The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 13 LACONIA CIRCLE 4/30/2018 (2) 13 LACONIA CIRCLE 210/106.13-0118-0000-0 I filLocation ' �� `� ' No. 7 Date �r �� U✓ gORTq TOWN OF NORTH ANDOVER ?C't•.•u I•',i+ O • Ow Certificate of Occupancy $ �i�s'••°•E<�' Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ l`5+2 r� Check # I / U Building Inspector G' Oct 15 03 12: 48p NORTH ANDOVER 9786889542 p. 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MAI RENOVA1&1 OR DEMOUS>EI A ONE OR TWO FAMILY DWELLING �5 BUILDING PERMIT NUMBER DATE ISSUED: M SIGNATURE: Building Commissionedi r of D v 0 Z SECTION I-SITE INFORMATION -11..1 Property - 1.2 Asmsors Map and Psrod Number V _}2L A c O ry 1 ) lL 1106(, X Q 0 O Map Number Parod Number 1.3 Zoning lufer miion: 1.4 Property Dimmsions: \ ' V ZoninitDisLrict Proposed Use I LA Am a Fronto ft 1.6 BUIIDING SETBACKS ft Front Yard Side Yard Rear Yard RegWred Provide ReqWred Provided Ramired Prmided 0 1.7 wave Sapply AGI-C.40. 54j 13. Flood Zone lnfersnpion: 1.E SCWMv A*WA Soto= a Public a P+4vc 0 zaao Outside Flood Zone a Mnoicod o On Site»pa nt Syaem 0 SECTION 2-PROPERTY OWNERSffiP/AUTHORIZED AGENT m 2.1 towner of Record p Namc(Pfint) Address for Service: , TR (0a Signature Telephone O 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ L .e�►� �< 6 Y - Licensed Coastruction Supervisor: tk-A q M A t z/ r V),D,4 by DY MA D 1 I L,a Lv=w Number „n Address W 7 8 - l 223 �( 5� iration A- 3- t-( Signature Telephone `.. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Name�'b LY Company / on 1 / M 1 L4 4 M� t '� �� 6O D„ MA 0 ` �6D Rcgtstiation Number r address �1 p v`71 Z Signature.�—� 3 Expiration Date /ti uu1 10 vo 1c: -top 11UK t n n1111uvtK Zj ittbatsboAtd p. e SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 2546) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit%ill result in the denial of the issuance of the building it. Signed affidavit Attached Yes.......0 No......n SECTION 5 Description of Proed Work cbeckallapplicable) New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMA'T'ED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building , (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total f 1+2+3+4+5 C !aV I Check Number SECTION 7a OWNER AUTHORIMTION TO BE COMPLETED WHEN O'WNNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ! l �+2.►.�/f� -0 a-- Cruet'f r _ _as owner/Authorized Agent of subject property Hereby authorize L y;,✓ 6 r 6, 1,Y6>Z= t! to act on My behalf.in all-matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNERtAUTHORIZEDAGENT DECLARATION 1. L—�� .Ldp Z. as(hvn uthorized Agent f subjcc t property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of m}•knowledge and belicl Print Si iature of Owrnet eu Date NO.OF STORIES SIZE 0ASENtENT OR SLAB SVT:OI:FLOOR TINMERS IS12 No3 tiPr1N DIMENSIONS OF SILLS D1ME•NSIONS OF POSTS DiM NSION5 OF GIRDERS II1)kiIII.OF FOUNDATION THICKNESS "l/l;Ol FOOTING X MAITRIAI.OF CHIMNEY IS I ILILD NG ON SOLID OR FILLED LAND IS I M11.11[NO CONNECTED TO NATURAL GAS LINE tAORTH Town of 4 over 0 No. 0 LA COCHiCHEWICK 0 dower, Mass., /0 0RATED BOARD OF HEALTH Food/Kitchen PERMI Septic System 0070,04 BUILDING INSPECTOR 11 THIS CERTIFIES THAT.......................................... .................... .... ............................................................... Foundation has permission to erect........................................ buildings on .13........ . ..... ........... ................. ..........c4to... Rough to be occupied as. .. ......... .......... ... Chimney n i�cepi- is permit ..................................................................... 1 is permit pe form to the terms of the application an file in Final provided that the person accept! ,- in )e sh 11 every res of the Codes Y_ ti this office, and to the provisio f the Codes and B Laws rela n 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 STARTS ELECTRICAL INSPECTOR Rough ......00# ................... .......................114�....................................... 