HomeMy WebLinkAboutBuilding Permit # 1/26/2017 1
BUILDING PERMTOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EX I
Permit NO:-7
Datc
Date Jssud:. � �
[IMPORTAINIT.,_ hcant must ail items on this gag
0 ON
.;:
PROP
OWNED �AX
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_ V't
' lyf �MPROVEMENT °PROPOSED USEResidential tion-- Residential
>(one family
Two or�� fall
r f
Alteration ti o. of units:
Demolition Other
IdentMcation PleawType or Printlearly)OWNER- Name- Al ZC S Pe7 r Phone:� .r
Address:
� r - r
I .HoMeJ
.
ti
ARCHITECT/ENGINEER— Phope-,
Address- —RegNo.
FC-E SCHEDULE.gULD1W PERA117--$12 00 PER 31000-M OF THE TOTAL ESTIMA TED COSH'SASE 3 o $125M PER S.F.
Total Project Cost-, FEE.
Chec�¢v`''�vp No.,pypp (p pA _y g �g{���gg�Z�g gP,£pp c5eiptg p o..:
` SG�! :
Sign tur o nes v-
NORTH
Town of2 FAndover
o
No. 244
7a
iii - � (
� o : k..Kt h .� ver, Mass, 1 � 0 mor ?
COMIC M(WICM 7�4
QA `y J
,4S Rwrev
U BOARD OF HEALTH
Food/Kitchen
PEmMIT T LD Septic System
THIS CERTIFIES THAT .....7(]�.�. �. � V ..... C r V C „� .,.,... ..,. BUILDING INSPECTOR
has permission to erect ........................... buildings on
...5.........0.'*stfqt 0+qtr.1.............................. Foundation
Rough
t0 be occupied as .........#� t �1 o► .. • •i.. p 0"CL W j-j s 01� �.$v/i**"i/✓ Chimney
............. ..., ...................... .... ..
provided that the person accepting 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO A TS Rough
Service
...........I.
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Fina.
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
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JOB DESCRIPTIOIN
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JOB DESCRU'"HON
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Total: $3,593055
Program Incentive: $2,929A0w
Customer Total- S664AS
14E AGREE HEREa s'TO FUR105,H SMVIcES�CG.`,%-LC-T.lt3 t C-0R0ATXL:fYA60 JE Sts'Ea WXATIWg S.POR THE 531.11 OF
E
'..Six Hundred Sixty-Four afi 161100 Dollars $664x'95
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RISE60 Shawrnut Road,Unit 21 C-mitan,MA 02021 339-502-6331-5
F N'G NF Ri N G wwW,R3SEC-nqineeriuq.com
OWNER AUTHORIZATION FORM
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if jfn`;s puf IV Addfe! •j
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to d"-�OL'olA this pek
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Plans Gubmitted Plans Waived Certified Plot Plan El Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewerwinw6nv Pools
TanningfflassagelBo4y Art
Well Tobacco Sale-, Fcod Packaging/Sales L
/IJA
Private(septic tank,etc. Permanent Dumpster on Silo
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF -U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT D
COMENTS
CONSERVATION El El
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH El El
COMMENTS
Z
Zoning Board of Appeals:Variance, Petition NO: oninq Decisiontreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision. Comments
Water & Sewer Connection/s1amature&Date Driveway Permit
Located at 384 Osgood Street
RTME ' D
A Nt! �'J`empt urho
FIRE,ZEP 1;
7
77�
Lbcat12 4,Main Strb6f-
ed'�it
,F
i77 7 j
77
COMMENTS
Dimension
er o Stories,
rr�b es: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: o e f Meter location, mast or service drop requires approval of
Electrical inspector Yes No
DANCER ZONE LITERATURE: Yes No
MGL Chap1ef 1661 Section 2.1.E-F and G min.$10€341000 Acne
NOTESand DATA—(For department use)
a
U Notified for pickup - Date —
Bac.Bijilding Permit Revised 2012
"lie Common wealth vf Plassach usefts
Department of Indaylpial Aeeidew-s
Offwe of Invesfigadons
600 Washington Street
Boston, MA 02111
www mass go v1dia
Workers'Compemation Insurance Affidavit:Ruilders/C"traetors/E lectricians/plumbers
Applicant Information Please Pyint Lggjb!y
Name
Address:_$�W
-A CM 925 Phone##: 44 0 k
Are you an employer?Ck"k the appropriate bol: Type of projed(reqrjjrtd):
1,W maemployer-with %C� 4, 0 1 am a general contractor and I
6. 0 New construction
employees(full and/or part-time).* have hired the sub-conte-actors
tisted on the attached sheet;
2.El I am a sole proprietor or partner 7. E]Remodeliog
ship and have no employees These.stria cotrfractors have 8, El Demolition
worknforwe in ca workers'comp.inse.p9. 0 Building addition
[No worker s' inswance 5, El We are a corporation and its �10.0 Electrical repairs or additions
required.] officers have exercised their
3.El I am a homeowner doing all work right of exemption per MGL I LEI Plumbing rapairs or additions
myself:[No workers'comp. c.152,§1(4),and we have no 12.E]Rwf repairs
in nee required-]I employees.)No Nvorkm' OtherL
C.>V1
comp.insurance required.)
L- 105UA0:b
*Any.W1icwA that ch,,x*s box9f rmist also fill out the section betiny s1ming their urorkm'mnrAwaim policy Wbrm-aion.
t Howitownas who submit this afridwit Mmfing they are dainz all mvrk and then hire outside enawms mwitsiihmit a ktctiv affidnif indiceling such,
+Coaftadmv 01a4iccl;this bm MUS!?MKW an addition shut 0MVMg LIM nantc 61 ilie st coasfta s aM4 thele wvtkers'COMP PAICY Inronnatm,
I ant an employer fhat is providing workers'e4oritpeawdon imuraimefor my employees. 11dow is the palky andjob site
inforlmdoft-
Insurance Company Name:_5caclom
Policy A or Self-ins-Lic-k7 Expifafion Date:
Job Site Address:— City/State"75p;
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expimtian date).
Failure to sec=coverage as requhvd under Set-lion 25A of MGL c- 152 can lead to the imposition of criminal penalties off a
fine up to 51,500.00 andlor one-year impvisoomem,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250,00 a day against the violatcw. Be advised that a copy ofthis statement may be forwarded to the office of
Investigations of the DIA f6r insurance coverage verification-
fdo hereby eerdfy anderikepales andpenaffies qfperjary that Me informathynprotided above it tree andeorrect
iggature: Date-
Phone fi-, '4o i • q to s • a S a
Official Use only. Do not uq*d im Ibis area,to he evnTMtedby efty or town offi4aL
City or Town- Permit/License N
L"uiug Authority(virete one)!
L t id of Health 2.RuDding Department 3.City/Town Clerk C Ek-ttewal Inspector 5.Plumbi g I r
6.Other
Contact Person-. Phone 0;
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ACUMDi
CERTIFICATE OF LIABILITY INSURANCE
,9d Q16
I EE fi dCATE ES EMED AS A MATS OF fflFORMATIou ONLY AND CONFEn NO R.# TS UPON THE.C 2TERCATE HOLDER.R.'RHES
CERMF'CATIE EES NOTAFRFMATPJELY OR NEGATIVELY MMUD. EXTIEND OR ALTER THE FOI;£3E D PRY THE E ECdEs
BELOW. TM CERT ICA' FES CE OCEa NOT CONSTITUTE ,fit CONTRACT THE pS�%-R C, VUSUpC�( )g AUTHORtzr=o
REPRESENTATME ON PROMCM AND THE GERYWICATE HOLDER-
IMPORTANT.
°'ft LDER.$3 f fgT T: E CeWfffcale Wder is an ADDMONAL ED,the E H EO AT 3 E 3EP7E ,eta efi to
exrnttt$a�t€t� i c� Y � e Ef rei arae moi_ A s Ear f€i ciz� Wt Confer€�E fotr
cargiffrate hotter in Neu of sxada endaTs�al�aaff�s�
PRODUCER icogrAXT
gra @tea
279 Dexter Street
P. Oa Box 1148
PavrE=xxckA--t R1 02862---1148 �• �� ra�a�� Aga _
RMORa
Egllm a: Bacon Muhl Mnsaranca co 03
Af:Eordable Building r. Weatherization, c- � 3 � SUR= 0012
77 pi am Street � Ins- 'CO.
unit loo
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Pre3v±dence R1 02906
COVERAGES CERT C'ATE NUMBM:Kazter 2016 _ _ REIASWN KUER.
