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HomeMy WebLinkAboutMiscellaneous - 2177 SALEM STREET 4/30/2018N Location No.,' Date 4ORTN TOWN OF NORTH ANDOVER 400 - 0 - Certificate of Occupancy $ 77 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14 US 5 6 2 5 L Building Ins0e6or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ....... SeEiib+(�H"iczati3"OIiI BUILDING PERMIT NUMBER:�L2 A A DATE ISSUED:_ 9— Q/ SIGNATURE: Building Commissioner/1for of Buildings Date— �'j _ Q JEU11VN 1-JlIE 11NIPVK1VlAllVPI a ' 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Al 99 S7 -L 0 �0 0 AJ,3 HA Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District . Proposed Use I Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required I Provided Required Provided 1.7 Water Supply M.G.L.CA0. S1 54) 1.3. Flood Zone Information: 1.8 Sewerage Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT On Site Disposal System 2.1 Owner of Record r D, 2 2 aL. AL 0 Name (Print) Address for Service : [I Signature Telephone 2.2 Owner of Record: i SECTION 4 - WORKERS COMPENSATION (MG.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 .......0 No ....... 0 SECTION 5 Description of Proposed Work check all a Reable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specifyag NRA, 314 1A' Brief Description f Propose"ork: 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item . Estimated Cost (Dollar) to be x Completed by t applicant { x 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 ( L✓ 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER Al RIZAT14 O BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BULLDING PERMIT as Owner/Authorized Agent of subject property Herebiauthorize to act on My behalf, in all matters relative to work authorized by this building permit application. a Signature of Owner Date SECTION 7b OW R/AUTHORI ED AGENT DECLARATION ,as Owner/Authorized Agent of subject property Hereby declare that the atements and information on the foregoing application are true and accurate, to the best of my knowledge ane / \ e /� lllflr���� NO. OF STORIES SIZE OF FLOOR MMERS 111 SPAN DIMENSIONS OF SILLS MIENSIONS OF POSTS DDAENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING - MATERIAL OF CI-MVMY �. IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Date l THICKNESS X u: Beard of:Buildin eP 1 ns.a�t� Building R.., O HOME IMpROVE"AENT CON TRACTnR Registration 194569 TY?? .PRIVATE CORPORATION C4VIDCAS IRICONE' OFIR'u c_ t 7 Hillsroe Ro -d Bcxford� AA U 92 f x` License at registration v:ihd for individul us .oil before the eapu anon date. 1fjfound return to: , Board of Baiidin?. b,Regulations and St ndards i OneAshb�rrton J'„tare z„ Boston; 11a t i Nit v:,iid wirhour: •• - , W- � _�.:.: - -. O z W W �¢ a w M•1 v \ O w v V)u. o z z A b O ..0 O w U C w O v � Z ..0 p u: G O w U .0 tko p Uto O to O w G w w A C: m cn E cn a x N W H x W V H zoo x S,s 0 m c o � C H O 0 V CL C MM C :CD O Q L N 1� ECD Q .-. CFO L +. CD :... 0 o. N O W C rte.+ O O : m C NC _ 16A m m CD �' N cm : m 3 m A •p � .m N A ;tN o L m � c 40 '� 2 :• ac13 t O : V I MC•�Z c o 0 CL ® y O C ® m� O CCD C� w t H � C •ca .� dt .. cm Vm •- C C O •_ A NCL CC a 0 !9 TIT P4 co 0 E co O Z O 0 y coMOD •co L co C Cl C CL CO2 O .n COD C O O C _CC CL. V! r�mftl L O cs W/ CL CO) C C Q! 0— ca W uj C) U) LLJ W W W A CORD CERTIFICATE OF LIABILITY INSURANCE DATE,MM,DD,YY) MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH I POLICIES. AGGREGATE LIMITS.SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 01/30/2001 PRooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EFFECTIVE POLICY EXPIRATION _ POLICY NUMBER PDATE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ` INTERNET INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LIMITS ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 522 CHICKERING ROAD I EACH OCCURRENCE 5 8500012710 NORTH ANDOVER, MA 01845, I INSURERS AFFORDING COVERAGE INSURED I INSURER A. ARBELLA s DAVID CASTRICONE 1 INSURER n ARBELLA PROTECTION ROOFING AND SIDING INC.-- MED EXP (Any one person) S 7 HILLSIDE ROAD I INSURER C: EASTERN CASUALTY BOXFORD MA -01921- INSURER 0: - - r- �. ? CnVFRAt;FS .<. 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 I POLICIES. AGGREGATE LIMITS.SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !' INSRLIS TYPE OF INSURANCE EFFECTIVE POLICY EXPIRATION _ POLICY NUMBER PDATE -- - - LDQIYYIh LIMITS GENERAL LIABILITY - A ®T I EACH OCCURRENCE 5 8500012710 -1 000;,000 COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE OCCUR 06%06/2000 06/06/2001 FIRE DAMAGE Ari n -f" _ ( yo a ue) S -50,000 ❑ MED EXP (Any one person) S - 5, 000 �' { _", PERSONAL &ADV INJURY S ,. 1,000, 000 �. GENERAL AGGREGATE $ - 1, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: PRO• 101POLICY PRODUCTS . COMP/OP AGG $ 1,000,0001 • IUI ❑ -LOG AUTOMOBILE LIABILITY ❑ COMBINEDSINGLELIMIT . ANYAUTO fff � - f (Ea accident) ❑ ALL OWNED AUTOS. B ® II 44506400001 08/0,1/2000 1 08/01/2001 - BODILY INJURY SCHEDULED AUTOS - - i (Per person) S ` _ 250, 000 ❑ HIRED NON-OWNEDAUTOS•" _ 1 BODILY INJURY (Per accident)r. ? -: 500,000 - i HE01 PROPERTY DAMAGE (Per accident) - $ 100,000' GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S I14 ❑ ANY AUTO- - - E:, ACC S OTHER THAN _ AUTO ONLY AGG 5 - EXCESS LIABILITY _ ❑ OCCUR CLAIMS MADE - - '. - I EACH OCCURRENCE - _ - AGGREGATE S - - DEDUCTIBLE —• I ❑ RETENTION S I COMPENSATION AND - - WC STATU- OTH- IWORKERS EMPLOYERS'-LIABILITY OR E.L. EACH ACCIDENT c 100,000 C WC99 A24009 09/29/2000 09/29/2001 E.L. DISEASE - EAEMPLOYES 500, 000 E.L:.DISFASE-POLICY LIMIT S 100,000 - - .. I OTHER _ ... DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS `- - ROOFING AND SIDING i u-r�r t c nv�.aJcn ILJI ADDITIONAL INSURED; INSURER LETTER: LAN(-tLLA I JUN 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR -- - - - REPRESENTATIVES. .� AUTHORIZED REPRESENTAjIV - •, i ACORD 25-S (7/97) ©! ORD CORPORATION 1.988 CAST tC