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HomeMy WebLinkAboutBuilding Permit # 2/26/2016 ..........-....................... -------------__............. ------- ------------ I IAORTIJ BUILDING PERMIT qH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION --- Permit No#:--. Date Received Date Issued-2Z _4 all F IM 61,T PORTANI:AUE,a-t-11 t mpl.tc�al erns ant ................ s� LOCATION 15'4-111` Print PROPERTY OWNER_,&;�h, , 5 t � P,in 100 Year Structure yes MAP_06PARCEL: &1ZONING DISTRICT:_,___.Historic District yes .0 Machine Shop Village yes L. ........... _WpEbF AMPROTEMENT— PROPOSED USE ------—-------- —----- Residential Non-Residential —--------.................—--------- --------------------------- [I New Building FJ One family 0 Addition e-o or more family 0 Industrial 0 AlterationNo.of units: ❑0 Commercial-,-------------- _--------------- 0 Repair,replacement [I Assessory Bldg 0 Others: 0 Demolition 0 Other ❑. ........ I Welland' S, 0 Floodplain 'r-qg, J,Vv to, P DESCRIPTION OF WORK TO BE PERFORMED: _15b.1i®r--------41 d1_11 1`1 'r —1 1 4_4 T 1<14i'651 -. Identification- Please Type or Print Clearly OWNER: Name:_N_L4­,r Ltn<4 Phone. Address: I e Contractor Name:T-A-(ZC hl:r; enc Phone: Email: Address: Supervisor's Construction License: 010 —Exp. Date:_71-7 1 17 Home Improvement License:_ / EDate: _ —Exp. _4 ARCHITECT/ENGINEER Phone: Address:— 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:$ Check No.: Receipt No.: 7- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty funic Si _§ignatqr _n(corrlra�__­ Town �, NORTH L Andover No. _ jj' 1 h ver, Mass C t �p c«knew a� 911 q�RA7EDPER IoT T S U - e " ARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT........... ... 1►r .........................................,............ BUILDING INSPECTOR ............................... .'� .,,has permission to erect..........................buildings on... ... .. Foundation 4e Rough to be occupied as..... � ... Y�.. . .... a f'��VI.... ... .................. ........... 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TART+ Rough �JService ................ 7.. ,. ......................... 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. BIC,0L ?1503 AIRTypes of lloit'ne tlm'x proveirneint vvnrvry yuuu}{tut4rvr-,.+:arour't 38-40 Lancaster S,Irm a liam hiff,MA W 830 lia—I,ftt,Min: f978f f72 3088 POIL 595-2272 bkr Ar v«u 5m f°ulFSl h1,5,3-",t��5 k'4>m'Yurtrn�.itUti.lrC0.#: ( 1J.13 mn 1 rhurut.r ikllmn Pfl)937'.k212 ihft nne➢4ou.¢atu;'NH: faa1,5)ner,kv-,7:SY.'k l i t"Irk Ir,.1VVA� fiPtWM 653.22R) Y,h m:",]101 9603J140-„4Q""O R"41^5,,tWA: (hl/)!Y 3-355Ir R Acht Fiat 0.fol t.afm,,,Qe g f,lr (C,0,0 t t.l-f,01A � P .. �...,. ., sw�u - �m'Pdal Fore 7mkgUtGVIIANVA4Ae:gqhn4nn pflid fadm �( i Fax 078)372-0360 .........._............._........._..........._._.........._ ......