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HomeMy WebLinkAboutMiscellaneous - 151 COVENTRY LANE 4/30/2018 151 COVENTRY LANE C 210/1()4.C-0138-0000-0 •C I Location No. Date �aRT►, TOWN OF NORTH ANDOVER � 9 • ; : Certificate of Occupancy $ " �'�s'•" E�� Building/Frame Permit Fee $ /a s�CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5 �v '1 .7 )y' v Building Inspector TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION o ,".o ,6,��0 0 I0- 7�0 Permit NO: Date Received AraD Date Issued: s Ssgc►+us���� IMPORTANT: Applicant must complete all items on this page LOCATION C. b 4 y e 0 T e ' ,o ty ' P ' PROPERTY OWNER Fid ll) JC, S Print MAP NO.:j OYC PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑ One family ❑ Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED 4s'- -A.6 Identification Please fype or Print Clearly) OWNER: Name: p d y(� N w-5 Phone: f7 6 •�i is l��3oS,Z Address: I S-t C o rJ lJ N)1 C�N� �e A)CONTRACTOR Name: ®C r/V N E S (2F1 c5 Phone:97 Address: C) Supervisor's Construction License: CS 6(S'&S7 Exp. Date: M- Home Improvement License: (:L�p Exp. Date: 05 UQ(a ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ , Ya- x10.00=FEE:$ Check No.: Receipt No.: Page W4 4 TYPE OF SEWARGE DISPOSAL Swimming Pools El Public Sewer Tanning/Massage/B Art ❑ Well Tobacco Sales ❑ Food Packaging/Sales 11❑ ❑ ❑ Private(septic tank,etc. Permanent Dumpster on Site Electric Meter location to I project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature gnatu e of Agent/Owner Signature of contractor 1A 14_40� Plans Submitted ❑- Plans Waived ❑ Certified Plot Plan ❑ m ed Plans ❑ p THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION // ❑ LAY 0� COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes—no Fire Department signature/date Building Setback( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA— For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ 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) 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 ❑ Mass check Energy Compliance Report 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Pace 4 44 V40RTH Town of over No. E dover, Mass., ' COC MICMEWICK OrbCc Fk `S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System 41 BUILDING INSPECTOR THISCERTIFIES THAT......... 04................... A........................................................................................ Foundation has permission to erect........................................ buildings on ...VTJ.........0 ..... ........ .!!v ....• Rough to be occupied as..62.*.S �. f4. .14%.....S''� ...j. ................................ Chimney 1 . . ........ ......... .. .... . provided that the person accepting this permit shall in every respect conform to the t ms 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 CONSTRUCTIFccuptry S Rough ................. ........... Service Final Occupancy Permit Required to Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer Street No. SEE REVERSE SIDE Smoke Det. '}\ ✓l" 60"Afil" ruaeala a1-A11,Jjadw0eC.t Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: `j Registration: 126398 Board of Building Regulations and Standards -- One Ashburton Place Rm 1301 Expiration: 5/26/2008 Boston,Ma.02108 Type: Individual Jocelyne Sirois Jocelyne Sirois Elm St Q-�, -- - _. ;q- 77 _tPv✓ Methuen, MA 01844 Deputy Administrator of va without signature ✓lee -�o,�iriauuva/,C� a��oacu/ucaP.tta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR - Number: CS 065857 Birthdate: 12/29/1952 'Expires: 12/29/2006 Tr.no: 5449.0 Restricted: 00: ' JOCELYNE SIROIS c, PO BOX 246 ` METHUEN, MA 01844 Commissioner j J. Sirois Woodworking and Construction Invoice No. PO Box 246 Methuen, MA 01844 Tel, 9 78-685-4504/Cell 978-360-8448 INVOICE Customer Misc�r Name Mr&MRS Sean Rogers Date 6/26/2006 Address 151 Conventry Lane Order No. City No Andover State Ma ZIP 01844 Rep Phone 978-689-3052 FOB Qty Description Unit Price TOTAL 1 Removed existing step in front of house. 