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HomeMy WebLinkAboutMiscellaneous - 78 COVENTRY LANE 4/30/2018N O v 00O h < o mZ -74 J � 0 O Z O Z 0 m l z North Andover Board of Assessors Public Access r OE %AORT{i H °w4n°'��,�y SS^CRUSES Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 roperty Record Card Location: 78 COVENTRY LANE Owner Name: PUNUKOLLU, RAO R ANNA P PUNUKOLLU Owner Address: 78 COVENTRY LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 8 - 8 Land Area: 1.19 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 4865 soft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 864,900 857,900 Building Value: 623,800 626,500 Land Value: 241,100 231,400 Market Land Value: 241,100 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2257240&town=NandoverPubAcc 10/7/2013 00 00 cc N N cc u O o X W U :) N N N N (0 -0 W C) U ... 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C-4 >- E rn F- 0 m U 2 m �•6 -acOi— F 2 U o a F- �- ca s F- 00 p N=3 2 N Lo Y X'� cn U) QY w 2 U- S w LL U > a> Location �%��lJ[.(Fv �✓ uG/lrr No.��� —�� / Date ✓ Check # (—/7 7 2 2 :; TOWN OF NORTH ANDOVE Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $� Other Permit Fee $ TOTAL $ 7 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 171, Permit NO: I U— k 1 Date Received Date Issued: �I1 0 IMPORTANT: Applicant must complete all items on this page LOCATION i� C 1 GO PROPERTY OWNER _ n� .. P N ok o t i v Print 100 Year Old Structure MAP -NO: PARCEL:() ZONING DISTRICT: Historic District Machine Shop Villa yes no. yes no ves (no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Poene family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OWNER: Name: & rl Address: 9>7 C oO 4- /?C/?oz46�-- ion Please Type or Print iJr'I C) i, 61 )/i PA 'hone: CW'. 4y CONTRACTOR Name: _LL 45 1/1L4* -Phone: Y71 t Address: Ali t-Af Z _ Supervisor's Construction Licenser 71 Exp. Date: _ 2w Home Improvement'License: S Exp. Date:—Aa ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PE MIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ /27-106 Check No.: A �� Receipt No.: 4- ��— NOTE: Persons contracting with un ` istered contractors do not have access to t guara ty fund Signatureof Agent/Ovvner Signature of contractor Plans Submitted El Plans Waived El Certified Plot Plan ❑ ampe Plans ❑ -,. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ ... Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS r .DATE REJECTED DATE APPROVED ❑ ❑ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments Conservation Decision: J Water & Sewer Connection/Signature & Date Driveway Permit DPW Towi! Engineer: Signature: FIRE D EPARTM NT - Temp Dumpster on site yes Located at 124 Main' Street Fire Departmert signature/date COMMENTS Located 384 Osgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — (For department use B Notified for pickup - Date I f [ Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app; al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 m m m m y m y mm < 00 •a =r -•I O O •% C 4) 2 = _; >_ c �• CD O n U) O 0 o' 0 10 z o N =i O� 7 �n s - CD' C T C ,opo �C m �• c� cC ON 2 0 Q O' N CD > 00 co _N• c oo " �, CD Z C � c -o CD O '� Z 'G n c o :�. �r-�• rco m o cn CL cl) Z CD > c� N 0 � -a O '� O 0 y CDN CV O CA O 0 Q— N cDCD CL =r41D CD CD � o Dai ��: CD O O Z 3 U)� �• CD D—� _a0 ch CO CD Cl)=rv `° CD C CD Z CD CD " U o �•' :� O _ =: .