Loading...
HomeMy WebLinkAboutMiscellaneous - 318 SALEM STREET 4/30/2018 (6) 318 SALEM STREET 210/037.6-0068-0000.0 \ 1 P. Location s -S No. G Date 9 NORT" TOWN OF NORTH ANDOVER 3 OL t Certificate of Occupancy $ Building/Frame Permit Fee $ !9 �cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # b 16 8 1 1 /V Q_,,/ Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMrOLISH A ONE OR TWO FAMILY DWELLING .>: f �?.,• s.,"�y�aC s"�`+�sz w tg4 �a s�a,�34r,t�1 ,�3,��'..t..- .., ;'o1Q1`�a ..��.1����� Sa�j��s'�'�6�j�irc3 .',t��t��r`�''°�l»�t t sn r�sr r far ...as -c ' BUILDING PERMIT NUMBER: DATE ISSUED: rn ic SIGNATURE: Building Commissioner/ImeEtor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0069 Ma� °mom Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area 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 ❑ -zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record ,44,EAf STT Name(Pnnt) Address for Service: C [:)C) V JER 14/} Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Si i;Sature Telephone Amw SE TION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: \ O License Number Address mn rati Signature Telephone Expion Date ic� r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 D16V f DRaoIFCA 6, ?- SID/A)GZXC S` Company any Name m Registration Number r s r A, � g 3 3 [1 Expiration Date Signature Telephone y, i SECTION 4-WORKERS COMPENSATION(NLG.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 DesciA tion 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be £; 7 OFFICIAL IISE 4NLYFt C leted b ennit a licant ry 1. Building Q (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X M 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number ('a SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION c� 1, PAV IP CA S 711 C—o ALL 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 DAYID .S (—oE Printe %, _— 2 r—.JZ / / � � it Si na,tue of Owner/A ent Date L� NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2ND 3RD 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 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-954 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant 6 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i AcoRfld CERTIFICATE OF LIABILITY INSURANCE 9/18/2003 PRDDucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INTE)RmT xrrsysuwc9 A=Nc`t HOLDER.TH19 CERTIFICATO DOES NOT AMEND,EXTEND OR 522 CKICKERING ROAD ALTER THE COV)RA09 AFFORDED BY THE POI.10118 BELOW NORTH AMMR, 9A01845 IN9URER8 At FORDIN4 COVERAGE , INSURED INSURERA! AREELLA nAVID CASTRICODZE INSURER B: AUMIJ F, PROTEC$'ION RODFINO AND 8104NO XNC, INSURER C; StOln_SUN ALLS = 200 SUTTON STREET, SDITE 226 cz INSURER D: WORTS ANDOVER MA 01045- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIO PERIOD INDICATED.NOTWITHSTANDING ANY REQUIRInMENT,TSUI OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH T Ib CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUOIEG DESCRIBED HEREIN I6 SUBJEOT TO ALL THE TERMG, LU810N8 AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY)•IAVE BEEN REDUCED BY PAID CLAIMS. Iim NSR TYPE OF INSURANCE POLICY NUMBEP. F TI PIRA, LIMITS OENCRALLIAaILITY OCCURRENCE S 1,000,000 JL ® CoMMERCIALGENERALUABIUTY ®500012710 06/06/2003 05/08/2004 ' IRIgNggE An onoiva) 8 _ 50,000 CLAIMS MADE 170 OCCUR CD EXP(Any cne Person) $ 5 000 ❑ ERBONALaADV INJURY $ 1 f 000 000 , MNZRALAGORMATE $ 1,000 000 O^EN'LAGGREGATE L1MIT APPLIES Pak, J Pli0WCT5•COMPlOPA60 $ 1,OOC,000 POLICY ❑ PR LOG AUTOMOBILE LIABILITY �OMSiNCD SINGLE LIMIT � © ANY AUTO {Ea a=wanl) B ALL OWNED AUTOS 44506400001 SCHEDULEOAUTOS 08/01/2003 08/01/2004Ip op�laN'RY 8 250,000 HIRED NON•OWNED WNED AUT08 IBODILY INJURY g 500,000 I (Per aeaWerd) 1PROPERTY DAMAGE s=derd) UARIXY AUTO ONLY-EA ACCIDENT17 S ANY AUTO OTHER THAN EA ADC 5 ❑ TO ONLY: ACG $ EXCESS LIABILITY 'EACH OCCURRENCE $ OCCUR CLAIMS MADE I t3WREOATE $ S OEQUCTIBLE $ ❑ RETENTION 9 I 8 WORMERS WNIPENSAnON AND QMPLDYSki'LIADWTY - c 791XST6A01 100/23/2002 08/29/2004 IE.L.WHAC,CIDENT $ lo0 000 E.L DISEASE•EA EMPLOYO 8 500,000 I Y l00 .000 OTHER I DEBCRLPTION OF OPERArONB(LCCATIONFdVEIUCLESrEXCLUSIGNS ADDED BY ENDDRBEMENTISPECUIL PROVISIONS CERTIRCATH BOLD CANCKLLAT16N BHOULD ANY Of THE ABOVE DAVOR11516 POLIOIES BE OANOELLEO BEFORE THE EXPIRATION PATS TkEREOF,TNEi I$$IJINO 1%U146111i WILL GNDEAVOR TO MAIL 030 DAY$WRITTFiN NOTICE TO THE CERTIFICATE MOLDERED TO TME LEFT,BUT FAILURE TO DO SO SMALL IMF086 NO OBU0A11ON OR LIABILITY F ANY HIND UPON THE INSURER,ITOAOENTB OR REPRESENTATIVES. AUTNORIM0 kgPF&RENTATIVb ACORtT 28•$(1147) v ® ORD CORPORATION 1888 I t Board of Building Regulations and Standards,, p TRA TOR k! HOME IMPROVEMENT CON C l Re istratldn;_1.04569 Expiration 7!14'!2004 i _Private Corporation r t z. DAVID CASTRICONE ROOFING,;S IAI!` x�d tastricone '', 01e y l � 7 Hills ide,Road Boxford,MA 01921 Administrator i I