1 Build new with pressure treated wood frame and trex floor. 1 Railing with weather best system. 1 Permit included. 1 Material and labor $11,542.00 $ 11,542.00 SubTotal $ 11,542.00 Shipping Payment Select One... Tax Rate(s) Comments TOTAL $ 11,542.00 Name 1-p CC# Office Use Only Expires Insert Fine Print Here Insert Farewell Statement Here ACORD. CERTIFICATE OF LIABILITY INSURANCE OP IDC DATE(MMIDD/YYYY) SIROI_3 06 .26/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Michaud, Rowe And Ruscak Ins. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198 Massachusetts Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845 Phone: 978 688 8829 Fax:978 557 2130 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Preferred Mutual Insurance Co. 15024 INSURER B: Sirois Woodworking Jean Guy DBA INSURER C: 77 Elm Street PO Box 246 INSURER D: Methuen MA 01844 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. SR L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE DATE MM/DDIYY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 COMMERCIAL GENERAL LIABILITY CPP0180526510 PREMISES(Ea occurence) $ 50000 CLAIMS MADE ❑OCCUR MED EXP(Anyone person) $ A X Business Owners 03/12/06 03/12/07 PERSONAL&ADV INJURY $ 1000000 , GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POLICY PROECT LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY i NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN _ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 17 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC - TH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMITAIUS ER j ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Woodworking CERTIFICATE HOLDER CANCELLATION NORTHA9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn. : Building Inspector IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1600 Osgood Street North Andover MA 01845 REPRESENTATIVES. AUTHOR REPRESENTA ACORD 25 (2001/08) ©ACORD CORPORATION 1 .�f�s.�rP.� 0 � a al l �!v { i 1 i ry 99-ul 3#-L rw O-V Ilog `� S Residential Property Record Card PARCEL_ID:210/104.C-0138-0000.0 MAP:104.0 BLOCK:0138 LOT:0000.0 PARCEL ADDRESS:151 COVENTRY LANE PARCEL INFORMATION Use-Code: 101 Sale Price: 559,900 Book: 05777 Road Type: T Inspect Date: 05/03/2004 Owner: Tax Class: T Sale Date: 06/14/2000 Page: 0101 Rd Condition: P Meas Date: 05/03/2004 ROGERS,SEAN F Tot Fin Area: 3396 Sale Type: P Cert/Doc: Traffic: M Entrance: X JENNIFER S AN F Address: Tot Land Area: 1 Sale Valid: Y Water: Collect Id: RRC Grantor: JOHN SHEA Sewer Inspect Reas: M _ 151 COVENTRY LANE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LeaO Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CP Tot Rooms: 9 Main Fn Area: 2264 Attic: NBHD CODE: 8 NBHD CLASS: 8 ZONE: R1 Story Height: 1.5 Bedrooms: 4 Up Fn Area: 1132 Bsmt Area: 2264 Seg Type Code Method Sq-Ft Acres Influ Y/N Value Class Roof: G Full Baths: 3 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 217,364 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade. VALUATION INFORMATION Masonry Trim: 46 Ext Bath Fix: Tot Fin Area: 3396 Current Total: 717,900 Bldg: 500,500 Land: 217,400 MktLnd: 217,400 Kitch Qual: T Eff Yr Built:- 1987 Mkt Adj: 11..2 Foundation: CN Bath QT RCNLD: