HomeMy WebLinkAboutBuilding Permit #613 - 554 Turnpike Street 4/18/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: a
IMPORTANT: Applicant must complete all items on this page
LOCATION u il, yV ri,
sir
/1 1 I t /' Print
PROPERTY OWNER ., C? 6tUt' C510t:t
Print
MAP N0: 1-5' PARCEL: ZONING DISTRICT: Historic District
Machine Shop
p ttLeo �6♦6~�
yes no
ves 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
OWNER: Name:
Address:
CONTRACTOR Name
Address:
DESCRIPTION OF WORK TO BE PREFO MED:
157
7 ie tification Please Type or Print Clearly)
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(XI t /-r4t/av itif" Ph
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Phone:
i'' 3.--
t
Supervisor's Construction License: CIS -T16L,41 Exp.. Date: -zo d s
Home Improvement License:
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: $ �?U FEE: $ 103
Check No.: a A Receipt No.: Ca ( C)
NOTE: Persons contracting with unregistered contractors do not have accessp,tft guaranty fund
nature
er.
y'? (r -D
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
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
DPW Town Engineer: Signature:
Located 364 UsgooCI Street
FIRE DEPARTMENT - Temp Dumpster on site yes, no
Located at 124 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
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
No
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 2.2008
C tjv�--j tij-r
Location5SS- TVa.AJPJ�j
No. 6d 3
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
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2 10 9 2 Building Inspector
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CLAUDEE DEAUDOIN
16B Harry Brook Dr.
Goffstown, N.H. 03045
DATE•
TMS ESTIMATE US BEElY MEPARED FOB:
woiuc TO eE conirLEn:
k'5-/
Insurance and Material included in price unless otherwise noted above,
Total estimate for the work described above:
rq
2440--e (q3
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We thank you for your interest in doing baleen with us. If I can be of any fort r
assistance to you, Please contact me.
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1forkers Compensation And Employers Liability Insurance Policy
`RENEWAL
Transaction Effective: 09/29/2007
INFORMATION PI AGE
'OkPeerless
Insurance,,,
MCM?xr , Ut MT Mutual ('—r
r3lPICP_T Rif I
2. Policy Peried:-
The Policy Period is from 09/292007 to 09P2912008 , 12:01 AM Standard Time at the. insured's mailing address.
3. A. Worker's Compensation Insurance:
Part One of the policy applies to Worker's Compensation Law of he states listed here:
MA, NH
B. Employers Liability Insurance:
Part Two of the policy applies to work in each state listed in 3.A. T ie limits of liability under Part Two are:
Bodily Injury by Accident $ 5 D 0 , 000 each accident
Bodily Injury by Disease $ 5 0 0, 0 0 0 policy limit
C. ®cher Mates Insurance: Bodily Injury by Disease $ 5 00 000 each employee
Part Three of the policy applies to states, if any, listed here: All atr ,te.; except North Dakota, Ohio, Washington,
West Virginia, Wyoming & states designated in item 3.A.
P. Endorsements and Schedules:
This policy includes these endorsements and schedules: See alta ch ed ENDORSEMENT SCHEDULE
4. Premium:
The premium for this policy will be determined by our Manuals of Rule s, ;lassifications, Rates and Rating Plans, All
Information required below is subject to verification and change by ou( it.
Pr rrn iurn Basis Rate Per Estimated
Code Total Estimated $100 of Annual
Number Classifications Annus d_I;emuneration Remuneration Premium
See attached EXTENSION OF INF DF;MATION PAGE
M14.
POLICY PREMIUM TOT AL S
Total Estimated Standar i F remium
Expense Constant
Total Premium Discount
Total Estimated Premiur;
Total Estimated Cost
A+Nnimurn Premium $ 900-00 Deposit Premium $ A 15,719.00
$ 16,663.00
$ 318. 0.0
$ -1,262.00
$ 15,719. 00
$ 15, 719.00
Adjustment Period:. ANNUAL
Date: �� �
Countersigned by:
Auth ' ed Signature
Copyright 1987 National Council on ee - icn Insurance.
