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HomeMy WebLinkAboutBuilding Permit #42 - 59 SALEM STREET 7/25/2003 j I { y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT P •, - S APPLICATION TO CONSTRUCT REPAIR,RENOVATE,. OR DEMOLISH A ONE OR"TWO FAMILY DWELLING ". i BUILDING PERMIT NUMBER: DATE ISSiJED: iy SIGNATURE: Buildinj CommiSSioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Propeity'Dimensions: Zonin District use Lot Area Framta ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard. ... Required Provide Provided RepiredProvided 1.7 water SupplyNLGLC.40. 554) 1.5.' Flood Zone bdfornutiow La` Sewerage Dispos,l-System Public ❑ Private Zona Uusido Flood Zone ❑ Municipal p on Site:DrsposaI system ❑ SECTION 2-PROPERTY OWNFI:RSMP/AUTHORIZED AGENT T 2:3-Owner1of Record Nine Print Address for Service Si lure Telephone 2. jFi✓L9� .f N_erre 'nt Address for Service: ature Tele.hone "C-PON 3-CONSTRUCTION SERVICES Licensed Construction Supervisor: Not Applicable. ❑ Licensed Construction Supervisor. License Number Address• Expiration Date Signature tore Telephone 3.2 Registered Home mproveme ntractor Not Applicable p. �C CT-< )hn Company Name Registration Number Address 8-1 5-J41 '41 J5;�O— - Expiration Date SiZinattfre Telephone I f I SECTION 4-WORKERS COMPEIeISATION(NLG.I, C452 .§ 25c(6) Workers Compensation Insurance affidavit lie completed and submitted with this application. Failure to provide this affidavit will result ` in the denial of the issuance of the buildi rmit. Si ned affidavit Attached. Yes....... No. 1.0 e SECTION 5 De cri tion of Pro'•osed Work check ape licable' . New Construction. ❑ Existing Building Repair(s) Alterations(s) 0 Addition Accessory Bldg. ❑ Demolition . 0 Other 0 Specifyt ? ~ i Brief Description of Proposed Work: tiws i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by applicant 1. Building (a) Building Permit Fee r y� AMti Tier 7 2 Electrical (b) Estimated Total Cost of Construction 3 Plu-mbing Building Permit-fee(a)x 4 Mechanical AC 5 Fire Protection 6. ._Total,. 1+2+3+4+5. Ud; Check.Number SECTION 7a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _---� as Owner/Authorized Agpi of subject property t y /Lll4� 1� c Hereby authorize U��.J'�� �� 6?v�� ��t on alf,in all matlers relative to work authorized by this building permit application. _ -��o`�. S ture of Owner Date S ION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �"�r ��1 ,as.Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge: and belief Print Name S i attire o Owner/ ent Date O.OF STORIES SIZE BASEMENT OR SLAB7 SIZE OF FLOOR TIMBERS l 2 3 SPAN DEMENSIONS OF SILLS D)IvfENSIONS OF POSTS DIMENSIONS OF GIItDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Location No. —' � Date ��—el2, N01tTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ bis', •Eta Building/Frame Permit Fee $ SACNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15732 `" Building Inspect«„f/ ACORDr� °AT22/02 E,MM/pD/YYYY, CERTIFICATE OF LIABILITY INSURANCE 3/ PRoou�Ea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION APPLIED RISK SERVICES, INC. CONFERSONLY AND HOLDER. TH SCERFICATE DOES OTO CERTIFICATEN THE AMEND, EXTEND OR P.O. BOX 281900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SAN FRANCISCO, CA 94128-1900 i INSURERS AFFORDING COVERAGE__ ___—I NAIC/l INsuaeo RMA HOME SERVICES, INC. I -- INSUR`---ERA_V1AClfll1A_Sl1.E�E�Y C:nMPANY IN 3200 COBB GALLERIA PARKWAY, STE. 200 