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Home My WebLink AboutBuilding Permit #380-12 - 41 CHICKERING ROAD 10/27/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �2 Date Received Date Issued: � ? O7 4 IMPORTANT:Applicant must complete all items on this page e LOCATION `Z' j C#I C"W 6_ A--112 Print PROPERTY OWNER 1/ �� CDNfi�Y�I Unit# — op�0 , O Print MAP NO: ©q(o PARCEL: ZONING DISTRICT: 3 Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial .Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other >Septie Well ©fFloodplan q�Wetlands WatershedlDistrigt [TW, DESCRIPTION OF WORK TO BE PERFORMED: of r (Identification Please Type or Print Clearly) OWNER: Name: at A)�c Co AAE/f i4Phone: 970'4d,-2_lro s3 Address: '/�i C�'r�2,.✓� /1 /Ile Ngo r/2_5'eA CONTRACTOR Name: Cl s A e r Phone: Address: �► ti Supervisor's Construction License: 696 -20Exp. Date: �- Home Improvement License: 73 113 Exp. Date: l0 f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No. Receipt No.: NOTE: e sons contri c ith u re istered contractors do not have access to guaran fund Alt7111 Location No. Date 10 -61-4 -41 �aRT� TOWN OF NORTH ANDOVER 3?0: . o ,•1hO0 F A A Certificate of Occupancy $ Buil�iin /Frame Permit Fee $ sACNusE Building /Frame Permit Fee $ i Other Permit Fee $ TOTAL $ Check # 0 24771 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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 Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit 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 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 LJ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products DOTE: 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 o 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 nust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi r . J V� t°��i�°°V Office of onsumer airs u mess egu_, HOME iMPROVEMENT CONTRACTOR Registration: 127343 T Expiration: 10/13/2012 I nciNklua ti D J.ROPER --_ D4VID`RO PER 80 INLANLS ST g LOWELL, MA 01851 Undersecfeta *� Massachusetts- Department of Public Safety Board of Buildimy Re,dations and Standard! Construction Supervisor License License: CS 68670 DAVID J ROPER 80 INLAND ST ., LOVVELL, MA 01851 Expiration: 12/29/2012 ('unnnissiuncr Tr#: 9193 z� TON- M AORTH of _ No. o 0 , dover, Mass., cOCNICNEWICK 7,p BORATE 7 N BOARD OF HEALTH -T D Food/Kitchen Septic System E R . IT BUILDING INSPECTOR THIS CERTIFIES THAT......V.[ (is!�l(..... M� t".!✓{..............................................:.................................................... Foundation / cam! A61I wcl has permission to erect........................................ buildings on ..........................................7.................................................. Rough Chimne to be occupied as...........................................a...�..................................................................................................................... y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 STARTS Rough --� Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. JP & SON'S ROOFING, INC 145 PERRY ST. UNIT B LOWELL, MA 01852 (978)452-1600 PHONE(978)452-1602 FAX Page No. of Pages DESCRIPTION OF JOB ARCHITECT DATE OF PLANS PROPOSAL SUBMITTED TO: JOB 01;/ Pf- CO/ 4' _FA /,/� ADDRESS ` 1 C `G J/IV lC_J(7�f�� CITY STATE ZIP ` 44)eo v,aE ,trig, , i ` © ��c�� PHONE DATES N WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES t/ G `/U !/ j2 chi �v� �� lSf asp a� ��STh �toar�h /,07 S 7-41/ /0 04 eta 7 70" -d pc`S I-7STi�CJ !r!c �g7�� S/�i�lO Ovr Z %7 l hS lam!' l G �c✓.