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HomeMy WebLinkAboutBuilding Permit #1057-2016 - 16 GREAT OAK STREET 4/11/2016 I Ly t BUILDING PERMITo� NORT,4 q Etta° ib ti TOWN OF NORTH ANDOVER �� h 4, o APPLICATION FOR PLAN EXAMINATION * _ A A. "° m" J I " Date Received °°�Rcc Permit No#: ^re°� 4 gSSACHUSE� Date Issued: MPORTANT: Applicant must complete all items on this page LOCATION rint PROPERTY OWNER ' �C�� r Print 100 Year Structure yes ' MAPy�PARCEL: ZONING DISTRICT: Historic District yes (: Machine Shop Village yes (� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New'Building A Ope family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial p4-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer _ _ - DESCRIPTION OF WORK TO BE PERFORMED: dentificatio' ` Please Type or Print Clearly OWNER: Name: l C'C� d"`�34.��n Phone: Address:' Contractor Name: Phone: Email: I Address: Supervisor's Construction License: Exp. Date-.-- Home ate:Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: 4• , Address: Reg. No. FEE SCHEDULE:BOLDING P9ttMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. otal Project Cost: $ �J- FEE: $ )7-0 r Check No.: 42�7, Receipt No.: Z 7iZ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Rnature of Aqent/Qvvne.16�z�-UYWQ&,js-e� Siqnaturp- of contractor �F e v� Location P o,4- �A IL �� P �No. � �! ��� Date 1 • • TOWN OF NORTH ANDOVER „ .. T Certificate of Occupancy $ Building/Frame Permit Fee $ ZU Foundation Permit Fee $ ” t Other Permit Fee $ TOTAL $ Check#47 +-Z- r Building Inspector J Plans Submitted . Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art ❑ Swiznnling Pools ❑ Well ❑ ❑ i Tobacco Sales Food Packaging/Sales ❑ Private(setic tank p ,etc. Permanent Duca ste p r on Site ❑ � i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments e + 41 1 C lservationI Decision: Comments Water& Sewer Connection/ Sigrtature & Date Driveway Permit DPW Town Engineer: Signature: FIRED ART ENT `TempDurnpsteronlfslfe� eyes. _ --_ - oo _ Located Osgood Street �K,Jine(Departments�signature%date, S.C.QMMENTS. - — - - -- - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Pennit Revised 2014 _. r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4 Floor Plan Or Proposed Interior Work 6 Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit j � f Addition Or Decks I Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit ` Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) i Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products IN OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products IN OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 t""'At. own o . : Andover No. 1 %157� 26 � - �` h ver, Mass .Q COCKIC"IWI[K 1. �i9 ARRA TE D r -IFLN 5 s V BOARD OF HEALTH Food/Kitchen PER IT LD Septic System THIS CERTIFIES THAT .,,.,..,,. BUILDING INSPECTOR ....... . ... ...... .. ........... ., .......... .... .. ....... . . .. . .... .. .. .. .. . .. Foundation has permission to erect .......................... buildings on .. ....... ....Q .........�.... �r...... Rough to be occupied as ..��!!. ... � �.. ..'5 .Y ...... 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 CONSTRUCTION ST RTS Rough Service .................. . .. . .. .. ., ......................... Final ILl) SPECTOR 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 Done - - FIRE DEPARTMENT Until-Inspected- and Approved by the Building Inspector. Burner Street No. Smoke Det. TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT r 1600 Osgood Street Building 20, Suite 2-36 _ North Andover,Massachusetts 01845 - Telephone(978)688-9545 Gerald A.Brown Fax (978)688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: 16 0_7r-ed 00h 61, Number Street Address Map/Lot HOMEOWNER el/1X�rCI / % �i`t 6 0 �7 8- Name Home Phone Work Phone 'Po(30X 36 , iff 44) �t,�PRESENT MAILING ADDRESS IVC�r h 142c e f /"/A 01,3 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a'one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department r and tion procedures and requirements and th he/she will comply with said procedures minimum inspec p q P Y requirements. HOMEOWNERS SIGNATUREAN C APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption �rjc) The Commonwealth of Massachusetts Department oflndustrialAccidents -4.d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WIT THE PERMITTING AUTHORITY. Applicant Information Pck4j Please Print Le b1 Name(Business/Organization/f idividual): C .Address: City/State/Zip: IV64h �i o' ycir' Phone#: Are you an,employer?Check the appropriate box: Type of project(required): 11-11 am aemployerwith employees(full and/or part-time).