_�..N ..._m PFlf7PUSAl..4>UG3fv1E7fEL 10 IPHONEE 17AiF :. ._.._.___ ----- ... _ uTREET Irraf ly li�,r J/;5 �, JOB NAME ff: IL i ,f>42rs.,,kl..l {il"o zJ._,7.r..”.�,.�,-.,..,+,';.......�,_,k:.;. _.....__._.._._;.5i_i.dF�,a.-,. ,✓, __'ate.,+,.» ',�.�. .__.� .._ r,„Tk Y rAT'E and ZIP CODE JOB LOCATION i t r 'fruxf7et'm�e;NnaueGy to furnish rna4erlal a Vabor-compVete hr accordance Mth Bpecffkatlons bel0ta,for fhe su al of: ,jjjj ...dallale(w..... ' f ....___._........._ pay Sent to be YYnad.ad fsilows: =7"=7—=- �,._.-Tr '#”fb' r „r"`m°Y'"+'yrr i5'�9r✓Y,mrc' ?-- i m is✓.,,J,, ,., !„4,,6 �rW r4, fi,i�4�,' ' Autho eed ..�? Notie tlhLs proposal may be ' r, ...-.�” "'"""°....- .., .... wlfttidta—by us hl'not accepted wl4Ynin ..°.., � ....r aYS. Sig-tune c7r.ntur¢a ..........._ ....,_...., ✓Iff. 1+4 ( We 156 qupy�s!ap lit bo inations and estm5ates for: a,r1,... ... f`f�ry "'I" i tri+lija „w1'7�. oc,..ai�1",mUt if,Y %nh1TPti.14r�4 a� �'APeda,Ja�,fll` ff r/ ✓Yzar.Nv '.r,✓ „ ,r✓dv5(, r,f,✓� � rl fj19I ffI 'r,Ir,. ' c h"" f ""o6' 1lfp/ ti%R R Jt ,,,0,nq v,ke , ,:"fane", .tlfi ry si n1i Ldittl2;r rtr "mr, a ¢p,....� u/'- LL i.;1„I FIrv7.r��,✓r�r .f.✓P, e BAs m(5”lf,T ilfrf,6w, drNmt,n r.11lr tf t t,r;,>.rt✓"'JI4 4 ve' n' , r-a Nr,.f,r„�;IfY,. rsp ..l 'e z'faroc If.43'. t',if ,i 0,"""'e e5„.e,A er r m5gp”,'.Df dwq(',seta'p-'(. a Wristaft 3, .dick,r..l.Irf1: a ac &r„r,it iur:r mpfp a(wrf ✓r[r,4t N✓,.q:.,✓i���ft r;. in"'Jlelfi-0oiff1(,r E,„itr31 ;. D4rTdf,�Jf�6,;f. r, f6i, r r,mil IJ(r'aa',.-„L o., 3,I,�,, ,'1' ..a4lr'rf,rf eM. 4o rr(Irf m 4,2'rra5,, . QE ,y,il,<Rm r V,a,1=r.J Jlr r,fb% £t”5,1,{..U",.it1 f,f ,.fiL.94 rf1,IcfiA.,f n;rul r. r ",f r✓Iw „A,' fA.F'ff„Arndt nu" l f fdf.,_, It m- Rt"'C. ,fl Ar,.L ailh,Y/a (,(,.,"A,.) Er(P.J S(.E%,-[J u, 5 ff a.,.,fl: !tmr S7src f f,✓"` SRNs re 1'jf „/t1r,45,rm*,T a 'wr<cs.,,�,r�l ;P r ua, s J�L,rc .rr,.d",1,11 I5,11'f rn'N'� ,.lmrfmrP,c In 9 r J-N Clrc"lr mfyA4f 13)f 5Y1�5ud 41 Mall tµl4mfr J511r�! fl lFJm Crrc 11 lr rSYffU /rlrrOf? 6(f „7yo„�:r.✓�/dd iv y(,b,ll„t�.,(lf A/ -r,,,l.ffl ,m m„' No ri t9ta4,v f✓I ANY i, ,rmgy "pdbmx. Arreptrsxmre of lrLf xxTSA rhe adc. adeceicatisnsand cm not sign this contract rr„unditrons kim d above surd on lite back of this farm ors satnvfarWry and ars if there are any Wank paces: he r ac'c'eapled.You aro auYho ced to do the esrk as specified,Payment will ['a fi ode as ontRued abcore. T t re day mcosel1a4Mon 69his under su for,f¢7 ry elghl:of ch rpter nlriwt'ythree,sora yf'24s Yi;xn faufte-of chapter two hundred and fifty five.D or saaffa or, n of ahapte,one ^�gnete e 9t.%/f .... r f Ps c°r hundred and forty D as may be applicable. L7ta1.c,ai Acceptance: ............. ........_..... .......... _.. .............. &g'anurc; ....,.. .....,.__ _........ 1 1'he commonwealth of iva.,ssachasetts Department of•industrial Accidents X Congress Street,Solite 100 BOs'ton,.MA.02_W 2017 e www.rnass.gov/daa 'y.'