HomeMy WebLinkAboutBuilding Permit # 2/22/2017 BUILDING PERMIT of"SRT 6�4
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * 1 -
Permit No#: I Date Received
WOVORTAINNT:
Date Issued
Applicant must complete all items on this page
LOCATION. .I0, E- i o=t ,
Print
PROPERTY OWNER
Pant i€1DYear,StructuPe yes
a
MAP—k02. ARCEL ZONING DISTRICT:-Rz—Historic DiStnet yes
Machine Shop Village yes _ no.-
TYPE
oo TYPE OF IMPROVEMENT 1 PROPOSED USE j
Residential Non-Residential
i
New Building One family
E Addition E,Two or more family E Industrial
i ❑Alteration No.of units: F Commercial
U Repair,replacement Assessory Bldg o. Others:
Demolition ❑Other
E Septic U Well u Floodplain 11 Wetlands P Watershed District
Water/Sewer ;-
DESCRIPTION OF WORK TO DE PERFORMED:
_ % .r 1
'c' L",€> -U,I as1— fir = r"
ad
Identification- Please Type or Print Clearly
OWNER: Name: z L Lt t` Phone:9-?F
Address' = S L t i`A-A C_'FI
ri"
Vie =
Contractor Name: LV, Phone'
Address: ' � 1
Supervisor's Construction License: 717 Exp. Date:
j Home Improvement License: Exp. Date:
ARCHITECTIENGINEER Phone:
Address: Reg.No.
FEE SCHEDULE:BULDIAI6 PERMIT:S12.Q0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SE
I-otal Project Cost:$ t ,06-- 4' FEE:$ t -
Check No.: = Receipt No.: ii
NOTE: Persons contracting with unregistered contractors do fiat have access to'de grcarariN fiend
Sig re Q Agent Wner Sign e of coni�acforp
Plans Submitted Plans Waived L Certified Plot Plan Stamped Plans
i-Type bF SEWERAGE DISPOSAL
Public Sewer Tanoning NIa» e -,rt Swimming Pools
'i a°n i'Body-
r
'WellTobacco Sales L I FoodPackags Sales L
i Private(septic tank,etc. El Permanent Dumgser on Sim El
-
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
PLANNING&DEVELOPMENT Reviewed On, Signature
COMMENTS P,J
t
CONSERVATION Reviewed on i %};` Siqnature
I"
COMMENTS O
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals:Variance,Petition No: �{�� Zoning Decision,''receipt submitted yes
Planning Board Decision: Comments
Comments _
'
Conservation Decision: t iz Comments
f ;; t
Water&Sewer Can nectiontsianature&Date € '` Drivewav Permit t
DPW Town Engineer:Signature
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date '
COMMENTS
Town of "ORT" Andover
O g
IN-201
16.
* n h ver, Mass
�q p�aA7E0 FPP� �(�
u
BOARD OF HEALTH
Food/Kitchen
F� ERMIT TO ILD T�y,�� I"� Septic System
THIS CERTIFIES THAT................l..Y...! . ....':..... !+•��RV►� I► BUILDING INSPECTOR
�.. s,.11 � ��`' Foundation
has permission to erect ...... ...........buildings on....... 7�1rr// V{.MX4t�
............................................................ Rough
to be occupied as............... .e!� � .....��` Chimney
provided that the person accepting this permit shall in every res 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 ® Ii ELECTRICAL INSPECTOR
LESS C T CT ST Rough
L Service
.......... .. .................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Final
No Lathing or Dry Wall To Be Dane FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
VIU
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50.241.73.83 C [� + []�
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MTo IIIc PLANNING BbARc: 416600x$ a'Tv,D,2a:ce
VRPOSE CF PLAN:0 OMOE MNP O .LOT I INTO Rl LOTS. \
+..Y,. NAP 102,LOi 5 IS LdI N'JInBGR 7rvb ON N.E.R.D.PLAN gt40d0. � y I CN r 4l pT,