Prior Total: 671,300 Bldg: 470,100 Land: 201,200 MktLnd: 201,200 al2 Heat Type: HW Ext Kitch: Year Built: 1987 Sound Value: Fuel Type: G Grade: GV Cost Bldg: 500,500 Fireplace: 1 Bsmt Gar Cap: Condition: G Aft Str Val 1: Central AC: Y Bsmt Gar SF: Pct Complete: Aft Str Va12: Aft Gar SF: 982%Good P/F/E/R: /100/100/93 Porch Tvae Porch Area Porch Grade Factor P 132 W 230 SKETCH PHOTO 10 230 Sq. 0 2 71 72 �:. W0.5/61TIVI34 992 Sq.R- 28 2264 Sq.R. 32 .. a 151 L-11 COVENTRY LANE Parcel ID:210/104.0-0138-0000.0 as of 6/27/06 Page 1 of 1 ! f •! f f rr .�� !f Alt, / tL� • A x.R r� r 4' ^ lj 't r • K �: a ESRI ArcExpiorer 2.0 Map Title 0 core_naparcels core_nawatersheddistrict ® core_nahistoricdistrict core_nazoning (ZONECODE) 210B1 210B2 210B3 210B4 21 OGB d 21011 •'� 21012 9 � 21013 2101S f 210PCD i 210R1 21082 210R3 210R4 210R5 — 210R6 I 210VC 210VR 1 G C N Tuesday, Jun 27 2006 Location z5 J �U vTlvllv '/ 4V No. r C Date MORT1y TOWN OF NORTH ANDOVER A i Certificate of Occupancy $ ♦ i # Building/Frame Permit Fee $ s�cwus Foundation Permit Fee $ f' Other Permit Fee $ If TOTAL $ aq Check # 1 5 1 2 6 / Building Inspector 1 TOWN GP NORTH ANDOVER BUILDING DEPARTMENT PPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING UILDING PERMIT NUMBER: DATE ISSUED: rn CP Y-91' .GNATURE: Building Commission r ctor of Buildings Date ?,CTION 1-SITE INFORMATION 1.1 Property Address: 1.2. Assessors Map and Parcel Number: Irv ' Map Number Parcel Number 1.3 Zoning Information: l_ 1.4 Property Dimensions: ning District Proposed Use Lot Area Frontage ft i BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided R uird Provided t 3 ® R Water Supply M.4aLC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: lic ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 ;CTION 2-PROPERTY OWNERSEUP/AUTHORIZED AGENT Owner of Record N't¢ - me(Print) Address for Service =:1 g S- 30T2— Telephone vs2---Telephone Owner of Record: ame Print Address for Service: M nature Telephone CTION 3-CONSTRUCTION SERVICES Licensed Construction Supervisor: Not Applicable ❑ j ,nsed Constig6clion Supervisor: �S o� ss7 �1�7 � � U 2 LA-. 01w/ License Number r_esss lL G -a4 o a 'j t 7 Y SO y Expiration Date a� ature Telephone Zegistered Home Improvement Contractor Not Applicable ❑ 1yrJE S(40 t> pany Name X02(0 318/ Registration Number ess �bP;L-- z Expiration Date tture Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant a 1. Building (� �_ (a) Building Permit Fee ME / o K� ' Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(+)x(b) 4 Mechanical HVAC 5 Fire Protection (�J 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,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 i Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB ` SIZE OF FLOOR TIMBERS 1 2ND 3RD - 1 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND t' IS BUILDING CONNECTED TO NATURAL GAS LINE 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 Number 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. The debris will be disposed of in: (Location of Facility) gnature of Permit Applicant t /1- 67L ' l Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ✓. k v f.rfl q.t �t� {t ky.,Rrir .> a .'' , .;. ` �� ��r� _ t -G t ` 3 The Common wealth of Massachusetts Department of Industrial Accidents y -- -- { ._= 0!f/ceoJ/nsestig�tfons 600 Washington Street . Boston,Mass. 02111 Workers'Compensation Insurance Affidavit Ala XV is Iocatio_ n��/�/ (7)-Vy{�,•t�,•L� tU/k(j Lra'l am a homeowner performing all work myself. I 0 1 am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job, camnan namE 777 (�1't City" on iY• -Coe nY 4 p I atn.a sole proprietor,general contractor,or homeowner.