�01:ISeXS�Comp enSatAen DlSnran,CO AfCxda'Vit:BUiideT.4lCOR$XRCtOXSI�'iXe.CfA'1CIanSI�XLIRxI1eXS. TOT3��T7�FAWJ(TILT.III:PERNI7.TTINGs`i.'C77CSORX7CY. kleasePriRt T.e'bl ApplicaRtInformation NaMe(Business/OxgaaizatiovLl'ndividnal):— -T' �r`+�- --- -- A.dcJr:ess:_.—�� L utY��t Phony#• CC��3�z �(y���v_ city/State%Lip: Arcyon an¢mpIayer?Che Type of project(Xg4uired): ekthe appropriate box; 'r em Io ees fuII audloz'partlhne)a' '],��New eonstractlun Y.�Tamaemployorwith�,,a-� p Y f' 2,��Tamasole pzoprietoror parfnexship andhave uo employeesworking for mein $. []Remodeling , auy .capacity.[Noworkers'comp•insurance requkecll 9,El Demolition, 3.Q Taxa ahomeowaer doing allworkmysel£@To woxkers'comp.nuurancexequkrd.]t 70 —IE- EWl�g addition, 4.L Tamahomeowner andwillfie lilring contractors to nonductall workoumy property.Twill ll El oradditions ensue that all contractors eitherhaveworkers'compensation insurom:c ox are sole ._- 12-QPlumbing): irs.o add tons ---_-- prapxrotors wrfh S,�:Cam.a general coutractorandThavehiredtYte sub-coixt[ators lisfed onthe affached sheet. 13,C]Roofrepa'irs ,fhesb sub-contraetoxs hale employees aadhaveworkes'comp.in-amae.t 14, Other _. 6.E]We are a corporation audits offirrers have exerokedtheir right of'marepfionperMGL e. 152,§i(4),andwe havano,employees.[No workers'comp.inmrancexequired.] fir applicant that checks box#1 must also fill outflw seetionbelow showmgtheirworkers'eompevsationpolley infortnafian. indicating they me all work }Contractors Homeowners checkfbisbox:mud$� daa additional she,t'showingth,name o£thesubconhactors and sfatowhther mpotot,thoso enfltresbve�. employees.I£tlte sub-cthfil tars have employees,�liey mustprovidcthek workers'comp.policy amber. Zaman'M'P yerthatispl'ovidirzgworkirs'compensationinsurancefornzyemployees.'Belowisfhepolicyandjobsite information. 5 � _ TnsuxanceCampanyNamet_L�VI'4- , _.—. C t1� Expiration Date_gFo�4_— Policy#or Self'-ins L,ic.ll_�0�'JO CG�� 1 � ----- Sob Site A ddress:_ t--- Attach.a copy of the workers'compensation polxcy declaration page(sho'wingthne policy number and expiration date). Failure to secure coverage as requited under MGL c.152,§25A is a criminal violation punishable by a Rue up to$1,500.00 and/or one-year,imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator.A.copy oftbis statement may be forwarded to the Office ofluvestigations ofthe DTA.for instnanee — covemge verification. — P'do hereby certify under•thepains andpsnalt es ofperja!v�that the infosmationpr'ovidedabove is tNue and correct -_-- i Phone_0 .5 OffacYaal use only.Do notwr•ite in this area,to be completed by city or town officiaL • PermitlLicense# -- City or Town: ------ IssuingAntlxorYtq(circleone); P P ec8or 1.Board o£ECealth 2•Building Department 3.Ci /Town Clerk 4.Electrical l"s eotor 5.Plumbinglnsp 6.Other ----...