� %c� �i�/�/� '7 toll P 1S Oe k $ lk?j iR_l/ 30�. �Ah s/�, h &C= s o- � �¢G, S 7c tp /'` KK st4S Jt/G �9/// fart 0 V 10 A �� /� f c�a� N 04y We hereby propose to (furnish material and labour/complete in accordance with above specifications, for the sum of �1 x � vsAn `C U(�Ae6Ld Qh Z7:;6dollars ($ A I with payment to be made as follows: l oJC S�'Q�Z T l h Ud af 017 e'fon � _'//,q AV All material is guaranteed to be as specified.All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications Authorized involving extra costs will be executed upon written orders, and will become an extra Signature //'�j K;1 charge over and above the estimate.All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This pr sal may be withdrawn by us if not accepted insurance.Our workers are fully covered by Worker's Compensation Insurance. within days. Acceptance of Proposal -The above prices, specifications and condi- tions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: < Signature RightFax Cl-1 10/27/2011 6:34:42 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 1012712011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEk,THIS 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IONAL INSURED,the s)must be N IS IMPORTANT:If the terms and conditions oificate the policy,certain policies may require and endorsr is an ADDITement, A statement andthis certtificate do0es not cc tern rights to the AIVED,subject to he certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: PHONE FAX (AJC,No,EA.r FAX FRANCIS E PROVENCHER IT (AC,No): .530 ROGERS STREET EMAIL ADDRESS: PRODUCER CUSTOMER ID#: LO�tiELL.MA 01852 INSURER(S)AFFORDING COVERAGE NA1C# 26F9GINSURER A: TRAVELERS DIRECT ASSIGI`I�IEti"C INSURED INSURER B: IP AND SONS ROOFING INC INSURER G:INSURER D: INSURER E: PO BOX 1482 INSURER F: LOWEI1.,MA 01853 REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERT FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE EEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEIdT WITH RESPECTTOVlHICFI THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAI D CLAIMS. ADDLSUBR POLICY EFF DATE POLICY EXP DATE LIMBS INSR POLICY NUMBER (MV. ,DDIYYYY) (MM\DDIYYY`Q TVPEOFINSURANCE $ LTR INSRWVD EACH OCCURRENCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea Occurrence) CLAIMS MADE OCCUR. MED EXP(Any one parson) S PERSONAL&&ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PP,ODUCTS-CCMP/0P AGG $ POLICY PROJECT LOG COMBINED�iNGLE $ AUTOMOBILE LIABILITY LIMIT(Ea accdent) ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per person) SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per accident) PROPERTY DAMAGE NON-OWNED AUTOS (Per accident) EACH OCCURRENCE UMBRELLALIA6 OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ DEDUCTIBLE $ RETENTION $ WC&TATUTOP.YLIMITS OTHER WORKER'S COMPENSATION AND YIN EMPLOYER'S LIABILITY UB-4672P1491t Oft&'2011 OF2fi`20t2 E.L.DISEASECEACNT $ 100,000 EMPLOYEE $ 100,000 ANY PROPFRITOWPARTNFR!F)(ECUTIVE Y OFFICER/MiEMB6R EXCLUDED? E.L.DISEASE POLICY LIMIT $ 500,000 (Mandatory In NH) I:yes.