(ckde.one)and have hired the contractors listed below who.have the following workers'compensation polices: o S ./Za 's ren . } is Failure to secure ease as required under Section 25A of MGL 152 can lead to.the Imposition of criminal penalties of a flue up to S1,500.00 and/or one.years'imprisatitetnt as well as civil penalties in the form of a STOP WORK ORDER and aline of$100.00 a day agonst me. I understand that:a copy of this statetiaent may be forwarded to the Office of investigations of the DIA for coverage verification.. Ido hece6ty ce aider the pains and penalties ojperjury that the information provided above!s true and correct Signature Date Print name.. a n-01 - . hone# X17 � S olficlal use only do not write in this area to he compicted by eity or town oMelai city or town: permittlicense N _oBuilding Department OLicedsing Board p check if InawA iate response is.required C7SelectmeWS ofhee oHealth Department contact person• phone#, `00ther (revised 7/95 PIA) Jean Sirois Woodworking Invoice No. P.O. Box 246 Methuen, , MA 01844 978-685-4504 Invoice Customer Name MR& MRS Shawn Rogers Date 7/31/01 Address 151 Conventry Lane Order No. 1 City NO Andover State MA ZIP 01845 Rep Sirois Phone 978-689-3052 MY Description Unit Price TOTAL Strip roof installed new drip edge ice shield where needed flashing,build a cricket roof behind chimney installed new flashing around chimney installed new architect shingles include dumpster and permit Material and labor $13,065.00 IF agreed on terms down payment of$6500.00 and balance of$6565.00 when job completed SubTotal $13,065.00 Payment Details Shipping&Handling $0.00 O Cash Taxes ® Check O Credit Card TOTAL $13,065.00 Name CC# Office Use Only � Expires Insert Fine Print Here Insert Farewell Statement Here 10/25/2001 11; 44 19789753987 LANDMAPKIkE PAGE 01 ,GywvNnDw10/23/01 IS CERTIFICATE Is MmUmD Aa A MA ERTHE OF INFORMATION LanCERTIFIGATE 190 misrkMmmo Ihumot Rce &jauInc ONLYHOLDER.THIS CERTIFICATE DDE NOT AMEND,EXTEND R 198 t4rasdovar MA Avenue845-4 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, North ]►adnvor MA 018454190 COMPANIES AFFORDING COVERAGE Laurance A. Michaud, CYC COMPANY naNe. Q - 02.9 F 0.978-975--3987 1 A Preferred Mutual Insurance Co. INSURED COMPANY e Siro3s Woodworking COMPANY Jean GUY DEA C 77 blm Street 20 Box 246 Methuen HL 01844 00WANY D THIS IS TO CERTIFY THAT THE pOI.ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 11ME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM ON CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE&PECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOADEC BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITO SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COI TYPE OF INSURANCE POLICY EFFWTIVIr POLICY 1I MRATION LTR POLICY NUMBER DAT!IMM/DOtYYy OATE(MMIfDDIYYJ uMITtl 3ENF.RAI.LIABILITY GENERALAd4ftQA7i $2000000 A COMMOWIALGENERALLNASLITY 12pP0150326510 03/12%01 03/12/02 PRDNxcia-crr Pa ram 12000000 CRMADE E]ODOUR PERS 4AL I ADV IMJURY $1000000 OWNN<R'$N!&•CONTRAtTOCCa PROT I EACH OCCURRENCE f X sop 1000000 FIR!DAMAGE("uerFln) $50000 AUTOMOSiLELWIILITY MED lXlWNot»Pe�°n1 f 5000 ANY AUTO ' COMINNED OINOLE LMNT f ALL OWNSO AUTOS SCHEDULED AUTOS i BODILY INJURY HIREDAUTOb ��._ HON•OWNfIAUTOi Katy INJURY f ` -N (Par aaakkM) PROPOITY DA me $ GARfV3@ UABIIJTY ANYAUTO A:ITOONLY•EAACCIDpIT s i OTHER THANAVTOONLY: ' t EACH ACCMW f WME310 LIAAIUTY AOGREN<ArE i I EACH OCCURRlHDJi i �_7LA FORM IEACHOiATEHAN UNIRELLA FORM $ tERN1�11FS�NIATIONANe W ° EMPLOYVQ'L"UTY TO TV THE PfWRETOR/ FL EACH A=007 