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HomeMy WebLinkAboutMiscellaneous - 25 PLEASANT STREET 4/30/2018NORTH ANDOVER BUILDING DEPARTMENT .1600 Osgood Street North Andover Tel: 978-688-9545 Fax: 978-688-9542 BUSIMESSFOMFOl? TOWNCLERK DATE: NAW-. ADDRESS: ZONING DISTRICT: TYPF,OF13U8lNES8-: �� L l cJ d (�- d DJ CTS (� 1�,r� G Y1 J �'� 1, ��j SJ IMI DING LAYOUT PROVIDED: YES NO AY15M1,A]BIB PARKRNTG SPAMS: W USAGE: ZCNMBYlA YES NO ....... ....... SIGNATURE 4 A4. ray"2 Location No. 10 `. Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ,!!�09 17242&6 U �P 17242( 1&6 BGilding Inspector 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 CommiWoner/InEwor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Propett ess: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number / ) y /) An 2.1 Owner of Record Name (Print) 1.3 Zoning Information: 7?= .A VS 1.4 Property Dimensions: Zoning District Proposed Use LA Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide Required Provided Re(pired Provided 1.7 Water SupplyM.G.L.C.40. 54)" 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT Historic uistnct: res Ivo 2.1 Owner of Record 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: Licens6d Construction Supervisor: 3 u,t�/Lt, Ada ss %! e Sign re Telephone JFJQ�`� S� 3 Not Applicable 0 License Number I Loo Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Campany Name Registration Number Address Expiration Date Signature Telephone 00 M X z O 9 �Jo c 0 O z M 90 0 ic M VI SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) K Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 91 ^ ' 14 S �n SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to bei Completed by permit a licant �� � OF�CIAL USE O�NLY,� 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee (a) x (b) 117d 4 Mechanical HVAC 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 BUH DING PERMIT 1, as Owner/Authorized Agent of subject property Here autho e to act on behalf, in 1 matters iv o wo auth2oZd by this building permit application. Sr a 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 Pri e t Owner/ e NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 1 2 ND77- SPAN DEMENSIONS OF SILLS DIN ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Z /= 3 .nCL ■ / -w M \ 2 f ° f2,0 0 0f �9 .: % NO'OD X ; ' \ .§ ` G 02,: OL « .. Op /2 }\ ! NC3818-50 A 7/01' Carbonless _ PROPOS - C.. PROPOSAL SUBMITTED TO: . adams NC 3818-50 _ _ _ _. 3 PART — _ — k We hereby) Y se,to fury WORK TO BE PERFORMED AT: A DATE OF PLANS ' E e 77 77. 4 r � ss r 73 M All material is guaranteed to be ,as .specified, and..' he' above work to be performed in accordance with the drawings and specifi=. cations submitted for above work and completed in'a substantial workmanlike manner for the sum of Dollars with payments to be made as follows. 0. 51 j8�, �- 1 �C�� Respectfully submitted 1Nl Any alteration or deviation from above. specifications involving extra costsp will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents, or delays beyond our control. Note —This proposal may be withdrawn by us not accepted within ` - days. 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: (Locationof Facility 10 Signa re Zermit Applicant 3J Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D001 TM 04/15/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.P. Roberts Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845 978 683-8073 INSURED ARTHUR ALLEN CONSTRUCTION A.ALLEN & SONS CONSTRUCTION 369 WAVERLEY ROAD NORTH ANDOVER, MA 01845 COVERAGES INSURERS AFFORDING COVERAGE INSURER A: WESTERN WORLD INSURANCE COMPANY INSURER B: INSURER C: INSURER D: INSURER E: 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 i HE 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/VY POLICY EXPIRATION DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000, 000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100, 000 CLAIMS MADE F -RI OCCUR MED EXP (Any one person) $ 5, 000 A NPP832817 5/28/03 5/28/04 PERSONAL &ADV INJURY $1, 000,000 GENERAL AGGREGATE s2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1, 000, 000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR ❑ CLAIMS MADE - $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY STATU- OTH- TWCORY LIMITS ER E.L. EACH ACCIDENT $ El, DISEASE- EA,EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION TOWN OF NORTH ANDOVER BUILDING INSPECTION 27 CHARLES STREET NORTH ANDOVER MA 01845 ACORD 25-S (7/97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO 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. CORPORATION 1988 U) m X m vI m mm CO2 CD St 2c CD O CL r— �0 C� c ? ®1 CD O CO) CD a CD 71 LIi CA to Cl) CA 0 CA d CD CD CD CD H� CD CA CD O CCD E .j It." cn 2 ON O z c O to ® �H O cr ti d0 C ® y m Si® 0 q P Z H =r.0 y_� �. .O► Im go m H TI Ir m aam y ® .�O O N p NO = m w i �CD C a cc � ® O •-► O Z: S.n O ti. C2 0 ? _ "OO : H -- 7p: a-..�� eo O CD m O m H 'O CC2 C9'O CD aaW =-ftft� �q. .a rA H f dCL d :T -C:CA ` N IW H� O .� m� �O m LA oma: moo: m o : G o: F m. CD % en -3 O H I p' 0: o C 0 a, m CL n e7 o CD: cn 0 n cn � � ^' a�n C) � n• oGa CA C) 10• a. n 0 z H 0 Date.