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Home My WebLink AboutMiscellaneous - 1773 SALEM STREET 4/30/2018 (2)s 0 J 4 W W D o m co K Q cn om 0 CD -4 6 Mar. 1S '94 1:30 0000 SANFAX200 series P. 2 MORTGAGE PLOT PLAN EK SURVEY 17 ROYALSTREET, LAWRENCE, MA. 01841 TELEPHONE 508975-1415 MORTGAGOR _XalblW a _ DEED REF. BK. l pG. 10� ADDRESS OF PRINCIPLE BUILDING PLAN REF, - pmd Bill 0-13 5.4cgM Er' DATE OF INSPECTION X&I 11 19) 997tI Ani in M4 SCALE f" = 440 ► �- NOTE; THIS MORTGAGE MSPECi10N WAS PREPARED OPINII Ft RT IER STANT�E{ MIAATT IINijIRMY PROFESSIONAL P._(�181A'/�'� SPECIFICALLY FOR MORTT:AGE PURPOSES AND iS NOT TO BE RELIED.UPON AS A SURVEY. EK SURVEY ACCEPTS E/S AND ACCESSORY 607MILDIN SE NO RESPONSIBILITY FOR OAMAOES TO ANYONE OTHER VAN THE SAID MORTGAGEE' AND ITN AMON$ IN CONNECTION WIT" WITT4 VIE SETBACK REQUIREMENTS OF THE LOCAL ZONING ORDINANCES, AND THAT NO E]NCHROACHLONTS IT$ PROPOSED AIORTC ct FINANCING TO SAID UORTGAGOR. OF MAJOR IMPROVEMENTS EITHER WAY ACROSS PROPERTY LINES EXCEPT At SHOWN. CERTIFICATION TO: ALSO. Tli S tERIIFIOATION IBJ DASIM ON THE LODA71ON OF SURVEY MARKERS " PROPERTY IS NOT IN THE 100 YR. FLOOD HAZARD AREA �I. OF OTHERS, AND DOES NOT REPRESENT A PROP'.ERTY SURVEY, THEREPORI= OFFSETS SHOWN ARE NOT TO BE .USED FOR TIIE ESTABLISHMENT OFb PROPERTY IS IN A FLOOD HAZARD AREA J. INFORMATION I$ ISUMCIENT TO DETERMINE FLOOD HAZARD. PROPERTY LINES. FLOOD HAZARD DETERMINAVON FROM THE LATEST FEDERAL FLOOI INSURANCE RATE MAP PANELf 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 Comrnissioner/IEs Zctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /70 rfl i Map Number Parcel Number ,S AA ll 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service LP lCfc- Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed ConstructionSupervisor: Not Applicable ❑ �/ E% ! i4,eP�1 0 �. Licensed Construction Supervisor: (,� L It /r. License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable .0 14,C-f ez,,s o ^, Company Name r� %dam Registration Number Address f/ 20 of �°lT %�� • �.r/.►t/.��. i-e` �/�f✓ j � 0,7— 00,2 Expiration Date Si natur Telephone SECTION 4 - WORKERS COMPENSATION (M G.L C 152 � 2506) 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ [Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: (40A,5r�614 1,,eQ /0'/A-'- 0' lee SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant i-�t�F)(C�y >w F n. .xau Is ON . Y 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 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OW S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, w, �S , as Owner/Authorized Agent of subject property Here _ uth ize 6 �M L&WrenS (ti ri to act on My MaZa e a work authorized by thisuilding pennit application. r� 11Gia f 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2 ND _3RD SPAN MIENSIONS OF SILLS DINIENSIONS OF POSTS DMIENSIONS OF GIRDERS 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 ACORD CERTIFICATE OF LIABILITY INSURANCE T� DATE(MMIDDNY) 10/02/2001 PRODUCER (781)273-1630 FAX (781)270-4047 MacDonald &Vaccaro Ins Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 Bedford Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 799 Burlington, MA 01803-5799 INSURERS AFFORDING COVERAGE INSURED Stephen Lawrenson INSURER A: CGU Insurance Co 34 Roosevelt Road INSURER B: Tewksbury, MA 01887 INSURER C: INSURER D: $ INSURER E: L;UVtKAUtb 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 (MMIDDIYY) DATE (MM/DD/YY) LIMITS AUTHORIZED REPRESENTATIVE Robert MacDonald/BOBM �• GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ CLAIMS MADE F—] OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ X POLICY F PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND S24UB624X646- 5-01 04/22/2001 04/22/2002 Ulfl- X TORY LIMITS ER A EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER CANCELLATION m,UKU LO -0 (l/y/) kVALUKU L UKYUKAI IUN IUtit$ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Town of North Andover OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robert MacDonald/BOBM �• North Andover, MA m,UKU LO -0 (l/y/) kVALUKU L UKYUKAI IUN IUtit$ The Commonwealth of Massachusetts .Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing Address 3 T/. /660 -).0 <i /'IT 2� compensation for my employees working on this job. A- ytv �- %� Phone Insurance.Co.. ��&f 1066 . /�'u�t��ey Policv x73-16 3 Coln pany;name. . Address . City: Phone #: 01ue tg seoure'coverage as required under`Sacfion 25A or MGL 152 can lead to ttie rnposipon cnm�nal.penaliies of,' irieup fo $1,50 and/or one years' iMprisonmentAs-Ke-as.cixilpenalties.�e2l eformd.aSIQPII. ORK-ORE)-wd_:afine_ofl$lIlO:W 3iay-againstme 1 understandtliat a copy of this Statement may be forwardedto the Office of Investigations of the DIA for Coverage vet cation. l do hereby certify under the pains and penalties of perjury that the information provided above Is'true and correct. Signature_ Date Print name Phone ,# Official use only do not write in this area to be completed by city or town official - City or Town Permit/Licensing 0 Building Dept ❑Check if immediate response is required ❑ Licensing Board Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other Cs3 {S) 0 ) i --i Y� n m M } 1 0 T Z O :3 m c+ Ct3iiZZ i t 00 ---4 m O C Z 4M 7? 