PARTN/RWid{ECUTIVE INOL EL OIIEANIE.POLICY LINT $ OFFICERa ARE; ]1P ExcL, OTHER EL DIIEAS4`IRA EMPLOYE f A BOP CPPOISO526510 03/12/01 03/12/02 DEOCIMPTION OF OPERATIoNaWr-iy-IONSN IAL IrNtM3 NORTI'1A1 SHOULD ANY OFTHEASOVEOmplowPOLICIES 6ECANCgulmSIFORETHE EXMRATIDN DATE IHERBOF,TH!ISNANp COMPANY WILL ENDEAVOR TO NAIL DAY!WRTTTpV NOTICE TO THE I;lJtTIF1CATE LD6R NAMEA TO THE LEFT, Town of Worth Andover 120 Main Street BUT FAILURE TO MAk.IS,ICH NOTION WIALL IMPft L(ATION OR UADILITT North Andover til 01045 OF ANY MND UPON THE COMPANY,179AGEiTSO 7ATIVES. ALITH TIV! Lawrence R. Michaud, CIC :: �RpC ►T701�:'1�3. NORTFt Town E of over P _ No. C4 COC,; ' dover, Mass., ADRATED pP�\y` F BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D . BUILDING INSPECTOR THIS CERTIFIES THAT v o �� S ..........z......... ....................................... .....�..........V QJV�..............�`C�............................. Foundation has permission to IW.....� .�I..!r�............. buildings on ...I.c�.�..Cv..................1... P....................................... Rough to be occupied as.... ...R'e r d> F ' \'�`S ��^� a S r c�� ✓� Chimney ........................................................... ............................................................................................ 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. 104C/ 138 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C 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. Smoke Det. SEE REVERSE SIDE ✓jre a�sa»ranu.Pall� of lfcauacfruwm 13OARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 065857 Birthdate: 12/29/1952 r - Expires: 12/29/2002 92002 Tr.no: 4655 i Restricted To: 00 JOCELYNE SIROIS PO BOX 246 METHUEN, MA 01844 Administrator yy _ , Registration: 126398 q Expiration: O5/26/2002 Type: Individual Jocelr ne Siroi s Jocelyne Sirois Gew �, St ADMINISTRATOR en MA 01841 i Location No. Date J j -U f 6 NORTH TOWN OF NORTH ANDOVER 41 A # y Certificate of Occupancy $ Building/Frame Permit Fee $ �" �CNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 90, � 1 775 �. Building Inspector f � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING WELDING PERMIT NUMBER: DATE ISSUED. l SIGNATURE: ..� Building Commissionerff for of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: i i0ge 3 Map Number Parcel Number i 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1-117,7110District: YP No rn 2.1 Owner of Record N e Print) Address for Service Sig re Telephone 2.2 Owner of Record: ry Name Print Address for Service: Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ds $ 7 -J p S 2-b aL S Gc � y�1 I s o�S"��� Licensed Construction Supervisor: 0 n � ���� ��v License Number 11 II Address I r �pa J ( J Expiration Date na re Telephone r 3r Registered Home Improvement Contractor Not Applicable ❑ C6Wpany Nam 1, 17-4, Registration Number r' Address S Expiration Date Si re Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check a0• licable New Construction ❑ Existing Building ❑ Repair(s) Q' Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY ` Completed by permit applicant 1. Building (a) Building Permit Fee Multi lien 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X tb1 4 Mechanical HVAC 4JQ 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Her authorize to act on half,in all matters relative to work authorized by this building permit application. -4?1L Si at a of OQ6er Date SE ION 7b OWNER/AUTHORIZED AGENT DECLARATION h as Owner/Authorized Agent of subject property f Hereby declare that the statements and information on the foregoing application are tn:e and