HomeMy WebLinkAboutDemo Permit #470 - Permits #470 - 129 COTUIT STREET 1/30/2004 I
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Location
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Date
01" TOWN OF NORTH ANDOVER
Ceirt"'f"cate of
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Occupancy
Building/Frame Perm"'t Fee,
Cmu
Foundation
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Building Inspector
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TO" OF NORTH ANDOVER
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BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT PAIR,, N T. E TWO FAMILY DWELLING
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BUILDING PERMIT DATE ISSUED:
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SECTSINFORMATION
1.1 Propefty address, 1.2 Assessor,,%Map and Parcel Number:,
"ZC)
Map Number Parcel Nurnber
1.3 Zeabig hiform tiou; 1.4 Property Dimensions:
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Zone ax!D!i!s!tLricxt Pr used Use Lot Area S9Prong
1.6 BUILDING SETBACKS
Front'Yard Side YardFear Yard
Required Provide aired Pr Rejuired, Provided
1.8 Sewmage.Disposal System.
I.7 tau l M. ;.L. .40. 34) 1.5, Flood Zone Infonnation: >
Niblic Private 0 Zone Outside good Zone Municipal On Site Disposal System ICE WWI
SECTION . S UT
2.1 Oar of Record
ej ewe
.............
Nam Print Address for Service y
Telephone
2.2 Owner of rd-
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N u Print Address for Service:
aftire e ephr0iie 90
SECTIONCONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable
............
Licenseld Construction Supervisor:
Li n `u mb r
Address
c'e" Expiration Date
Telephone
1
3.2 Regis-tercd 11onie Improvement Contractor Not Applicable 1
A,
Registration uxt b r
;address
. . .,.�..w.,.
-
Expiration Late
'rown of Andover
tAORTH
............
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No* � Y
•- -over, Mass.,
LK 11
Ik OCHICHE Icrc %V .
A-r s
WARD of HEALTH
ood K.tcie
Sepik System
BIDING INSPECTOR
1".A e 0 0 )a b •'HIS CERTIFIES THAT...... rti aa....... ....... •aaaaa,Faa•a.....................+raa,iartr........... ... .......... ..... ....... Foundation
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•rtrta+trt+sr. +r+isFiar.ar+ra r.. .�•�rrt ■artrt aa.*. i oGLi.1Lln
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has permission to INN&..... •.. rt• art. ..... .... ....... buildings on .........taart ai...rt........ .... .. . ......... • Rough
0 A OR
SAW 16h 4ft J&I #V+t a I + heat Chimney
rt•...■...*.*rt•F rt rt#L i rt i..#...............w 4 R!f. rt rt S rt rt L i►rt.......... *!a f rt\i rt Y rt rt.•............ ...... ...............
.rt•�rt+�rtrti.rt. .*.*rtirrtaY+..rt... . .........
provided that the person accepting this permit shell in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the l spe tlo , Alteration and Construction of
Buildings i the Town o North Andover. mom PLUMBING INSPECTOR
,3o
VIOLATION of the Zoning or Building 'Regulations Voids this Permit. Rough
Final
PERMU EXPMS IN 6 MONTHS
L C MCA .INSPECTOR
UNLESS CONSTRUCTION ARTS •
Rough
asaaa•a aas asrsa •ft• r{••aafra•aa•a#•��#••a•af••ta+••gat••.tw....+raaaaYFraa•a#sari•art•t•a•r•a saran asYFaa•r
Service
Final
Occupancy Permit Required t Om Building GAS WS
Display in a Conspicuous Place on the Premises Do Not Reny Rough
Final
No Lathing or Dry Wall To Be Done
FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
tk Street No.
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FORM U - LOT RE'LEASE FORM
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INSTRUCTIONSis used.to,verify all-necessary approval/permits from
DepartmentsBoards and ` * `sn have been+ ► s does not relieve the
applicant "andor laltdowner
'sacs with.any,applicAbk requirements.
AM
APPLICANT
.. PHONE.
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NUMBER
SURD SO
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STREEOFFICIAL USE ONLY
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REC ATIONS OF TOWN AGENTS,
NORMAN Mina MUMMEMORPON It
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DAB 'PROVED
C VV"Jtg%( 40", og. bet 1, 18j it lied._
e4h('�-f UXA, as"
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, AIM APPROVED mDATE ,.
... CD
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DME APPROVED
FOOD,INSPECT.OR HEALTH DATE REJECTED,
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D PROVED
SEPTIC INSPECTOR-BEALTH
' .. .. _..
PUBLIC WORKS-SEWER WATER CONNECTIONS
Mrr-
D WAY rL.-dP .. ..
