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HomeMy WebLinkAboutMiscellaneous - 76 BOXFORD STREET 4/30/2018N O � � � O vT 0 w o � � � o m 0 Issued APPLICATION FOR PLAN EXAMINATION IMPORTANT: Applicant must c CATION Print JPERTY OWNER= Print WNO PARCEL: „r rtOL` 1'%V 139Th nl%fd" 1 Date Received: e all items on this ZONING DISTRICT: H1Q.TnRIC DISTRICT YES ❑ � rt Af4V U31V yr PE OF IMPROVEMENT --- PROPOSED USE Residential Non- Residential New Building D One family Addition J Two or more family G Industrial 'Alteration No. of units: Repair, replacement ❑ Assessory Bldg r: Commercial Demolition Moving (relocation) L Other C Others: Foundation only c,CPIP'FIC)N OF WORK TO BE PREFORMED 'I` Z X Identification Please Type or Print Clearly) VNER: Name: A-' i N t- �� ��5 Phone: 97B • �� 8%8 [dress: 76 " R -©)e .neu> )NTRACTOR Name: pervisor's Construction License:—K) Vo 9 Z.- Exp. )me Improvement License: % �3 6� 16-- Iz- Exp tCHITECTiENGINEER iU vA)Name: Phone: Jdress: Reg. No Pho ® 7.37 Date: Date: .E SCHEDULE: BOLDING PER NIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. )tal Project Cost :$ `/Q x10.00=FEE:$ s f� Teck No. ic Iof'4 Receipt No.: 4� v 41 -� ,x o! Ni ,J a y DT 10 r - N Q) LLJ O . (!1 OCC Q z z 0 V a O w W 0 N 1--- X CO D< --' 0 m;; 1 _~ LLJ O 1 z oc o w 0 oc z w �. >. z O °- V) w y. J ..J v z J A N U.j N 10 LLJ OCC z 0- O °' v z A < U.j 04 h 11 °- ,z N do CO V) i k x D Z •, N CL �-- V) 2 0 10 TYPE OF SEWARGE DISPOSAL Public Sewer J Tanning/Massage/Body Art Swimming Pools �J Well — Tobacco Sales Food Packaging/Sales _ Permanent Dumpster on Site _I Private (septic tank, etc. Electric Meter location to project NOTE: Persons contracting will: unregistered contractors tlo not have access to the guara� f nd Signature of Agent/Owner Signature of Contractor Plans Submitted X11, Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 'LANNING & DEVELOPMENT 'OMMENT 'ONSERVATION OMMENTS EALTH DATE REJECTED DATE APPROVED 11 El []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED ❑ DATE REJECTED ❑ )MMENTS ling Board of Appeals: Variance, Petition No: ling Decision/receipt submitted yes ening Board Decision: Comments servation Decision: Continents er & Sewer connection signature & date p Dumpster on site yes_no_ Fire Department signature/date Iding Permit Approved and Issued by of G! ' DATE APPROVED i I 1 { DATE PROVED I Phone: 978-632-2660 JAMES A. TRUDEAU Adjustment Service rnc. P. O. Box 7 Fam 978-632-2662 Gardner, MA 01440 elaims(&trudeauadi& Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 3B March 4, 2015 /Building Inspector 120 Main Street North Andover, MA 01.845 Board of Health. 120 Main Street North Andover, MA 01845 Fire Department Dept. of Records 124 Main Street North Andover, MA 01845 Insured: Kathleen Borys Loss Location: 76 Boxford Street, North Andover, MA 01845 Insurance Company: Preferred Mutual Insurance Co. Policy No.: PHO0100830999 Date of Loss: March 2, 2015 File Number: 15-13002 Ctaim N VVA6X5& Type of Loss: Ice Dam Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed 1.000.00 or cause "Mass. Gen. Laws, Chapter 143, Section 6" to be applicable. If any notice under "Mass. Ldws; -'11p, iaF ",'s �i�xa*: its aartit9-a��ef',i t�tie .�€ ►�� to iC captioned insured, location, policy number, date of loss, and file or claim number. Claim has been made invobing loss, damage or destruction of the above -captioned property, which may exceed $5000: If any notice under Massachusetts General Laws, Chanter 175 Section 97A is appropriate, phease direct it to Yne attetifion of Wis wrtter ants in tube a rt'%rence to Yue doove-captnoneb insured, location, policy number, date of loss and claim number. On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, Joshua M. Trudeau Claims Adjuster