THE LOCUS CONTMNS NO SIGNIVTDANT WrANO REBWRT ARPAE. rb4f O`(�tAVE"lu` f� i
CON7,GUOVS SIJI JABLE ARCA c'—S LOT AR_A ON BOM LOTS. NOME ORAFPNG ERROR OISCOVCIREO ON PLAN#14< 0:I'ON THE BOUNDARY i COUNTY LAND SURVEYS, INC'
SON COTS..r.—L.VAOTH REOVtRt'kCHI lICO FEET IN R-2) UNC SEPARARNG Lp5 I ANO 2,AOD 45-00-00 TO LASELE0 BEARINGS. II„m:xm nwa Inwvfaf cSvm.✓n,.UFl UI,AfI A.+.r'sJN%wN+
AT ALL POSS{BIS DNELUNC LOCATIONS. CORRECT BEARINGS
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ACii DATE SMMfOdYYYYCERTIFICATE OF LIABILITY INSURANCE ''
2/22_L17
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS I
CERTIFICATE DOES NOT AFFIRMATIVELY 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 l
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If tl>Q certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions ofthe policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PROWGF.R NAME: Sandi Munroe
M.P. Roberts Insurance AgencyHE-EI, _ 7803 arc NJ (978) 083-3147
I
1060 Osgood Street ADDRESS Sandi@mprobertsinsurance.com_ _
North Andover, MA 01845 --
INSUlEFi(SjAFFOROiNGCOVERAGE j NAILY
INSURER- ES BOX IRs Cc
INSURED INSURER B:Associated Employers .Insurance I
TKZ, LLC INSURER G: _
c/o TOM ZA.HORUIKO INsuaERD
78 GREAT POND ROAD INSURERE
NORTH ANDOVER, MA 01845
NSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, III
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR; IAWLSUBRI POLICY EFF POLICY EYP I
LTR'. TYPE OF INSURANCE 3NSRIWtD POLICY NUMBER MdtICOtYYYY'MM70DlYYYY LIMITS
A 3EE0829 EAGIOCCURREHGF <_1,II0000 I
DAMAGE TO RENTED s_ 50,.000
7/13/16 7113 17
CONMERCIUVL GENE PREMISES(E a:ci e, - -
X_�jclAMs+nD_RXLIOCCUR
I�'I IwDEXPA.,o p—w S 5,000
PERSONAL&ADVRIURY < 1,0_00,000
i GENERAL AGGREGATE 3 2,000,000
GENLAGGREGATE Lee TAPPUESPER iPR00UCTS COM.POP AGO
I.X F*OLSCY .PERCT LOC !, 5 i
AUTOMOBILE LIAetUTY 'i.. ',. COMBINEDSINGLEIIMIT I
AN YAUBI BOISLYI.NJURY(P N-1) S -_
ALL O,,wo SCHEDULED BODILY INJURY IT,, denUlS
AUTOS AUTOS
NONP}VNEO -.-
j_
PROPFWY DN*IGE 5_HIREDAUTOS AUTOS
5
tfMBRF LLA Li-B
I OCCUR f - �Eaca occuRRENGF s
--. _.
EXCESS LIAR CLAIMS MADE 1 -AGGREGATE 5
DED RETFNTION$ S
B MRKERB COMPENS-TION WCC5005006517-2016- 10(1/16 10/l/171X wG STAID
OTH I
ANDEMPLOYERS'LIABILITY TORYLINIITS
ANYPROPRILTOUPARTNEIL'EXECUUVE - _ I EL LACRACaBENT �3-. S,000,OOO
OFHCE INv'c NflER EXCTtAEO?
(Myyaraafnry In NH) YIN
INCA: ,EL DISEASE-EA EMPLOYLC!S. 1,000,000
DESCRIPTI•JN OF OPEtMTiONe Oetuv EL_OLSEPSE-POLICY LIMIT i i 1 000 000
S i
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES
(-Hach-CORD tet,A tlitionel Ra+mrks Schedule,if rnura syce slrcgli+cdt '
i
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DE SG RIBED POLICIES BE CANCELLED BEFORE
1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i
TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING DEPT — I
MAIN STREET AUTHORIZED REPRESENTATIVE r
( AIr
_----
NORTH ANDOVER MA 0_1845
cp 08-20 0 AL`ORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
Phone: Fax: E-Nail
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License:CS-055417
Construction Supervisor
THOMAS D ZAHORUIKO
4 HIGH STREET SUITE 201
NORTH ANDOVERMA 01845
(`-lz;7, l/S.A – Expiration:
Commissioner 04/0512018
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