� CD D c� Z• C� co) m : c c—; CD O = �. 2 o CL y 0 L M O Ln (DN •* z O W C m M M D X m T 3 �o O C S H m O T O' ci In O Z 7o O C S r m A Z m 0 T j N A O C S D C W G1 Z m 0 T j N (� S 7 .Z7 O C S T O C O_ . j W C p Z G1 m O M N fD 'O rt f1 N 3 T O O m W D O m D 2 0 C w 11equialloll - & Consumer Affairs and 8timness Regula"On ititprovemeni Coplfacanij ntractor Registra"M Lookup Home JMprOvetnent CO i3 -ie re9jSb--tj1Dr) fist by any of the ce"er" .'0. ?,n search1l, by ReSe2rChl bl.15-3-7-0F1 �- Regi MUM Search t)y RegiS"nl Name Search OV City Zip Gode I 5earch ReglStranS -v-F1�4ji"j you can alSO Kw a ierW�l ri- 00-1 the r, egisrl-atinn numf to view C;Omp ainthistory �Je list is curreint a, of Thursday, September 20, 2012 REGISTRANT RESPONSIBLE NAME INDIVMAL :,DFP ONF W'10. I-AN7-AFAk1E OHN Search Results REO ST ADDRESS NUNIBER 057 166 A FINACHARO BuiLDING M-ETHEUN, MA 01344 P! - Oil ugmfnqnyvg aitr, ,, Massachusetts .,.Oafth Of k6uhugh OKu,, -.0 seance mark of the COMM ass , _, amc,51ef� Adel. 1�4isSachi";`tzs nicri, ,-^C cS-069120 3OHN LANZA 30 TEWWLE OR M,ETtWEN MA EXP:RATf0N STATUS I TATE I. '2C The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, AM 02111 Ut www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMe (Business/Organization/Individual): fi(j U 44 ­r -,A 0-1.c a Q s Address: 3- T- M, p�( City/State/Zip: f-' 5) Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. L`I am a employer with 4 4. ❑ I am a general contractor and I 6 ` ❑New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' Ito Other- - I �aM ��.J� comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: AQ,,, /yjvl -,U'rV64 Policy # or Self -ins. Lic. #: /.SIJ C-- A o Expiration Date: i k k q ( z -A Job Site Address: City/State/Zip: A Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 9��'���1 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector. 5. Plumbing Inspector 6. Other Contact Person: Phone #: ;il1ZcC._ f� d R j,iTY INSURANCE CERTIFICATE '� F ��" � tills Ci3T4i8iPssE klIE7 ► Ra: 7tYRn U� tpy La w ZU�S C£RTIrICATZ 0.° L1i£OAfpTIO11 tI9[LY mai 71[C fix SNt OA ekDti3trC=a, Aiti? T!r£ i oA AL2Sn t pLgyt�azMTi►xI VIt `piCl� Y�wYsic3cars'ci%�Y;� �rrFca_�:IxEI.Y #�ta�rabct*'� =p� IItsvR�iRts). hisl7tag26LU Lstt s r24T &VrrRta f SLISAaIIATIatt ID RAT tea. sab�ec• ' nMlligrUWCL OpE$ NaT Cori D7=TityY'L X CafiEIHC%'I' uliar{Lest creat !!� srtda=sem Z� on chfe a+sLlFieaca 8a60 rut 4YiIC1►TF iroiAi4 �pYTlal the D t A m .e+meo to aiteics anti �quiia sa cw3acavic� yyyt7, zE cbe eatti[tcate Roldesasic cote► F �esaasottAf x,d cai•Aiclarlo oe cao i lte+i of aucti t{ tTt@ 4AiPMA lt1 '-E'QA�cc ta4Uta to the C:ci lsEys¢to leSldez `�: #�.t ... ewK LC �*erxy Insurance A9enc1% i' rsJc. •• s.�t j 12 o-e.tz -522 Chickering Etd. it aiB45 NorthAndover . mil tlgorimlat hs•ta'tcsci s+nwc 4urual In urattclz Ca _ ...., All [irides One 30 Tesaple Drive thus,. MA 8264; pgV2s3tali iliMBER : -- - - ...