HomeMy WebLinkAboutMiscellaneous - 41 UNION STREET 4/30/2018N
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No.
NpRT1y TOWN OF NORTH ANDOVER
Oft.•° .�'�tip
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9
Certificate of Occupancy $
'+s'••° E<� Building/Frame Permit Fee $
s�►CHU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #'�
Building Inspector
O','! V rV ATAL Id
BUILDINGEY-
BUILDING DEPARTMENT
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.3
District Proposed Use
Date �-/— /5" I - -:1V 60
1.2 Assessors Map and Parcel Number:
Map Numbdr Parcel Number
1.4 Property
Area
Front Yard I Side Yard I Rear Yard
Required I Provide I . Required I Provided Re red Provided
1.7 Water Supply J jG.L.C.4o. § 54) 1•5• Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service
Signature 1 eiepnone
2.2 Owner of Record:
Name Print
SECTION 3 - CONSTRUCTION SERVICES I
3.1 Licensed Construction Supervisor:
Licensed Constniction Supervisor:
Address
Signa -"re Telephone
3.2 Registered Home Improvement Contractor
Company Name
Address
T,
Address for Service:
Not Applicable ❑
License Number
i
Expiration Date.
Not Applicable ❑
Registration Number
% /
7,/ 7 J'
Expiration Date
SECTION 4 - WORXERS COMPENSATION (1VLG.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
applicable)
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s)
Addition ❑
Accessory Bldg. ❑
Demolition 0
Other
❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTEVIATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
1. Building If P
(a) Building Permit Fee
Mu1ti lien
2 Electrical
(b) Estimated Total Cost of
Construction
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 BUILDING PERMIT
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.
I Signature of Owner Date
- - - - ---------- - -
I SECTION 7b OWNER/AUTIWRIZED 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
of
Date
6/?,
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE OF FLOOR TIIVMERS 1 s 2 3
SPAN
DEvIENSIONS OF SILLS
DEVIENSIONS OF POSTS
DROENSIONS 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
a
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Apr 18 01 CG:30p Jot
Comme 'In
rcial 0000
proplAal
Licensed & insured
• Roof Leak Experts •
(978) 794-3883 • 1-8pp..WATf-4-US
1Hme , nae f
il f- L--- � / C � '?� job Nmnc
Storer (43 o&)1~�J 3 i boll
Job iocaiioa lob Phone
City, ;.We & Zip coda
c;0cX, I/
We propose hereby to furnish and labor in accordance month specifications below, for the sum of:
E �� (rl 1 B /u Dollars (S
All wosit to be cotnplrad in a workmanlike Authorized
All taeerial is l a be ttom S><gMt=:ffomff aeawdM9 10 standard
txs ,IUMM w de•itttim
an
toss will be awcoW only qpmwfta ardWLmakes, NATE: This pmpasel may be
C
charge ovc and above 1, o tine o imd WIN ne�Y ice• wi*dm" by a if not staptod within_ days.
0 delays beyond our wn v d b y,,,, --
Our workers ■te fully wvaoby 5
We hereby submitspeeific&onsand CBUMBW for Shingle over existing Roof
1 install 3 feet special Eave seal ice & water shield along
all bottom ed e & top to bottom in vallies.
2 Install new Alum Drip edge on all bottom edges & Rakes.
3 Replace all pi e boots where applicable.
4 Apply 25 year IKO premium asphault shingles throught.
5 seal all chimmney & flashing with clear geo seal caulk.
6 Remove all work Related Desire.
7 Contractor warreur.R-
workmanship for 12 years under normal circumstances.
Local current Reffrences
and proof or workman's comp Insurance Glddly given
Additional/� n"`y`� TSL-
r
ptaDee Of pr'ap.al ' The AW a�'..s•-____calions
and conditions — 5 M f8 kNy and 8[e hereby
you are authorized to do the `NO* ranamcptcd-
payment
will he made as outlined a ve.
Date of Accepla=.�—
S]goature:
Signature: ` ,
.. 11/0812000
�.. CERTIFICATE OF LIABILITY INSURANCE ROFINIwR TION
THIS CERTI THE CERTIFICATE
Cpl ONLY AND CONFERS NO RIGHTS
UPON
=e1TEiis18T INBVRA= AIT�1= � I!>rC HOLDER. THIS CERTIFICATE DOES NOT AMEND, !EXTEND OR
S22 CAICis$RING ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INWJREM AFFOWING COVERAGE f
,MTN ANDOM, ma 01545
INSURED
ALL UIQALR ONE ROOF/P38T ly 7yj
70 Jgyr=aog STiMST
WMTR ANpCVER xx 01645-
INSURERA: 9AVt,RB ilOFBRTT P" CJ18MTY
NNOURER 9,
INSURER C:
INSURER D
IRSURER E:
pVERA0E8
TH RESPECT TO WHICH THIS CERTIFICATE IAPY Be ISSUED OR
THE POLICIES OF SS M OR CONDITION OF NANCE LISTED BELOW Y CBEE
TNRACT 0a OTHERE I R E D ABOVE fOR THE POLICY PERi00 INDICATED. NOTWITHSTANDING
ANDIN
ANY REQUIREMENT,
�Y�1eeT� REG�ATE L@NffSEAFFORDED BY THE SHOLVN MAY HAVE BEEN�IREES DESCRIBED 0410ED BY PAIDCRELAIMIS. IN IS SUBJECT TO ALL THE TMS. EXCLUSIONS AND CONDITIONS OF SU H
ne....wr cc _ POLICYNaT_NQN LIMITS _
LIABILITY
MERCM GENERAL LIABILITY
w%is MADE 03 OCCUR
OMIT
AUMMODILE LIABIUTY
mi
AUTO
ALL OWNED AUTOS
SCMEDULEO AUTOS
MIRED AU703
❑ NON c [) AUTOS
OARAOE LIABILITY
i in
n. ANY AUTO
EXCSBS LIABILITY
pOCCUR 1tom;CLAI0MADC
^DEDUCTIBLE
!J RETENTION i
WORKERS COMPENSATION AND
FAFLOYERr LIABILITY
A
pERgO" 3 ACV INJURY
(�NE�' AGGREGATE S
PRODUCTS -COMPIOPAGG I
IcomaimsiNOLELIMB i6
I BODILY 9Wq/RY I
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AUTO ONLY -EA ACCIDENT
iOTHER THAN EAACC f
AUTO ONLY: AGG 6
! BCH pC,CUFRENCE 6
1 AGGREGATEE
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EL EACH ACCIDENT I 100
11/09/2000 11/09/2003 ELOISEASE.EAEMPLOYE s 100
�► o1sFAsv.voucYlwllrla - 500
SHOULD ANY OP THS ABOVE CEBGRIBED POLO" BE CANCELLED 6lEOR6 THE EXPIRATION
DAT! TNgagor, THE IblIIND 0600t WILL ENMVOR TO MAL 010 DAYSWIRMIN
NOTICE TD iH[ BERTIFlCATE HOLDER NAMED TO THE Lf", BUT FAILURE TO 00 50 SMALL
NMP'OJE NOOBWATION OR UABU-y OF ANY KIND UPM THE IvMW. R, ITII AGSM OR
TACORD CORPORATION 1