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HomeMy WebLinkAboutFOUNDATION FOR BUILDING J, 38,40,42.44 COMPASS POINT 01 OOR BUILDING PERMIT ,,EH DT#6 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 0 Permit Date Received so TED Date Issued: L(; CHU IMPORTANT: Applicant must complete all items on this page MN , S" "v" ni"'Wo? rr .......................... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building El One family El Addition1 Two or more family [I Industrial 11 Alteration No. of units: 11 Commercial 11 Repair, replacement El Assessory Bldg 11 Others: 0 Demolition 11 Other S er District -A,,'O�F I d od ''t n'd n, e a U b,ed,Djst -t" 771/'111"" N DESCRIPTION OF WORK TO BE PERFORMED: 00 U I Identification- Please Type or Print Clearly OWNER: Name: bPnc "' Phone: (1-*ILL� Address: .5 tp4- Contractor Na""" / Phoned. 3 ;o IR F 3`4 A ARCH ITECT/ENGI NEER— V)OJY,gn, Phone: Address: L)'ec �- 4-\ko LoGS Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $— ' %W Receipt No.: Check Na.: 1 NOTE: Persons contracting with unregistered contractors do not have access to the guar tyfund Signature of Agent/OwnerSignature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swirmning 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 Reviewed On ! Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS `�c �,L r (� -nc1 ��e �<c OJ C� HEALTH Reviewed on Signature COMM�NTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT ' Temp Dumpster on site yes no Located at 124 Main,Street Fire Department signature/date COMMENTS' V-sm"M AM tkORTH -w% dA­- ver Town of 11 . U ® O O LAKE h ver �J"44 , ass, COCKICKEWIC.( ' �.95 RATEDP y U BOARD OF HEALTH ERMIT T NNEW Food/Kitchen Septic System Se THIS CERTIFIES THAT ..........................Q...... ............®.►...... � BUILDING INSPECTOR �j Foundation has permission to erect .......................... buildings o �..�`.:�. .,. ��• . . ..... ......... . . ....... ....... �1�—"� jweiw �� Rough to be occupied as ....... .1..t�t . .. ............................. ..................................................K..!4!. Chimney pprovided that the person accepting this permit shall in every respect conform to the terms of the application p Final 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C STRCI ARTS Rough Service ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy PuildinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DATE(MMIDDYYYYI TIFI LIABILITY INSURANCE 4/7/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions ofthe policy,certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT NAME: Coonan Insurance Agency, Inc. PHONE _ _ FAX (508) 987-7152 508 87-7122 267 Main Street AoRE Oxford, MA 01540 ss: cindy@coonaninsurance.com ---------__----_INSUREDS)AFFORDING COVERADE--------_._____-- NAICq._-_ ------ ------------------------------ INSURER A:Travelers INSURED INSURERS: TJK, Inc. INSURERC: POBOX 12 -- _-------- -- --------- ---'-- -_------------------ INSURER D: South Grafton, MA 01560 INSURE_-_- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED 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 HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - - - -ADD SUER - - - POLICY EFF POLICY EXP - -- - _ - LTR TYPEOFINSURANCE POLICY NUMBER MIDDYYYYI (MMIDD/YYYYI UNITS A GENERALLIABIUTY 680-335M1703-13 11/3/13 11/3/14 EACH OCCURRENCE $ 1,0001000 $ COMMERCIAL GENERAL LIABILITY DAHAAGETORENTED $- 300 00__ EMISES(Ea_oocu¢FarceZ_ CLAIMS-MADE 5d OCCUR PERSONAL&ADVINJURY $ 1,000,000 -- -----_----------------_----_ _GENE RALAGGREGATE_ $2.0_00_000_ GEN'LAGGREGATELIMITAPPLIESPER PRODUCES-CDMP/OPAGG $ 2 000,000 }( POLICY PRO-JE CTLOC - --- $ — - - AUTOMOBILE UABIUTYLE LI .TINED aWdert $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIREDAUTOS _AUTOSED ranDO___ $ $ PUNEFtEt1AUAB OOCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE-------$----- -- DED RETENTION$ - $ _ A WORKERS COMPENSATION IE-UB-9914N01-3-14 1/26/14 1/26/15 XWCST TU- oTH- AND EMPLOYERS'UABILITYNY Y/N -- — APROPRIETORIPARTNERIEXC-CIJTNE EL EACH ACODENT _ $-___100,000_ OFFRERIMEMBER EXCLUDED? 7 NIA (Mandatory In NH) EL.DISEASE_EA EMPLOYE $— 100 000 If yyes describe under - - —L- -- DESG�RIPTIONOFOPEtTATIONSbelow EL.DISFASE-POLICY LIMIT 500,000 A Contractors Equipment QT-660-2D283058 5/8/13 5/8/14 scheduled 100,000 equipment DESCRIPTION OFOPERA11ONS I LOCATIONS/VEHICLES (Attach ACORD 101,AddlUonal Rerrerks Schedule,Nmore apace isregUred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Cindy Davis ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: thbuildinci@aol.com nmltme �ltsCZCR "t4 'A act �Covs®v�M�NS �r Gb A� aeg��tta�g0� �w � a W ` Uvdet BPR�� IDpC�5'f VANp168� Vis` h jo* y Mass ichtjsefbs -Depariment of Public Safety Board of Buildintj Requiafion• and Standards C�OItVP f'LI 1�4[trit .``e}l iPt'k'1'!ti{j Y" '. 7 s LiGensc:: CS-059359 r _� TIMOTHY M BAIRL O`W, P.O.BOX#12 South Grafton MA 015�Q 1AF-Kj.irai:ion Cc�rtirini sic»tier 01/24/2016