-.x-;,� � � SCLic piAiG3 I2Y3TCt .._ — r�A!rtTfcATE t+u"D,8 R- rats ' z� apses 7elif'S Sols a :I8 LCA7i i+A`Y ei' Isatl� na un: w4V£RA+I5 OR atom aaLpiYL h Ea11K%I=IDit3 0Y StICN pULF[IrtJ L:tlTZb ttsW+ i7rIs Is TO CE Trf1Y Il:IL @aLlt;"` rfr � i( Zk If susa2E•T TO ALL Z'.!C ZT' '• '=- 3•V5217N9 7X? i >tO:vliliS'%IiIG AiOt Itiioi' 6R CeCIDIRLi ElB''[ OOs ! yL^ctAlkl. IIS SM®11rU•IiYS ATEOHY? itiY RIIE !oZ-ZEYL>! 06T.YL�I SDr t7S } LSY't:ti1 t, tKl.Y liALS ARFFAiEm w ➢A1T! Gr \IIli6 �r El- E3-- DKyt,ptrA6 NVr4i ' LL.�Jl iC1SD lIIrC� u_ r � PY.$ pA4pDICtOR;PAATN`aiti/ j L7lE�r: IV, UFFI-EH9 AA€ ' A 10 7gLl6z, t1UAriY tsx ••ffunt G _......._ ta.est � aaera+er* Daasa� S3O. p?yHttiRCt --- i S — SE:G i'iC G r c 4Jafsic -y W1CY 12+tt>• t ..._— Z009+64012012 2z/Ei41201Z 11/09/2013 s, ayuorac , yg0.a00 L y p=KiN --�----•------`oisu:aDa�cn+n=,Vg. S1tTIUN POLICY. E4MtTYTa' Or NQRX" i t•3 3. r3tIYlER DICE ROOT t9 rIOT GQVERiLT HY CEFtTIFXCATE 80L01E"k _ Q epIWE L.ATYOM aLsCBtiE�s gat.Yt a flL i+hY="lu, moxz, a ill An* AM OL' 'M gatICT WILL BY piS.itti.:'.ID I!t AL1'.08!]. l3C2 i+iiN :rv; VOLT,:? tsualSWA amuatiiio �aacwr<.es..e Proposal To: Anna Punukollu Date 8/14/2013 -A 978-688-6361 N. Andover, MA Roof proposal annapoojaI@verizon.net IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect house Rew-Mntial & Con-Arinerciai Rac3ling de exterior and landscaping as best as possible. (tarps C h ima i P e- y etc.) Magnets run at final clean up. All TV13es Of Siding 14. Building permit included. Expert Masonry Work Mass Tol'! Fee Any compromised plywood will be replaced at an fed 1-800-WAIT-4-USLicense Total cost: $ 16,400.00 #034200 (924-8487) C­"Zef wazm :,O� iW4- Work Year Rotand 5. Install 6' of IKO Armourguard ice and water y.T shield along all eaves and top to bottom in all r valleys. 6. Install IKO roof guard synthetic underlayment to Proposal To: Anna Punukollu Date 8/14/2013 Street: 78 Coventry Lane 978-688-6361 N. Andover, MA Roof proposal annapoojaI@verizon.net IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect house 13. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. (tarps placed under dumpster to prevent any damage to etc.) Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 14. Building permit included. 3. Inspect and re -nail any loose or lifted plywood. 15. Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost of $55.00 per sheet of 1/2"cdx. Total cost: $ 16,400.00 4. Install heavy gauge 8" white aluminum drip edge {Angle's List discount applied and included) to all eaves and rakes. 5. Install 6' of IKO Armourguard ice and water Both IKO and Certainteed MFG. direct shield along all eaves and top to bottom in all extended non pro rated 20 year warranties valleys. 6. Install IKO roof guard synthetic underlayment to included in this proposal. Offered to our remaining sheathing up to ridge. Angle's List referrals at no additional cost. 7. Install all new pipe boots. Please refer to info pamphlets in estimate 8. Install IKO Leading Edge starter shingles to all package. • If Certainteed MFG. is chosen then all eaves. 