HomeMy WebLinkAboutMiscellaneous - 21 FOULDS TERRACE 4/30/2018TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: C� DATE ISSUED:
SIGNATURE:
Blidding Commissioner/I ctor of E udldin Date
SECTION 1- SITE INFORMATION I- , t
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
L--- C) 9/ Z,- . Q n S3 to
Map Number Parcel Number
1/
11.3 Zoning Information:
Zoning Distrid Proposed Use
1.4 Property Dimensions:
I Lot Area (so Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide R red Provided
R red Provided
1
1.7 Water Supply M.G.l-C.40. 54) 1.5. Flood Zane Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
_
2.1 Owner of Record
fibf !9 5ViEk )4,0U -.CW& AUV1 N O M,6s 1 DR,-') 1V6,00E&
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
i
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
'DA U /P rAs�l CP&)E ,k F6, -t
Not Applicable ❑
`0
Company Name
6 6 �� E,t_ P7—Q A/ SK �'�' C k j �"�
Registration Number
--9 T29!Z�
Expiration Date
Si nature Telephone
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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 ....... ❑
SECTION 5 Description of Proposed Work check a Ucable
New Construction ❑
Existing Building Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
S De _lL�� Q 4�
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
Estimated Cost (Dollar) to be
gWnpleted by permit a plicant
Yr
(iFF1�CIAL`USE p,y , ,,: r
(a) Building Permit Fee
Multi lier
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
d 0
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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 77b OWNER/AUTHORIZED AGENT DECLARATION
1, VAolo 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 ame
Si ature of Owner/Aent Date y
NO. OF STORIES SIZE '
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
DIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Location a /^ `�y l� �-e r IVA `L
No. �� Date 7 ; °3
MORTq TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
MUBuilding/Frame Permit Fee $ �—
ACS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # l J l
63 6 /V(641
Building Inspector
4.
Z_ t
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 104569
Expirat1on:- 7%14/2004
DAVID CASTRICbN
'r 6.astncone
7 Hillside Road
Boxford, MA 01921
Corporation
Administrator
ACOM. CERTIFICATE OF LIABILITY INSURANCE 09/23/20 2 .
PRODUCER _... - _ _ _— _ —_
= MZ]RlMT ZUSUP"C9 A=JACY
522 CHICxaA=Q ROAD
MATH AN DOM, MA 01845
IN*UREO
DAVID CABTRICCNZ
ROOFING ASID BIDING INC_
2Q0 $LITTON 92"ST, SRUITz 276
NORTH AMDOnA XII 01845-
COVERAGPA
ONLY AMP CONFERS NO RIGHTS U ON THE CERTIFICATE
HOLDER, TMIB CERTIFICATE DOES NOT AMEND, EXTEND 4
INSURERS AFFORDING COVERAGE
INSURERA:
INSURER 1 AMLLA PROTECTION
IN6VP4R C: ROZU Sidi AUTANC>Z
INSURER D.
INriURER E
THR POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REOUI"MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER 150CUMENT
WITH RfL§PfiCT TO WHICH THIS CERTIFICATE MAY AE ISSUED OR
MAY PERTAIN, THE INSURANCEEAFFORDED BY THS POLICIES DESCRIBED
HEREIN 13 SUBJECT TO ALL THE TERMS,
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS,
EXCLUSIONS AND CONDITIONS OF SUCH
TYPE OF i- AURAKE - POLICY NLJMeER . �OUCY E�PECTVi POUOY EXPIRATI N
GUARAL LLAWUTY
UNIT*
A 8500012710
COWMMMALGENERALLMILITY 06/06/2002 06/06/2003
EACH"r.URRQMGE i
000 000
CLAIMS MADE E OCCUR
PIREDAMAGEIAnrorafinr f
50,040
MED EXP An ons )
( P�1son i
--Al 00 0
PERSONAL/ADYINJURY i
1,QQQ,000
GEFPLAGCIIEGATELBAITAPPl1ESPER:
GENERAL AGCREOATC S
1 000, 00 0
rOLICT P LOG
PRODUCTS -CIDW/OPAGO ;
1-10-00,000
AUTON104" LURILrfY
ANY AUTO
COMBINED SINGLE LMIT
(FA as l"M)
s
ALL OWNWAUT06
® *CHEOULEDAUMS
44506400001�—
08/01/2002 08/01/2003
BODILY INJURY
Vol Wa*nl y
250,000
HIRED AUTOS
NON-0WNWAUTOB
b
(WLYINJURY *
RcadwiPROPERTY
$00,000
DAMNGE
100,000
GARAAE LMWUTY
ANY AUTO
AUTO ONLY . EA ACCIDENT
THYAN QA AOG
excan LL+1�ILf1'Y
. .
AUTOTHER
;
O ONL: AGO13
OIXUR D CLA" MADE
EACH OCCURRENGlE
AGGREGATES i
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s
RereNTloN ;
VADR S CGMPEUUTIO 1 AND I
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CIYPLOY101w UAElim
T H-
C 79IX97MQI 09/23/2002 09/23/2003
E.L. EACH ACCIDENT i
100,000
E.L. 016 A" 6A EMPLOYE ;
B00,000
OTNER
EL D78EASE- POLICY LIUJT
100, 000
046GR1!"TION OP 4PEAATIDN:ILOCATlpNt1YEHI0U:{GWSIONB ADDED
YY iNDON/tM4NT�PfCIAL PROWBIOYf
*HWLDAMY CP THE Amwa DEBORFYED POUtlIEf of OANc - 4EFORE THE EXPIRATION
DAT* THT Wf, THE "MIAkU NI* AM WILL ENDEAVOR TO MAIL 010 DAY* W PUTTEN
N0714
E TO THE CERTIi1CA71 HQWM "AMP TC TNA LEFT, EUT FAILURE TO DO *O *HALL
IMPOSE NO 00WATION OR LLMLITY OF ANY KIND UPON THE IN*VRER, ITS AGENTS OR
AUTHDRKW
2" (TAT)
I
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
c 11, S.150 A..
The debris will be disposed of in:
(Location of Facil' ) h�
Signature of Permit Applicant
4�
Date
NOTE: Demolition permit from the Town of North Andover must be obtained, for
this project through. the Office of the Building Inspector
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