HomeMy WebLinkAboutBuilding Permit # 4/7/2016 BUILDING PERMIT o� �oRry
R-C
TOWN OF NORTH ANDOVER
®
APPLICATION FOR PLAN EXAMINATION
Permit No#: � ���� '�� Date Received Arev P=a�a5
�SacHus``
Date Issued: 1
41P—OR'TANT:Applicant must complete all items on this page
LOCATION bQr*l//_
Print /
PROPERTY OWNERSvge-e AK- C®tuyG-yPi1,0
Print 100 Year Structure yes &no
MAP PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
e9iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
f x � �� �:� � ' _ � ' � , F ❑ U1/atecshedkhDistrict � ,
❑ Se t c. ❑UUell a ,,J ❑ Flood lam ❑Wetlands)„ ,�„� 4�� �, , , , x,�,�f
t r+ .�a:�.�.'�, J� ;asf r ( �,',d p',r .1, rl a. .?: rrr- � r `�,.a Ir"'��r�'f v.., � �" 2. ,! 'r✓>&�'a .
�'.u�Water/Sewer�� ,fC;�_,,,�v. �� ,c.,..��'�v � Y,.,�`` -�^, ,rh" r'/� . %..s} � .'�/1�`.������ �i� d ,,.. F✓ F� rr�l �'.i.,r r X
DESCRIPTION OF WORK TO 13� PERFORMED:
Identification- Please`I 7pe or Print Clearly
OWNER: Name: 'Co'lee4 (�.®�vG-on L4 Phone:
Address: So (M "(_owe "Dei#Ce cD va v,
Contractor Name: 3e4l;t�rl;�I �'- Phone:
Email Yampa,
Address: -1(9 DE. (lea 01-k4vaer-
.
Supervisor's Construction License: C S ®�.�'.3® Exp. Date:
Hom ense: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT..-$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST-BASED ON$925.00 PER S.F.
Total Project Cost: $_� FEE: $
Check No.:
Receipt No.:
(o 21� p
NOTE Persona contra 'ng registered contractor do not have acc to the rants fund
NORTH
town oi - A-tiftdover
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Food/Kitchen
rER IT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT .......... .. . .... . ...........k..... ... .......!^.."J. .... . .........G.......... .......`....
A0. �/ Foundation
has permission to erect ........ ................ buildings on ....i%........ .. ........ ......... . ... .....x
...... Rough
to be occupied as ............ ... . ........... . .. ..Ilow
.. ......... ..... . ......... .. Chimney
provided that the persona ting 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
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT IES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO ARTS Rough
Service
................. ...� . . .. .... ....:.::: Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired to Occupy Building 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.
Smoke Det.
NOTICE
Z NOTICE
TO
TO
:a 0
EMPLOYEES EMPLOYEES
The Commonwealth ovs Massachusetts
DEPARTMENT OF INDUSTRLAL
ACCIDENTS
I Congress Street, Suite 100, Boston, Massachusetts 42114 — 2017
617--727-4900 — http://wmv.state.iria.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &30, this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring month:
ACE GROUP
NAME OF INSURANCE COMPANY
P.O. BOX 1 45 0
MIDOLEBORO A 02344-1450
ADDRESS OF INSURANCE COMPANY
(GSG2UB-0G23626-9-i 5) 03-15-15 TO 08-i 5-1 G
POLICY NUMBER EFFECTIVE DATES
M P ROBERTS INS AGENCY 1060 OSGOOD STREET
m®
NORTH ANDOVER MA 01845
NAME OF INSURANCE AGENT ADDRESS PHONE #
® OLD SALEM VILLAGE OF NORTH HEPATICA DRIVE &
^� ANDOVER CONDOMINIUM TRUST; MAYFLOWER DRIVE
e
® NORTH ANDOVER
MA 0`1845
® EMPLOYER ADDRESS
n
Rig
EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE
MEDICALTREATMENT
The above named insurer is required in cases of personat 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 o%%m physician. The reasonable cost of the services
a provided by the treating physician "rill 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
NAME OF HOSPITAL ADDRESS
o11D18 W20PIG16 TO BE POSTED. BY EMPLOYER
Mia w cilu, etl ()epa trnent of Pubbc Safety
Board of BuHding RcgWafions and Standards
�..
"d'a�&����"fi�dCtiarke.roa�ixt"vBeu)'G"
Uceuri e; CS-075302
BENJAMIN C OSDO
,'� ,
69 Old�7illage L,�tCe �j�
North Andover AIA Ot fai
�� �
ommissmier 12/04/2016
Massachusetts -Department of public Safety
Board of Building regulations and Standards
Conortfction Supers icor
License: C"75302
BENJAMIN C 0som �•t
69 Old Villnge La e
North Andover KA 0
'Y \�
Expiration
Commissioner 12/0412016
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