HomeMy WebLinkAboutBuilding Permit #751-14 - 9 WALKER ROAD 4/25/2014Permit NO
Date Issue,
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
`.j � � e
Date Received
iL
TYPE OF IMPROVEMENT
PROPOSED USE
Residential ---
Non- Residential
D Npw Buildinn
-_• Ore f�;rnily
❑ Addition
j ❑ Two or more family
❑ Industrial
Alteration
No. of units:
!_
G Assessory Bldg
r1 Commercial
_�� —_
epair, replacement
, Others:
❑ Demolition
❑ Other
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Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Arrrl race
ARCHITECT/ENGINEER Phone:
Address: __. _ Reg. No.
FEE SCHEDULE: BULD/NG PERMIT: MOO- PER $100000 OF THE TOTAL ESTYMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ _v _ FEE: $_ D
Check No.:____Receipt No.: _
11 S
NOTE: Persons c ing with unregistered contractors do not have access to the guaranty fund
�inr enci
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t.
Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print,
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
.TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:
A d dms,-, -
CONTRACTOR Name: Phone:
Address:_
Phone:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCHITECT/ENGINEER
. Date:
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: $ FEE: $
Check No.: Receipt No.:
NOTE: , 'Persons contracting with unregistered contractors do not have access to the guaranty fuyvd
Signature of Agent/Owner Signature of contractor
Plans Submitted E Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
- Plans Submitted ❑ -Plans-WaivedE].- :Certified Plot Plan ❑
Stamped Plans ❑
'MR -OF SEWERAGEDiSROSAL
Public Sewer ❑
Tanning/MassageBodyArt ❑ ..
Swimming Pools ❑
Well ❑
Tobacco.Sales 0
Food Packaging/Sales ❑
Private (septic tank, -etc.- ❑..-- _
permanent Dumpster o on Site ❑
THE.FOLLOWING SECTI.ONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-- U FORM
DATE REJECTED DATE:APPR:OVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
"CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Signature
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 Toiv:, Engineer: Signature:
Located 384
FIRE DEPARTtVI: iVT =Temp Dumpster on site yes no
Located -at 124 Mair, Street
-Fire Deiiartiine►it-signature/date`'
COMMENTS.
Street
-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
NOTES and DATA — (For deaartment use)
IV 6`A-
® Notified for pickup - Date
S
t
i
Doc.Building Permit Revised 2010
Building Department
-`- The fol owing is a=list of the' required.forms to be filled out for. appropriate permit to .be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o B,tailding Permit Application
o Workers Comp Affidavit
Li Photo Copy Of H-.I.C. And/Or C. S.' L.- Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
a Building Permit Application
o Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Mass check Energy Compliance Report (If Applicable)
o 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)
Li Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
L3 Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all csscs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-zal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doe: Doc.Building permit Revised 2012
LocationY//
No. n — Date j
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $t
Building/Frame Permit Fee $
Foundation Permit Fee $a
Other Permit Fee $
TOTAL $
(-?D ���
Building Inspector
CD Todd
40 Windemere Way
Bridgewater MA 02324
508-245-3119
Licensed and Insured
Bill To
Kelsey Hitchins
9 Walker Rd unit 5
North Andover MA 01845
Invoice
Date Invoice #
4/19/2014 473
P.O. No.
Terms
Project
Quantity
Description
Rate
Amount
Remove the existing door and dispose of it. Supply a new brown vinyl exterior and
white interior MI slider. Trim the inside and out to finish the door.
1,950.00
1,950.00
Phone #
Total $1,950.00
508 245 3119
Office of Consumer Affairs& Business Reguintio
a
OME IMPROVEMENT CONTRACTOR
egistration: :10199
70199 1 Type:
Expiration: L._9/26/201
Individual
Al
CHRISTOPHER D. to"
Tw
CHRISTOPHER TO
40 WINDEMERE WA
BRIDGEWATER, MA 32
Undersecretary-,
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supvmisor
1"
Licdnse: CS -071415
-t. Is
C1Ut1$T0PH1K-R Q40D
40 WftMERE
W
BRIDGEWATERFI�k�!
Expiration
Commissioner 01/22/2016
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1gPR-15-2014 13:21 From:17813418302 Pa9e:1/1
ACC) O CERTIFICATE OF LIABILITY INSURANCE BATE1 41 MMIDIYYY)
4151
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tering and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsemen s .
PRORICER CONTACY
NAME:
Hardy Insurance Agency E 781 341-8300 FAXNo: 1781) 341-8302
31 Tosea Drive, Suite 2 a oR€Ss: sand Oh rgy1nsllc.coM
Stoughton, MA 02072
INSUREP451 AFFORDING COVERAGE NpIC H
INSURER A: Nautilus Insurance Com an
INSURED INSuREdtB:The Hartford
Christopher Todd INSURERC.
Julie Todd INSURFRO:
40 Windemere Way INSURFA E:
Bridgewater, MA 02324 INWRGRF:
(1nVFRAt=S: CFRTIFICATF N IIMRFR- REVISION NUMBER:
THIS I$ TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AWL
SUBR
POUCY NUMBER
POLICY EFF
MInory
POLICY EXP
MMMRrfYY
UMTS
A
CENERALUABILITY
X COMMERCIAL GENERAL L1AgWTY
CLAIMSNAOE F—I OCCUR
NN248616
6/25/13
6/25/14
EACHoccuRRENCE $ 1 000 000
DA GE TO RENTED $ 100,000
MED w (Any ore Person) $ 5A00
PERSONAL&ADV INJURY ; 1,000 000
GENERAL AGGREGAYE $ 2,000,0 0
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PRO- LOC$
PRODUCTS •COMPIOPAGO. $ 2,000,000
AUTOMOBILE LIABILITY
ANYAUIO
ALLOWNED SCHEDULED
AUTOS AUTNON-OWNED
HIREDAUTOS _ AUTOS
cow OSIN l
NEe
a scomrt
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PeOacc ent AMAGE s
$
UMBRELLA LIAR
El(CE$SLIAe
OCCUR
CLAIMS -MADE
EACH OCCURRENCE S
AGGREGATE S
pM RETENTION
H
WORKETffi COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPR(E7 "ARTNERrE%ECUT(VE YfN
OFFICERNIFMBER EXCLLOED?
(Mandatory In NH)
If ygs, dqualbe under
DESCRIPTION OF OPERATIONS below
N! A
6S60U8-5889445-0
3/26/14
3/26/15
WCSTATV OTH-
EL E HACCILENT & 100 000
EL DISEASE -EA EMPLOYCC 600,000
E.L. 4I8 FA E•POLICY LIMB $ 100,000
DESCRIPTIONOFOPERATIONS1 LOCATIONS /VEHICLES (AtRCIIACOR9191,Add&nalRermrksSchedule, ffmore OP00tismgdred)
Christopher Todd is excluded
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL CC DEUVER50 IN
Town of North Andover ACCORDANCE WITH THE 4LICY PROVISIONS.
120 Main Street.
North Andover, MA 01845 AUTHORIZED RE PRE SENTA
Sand Trethew
Q 198.2ACO D RPORATION. All rights res rued.
ACOR0 25 (2010105) The ACORD rmme and logo are registered marks of ACORD
Phone: Fax: E -Mail: