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Miscellaneous - 10 WOODCHUCK LANE 4/30/2018
Date ............... NORTH 14,0 TOWN OF NORTH ANDOVER D : PERMIT FOR GAS INSTALLATION 4 P'. This certifies that ....... `�..............4 ................... has permission for gas installation - ............. in the buildings of ........... ........................ at ,�o ©..'�� . ` = ;.,North Andover, Mass. Fee3o'2. No.. GAS W�C Check # 6142 MASSACHUSETTS UNIFORM APPUCATON FOR PERMPT TO DO GAS FTrnNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS nHUSETTS Building Locations ,�� �� _go�,(� %'L. _C Permit # Amount $ Owner's Name � V� a CAI New �� Renovation 0 Replacement Plans Submitted w � rl 7- Owner's Insurance Waiver: I am aware that the licensee does_, not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one:Owner 13 Agent 13 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under3gfmit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St ,asnCode and 0apter 142 uie (APPROVED (OFFICE USE ONLY) of Licensed Plumber Or Gas Fitter z v F W 4 G O Z p Z (} w w � V u � d w x x a z w E, G � x x q > x d V w x c w `4 H Q> ° �° 'z o Z w F W SUB-BASEM ENT x 3 c u s° > a a lw. o �1 B A S E M ENT 1ST. FLOOR 2ND. FLOGR 3R 13% FLOOR 4TH. FLOOR 5TH. FLOOR EM _ 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) � Name_ O,l ��— Check Chone: Corp. Certificate Installing Company Address 1 e kPartner. L_.j Business a ep one 7 7 -irm/Co. Name of Licensed Plumber or Gas Fitter�/42 INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial If have equivalent. Check one: Yes 1:1No you checked Les, please indi to tfe type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D Bond 13 Owner's Insurance Waiver: I am aware that the licensee does_, not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one:Owner 13 Agent 13 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under3gfmit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St ,asnCode and 0apter 142 uie (APPROVED (OFFICE USE ONLY) of Licensed Plumber Or Gas Fitter Location No. `�� Date Check # //111 1� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C r� l . _ O G/ Buildinglnpector 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT WAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING . �- F.. .�,,. FRfie.. .3.. ,t_:. - "` '..:a v a. �'`,.yt•a -+.'�8 e+t,f'&r:cvfn'k.�L�,f, .. .. .... .. ....... . - r BUILDING PERMIT NUMBER: � j / � DATE ISSUED- &2-1a —z�) C�) SIGNATURE: Building Commissiort6ifinspector of Buildings Date SECTION 1 -SITE INFORMATION 1.1 Property Address: to 1.2 Assessors Map and t Map ung' .a�,,� 0 3 '1 Parcel Number: Parcel Number .� � d S� _ �� 9 � �� , A n � 1 UVJ 1AAA, ' . 1.3 Zoning Information::' Zoning District Proposed Use 1.4 Property Dimensions: 45 Loi Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide red Provided Required Provided ©:O� ��©, r_ 1.7 Water Supply M.GL C.4.0. 54)� Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zona ❑ 1.8 Sewerage Disposal System Municipal ❑ On Site Disposal System ❑ ...�...�....�.r-aa�va au�ai vr•r�L•1�U111rrtfU ll�VR��,n.lY Alri�.1\1 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: r • SAyv`I— Name Print 31nawre lele none SECTION 3 - CONSTRUCTION SERVICES 3.1 `Licensed Construction Supe •sor: Licei,W. Construction Supervisor. QCT 3.2 Registered Home Improvement Contractor 1 �, o � ( S - clm��RA Company Name t\cam L 6 .. W1,10"I 12 E5 31%, Address for Service: Not Applicable ❑ bad® License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date 16 J SECTION 4 - WORKERS COMPENSATION (MGL C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit in the denial of the issuance of the building permit. Signed affidavit Attached Yes .....)No ....... 0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. Demolition ' 0 Other ❑ Specify' Brief Description of Proposed Worker A L,`-- r Z~'�2. Qa f) . I n I SECTION 6 - F.STTMATT.n (`nNCTRTT!