THIS IS TO CERTEEY Ti-EAT TSE.PEES OF hNSURANCE USTED BELOW IHA BEEN ISSUED TO`IKE ENSURED NAAWD ABOVE rOR THE PO4CY€xED
INDICATED. NOTWE 3`ESTAEtECRNG ANY REQUIREMENT,TERM OR C014 TIOM OF ANY CONTRACT OR OTFEER€OCUMeff WFE iQCTT�pO VIMICH•THM
CERTIFICATE MAY ISSUED MAY PERTP ,THE INSURANCE AFFORDED ByY THE€'OUCH DF-S�D NFREW 6S SU ,y
CT TO ALL TFE TERMS,
EXCLUSIONS AM =S OF SUCH POM ES.LIMITS SHOM MAY HAVE BEEN REDM BY AND
C €FiE S.SAX3'f
EAC"GCWME•CE
AWAI e TO r
caa cr r a sr�u�€ riv c r s�� o 5D,000
��P�9E(a'iT�___ 3 +2r4�43E9cQQQ
l3E!'d°E.AGGREGATE 9.l:,f'll'APPLIES KR= PROOUCFS-(XM5PMP'AGG $ .2,c000,000i
x Poucy PRO- El ux S
€NYAeIx6'ta '�t3fYY"a,Ydam'irzN�l'EPrs��'�°e) 5
Asa c -OWNED t O �sz !��€f2ast lacsAzca. LY9AAKY sa�r �rcs�ap
'X HMED AUTOS x PROPERTY
AUTOS
pq
EXCeSS LEAD C:ac€%Z-' �£.d r
.s 2r000,000
3
AND YYN
r E.E_.FltCR ACMENT MY SST ara�r�€at�xE�rse,�� � 5ElE� s10Q
n €racaFcaxceasc€k � aarA
E n<s:mss! a3 t7a Jam/'2 ass �gFa��1'aaas s ssem-�veroa�rrrr 50 000
17}^Us,desxniFe evts�tx
ua n m bauw SoQ 000
irsyep- DisEe€onesty �3�E€553 /1�Efz0a6 1gQ121�1�
s Worker's Comp 433 4dsafz�a 3�s +�s� 2.c ksdsS;Kss,c�€s
o f]E5 F FIF9ET F 1p HlE'E1d:P$5!'Locxnous IV 's E.6=ch Acom izi.Ad&Vznw ie gy p,i9 +rte mace is n0,:A1ke'4
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National Grid is named s an addktiona3 , nsured va the geme--zal and busIness auto policies as by
,signed written contract.
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CERTEFE1--ATE HMOER CANCELLATION
SHOULD ANY OF THE ABOVE INISF-0 POUCAF-S BE CANCELLED BEFORE
THE E 'MA-FION DATE THMEGF, NE9'110E Wft-L BE DFUVEREO it9
ACCORDANCE WM-1 THE PL3€.fCY faRf.39dlWO"
National Grid.
Westborough, MA €51581
CC Iy 2 X2037 11988-2010 ACCBR6]CORPOF�ATE . AE€�sgE� reservecE.
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TODD LEDUC
95 QUEENS STncy-0
RJ M18
sire er To-Mt.-W-ins:o 6awm Ccntm-accor
to p,3w--s a mrfeza ed-A!Qn o�the
St�je Pdildhng cado-is cimA' e fay rzvocmion Of this
PS U-
Licemeor registration v21id for individual use only
office qfct)nsum.�e
HOME IMPROVEMENT CONTRACTOR before the expirAtion.dale. If found return to.
off'lice€s$Co
n,
;umer jl*ffairs and Business Regulation
Regis t-ation: 1795722 Type:
to pqrk-P127A-Suite 5170
Expiration: 8118120i8 corpcTaomn
Boston,NIA 02196
AffbkDABLE BUILDING&WEATHERiZATRON ING
TODD LEDLICC
330 Vir—TOR RD.SUITE A
............
ATTLEBORO,MA 02703