-- Phone#G: -- A�a CERTIFICATE OF LIABILITY INSURANCE DATE IMM DDYYYY) 2/3/2016 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 endomement(s). PRODUCER NOME cT Glendaly Gomez Cross Insuran ce-PeabodY JtP.E%U:___..PHONE (9']8)532-$445 <9>6)532-221> ....._---_.—-----------_...... 139 Lynnfield Street E-MAIL S,44omez@crossagency_com aISURER(SI AFFORDING COVERAGE NAICY Peabody t4A 0196 ______ 0 INsulxErsA Eerkle�Reg_ional_Snecialty_Iras_. INSURED INSURERB3Qe2ghants MDtnal_IDS Co_____ _------23329 JNR Gutters, Inc. wsuN_B_R_c Granite State_=nsurance Company 38-40 Lancaster Street INSURERD _ ._ __ ._.____________,—..-. INSURER E:.............__. ____-------__ _. Haverhill MA 01830 INSURER F: COVERAGES CERTIFICATE NUMBER-CLI59249284 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 TYPE OF INSURANCE DL SuaR POUCY NUMBER—--------- MMIUDCDYIYYW MMIDOflFYVY LIMITS LYR X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 6AEm'si;i517"EN'r€—._________100.000 A CLAIMS-MADE OCCUR .PREMISU9�(Ea_rron9el__ $ CGL0050174 '!/20/2015 7/20/2016 MEDEXP(Arryonopereon) $ 5,000 -.__-------._. ....... _.._._._._._.. _________ _ PERSONAL&ADV INJURY $ 1,000,000 GE_N'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 PRC 1 PRODUCTS-COMPbP AGO s -2,000,000 X_ POLICY L ,]ECT L._ LOC .............__. ..— $ OTHER: AUTOMOBILE UABILIV EOMBINED BINGLE LIMIT $ 1,(100,000 _. ANY AUTO ._. ._.__._-____,_ $ BODILY INJURY(Perperson B ALL OWNED SCHEDULED AUTOS �AUTCE .01,134 6/21/2015 6/21/2016 BODILYINJURY(Peraaitlent) $ NON-OMED PeOarEnEe iAMAGES AUTOS PIRBetic $ 0,000 X UMBRELLA UAB OCCU-MADE AGGREGATER _EACH OCCURRENCE ,S _51000,000 A EXCESS UAB CLAIMS $ DED RETENTIONS 000050664 7/20/2015 7/20/2016 $ WORN ERS COMPENSATIONYIN TAT T ERH AND EMPLOYERS'LIA UTI' _E.L.EACH ACCIDENT b 5001000 ANY PROPRIEtORIPARTNERfE%ECUTIVE ('-'-'I NIA ------------" '"-" --- OFFICERIMEMBE0.E%CLUDED't L_J C (Mandatory W NH) RC009774192 9/20/2015 9/20/2016 E.L.DISEASE_EA EMPLOYE $_ 500,000 tt ye¢,de¢mbe ua., E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS beb DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES(ACORD 101,AOd fimad Remarks Schedule,may W atbcfled amore¢pace I¢mqulredl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Insureds Purpose THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORQED REPRESENTATNE Glendaly Gomez/MD1 ALY't l ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 nn+nni� Massachusetts Qepart"tnent.of Public Safety ,- Board of Building Regulations and Standards License:CS-080515, Construction Supervisor KEVIN M FRANCIS 33 LAYFAYEfTE,ST HAVERMILL MA-01 rl - P tt--j^^'K-vim-- Expiration: Commissioner 07/21/2017 r-5/-x, A[fairs&Bus n�R�g lot nn�rCf, ME IMPROVEMENT CONTRACTOR ( _registration: 108503 .,Expira0on: 8/19!2076 Type: � Gr Private Corpora:in` J N R GUTTERS,INC. - Jonathon Raymond 38-40 LANCASTER ST Haverhill,MA 01830 g Undersecretary d