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HomeMy WebLinkAboutBuilding Permit # 3/8/2016 OORT-1 BUILDING PERMIT of �t,ED �4, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date ReceivedA -/4pDR7ED P,PFp` �y CHUS Date Issued: IMPORTANT: Applicant must complete all items on this page „Ga! :,. ':.? -. r^^ e 'v,^ ! a.<. , -,•`;i;:�.•..r �k' -n:...:p�;. k"xavx..t,". am/ s�' �:fY, ✓I r, s: r ,1 �. 1... ,l-. �'rN t �,r< urf � dam,>r.w�. �, ,: ": �,,,.,u✓'.�.. -,�.f„�,:t� 3a .� .,:,��. �:,�;.b,.r,p„'..., „Y� lu. �r��� y�.xr�x �` ✓ �r„?� >'�f�l rr�,:.:r ���r. n ,r e ,kf fr r.>,- "'�: ,..,, "`g#'„ ..a '�° ".r,,:. 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Jw_,�.;� t .f✓.�' ,r s," ��.r --:=i7 dr wry.3,.,�.*,��- %�r`...;.+.s :�f'";,`✓rr,.. r ,r;, ,„ ..:.r i"�fiArr.F./ . .�, ,��rra' x ��'���r'x,, � �` N r a�,x`,� Af x rs,n s. � �e..rri � r�r ✓r`xr r' ,,,x-;'"""X;�✓y� �k»rrr,-rark:,.,,,ria.-fir.,.>YLr,?^�.� x'�:,7'r�'"":�✓.oh,iFar�,f�r".�.f�e:.s( r..��,�.r�",,..r<:,� ,�:.';-.;.s>,''�a._,�'= �a;� J ,r; :.f � „P ,,,g. �.y'y r _,f 1,r TYPE OF IMPROVEMENT PROPOSED USE Resi ntial / Non- Residential EJ New Building One family ❑Ad ition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other pry��S '.tic f ❑WelI � ✓f �✓ � � �.f�y ❑ Flaod lain ��t�❑Wet(a ds �4,r, � ✓ ❑ ,Watershed strict. l,.J'',"rc:;. p,.Y.. �� .r',c. f` -_', ..,rc, r ;%� .�.:-,..,' �, »dr,^,�f'.f,�m :.x-r..0.. � s.:- Y f r Ir✓ �I :.� ,. rm�,x .. u" �n f. � fr Y ..J-x 2, ..r,r v .a✓:"::rr xii•.-K ,4 s.: J .. , .;y,-1: r/ ,^ ,7 drr:irk �/ / f, :f.�j � �,: ,: rix � r r � .. a x ,e, fi��, �,vrr� t. ��.,A', xr<� „: ✓rrr, 'arm' ✓.�sf.xX ✓u.S�� c#vrs u ,.r` ,r,�,✓,v, f£.,„,.�/' r` f� >r .r',r � ;c,:?�,... 'x „�X`u t :� r�a�ff.,,., ✓ 2�rr hg arr �r t..: ��ris � s rzY lv'rr- :/ �� 4 �,'-J „?'x 4...NJ X4�s ;.,� 1•. ry #"�i. ,s:'Idl,ar�rxds` �lr"rrt.x ;:a.�' tiY�.r�S yas,� l fl ":�. / Gf'.lr''f rrF:' 'I, F r �, ,,�, ,r lid ✓:.. .s,� ✓ F F` n 2'X... a d>1' !,r G ,t ter r ,;. �, -�, x '.''r�,.r7',. �.��rf �:x�u ey$:.I.� � v,`f F ''xi'fx;'✓ n' _y,-f y.., X�✓t w',.,: �P r f x rj a r /Nr .n...,�,o <,.. 4.wK,,, _.,. ,�._,� �,�s_,,,.:f A.. .,..,1 ,f,k ..�, „-,.,..d „�. „ ,`✓r', ,,,.r. � ._ ,,.�,,.,.,r;.S.s DESCRIPTION OF WORK TO BE PERFORMED: ��5I ! i ► � � Cd� �� �` / 'ick° i Identification- Please Type or Print Clearly OWNER: Name: id:W14 Phone: Address:--&2, Gf e oe I r- , t sr e f :.i t .�r. { m,r"^`r -.,; r ,,✓ rr r er �ti M,r 3i ,',� a X' :✓;...,rz'� ;”?x X .� ;� 4r.,,s �r~;r''.-Ir ✓ �,.� ?� dl rrr'r r,; f rtr / Pr.. rf�.-&: yYf'.r. .�t z ��sw.,c,;�3`�A''.:.f-'',x;,l��.r7�r�" .r ./J,.7ryrrf n.�n�r a�r�., U .r:. a'r�'�'n�f •:..' r sl r!`9 ,.s,f ,ra yr�r,/x r .✓✓rr' f l..da t f „ t.:g,.x;�rx.�',�c,.,t x � .F;;2, a,/ X t .t�' ,yrs s d3� r„aY.Ia � ;`:'d,,r” r. .r.