`TTnN r>nVre 5 result Item Estimated Cost (Dollar) to be"`�i,{►j Y, *f� 4 5 Completed by permit applicant f rS,Mik Ct �� t� ��'�, r�,-4i:r��.zrf�.Q�'.fi Pu. � d#�i$i ���✓x... � � ����P ` � �;+ v 1, Building, (a) Building Permit Fee e Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing ---- Building Permit fee (a) x (b) e_ 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number ua.a.. iivL.a 1"OR i•.+11V1\ 1V JDk LVDWL&1E1J WkMf4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> t 4 VVl L as Owner/Authorized Agent of subject property Hereby authorize Q to act on My behalf, ' t 1 n er 1 tive to r au ed by this building permit application. --15 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 L_ Print .y.ql�.. bate NO. OF STORIES SIZE K 2� BASEMENT OR SLAB SIZE OF FLOOR TRVIBERS 1 2N15 3KD SPAN on DIMENSIONS OF SILLS DINIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION f&VC THICKNESS ` SIZE OF FOOTING Z - C' th¢ X MATERIAL OF CHIMNEY ---- IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE T J5 a' FORM - U - L07' RELEASE FORM T, (8 _0 v INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ................./.%.........c................................a. ■..........■ l 1 c)rGC� APPLICANT ,IV( PHONE ASSESSORS MAP NUMBER (i� 6 0— LOT NUMBER SUBDIVISION 1 % / LOT NUMBER �} STREET �/ Jct �% �(� L — STREET NUMBER 4y .......................... 0 0 . 0 0 .....'...... ■ ■ ............................. a ■ OFFICIAL USE ONLY RECOMNIENDATIONS OF TOWN AGENTS �............................................................ .. 0000...... DATE APPROVED ® D COMMENTS RECEIVED BY BUILDING INSPECTOR DATE DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED i(L1�/2 /l DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS SEWER 1 WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 0 z 9-0 ------------- Ac. v c C In in 0 • C • � Nt 9-0 ------------- Ac. :''`...'.,..::.?.:>f:2::'.•.:":.'::::` i,^<::::::'..:'`:..<:,.::::`..'':''...:2:::::f?:::::::::::::'''f:::::::';:£:L::::::::::::::::::::::::::::r;::::::::::'::.: �.�� .:.':...:.:.::.::::..:...::::.:::::.::.::::::::::::::::::::::.: ::.:::::::::::::::::::.::.................................::...........::.:::::::::.::........ ::. 0/15/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAI`rIQN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE A & K FOWLER INSURANCE AGENCY. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 200 PARK STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE NORTH READING MA 01864- COMPANY (978) 664-0366 A ZURICH INSURANCE COMPANY INSURED COMPANY W.S. CONSTRUCTION CO. INC. B TRAVELERS INSURANCE COMPANY 120 MAIN ST. COMPANY C GUARD INSURANCE COMPANY dQ NORTH READING MA 01864- COMPANY (978) 664 4462 D isi i f::r< ::`;::::::::::r,? 5 :: ;2::::> ;::: 'f:::: ;: ;`;`: ;: ;:::::: ;is : ;: ;:::?: v_: :`•3 ` ;;; :::: 3 3< ; :`< ;:i:: 3 ::: :::;`:%G::; ;%;: 2 :: :::::: `'::: ::: :: ......::..... is :..... :.... :: ;::: ;:: % t�iV... . • THIS IS TO CE :.... :..... :... . RTIFY 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY GENERAL AGGREGATE $600,000 PRODUCTS - COMP/OP AGG $600,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE x] OCCUR SCP35574921 09/30/99 09/30/00 PERSONAL &ADV INJURY $300,000 EACH OCCURRENCE $300,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ B AUTOMOBILE LIABILITY ANY AUTO I810970K2841 11/01/99 11/01/00 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ 100,000 X ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY (Per accident) $ 300,000 HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ rl 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY. «.. ANY AUTO / / / ' / EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM / / / / $ OTHER THAN UMBRELLA FORM C WORKERS COMPENSATION AND X STATUTORY LIMITS EMPLOYERS' LIABILITY WSWC038184 ,11/02/99 11/02/00 EACH ACCIDENT $100,000 THE PROPRIETOR/ X INCL PARTNERS/E)(ECUTIVE DISEASE - POLICY LIMIT $500,000 DISEASE - EACH EMPLOYEE $100,000 OFFICERS ARE: EXCL OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEh IS INSURANCE VERIFICATION ........................................................ :...........::::.:.:::.:::::::::::.::::::::::::::::.::: .rt��r�>t.....................:....:..::::.::.:::::::::::::::::::::::::::::::::.::::::::::.::::::::::::::::::::::::::::::. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, WILLIAM STROUT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 10 WOODCHUCK CIR. OF AN IND UPON THE COMPANY, ITS AG NTS OR REPRESENTATIVES. AUTHOR REP ES NT TIVE NORTH ANDOVER MA 01845 .: .:::: ............ ::X :::::::::::::::::::::::::::::::: •::::::::.:::: •:::::•::::::::::::::::::::::::::::::::::::.::::::::.::::::.::::::::::::::::: ,�yy��yy :: .►�i.:.. ..d.',' :: ;.:::;: ....` ` C ; : 3 ::::......:;:::.:::::::: :::: :>:: .::.:::::...............................:..................:.................. '::;:;:i3i:::$3 :::3::Z : 33::::: ::::G ::: ::: :::..................... . ................................................................... . i:: ;: < 3:;:::::: ;:;>'::::::.. : ;:; ;:;: ';: :::.; t:< 1::; ::: :::; ':. ' : . ' :. ..": ' , ' .; ..'' '... _ .: ,::..,• .:.._.: ........................................................Q.lii:�..:. .. .:. ... :. :. .................................... .P..H14M.::. r z N 0 H• N = 0., 0 r W cQ 0 r. g Z 3 H (n (D d ,� m D DC7 0 m N c D H 3 0 H 00 0 Z Z -1 Sv -h H U) XX�. �-1 z C t CO (D y trr =�� . RO L� -t M c (D �• fi N W .� �,(n zt Z0 . 0 0.. a . N 0 7' i-� -a(D c -I v U-0- (D ;o C C v (D D Z • C Nn ( 'S � 3 ct O N 0 0 H �r+ ►' nIn n;7 cm O N 'o n m C o 0 T a W n3 <S G\ N m c 0 0 U x U) (D c* Ilk O fi H. H. O 1 0 fi n 1 F.. rt x 0 H. 0 Q N 3 .j E,•OHL2 co W (!) N -( 0 rt O fu n \ c* 0- 0 0 n Q. N 0 O H 0 0 = D 0 g Z 0 2 0 m N c ;. 0O X_=.3 XX�. �-1 z y trr =�� . RO OX .� �,(n zt Z0 . cn a . N CD o (D ;o C C o cn 0 n ^ -I v O N Z iii 3 4 cm cr 'o m C o <S �.z 1 0 ?oo,00l , 1 1 1 r 7 ( / 'STb6t-q•C,�i t�� ' 1 � LOT woo b. ' s� M� ' a• _._6.15 r,GY To _ .:� ►tE5�121�'(10115 � Gc+I�t�liloFls ••• ;z lzv y WoobGnLJ�K 1,A�15 o �A Dc ' �J �� MORTGAGE INSPECTION PLAN • eu S'(K�aL1Y ,. ��� y' ,? TO THE FARA4JT MASSACHUSETTS 4A� r��A�� AND ITS TITLE �QCASEMENTS. " L HEREBY CERTIFY THAT I HAV[ EXAMINED THE PRFNIS[t AND ALL CASEMENTS, Q ENCROACNYENTS AND BUILDINGS AR[ LOCATED ON THE GROUND AS SHDWN. I FURTHER CERTIFY THAT THE BUILDING SHOWN DO( 1CONfORM TO TM[ ZONING LAWS AND AMENDMENTS, 1.•. ( FRONT, SIDL B HEAR YARD SET BACK ONLY) OF WHEN CONSTRUCTED. l FURTHER CERTIFY THAT THIS PROPERTY IS 2,.pnea .%+ andDEED -/ LOCATED IN THE ESTABLISHED FL000. HAZARD AREA. T1iIE1EY MAR ERS OfOn6 C BOOK NOTE : THIS CERTIFICATION 15 BASED ON THE LOCATION Of SURVEY MARKERS OF OTHERS, AND `, p Q —_ DOES NOT REPRESENT A PROPERTY SURVEY. PAGE EXAMINATION Of THE RFCORDS IS MADE ONLY SUBSEQUENT TO THE RECORDED DATE Of THE LATEST DEED AND OOW NOT INCLUDE VERIFYING THE -ACCURACY OF THE DEED DESCRIPTION PLAN PREVIOUS TO ITS DATE Of RECORD•, THIS COMPANY IS NOT RESPONSIBLE •FOR ANY INDENTURES MADE SUBSEQUENT TO THE BOOK -� RECORDED GATE Of THE LATCST IDEEO Of RECORD. WHENEVER BUILDINGS ARE SHO WN Less THAN ONE FOOT FROM THE PROPERTY LINE IT IS PAGE SURVEY .BL MADE TO VERIFY THESE MESUREMENYS, ADVISED THAT A MORE PR[CISE CERT. N0. __ —.... 42). r -c James W. BOUGIOUKAS RL r� PugpO�Fs ONL -• — BRADFORD ENGINEERING CO, SCALE; 1" ' 0' P.O. BOX 1214 Haverhill, Mass m3I TEL.. 373 ZSSS I& Cl) .tel m CO C0 m y — d CO) CM) CD MZ CO) CL '0. q CL CO) 12 4 0fu O p CD MQ O CLcc cr c ? d CD CD O oop. FECD -� CD Fy � O to CD I y O -CD CD z� o CD a O Ic CD ac_ C 0� 0 d 0 �• H ® O° CA = CL 0 m C7 mno.cl m C2 — P w C 70 :rlc H CL ... o• Er �Dm of o y y N O ?O : ® _ _O 9 Gco ® O w O z<_.� -+ OHn a CD c co, 'rt -3x z A � ''�^^ Vco O i° /V/�/ m m y J C O O COL ngjy O 0 _ d cr O `�ccl CA Q m O m ��l 111 JJJ .rt � m CO) ca ca �m �. Cl) z y -oma► CD CD �F t Ca �r y_ O_ C O O = (n 00O d (n o b7 M 'rJIx z 7 x C d b � O � Jf 0 • 0 c