HomeMy WebLinkAboutBuilding Permit #162 - Permits #162 - 45 TUCKER FARM ROAD 9/3/2008 o TH
BUILDING PERMIT
NTH A
TOWN OF �
APPLICATION FOR PLAN EXAMINATION
APP�.��
Date Received
10
Permit NO: A'rg D
Date Issued: L3
IMPORTANT: Applicant must complete all items o this page
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TYPE OF IMPROVEMENT PROPOSED USE
eid rl Non- Residential
0 New Building W00ne family
Ei Addition [i Two or more family 0 Industrial
alteration No. of units: [i Commercial
0 Repair, replacement [i Assessory Bldg El Others:
Demolition ion ❑ Other
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DESCRIPTION IPTI E WORK TO BE PREFORMED:
MED:
Identification Please Type or Print Clearly)
OWNER: Name:
MQ r S 01
Coyl 2 Phone:C?Add ressm.
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ARCH ITECT ENG I NEER Phone:
Address: Reg. No.
FEE 'DALE:BUILDING PERMIT.$1 .0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED N$125.00 PER S.F.
Total Project Cost: FEE:
Check No.:. Receipt No.:
NOTE: Persons contracting with r n c is erec contractors do not have access to the guarantyfund
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V%ORTH
170vm of ove
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Y dover, Mass.
COCHICHEWIC tµ
T E D
BOARDHEALTH
Food Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT.rtr..................+.++ ........................,..C*440............... ................+..... + ............+...•4. 4 rt f a t i.r.. .4+■+.F■4. ♦F 4 Foundation
has permission to erect...... ....... buildings o •...... ......f.-•+W. •rt4+rt 4t+.r.r..+. .. Rough
- e Chimney
to be occupied as
■rt.rtr+rt.rtt .. .a...... .,. 40g.0
. �... ..,......... .,.+............
. . ...... .. •f■r rte♦ ■4+rt ■rtria .i .ra i.�■ a .4F.��4!'f 1�Ti�i�i*rF4a\rir. .R.Q..'k
provided that the person accepting this permft shall 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 inspection, Alteration and Construction of
Buildings in the Town of North Adorer. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMU EXPMS IN 6 MONTHS ELEC�MICAL INSPECTOR
UNLESS CONST"
� STARTS
Rough
Semee
*.. .+.�rrra r4 rta rtr#r•a ra rrt rrt#rt art r�rttrt rrt rrt r4 rt4.4#rt•
BUILDING INS CTO
Final
Occupamy PeRequired Occupy Building GAS INSPECTOR
Displayin a Conspicuous Place on the Premises ",ww Do Not Remora Rough
Final
No Lathing or Dry Wall To Be Done
FIRE DEPARTMENT
Until InspectedandApproved by theBuildings � Burner
Street No.
ES REVERSESIDE Smoke t.
.. .......................................... .
/r
rl tarok
office
40 Off
1010
00
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*-6�-2 112" 5 7 112
nabs audray o'connor
po box 132 45 tucker farm rd
andover, r ya01845 r and over ar,
ma01845
mr and mrs o'connor NABC
45 tucker farm road General Contractors
n and over,ma 0 1845 PO Box 132
N Andover,MA 1845
:.tul ar 4atai
general conditions 11,170M
permit included
plans I engineering included
insurance included
layout included
dumpster included
tools included
equipment included
heat,light.Poorer by owner
toilet by owner
winter conditions
demolition -
site
building
sitewoirk $
excavation
backfill
driveway
concrete
footings
foundation
waterproofing
slab
walkways
masonry
chimney
galls
steel
beams
decking
rou_qh_caMptitry $ 3,641.80
framing per plan
roofing
rubber roofing
siding
windows
sky lights
fire door
exterior doors
garage doors
trine
/2812008 : P
rnr and mrs otconnor 1B
45 tucker farm road General Contractors
n and over,ma 01845 PO Box 132
Andover,MA 0184
finish qarpgntEy $ 2,78.00
base 1 trim included
doors per plan
stairs
decks rails
kitchen cabinets
bathroom vanity
counter tops
other cabinetry
insulation 897.00 walls
tloorir3cL - by owner
wood
carpet
tile
other
finishes 4,24 .00
drywall included
plaster
paint exterior
paint interior included
wallpaper
hvac 395.00
heat
air conditioning 2 drops
Riu bing -
electrical $ 3,112.00 use existing serVice
$ 16,226.80
qualifications
no unforeseen conditions
no hazardous rnatedals
per plan
no plumbing or gas piping
electrical per plan
2 drops of ac included
flooring is by the owner
no exterior door
no blue board in storage rooms
M8/2008 :84 Ply
The Commonwealth of Massackusetts
:- Department o*f`Industrial Accidents
��
� =fir� * Office ,f Investigations
60 Washington Street
k, ` '� Boston AM 02111
Workers' Compensation Insurance A da i : r it � �r G l ri i Plug r�
Al2plicant Information Please Print Le
Name (Business/Organization/Individual):- f\J A 6C
Address: P 0 Rok 1 3
City/State/Zip. Ai . A4)w\jer k49 016` Phone #;
— c? q(,,o tl
Are you n employer?Check the appropriate box: Type of project(required):
am a employer with 4. El I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors .. E]New construction
2.E1 7 are a sole proprietor or partner- listed on the attached sheet. 1 ' . ��modeling
ship and have no employees 'These sub-contractors have Demolition
working for ine in any capacity. workers' comp. insurance. 9. E] Building addition
[No workers comp. insurance 5. we are a corporation and its
required.)
officers have exercised their 10.0 Electrical repairs or additions
.El I am a homeowner doing all work Fight of o mption per MOL IL[ Plumbing repairs or additions
myself. [No workers" comp. e. 152, §X ,and we have no 1 .E] Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 0 ether
*A n y applicant(hal checks box#I must also Fi II out the section below showing their workers'compensation policy inform tion.
