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HomeMy WebLinkAboutBuilding Permit # 6/1/2016 BUILDING PERMIT t,®R7,� ®� tVao � 'aq- 00 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: � Date Received9�SSATED Ps��q`� CU Date Issued: PORTANT: Applicant must complete all items on this page r�v�`� l� ✓ �: ' t ,r r f7 f i� r:t z t i ✓t .5�e�s✓vf �;��, ✓" `$ l v�/si ` �f r .....1p ,. _ �; a %Tl ✓, `s✓n;s .;1r .,,�. �✓ �,,�'.✓u,✓sf✓r.: sra � ✓ y ,..e,J✓✓ a �,� lP, %�✓ �`a,��r:✓� t� F✓��rl d,,, of;� �+ �- e �h,.y✓j � i afi Y .1.✓. ✓i' ;,;'� ✓"-'c ✓r� r��'�-t :� 1 r .. �n✓�.:H�✓¢✓" �:' G ��_Y>r`'� �.. 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"� ,,.,.v r a 'its ;#!hY N/' �l'Y✓f �s 1 '✓ /I✓r�✓:r`�f �r`r� �r � ✓ f-✓ N r, � ✓:$. •' ". P OFERT�Y OWNER�� �,� � � :�� �, �r�:�✓r�,��r��,�.. ✓✓ �✓✓✓ ,� �� /� ���� � �x ����� �✓������� �4�,r„ ✓ /�✓'rr ;✓., � J`.,fi(,!J(?1 -:d' t /i'x- �.. v, ,. .u".. "Y✓"�i 1 {✓, ,✓:� "Wan'nn,�w.:w., .ia�s' .-':�^? rc' S '.;✓ e ✓'�✓✓✓r r�r.,n.t� ✓e. r ✓`�. 7r�+ ;rs� �..,�^ 7r �✓rx--F �;z„r�✓?"�;�"r'. ..�` a^✓'-� �.,. ter.. „a .�ia �:fr v��,r�,r : .Irl? ✓ �:.,. m ✓'r',�,!. "�. ;:>° .. 'f> ,,,.'e✓.v. .. 'd dc(tr ✓,�. r ,$t v ✓✓ , .,!- :..�, ” 4 a ✓:,r" �.�, � � ✓ �✓ ,✓, � ,✓f �✓ ����� �. ��� � � � �✓�Rrm K���r�, ,,.� ,1 100,Year�Struc�ure Fri ���s � es�,� no `r�•. �„✓f � ,=.✓ f,�M1✓ N ... ✓p P t 1 ✓✓ / :,1 r r .l J` l�✓;Y �a'au�.✓r .:,Pr ✓✓� ' :.�.:�,�`wr;%�;✓ r!L�r; ✓,✓°,.1✓/'ems°�f ,t r✓ ,✓,�....✓uF ✓,., f✓tr ox r�`�'�:�' 6G"�'�.��'✓�`7"'r�,��',:�✓��1/�✓.�✓��m��,,r �%s :., �-���� ✓a�PARCELf✓ �✓�� �� ZONING DISTRICT :Historic ®istrict���, sti�� r r��✓�t �✓ %9' "�'� � `° �f✓ ' �' � � „ �� Machine Shop Village yes no✓ TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building -- One family 0 Addition 0 Two or more family ❑ Industrial ❑8jLR ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other �❑ Septic ❑ Well ❑ Floodplam� ❑Wetlands ❑ Watershed Distract ❑INaterl;Sewer DESCRIPTION OF�WOR BEP RFORME r. Iden tif ca ion- Please'Type or Print Clearly OWNER: Name: Phone: Address: L Contracfior Name !/' Phone r ✓r r✓✓ o Email Address�� rf� ✓� .� � i✓ ��r 1� F � �� � � ✓f�✓?✓ur � � r�r✓�I �r���l�rs�ar✓ i � � x r ." �, uY/�✓ � / f .�✓ ! ': r r ✓�' �s �� ✓4`,%�✓7` ✓✓ i :,�l✓!��!`��r✓'� ./✓✓,✓6✓� �✓y,.. Supervisor s�Construction✓Licens,e ✓� , x , ✓ � ✓r� Exp ��Dafe�� -��,x�✓�� � � � ✓��� ✓ ✓ '�✓fi�y,✓,� ✓i" 7.,✓§ i {/ ✓ t tf.r r f �,. r�. a�� ,..✓ ..�, ✓ l` ! ✓s .-r r ,� ,�_: Y r .y a�✓rf r„ ✓ ✓,� ,z + F � /i ( f/✓.k�✓�a r ra �y tZ"rTn!'✓�N,��Z�, :r �(fir �r ✓f ria �� ✓��it ✓ f✓✓ .� ��✓ f 6✓ !✓ �✓ `. r 1/'r� � �i, / ✓ � ✓ ✓f f: /?��/'�5�5:.✓�� �'��(i`✓'i x l ✓ 6 ✓r✓s� ✓ �.�� ski/c� - �✓€"�./-1/ �r a✓ �1/� r ✓ t ✓✓ ✓ '�a t � "r"✓� �y.✓ Home Improvement License ; .. .v�. �✓%', -.Exp '-Date `..�. ,. �� �r����_✓��.>> ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ FEE: $, , Check No.: U 0 Receipt No.: 4�1] NOTE: Persons—contracting with unregistered contractors do not/lave access to the guaran Signafiure_of,ggent/awn er, Signature of contract - t%O R TFj Town of ,,=..., L0 i, ® hver, Mass4,4S j wix 2AI O • LAY(! q COC MIC MI MACK T � �.9 ®RATED S 11 BOARD OF HEALTH Food/Kitchen PERR T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ................ ............................... ........ ......... .. .. ........................ . ... has permission to erect ..........................Puildings on Foundation Rough to be occupied as ........ ..... .Vi " ........ , .. .......................... Chimney provided that the person accepting tit 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 T Rough Service ............... ... ... .... . ra, ................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Bulldzn Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 1v1,1 r%UU ti,I'-r000v CT Reg#0606216 Federal ID#20-2625129 RI Reg#26463 i hs Corporate Headquarters,20 Cedar St,Woburn,MA,(P)8003-t2-2211(F)781-933-9626,w mxnewpro,com THIS CO CTtNADETHE day of TV I 20_Z between-ORO/ gig- , (Home Owners) (Home Phonal (eusrCellPhaneJ of is olofbyenok Mt /endo► (rtddress) XV Mob) (Z/J the"Owner"and NEWPRO Operating,LILAC,"NEWPRO". (5401#fOfPMPA6181yuse on/y NEWPRO hereby agrees that!twill for the consideration hereinafter mentioned,furnish all labor and material necessary to Install the following described wor¢et e r 1 s located at: The Job address is a condominium, (Job Address Grids:U YE81W NO CONTOUR USDL UELIR0. U DIAMOND q WlndowC for QTY I Wlndowcolor QTY _ OBS1TMP:([ocer.) CITOP OBOTTOM Int: b Int; Screens:(E)tenorco(orFull Scree nStandard) HALF ❑FULL Ext: Ext: Vent latches: YES NO Cappin Color: P/ease/n/UB/- PVCIaBmoothLj uMarU No Cappin CON In: Out: Double Hung Active; Left Center R t Customer undersiands(hat NFWPROO 2Lila Slider HOWR: SN BB BGE WW does not do any paWng or staining. 3 Lite Slider (1/4,112,W) (le:WhOn removing or repladng Interior 3 Lite Slider on,tn,1n) Color In: Out: stops or tnm).NEWPROb h not respo• CSSement(Hinged Right) FIbero'llvis 3 el nslblafat oonditioreoramumslancesbay. Casement(Hinged Left) HDWR: .SN RH AGB AB ORB andltscontrolinupoingcondensationrasu- Twin CasementUng from or due to pre a dst ng conditions Stationery Casement Color In: ut:Triple Casement (1/4,112,114) CASH ;Triple Casement 11n1n,us)' Color In: Out. Balance paid tolnslaneratcompletion Picture Window HDwR: SN B AGB Ata Sash Only Left Wrge RI hta FINADrz Hopper Bank co tallation Awning Color out: Garden Window Fiberglass Steel rD Bay Window(Root Asomt) HDWR: SN BS AGs AB OR sow Wlndow(Roof18offil) ((( Other Co r In: out: ( m Other WR: l AO DESCRIBE WORK&PRONOT/ONS APP:IED.- Edu sw 9,600 W V Est.StartDets. Z°«Est.Comp Date- ne a�Ul�Customer understands this is an"estimated date" Owner has read and agrees to the terms and conditions on the front and the reverse of this Agreement. Owner, specifically agrees to the(1)Total Cash Price;(2)work being performed;and(3)work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode island Sales Only): Notice to buyer: (1)Do not sign this Agreement if any of the spaces Intended for the agreed terms to the extent of then available