1INSURERB- ATLANTA, GA 30339 IN INSURER C: INSURER D: ----_--- --- -i-- - INSURER E: ! COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I —� POLICY EF LTR EXPIRATION i— ------ —---'--'-"--- LTR Rd POLICY NUMBER M DD ! DATE(MWDD/Yyl LIMITS GENERAL LIABILITY tDAMAG�6RENTEU--j ---____ EACH OCCURRENCE S i COMMERCIAL GENERAL LIABILITY PREMISESIEaoccurence) S CU11MS MADE 0-OCCUR I � r MED EXP Anyone person) j $ !PERSONAL d ADV INJURY g i_GENER_AL_AGGREGATE I S GENLAGGREGATE LIMIT APPLIES PER: -- -"''-'— PRODUCTS-CO_MP,OPAGG I S ! PRO 1-7 1 F --I--'-- T 1 --.__.._. I I POLICY! I LOC I I I - AUTOMOBILE LIABILITY i ! I ANY AUTO ; ! COMBINED SINGLE LIMIT i I (Ea accident) Is I -I ALL OWNEO AUTOS I BODILY INJURY --.I — —i SCHEDULED AUTOS I I (Per person) F----- -- -- --- -�-'-- -- - ! HIRED AUTOS � j - ! -I j ! - i BODILY INJURY NON-OWNED AUTOS I j i (Per accident)I I ------ _— ---+ I PROPERTYDAMAGE L. IPeraccident) i g ; GARAGE LIABILITY ! AUTO ONLY-EA ACCIDENT S ! I ANY ALI fO ! OTHER THAN _EA ACC_- i S I AUTO ONLY: AGG!S EXCESS/UMBRELLA LIABILITY ! EACHOCCUNRENCE 'g !OCCUR ; CLAIMS MADE I AGGREGATE is am DEDUCTIBLE I __—._ S 'I RETENTION ' S WORKERS COMPENSATION ANDWC STATU. 10TH i EMPl01�ER5'LIABILITY ! i ` X;TORY,LIw ._ �-ER A j ANY,PROPRIETOR PARTNER.'EXECUTIVE 025-00000503 3/10/02 I 3/10/03 E.L.EACH ACCIDENT g 1 OOO OOO OFFICERIMEMBEREXCLUDED? If es,de under I I ' E.L.DISEASE-EA EMPLOYEE:S 1,000,000 S EGIALPROViSIONSbelow I i OTHER El DISEASE-POLICY LIMIT !S 1,000,000 I i 1 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RMA HOME SERVICES, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30DAYS WRITTEN 3200 COBB GALLERIA PARKWAY, STE. 200 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ATLANTA, GA 30339 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE OD04843 ACORD 25(2001/08) 0 ACORD CORPORATION 1988 r �r'p ✓CT, e ioomirnwiuueai o�✓GzaaC�2et6P116 Board of Buildiuz Regulations and Standards a HOME iMPROVEMENT CONTRACTOR*- ! Rugistratiori: 126893 r , .ExalraJonr OV0312002 >l`° Type: Supplement Card ; Home Depot At-Horne Sprvics fa ' fi MARK AUDETTE � 4 3260 COBB GALLERIA PKWY#25 ALTANTA,GA 30339 Administrator 0 y n �12e �o i/?/r�t.0�•tUJBczI.Gf'G 6�✓G�yczcf2u0e�`4 Board of Building Regulations and Standards HOME iMPROVEMENT CONTRACTOFC. t Rugistrafth: 126893 Expira.ion: 08,10-1/2002 Type: Supplement Card Home Depot At-Home Servicss b; MARK AUDETTE 3200 COBB GALLERIA PKWY#26 ALTANTA,GA 30339 Admmistratrr F N0RT►y Town of, E : over . No. o�A r0r". o: dover, Mass., • ORATED S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 4i , BUILDING INSPECTOR THIS CERTIFIES THAT.. ... .............................................................. Foundation has permission to erec ............�........................... buildings on .7 ...... .,:... Rough to be occupied as Chimney ... .......... ........ ............................................................. provided that the arson accepti is permit shall in every re conform to the terms of the application on file in Final this office, and to the provisions the Codes and By-Laws rel _' g 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 PERMIT EXPIRES IN 6 MONTHS. Final UNLESS CONSTRUCTION ST T ELECTRICAL INSPECTOR (L Rough ...................... K� ..... :� ...... 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 Until Inspected and Approved by the Building Inspector. Burn�FIRE DEPARTMENT Street No. SEE REVERSE SIDE smoke Det.