* 7. E]New construction 2.[]I am a sole proprietor or partnership and have no employees working for me in 8. tRemodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3..❑I am ahomeowner doing all work myself.[No workers'comp..insurance required.]t 10 ❑Building addition 4.AQ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors Have employees and have workers'comp.insurance.# 13'. Roof repairs 6.Q We are a corporation and its of=ficers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and Nye have nq emglcyees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who subnut this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have . employees. If the sub-contractors fiave employees,they must provide their workers'comp.policy number.• t I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information.' > Insurance Company Name: /yG4/f� "/- m - Policy#or Self-ins.Lie.#: 9l�c��t�� Expiration Date: 001/• CZI p fob Site Address: �CO V/"E'a (�gkS City/State/Zip: N.nt /"1>� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t Ae pains and p naId s of perjury that the information provided abo a is true and correct. signature: n p Date: Phone# Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity;employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to signand date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their ' self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space'at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia THEM0RF0LK 0[E®HAMGROUP@ January 13, 2016 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 I Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1605095 Insured: EDWARD MCALOON Address: 16 GREAT OAK ST., NORTH ANDOVER, MA Policy No.: D0473563 Loss Date: 01/07/2016 Loss Type: Buildingor Other Structure Damage 9 A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, i William Lamb Manager, Property Claims 1-800-688-1825 x1137 NORFOLK&'DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. [W@ Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. Fax:(781)329-1818 Date...arm OF ,010 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION KU This certifies that ....MU.,ti .................. ...a ...............!..�......�...,.....G..... ...... has permission for gas installa 'on .. �G.r:Q-...r, �9S' VL�eVe,2„ A .............. in the buildings of........�..:/. ....................................................................... at..... ..... .....(04...�<...... , North Andover, Mass. Fee.,;M.."".... Lic. No. P-3�......... ......................................................... GAS INSPECTOR Check# ��� %d' 9365 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK U CITY North Andover MA DATE l PERMIT# 1 JOBSITE ADDRESS OWNER'S NAME o G : OWNER ADDRESS Same TEI�' - ---IFAXI `� TYPE OR OCCUPANCY TYPE COMMERCIAL[jEDUCATIONAL® RESIDENTIALF11 PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 1 8 1 9 10 11 12 13 1 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE , GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ;t ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Re lace 1 Gas Meter x INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ® BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicat4willbempliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.PLUMBER-GASFITTER NAME Jose h Marino LICENSE# SI NATURE MP� MGF❑ JP❑ JGF® LPGI® CORPORATION❑# 3285C HIP❑#®LLC❑#® COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I ALlburn STATE MA ZIP 01501 TEL 508 832-3295 9FAXIL508-926-4347 JCELLI 508-832-4614 EMAIL JMarino@RHWhite.com IJ i � l ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# i PLAN REVIEW NOTES l EAL.TH OF MAS - - Bls; i ERS AND -� : -_D AS-Pr•-111�a�.-.r'ST��+^plTp�`�'E.f 5.�,-'�x�p'.�_' -�;r- _ f�SUES TA-E`•AeQNE'•'LIC6NSE Tit R, GTON $T R MA 0 - - : 05/01/14 - GOiti7lUl !NWEALrTFG OF .