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HomeMy WebLinkAboutMiscellaneous - 634 SALEM STREET 4/30/2018 634 SALEM STREET 210/065.0-0044-0000.0 0 Location (� 'S No. l Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��J'•• t<� Building/Frame Permit Fee $ ncMus ` Foundation Permit Fee $ tib 410 Other Permit Rw $ TOTAL $ Check # 16335 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: d DATE ISSUED: ic SIGNATURE: Building Commissioner/I or of Buildings Date z SECTION 1-SITE INFORMATION 0 1.1 Prop y Address: 1.2 Assessors Map and Parcel Number: D p'Number 4arel r� 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ -Zone Outside Flood Zane ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record 1 i me(Print) A cess forService, Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z m Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Conotruction Supervisor: O License Number Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contrac or Not Applicable ❑ v G ompany 14ame m egistration Number r S�� 4& Address Expiration bate /1 S' a e Tee hone Y 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.......❑ SECTION 5 Description of Proposed Work check su applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Des n of Proposed Work: I Z //' z SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be x omit" 'L"USEfONLY } Completed b ermit a licant 1. Building / �g a (a) Building Permit Fee �•(� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) >pr,M ' 4 Mechanical HVAC 6 / 5 Fire Protection ` �' /V0 c 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 permit application. Signature of Owner Date o SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 ka Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIABERS IST 2ND 3RD SPAN DDAENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CMMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 Perrnit 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 c 11, S.150 A.. The debris will be disposed of in: V(f-L, d 7 (Location of Facility) „t Sig of Permit Applicant / Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector 04/30/2003 VIED 11:42 FAX 15084538089 ALLIED AMERICAN SELECT 0001/002 AC 'LP CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDJYYYY) 04/30/2003 PRDDucrR C800)333-7234 FAX (508)653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALLIED AMERICAN INSURANCE AGENCY LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Carlin Insuranc-e HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 233 West Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 INSURERS AFFORDING COVERAGE NAIC# INSURED Bruce Yeager INSURERA; Travelers Indemnity Co 25658 DBA: Home Improvement INSURER B; 237 A Broadway INSURER C: Lawrence, MA 01841 INSURER D: INSURER E: COVE S 99 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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. INSR AUD-7 Typg OF INSURANCE POLICYCY EFFECTIVE POLICY NUMBER POLIPOLICYtMWDDNxL EXPIRATION LIMITS GENERAL LIABILITY IIACH OCCURRENCE 5 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S CLAIMS MADE F—]OCCUROGCUR MED EXP(Any one person) S PERSONAL d ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S POLICY ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO - (Ee acc(denl) S ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accIdent) GARAGE NABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO FA ACC S - OTHER THAN AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FICLAIMS MADE AGGREGATE g 5 DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND ORIGINAL TO FOLLOW FROM 04/65/2003 04/05/2004 WC STATU. oTH- EMPLOYERS'LIABILITY LIMITS A ANY PROPRIETORIPARTNERIEXECUTIVE CARRIER E.L.EACH ACCIDENT S OFFICERlMEMBER EXCLUDED? It s,desuibe unser s.L.DISEASE-F=A EMPLOYE S SPECIAL PROVISIONS bolow E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPPRATIONS I LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Job: Salem Street, Vince Siwicki CE TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVH 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Town of North Andover OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Corinne 3-R ers ACORD 25(2001/08) FAX: (978)687-6730 (DACORD CORPORATION 1988 APR-30-2003 WED 11:43RM ID: PAGE:1 a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers'compensation for my employees working on this job. Company name: Address .City: Phone# Insurance.Co. Poli, # Company name. Address City" Phone# Insurance Co. Policy# Faiture to secure coverage as required under Section 25A or MGL 151 can lead to the imposition ofcriminal penalties of.a fine up to$1.500.00 and/or one years'imprisonment_as_w*elt_as_c ivd pmabi sinlheSorrnda-STOPYYORKDandRDERafm -d 1JWM-a understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veYificationI ag . /do hereby ceitily under sand penalties o ury the irrfonnation provided above is true and correct Signature Date —50 Print name Pbme.# Oficial use only do not write in this area to be completed by city or town official' City or Town Permrt/Licensing I] Building Dept El Check Yimmediate response is required .0 licensing Board F1 Selectman's Office Contact person_ Phone# E] Health Department Other I �F ... � ;,JI/t6 Vd)lYlncilCa/ttZl.Ut O�f��.JSf6C/t[A�d� ji r• 3.1 i ' _ ` Board oYBu�Iding Repilati.6s and Standa> l t HOM E IMPROVEMENT CONTRI+.CTOW ' , .. c Rcgistiallo» !6o98 A., WE iratiarr 9/2&2004 t: ';. Type'.,fndi�ittual rYA L- ; st�ucl=PArR�cK v ��R h KIRK ST. --1 .i A.n44dd A.F.v.C.�icfrAfOY� a J� I it I I i I Page No. of Pages • He o. nn e Improvement Inc. 1 237 A. Broadway Lawrence. Ma 01843 ( a 8) X57-3785 Bruce Yeager PROPOSAL SUBMITTEl PHONE DATE STREET j JOB NAME CITY.STATE and ZIP CODE JOB LOCATION" 4f ARCHITECT DATE OF PLANS JOB PHONE e2 Z Z S We hereby submit specifications and estimates for: -All At k VVU Mr Vrupost hereby to furnish'material and labor 7—com. I-6te in accordance wit above specifi.qations, for the sum of: tabe-7�6-de as fol0vS� doll All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tomado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. �1L�P�tttri�P O1 �rO�Osttt —The above prices, specifications ; ���_ __ and conditions are satisfactory and are hereby accepted. You are authorized Signature - � to do the work as specified. Payment will be made as outlined above. \ Date f Acceptance: Signature NORTH I E ' Town of Andover 0 No. %943 o�A ':O 'C ( �` dover, Mass., .3 0 •a o� 3 ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 0 • BUILDING INSPECTOR. THIS CERTIFIES THAT.... .. .. .:.. ...................... ... ...��`. .. .. ............................... ............ Foundation has permission to erect....��. '. .�,. ........ buildings on ....4P.. ........ ..,`�,W!�....... Rough to be occupied as � �......t .0..�........ W+! �.�„� ►,,,, Chimney .................................................................. provided that the person accepting this permit shall in every respect con or to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws r lating to the Inspectio , Alteration and Construction of Buildings in the Town of North Andover. �G S, 4 4 Boo.- A0 12W%4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. #- drV APOough PERMIT EXPIRES IN 6 MONTHS Polo Final UNLESS CONSTRUCTION ARTS ELECTRICAL INSPECTOR C Rough ........................I....................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises ^ Do Not Remove Rnalh 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.