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Home My WebLink AboutFOUNDATION ONLY BUILDING K 30,32,34,36 1 FORTH 9 BUILDING PERMIT 'J.(.ED 6 TOWN OF NORTH ANDOVER o f APPLICATION FOR PLAN EXAMINATION n �¢ eaeei��hewrsn �� i Permit Nm#: - °� " Date Received �� OArEDAc"us'��y Date Issued: IMPORTANT Applicant must complete all items on this page r , r r rrr „ 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 r r rDi/r ri r r rii /// r riij r� Gi/i2�/�///� /i i ❑1Nater/,Sewer,,,,.,', , ,,�� ;'�% ,r /� /�i/%�;�r�,, ;,; „%, �/ ,, ,r ,r,,, DESCRIPTION OF WORK TO DE PERFORMED: _:o 'r ./" � .. Identification- Please Type or Print Clearly OWNER: Name: f Phone: Address: - ., ,b o 0'")(' ' Contractor Narne rr � /, rP hone rr /A'ddress rWe ,,:,,. /lG ,...., r r / ori rr r ,i/ii,.,,. ,, ✓ ... r/rr/�/„///,„ ,/,,,.,. r, ;//r r ///r//i r;% i///j// /or/ii/%////� '/ r/^ r,��%i r � / ,,, „✓ �„ t, „� c,,,, r� �jirra r l/ii�r/,l i' / , / structio r,l_c . i� rr ,prr/ sor s.Con,.. / ervi r r rrr / r,,, / .,, r , r, D ��//;'////' / ,,: � � ✓ /�/r rllj //l ////�r � /ri E�p r .,�rii,r,�,.v,'%/G cr�// ocB,!, ,,/✓�r//irr/i/r/Or ir�r�._ c,wG„ c/,,, o,.,ate til ,t 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 V'V 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"- ' "Z Fire e10 en 'sidna'tUre"Ida' 'to `1 A11 k,r6"" t COMMENTS "11 -� t%ORrF Town of over r _- 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 o, TIMOTHY Rei BAt1[.O e P.O.BOX#12 South Grafton ► 01"' �r � ,v r j1A " C or nenns s si of near 0112412016 ` Pv:,,a<�°dNPr�'r✓'Pk'°r8d�u�y+'t a"4` 14,,awa•'dRa"em"4�.r 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 tJncicrseeretnry