°PfU]UIBERS AND GASFIT ERS ' `_.:•i t --it'c��us° ti As A ,�c�u.RN��n� i >� . ..z..� iSbUES THE ABOVE�'LIOENSE _ - :M'ARINO' v .F;4RRZYNGTO N S.Trn • 05/01/14 I , i i AC R'D® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 oiai2o aI THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEkOW. 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 an ADDITIONAL INSURED,the poliey(ies)must be endorsed. If SU13ROCATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the eertifiaate holder in ifeu of such endorsement(s), PRODUCER CONTACT willia 09 Massachusetts, Inc. PRONE C/o 25 C"tury Blvd, .No.txrl: 877-945•-7378 FAx�o). 888-467_-2378 P. 0. Box 305191 -MAIL N3011ville, TN 37230-5191 DRKM_Qextificat:a w•illis.com INSUR ER(S AFFORDING COVERAGE NAIL rI INSURED INSURERA,The chArter Oak rine insuranoo Company 25619-001 R. H. White Construction Company, Inc. INSURERS:TrILVOlArD Property Casualty Cotgpany of Am 25674-003 41 0. Dox? Street INSURER C:National Union Firo xnauranc* Ccmparuy o£ 7,9445-001 P. C Boa 257 Auburn, MA 01501 INSURERD;Travelers Indamnity Company 25659-001 INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20267680 REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES 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 BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN Is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTypE Qp INSVRANCC` OD' SUE POLICY NUMBER POLICYEFF POLICY EXP LIMITS A GENERAL LIABILITY VTC20co 87789948-13 9/1/2013 •9/1/2014 IDEXP(Anyone HOCOURRENCE 2 2,000,p00 X COMMERCIAL GENERAL LIABILITY TORENTF,O;tEeoceu.D..r 300_QQO CLAIMS-MADE10OCCUR arson lQ�Doa PERSONAL&ADV INJURY s 2 D Q Q 1 0 0 0 GENERALAGGREGATE 8 4,000.000 GEN'LAGGREGATFLIMITAPPLIESPER: PRODUCTS-COMP/OpAGOlr! $ POLICY PRO LOC 000 000 B AUTOMOBILE LIABILITY VTJCAE 977K93SZ6-13 9/1/2013 9/1/2014 4Mt31NEDSINGLFLIMIT X ANY AUTO accident 2.000,000 ALI.OWNE SCHF.DULED BODILY INJURY(Perperson) 8 AUT08 AUTOS BODILY IMIURY(Peracaldonl) 6 X HIRED AUTOS X NON-OWNED x Ce Defl X Cc111 Pad erRccldQPER enl A 3 C UMBRELLALIAB DccuR BE8766140 /1/2013 9/1/2014 EACH OCCURRENCE x EXCESS LIAf3 CLAIMS-MADE $ E�000,000 AGGREGATE $1000,000 DED $ DETENTIONS 1D,00( D WORKFR900RS COMPENSATION V RKUB 820514.7.95-13 9/1./20x3 9/1/2014 X C AND EMPLOYER8'LIABILITY TO [J, R, 0 ANYCERIMEMB RIPARTNbED? GUTIVE NIA VTC2KUB 8203A73A-13 9/7,/2013 9/1/a01�4 E.L.EACH ACCIDENT 1, OFFICERT4EhAeFREXCLUDED7 L}(_"JJ 000 OQQ Mendetorvbduni E.L.DISEASE-EAEMPI.OYEE 5 1,0001000 u�si nn%iiuw uF Uf'IcRATION3 below F,L,DISEASE-P0Q0YLIMIT S 1,0001400 )FSC RIPTIONOFOPERATIONS L,4CATION$IVEHICLES(AtIfichAcord 101,AddllonplRemarksSehadula,Ilmarespeenlaraqulrad) :ERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Xvid6nce Of IIIRiUXance AUTHORIZEDREPRESENTATNE 0011:4197604 xpl:1694012 Cert:20267680 ©1988-2010ACORD CORPORATION.All rights reserved. ,CORD 25(2010105) The,ACORD name and logo are registered marks of ACORD Location No. 1, ! Date 4 2S k A �►ORT1y TOWN OF NORTH ANDOVER OL 6 b.- : ' p Certificate of Occupancy $ ar • : Building/Frame Permit Fee $ 0 sari '• ,q' MUs 14 Eta' Foundation Permit Fee $ sAt Other Permit Fe ��1 $ • Sewer Connection Fee $ Water Connection Fee $ TOTAL $ & V 2tob� Building Inspector �.10 p 2 n G Div. Public Works PER111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 7-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. F 1-1 LOCATION // PURPOSE OF BUILDING i/� w (1 "!�!/lil OWNER'S NAME Kf NO. OF STORIES 0. SIZE i OIYNER'S ADDRESS / BASEMENT OR SLAB :1' 06013 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2NlDJ�J� `U 3RlD-^�"J BUILDER'S NAME 09SPAN DISTANCE TO NEARES BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING K IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COSTS! OO09 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BUILDING INSPKCTOR SIGNA=N E OF WN TIZAGENT FEE , � �00 OWNER TEL.N P'RM1T GRANTED - - - - CONTR.TEL.# �Qv V a 7J 2 C�.� 19 �_ - - - - - - - - - - - - CONTR.LIC.# U z- H.I.C.k / b 3 3`�Q BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. r CONSTRUCTION r 2 FOUNDATION 8 INTERIOR FINISH - CONCRETE __ d 1 2 13 CONCRETE BL'K. PINE DRY WALL BRICK OR STONE H PIERS PLASTER_ _ UNFIN. 