9. Install IKO Cambridge AR (algae resistant) accessory material will be Certainteed. Limited Lifetime architectural shingles to entire *Note*: Please be advised, valuables in the attic house and garage. 15 year non pro -rated warranty should be moved or covered due to minor debris, dust by mfg. 10 year if Certainteed is chosen. All and asphalt particles that will accumulate during the shingles will be installed and fastened according stripping process. All Under One Roof not responsible to mfg.specs. Lay over existing shingles on for any damage or clean up that may occur in attic. Gazebo with new shingles to match main house. 10. Counter -flash existing chimney lead and skylight Balance due upon completion flashing with ice and water shield, tie into new shingles and seal. 11. Install a new GAF Cobra ridge vent capped with References available upon request color matched IKO hip and ridge shingles. HiLyhly rated member of the accredited BBB and Angie's List Y4 f)q4q '41 Thank you! I lcx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledb y Name (Business/Organization/Individual):. <T& T 90 -A4W,AdC*J City/State/Zip: i-41-14 /0/141-Y Phone #: Are yo an employer? Check the appropriate box: `� I -alh a employer with 4. am general contractor and I employees (full and/or part-time).* 2111 am a sole proprietor or partner- ship and'have no employees working for me in any capacity. [No workers' comp. insurance required.] 3111 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' coma. insurance required.] Typo of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Ro frepa' 13er, *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date:. Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby -f % ofperjury that the information provided a` bovve its true and correct Date-. / �'1' ( 3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone Rightfax N1-1 8/LJ/•LU1:3 5:5J:L•L AM PAUL -L/UU-L rax z3erver CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYYI T%LC,"-RTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATNE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to he terms and conditions of the policy, certain policies may require and endorsement A statement on this certificate does not confer rights to tie certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME PHONE jvC, No. Ext}: FAX (AIC, No): DAVID E ZELLER INS AGCY 370 LYNNWAY EaMAtL LYNN, MA 01901 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 25D6D INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY INSURER B: BERRY, FRANK & BERRY, JAMES DBA FRANK & SONS INSURER C: !!mUiRE,R B: I 45 WINDBROOK DR INSURER I - EPPING, NH 03042 INSURER R COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY T14AT THE PO SOF INSURANCELISTED BELOWHAVEBEEN ISSUED TO THE INSURED NAM® 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 HHIEN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM. WSR LTR TYPE OF INSURANCE ADD L SUBPOLICY R POLICY NUMBER EFF DATE (MM MYYYY) POLICY EXP DATE (MLWMYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE r7 OCCUR.:'REMISES (Ea occurrence) ED EXP (Any one person) $ RSONAL & ADV INJURY $ GEML AGGREGATE LIMIT APPLIES PER 3ENERAL AGGREGATE $ POLICY Q PRO,:ECT Q LOC =RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ AP1Y AUTO LIMIT (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) . 