accurate,to the best of my knowledge and belief -I-©ci 1yx7Z S ( ILD rii Name n 4t4&' o /I- e of er/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVlBERS 1' 2ND3RD SPAN DM ENSIONS OF SILLS DII% ENSIONS OF POSTS MvIENSIONS OF GHtDERS HEIGHT OF FOUNDATION THICKNESS i SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 126398 Expiration: 5/2612006 Type: Individual Jocelyne Sirois Jocelyne Sirois 77 Elm St -6 E Methuen,MA 01844 Administrator �I T omvircaxu�ea i o19, 4&Ma44uePl a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 065857 Birthdate: 12/29/1952 I Expires: 12/29/2004 Tr.no: 5597 Restricted_!-ft JOCELYNE SIROIS PO BOX 246 t.•Ew•�r METHUEN, MA 01844 Administrator it i I I F NORTH Town of � , . 4Andover No ft/ J&Lz �- LA E o over, Mass.,_ COC"ICHE WICK RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ............. ... . I�.j................. .... Foundation has permission to erect.... .... buildings on.... �d V�N"�I►.y.....44........? Rough ............ ..................... . to be occupied as t AI Rwovov* .!. �A�� Chimney ...... ..... ...... ...... .................................. .................6..4.......... provided that the person accepting this rmit 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 relatingto he Inspection, Alteration and Construction of Buildings In the Town of North Andover. ' d y C ,3 J PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S ART ELECTRICAL INSPECTOR 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. I Jean Simis Woodworking Invoice No. P.O. 246 Methuen, MA 01844 978-685-4504 �I INVOICE Customer Misc Name Sean Rogers 09 Date 11/112004 Address 151 Conventry Lane Order No. City NO Andover State Ma ZIP 01845 Rep SIROIS Phone 9789-688-3952 FOB 4tY Description Unit Price TOTAL 1 Replaced board on deck with trex 22 board of 16 feet and 22 board of 1 8 feet and stain 1 Material nad labor $2,469.00 $ 2,469.00 1 Removed cement pad in 2 area $1,669.00 $ 1,669.00 i I i i, SubTotal $ 4,138.00 ! Shipping Payment Select One... Tax Rate(s) i Comments TOTAL $ 4,138.00 Name CC# Office Use Only Expires Thank You For Your Business Insert Farewell Statement Here ACORD, CERTIFICATE OF LIABILITY INSURANCE OP ID ,n fMIDDIYYYY) SIROI-3 /10/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOK ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Landmark Insurance Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198 Massachusetts Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, North Andover MA 01845-4190 Phone: 978-688-8829 Fax:978-975-3987 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Preferred Mutual Insurance Co. 15024 Sirois Woodworking INSURER B: Jean Gu DBA INSURER C: 77 Elm Street PO Box 246 INSURER D: Methuen MA 01844 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. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYY) DATE(MMIDDIYY LIMITS GENERAL LIABILITY I EACMjVrH OCCURRENCE $ 1000000 A COMMERCIAL GENERAL LIABILITY CPP0180526510 PREMISES(Ea occurence) $ 50000 CLAIMS MADE FXI OCCUR MED EXP(Any one person) $ X Business Owners 03/12/04 03/12/05 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 1-1 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND AOTI- TORY LIMITS ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E .DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ANDOVE+5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Town of Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Inspector IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 36 Bartlett St Andover MA 01810 REPRESENTATIVES. AUTHOR REPRESENTA ACORD 25 (2001/08) ©ACORD CORPORATION 1