0 Ll �^ < ci 3--- � � (D 7 0— C7 Z T r. m Y � 3 O Zr• G� £1 3 ct fQ Z Cf) v3 O fl 0 n Z r� CJ O f4 OD0 y� w Sv 0 0 iia � 70 't0 a t i fi) ) J O � !V3 0 W W Y� O (- 0 t C O �. 4 0 � C� y Z D 7�J c r v a rn H TJ 9 G H m z O N C'9 d r .y | -u 8 < "n M ZCt ' o p-' Ln ;'1. 0 . '2 0 (A w y §co Z, \ / z 0 e.|ic=: L 0 Z z a co 0 o ;u Z Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax, (978) 688-9542 DEBRIS DISPOSAL FORM 2 Y0 eti Y6 Q0 O h S.C��TEO S In accordance with the provisions of MGL c 40 s 54, and -a condition of Building permit-# the debris resulting from the work shaIl.be -disposed of in a properly licensed solid waste disposal facility as defined by MGL cI 1, s150posed The debris will be disposed of in /at: Facility location Signa re of�P 'cant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. r-J r t NpRTFi 0 Ak a3 D Date..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION L . This certifies that ...... .. .�4!.� .... . n has permissio`•for gas nstallat�on�� .,��.�✓... r in the buildings of ��-.��. �-� ........... at .. '1.77j . .....4 ....l I. ....... , North Andover, Mass. Feet Lic. No -3.... .......................... GAS INSPECTOR ' Check #Gf 5 }n[+7 r. ` 8 e MASSACHUSETTS UNIFORM APPUCATIONcFOR PERMIT TO DO GASFITTING _ (Print or Type) ji 7 G�o?S y_ %:'7/'1 1 IYY((-ye .Mass. Date V aU 19�Permit * j a hiding Localtioni—Ij�a (.�,rnrn' Owfe s Name Ce, ��-Y�" Type of OatPan;y New p Renavation Gd' Repiacement Q Plans Submitted: Yesp No Q/ Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET EX Corporation 1 0 3 C MIDDLETON, MA 01949 ❑ Partnership Business Telephone 978-774"2760 p Firm/Co. Name of licensed Plumber or. Gas Fitter WILLIAM R -HARRIS INSURANCE COVERAGE: I have a Gwent liability insurance policy or As substantial equivalent which meets the requirements of MGL Ch. 142- % 42% Yes 13 No p it you have cherked yes. please medicate the type coverage by checking the spite box ,) I A liability insurance policy 13 Other type of indemnity O Band p OWNER'S INSURANCE WAVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General taws. and that my signature on this permit application waives this requirement Check one: Owner 0- Agent 0 Signature of Owner or Owner's Agent hereby certify that all of the details and information 1 have submitted (or entered) in above app icaticn ar a and accurate to best of my knowledge and that all plumbing work and installations performed under the permit' for thus i •II be co plia with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of er taws Tjof license: Plumber Stgniture of 1. Rter asfiTitle Mast tst er txense Number 3785 OtyfrownJourneyman11PPfi0Vm ( 1 h ti a Y z S A m >t 0 Q O W w S W O F V m Z C O z .+ ® s ei t- < < aF- < m a t'- m u 0 0. c• t W ata t= s c c a+ m a c 6 f s W a a v a= 3 a A J V c> d O SUB—eSUT. BASEMENT IST FLOOR 2ND FLOOR 311D FLOOR _ 4TH FLOOR STN FLOOR 6TH FLOOR TTH FLOOR STH FLOOR Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET EX Corporation 1 0 3 C MIDDLETON, MA 01949 ❑ Partnership Business Telephone 978-774"2760 p Firm/Co. Name of licensed Plumber or. Gas Fitter WILLIAM R -HARRIS INSURANCE COVERAGE: I have a Gwent liability insurance policy or As substantial equivalent which meets the requirements of MGL Ch. 142- % 42% Yes 13 No p it you have cherked yes. please medicate the type coverage by checking the spite box ,) I A liability insurance policy 13 Other type of indemnity O Band p OWNER'S INSURANCE WAVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General taws. and that my signature on this permit application waives this requirement Check one: Owner 0- Agent 0 Signature of Owner or Owner's Agent hereby certify that all of the details and information 1 have submitted (or entered) in above app icaticn ar a and accurate to best of my knowledge and that all plumbing work and installations performed under the permit' for thus i •II be co plia with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of er taws Tjof license: Plumber Stgniture of 1. Rter asfiTitle Mast tst er txense Number 3785 OtyfrownJourneyman11PPfi0Vm ( 1 4( 0 FORM U - LOT RELEASE FORM �P�✓ �� c�� INSTRUCTIONS: This form is used to verify that all necessary approvals/p mits Wom Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION************************ APPLICANT )4 1q_g'�� PHONE �T ' �UJ • ' LOCATION: Assessor's Map Number D PARCEL- SUBDIVISION ARCEL SUBDIVISION i LOT (S) STREET J� !'Q `� ST. NUMBER *****************************************OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROV9D'„ DATE REJECTED i D I lMIN i TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH J SEPTIC -INSPECTOR-HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT IJI:14979Ly, 14111 RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 Im A