HomeMy WebLinkAboutMiscellaneous - 48 COTUIT STREET 4/30/2018 48 COTUIT STREET U-1
210/023.0-0073-0000.0
9
Location
No. a d Date 0-12-
TOWN
2-TOWN OF NORTH ANDOVER
F w
L 1a ; : Certificate of Occupancy $
CM � Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
r, 'a
TOTAL 317,
Check #
� 7 0
' Building Inspe6r/
• TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER. DATE ISSUED:
ic
SIGNATURE: Pnsnector
Buildin missioner of Buildings Date z
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number: O
Ll i, Cof U, f- f G()a3 C 073
ii n Map Number Parcel Number
Y1.�f,��J !f J
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Fronts ft
1.6 BUILDING SETBACKS 00
Front Yard Side Yard Rear Yard
Required Provide Required Provided Re red Provided
v
1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1.1;7 ! '1 'Ct; 1rc? �)
2.1 Owner of Record
Name(Print) Address for Service
�i -
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service: 0
z
M
Signature Telephone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: 0
License Number
Address
Expiration Date �
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
T13�,�,�5
Company Name M
SRegistration Number r5'-j �•� ��'�v�-�w vel S 14l-wrt , N�`�' 03 L��,
Address r
Expiration Date
SiL4 re Telephone
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.
Signed affidavit Attached Yes.......❑ No.......0
SECTION 5 Descri tion of Proposed Work check alta licable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ [Addition 0
Accessory Bldg. ❑ Demolition 0 Other ❑ Specify
Brief Description of Proposed Work:
/y V oY1 Au 'ow
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
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
6 Total 1+2+3+4+5 €i Q Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
r 't
�/►
I, /1 G'A u'��' as Owner/A o ;i Agent f subject property
r
Hereby authorize_ to act on `
My behalf, l a a o ns b dung permit application. _�
w /G L/
IV
Signature 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
Print Name
Signature of Owner/Agent Date
e
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T11VIBERS I Sr 2ND3KD
SPAN
DDv ENSIGNS OF S.9_LS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
l-IEIGHT OF FOUNDATION _ THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
1S BUILDING ON SOLID OR FILLED LAND
IS BUII.DING CONNECTED TO NATURAL GAS LINE
NORTH
11 To ; .1,own f over
No4p w
0 E
over, Mass.,-
LA
LA
i
COCHICHE iC iCK
0):?ATED P' C7
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
•
_A.A BUILDING INSPECTOR
THIS CERTIFIES THAT....... .... d
a.............. ......................................... Foundation
E� •
has permission to erect........................................ buildings o%...... ................
.. .......... Rough
to be occupied as%,o ........................................................ Chimney
provided that the person acceptingper 1- i-ihilamlliolilino4eoovhellrllrleoolsllpllellcllIlI Ucon6MI7 t6--t.e..r...m-s--o-f--th--e-- -application an file Final
this office, and to the provisions oc�aides 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 ELECTRICAL INSPECTOR
45y Rough
................................................................................................................. 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.
✓fie �ai�vinmuuea a�/�aaoac�ivael7d
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
RegistFatibn 101682
l=x�t San -- /29/2006
I 'OPlement Card I
BROOKS CONST IN R-LA
WARK DI PRI '
254C N.BROADWST
i !. SALEM,NH 03079 Administrator
awl- -
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 tdebris will be disposed of in:
RQc Qon)p i np r
(L74iof
ermit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
FROPi : DAI,IIS DPOIS MOODY INSURANCE PHONE NO. : G03 302 770E Oct. 01 2004 03:02Pti P1
DATE(MMA)DIM
.�roRn CERTIFICATE OF LIABILl�� IIU��.11�,�LIV�1�OCO01 � ro1o1 0� f
PRooaceR TES CERTIFE(:ATE 13 ISSitED AS A MAT R OF 1NIFI ATION
ONLY ANn CONFERS NO RIGHTS(UPON THE CERTIFICATE
llavis, Davis 6 Idaociy HOLDER.THIS CERTIFICATE[DOES NOT AMEND,EXTEND OR
ALTER Tt COVERAGE AFFORDED BY THE
POLICIES BELOW.
Aoute 125
Plaistow NH 03865- INSURERS AFFORDING COVERAGE;
Rhone: 603--382-9354 Fax:603^382-7796 ---
- mrs hantS
F3 okttgg Conatru0t_ion Co. , Inc. INsurGac.