1 i UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE r- __ $ EXCESS LIAO CLAIMS -MADE -- DEDUCTIBLE •-• $ RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YM UB -4889P893-13 07122)2013 07/2212014 XwC STATUTORY LIMITS OTHER E. L. EACH ACCIDENT $ 100,000 ANY PROPER ITOR/PARTNERIEXECUTNE E-1 OFRCER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE- POLICY LIMIT $ 500,000 r yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATtONSILOCATIONS/VEHtCLESIRESTRICTIONSISPECUIL 17EMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. NO PARTNERS ARE COVERED BY THE WORKERS' COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION ALL TJNDER ONE ROOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL ATTN: NORMAN JOHN IN ACCORDANCE WITH THE POLICY PRO 30 TEMPLE DRIVE AUTHORIZED REPRESENTATIVE METHTJEN, MA 01844 HL+V KU G, (GV IVI VJJ IIICHW RV I/AItlC attY IVa'v alG lca�l�acicaa tttot��va r�vv�av •vv.r..v ....•��•�.. --•�•—•—•••---- -••• ••p•••— •----- r 1L. Location Z, :Z-, No. Date P, O % � /;'// TOWN OF NORTH ANDOVER Certificate of Occupancy $ c, Building/Frame Permit Fee $ / r� 'T CH SES �Q oundation Permit Fee $ (frPermit Fee $ �p0wer n Fee $ a W nnec I �S�Fee $ ef*� o vto gAL $ Building-insOector AV Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP-4qO. I LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. �� �CQ-R 09 — LOCATION Q /'_ L) -e v v �R PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SlZdjc, OWNER'S ADDRESS O��f _ 1� 2 C%gyp l `j BASEMENT OR SLAB ARCHITECT'S NAME C�p `CS Ft S C,T� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME G-\ SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES - SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION /rieomf Pbsf -t, 'Dec van f le- IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE / Y IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY 10 �! IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES 1 5 A Vj� && �1ra.V-ce PAGE 1 FILL OUT SECTIONS 1 - 3 +p yr -o.- 1- M1-? lti0 J S C PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E�� PERMIT GRANTED /j, L- I 1 19 3 PROPERTY INFORMATION LAND COST W ST. BLDG. COST �3 .0d P al � EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM OWNER TEL. # (P�O `E - 3 S7 6 CONTR. TEL. # le 6 4 - 55g7 CONTR. LIC. # 0S3 18/ SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 'NV"ld lO1d S30b-ld3U SIHl 'a3SOdWlH3d11S '013 'S3!JVM -VE) 'S3H721Od HIM 'S9NIa11f18 d0 SNOISN3WIa 10VX3 aNV S3N1-I 101 WOMal 30NV1Sla aNV 10'1 JOSNOISN3Wla 10VX3 M0HS1Sf1W N01103S SIHl Z l I A0N Vd f1000 t - aac3aa ONiaiins 0NIIV3H ON_ I P'C I PL PUL 1.W.9 I313 J81J 110 SWOON dO 'ON L SV0 S831V3H 11Nn 0.1.H 1NVIOVd ONINOUICINOJ 81V _ S831iV8 QOOM 80dIIA SO 8.1.M IOH SIOJ '8 'SW9 1331S MRS NSni SIV IOH 03J80i 3JVN8ni SS313dId _ 'S10J'8'SWSN39WIl 1S10f BOOM ONIMN