Humeownets who sui m t f affidavit ii� �eat�E t f uoi at# work slid 11heil hi ou[siae contractors must submit a new afciavrt indicating such.
TC ontraetors tin at check,this box must attach ed an additions-shut showing the name of the sub-contractors a rid their wor ers'comp.poi cy information.
I arty an employer that is providing workers'compensation insurance for my employees, Beloni is the policy and job site
Insurance Company e• Aj"
p y are .
Policy#or Self`-ins. Lie. : 60 C - q�;k I I f 0 1 to -ration
p Date. � 1-310
Job-Site Address: Is "V6k4(%- Fqnl Ria
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 M L 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 forty of 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 he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
do hereb�eer y#y un der Ilse pains pat*ns andpenarl ies qfperjur )that tit e information pro videdabove is trite mid convect,
ignature. Date:
Phone#:
Official use only. Dry not tPrite in this area,to be completed by cio?or Inivii official.
pity or Town: Perm it Licen
Issuing Authority(circle one):
1. Board of Health 2. BuildingDepartment I Cityffown Cleric 4. Electrical Inspector 5. Plumbing Inspector
.Other
Contact Person: .,,,,. ., Phone -,
CERTIFICATE OF LIABILITY
:.. DATE(MM10OfyyYY)
"+ 1208
:r
ryf: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
+++ w l 'T INSURANCE G C ONLY AND CONFERS RIGHT UPON THE CERTIFICATE
,...: HOLDER..THIS CERTIFICATE DOES NOT AMEND EXTEND OR
CLING ROAD
ALTER THE COVERA E AFFO RDED BY TIDE POLL IES BELOW.
ANDOVER
MA 01845
{ INSURERS AFFORDING COVERAGE LAIC I
INSURED $�Ddh r1
:n«. INSURER A'
L MAN
INSU ER rEi~: AIM
PO BOX 132
FAY
,:. INSURER C.
NORTH s` Ai D V R, MA 01845 INSURER r :
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING.t ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUME# TWITH RESPECT T TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
f,
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRI ED HEREIN 1S SUBJECT TO ALL.THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS.
1"SRO TYPE I RANCH
�. POLICYI -EF RAY )13 LIMITS
t :
Iw r*LIABILITY TBD 0 /09 008 9 1 912 09 EACH OCO 1 RENr,E o,oa .Oc
COMMERCIAL FERAL LIABILITYE RENTED 5f�,# .04
PREMISES a occuren
FIGLAIMS MADE OI:C R ME E X P(Any one person) 5.000.00
PERSONAL&ADV INJURY S I. - •DD
GENER AGGREGATE ,00a,00 .o
A.
EI `L AGGREGATE LIB,#IT APPLIES PER PRODUCT -COMPJOP A $ 200,0b0,40 .
POLICY PROJECT_FjL C
AUTOMOBILE LIAMLITY
COMBINED SINGLE LIMIT
! # AE A C (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- SCHEDULED AUTOS (Per person)
F#IRED ALTOS BODILY INJURY
NON-OWNED AUTOS (Per accideni)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY-EAACCIDENT
ANY AUTO THERTHAN
FA ACC
AUTO ONLY: O
EX E Sfi;MBRELLA LIABILITY EACH OCCURRENCE
OCCUR � CLAIMS MADE AGGREGATE
S
DEDUCTIBLE
RETENTION
o r� ATc AW 1 1 1 O `� 131 1 11 1 09 V T YLIMIT ER
OTH-
E��lPLIPLOYS Y�#� 'LIABILITY
ANY PROPRIET MPARTNERIEXECUTIVE E.L,EACH ACCIDENT 100,O .O
OEEIC RIMEIr4+BER EXCLUDED?
If xes,describe under
ECIAL PROVISIONS bei�n� 100,0�0600
� E.L.DISEASE-POLICY LIMIT
OTHER
e
4
-CERTIF(CATE.HOLDER R ANCELLA"TION -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE T14E EXPIRATION
DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 PAYS WRITTEN
NOTICE TO THE CERTIFICATE N LDER NAMED TO THE LE ,BUT[FAILURE TO DO SO SHALL
= IMPOSE NO OBZES,
j R LIABILITY Of N KIN ON THE INSURER,RER,ITS AGENTS R
REPRESENTAT
AUTHORIZED EPRES T TIVE
� y
AC RE 26(2 110B) ACORD CORPORATION 1988
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w r M I W Vee
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137
552
Expiration:111/26/200,8, TO: '1241,910,4
Type: P"f6vate,Corporation
'DOVER BUILDING
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CORP.
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A 012186
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License: CO,NS]"RUCTION SUPERVISOR
Number CIS 0828,16
`2 Expires,,
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Resttictod: CID
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