5aletn NS 079 Itiihli0rd,lIsy IN3,RFR 0:254 Wor — —�--
I'Ns�IaERE:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURPO NAMED ABOVE FOR THE PCLICY PERIOD INDICATCD.NOTWTThSTANDING
ANY REQUIREMENT,TLFiiw(OR CCINDETK?N OF ANY CONTRACT OR OTt rR DOCLMENT WITH RESPECT TO WHK:h THIS CF-RTIF)CATE MAY BE ISSUED OR
MAY PERTAN,THE MURAN015 AFFOPMED Bv THE POLICIES gP_3CFii6ED H-WREIN 19 SUWECT TOALL THE TV"4S,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIIATS SHOWN w)AY HAVE!BEEN REDUCED BY PAID CLAIMS. _—. -- —
_ '�� -- LIMITS
LTR r ROLIOr NUMBGR 1 DATE(MWObNY3—
—�— j FJgGtiOCCURRENf,E j S lO_OOOOO
GcNFRAL LIABILITY j I
t OA{2E3f 05 FIRE DAMAGE(Any an&timi s 100000
A �CNIM
OeRCIALGENERALLIABI:iTY � CCP614552i 04f28/04 1
1 !•--.. -
���} ryI lrMED EXP(Ary OM WSW)!S 5000 _
1 CLAIMS MADE L.."= OCCUR ` I PEft80NA1 G/+4V INJUUR— S1,000000
GENERAL A=REGATE '52000000
—, rp—poouc;s-COraPIoPAG'. s 2000000
�GIiNL AGGREGATE L'.MI`.AP—PLIE4,ER: '
PRO. ?—�LOC
' PQLICY JEGT _—�,,,__.�s
[ALSBINEDSINGLE LIMIT B
!AtlTOMOEIIL,E LIABILITY —� 'i `SF ecciddlHl
ANY AUTO
ALL OWNED AUTOS I I BODILY INJURY S�—�
i (Per 7i"rsm)
^^j{ ;CHEDULrn AUTOS I I I—. .---" 1 •+—
HIRED AUTOS I SODILY INJURY `$
((3g!A[cidena
I NON-OWNED AUTOS
RR.SPERTY CAMAGE
(Per c aanq s
— - --,-
9ARAOE LIABILITY i I i AUYOOIe'LY•1`A ACCIDENT �—
�OTI-�Fc THAV EA ACG!S
r�ANY AUTO I AUTO ONLY - -.
AGG w
EXCESS UABIWTY c/1CM!OCCURRENCE ('3
OCCUR ` CLAIMSMADI ! ACj4REGATE _ 3—
f {'G{JUCTiF3LE � ( �— -•-^—•--1-5 -- J
RETENTION
WORKER6 GCAIPEN84TiON AND
TQRY CImrTS I R '•rte ^--
A j pMOLovER�S'LAETILITY i WCA6145529 05/16/04 05/16/05 QTH
sL.EACH ACC0EW ISS 100000
i E.L.O(SEASE.EA EMPLO+WE.i•5_00000
E.L,OISSr•POLICY LINT $ 100000
1�67NER I .
06SCRIPTION OF OPE .JaT)ONS,NE.NiCLESJEXCLUSIDN3 ADDED I Y fNOORSEMENTIS!" AL F'K6%A&0N3
CERTIFICATE HOLDER. Z3 Apwri NAL IN3URCO:INSURSR LETTER__- CANCE=LLATION
Dy1,WA Y 5MQUL0 Adv OR THE AEOVE DESCRIBGO POLICIES BE CANCELLED 39POAP THC EXPIRATION
,PATI TWCA90r,THE ISSUING INSURER WILL Sl bEWWOR T6 MAIL -IfL_DAYS WRITTEN
l4Abl:Lm JOHMSON NOTICE TO TH ERTIFICATE MOLDER NAMIED To THE LEFT,BUT FAILIM6.TO DO W BNALL
DEBBIE aER24HTM IMPD NO C06 ION OR u0&LITY OF ANY KIND UPON THF,W&URWR,ITS AGONTS OR
4s COTUIT S` T
NORTH MDOVM MIA 01845 RESENTAT s —
TNORLZED
ACOR025S CV97) CA RO CORPORATION IUll
W OKS-
LC-))
r �I
SIDING- WINDOWS- DOORS
Family Owned And Operated
254 North Broadway a Salem, NH 03079 In the Breckenridge Malt
www.brooksSWD.com
(978) 686-0260 0 (603) 894-4488
Uwe the owner(s)of the premises mentioned below hereby contract with and authorize you to furnish all necessary materials,labor and workmanship,to
Install,constrict and place the improvements according tfo,me following specifications,term and conditions,on premises below described:
Owner's Name: 61A inc, <JortA Sari 1.04-bA e-- F--P11 h'l� Phone' {q7J9 -'> 7
Job Address:ys' (r;�k,;t S'M,cf City N r Ylt rYrt JI.vPu State 11?( PID COI b" S
(WINDOWS)SPECIFICATIONS
TUTALwtntwWS A I F L A 5 G ADDITIONAL OTHERWORKTO
`11 T O O R R R WORK BE PERFORMED
tvry �,k- . ��_ G A WG E )
BRAND COLOR HOW MANY? M 0 E D Yes/No YesMo
N
E N s S u rs VIC
Double Hu U 0- e� a5 Trim Doors
PICTURE IrlsulPath Doors
2 LITE SLIDERS
3 LITE S DERS Buikl Roof s
Tie Into Overh Remove AN Debris e
BOW GARDEN U 00 c PVC mm e oDruer Requirea 0"
CASEMENT,AMMING
BROOKS does not Oo any paknYp or staikn¢BROOKS is not respmsb%for the caMkions
PPER o a�ctr sraxrs tseykv d 8 cont d resuttg from o doe m p aedsS god tit o s
SINGLE HUNG
Pa~dYnient to be merb ei blb�
TOP SASH DOES NOT WORK TOTAL [31191r- 00
2L% 1-060.i;(j)upon signing contract
-3Y d� � t`<,
n (SJ-2,0(A' ce upon completion
was (SIDING)SPECIFICATIONS
Apply f9)nc f'L 6,41-111 over body area of house.Type of irtstdation -ilk
Rom not covered or installed: Yes No Yes No Yes No
Provide x
r
ra Soffit X Wu Marrmis
Door Surrounds Gutters X
Full Wkrdow Cas Deno!Mantels X Gutter off&an
Provide Vicryl Accessories light �y nice luted oost
blocks d r v event faucets. x Ceif Traditional
rwnA& InsideButhess RRrtvwa al riS
'h rr CJ
oM STARr All-dORC•"nWCWNFRC MUST RFerOUR ALL MENS FROM WALLS L CNG WGC
Constn¢aon related permits:M are homeowner obrakrs hm wm�nsd wmdfs ro.Me work msc.bsa u,dsr urs aar.smsm.ms nor�owrrr is rraebv adds.d not ii
this event of dkpese,PaI rmat And ampsynimt of the coursers:the hemamww wm not be wdided to mattea4ahrtoaeoeeU Irom the gvarertty f+wrdestabllslted by ChpYr
usA,LLQJ.