t t II ONIWVYi 9 OOVO 3111 SOMA 3111 _ S321n1X1i NdKOW JNI900d 1108 _ 83MOHS 11VIS 13AV60 S 8V1 EJN19Wnld ON 31V1S ANIS N3HJ11X 139NIHS DOOM QOlVAV1 S310NIHS 11VHdSV 13SOIJ 831VM O3HS 1Vli ('Xii Z) "W8 131101 OBVSNVW1389WVJ 'Xli £I H1V9 diH 319VJ oNrewnld OL dooa 9 LNoN t -I 3dO183daS a00d ONI81M 3WV84 NO 3NO1S ABNOSVW NO 3NOIS X19 830NIJ 8O 'JNOJ _I iOOli 8 'S81S J111V 3WV84 NO XJI89 kdNOSVW NO XJ189 —� c E I �z L I I 9 3111 'HdSV N7WWOJ 3WV8i NO 0JJn1S ABNOSVW NO OJJn1S JNIOIS 'ISM `JNIOSV IS SO1S39 O h�O8VH ONIOIS 11VHdSV H1dV3 S310NIHS DOOM 313yJNOJ SC18Vl09dOa0 SSOOIi 6 II S11VM b N3HJ11X N83OOW MVld 3MId V36V JI11V 'Nli V38V 1.W.9 'Nli WOOS OV3H 1.W 9 ON llnd V38V — — E� L — 1 _ 9 NIiNn IlVrA AdO 1N3W3SV9 £ S831d 831311d O.M 8VH 3NO1S 80 XJ189 3NId 'X.19 3138DNOD 3138JNOJ HSINId M01831NI 8 NOILVONnoj Z N0110(1LI1SN00 S1N3W18VdV SDIii0—_ Allwvi 'ainw S31110!S AIIWVJ 310NIS Z l I A0N Vd f1000 t - aac3aa ONiaiins FA CIL Yr Js to Al FA CIL Yr Js to `�, [/ l N. z r (n n O Cf) M 0 m �o m Ef z 0 C7.. * TO v CA .0 CA f ..� •nn � . . . r ak.s' Il j � j (DD O j O 'Fill `�, [/ l N. z r (n n O Cf) M 0 m �o m Ef z 0 C7.. * TO v CA .0 CA f D 'l' Tom Il j � j (DD O j O fi O VJ T °1 a' 3 Q. to S T co 7 V �' =r cc `�, [/ l N. z r (n n O Cf) M 0 m �o m Ef z 0 C7.. * TO v CA .0 CA f D 'l' Tom Il j � j (DD - 4b v CA .0 CA e! - 4b -ncpm Tom j O j (DD O j O O T °1 a' 3 Q. to S T co 7 V �' =r cc (D f9 W n 3 X O Z T ro N - 4b Location No. 6 7-3 Date 2 � �O NORTH TOWN OF N THANDICER p Certificate of Occupaii% $ Building/Frame Permit FQV $ '`_• cv ,"a Eta' Foundation Permit Fee SACHUS Other Permit Fee $ ?0, Sewer Connection Fee $ �� ✓ Water Connection Fee $ TOTAL / 1-� O U -J L)7 Building Inspector ector 5 0 Div. Public Works PER -MIT NO.OTZ All APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP dJO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE i OOK iPAGE — ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING J 11 �� t OWNER'S NAME NO. OF STORIES SIZE y I x a1L 10 i �F 7 14y C OWNER'S ADDRESS, y e d F [ [ BASEMENT OR SLAB •3 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME C 1 " I jigCi,- porA c. re-i,-C t SPAN DISTANCE TO NEAREST BUILDING IDI DIMENSIONS OF SILLS DISTANCE FROM STREET I POSTS DISTANCE FROM LOT LINES — SIDES/ REAR pa ) GIRDERS AREA OF LOT `�' O► 1 T FRONTAGE t� 0 7 HEIGHT OF FOUNDATION `f I _ ( 1 THICKNESS IS BUILDING, NEW Y�4Jy SIZE OF FOOTING I 7( 4 IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND r �� I WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ye -S ✓� ye -S IS BUILDING CONNECTED TO TOWN WATER II BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER rl IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS i - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS A PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 3' 20 - q2 SIGNATURE OF OWNER OR AUTHORIZED AGENT _ i 041 FEE PERMIT G NTED 30_ t 9 WHITE: Building Dept 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST /4/0 G D G O EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL. #L f5'6 6 8f CONTR. TEL. #— CONTR. UC. P Q :2 CREAM: Assessors