Information are left blank. (2)You are entitled to a copy of this Agreement at the time you sign it. (3)You may at any time pay off the full unpaid balance due under this Agreement, and In so doing you may be entitled to receive a partial rebate of the finance and Insurance charges. (4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased Itsts under thla r ement. {ti},Xou may Dance!t is rsenlighl�If It has not been signed at the main office or branch office of the#eller;"' dsd you notify�gwsgller of*or rpt 114 or brano"Pics,shown In the Agreement b registered-or.certified mall,which shall be posted not later than midnight of this,tfiTr"d'calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made. N Sae the accompanying notics of cancellation form for an explanation of buyer's rights. 4 (Rhode Island Sales Only), Owner acknowledges receipt of required Contractor's Registration and Licensing 1b Board consumer aducation:materiala. (Owner's Initials) t = grG J W HINk signed: �._.._._ Pir1aclelrarjFW,!BOF met) sy a l The Conawonwe4 M o}F1YI,assgrhrssetts Deflaraaene ofIndushidlAeddents 1 0ongress Areet, ,Suite 100 Boston,AM#2114-2017 wwav ma=gotv/dia >• V workers'Compensation insurance AffdavW Bnilders/f ontactors/EleeWCians/PluMbers. To BE, FH THE lPERAUTMG AUTHORM. Agglicant Information Please Dant b A1anle(Basiness/t tion7ludiv duaY): Address: I 1 City/State/Zip: Phone#: alL_ Are youto ea?Cbei t eo r p y PPoP box:- Type of project(recintred am a employei wit& emptayees(frill and/orpart-time).a 7. ❑New construction , 2-E]I am a,sole proprietor o.pazmersh►pd Lave no employees worl�g forme m $; ®jtpdeling any capailt3i.[No 'wrap.iairua"tice nq�) 9. QDerriolition' 3.0 I am a bomeownea doing all work myself.[No workers'COW.a m o=requved.]t 10 0 BORdifig addition. �.Q I am a homeowner and will be Ding contractors to a all work an my property. I wt71 ennae that all contractors either bave workers'compeasation insurance or are sole 11.0 Electrical repairs or s w;hnoyees• 12.®Pltimbiilg'tepairs or�Jddtti:_ 5.0 I am a general coirtiact&and I liave hired$ae sub.Witro listed ori the aniched SbeeY I .0 g These sub-contractor have employees and have why'gip.in—Mcel p�6.0 We am a corpoiaiian anti its officers have exercised theirrrgiit of exemption MGI, 14. er:C. 152,g1(4),andwehavenemploye Weworkers'bo mswan . .. - sAny applicant tlit+tcliecka boas iiitrat also tStl'onf the eechon 6etow s}towuig Sre eskers' bon P?>iei?a ?n:_.. . ... t Homeowners who s6fi*rhes sffidavh iiidreabmg)!*ale all IW grid @ren hht ouLvcdIItmctarB must srilnait anew affidavit ladi ng such tContractois that check this boa must attached Maidditional sheet ShDwbZ the na=Gf_4rd subde c sand state w isthz ar rot those cadtki have must their,:viagloe—_comp.policynrm�ir?..,.: employees._Ifthesyb-eoatrsbayeemPl-ayoes,they_ ...Proms . .. - �'am art;eptployer that as providing rvorFrers'compen�ution insuranrce for i sy eiaptPy es Belaw ds the poFi'a�±arrd jah-site_ Insurance Company Name: Policy#or Self-ins.Lic.