' e " DATE
APPROVED
FIIRE . T
DATE REJE CTED
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Town Unf.NOwthAndover tAORTH
. it,
27' Charles Street 0
North Andover, Massachusetts,
(978) 68 Fax (978) 688-9542
�N I Ii� 1 NMC 9Fk *111
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aBuilding �` � '
DATE
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OWNERS E &ADDRESS
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PROPERTY LOCATION
DESCRIPT ION
' ASS INZ,CONTRACTORS NAME &A
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DEPARTMENT SIGN-OFFS
D.P.W./WITR /,foll,,
SEWER
GAS
072
ELECTRIC
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TELEPHONE
CABLE
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POLICE /4
EXTERMINAT OR
D'UMPSTER-ONY OFF STREET
DIG SAFENUMBER I
BLDG. INSPECTOR DATE REUD
y
BOARDOF BUILDING REGULATIONS
{° v. Number: CS 093 f
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tpir . 02/17/200 Tr.no: 76963
Restricted To. 0
T r E SARACENO
127 HIGH STREET +
i 1AWRENCE,
'MA 01841
"# Adthinistr for
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one Cmnwea Massachusetts
nt of IndusNal
" Office of Invesfigations
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Boston, ass. 02111
.' ' Workers'Comp ens an' snce A ffia vit
Name Please Pdont
Name.
Location.6
CWLI Phone
L_j I am a homeowneri all work myself
I am a sole propnietor and have no one working in any capacity
. an employer providingF this
CoM
Address
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Fe under Seetl6n.25A or MGL 152 cawmd too-am kq= of"Cr .. Oftmules
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Lwiderstand
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µ that a copy cif this,statement ^forwarded to the Ofte c(I i . ci thecoydrage . , ..
I do hereby .� , dar Me pains andpenaltias of pajoythat ,,d
Slog' Date
Print ,,,
��� ,.
OfficW, use . ,in this area to be compWed by city or town dWal-'
Ale
C,hec*if immediate twPonse
El Solectmar
Contact person., Phon'e k E] H60#h Del
Other
FROM 4-ROBERTS INSURANCE FAX NO. :9786833147 Jan. 15 2004 10:38AM PI
ACORQTm CERTIFICATE OF LIABILITY INSURANCE 0
PRODUCER THIS CERTIFICATE IS ISSUED AS A mAirfe W INFORMATION
I !>. Roberts : a � jr; �4 1�► ;� � ONLY AND CONFERS N RIGHTS UPON THE E TIFF .AT
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND C7
10 C!i g c od street ALTER TIME COVERAGE AFFORDED BY THE POLICIES%.BELOW.
North Anduver NA 01.845 INSURERS AFFORD)NO COVERAGE
7 —87
.F r4xi4_�.__ , •_,.�
IfigufteD SARACENO CONSTMICITTOk TRUST WF*'"'TKIIN T, INSURANCE Co _,_ �
J.,*'RR I) & 5TF.VFX :i11RACE Or TRUSTEES INSURER a! #
LAWE � , MA '1 41 INSURER D: l 130 '+Ni TA I T ] ACO -
I#�#�I.��if�f�
COVERAGES
THE POLICIES OF INSURA f!LISTED BELOW HAVE BEEN I SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
G
ANY I E I � F T�TERM C CONDITION OF ANY COI TRA T R OTHER DOCUMENT T WITH 1REV T TO WHICH THIS CERTIFICATE MAYF f ly R
MAY PERTAIN,THE INSURANCE F IROr:D BY THE POLICIES DESCRIBED HEREIN IS SUDJrCT TO AFL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POL-101ES.AGOREOATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ,�., ._..__........ ..., .. ._._.�..�
cif BR RK01�' I lAT N u ll�rrs
TYPE OF INI3kJ1�ANC E POLICY�J1�M I39R Ia rE �Y
oANKRAL LI:ABIUTY CACH OCCUnnENCIE S 1,000,0
00
# r r:*AI. 'tdI+R 1�.Lai11#1LIT1 FIRE DAMAO.E(Any one#Rro) % 100
'f 0 0
�..1 IA+IS MADE C C�4�R ICED r (Any one Darso"�)... . $ ir 0 Y
NL)1)819077.. 1 1/35 04 11.5 05 PERSONAL&AO'VV lLIRY S ;I.,0 ',000
` a ENURAL AGGREGATE $ r j
000
01-N-1,AAAR OIATE LIMIT APPLE 5 PCRk P OMOT -(;&HIOP A � �,!�00, 0
0
...a_a..a.aa
POLI 1 �� :
AUT{iMOIEL6 LIABILITY COMBINE€}SINGLE LIMIT
ANY AUTO ......
