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Home My WebLink AboutBuilding Permit #591 - 894 GREAT POND ROAD 3/12/2007 BUILDING PERMIT o`"�oT 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h T Permit NO: -521 Date Received �4A7[O nPPy'(5 'J Date Issued: IMPORTANT: Applicant must complete all items on this page L t � -XIS P�CPE�TXOWNEI e a7Laela � � IiGSTulll1e39 zIJmOIT�RT yev �� ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ teration No. of units: ❑ Commercial epair, replacement IiAisessory Bldg &L('Q ❑ Others: ❑ Demolition ❑ Other {{{ 11 � y # „�,./..r�a.,�,.,,,, � Q DESCRIPTION OF ORK TO BE PREF RMED: / ao 2, C�.iVG �� - 1�GCS j ti► v�1 O C9�� D U rA.) l fJ Idenfi ation Please T pe or Print Clearly) OWNER: Name: �OIVq C �e�'ti�� -Se Phone: 6' P�Address: � t � ry / 9 -"Ct�NTRZ," # �Nam es o41 It y � x« 12lc�'�i��"` �m I�provem�t' ARCHITECT/ENGINEER 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: $ ,� 6 I FEE: Check No.: / Receipt No.: �2?o o 3- NOTE: Persons contracting with unregistered contractors do not have acces to uaranty f d Signature of Agent/Owner Signature of contracto 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 ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS TYPE OF SEWERAGE DISPOSAL Public Seker ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales Food Packaging/Sales ❑ Privatese tic tank etc � p � ❑ Permanent Dumpster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments � w Conservation Decision: Comments Water & Sewer Connection/signature&Date Driveway Permit Located at 384 Osgood Street 1 x a s DIRE[ � ARTflEeT1pDumpstr oh steges nc� 1 "y � S� F�reDeparm�ent srg atuelcla#e, k s � y � s w CO %I'MENTS 3 � zi, r tl y Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or service drop requires approval of ElectricalInspector Yes No DANGERZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine li NOTES and DATA— For department use i �I I i it I �I 1 ❑ Notified for pickup - Date ...................................................................................................... ....................................................................................................................................... .. .................................... .................................................................:.......:............................................................................................................................. 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 ❑ Engineering Affidavits for Engineered products 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/Crossection/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 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 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 j Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 i I Location v No. Date NORTIy TOWN OF NORTH ANDOVER -. f 9 i Certificate of Occupancy $ Eta Building/Frame Permit Fee $ S CNus Foundation Permit Fee $ � a Other Permit Fee $ TOTAL $ Check # 6 20062 Building Inspector 3/12/2007 9:35 AM FROM: Obrey Insurance TO: +1 (978) 688-9542 PAGE: 002 OF 003 ACORD CERTIFICATE OF LIABILITY INSURANCE OP TSO-1 03/12 /0oT DATE(MWO � WATso7 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OBREY INSURANCE AGENCY HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1 E COMMONS DRIVE UNIT #27 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LONDONDERRY NH 03053 Phone:603-432-3883 Fax:603-425-6769 INSURERS AFFORDING COVERAGE NAIC# INWRED INSURER A PEERLESS INSURANCE 24198 INSURER R. AS Watson General Contracting INSURER C: 3 Ed emont St Derry NH 03038 INSURER 0: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING 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. LTR NM TYPE OF NSURANCE POLICY NUMBER DATE MMIOD DATE(MINDDIM LUSTS GENERAL LIABILITYEACH OCCURRENCE $1000000 A $ COMMERCIAL GENERAL LIABILITY CCP9399272 PPEMISES(Eeoccu're nca) $100000 CLAIMS MADE I X I OCCUR MED EXP(Any one person) $5000 % Business Owners 03/06/07 03/06/08 PERSONAL 8,AoV INJURY $1000000 GENERAL AGGREGATE $2000000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG $2000000 X7 POLICY F7 JECT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO BA9382810 02/11/07 02/11/08 (Ea accident) $500000 ALL OWNED AUTOS BODILY INJURY $ $ SCHEDULED AUTOS (Par person) HIRED AUTOS BODILY INJURY $ NON.OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ EAUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ i $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND $ TO11 RY LIMITS ER A ANY PROPRIETORJPARTNERlEXECIRtVE EMPLOYERIETORI utY WC9304376 03/06/07 03/06/08 E.L.EACH ACCIDENT $100000 OFFICERJMEMBER EXCLUDED? E.L_DISEASE-EA EMPLOYEE $100000 If yes•desvlbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS JOB LOCATION: 894 GREAT POND RD NORTH ANDOVER MA CERTIFICATE HOLDER CANCELLATION TOWNOFN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER W ILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF NORTH ANDOVER IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 894 GREAT POND RD REPRESENTATIVES. NORTH ANDOVER MA AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 0 ACORD CORPORATION 1IM tAORTH Town of . s over � , 0 No. � A K E COCH over, Mass., ICKEWICK V' �AORATE D '9 S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ........�.I.C.A-1rw....7 .8........................................... Foundation has permission to erect........................................ buildings on ..AlY.... rte.. ..+ .T...,�Po.�t ... i�/. Rough to be occupied as I....... r =' #.................. /� �/ Chimney provided that the person acceptin this permit shat m every resect 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONS TR -ST S Rough ....... ..... ...... Service B 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. irt � r C•• ib .:.� ,,, . a si3 ; '- ��/)f'ir!.'?.1J�fIYtGo4u JlGOyGj a7j/-• , � o ._ '' + . w �.�'� � ✓fie �oarv%�rcoru�seafl,/ a�.i�ar�a��,uJvlla b ' BOARD OF BUILDING REGULATIONS License. CONSTRUCTION SUPERVISOR dumber:,CSr, 063168 Birtkdate 02/12!1956 Expires 02!12!20,08 Tr.no: 17019 74, ARTHUR f 1 3 ED GEMONT DERRY, NH 03038 L_y Commissioner