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HomeMy WebLinkAboutBuilding Permit # 2/10/2016 BUILDING PERMIT 16 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#- Date Received AC us Date issued IMPOWrANT: Applicant must complete all items on this page LOCATION Orint PROPERTY OWNER '21 Print 100 Year Structure yes no MAP PARCEL: NVO Z NING DISTRICT: Historic District ye no Machine Shop Village ye 11) TYPE OF IMPROVEMENT PROPOSED LISE Reside,pkral Non- Residential 0 New Building �kbne family []Ad itib n [I Two or more family 0 Industrial 1-1 Veration No. of units: 11 Commercial P"Repair, replacement F1 Assessory Bldg 0 Others: El Demolition 11 Other Identification- Please Type or Print Clearly OWNER: Name: Phone: Contractor Name: Phone: a�:n> Supervisor's Construction License:— Exp. Date- -7/_�v -7 Uzt Home Improvement License: Exp. Date: ARCH| | EC |/ENLj|NEER Phone: ^ Address: Reg. No. F=="""=""L= BULDING PERMIT.°Z""PER*'"""""`"FTHE TOTAL ESTIMATED COST BASED`~.~.~^..PER~Check No.: Receipt No.: � Total Project Cost: $ FEE: $ � NOTE: Persons contraeting with unregistered contractorsdo not have acce t th gu ntyfund � NoRTM Town ol'Iq `' Andover ® ® IT, O LANE ver' N.��y �qC0C"1CM[WICK "�' S RATED � �S FOR% U BOARD OF HEALTH Food/Kitchen rwERMIT LD Septic System THIS CERTIFIES THAT ................. 0.. . .......T 0.`. SQ........................................................ BUILDING INSPECTOR .. has permission to erect ....... buildings onFoundation .... ....... . rf.04v7 ® Rough Ac to be occupied as .. .�....... .M !' Chimney .............................................................. provided that the person accepting this permit shall in every respect 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 EXI MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service .......... .... .......... .. ....... ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final- ® Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i 4 KITCHEN INSTALLATION ESTIMATE WORKSHEET - USA stoic: service Provider. 2663 R.J.Construction Customar. Date: John Raposo, 6x17-686-9458 1/712016 Cate v .Bireakd6v�n Demo and Haul AwayMindow $3,257.00 Electrical $1,290.00 Plumbing $1,330.00 Tile $1,010.00 Drywall/Repair $1,210.00 Cabinetry/Appliances $3,200.00 Additional Charges/Materials/Permits $750.00 TotalGrand 0' 00 Customer Signature: Date: Associate Signature: Date: GC Signature: Date: Z-d 9990LLZ9L6 uosipeA paeyol�j d90:609L ZOge_� j i I 1 • 766:'. r 43'. all. 24" '. 2663 JOHN RAPDSD 42' 33f 54:" • 37;- .}" 24- 24" 36" 36" F3t W3333 IMB33� 33RNY332424R i �, ,� i N FRIDGE111111///11 t I l'�. W 1.SIAlinteretl 64"Oil the fight wall,no disposal. v cNi VW57524 f B24 DI H 4 c (+ ' DAe✓I�: 9 2.Drain goes to the right into the 83.75"wail. 3,DWd4 centered 83"off the right wall. 130 "�"—'"-'°'• \.,:_- 4.Stove 30"alactric,tray standing centered 66'.1 the lett wall. gMlcro,30"vent In. e:Fddr 33w x 32d x 67 7.Calling set at 89.5" .4 ---� - The custamai ties a hard wood tioor which goes undor ' /fi5 the exisiinig Island. IP• N H - •i• m O v - o 133ORT Meta � is•� v' VIAndow amended from 43 112"Io 42"wida, C!L remains the same, • m N I _ j e7 1 _ (to aCWmOdale cabmal with cust's reported kn '—�r9V3JVW� ;N Head to change) O g N 1 STM451 �ssvw 24" !, 139:" 34i' . 66.'• 67,. 24" 140" 164. .. i b T77is is art ort Ali dimensions size desi nations ro'+;'+- ' inul design and must I Designed: 11/15/2075 s i �� r,� given are subject to verification on t � j not be released or copied unless Printed:2/1/2016 job site and adjustment to fit job V' ' i applicable fee bas been paid orjob 1 conditions. ` " order placed. 615036afkit All Drawingfi:I No Scale. £'0 9990LLZ9L6 UOSI N pleyeN 090:6096 ZOgej ra < c2�M'u�souBPldr Q I�c�153�2� IVES,c? t �? u lam&of Ikmsdg@9kRg .." .Dona PIM 0 111 -'d(cqr.n tra a} 1T rG Na�,Le(—Rusioess/Orgmizatiorjmdividual)' i Arl ❑ty/state/tztp: Aa e y'D D a€. employer?Checktheappropriate bo--: Type of project(required): i.❑ 1 am a employer with 4. l am a general contractor and 1 6 N co71inS ction have hired the sub-contractors 7 Remo: employees(fail and/or Part-time) listed an the attached sheat 2.❑ 1 am a sole proprietor or partner- s_�nip and have no emp€ogees These sub-contractordemolition s have �- ❑ working for me ira any capa6it��. workers'comp.insMs ai e. g, []Building additior, [No rvoricers, comp.insurance 5. ❑ We are a corporation and its 1O.M Electrical repairs or additions required.] o-jicr€s have exercised their right of exemption per AIGL i l•❑Plum}ing reoairs or additions .❑ 1 am a taonecv�er doir-ag:ail v�ot•l; P c. 152 §1(4),and we have no 12.7 Rrepai n t;s�r serf. [No workers' rani..)