Ak.l.r)lAjt4 F0AkMIS 80my If4iiIRv
(Her) n)
CHEDULED AVTO 8
MiR60 AUTOS RODILY INJURY 'IE
NON-OWNED AUTOS
jper flee errs} _.......,�. a_.....�.. .a ......�
PR0Pr-_'KrY flAMAOk'
(e'er s4CIdAnt)
FOAlRAQEI,.IABIIITYAUTO ONLY-EAA IDENT 5A14Y AI rI.0 OTHER THAN F.A A r Ate►ONLY;
P�iO ; 1.f11BN.ITY i EACH OCCURRENCE �t �—
nccu l CLAWS MADE AGGREGATC
---------------
- a,a... ..a.. .....�. .. a .,..a a............�
O DUC'TISLE a i
RETENTION
woRKERSCOMPENSATTONAND TORY LIMFIV ER.A
IRWIPLO`f r 3'1JABILrTV WC - 13 -3: i1 C 9A—0 1 0 5 0 0 9 15/0 4 Kt..EACH ACCIDENT # 00
D El.DISEASE*EA EMPLOYEE V 6
F.J. I FARE POLICY LIMIT 0'0#no(�
DES RIPTION OF OPERAIJDN 9IL lIONS(VEHIDLESIEXCLUOIQNB A130E0 FlY 12NDORSEMENTISPECIAL PROM IONS
CIERTIFICATE HOLDER APOITIONAL INSURED;INSURER LETTER: ANGEL A'nON
I!OU1.0 ANY OF THE ABOVE ORSCRIBEa POLICIES I3t ANCELLI=0 E IS THE FSXPIRAT#011
TOWN OF NORTH'1'IE'I RII I;.ik I}ATE THEREOF,TKE ISRUING INSURER LL ENDEAVOR TO MAIL UAYtj 4 KnTEN
TTU: BUILDINU INSPECTOR NOTICE TO T4L<CERTIFICATE HOLDeR NAMED TO THE LEFT,BUT FAILURE To DO 40 8"ALL.
7 ClEARLES STRME1' 1111;FOSE NO OBLIGATON Oft LI $IUTY Or ANY 1040 UPON T14E INSiJI OR,ITS AGp-NT8 OR
No, AN DOV ZR I MA 0 18 4 5 REIRHRORNT TIVED.
AUTHORIZED RNPREGENT•ATI•VE
ACORD -6( 197) ioACORD CORPORAT113N 1989
Liberty Mutual Group
Ann1 P Box'202
Portsmouth,NCI 0 2- 202
Nlutu I. Telephone 00653-7893
Fax 03)431-5693
January 16, 2004
TOWN OF NORTH AND v R
A.TTN: BUILDING INSPECTOR
27 CI A.RL S STREET
NORTH AND OVER,MA 01 5-
R ; Certificate of Workers Compensation Insurance
Insured: SARACENO CONSTRUCTION TRUST
R WOODLAND ST
LA ANC ,MA 0 1841
Policy.N, b �'C �•315� �� 3- 13 „ .1` t1v : 11.5 20�3 Expiration- 1 2004'-:
f.
................... -------------
Coverage afforded tinder Workers Compensation Law of the following t t MA
Employers Liabiljjr.
Bodily In*ury By Accident: 500,000 Each Accident
Bodily Injury by Disease: $ 500,000 Each Person
Bodily li�jury by Disease: 500,000 Policy Limits
As of this cute, the Bove-referenced policyholder is insured by LM Insurance Corporation under the policy
listed above.
Tire insurance<fford ed by the listed policy is subject to ail the term s, ex clu ions and conditions, quid i s not
altered by any requirement, term or condition of any or other documents with respect to which hich this certificate
may be issued.
This certificate is issued as a natter of information only and confers no right upon yore,the certificate holder.
This certificate is not are insurance policy and does not amend, extend, or alter the coverage afforded by the
policy listed above.
If this policy is cancelled before the stated expiration.date,Liberty Mutual will endeavor to notify you of such
cancellation. A t";Af
AUTHORIZED REPRESENTATIVE
LIBERTY UTUAL INSURANCE GROUP
Th1%Ceftifi to is executed by LIBERTY MUTUAL INSURANCE GROUP a3 respects such insurmee:ts is afforded by those wmpanies.
cc: Insured: Producer of Record-
SARACENO CONSTRUCTION TRUST M P ROBERTS INS AGENCY INC
R WOODLAND ST 1060 OSGOOD STREET
L.AWRENC , MA. 01841 NORTH ANDOVER, NIA 01845
P 1();'2 04
North Andover ui l i r a r tmer t
Tel: '8 - 4
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 properlylicensed solid waste disposal facility as defined by MGL
Ill 150A.
The debris will he disposed of in:
C:A, M uc) cc(,->Fes,
(Location of Facility)
Sign ermi Applicant
e2,00q
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the office of the Building Inspector