CANARY: Treasurer BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN M BUILDING RECORD 1 OCCUPANCY 12 r SINGLE FAMILY ISF IES MULTI. FAMILY _ OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE PINE HARDW D a 1 2 I3 CONCRETE 81. K. BRICK OR STONE PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL y, 1/2 1/1 FIN. B'M'T AREA FIN. ATTIC AREA _ _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 fl00Rs CLAPBOARDS DROP SIDING WOOD SHINGLES B _ 1 2 �_ 3 _ _ CONCRETE EARTH HARDW'D _COMMON ASPH. TILE ASPHALT SIDING ASBESTOS SIDING _ VERT. SIDING STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I- I POOR ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE GAMBREL FLAT HIP MANSARD � SHED BATH (3 FIX.) TOILET RM. 12 FIX.) WATER CLOSET _ _ _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & COLS. _ HOT W T'R OR VAPOR WOOD RAFTERS _ _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS 011 B M'T 2nd _ ELECTRIC 3rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. I 2___ I / { ' r 13 j i i LUX 31� 1� Z 72 ?oat n t a IST Irv. { 1 �3L ,:i I 79C o v e r17'r v c -r a i I 0 4 FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORki, SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT NENT ADDRESS ASSIGNED BY D.P.W. STREET 2 (-�� APPLICANT PHONE DATE OF APPLICATION TOWN USE BELOW Tii1S LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED C040SEERVA ION COMMISSION LO DATE APPROVED•Llo•°i�» CONSERVATION ADM I �L llA'rE REJECTEll BOARD OF HEALTH V4t-66 HEALTH SANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. DATE: APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Rortrds, the Conservation Commission prior to the issuaiice of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. ob ON ON a O rD FLCD � -u m CL n n -: > > m o m Z CD CD -v 3 ° O CD--% 0 > > m = W c Z -n m � 3 O m m m n 0 —� Z 4w 69 69 �v v 1° o < v CD z OA Im s v th O O � O p C z �. c P* .0► O C � H W, A CL �. CL -� IT va 3 .o MID A CL v� N z r m K ca 0)71 c T fA m T mn c7 O C m C 7 O m O =TO z a ? �c ¢1 3 cc m = C ::rC o , n f7D ao m -� K O �+ H ao O > z z a c � n cl n Z z z �+ .4 V � _ o x 0 0 a til m z m N H 0 .� a Location No. — i, Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee $ Other Permit Fee 7 Sewer Connection Fee $ „Vy4ter Connection Fee $ FR Q Wgi Vit„ rf�r4,.> Building Inspector Div. Public Works q '0-37— PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �' ' PAGE 1 MAP dJO. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE SUB DIV. LOT NO.y`$0 LOCATION .7'e Cave a y CANe PURPOSE OF BUILDING OWNER'S NAME / rI / h't c! e 7��f a 6 c r2/) NO. OF STORIES SIZE OWNER'S ADDRESS UC OCICA L c 0& w '12e ft BASEMENT OR SLAB {�� f (? , �j ARCHITECT'S NAME e L SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME � f . O p �T� 1 j 5' S GcL TG (rC c - SPAN / & , / I"t DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DIMENSIONS OF SILLS e DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE e IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS / ,//� SEE BOTH SIDES // �Z�Z .J .rSSG.Ld Sal ��Gt / C) PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS i - 12 ©� �ZC'C ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE ',+p SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE .42 `3 -5-- PERMIT PERMIT GRANTED• / �! C� r () 19 Owner Tel # &&5(-3 Contr. Contr. Tel #66 42-23 Contr. Lic #0.5r31271 I 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST OO 0 EST. BLDG. COST PER SQ. FT. /)?