HomeMy WebLinkAboutPermits - 34 COMPASS POINT ROAD 1 FORTH 9
BUILDING PERMIT 'J.(.ED 6
TOWN OF NORTH ANDOVER o f
APPLICATION FOR PLAN EXAMINATION
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Permit Nm#: - °� " Date Received �� OArEDAc"us'���y
Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building ❑ One family
[I Addition ,Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wefilands ❑'Watershed District
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DESCRIPTION OF WORK TO DE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name: f Phone:
Address: - ., ,b o 0'")(' '
Contractor Narne rr � /, rP
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ARCH �`l �1.� Phone: J
Address: � �_koe( CL. 6 C Reg. No. .`3 L(I-
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: $
Check No.: M Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund
Signature of Agent/Owner Signature of contra ctor—v-
Plans Submitted El Plans Waived El Certified Plot Plan ❑ Stamped Plans El
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Taiining/Massage/Body Art F] Swiraining Pools 11
Well ❑ Tobacco Sales 0 Food Packaging/Sales [I
Private(septic tank,etc. ❑ Permanent Dumpster on Site [I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature
COMMENTS
CONSERVATION Reviewed on 1 f 11,5- Signature
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COMMENTS 04
V
HEALTH Reviewed on Signature
COMMENTS
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
Temp Dter,'o' n site, ves no
IRE DEPARTMENT,,,-" u'm' ps
Lbc'a' t'&d:'at`,'124,',iv[' '6""Sfreei"- '
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COMMENTS "11
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Town of
over
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oh ver, Mass,
COCNICNEWICK 1'
RATED J''P�`�'(y
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT ........z � ��° ,,,,,,, BUILDING INSPECTOR
........... ....... .. ....... . .... .. ................... . .�..
pbuildings �6 � Foundation
has permission to erect .......................... on ......... ... ... ...........� ..y.� .... ........................
Rough
to be occupied as ................... ....
....................................... ...................................................................
Chimney
provided that the person accepting this permit shall in every fespect conform to the terms of the application
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 STR CTI TARTSRough
................ Service
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
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.
_—� 0 DATE(f"/DIYYYYY)
ACC>RD� CERTIFICATE OF LIABILITY INSURANCE
2/10/15
THIS CERTIFICATE IS ISSUED AS A 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
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
HAUS: ---------
Coonan Insurance Agency, Inc. PHONE FAX
_Wfl-un EYN! 508 X87-7122 987-7122 (508) 90-7-7152
267 Main Street E-MAIL
ADDRESS: oxndy@coonaninsurance.com
Oxford, MA 01540
INSURER A:Travelers
INSURED tKSURERB:
TJK, Inc. INSURERC: II
PO Box 12 INSURER D
South Grafton, MA 01560
INSURER
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,
IINTR A , R i POLICY EFF ' POU Y EXP
SR SUB LIMITS
T TYPEOFINSURANCE 1 INSR[V141D POLICY NUMBER
11/3/14:1 11/3/151 EACH 1EIERAL LIABIUTY 680-335M1703-14 S1-000,000
DAMAGETO RENTED I
X COMMERCIAL GENERAL LIABILITY i PREMISES_(Ea_occurrence) L.$ 300,000
1 1 ---
CLAIMS-MADE I-XI OCCUR MED EXP(Any ore person) $ __5--, Q 0,_
PERSOIAl_&ADV INJURY $ 1,000,000 _
GENERAL AGGREGATE S
2,000,000
• GENT AGGREGATE LIMIT APPLIES PER PROpucTs-CO F,4910P AG- z 2 000,000
ix PRO f-1 POLICY I Ty LOC $
COMB INED SINGLE L M IT
AUTOMOBILELIABILI (Ea acciden1L —J $
ANYAUTO 6130ILY iN3URY(Pei Person)
ALLOWNSID SCHEDULEDBODILY INJURY(Per acadent)'
AUTOS AUTOS
PROPERTY DAMAGE
NON-OWNED
I HIRED AUTOS AUTOS
'fie a-r�erti
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESSLIAB Ct.AIMS MADE I AGGREGATE
—DED RETENTION$ $
A �AND EMPLOYOMERMRKERS CPENSATIS'LIABILOITY N IF-UB-9914NO1-3-15 1/26/151 1/26/16� X TP WC STJ1&TSATU- JOTH-1;
Oi YL
ANY PROPRIETOR/PARTNEIR/EXECUTNE YIN 7�,J 1
OFFICE RIMEMBER EXCLUDED? NIAE1EACH AC
. CI DEW S 100,000
(Mandatory In NH) $
IV ��EL.DISEASE-EA EMPLOYEE 100,000
es under
D RIPTIONOFOPEPATIONSbelow I E L D)SErS-P POLICY LMOT J 3 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS.
120 Main Street
North Andover, M.A. 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: tdbuildinq@aol.com
Massachusetts sett -De partrunent of Pubfic Safety
Board of BtMdi u Reg,Al Imrunrn s and Standards
Q_Iunw CS-0519359
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TIMOTHY Rei BAt1[.O e
P.O.BOX#12
South Grafton ► 01"' �r �
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C or nenns s si of near 0112412016
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OCt1cc Of Consumer Afthirs&Business Regulation
ME IMPROVEMENT DONTRd1 TOR
9istration' 143766
Typo:
n °, XPiratl0n; 7129/2016
DBA
BARLOW BUILDING
TIM BARLOW
13 DEPOT ST
S.GRAFTON,MA o1560
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