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HomeMy WebLinkAboutBuilding Permit #158 - 94 MAIN STREET 9/2/2008 BUILDING PERMIT o*N°eT b TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION t 7D Permit NO: Date Received �oRA7[O SPF�,�y e� �SSACHUS�� Date Issued: GIMPORTANT: Applicant must complete all items on this page LOCATION 7 a r VX1Vc7 \i� A-1n r Print PROPERTY OWNERU C C( Lee� Print MAP NOQQ 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 PREFORME : Identification Please Type or Print Clearly) OWNER: Name: v C , 1 Phone: Address: S+ o ve d` CONTRACTOR Name: t G res Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ n FEE: $ �� ., Check No.: 5-33 Receipt No.: c� I 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund signature of Agent/Owner - signature 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS �\ CONSERVATION Reviewed on Signature ` COMMENTS HEALTH Reviewed on Signature COMI,tIENTS i 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 924 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 NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 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/Crossection/Elevation Plan Of Propsgd 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location1 �/�'1 No. Date �O NORTh TOWN OF NORTH ANDOVER f 9 + • ; ; Certificate of Occupancy $ — ;' Building/Frame Permit Fee $ — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #2 46 J Building Inspec AC CERTIFICATE OF LIABILITY INSURANCE OP ID NN DATE(MM/DD/YYYY) PRODUCER ERICS-1 r OS 8 08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO Santo Insurance - Salem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 224 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Salem NH 03079 Phone: 603-890-6439 Fax:603=890-0315 INSURERS AFFORDING COVERAGE - -- ----- -- --- --------- — -- ------ _ NAI C # INSURED --- INSURERA: --Penn-America Insurance compaay INSURER B: ------- ------ -- --- ------ Eric's Landscaping INSURER C: ----'--'"---- 52 Lake St Salem NH 03079 INSURER D: — - COVERAGES INSURER E: ---- ------- ----------- 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 NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION j DATE MM/DDIYY DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300000 A .x COMMERCIAL GENERAL LIABILITY POLICY # PENDING 08/18/08 08/18/09 pREMIs� ao curence) Jl CLAIMS MADE D OCCUR - --- $ 50000 t MED EXP(Any one person) $ 5000 — PERSONAL&ADV INJURY$ 300000 ---- -- GENERAL AGGREGATE $ 600000 GEN'L AGGREGATE LIMIT APPLIES PER: -------------- —__—_.__-..-_. OLICY Pr PRO- `_____jPRODUCTS-COMP/OPAGG $ 300000 i JECT I ILOC -------------- --- —..- AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT --- (Ea accident) $ j ALL OWNED AUTOS ------------ ------------___-- SCHEDULED AUTOS BODILY INJURY - Perperson) HIRED AUTOS —_— NON-OWNED AUTOS BODILY INJURY I$ f"-- (Per accident) [PROPERTY DAMAGE $ er accident) GARAGE LIABILITY j AUTO ONLY-EA ACCIDENT I$ I(" ANY AUTO ---I----.-----------__. OTHER THAN EA ACC I $ AUTO ONLY: o —1-- --------__.__.. i EXCESS/UMBRELLA LIABILITY AGG $ EACH OCCURRENCE $ OCCUR (� CLAIMS MADE AGGREGATE $ --_, DEDUCTIBLE ---_ $ _-----_- RETENTION $ .—__—___ $ WORKERS COMPENSATION AND $ EMPLOYERS'LIABILITY A U- _ 1TORY LIMITS _yER I ANY PROPRIETOR/PARTNER/EXECUTIVE EACH ACCIDENT $E.L.OFFICER/MEMBER EXCLUDED? _ It yes,describe under E.L.DISEASE-EA EMPLOYE $ SPECIAL PROVISIONS below ----_ —_ ----]OTHER E.L.DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ERICSLA SHOULD ANY.OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Eric's Landscaping IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 52 Lake St REPRESENTATIVES. Salem NH 03079 AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) Ro Teresk ACORD CORPORATION 1 NORTof TOWN OF NORTH ANDOVER �:;•�;`" 1"�0� OFFICE OF BUILDING DEPARTMENT 4L 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 SswCHU`�� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please odic DATE: �y JOB LOCATION: Number Street Address f NUTA t HOMEOWNER S��, Name Home Phone 11 L Work Phone PRESENT MAILING ADDRESS 0- City Town state Zip Code The current exemption for"homeowners"was extended to include or-mer-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE w APPROVAL OF BUILDING OFFICIAL Rid 10.2005 Foam Honwownm Exemption 1:10AR13OF \PPEALS 688-9541 CONSERVATION 688-9530 I1EAiAll 6S8-9530 PLANNING 688-9535 1 t NpRTIy '9 own of : t _ RAndover No. - _ - z-_ o dover, Mass.,' o - C A It. COCHICHEWICK %ps RATED PP� �CC 1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... . ..�........�...�....�.�... ............................................... ............................. Foundation q �r► has permission to erect ..................................... buildings on .......... ...... ........... ....... 1.1^..... ...... . ............... Rough - to be occupied as......... .... W.................................................... .. Chimney provided that the person accepting this permit shall in every respect 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 Final 3o — PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N STAR ` Rough ...... ....... ............ .. ...............:T= .. ........... Service BUILDING INSPECTOR 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.