#: EapaationDate: Job Site Address: ' : t Attach a copy of the worlds'Compensation policy declaration page(showing the policy rinmber an ezpirllUOn date). Failure to secure coverage as required under MGL-c.152,§25A is a criminal violation punishable by a fall up to$1,500.00 and/or one llmmp.Mmmirnt,as well as civil penalties m t}te fo m of a STOP WORK ORDER spd a Sae of up to is2:. . a day against the;yioletar.A copy ofthk ata 6ci may be foatweicled`to$ie'Office of lnvestigations.of the DIA far insurance coverage verification. I do hereby certify under en of a information provided aboveAr true and coned sign Phone M4 of wial use only. Do not write in this area,to be completed by city or town o, cw City or Town: Permit/License# Issuing Authority(circle one): 1.]Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/29/2016 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(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 Melissa Pflug g Mackintire Insurance Agency Inc AlcNNo Ext: (508)366-6161 AIC No; (508)366-5202 11 West Main Street ADpResS:melissap@mackintire.com INSURER(S)AFFORDING COVERAGE NAIC# Westborough MA 01581-1931 INSURERA:Netherlands 24171 INSURED INSURERB:Libert Mutual/Peerless 24198 Newpro Operating LLC wsURERC Acadia Insurance Co. 26 Cedar St. INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 15-16 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 DDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE �OCCUR DAMAGE (Ea occurrence) 100,000 PREMISES $ CBP8589577 12/31/2015 12/31/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY F PRO- 2,000,000 ECT LOC PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED BA 8584174 12/31/2015 12/31/2016 BODILY INJURY Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OVAVED PROPERTY DAMAGE AUTOS Per accident Uninsured motorist BI split limit $ 250,000 X UMBRELLA LIAR I X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 CU 8582578 12/31/2015 12/31/2016 $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEY•ECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? Y NIA (Mandatory in NH) WC-20-20-003506-02 5/1/2016 5/1/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom it May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE T Moynagh/DORRIE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IN S025(20140 1) 2%, 1C ?Cf�:I A S P.,":iL CIX0,?,j '3e YvALi%!L; Vic.=t.vii••IG iv!:`. l i2;37 j d;-�1317 ^1 F Yb f ir�Cp9 Re9�s Suppjemeni�==rd < " ONIAS 26 CPDAR ST- �` A 'v T exon far chap,. ii�jQ ��� s t�l� �$G� to �� return curb-? ars r rt Cz.d Jpdafa dd125H SII(1 �IDpto'jln8Ilt o- ,st -� ddr;ss []RenaFlai (=1 :9iir0 I I Pe cri a � >.dn- an� vatic fos ia�� vrGd��TTrgi51(�cwc� �Vf='at:sU� I.1C9Rfi8OY�3gi�d� a0t131t�YpL�1Sio: a be:orethe; iratia� date. tion _ iCtee ai Consumer L irS uZ B�Slnras aa1taRun O-T 0I p11SUlSZda Agair5 30 PrZS5ISIE.- $3 - �,4611i COtU+tGTOP, -Su 3 =W _dl tNlE!iv4�Qauc ` 1 ani, _o �I7 �tton_ss =Tr�,u 3ost'��%�`egl5it .. •�---_�rt 8uQp19m2Cd rv;_ ,;t i�CJi�•'•`7 :-.�, '�. /�%r ��..`'= ,�� 1 - F"i Fi12iIQOL 513CtL� ?5������H i• `ter=_=C4r,��;