HomeMy WebLinkAboutBuilding Permit # 3/29/2016 F NORTH
lictover
town of
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S tl BOARD OF HEALTH
Food/Kitchen
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Septic System
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. BUILDING INSPECTOR
...
THIS CERTIFIES THAT . .....................................
....................... .. .... ..
. Foundation
has permission to erect buildings on .. Rough
to be occupied as ...... .....`.... .... 11.0 .
................................................... Chimney
provided that the person acc g this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR
Construction of Buildings in the Town of North Andover.
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMIT EXPIRES IN 6 ®NTS ELECTRICAL INSPECTOR
UNLESSTI STA TS Rough
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BUILDING INSPECTOR
GAS INSPECTOR
ccuganeVer it Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the Premises —' Do Not Remove FIRE DEPARTMENT
No Lathing or Dry Wall To Be Done
Until Inspected an proved y the Building Inspector. Street No.
Smoke Det.
eoac)o Verizon T 12:45 PM 51%01)
G REAT LOT 2
LAKE 20.3' /
LINOc�
"33.3"-,_
7 EXIST.FND. 34.E
TOF="197.6'
'r
100 BVW a
SETBACK 01
o
WETLAND
rtFkOFAyp
ASS,
MICHAEL 0.�,
O J. G
SERGI m 215.0"
No.33191
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stov�qQ�
I CERTIFY`rHA r THE PRIMARY STRUCTURE SHOWN CONFORMS TO
FOUNDATION LOCATION "TI IE HORIZON rAC.SETBACK REQUIREMENTS OF THE LOCAL
APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED.
CERTIFICATION NCDE:R ANYOTIER
CLIENT: TKZLLC RESTRICTIONSSUCHAS(UVE�P4ANTS,NETLA+dDSEASEM
EN TS,
THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT ORDERS OF CONDFHOfi.�,ETC.t THIS DRAWING;SHALL NU"I BE USED
Y Tl IE CLIEN I FOR ANY PURPOSE OTHER THAN I HAT OUTLINED
LOCATION: NORTH ANDOVER,MASS. ABOVE,EXCEPT WfTH THF--WRITTE�I,d PERMISSION OF CHRISTIANSEN
h,SERGI INC.FURTHERMORE'THIS DRAWING IS THE COPYRIGHTED
DATE: 3�24�16 SCALE; 1"^PJ'0' PROPERTY C)F(:aiRISTIANSCN&SEfl(,I IINq.AND ANY
UNAUTHORIZED USE IS PROHIBITED.CHRISTIANSEN&.SERGI TAKES
NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS
DRAWING,OR ANY INFORMA'HON CON LAINED HERFON,
- PROFESSIONAL. ENGINEERS & LAND SURVEYORS
CHRISTI 1, INC.
-
160 160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830
_ WWW,CSI-ENGR.COM TEL. 976-373-0310 FAX. 978-372-3960
DWG.N0.;13'I 14.001.014
iiormr,'� Energy Plafli"vg Certificatc,,�,�,
llrgf� liy 111113
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tstfmatA Annual Lner;v Cost
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EMPLOYEES Yc $�a EMPLOYEES
lQ�� aVBy�
The
Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900
As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30,this will give you
notice that I (we)have provided payment to our injured employees under the above mentioned
chapter by insuring with:
Associated Employers Insurance Company
NAME OF INSURANCE COMPANY
P.O. Box 4070 Burlington, MA 01803-0970
ADDRESS OF INSURANCE COMPANY
10/01/2015 - 10/01/2016
WCC-500-5006517-2015A EFFECTIVE DATES
POLICY NUMBER
1060 Osgood Street (978)683-8073
M P Roberts Insurance Agency North Andover, MA 01845 PHONE
NAME OF INSURANCE AGENT ADDRESS
TKZ LLC 78 Great Pond Road North Andover, MA 01845
EMPLOYER ADDRESS
08/12/2015
DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and.
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
NEAREST AND BEST MEDICAL FACILITY
HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
CS-055417 's
Thomas D Zahoruiko `
78 Great Pond Road
North Andover MA 01845
04/05/2016
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer 10 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
PLANNING & DEVELOPMENT Reviewed On j( !(o Signature-
2-
ignature_
COMMENTS Ttjwja ; -ice 1t1lsty-1
r20h 1 d N C4&}pro L I m Mce Lo 5Z-Ke('�
CONSERVATION Reviewed on ! l - ��a Signature- ,b r
COMMENTS , E,�ti`-fE ti yi
HEALTH Reviewed on Si afure a
/
COMMENTS ! ,' ,(2 ! '
Zoning Board of Appeals:Variance, Petition No: <i f`h Zoning Decision/receipt submitted yes
Planning Board Decision: :d5o3��D S i �j Comments
Conservation Decision: &12 Comment
Wafer& Sewer Conn ection/si nature& Date Y -� Drivewa Permit_
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE°:DEP/ RTiIlIENT P"
D,umpsfer `n site yes no rr -r
r
Located at 124 Main;Street;
Fire Department Signafure7dafe
v.
COMMENTS
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