WARRANTY
The CW*actw wartams Mat Me work fumisfmd tmreatder shall to free from dabcCs in rnatmiafs and w damnWp for a period of 1 Year
rn nfty wkh ere ropuiarru+nta d Nie 4greernor+.to Yw ew,t n^Y dotoot m vrodononeh'y w mnlerinb,a darrv,ge cowed 4'Y Me Oanrstor,Ria aWu.ba.4wa ar Wyne pU mpkbon and 6hes
dfeWvered%Mkt one year atter complokion a any p0.Including aeamp,tum Contra=stmt,at hs awn expeme,tadtwdUt remedy.topair,cored,replace,or rause to be ren ted repaired,or
replaced,such damages or sulk Uelect b meterlak a wodurmrMW The foregoing%smaRbes shat anvive any-pacbm performed m cemectbn wth the agreed-upon work.No guarantee on
90orback rp in root no ouararnas on ice back tp ant no gtsrardee on fading of 4rA sting.BROOKS is not rospandble tar mad or mildew All warraniss a porw ass relate back to the
rtrer>uFa<xeer.llyder such monulecWrers'warrtrties,dm Owner maybe required to regster or mad b a warramy Card or other evidence of ownership and use a such equonent n order to acti-
vato suds warardies.The Ownees fatwe b mag b o.reglsler sudt dooumerttatiom%Itch lathrre voids to maxoacaraes v—anty,shag not croete any rosporvANUy for Ma Commcw to war-
ranty sk ch owvrrtenL MANUFACTURER GUARANTEES LABOR AND MATERIALS NOT BROOKS SIDING SUBTOTAL:
A service dteng0 a 1 112%of the urpeid balance per month will be added to belanoe d not paid aux;mdig to terms of contract an completion of cora w,
TOTAL: dollars($ Q 2p��D W))
Payment to be made as foto s,
% $ Brooks Vinyl Siding-Windows•Doora
( CJ(70 G{s)UllonsigningContract: Nam 01Camactorfoe'W WRegistmm
so%($ VOC,O•CO )Start of job 254 N.Broadway-Bredgenridge Mall
sweet Address
50% ($ CJ,SUO.CYC )Half of job o�mcl We-V- Solemn NH 03079 (603)894-4488
(7yrsram Pt
50% ($01 9SC k= )3(4 of balance•3 r: »4 101682
C-i) Balance upon completion QED DI PRIMA
Note:N Cancelled After 3 Days 50%Non-Rekndable Nam,at salesmen
Notice: No agreement for home improvement cormactin work shall require a
down payment(advance oepasty at more man—WA--o�the tDfaf contract price A.W-bO SO aura
or the total amount of all deposits or payments which the contract or must make,
in advance,to order and/or otherwise obtain delivery of special order materials and
�
ekgquip� t,mennYwhichever amount is gMr
y��.a of ProPOBal-I accept Ma prices,Spoff Caburs and owdil wis staled-I ukdek5tand dot Wpk Sillktm.MR brapar I a n h'Mnp rMrarl Y—Ah-L ed b de Me
wok as spedtmm d Paynmwill be made as outrned above.You,the Buyer,May cancelrids transaction at ary tare prior to mMnW of the third business day atter the date of
this transaction.Canceitenon must be donne in writing.Yde reserve the right to chock your cred(L
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
IN WITNESS WHE 'EDF d m h unto have signed their names this J3 day of A)LC 20�i'�
Rignrari - t t. Social Eoourity Number
Signedx §,1 prrlOwnBi�l:YQ tee nc -
�, rrr���r��� Somal Security Number
Yes,J am the Owner