(i.P.SC(:he inmr DFSCRIPTION OF OPERATIONS beIOw DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESJRESTRICTIONSISPECIAI.ITEMS THIS REPLACES ANY PRIOR CFP.TIF[CATE]SSTIED TO THECERTII•TCATF,HOT-DER AFFFC. GYLORIERS C0T1P COVERAGE... JOB LOCATION:DIANE CONSERVA.41 CHICKERINL,RD.N.ANDOV.bR-DIA CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED TOV,'N OF N.ANDOVER BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 114 1600 OSGOOD ST BLD 20 SUITE 36 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Charles J Clark N.;ANDOVER,NIA ()1,345 1986-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) Page 1 of 2 Date:10rdbf[uT I"'" " From:Bonnie FaxID:9784549343 OP ID: BW E(MMIDDIYYYY) A'coR". CERTIFICATE OF LIABILITY INSURANCE--E10125/11 ER. THIS ATiVELY AMEND, EXTEND 4R ALTER THE COVERAGE AFFORDED BY RTIFIC THE POLICIES THIS CERTIFICATE IS ISSUED AS A MATTER OF IGFORMATION ONLY AND CONFERS NO RIGHTS UPON SUINGTHE EINSURER(S)yAUTHORiZED CERTIFICATE DOES NOT AFFIRMATIVELY OR NE BELOW. THISTI KATE 0ERi ANDRTHE CERTIFICAOE HOLDER. A CONTRACT BETWEEN THE REPRESENTATIVEbe endorsed. if IMPORTANT: If the ceect to rtificate holder Is an ADDll11kL INSURED,may rrequi a ane ths'POIICV,Ies)Must A s atement on this certBifi aGe does noATION ist conferDights,to the the terms and conditions of the policy,certain policies certificate holder In lieu of such endorsements _--------- 978459-8681 PRODUCERPHONE IFNC Nor — Francis Provencher insurance 978.454-9343 AIC No ExtJ• _ EMAIL Agency, Inc. ADDRESS: _ 530 Rogers Street CUSTOMERIDI:JPROOmi Lowell,MA 01852 INSURER�AFFDRDING COVERAGE 34,7.4 INSURED JP ad Sons Roofing Inc. J INSURERA:CommerCe�nSUCBnC@ COmpSny__------ — INSURER B: PO Box 1482 INSURERC:NOrthland InSUranCeCot11__pan1eS — — !--- Lowell,MA 01853 — INSURER D INSURERE: _—.------ ------ --------- INSURER F REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: VVH UIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 0 DESCRIBETHER DE EEN ISSUBJECTTOTAL THE TERMS, THIS IS TC CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOV1t HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER INDICATED. IJOTVJITHSTANDING ANY REQ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSHOWN�E B EYRoLUTPID LIMITS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY MeER1E BEEN REDUCED DCDED By PMItDpp1YYMY 1,000,000 LTR* TYPE OF INSURANCE EAC`iOCCURRENCE AK L �y 50,000 GENERAL LIABILITY I S061991 I 04112111 104!121112 PREM SES(Ee.CUCu-rence, 1,000 C I K i CO"nME4CIA-GENERAL jFBILTY l I MED EXP(Any(Any oma_ § 1,000,000 CLAMS-MADE I^ I OCCUR I FEPSONP.L 2 A_Gl l_dJIJRr 5 2,000,0 I GEIJE—RAL AGGREGATE 40 000 — -- -- _— I- FPUDUCTS-COfdPlO'AGC GEN'LA3GRE3P.TELM17,%=p;--_�IESPER: C064BNEDSINGLE 0101- 'g 1,000,000 PFG- I I LOC PO-ICY ECT 11 (Ea accident) -- AUTOMOBILE LIABILITY BBGS09 12104/10 12104111 P- I'r INJU— R— �(scn) $ ,er pe r I �a•a _ioer A ) 4' I �AN'i AUTn E0 1L(IPiJUR"( - �—.---- I ALL"D'N\IEDALTOS I I FR'OP=f T`r DAMAGE ri I (Perecdd�nq —.--- --.--1-- XJ SCHE9ULcU AU-C%S ---- 3 --_--- H IF ED AUTOS ---- J hJON-OWNED AJTOS --------_-'— I I EP.CH O_C_UJRP,ENCE _--_ 1 — UMBRELLA LIAR OCCUR -- -- I PGGREOA t _ EXCESS UAB j t LAIPA3-t:AADE $ DED'JCTIELE I �v STATU.` - !RETE`JTION S TCP.Y WA,T WORKERSCOMPENSATION E.L.EA.CH ACCO— $ i AND EMPLOYERS'LIABILITY YIN — AN`'PROPR ETORIPAR-NERIEXECLIT VIF (-1 NIA !E.L.DISEASE-EP.EMPL�7Y= $ OFFICERfvEh18ER EXCLUDED% L._f E.L.DISEASE-POLICY LI PAT 5 I(Mandatory In NH) i I'ya, ,'65c IJ?Under p�.r.PIPT ON OF OFERATIOtJS belwv --- --- II Addlttonal Remarks Schedule,If more&Pace Is required) DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,. ROOFING "CERTIFICATE FOR WORKERS'COMP COVERAGE WILL BE ISSUED DIRECTLY FROM THE COMPANY WITHIN 2 BUSINESS DAYS" RE: 41 Chickering Rd.N.Andover,MA CANCELLATION CERTIFICATE HOLDER NORTHAN ES SHOULD ANY OF ABOVE DATETHEREOF, NOTICE!WILLL CANCELLED DELIVERED BEFORE THE IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover AUTHORIZED REPRESENTATIVE 1600 Osgood St. Bid g.20 Suite 2-36 N.Andover,MA 01845 O 1588-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD RightFax N1-2 10/27/2011 7:04: 14 AM PAGE 2/002 Fax 5ervfaz ACORD. CERTIFICATE OF LIABILITY INSURANCE 1012V2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA"fE HOLDER.THIS 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, endorsed. it ,subjectto terms and coIf nditions certificate Pol[cypcerta n potirieONAL s may require and endorseED,the ment. A statement on this certificate es)must be do0es noN IS t colnterDr rights to the he certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: FAX PHONE (ATCNo,Ext): FAX , FRANCIS E PROVENCHER INS (A'C,No): EMAIL 530 ROGERS STREET ADDRESS: PRODUCER CUSTOMER ID M NAIC# LO�VELl,1RA 0182 INSURER(S)AFFORDING COVERAGE 26F9G INSURER A. TRAVELERS DIRECT AySIGIYAiE: INSURED INSURER B: JP AND SONS ROOFING INC INSURER C:INSURER D: INSURER E: 110 BOX 1482 INSURERF: LOWFLL,MA 01853 REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, THIS 1S TO CERTIFY THAT THE POLICIES OF INSU NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH FRMS,EXCLUSIONS AND CERTIFICATE MAYBE ISSUED LIMITS MASHOWN MAY HY PERTAIN. E ESURANCE AFFORDED By THE BEEN REDUCER BY PAID CLAIMS. POLICY DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS,E%CLUSIONS AND CONDITIONS OF SUCH POLICIES. POLICY EFF DATE POLICY EXP DATE LIMBS ADDLSUBR INSR POLICY NUMBER (MM',DCIYYYY) (wAomYYYV) TYPE OF INSURANCE INSR WVD EACH OCCURRENCE $ LTR GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) CLAIMS MADE OCCUR. MED EXP(Any one person) $ PERSONAL&8 ADV INJURY GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ POLICY PROJECT LOC COMBINED SINGLE AUTOMOBILE LIABILITY LIMIT(Ea accident) ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per person) $ SCHEDULE AUTOS BODILY INJURY HIRED AUTOS (Per accident) PROPERTY DAMAGE $ NON-OWNED AUTOS (Per accident) EACH OCCURRENCE UMBRELLA LIAS OCCUR AGGREGATE EXCESS LIAB CLAIMS MADE $ DEDUCTIBLE RETENTION $ We STATUTORY LIMITS OTHER WORKER'S COMPENSATION AND 100,000 EMPLOYER'S LIABILITY YIN UB 48Z�Pt49 tt 082ry2011 Ob26/2012 E.L.DISEASE CEA EMPLOYEE $ 100,000 ANY PP.OPERITOR/PARTNER:rXECtJTIVF Y OFFICER1MLtd6ER EXCLUDED? E.L.DISEASE-POLI:.Y LIMIT $ 50C,000 (Mandatory in NH) It yes,describe Sider DESCRIPTION OF OPFP.ATIONS LeloW DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES!RESTRICTIONSiSPECIAL ITEMS TING THIREPLACES.AIr'Y PRTOR CERTIFICATr ISSL GD TO THF.CERTIEICATEHOLDFP+AFFEC S A ORIO RS COMP COVFRACiF. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DIANE CONSERVA BEFORE THE EXPIRATION DATE THEREOF,NOTICE VVILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. 41 C:HICKERING RD AUTHORIZED REPRESENTATIVE Charles J Clark N ANDOVER,MA 01845 1989-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) /. A14 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: ro-kc 1 W1 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) ------------ Signature of Permit Applicant Date r,"ge eh qs /v ►5saf— Clkkp 'om% PERMIT NO. - APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 t MAP NO. LOT NO. 12 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV. LOT NO. i LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS L BASEMENT OR SLAB J it ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING , DIMENSIONS OF SILLS DISTANCE FROM STREET ,(/c POSTS DISTANCE FROM LOT LINES—SIDES �� (ff C/ReEAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION 2 