HomeMy WebLinkAboutMiscellaneous - 72 WENTWORTH AVENUE 4/30/2018Iti
Location 17 w o M A cr,L
No. 3 Y Date
NORT#j TOWN OF NORTH ANDOVER
0 9
` Certificate of Occupancy $
• s, a
MUS E<�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
¢, Check # a g 3 Y
t
16929
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
f,TT� .:
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: —AAtt CC,—�
Building Commissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
7 3 LJ At jl
a�
1.2 Assessors Map and Parcel
m p
Map Number
Number:
o? 116
Parcel Number
pp
1.3 Zoning Information:
Zoning Dista Proposed Use
1.4 Property Dimensions:
Lot Area
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required
4
-Provided
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ Private ❑
1.5. Flood Zone Information:
Zone Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
I SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT I
2.1 Owner of Record
Name (Print) G
2.2 ?wner of Record:
Name Print
-7 3 ��'t ,, ,7 CA A -v
Address for Service:
T�- L(
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed ConstUktion Supervisor: cQ
Address
q7 Y. 6`6t; -
i( Qvj �
Si re Telephone
Home Improvement Contractor
1z -a A
d. / t-5 • ((51
C s 0(0s79�
License Number
zq/Z_o o
Expiration Date
Not Applicable ❑
17&39£'
Registration Number
Expiration Date /
q*78.69)-o).
T
M
O
�r
SECTION 4 - WORKERS COMPENSATION (rLG.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 all 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
Completed by permit applicant
f)'ICIAI,.IiSE Q(TI,y F
x.
1. Building
(a) Building Permit Fee
Multi Tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
u �-
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
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 permit application.
-Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
pr y
.Ateby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
c(�5e a.
' Na
Pr'Name
-Z% �3
S' ture of er/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 217r53RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FR LED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Jean Sirois Woodworking
P.O. 246
Methuen, MA 01844
978-6854504
Customer
Name Debra A McElhiney
Address 73 Wentworth ave
City No Andover State Ma ZIP 01845
Phone 978-687-0291
Invoice No. 103
INVOICE
Misc
Date 11/30/2003
Order No.
Rep SIROIS
FOB
Qty I Description I Unit Price TOTAL
1 Remodeling in bathroom,removed old the and installed new tile,around
tub and floor,paint bathroom.
1 Material and labor $5,200.00 $ 5,200.00
1 Down payment received
SubTotal 1 $ 5,200.00
Payment I Check Tax Rate(s)
Comments TOTAL $ 5,200.00
Name
CC # Office Use Only
Expires
Thank You For Your Business
Insert Farewell Statement Here
Landmark Inst_+rance 9799769987
11118/09 01t19pm P. 001
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID C DATE(MWDDIYY)
__„ IROI 3 11/18/03
LICERTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CANFERS NO RIGHTS UPON THE CERTIFICATE
Landmark. insurance Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
198 Y. assachurptt,s Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North And*vjtax NIRA, 01895-41190
Phonc:978-688-8829 Pax:978-975-3987
_
INSURED...._._............_.._...__,..._._..._...�.__.-_. _...... ....... .....
Sircis WOO
dworking
Jean Guy D
77 Elm SEreat PO Box 246
Methuen MR 01884
COVERAGES
IN6URGR A:
INSURER 8.
INSIIKkK (.'
IN9URCR D^
IN;;I.IRtR E:
THE
POLICIES OF fMUR.ANCE LISTED BELOW HAVE WPN ISSUP_D TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY
REQUIREMENT, TERM OR CC9,MITION OF ANY CONTRACT OR OTHER DOCUMENT UYITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THC THRNIG, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_...A.. .___.._ '-"I-_�...._......... Tk�L_Pr=TKC_'T M;''1101-010.NN_C_POLICY NUMBERTYPEOFINSUR.L'
DATE(MAI.DATE (MNDpYY}j LIMITS
OENGRALLIABIIIT� I E
; EAC ('RRE%( __ 111000000
A
,OCC _
COMMERCIAL OENERALLIABII_ITY CPP0170526510 ( erlra) $ 50000
Ae
r___
CLAIM., MADE $ OCCI,IR n
MED EXP p
.—.-AMACE
Ye $177dineSB OWElOrP. ! 03/12/03 03 12/04 PERSONAL &YADVINJ 1$1000000
.URY
GENERAL AGGREGATE s2000000
CENLAOURCOATELIMIT APPLIES PFR PRQWCTS CCMPlOPAGG ; S 2000000
Pol icy rrr. ,
AUIUMUSILE LIABILITY t: MOWED P,INCLC LIMIT
4
ANYAWC) (CA,ctidett)
ALL vwNEunuros---.------.___ . ..
- I II
PJ'itNl"YIN,IIIRY
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ktUL�IL,Y INJURY S
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NUN.UVVNI-Q AuItM:i (1'elasuuvnU
PAW NJLUAiRLIfY
ANY AU IrI
1_-XL'ty!1 LIAt9UTT
! nC.CIJR I CLINMS IdADe
ULULII: I ILiLr
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WGRKFRRGI'1MI+PNRATIi1N ANA
EMPLOYERS' IJABILRY
by
RRCI'CRTY DAM.Ar,C —
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AU 10 (". Y - to A(G(%IUtN1 Z
0714PR THAN CA JCC I I(;
Al ITo a L'r: Arr• 3
tACH UCf:
CURRENC........'..... $
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t.L tA4;H AVUIUtNI 1 $
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EL...pIaCA: ...... ... .. ...
.. rA96 _ P31.4V I IMIT 1 1;
CERTIFICATE HOLDER IN 1 ADDITIONAL INSURED; INSURER LETTER! CANCELLATION
NORTWA3 LHOULD ANY OF TI IC ADOVE DCSCRIDED POLICICS BE CANCELLCD BEFORE THE EXPIRATIDN`
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .... , ... DAY8 WRITTEN
wavm of North .AndtIver NOTICS TO TFE CRRTIFICATE HOLDGR NAMGD TO TNG LGPT, BUT FAILURE TO DO SO SNALL I
f Building Inspector
27 Charles StrAet IMPOSE NO OBLIG;AT ON OR LU6Ei1lSTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
North Andover DSA 01945 REPRESENTATIVE.
� ✓� � n�yrtiuea�fi o�,.,/�aaaaclucoe�
I Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
a
Registration: -.126398
Expiration 6/04
Type Individual
Jocelyne Sirois
Jocelyne Sirois 'T
77 Elm St
Methuen, MA 01844
Administrator
� ✓fie �om���ao�U�rea. � o� �,traaacfivae%t6 1
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number.,::CS 065857
Birthdate 412/29/1952
}Expire§ 12/29/2004 Tr. no: 5597
R6stncte 9
JOCELYNE SIROIS' _
PO BOX 246
METHUEN, MA 01844 Administrator
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