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HomeMy WebLinkAboutBuilding Permit #556 - 95 FOXWOOD DRIVE 1/19/2012 BUILDING PERMIT of Ko Dry TOWN OF NORTH ANDOVER ,�� 6`�t =6tioL O m APPLICATION FOR PLAN EXAMINATION Permit N0: : e« * Date Received Date Issued: IMPORTANT Applicant must complete all items I p on this page t` ..na_H .�r�-�r'1� r-•r {.gip\��a,�S yC• s �� ` 4{' /..,nA + � F ' .w, [, r5�'�.�C_Z�aN0t10, �,•i>'; 7q;.%?;t} k�Fti n+Z5 l J' E L 4.: 1h. :i Z f .1 tyr e e •C I rh bq 1 2 R , � Z C•4 '/ -+"i.tr 1"a' F - i ,a Lam: Pr:mm?•Sfr`•'ri.l• -`�'.sj=��..:y f-;e77:' f �'�aSJ'.u7'•+.3� �'EU ,�.,Y.4.1, ,4, r Y-- rl °\" y.J,�, ^�; Sfl~ .i; = ^AI" `moi�y�: 1" �„ r `�-15 ; `°` J �• -F�,^" t�'"y�'�d ` �'.'j� 'lic v W,a`<rci{ ti^. A-+tea a ,k•Tt»m>a;M1y� - _ s _ -rYCOOto- .�t?5R_-+�' lwit•5:�iv .,�+°::I f1,'lr tY n" ,�1+'[rs mss `ri',`2F?i.n�bt• x-a r.;. a `R _ ,t =t� "•y }�- .. .. 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No. FEE SCHEDULE.-BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CAST BASEDON$125.00 PER S.F. i Total Project Cost: $ J r (:� FEE: $ Check No.: 0 QJQ I ) Receipt tJ'.fu No.:_ NOTE: Persons contracting with unreb�stelned contractors do not have access to the b Qu a/an nd �nt/Own er - ' . - - � �_,. _u r 9w `Signaturexof coraet�r .w. Location No. ® Date -1�-/ N°STM TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ ss�cMust< Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #r"i)<Do ( 7 o l s 24968 Building Inspector Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody Art Swimming Pools Well Tobacco Sales Food Packaging/Sales , Private(septic tank,etc. Permanent Dumpster on Site { THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENT _ AL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature r10►�� er_?t!_r. IIVIVI�VICIV 15 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments I Water $ Sewer Connection/Si_ynature Date Driveway Permit DPW Town Engineer: Signature: Located s ood Street _ � T �ferp'Dtpste� � s�t ae `� 'F y, ti :, re�Depare>rt ;s� ni3 �r�eldate ' _. .+ t x � - ITt v_ r x x J COM ' TYL'S it I 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 PP I Electrical Inspector - Yes No. DANGER ZONE LITERATURE: Yes No 14 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i' NOTES and DATA— (For department use) i i i i ❑ Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department 1 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 or W ork ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or..Dec ks i ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Co of H.I.C. And C.S.L. Licenses uses ❑ 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 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 ❑ Ceifieu 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:Building Permit Revised 2008 I NORTH Town of Andover _ C o , over, Mass., ' Ldt 1 LAKE COC MIC HE WICK � �d ADRATED P'P�,��� i S BOARD OF HEALTH Food/Kitchen [ Septic System - .PERMIT T D Irr BUILDING INSPECTOR THIS CERTIFIES THAT.....:.... ,r 4l. ` ' . ........ .. ........................... Foundation has .........................to erect............:........................... buildings on ...... ..c....... P 9 ......................... Rough c Chimney to be occupied as vT 1z ;.► y .... provided that the person accepting thisIr-mit shatIRh 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 3� 2 PENT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC TS Rough - ......................... 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 FIR_E-DEPARTMENT. ' Until Inspected and Approved by the Building- Inspector. Bumer Street No. SEE REVERSE SIDE Smoke Det. NORTIy Tovm of _ Andover 0 w C, o , l over, Mass., COCMICMEWICK �SDRATED PP ,C�'CC BOARD OF HEALTH Food/Kitchen ,,- - , , PERMIT T D Septic System BUILDING INSPECTOR i THIS CERTIFIES THAT........... I{ `°. ........ �................................. .........................:... Foundation has permission to erect........................................ buildings on ..a. ....... ....... . .�......................... Rough ... .... ..... to be occupied as �acce f� 11�'� Chimney . ..... .......... ......... .......,�.�.:.. ....................... y provided that the person p this p�rmit shalPrn 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 X 2 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC TS Rough ................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR gh Display in a Conspicuous Place on the Premises — Do Not Remove F nal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Bum�FIRE_DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. �.1ORTH Town of o , '� lover, Mass, . 'pA COC HIC ME WICK\�� � A�S RATED p �C '7 BOARD OF HEALTH I_ PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... ,r ../I .....C fuoow� Foundation has permission to erect. • buildings on .. ....... .... .V4,40. ...... I ............................. Rough to be occupied as......... v.......A-W... ....... ...... imn y � .....one .......... Ch' e provided that the person accepting thismit shal h 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCtop TS Rough ................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR , I Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. BumerFIRE.DEPARTMENT - Street No. SEE REVERSE SIDE Smoke Det. Massachusetts-.Department of Publ:ic".�afctN 1: Board of,Buildin-Re-mations and Standards'' Construi:ion Supervisor License License:-CS 90592 ; i?estrictecLto 00 GEORGEW BAILEY; •78 NORTH,.ST. •�.'�' N•.WEYMOUTH, MA;02191 Expiration: 3/10/2012- Cf, i i /10/2012-(`usnraaissi _ Tr#: 22428 44 o`-- X1357875 asa C. , 'EV A 2 �'+ 1 �AIL EY `aunk, �H'JS f•. J .11,A �I ; MRSa{S ..a" r'.y.i";g.s GEORGE - I i I • i ' I Fire, Soot'19'Water D �C�ealyi gr 888-428-48a maS f ' 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 �`Workers llding Permit Appllcatlon Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract f ;/Floor Plan Or Proposed Interior Work I� ❑ 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 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 'ACORD `CERTIFICATE OF LIABILITYINSURANCE OP ID KP DATE(MMIDDIYYYY) SERABOI 01/03/12 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Damiano Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 20630 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ,-.anston RI 02920-0947 one: 401-946-6800 Fax:401-946-7293 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Selective Insurance 19259 ABOJ, LLC DBA Servpro of INSURER B: Argonaut Insurance Company 19801 Boston Downtown Back Bay South Boston INSURER C: Endurance American Spec. Ina. 41718 1193 Broad Street INSURER D: Providence RI 02905-2910 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. P I Y EFFE IVE POLICY LI Y EXPIRATI N LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE(OP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY S 1880480 12/31/11 12/31/12 PREMISES Eaoccurence $ 100000 CLAIMS MADE FX�OCCUR MED EXP(Any one person) $ 10000 -PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3000000 POLICY X PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO A9091942 12/31/11 12/31/12 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) r1 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $3000000 A X I OCCUR CLAIMS MADE S 1880480 12/31/11 12/31/12 AGGREGATE $3000000 $ 0DEDUCTIBLE $ X RETENTION $0 $ WORKERS COMPENSATION AND TORY LIMITS X ER B UlH- EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE WC477378303464 12/31/11 12/31/12 E.L.EACH ACCIDENT $1000000 . OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 OTHER C Contractors ECC101004849-03 12/31/11 12/31/12 Ea Occur 2000000 Aggregate 2000000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS I 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,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Ga Desno ers AIC ACORD 25'(2001/08) ©ACORD CORPORATION 1988 f OORTH q BUILDING PERMIT TOWN OF NORTH ANDOVER ,o .