j� �- eJV14 Lb 51d, Identification Please Type or Print Clearly) OWNER: Name: y A/vr I-L o y N Phone: Address: �=a 1�f S f- NO 4-W o j/ltR 0 CONTRACTOR Name: d t-- A, — Al O � V , C ° "'l )/ 1 U X ne: � Y 3 K O y''gel Address: / y3 110 N*— RP- / 45't ' / x/04 P S tf`0 -- N-# 0 19 2 G a Supervisor's Construction License: 6 Y�(3 9 Exp. Date: l/— p 6 ,q Home Improvement License: l y a G 6 Exp. Date: 1) -16 - �d 0 7 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12. FE $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ FEE:$ ISO -� Check No.:- 02646 Receipt No.: _ Page lof4 Locationy/Z S- No. Date /Qat r 4 TOWN OF NORTH ANDOVER _ F w 9 Certificate of Occupancy $ Building/Frame Permit Fee $ �� +cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (!il ` 9725 1 B ilding Inspector TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art ❑ Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales El ❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ftA t_ Signature of Agent/Owner �/ �ture of contractor ` *a�-> Plans Submitted ElPlans Waived ElC ified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS ` DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Sf FIRE DEPARTMENT - Temp Dumpster on site yes no X 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 Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 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 g ermlt pp Icatlon _ i avI I.C. And/Or C.S.L. Licenses ❑ Floor Plan Or Proposed Interior Work Addition Or Decks uil ing Permit cation ��urveyed Plot Plan rs Com it ❑ Photo Co .I..C. And C.S.L. Licenses ❑ o_y ssection/Eleva ' an 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 � NORTH Town of Andover No. o 0 .� =. °.. P-01 = dover, Mass., 2z• D d COC LA HICHEWICK I. ADRATED O'PVL �� `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... )904 . �.h N ..................................................................... Foundation has permission to ere ........... buildings on .... ..W.........ISOLW.- 7W..W./................ Rough to be occupied as.. Q. .. .. ........ 1.�►...W4j%d@jt... �.��� .... ... hinny c provided that the persona ting this permit sha in every respect conform to tKe terms of the appl anon 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS Rough ........... .... ......................... .. Service BUI 'OR Final I 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. IF SEE REVERSE SIDE Smoke Det. ACOR4 CERTIFICATE OF LIABILITY INSURANCE io%zo%i o6) PRODUCER (603)382-4600 FAX (603)382-2034 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Solutions Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 60 Westville Rd HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Plaistow, NH 03865 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dolores Magl is INSURERS AFFORDING COVERAGE NAIC# INSURED Jean Morin INSURERA: Central Insurance 20230 DBA Jean Morin Construction INSURERB: Zurich-American (AR) 143 Hunt Road INSURER C: East Hampstead, NH 03826 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN, ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY BOP7993834 04/02/2006 04/02/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $cr RE 100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY PRO- JECT El LOC AUTOMOBILE LIABILITY BAP7993829 04/02/2006 04/02/2007 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 500,000 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 6ZZUB3198BO6706 06/15/2006 06/15/2007 X I WCSTA OTH- EMPLOYERS'LIABILITY — I TORY L11 B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS PERATIONS: CARPENTRY E: DANIEL B. RYAN - 871 FOREST STREET - NORTH ANDOVER MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 566 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845-4011 AUTHORIZED REPRESENTATIVE- -D INSURANCE SOLUTIONS 01 T ONS ACORD 25(2001/08) ©ACORD CORPORATION 1988 A U IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) s�2 " t W. 4,492 O ``w a fA tSamr� U@ Y i aAS�w` p tl f ""V.Wm for Omwov4 '7M ddin AM �����t t' f �e'#o=jwd StmdA1'QS . ir GniTEI ASM { t -- i of aaiic�withottt'aignA"