The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #414 - 2010-02 39 Rosedale Avenue 12/5/2007 BUILDING PERMIT 0 "ORT" TOWN OF NORTH ANDOVER 3� �� '' *° ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �SSACHU5� Date Issued: Z U7 IMPORTANT:Applicant must complete all items on this page LOCATION '. ' 1 Print PROPERTY OINNERL i � Print MAP'NO: .0 4Z/7— 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 PREFOR E : D C L Cid c g-r �v�2 Ident' kation �Please Type or Print Clearly) OWNER: Name: "5- L l)o �-Y,6 Phone: Address: CONTRACTOR Name: ,r 4J �I-Yaly 5-lzx hone: �12 Address:- C`? St �d Supervisor's Construction License: Exp. Date;_ ,712e 0:�, , 'Home lm rovernent'Licen / p se: �� .��: Exp. Date. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PETe :$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S� FEE: $ Check No.: �a�y Receipt No.: d�3� g ��t1�..�d'�'e -� n.s.=,y e access to guaranty fund Persons co Rractcn waunre i ered contractors do not hav ee ^q'V'LL �grature of Agee Owne SJgnature 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS 4 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 .FIRE DEPARTMENT - Temp Dumpster on site yes no 'Located at 124 Main Street Fare 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 i Doc.Building Permit Revised 2007 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 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 Location m A U Se , `d 1,f No. `7�y Date /Z'/�A 7 NaRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ NusE<� Building/Frame Permit Fee $ � Foundation Permit Fee $ `• Other Permit Fee $ TOTAL $ Check # /01F I/ l 2006 Building Inspector NORTH TO" of '17 6 Andover No. 0 ndower, Mass., 0 LA LA 0COCHICHEWICK RA T E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... ........ .............................................................. ............................ Foundation has permission to erect........................................ buildings on ..:.�............. ............................................... Rough t.o be occupied as............... Chimney provided that the person accepting this permit shall In every respect confoVh to the termsr_o��the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to thInspection, 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 NSPECTORUNLESS CONSTRUCTION TARTS Rough .................... ...... ................. ................ Service Final Occupancy Permit Required to Ocmpy 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. CERTIFICATE OF INSURANCE fT1Tf f1RM This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois , ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois INRYIANtF� ❑ STATE FARM FIRE AND CASUALTY COMPANY,Aurora,Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY,Winter Haven, Florida ❑ STATE FARM LLOYDS, Dallas,Texas insures the following policyholder for the coverages indicated below: Policyholder John O'Brien D/B/A O'Brien Construction Address of policyholder 4 Don Roulston Drive Salem, New Hampshire 03079-1884 Location of operations Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms,exclusions,and conditions of those policies.The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period) 94-BR-6869 4 Comprehensive 09/15/2007 09/15/2008 BODILY INJURY AND Business Liability PROPERTY DAMAGE This insurance includes: ® Products-Completed Operations ®Contractual Liability Each Occurrence $500000 ® Personal Injury ®Advertising Injury General Aggregate $1000000 ❑ Products-Completed $ 1000000 ❑ Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑Other Aggregate $ POLICY PERIOD Part I-Workers Compensation - Statutory Effective Date Expiration Date Workers'Compensation Part II-Employers Liability and Employers Liability Each Accident $ Disease-Each Employee $ Disease-Policy Limit $ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Data (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certificate Holder If any of the described policies are canceled before Al Deldotto their expiration date,State Farm will try to mail a 39 Rosedale Ave written notice to the certificate holder 30 days before North Andover, MA 01845 cancellation.If hO�r,we fall �h notice, no ob' 'on orliability i tate Farm or its is or re Ives. Signature o Authonz presentative Agent 11/30/07 Title Date Brian M. Bosies Agent Name Telephone Number (603)898-5220 Agent's Code Stamp Agent Code 2038 AFO Code 558-994 a.6 Printed in U.S.A. Rev.05-09-2006 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Reg�stcation 1A3636 77-Expiration 7%9/2.D08 Tr# 127528 � O'BRIEN CONSTRUCTiC3 1 John O'Brien Jr. 41 j 3 WALKER AVE. ``y` AV ANDOVER,MA 01810~ ~ ~� •- Administrator 1 fie omvrrearuvea�i a�✓�aQaczc/zuae(.Za ; Board o Building Regulatiornis and Standards Construction Supervisor License Lic(inse: CS 48500 Birthdate, 8/20/1958 -60p1fat X20?009 Tr# 4452 1: est tirf n t t 7 A j i k! JOHN F OBRIEN 4 WALKER AVE ANDOVER,MA 1810 `?�� Commissioner