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HomeMy WebLinkAboutMiscellaneous - 44 SUTTON HILL ROAD 4/30/2018 44 SUTTON HILL ROAD f _.� 210/097.0-0033-0000.0 v►ORTq Of♦tn ♦1�0 0 O p i NORTH ANDOVER BUILDING DEPARTMENT r 4nD 400 Osgood Street ,SSACHUStt Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: /'s-b NAME: ADDRESS: q q s��r � t4- ( / 4 A-0 Na,cTr-� 74- ✓P --f-- ZONING ZONING DISTRICT: TYPE OF BUSINESS: y 5•°`'e s 5 Ccs ti.5 y L-7- BUILDING -7`BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: i ZONING BY LAW USAGE: �S NO d BUILDING INSPECTOR SIGNATURE Revived 11.5.04 BUSMESS FORM FOR TOWN CLERK t Location ` No. e Date) NORTNj TOWN OF NORTH ANDOVER Of• .•o ,•�ti 4L ' Certificate of Occupancy $ i , ��s'^••° Eta Building/Frame Permit Fee $ ncNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ' 17 4 9 9 - �--.�..�,- ,uilding Inst or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPRENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING WNW-2111,11,11- M BUILDING PERMIT NUMBER. DATE ISSUED: (e 14,/ X SIGNATURE: Building Conurlissioner/IE§eector of Buildings Date --e z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ►-r ,�, 1�e c � �' civ 3� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dish c—t Proposed Use Lot Areas Fronta e`ft 1.6 BUII.DING 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 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone m SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ L (� tDeLY Uhnsed Construction Supervisor: ) �f License Number Mn ' Ad reser -t 7 Expiration Date ic Signature Telephone r. 3.2 Registered Home Improvement Contractor Not Applicable ❑ ll^ d LV ) Company Name 0 1 r Registration Number Address "2 _3 �Jl"ta ® ' 8 as, 3 Expiration Date /� Signature Telephone Y� i A 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. Si ned affidavit Attached Yes.......0 No.......0 SECTION 5 Descri tion of Proposed Work check applicable New Construction ❑ Existing Building zW., Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: S.— 4— T � SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be v 7T " Completed by permit a licant 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 o� _ 6 Total 1+2+3+4+5 / (? Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN f OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r� G,(1 LY as Owne Authorized Agen£�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 SEC/TION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Own Auth�edAgenf 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 N e i ,•, `7` 2 77- 0 � Si ature of Owner A en Date / NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DEMENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i 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 c11, S150A. The debris will be disposed of in: (Location of Facility) Signatureldf Permit Applicant _ . -7- 2- -7- e D e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r a/%1►�.��e CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 08-11-03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SENNOTT INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 MAIN ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO BOX 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TOPSF I ELD MA 01983 COMPANIES AFFORDING COVERAGE ------------------------------------- 2946N COMPANY — A ROYAL INSURANCE COMPANY OF AMERICA NSURED COMPANY LEN GIBLEY CONTRACTING COMPANY B INC I COMPANY C COMPANY D ;OVERAGES THIS IS TO CERTIFY THAT 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 0 A TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM\DMYY) DATE(MM\DD\YY) LIMITS I GENERAL LIABILITY 177 ' g COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE I PRODUCTS-COMP/OP AGG. $ i _J CLAIMS MADE OCCUR, PERSONAL&ADV.INJURY g _ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE g FIRE DAMAGE(Any one fire) $ ALT)MOBILE LIABILITY MED.EXPENSE(Any one person) g ANY AUTO COMBINED SINGLE $ LIMIT ALL OWNED AUTOS i SCHEDULED AUTOS BODILY INJURY(Per Person) g j _ HIRED AUTOS i NON-OWNED AUTOS BODILY INJURY (Per Accident ' $ -- PROPERTY DAMAGE $ GARAGE LIABILITY I �ANS AUTO AUTO ONLY-EA ACCIDENT $ �— OTHER THAN AUTO ONLY; r EACH ACCIDENT g AGGREGATE EXCESS LIABILITY g EACH OCCURRENCE g i UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-754X134-7-03) 08-03-03 08-03-04 1 STATUTORYLIMITS I THE PROPRIETOR, EACH ACCIDENT g j I PARTNERS/EXECUTIVE X INCL 500000 OFFICERS ARE' EXCL DISEASE—POLICY LIMIT g SOO 000 .,,OTHER DISEASE—EACH EMPLOYEE S 500,000 iSCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS :RTIFICATE HOLDER �- CANCELtATIQN I Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -ORD 25-S (3/93) ®ACORD CORPORA 1993 ACORD,M CERTIFICATE OF LIABILITY INSURANCE oii3oizooa PRODUCER (978)887-4900 FAX (978)887-2404 OWIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfiel d, MA 01983 INSURERS AFFORDING COVERAGE INSURED Len GT bel y Contracting Co. , Inc. INSURER A: Western World NSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THEPOLICIES 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 POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRP L E I I XPIRATI LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/ DATE I /YY LIMITS GENERAL LIABILITY IMA577724 01/29/2004 01/29/2005 EACH OCCURRENCE $ 1,000,000 'TCOMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADE M OCCUR MED EXP(Any one person) $ 51000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY F1 PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - 0 r ALL OWNED AUTOS BODILY INJURY $ B iCHEDULED AUTOS (Per person) I HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPER DAMAGE $ (Per accidnt) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ ATU WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHI' LES/EXCLUSIQNS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS E: Evidence of Insurance CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Peter Sennott LA ACORD`25-S(7/97) FAX: (800)404-9880 ©ACORD CORPORATION 1988 NORTH Town oft 4Andover 'k No. o �9 t. _- LAKE A dover, Mass., J'' y -wyO COCKIC EWICK y d AERATED P'P�` �y 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.................... ... ................................................................. .................................. .. .................II. Foundation has permission to erect.................... ................... buildings on .... ... ..............................................1. Rough tobe occupied as.... .... . ... .. ...... .............. . ......................... ......................................................... provided that the rson accepts this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST T ELECTRICAL INSPECTOR . rRough ................................1............................. ............................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done . FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. a� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 059482 by Birthdate: 04/23/1953 Expire5;.04/23/2006 Tr. no: 21288 Restricted: 00 LEONARD GIBELY. Acting C imnisxoner I Board of Building t�cl;ulationr� �rrr�l�fr��frr�r�lr _JfVii_