� rr'.,,rr,;. �r .,�7 s _Jyr ✓ ,...1�<r.rr/,r ..�,s f.:;�}r d r ":rA .r/ } r ✓` e rxrs�"/r sr ✓ �r 9,:r:M �5 f �.rv''" ✓, � a °'rti � r Ii r t" e�`t G, ✓i :F'f...� , .�",-r:. 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'��,a'.-k=rr ✓ i x m.J�ayuza$�l�$sr,almnan..m sfiRfer.�Lw�M3.xa;n „r,.':'�.�v. .,.�5r���.✓;,�r:+ .._. .._, �..�,fi,7, �rvA.!�,av s..�,.✓:r✓s.a _ r!;;r.' ARCH ITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING ERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ /0, 6712 FEE: Check No.: Receipt No.: �`° / NOTE: Persons cont actin with un�egis ed contractorsg, o dot hIL ss to tla�aranty fund 9 ��` r cr ,� Signature of Agen ; wrier Signature' f contractor t%®RTH Town of Andover .. '0 ® ® -s T C% LANE h verb aSS' COCHICME WICK V S U BOARD OF HEALTH In PERMIT �T Lu Food/Kitchen Septic System �/ �, / p BUILDING INSPECTOR THIS CERTIFIES THAT ....U�.cGrr�l:. �%� !.N f :r.�. ..................................................................... Foundation has permission to erect.......................... buildings on ... r�7. fl�(- :.2r.:......................... r / Rough to be occupied as ................................� ` ��: :�.. . ' ` ` �a O� .... Chimney provided that the person accepting this permit shall in every respect conform 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 EXPIRES IN 6 MONTHS O T S ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STA TS Rough Service ................. ....... . .. .. .. .. ..................................... Final G INSPECTOR - GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final ® Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. pF Ila r jo t � ©o V i 1 t NOTICE NOTICE w TO a o TO w a EMPLOYEESaEMPLOYEES MassachusettsThe Commonwealth of DEPARTMENT INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 2017 617-727-4900 — http://ww-,v.state.ma.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 with: ACE CROUP NAME OF INSURANCE COMPANY P.O. Box 1480 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6562UB-OG23626-9-15) 0615-15 TO 06--15-16 POLICY NUMBER EFFECTIVE DATES M P ROBERTS INS AGENCY 1060 OSGOCID STREET NORTH ANDOVER MA 01845 NAME OF INSURANCE AGENT ADDRESS PHONE# OLD SALEM VILLAGE OF NORTH DRIVE & MAYFLt ~ ANDOVER CONDOMINIUM TRUST; NORTHAND DRIVE NORTH ANDOVER MA 01845 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) 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' aimpensadon 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 NAME OF HOSPITAL ADDRESS TO BE POSTED, BY EMPLOYER D11818 W20PIG15 f Massachusetts -Department of Public Safety Board of Building Regulations and Standards License: CS-075302 BENJAWHN C OSG-bOD 69 Old Village Lalfe ' North Andover P&A OMI Expiration Commissioner 12104/2016