It Ann lftllnrt AMOK ne nye AA 1% M01 pr1l)",nmr) T)iim A�at�a�r 1kY14ZSAR n��
Policy Number: WC 9119805
Prior Policy: 91198C 5 Date Issued: 08/13/2007
Coverage Is Provided In PEERLESS INSURANCE COMPANY - A STO ah. COMPANY NCCI Number: 11355
1. Named Insured and Mailing Address:
Agel it:
BEAUDOIN FAMILY
EP TC 1N & BERUBE INS AGENCY INC
ENTERPRISES INC
36 i NASHUA ST
C/O CLAUDE BEAUDOIN
PC B ?X 37
16B HARRY BROOK DRIVE
MIi .FI )RD NH 03055
GOFFSTOWN NH 03045
Agel it i Pode: 0410001 Agent Phone: (603)-673-0500
Federal Employer ID Number: 020473817
Fifin4 N umber: 280241059
SIG Code: 1751
Other Workplaces not shown above: REFER
TO ADDITIONAL WORKF ,U,CES SCHEDULE
Entity of insured e CORPORATION
2. Policy Peried:-
The Policy Period is from 09/292007 to 09P2912008 , 12:01 AM Standard Time at the. insured's mailing address.
3. A. Worker's Compensation Insurance:
Part One of the policy applies to Worker's Compensation Law of he states listed here:
MA, NH
B. Employers Liability Insurance:
Part Two of the policy applies to work in each state listed in 3.A. T ie limits of liability under Part Two are:
Bodily Injury by Accident $ 5 D 0 , 000 each accident
Bodily Injury by Disease $ 5 0 0, 0 0 0 policy limit
C. ®cher Mates Insurance: Bodily Injury by Disease $ 5 00 000 each employee
Part Three of the policy applies to states, if any, listed here: All atr ,te.; except North Dakota, Ohio, Washington,
West Virginia, Wyoming & states designated in item 3.A.
P. Endorsements and Schedules:
This policy includes these endorsements and schedules: See alta ch ed ENDORSEMENT SCHEDULE
4. Premium:
The premium for this policy will be determined by our Manuals of Rule s, ;lassifications, Rates and Rating Plans, All
Information required below is subject to verification and change by ou( it.
Pr rrn iurn Basis Rate Per Estimated
Code Total Estimated $100 of Annual
Number Classifications Annus d_I;emuneration Remuneration Premium
See attached EXTENSION OF INF DF;MATION PAGE
M14.
POLICY PREMIUM TOT AL S
Total Estimated Standar i F remium
Expense Constant
Total Premium Discount
Total Estimated Premiur;
Total Estimated Cost
A+Nnimurn Premium $ 900-00 Deposit Premium $ A 15,719.00
$ 16,663.00
$ 318. 0.0
$ -1,262.00
$ 15,719. 00
$ 15, 719.00
Adjustment Period:. ANNUAL
Date: �� �
Countersigned by:
Auth ' ed Signature
Copyright 1987 National Council on ee - icn Insurance.
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Property .Management of Andover, Inc.
P.O. Box 488, Andover, MA 01810
James M. Toscano, PCAM
President
April 17, 2008
Town of North Andover
Building Inspector
1600 Osgood Street
North Andover, MA 01845
Attention: Brian Leathe
Dear Mr. Leathe:
Office: (978) 683-4101
Facsimile: (978) 686-4664
Chestnut Green at The Andovers has given permission for Dr. Stephen Galizios'
contractors to do demolition work and re -configuring of the reception area at
Building 555 Turnpike Street, Suite 41A North Andover, MA 01845.
Sincy,
Ji To roperty Manager
For Chestnut Green at The Andovers Condominiums