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HomeMy WebLinkAboutMiscellaneous - 17 FULLER ROAD 4/30/2018 17 FULLER ROAD 210/065.0-0075-0000.0 >•I \ I r i Location 'f 1 No. Date RTM TOWN OF NORTH ANDOVER Of "•O :•,�O F 9 ' Certificate of Occupancy $ �'�s'•••°•ESQ' cMus Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check # ( r t� 5 7 Building Inspe6for 7 6 :�L Date. Ov�... ..... NORTH Of ,.ao 14, o'k% '` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,SSACHUSE� u This certifies that . . . . . .St-G� !l . . . !!. has permission for gas installation . . j v.. . . . . . . . . . . . . in the buildings of . f . . � �� t .. . . . . . . . . . . . . . . . . . . . . . . . . . at .0. . . . . . . . 1�L. . . . . . . .I North Andover Mass Feb�:u�. . Lic. No. 3. . . . . . . 7 r_ GAS INSPECTOR . Check# 1 1 3 `� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING i� CityITown: MA. D te: 0 Permit# Building Location: Owners N m e / / Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential[� l New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES W W rn W t— Y� Z Y N M W a O W _ to m 2 O W W V In 1— O 1Z W 2 Lu atZ I— Z J 0 W Ix O :31W OH W OG 0W XaL > co U W N W V' � W H D = �- > W W Z o f 1- 1-- O Z --1 (D W ly- = W FW- W W U 5 G w aU' o Z = 1 O o.. R X H > > > 'S O SUB BSMT. BASEMENT 1 5T FLOOR -P-FLOOR 4 3 FLOOR 4 FLOOR 5 FLOOR { 6 FLOOR 7 FLOOR E 8 FLOOR Check One Only Certificate# Installing CompanyName. f' J? ?Corporation Address: City/Town State: ❑Partnership Business Tel• Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes Wao❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liabilityinsurance olio Other a of indemnity Bond policy fid" type tY ❑ ❑ OWNER'S INSURANCE WAIVER:1 am aware that�the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box 0;1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plu ing Code and Chapter 142 a General Laws. Type of License: By 0 Plumber Title ❑G Fitter ature of Licensed lumber/Gas Fitter Waster City/Town []Journeyman License Number: APPROVED OFFICE USE ONLY) El LP Installer TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner for of Buildings Date acj' SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: b �,�' 14A Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �. Zoning District Proposed Use Lot Areas Frontage fl 1.6 BUILDING SETBACKS ft Front Yard I Side Yard Rear Yard Re red Provide Required Provided R red Provided 1.7 water supply\t.G.L.C.40. 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System C SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r 2.1 Owner of RecordZ9 F_ k9 , -9 f. r Name(Print) Address for Service: Q+ Signature Telephone 2.2 Owner of Record: Name Print Address for Service:. C n Signature Telephone SECTION 3-CONSTRUCTION SERVICES Q 3.1 Lic,-Zsed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C License Number OT Address Expiration Date 3 Signature Telephone r 3.2 Registered me Improvemen Contractor r Not Applicable ❑ C R .L__,AAJ1J C, 'Pic m:z Company Name Registration Number r.. ss J Expiration Date ^ Signature Telephone Y� f , r I . i SECTION 4-WORKERS COMPENSATION WG.L. C 152 § 25c(6) I i Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result i in the denial of the issuance of the building permit. Signed affidavit Attached Yes....:..0 No.......❑ I I SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition ❑ I Accessory Bldg. 0 Demolition 0 Other 0 Speciflr� Brief Description of Pr sed Work: Y`f•', Ii a i i r if j SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed b rmit a licant n. ,1ii "' f r 1. 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 97, 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 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. A rp� i nature of Owner Date ECTION 7b O ER/AUT ORIZED AGENT DECLARATION t ,as Owner/Authorized Agent of subject operty ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Pri t Nam Sr ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TII 1BERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DDAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t ✓� -Pam„h,,�,� o� '—_�_`"�� -,�,� Board of Building Regu 'Ons afirr ROME IMPROVEMENT CONTRACTOR License ar.registration vAd for individul us only �i. before the eapi'anon d ke9a,trtion: 104;,69 ate. If found return to: Board"1';L'iljinb Regulations and St;ndards i:ac�str ,ion %14/0?. OneAshbtirton Pla3n I Tvpcez:.PRIVATE CORPORATION Boston;11a.Otlftii I 1 CAVID CASTRICONE ROOFS ' r ( 7 HillsideRo�;d :�' k Boxford MA — 1 Nit v:.$d wi*hour _�igna.>iro t ACORD . CERTIFICATE OF LIABILITY INSURANCE 1/30/2001 01/30/2001 PRODUCER -_ _.. — I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INTERNET INSURANCE AGENCY HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 522 CHZCKERING ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE INSURED INSURER A. ARBELLA DAVID CASTRICONE INSURER R ARBELLA PROTECTION ROOFING AND SIDING INC. -- -- — 7 HILLSIDE ROAD INSURER C: EASTERN CASUALTY BOXFORD MA 01921- INSURER D' 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. ILTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S 11 000,000 A ®, COMMERCIAL GENERAL LIABILITY 8500012710 06/06/2000 106/06/2001❑ CLAIMSFIRE ` DAMAGE(Any one fire _ 0,CIMS MADE OCC ) S 0 0 0UR I MED EXP(Any one person) 5 5,000 F ❑ r PERSONAL B ADV INJURY 5 11000,000 ❑ I GENERAL AGGREGATE S 11000,1000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG S 11000,000 ❑ POLICY ILJI PRO-jFCT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . ANY AUTO - (Ea accident) S B ❑ ALL OWNED AUTOS 44506400001 I 08/01/2000 II 08/01/2001' BODILY INJURY ® SCHEDULED AUTOS j (Per person) S 250,000 ❑ HIRED:,..:_:; I I! NON-OWNED AUTOS i I BODILY eraccident) ent) 5 500,000 6 ❑ (Per acddent) ■❑ I PROPERTY DAMAGE 5 (Per accident) 100,000 GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT 5 ANY AUTO OTHER THAN EA ACC ,S---_-_.. AUTO ONLY:. AGG S I EXCESS LIABILITY EACH OCCURRENCE $ .. OCCUR FE-11 CLAIMS MADE I AGGREGATE 5 ■ DEDUCTIBLE I i $ ❑ RETENTION S I - 5 WORKERS COMPENSATION AND I WC STATU- OTH- EMPLOYER S'LIABILITYFIR C WC99 A24609 09/29/2000 ! 09/29/2001 E.L.EACH ACCIDENT S 100,000 E.L.DISEASE-EA EMPLOYE 5 500,000 I OTHER E.L.DISEASE-POLICY LIMIT S 100,000 1r1 � I +!! 1 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ROOFING AND SIDING CERTIFICATE HOLDER IE]IADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN NO-. THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT? IV I I ACORD 25-S (7/97) ©/j ORD CORPORATION 1988 CASTR tC NORTIy E Town of Andover 0 No. c2 q Y 4/ "AT o�A CoCH,C�� dover, Mass., ORATED p'\ C5 S u G n 4 BOARD OF HEALTH PER IT T D . Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... __ .. ..... ..�................................ ............................. Foundation has permission to erect........................................ buildings on .11......... .... .................. Rough t0be OCCUpled as ................................................................................................................................... Chimney provided that the parson accepting permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions o e 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 PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION ST TS 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.