` EST. BLDG. COST PER ROOM �c 7 SEPTIC PERMIT NO. 4 APPROVED BY N, BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 'NV1d 101d S30V1d3U SIHl 'a3S0dWIU3dnS '013 'S39V21 'V9 'S3H02LOd H11M 'S9NIO11n9 d0 SNOISN3WIa 10VX3 C3NV S3N11 101 W02dd 30NV1Sla ONV 101 d0SNOISN3Wld 10VX3 MOHSiSnW N01103S SIHI zL I A�Nddno�o t - aaoDaa JNIGlit19 ONIIV3H ON _ I Pie I PL P"L I.W.9 JISIJ313 110 SWOOM dO SV J S831V3H IINII EXAM 1NVIC)VS ONINOW(INOJ SIV lOH _ _ Sa31dVa d00M SIOJ 8 'SW9 13315 �IOIVAdO.M V31S 'S10J 7 'SW9 S39WI1 Q3JSOl 3JVNSn3 SS313dld 1SIOf OOOM ONIMH I L II DNIWV1d 9 O4V0 9111 N0013 3111 S3SnlX13 NS340W ONI1004 1105 63MOH3 11VIS 13AVSO T SVl _ ONI9Wn1d ON 31V1S ANIS N3HJ11X 110NIHS BOOM A8OiVAV1 S310NIHS 11VHdSV 13SOIJ 831VM a3HS 1V11 ('X11 L) Wa 131101 ONVSN1W 13S9WV'0 'XI3 E) H1V9 dIH j� 31910 ONI9W(11d OI 1001 5 I 3SOIa3dnS a00d I ONIUM 3WVa3 NO 3NO1S ASNOSVW NO 3NO1S X19 S34NIJ 80 'JNOJ _I 50013 1 'ShcS JIM 3WV43 NO ADM ASNOSVW NO XJIa9 —� C E �—z _ l _ 9 3111 'HdSV N:-l^IWOJ 3WVSi NO OJJn1S ASNOSVW NO OJJn1S JNIOIS 'ld3A ONIOIS SOIS38SV (IM( VH °ONMIS 11VHdS7V HldV3 S310 IHS DOOM 313aJNOJ F oxo ISoaVl09 510011 6 II S11VM b N3HJ11X Nd300W S3JMd 3513 V3dV JI11V 'N13 V3aV .1.W.9 N13 WOOS CIV3H 1.W 9 ON % t/i %, lln3 V3S7v 1N3W3SV9 £ — £ — L _ — _ 9 N13Nn 11 VM ASO HISVId sS30 M(38VH O.QaVH 3N01S a0 XJI49 3NId 'X.19 313SJNOJ 3138JNO5 HSINId HCI131NI 8 NOI1VONnoi Z NOI10n211SN00 S1N3WINWd S3JI33o_— AlIw13 ulnw S31S0!S kitwvi 31ONIS zL I A�Nddno�o t - aaoDaa JNIGlit19 No. n�y �+i'�Y� i - �a ,f- fes• I2 y 7 F-4 7'v�a r THIS CERTIFIES THAT.. ..: has permission to ectP. ®. to be occupied as ® 9 ...�. � . r ...��. ..� .. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS UNLESS CONST ION STARTS • • • . • a .BUILDING INSPECTOR Occupancy Permit Required to Occupy Building Display in a Conspicuous Place on the Premises Do Not Remove No Lathing to Be Done Until Inspected and Approved by Building Inspector BOARD OF HEALTH BUILDING INSPECTOR Rough Chimney Final PLUMBING INSPECTOR Rough Final ELECTRICAL INSPECTOR Rough Service Final GAS INSPECTOR Rough Final FIRE DEPT. Burner Smoke Det. t r BOARD OF HEALTH BUILDING INSPECTOR Rough Chimney Final PLUMBING INSPECTOR Rough Final ELECTRICAL INSPECTOR Rough Service Final GAS INSPECTOR Rough Final FIRE DEPT. Burner Smoke Det. t L. F Its Al I r va w`vv 1b; 4f .41 N"Ar T a V. 14 I'm, i;- Z� Atte 1� x, -oMl M VPt 41. It Jig, Ici Ae1S gy 71 1,P A, I- I. 4, if x. I l!"4V _.Y t- �, l i 4 l nA IN 4a* I. "Zr, 4. 4, A— 4. I 1, P", f iij - R -;z'.5d 4. 11-r I tl RIL". Vi IT, 4. 44 4 Jl +,o L� L�J owe MINS n a®• wars . own Sol' aa�f 00 �A cr NOW S .zz 2 3 Pr PLO -n cn �o w o r ? 3 IN y • 'd \ M cr NOW S .zz 2 3 Pr -n cn �o w o r ? IN 'd \ i•i f N V' \ nA \n \�1 Lsi 0 c c� 1 d