PS. IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQU EMENTS 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. COST PAGE 1 FILL 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 METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS FIM ALARM; PLANS MUST BE FILED AND APPROVED/BUILDING INSPECTOR DALE FJLED L/ ` BOARD OF HEALTH .IGUATU O NER A ORIZED AGENT FEE Uv PLANNING BOARD PERMIT GRANTED / BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 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 _ _ 3 1 2 13 CONCRETE Bl.K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN:. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/4 1/2 1/1 FIN. ATTIC AREA _ NO B'M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIM. ( = 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 6 FRAMING II 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 1st 13rd I NO HEATING Location No. Date ,.ORT" TOWN OF NORTH ANDOVER , 1{O0 p Certificate of Occupancy $ 1ie+aZ : Building/Frame Permit Fee $ �7s�cNusE ACHU Foundation Permit Fee $ s Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ JUN 91W $ No.AndoverCollector Building Inspector Div. Public Works PF12: APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. C/YAGE 1 n.ti.. .v0. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING C' L / A 0D X OWNER'S NAME w 14-J� ` l� — NO. OF STORIES -' ` Bak OWNER'S ADDRES , /►/, I� �� ,/( //'N!fjtBASEMENT OR SLAB - ARCHITECT'S NAME [ UC. Cs� tl �cJ/� SIZE OF FLOOR TIMBERS IST 2ND 3RD . BUILDER'S NAME SPAN DISTANCE TO NEAREST 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 X 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. COST 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 y ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS f� 1 PLANS MUST BE FILED AND PROVED BY BUILDING INSPECTOR DAT FI BOARD OF HEALTH GNATURE OF OWNERO THO ZED AGENT F E E CONTR.TEL. CONTR. LIC.# PLANNING BOARD PERMIT GRANTED 19 BOARD OF SELECTMEN BUILDING CTOR I _ I J BUILDING RECORD 1 OCCUPANCY _ 12 SINGLE FAMILY STORIES THIS S SECTION MUST SHOW EXACT DIMENSIONOF LOT AND Dl$tANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF' BUILDINGS.,WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN:_ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE 81.K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAII UNPIN. 3 BASEMENT il AREA FULL FIN. B M AREA _ 1/4 '/2 �/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ'D ASBESTOS SIDING _ COMtACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I-[ POOR UATE ADEQNONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) _ ! GAMBREL MANSARD TOILET RM. (2 FIX.) _ 1 FLAT SHED WATER CLOSET _ t 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 RADIAN},H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS Oft B'M'T 2nd _ .ELECTRIC 1st I13id ,I No,HEATING � FINAL C0410vtfl( SEWER/ ��TNORTHPLAHNwo_ FINAL own of 6 ndover p 'tr.ti8r. ;n, to NO. s2 DRIVEWAY ENTRY PERhAIT _ - N AAF JI A C ,Ela er, Mass., 1 oR PP SS BOARD OF HEALTH PERMIT T LD THIS CERTIFIES THAT. . . .. ..... 7..... . . .... . . .......... BUILDING INSPECTOR has permission to erect ......... .............. buildings ono .'...C�� .. ...n� Rough Chimney to be occupied as.............. .....�.�....'�......P-4W111111:w................................ 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 NUILIt. PERMIT EXPIRES I NTHS ELECTRICAL INSPECTOR Rough UNLESS CONST CTIO 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 Approved by STREETSmoke No . Building Inspector