//,) 3 5 6 t NpRTM TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION This certifies that................ . has permission for gas installation ... ................... in the buildings of .............. ! .... '....! ................ . at .... ? ...../............`....... , North Andover, Mass. Fee.. � 1..... Lic. No..... ...:.. ......... .... . GAS INSPECTOR r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer FEF =9 = = M— — ZASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING or print) Date ' 19 lwnIH ANDOVER, MASSACHUSETTS �,.�' Building Locations �asiQ 0 idZe .�' ee -7— Permit# A22(19W Amount$ 2J-^ Owner's Name �� • New ❑ Renovation ❑ Replacement Plans Submitted ❑ • ;� w z a z C z C z L v � — C � �. rnC cn n Z ! C w w C z SUB -BA SEMI ENT B A S E H E N T IS T. F L O O R 2ND. FLOOR 3 R D. F L O O R 4T H. F L O O R Tr H. F L O O R 6T II . F L O O R 7T[I. FL00 R 3"17 FI . F1,00 R (Print or type) /LL/� Che one: Certificate Installing Company Name Corp. s Address ®�'i��� ❑ Partner. Al tk°.0 Business Telephone 97 1 ❑ Firm/Co. dame of Licensed Plumber or Gas Fitter ---( d4',�/„/J� lS" . INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked ves, please indicate e type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ED Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in ove appiicati ar true and ac to to the best of my knowledge and that all plumbing work and installations pe rmed under .., I ue ort s appii atio will be in compliance with all pertinent provisions of the Massachusetts State,(46s Code agd ap,2r 42 fth w . By: Title City/Town APPROVED (OFFICE USE ONLY) Signae of 1 ❑ Plu er, . ©Fitter LLaster ❑ Journeyman sed Plumber Or G Fitte ,� Icense Number �___\__MX—SSA IETTS UNIFORM APPLICATION FOR PERMIT TO DO QASFITTING (Print of Type) � NORTH ANDOVER , Mass. Date ?,"Iqll t9�r y� V UV Building Z S1 hl L=h�4-"9' CZ Permit # Location_ I"0 • 'nrj 12 G VLLq 7 -id f owner' s j�5� l3' ✓ 9 veT� Name New 0-'_ Renovation U Replacement 0 Plans Submitted: Yes [7 No Check one: Installing Company Name /7 . /I, L�� /� w f !/ �+-✓ fiJ Corp. Address_C1 Partnership w► r X H ✓ a-%, T All ,K-ys LTF Irm/Co. Business Telephone 6 e % -K Name of Licensed Plumber or Gas Filter _ L2 If yl d /qL �l�y �c v✓ r 1� �� INSURANCE COVERAGE: : Check one have a current liability Insurance policy or its substantial equivalent. ' Yes C-- No O If you have checked rtes, please Indicate the type coverage by checking the Appropriate box. A liability Insurance policy Ca-- Other type of Indemnity O Bond O Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: %nature of Owner or Owner's en Owner O Agent O I= hereby certify that all of the details and Information i have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for We application will be In compliance with all wUnenl provisions of thha Massachusetts State Gas Code and Chapter 142 of the al Laws. BY Tg of Lkense: Plumber Signature o cense um er or as Filter Tale Gasfitter L*umeyman Ucense Number P '� l�l� City/Town A TnOVED (OFFICE USE ONLY) CM M Check one: Installing Company Name /7 . /I, L�� /� w f !/ �+-✓ fiJ Corp. Address_C1 Partnership w► r X H ✓ a-%, T All ,K-ys LTF Irm/Co. Business Telephone 6 e % -K Name of Licensed Plumber or Gas Filter _ L2 If yl d /qL �l�y �c v✓ r 1� �� INSURANCE COVERAGE: : Check one have a current liability Insurance policy or its substantial equivalent. ' Yes C-- No O If you have checked rtes, please Indicate the type coverage by checking the Appropriate box. A liability Insurance policy Ca-- Other type of Indemnity O Bond O Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: %nature of Owner or Owner's en Owner O Agent O I= hereby certify that all of the details and Information i have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for We application will be In compliance with all wUnenl provisions of thha Massachusetts State Gas Code and Chapter 142 of the al Laws. BY Tg of Lkense: Plumber Signature o cense um er or as Filter Tale Gasfitter L*umeyman Ucense Number P '� l�l� City/Town A TnOVED (OFFICE USE ONLY) V m 'n x� z 'fA � r z � o N m 23 V D rn Y n -1 m O d O A C N n' Z N � 10 L m D' I o • 'n z 'fA � r z � N V rn n -1 O Z I(A X in -+ 0 x m N 2 rn C n' m Occ D' m • ` V p ' _ r o, i m o In m > W ai •` c m C r� i p i -1 m O N v m , y •Z V W O O • m N N z N b m 0 O z Date .... REIVED PAYMENT HQRTM NOV T49" OF NORTH ANDOVER Q�tt1lE0 X616 PERMIT FOR GAS INSTALLATION A No. Andover Collector This certifies that has permission for gas stallation c... — :-.7.. . in the buildings of ,: " `•L.,! ...j'.(r at .... -'.! North Andover, Mass. Fee.. —'Liic No.ljo.� A .......................... ((ff''jj GAS INSPECTOR WHITE: Applic ra:CANARY: Building Dept. PINK: Treasurer GOLD: File Say State Gas Company e� AUTHORIZATION GAS _INSTALLATION AU RIZATION O Date 1,0-A-9-9 / Issued toif� u/ oS u�Tf� Address�l 7 S S' , f C For Installation of: S �< BTU Input Restrictions BSG Representative PERMIT ISSUED BY INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: ❑ Heating System (BTU Input ) ❑ Range ❑ Water Heater ❑ Clothes Dryer ❑ Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO. 721 LAWRENCE, MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840