3 BASEMENT AREA FULL FIN. B TAREA _ v, 1/1 1/ FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD!✓'D ASBESTOS SIDING COMMC:N VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR 11 ADEQUATE ONE 5 _ ROOF 10 PLUMBING GABLE HIP BATH )3 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO re 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE i FORCED HOT AIR FURN. • TIMBER BMS. 3 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 7;—,—1_3,_dI 11 NO HEATING ' NORT F 0 0 K 4 L over 0 , No. �. . x A* �, rt " dover, Mass.,dpPt 1 Z s' 194(S' 'T O �- LAKE e COCHICMEWICK ADRATED P'V s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System s M BUILDING INSPECTOR THIS CERTIFIES THAT. !%A.N ..................................................................... Foundation has permission to ereet...A li...........:......... buildings on ...j.co......42=4*....OAK.....5'i'............................. Rough to be,occupied . as-,..A.4 �....stbloNa.....' '. t? .... ...�4. ..... . ...................I. .... ...... Chimney provided that the person atcepting this permit shall In every respect conform to the terms of the application on file in thioffice,-and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final s 'Buildings,In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough j �.. Final F PERMIT EXP 6 MONTHS • # � � UNLESS CO TR T T � ELECTRICAL INSPECPOR�` r: , t � f r � i fi Rough . i ... ... .... ...... Service ti ° BUILDING SPECTOR i Final 'Occupancy Permit Required to Occupy Building GAS INSPECTORS 'Display in ,a -Conspicuous Place on the Premises — Do Not Remove - - -Rough Final - ,, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until`Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. Y SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT ~ J Location • No. - ' ' Date 01 NORTH TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ 41 *R ; Building/Frame Permit Fee $ Foundation Permit Fee $ SSACH Other Permit Fee $ Sewer Connection Fee $ Water.Connection Fee $ TOTAL $ .'.1' V Building Inspector Div. Public Works PER11IT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. 12 RECORD OF OWNERSHIP IDATE (BOOK 'PAGE — Z©NE +� I SUB DIV. LOT NO. L®CAT10 -PURPOSE O /)1(<c4z. 1/lcl OzI t-o i4�% 1 urr2✓- OWNER' • NAME r �, _ pl NO. OF STORIES L SIZE �, , n d�?id OWN S ADDRES �V�/ BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ce- v-) SPAN DISTANCE TO NEAREST BUILIJIING C G DIMENSIONS OF SILLS r, '_ ���--� DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES -SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION i MATERIAL OF CHIMNEY /IS BUILDING ALTERATION t �5 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY , IS BUILDING CONNECTED TO TOWN SEWER 5 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION 11 LAND COST }'SIDES N EST. BLDG. COST L am`�Ll L OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR JDATE FILED BOARD OF HEALTH SIG FrE OF NER OR AUTHOArZED AGENT OWNER TFL. -Dd F E E / CONTR.TEL.#_ . CONTR.LIC.# PLANNING BOARD PERMIT GRANTED -- - 6 G f 19 BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ B t 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL IN. B'M'T AREA _ '/ 1/1 3/1 FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON STUCCO ON BRICK Or f ATTIC STRS. 8 FLOOR (- BRICK ' CONr ..iDER BLK. STC ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I_] POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. )2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T.'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC lsi 3rd NO HEATING -lu1-1a3L;,a-1 • r i•i�y�r1� f ilVH,L'%� QI= VVL.1B! VV NORTH own o - 6 ndover DRIVEWAY ENTRY PERMIT _ ®'j/ , 6 -- er, Mass., 19 9/ M SS PERMI T BOARD OF HEALTH THIS CERTIFIES THAT......�l. .. . .... . ..... ... BUILDING INSPECTOR haspermission to erect ................-bWdings on .�... .. .... ... ........ .... ...! ..... Rough to be occupied as........ ... Chimney ' Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION STARTS Service Final ..... .�.. .. ..... ...... .. .... .. -- — -- -- —- — _ _ BUILDING INSPECTOR GAS INSPECTOR — Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and App roved by Smo a ET N 41 Building Inspector