HomeMy WebLinkAboutBuilding Permit # 8/2/2016 tAORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 4� Permit No#: w Date Received � 0/ , ACH 0,7 Date Issued: ,oel IMPORTANT: Applicant must complete all items on this page ----------------- LOCATION c.) L 6T s) Print PROPERTY OWNER T 6 .', 11 Print 100 Year Structure yes no MAPS " PARCEL: ZONING DISTRICT:_-?,3 Historic District yes Machine Shop Village yes (,,"qqlll,� ------------- ­----- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ArNew Building One family 11 Addition 0 Two or more family E] Industrial F-1 Alteration No. of units: ❑D Commercial ------------ 11 Repair, replacement E)Assessory Bldg [I Others: F1 Demolition Li Other N" - Wetlands ❑ V,64rs6, E �4 R Wer/ -le- T, DESCRIPTION OF WORK TO PERF RMED: -f-C saa�-IzJvtv\ 0 Y Identification- Please Type or Print Clearly 7 JEL L C' Phone: 1�,177.os? -Y(b? OWNER: Name: Address: 4 V'l 1wkP&' ,IC � Zx) Contractor Name"7,/1,,%o&..1,, 40 Phone; V62, Email: tze- Ap Ok) Qmg2 Address: 1, "s Supervisor's Construction License: Exp. Date: .......... ARCH ITECT/ENGINEER Phone:- Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ( 17, 5-60 - OVA FEE: $J CF�wq-A'7,,�o ZZ 69, Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty7und 5ignatdr torte Plans Submitted,® Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERACE DISPOSAL Public Sewer 19 TaminglMassageBody Art F1Swhmning Pools Li Well ❑ Tobacco Sales ❑ Food.Packaging/Sales ❑ Private(septic tank,eta ❑ Pennanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF" e U FORM PLANNING DEVELOPMENT Reviewed On ?1-711l � Signataare_ COMMENTS /�E2 r�� ICS Zxl� 6F- SobC)kv �j()i`1Ce u CONSERVATION Reviewed on Si nature N1� COMMENTS 1'—C) HEALTH Reviewed on � � Sicinature COMMENTS Zoning Board of Appeals. Variance, Petition No: Zoning Decisionlreceipt submitted yes d Planning Board Decision: �e ' �g� 1 Comments Conservation Decision: Comments Water Sewer Conn ectionisi nature & Date ` 1 Driveway Permit DPW Town Engineer: Sjgnatuire; I Located 384 Osgood Street FIREDEPARTMENT; Temp Dempster on;s�te ye no Located at l 24e Main Street He epaEtrnent rgnatureldate COMMENTS c10RTIy Town of s _ �* ndover O No. V�r h ver, MassAMR Ab Coe-41N.-CK �RATea S iU BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT T.Aw,Z., ,,,,,� ...... ,. ,.:.,,, BUfLDING INSPECTOR ............... ...,. .....,............ ... . has permission to erect.....,. .....,. ildings on ��� • Foundation ..... . .�. ... ......, . .............. Rough tobe occupied as ................... , .. ........................................... chimney provided that the person accepting this permit shall in every respect confor o 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service "'"""' TOFinal BUILDING IN R GAS INSPECTOR Occupancy q „ ®ccupV Bl�lt�d�li2� Rough �'e�naatdZe Required to 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. 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"7 Or r i:i :iismil IN 11IT 1111 illlli!;�Vl! igill!:l�h1i eeeeo Verizon LTE 10:00 AM { tsaio Sent from my Pad ,_- � naxF(ratlJ6n/21/{16. A,C F TIF "r LIABILITY ITY I N THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hot-DER.THIS CERTIFICATE DOES NOT AFFIRMA71VEI_Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is-F,, IIIONAL INSURED,the policy(iEs)must he endorsed. If SUBROGATION IS WAIVED,subject to ADO the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the w certificate holder in lieu of such ondorsemengs). --i PRODUCER San(97.CE#7 xranae Agency Osi ) M6ufl431z'98c0'�73 _ ..:.