• er—nDtoees.j'rlo workers' -- ' ince reguired.l y 13. - mer comp.insnl-ance required an,spplicart that che~Ics box gI must also alt i out the seojon mom all worowing k and then hire ttt9id-coufte Drs hist submit anew affidavit imitating such. Y Homeowners vno submit this a�udavir indicating t g It infattuation. �Corrtractors that check this box must attached an aitionl s showing the tsame afthe sub i^rnttactots ewe dreir vror'�ets'comp.policy Jh am-arae pa3ycdkg �� 'c� ,�c �L a�se��arzc� a�iii �o�ot e/es, Maw is Me poau and job site i?13I:12LCe Company Alpe: �"� ��°f,` C����✓ �`�� i?ciicy it or Self-ins-F ic.#: f fxpirafiog Dale: sob Site Address: Attach a Coley of the V�Orkers'eompe fian polky dee@aMtion gage(showft the policy umber and expiration date. FaiHure to secure coverage as required under Section 25A of MGL c. 152 can lead toAhe imposition of criminal penalties of a me up to i,5u0.0c�and/or one-y ear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine o up o$250.00 a day agairx-L the violator. Be advised that a copy of dies statement may be ferularsled to the Office of Znvesr>gatlons of the DLL for insurance;overage verification. I do Aemby Cir de -e d ofPerY 96208 Ifae!Rf0F Msttaa Pmv ubm a�d casrs�eP Date: Signature: Phone#: c7 FFL�ssuing useoply. Do pao9 wr&a�Vacs area,go be c k9ed by city or dorm o�1 ,n• Peemi>x1slie�se# hor ity(circle one):Health 3.BuaE agIDepartment 3.City iTo-m Clerk 4.Eiech iea6 IosgaestOr a.Plumbing IMsgeetophone#• CERTIFICATE OF LIABILITY INSU NCEDRTE(MPNDD YYYY) 02292015 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 REP 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 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 MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER a o Ext): Arc Nol: 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 100492-HorneD-GAW-15-16 INSURER A:Steadfast Insurance Company 26387 INSURED INSURER B:Zurich American Insurance CO 16535 THD AT-HOMEHOME DEPOT AT-HOME New Hampshire Ins Co 23841 DBA THE HOME DEPOT AT-HOME SERVICES INSURER C: P 2690 CUMBERLAND PARKWAY,SUITE 301) INSURER D;Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685-09 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, ILTR TYPE OF INSURANCE DDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MIDD MMIDD LIMITS A GENERAL LIABILITY GLO4867714-05 03/01/2015 031012016 EACH OCCURRENCE I$ 9,000'000 X COMMERCIAL GENERAL LIABILITY DAMAGET E ED PREMISES PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR LIMITS OF POUCY XS MED EXP{Any one person) $ EXCLUDED OF SIR$1 M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9;000,000 ',.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 9,000,000 X POLICY JE 0. LOC $ B AUTOMOBILE LIABILITY BAP 293886312 03/012015 03/012016 COMBINED SINGLE LIMIT 1 Ea accident s X ANY AUTO 130DILY INJURY(Per person) S '.. ALL OWNED SCHEDULED SELFINSURED AUTO PHY DMG AUTOS AUTOS BODILY INJURY(Per accident) 5 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccltlenl S S UMBRELLA LIAR OCCUR - EACH OCCURRENCE S HEXCESS LIAB CLAIMS-MADE AGGREGATE S '... DED I I RETENTIONS $ C WORKERS COMPENSATION WC017-731493(AOS) 03/012015 03/012016X we STATU- oTH AND EMPLOYERS'LIABILITY TOR LIMITS E C ANY PROPRIETOR/PARTNER/EXECUTNE Y/N WC017731495(AK,KY,NH,NJ,VT) 03/012015 03101/2016 1.000,000 OFFICER/MEMBER EXCLUDED? FN-] N I A EL EACH ACCIDENT $ D (Mandatory In NH) WCOIT731494(FL) 03/01/2015 03/01/2016 EL DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under Coniinued on AddrUonal Page DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT S I.OD0,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mul(hedee, —14-Ax-­ m %-a ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD =i g x' S :1 - rs�. ,�.� sand Business Regulation office of Consumer Affairs 10 Park Plaza - Suite 170 ._ Boston, Massachusetts 02116 Horne Impro�'ement Contractor Re�1tration THD AT HOME SERVICES, INC RICHARD FALLONE 2690 CUMBERLAND PARKWAY SUITE GA 30339 ATLANTA, - _ tpda_e kddress and return card.afar?:reason Card _ address — Renewal £mgio�ment — ut-osa• Jul 28 15 09:40a Richard Madison 9782770685 p.1 Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CS-030(300 , , _=<s: Constrt.^y tion 5np�r✓isc;- RICHARDJ MADISON r? '`'4 3 MADISON AVE GROVELAND MA 01834 - f—jz� ;K Expiration: Commissioner 07/2912017 � T��e�f;=rr�rrurarss�c«l!�c��%l�iu�ur.�tt;eU.° •_;Office or Consumer Affairs&Business Regulation !@5—!9 �.NOME IMPROVEMENT CONTRACTOR � registration: 118509 Type- � S�Expiration:- 3/29/2017 DBA- R..l_CONSTRUCTION- RICHARD MADISON - 3 MADISON AVE GROVELAND,MA 01834 Undersecretary