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HomeMy WebLinkAboutFOUNDATION ONLY FOR BUILDING P, UNITS 24,26,28 0O R TN BUILDING PERMIT 0 11A""D ,6�.y g 6 OTOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION, z Permit No#: Date Received Date Issued: im ORTANT: Applicant must complete all items on this page l LOCATION (, �� P in fi Pnnt r 100 Year Structure yes no MAP y J PARCEL ZONING:DISTRICT Historic District yes' ° no 77 rE Machine"Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential CYNew Building ❑ One family ❑Addition $Two or more family ❑ Industrial ❑Alteration No. of units: _ ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �Septic WeIC „ ;: D Floodplain Q Wetlands ❑ watershed'Di'strict f 0;1Nater/Sewer DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: ���� co Uc- Phone: "t-7 11 `-t Address: C : ontractor Name . Phone. ' ' 7,7 Address Supervisor's Construction License C Ex Date , �r P Home Improvement License Exp ARCH ITECT/ENGINEER Phone: r Address: Reg. No. g FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: <361C� MOTE: Persons contrac ing with unregistqq contractors do not have access to the guara fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 1� PLANNING & DEVELOPMENT Reviewed On 3 Signature_ COMMENTS 10A pu n l CONSERVATION Reviewed on 3> j \ / Signature La COMMENTS Lo� 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 FIRE DEPARTMENT -Temp Dumpster on site, yes no Locate4 at 124 Main Street Fire'Department'signature/date COMMENTS' RIORTF/ Town ofAndover �' "' O 0% I ver, Mass, COCNIC NC WICK y�. RATED' tl BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THATLkt ...,,. BUILDING INSPECTOR ....... Ve� .................... ............ ....................... .. .. . ......... .e .. Foundation has permission to ere ....................... buildings on .... .. .f ... . .. . ... .... ..... � Rough s to be occupied as ......0 . . .... .... . ... ... ............................................Pappricalin .. . .. Chimney rovided that the erson acce tin this ermit shall in every r pect conform to the terms of t \. Final p p accepting p 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 ® p� Final PER T EXPIRES I yPI ESI 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ............. ...... ... .... .. .......... .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. ACCOR& CERTIFICATEi 1 I R'ATE(MMIDD/YM) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIKIATIVELY 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 eNorsement(s). PRODUCER CONTACT FJHON Coonan Insurance Agency, Inc, PHONE ---508 987-7122---- I F�N t50S) 987-7252 267 Main Street AIC.N Oxford, MA 01540 ADDREss: Cind @coonaninsurance.com MAIC# ----------—--------- --- ---- INSURER A_LibertV Mutual INSURED 1NSf,IRERB:'Pra�elars_ _ `JK, Inc. INSURER C aaf2t In8t12aTiCe Compan -----—j---------- PO Box 12 — - - --- — -----!------ �ra;�Ja��_---South -- Grafton, MA 01560 ------------- ---- ---------= ----- INSURER E` I t4URER 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.Li Vi1TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. fNSRI--- --------- ---7-- ---------- LTR 1 TYPEOFINSURANCE AfSR VAM' POLICY NUMBERFP814fCp0 F"*OitDIyYyyy)' ----- tl 7S- --- - GENtOiALLIABILITY ` 680-335M1703-15 11/3/15' 11/3/16 ,_C- R;C t�„_URREf CE 1,GGG1 GGG COMMERCIAL GENERAL LIABILITY DP Ah4QE TO REDiTED ERE,1�S(Eaoccs rence) a 300 Q00 i CLAIMS MADE }—i OCCUR - I.iDE{P(Arlor�persen} $__ _5-O00 ---------} I ! I ; PER 50 NAL&ADV INJURY GENERAL AGGREGATE $ 2�QOO,000 GENT AGGREGATE LtF,°ITAPPLIES PEP. PRODUCTS-CO P"OP AG - PRO- ! 200©LOGO__ POLICY 1 _FQT LOC I j - -- - -- --- C AUTOMOBILE LIABIUTY } 1 CCP."INEDSItdGi LIt,9tT 39529 9 l3/25, 1_I26_;Eaacdck ANYAUTO I EODiLY1NjURYkParpsran} ! S 100,000i ALLOWNED SCHEDULED -- ------- -_-- AUTOS AUTOS BODILY INJURY(Per a`cd nt). g �'* 30G G00 TOS NON-OWNED PROPtRiY D,�, _O4 -- 5 — —'-- HIREDAUTOS AUTOS �Pe �rderf100 000 1 i - 5 0,0 0 UMBRELLA LfAB OCCUR `E1CF OCCURRENCE $ EXCESS LIAS CLAIMS_MADE� ;AGGREGATE S -------- DED RETENTION$ --------- --__--_--- $ }IAORKERSC04APEN5AT10N -fj 2%26/16 1/26/27' WCSTATU I OTH AND EMPLOYERS'LIABILITY Y INI �i v - ANY PROPR IETOR/PARTNERIEXECUT OFFICE RtMEMBER EXCLUDED, ='NIA ? F.L.EACH ACC! t — S 1OG,OOO- (Mandatory In NH) -- - IfunFd I EL_DlSEASE-EA PP.ALC EE S___ 10_O_r 000_ E.L.DISEASE-POLICY LlAa1T SDESsRIP0O 500,000 A !Contractors Equipment IM 8988315 5f£3125; 5/8/16;property Limit 79,000 1 4 (Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Retmrits Schedul-,if more SMce is requred) CERTIFICATE HOLDER CANCELLATION SHOULD AW OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCEVJM THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -Cindy Davis ©1985-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: -'burns@blackbrookrealty.com �., r'%/rr�onrvranrorfrt'(�r�r'��r�Jar/zrrle((� OMee of Consumer Affairs 8c Business Regufiation ME IMPROVEMENT CONTRACTOR t gistration: 443758 Type: xpiration; 711g/2616-- DBA BARLOW BUILDING TIM BARLOW 13 DEPOT ST S.GRAFTON,MA 01560 mss= Undersecretary ` Massachusetts Department of fatid Standards Public Board of Building Regulations Safety 5 License: CS-059359 ConstrUction Supervisor TIMOTHY MICHAEL BARLOW P.O.BOX#12 SOUTH GRAFTON MA,01560 !-ommissioner Expiration: 01/24/2018