(AAm rL1 .... ',..A IM,P. Roberts Ins 106E Osgood Street E.AIATI :ands@m robortsinsurance,coin c3 aoDRFss: t'........... _. North Andover, MA 01845 INsuRr rqt)Au9ITofNG COVE,:RA GC NAICh INSURERA:Ess", Insurance Co... , INSUREO INSURERT3.Associat:ed Employers Insurance TKZ, LLC INSURFRC: ._.. c/o TOM ZAHORUIKO INSURER D: '78 GREAT POND ROAD INSURER E: NORTH ANDOVER, MA 01.8415 fNsuRlrzF REVISION NUMBER: COVERAGES CERTIFICATE NUMBER ._.,..,... w_.__.— .. _ — TWlS 1$TO(:EC2TIFY'Tf IAT Ti IF POLICI($C)I'INSUf2APJCf LI$TE()BEL 0011(AVE OEEN I SSUI"t)"fO TIIE 1N$tIRCD NAM ED AI',OVti rOF2 fl IE POLICY PERIOD INDICATED. NOTWJTWSTANDJN(S A1dY f2Ff}UIREM[NT",'TERM OR CONDITION OF ANY CONTRACT OR OTWFR DOCUMENT IfidfTl-i i2t"S!'I"C6 rO V+IFifCIt fill,'; CERTIFICATE MAY BE ISSUED OR MAY PERT"AINI,THE INSURANCE AFFORDED BY'f HE t"OI_ICII:wS Ul-SOFlIBED H-J?r--N IS SUBJECT TO AIL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI-I POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID Cl AIMS, LIR IAUCIL{t,UaR'. f POLkCY EFF POLICY EXP Milli TYPE .,..,..'�r33 t,�'t!Z _._POLICY JAIP BFFi,....._,_m.,_,.w j�,!11dlF7DNYYY�_(1i7F6/n[YYYYYl AJ I _ 711 ,1/Tl/T6 LAGIIurrUMMNGL 5 A CiFNE3DXN3936 RALLIABIl11Y 1,000,000 UATn"C�� I o JtbNrFt7 s 50,000 000 X t,01NAFICIAI(ONFRA(LIABILITY PROMSES(17.4,V.Llrn r _ r { I r0 rYT LAl,nirr SArr rri� 'r` -5,000 (;LAIMS MAUL ? X oCCUR ' f.oJJ� AL,&IUJV INTURr 1,000,000 t �1 AG(M Gntl ., 2,000,000 I . � f'il(IDLIcjI4Tt !!nJ ACG 5 GLN I A(3(if?fGA ff.I IMHAPIII SITR PRO L OG r:OVISIrJI U}W"A I I.If.tI I$ X I PCTI Ir Y t y _AUTOrdORILE LIABILITY f [n nCcrtY r4 5 11I11111.V IN.II IICY IPO! AJYAUIC) ALOWNT.D `'1•IIt IJULLI) RCYDIIYfN AIRY IP,-, enrl tl�:E AUTOS AUTOS PItovfF 141 Y ON 14t3f3 y i NOWOWNF.1) (Prrmet,n91 1 UInFDAUMS .._. AUTO'S } C S uMaRIcLLA LIAR (>(x:tLLT � f ticl I o1,t.I7RrtJ rrCl w. DIA) Rf_11�� CLAIMS MADE _? t4A' 1U/]/15 1UJ7/aG }{ [rnn r EXCESS LIAOI AC t'rfl B woiawLRSGoalrsrJSAxrol �VICC500500Fi! 0 �� ntYwrvl� to I_ AND EMPLOYERS uaen.ITY Y rN I 1 eAf I AucuA rlr , 1,000,000 `ANYFt.OPRILIOWPARTNLIUI:xERU'J JTf A� 17 rllf.fUJ1$..Li JER F7i Mrf1, P U1 DIS I AfA -l A 14/110YffS 1,000,00a, P If t axle fary in rJ lq JI I�Aasuiltr II,flEJft6 f f UL€:ktIPIIUIJC7{>OPE41r411UNLchw � LL.IYIfiC/SE-POL84;YLIIAYT S l�OQ0000 � f 1 I 1 .._J.__...... j (7E$CRIPTION OF OPERAUOU&J LO[:l1TIePNS i W6PA GL.E!x tAY1ath ACORD 161,AtbYellnnnl Ram�rkv 9eM�dAiln,U mhren(wen Cx re qn rexl) j{t CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIC IFS RE CANCELLEOR FFORF THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN f TOWN Or NORTH ANDOVER ACCORDANCE WITT1 THE POLICY PROVISIONS. r ElUITDING REPT __ nuTLtn_RJz.---D _ ePRESFrJTA__J _T .__--..__... 1600 ON7OD STREET NORTH ArmovLR, MA 01845 /f 0 gg0g-2090 ACORD CORPORATION. All rights reservJrc. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Pholte: Fax; E-Mail; Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-055417 -c S° v so� THOMAS D ZAHORUIKO 4 HIGH STREET SUITE 209 NORTH ANDOVER MA 09845 = ( - Expiration: Commissioner 04105/2098