-.APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: �9SSACHUS IMPORTANT: Applicant must com lete all items on this page y 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 DESCRIPTION OF WORK TO BE PREFORMED: MDf�O`C�j`r�til 00 'G" A O C A& C--AP kG-4, G20112CMpUJ Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: v' u 5- i i, J. z 5 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: $ 1 'E�n)o, oo FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 87ate�ger # � Egttr Q 'w °ter r : Plans Submitted ❑ Plans Waived ❑ ,, Certified Plot Plan ❑ StampedPlans ❑ 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 ❑ ❑ C TS j^ wA, I El DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED j HEALTH ❑ ❑ 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 Located at 384 Osgood Street <ws IR, Hy r y% ,i u t r e 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 IMP lyl lu�*O ❑ Notified for pickup - Date f __- _.......-.._..._._...._......__._-__.......___.____..__..__..... � Doc.Building Permit Revised 2007 1 a Authorization.to'Perfo`rm Services and. Direct ion of9Payment Customer Name: 7� " Date of Loss: fZI I Z- Loss Address: 9,g rawatJ. :Lc City: . AJ6� ,10 ver State: r I' Zip: Client: Claim Number(if available): The undersigned client being the building owner, owner's representative, or resident, authorizes the Provider 'identified below to perform any and all necessary cleaning and/or restoration services on Client's property located at the property address above, and with respect to items that need to be cleaned at a remote location to remove and clean such items as necessary. Client authorizes LMAcr== 6,_r-�surance Company, herein referred to as"Insurance Company," to pay Provider solely and directly for that portion of the work covered by Client's insurance policy. If, for any reason, Client receives a check from Insurance Company made payable to Client, Client agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Client hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Client's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Client agrees to pay Client's deductible in the amount of $ that applies to this claim. If any amounts owing to Provider for Provider services are not covered by insurance,Client agrees to pay those amounts to Provider within fifteen (15) days of Client's receipt of invoice. It is fully understood that Client and its agents, successors, assigns and heirs are personally responsible for any and all deductibles and any costs not covered by insurance. Interest and finance charges will be charged at the maximum allowable by law, or at 1.5% per month, whichever is less,on accounts over thirty(30)days past due.Time is of the essence. Client agrees that Provider is working for the Client and not Client's insurance company or any agent/adjuster. Property Owned By: r� Remarks: �l I.J N j V E WET I KJ15uL -rl©&4 I HAVE READ THIS AUTHOR17ATION TO PERFORM SER ES AND DIRECTION OF PAYMENT,INCLUDING THE TERMS AND CO NS OF ICE ON T V SE SIDE HEREOF,AND AG 0 SAME. 6a 5 i5� $ r"K ..vk�y b #' ;. � °'� .,r `4T•�. is i� � z ,: � Client s Signature ' T er's Signature wPnnted Name k ranchise Legal Name QBa7 L.ZG ` T, Client Reviewed Customer Info�mat/on Form} �Y OMN ` a SERVPRO®of "S -40 White: SERVPRO® Yellow: Claims Professional Pink: Customer ©SERVPRO'INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1.0 28000 06/11 Each SERVPRO"Franchise is Independently Owned and Operated. /Soo - 72-;7- _ ��vo IMMME I MIN SENSE M M MMMMMMMMEMMMMMmMMmM So imommmmimmmmomm No M MENEM INMEMEMEMENNEM MMEMEN IN lMMMMMl N■ �Ommm M mm ■Em ME EMMONS MEM mimmmm No 0 tom lMmMMMOMM EN , o MEN ME MMMMmMMMlMMlMM 0 MMEMMMM ME SM ON No MENNNNEE ONION MmMMMMlMM EM M MEN MmMMmlMM MMMMlMMMMM M ME SENSE MENENNEEMENNEEMMEN MMl M ME M ME MMMMMMMM mmimmm M M ME MMl ME MMMMMMllMMMSMMMM I ON I SEEN M MEN I NEE MEN ■ME ME Me M MENnME 1 � T�� ��-I� Z ��I � �-I �'-_ +�! _ i �_ I _" __ _�I� I ► � i_ 1 . 1 � _ I I � � - -� � I I I � kkkk ITI � 1 I ► � � I � , i I