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. H�.vrcuri ucm I Irl%wA I C UI' LIAMILI I T INJUKAMot 01/29/2003 PRODUCER (978)887-4900 FAX (978)887-2404 THIS CERTIFICATE IS WE—AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 50Uth Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXYENO OR ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. P. 0. Box 457 Topsfi el d, MA 01983 INSURERS AFFORDING COVERAGE INSURED Len Gibely Contracting Co, , Inc. INSURER A: Western World INSURER B: INSURER C: INSURER p 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. LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDOM 0 TE ! LIMITS GENISRAL LIABILITY IMA577724 01/29/2003 01/290004 EACH OCCURRENCE S 1100010(q X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(My one(Ire) S S0,00 CLAIMS MADE XT OCCUR MED EXP(Ary are person) 1 1,000 A PERSONAL&AOV INJURY $ 1,000,0()( GENERAL AGGREGATE S 2,000,00C GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000, POLICY 7 PERC� 171 LOC AUTOMOGILE LIABILITY (EMB DISINGLE LIMIT ANY AUTO r ALL OWNED AUTOS BODILY INrURY S SCHEOULED AUTOS (Per pereon) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (PIA acc4em) PROPERTY DAMAGE S (per ece aenq GARAGE LIABILITY AUTO ONLY.EA ACCIDENT it ANY AVTO ` EA ACC S OTHER THAN AUTO ONLY: AGO $ EXCESS I IA81UTY EACH QCCURRENCE S OCCUR a CLANS MADE AGGREGATE S a OEOUCTIBLE S RETENTION S S WORKERS COMPENSATION AND TA TOR ER_ IOTH E. EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S E.G DISEASE•EA EMPLOYE S EL.DISEASE•POLICY LIMIT S OTHER DMAIMON OF OPERATION&LOCATIONSNEHICLE&EXCLU&ONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICF TO TME CERMPWATE MOLDER NAMED TO TME LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATQN OR LIABIUTY OF ANY KIND UPON THE COMPANY,ITS AGENT"OR REPRESENTATIVES. EVIDENCE OF INSURANCE AUTHORIZED REPRE9ENTATVE [Robert Sennott LA ACORO 25-S(7/97) OACORO CORPORATION 1988 I AI;111:11 CERTIFICATE OF INSURANCE DATE(MM\D°m 08-11-03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SENNOTT INSURANCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 MAIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 457 TOPSF I E LD MA 01983 COMPANIES AFFORDING COVERAGE COMPANY 2946N A ROYAL INSURANCE COMPANY OF AMERICA INSURED COMPANY LEN GIBLEY CONTRACTING COMPANY B INC COMPANY C COMPANY D I COVERAGES 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. c01 TYPE Of INSURANCE POLICY EFFECTIVE POLICY EXPIRATION TA; POLICY NUMBER DATE(MM\DD\YY) DATE(MM\DDWY) LIMITS I GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. 5 CLAIMS MADE[::]OCCUR. PERSONAL&ADV.INJURY g OWNER'S&CONTRACTOR'S PROT, EACH OCCURRENCE g 7 FIRE DAMAGE(Any one fire) S i MED.EXPENSE(Any one person) S j AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS �— BODILY INJURY SCHEDULED AUTOS (Per Person) S 'IRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per Accident)' PROPERTY DAMAGE S (GARAGE LIABILITY r-- AUTO ONLY-EA ACCIDENT S I I ANY AUTO OTHER THAN AUTO ONLY: j EACH ACCIDENT S I AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM 4 WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-754X 134-7-03) 08-03-03 08-03-04 STATUTORY LIMITS THE PROPRIETOR/ I---1 EACH ACCIDENT S 500,000 PARTNERS/EXECUTIVE I X INCL DISEASE-POLICY LIMITS 500 000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE I S 500,000 iOTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS I ;ERTIFICATE HOLDER CaNCELIATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Evidence of Insurance EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE CORD 25-S (3/93) CACORD CORPORA 1993 O�e e Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration•`'100811 Expiration: 6/23/2004 Type: Private Corporation LEN GIBELY CONTRACTING CO., Neonard Gibely 149 Main Street Peabody, MA 01960 Administrator -P� � � BOARD OF B,IJILQING.BEG.tjItATI.QNS License: CONSTRUCTION SIPERVI$OR Numbe�6 Q59.482 01 h Ott [231953 04 Tr.no: 207;19 EELEON ARD`GIB Administ 00-1- I