HomeMy WebLinkAboutPermits Permit # 7/26/2016 gao�r�
BUILDING PERMIT of
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: O Date Received-
Date Issued:
IMP®RTANT:Applicant must complete,all items on this page
LOCATION.
Print#
PROPERTY OWNER LAWsC l,td;iA
SD
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes ID
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑ Addition ❑ Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement- ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic'. ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District
Water/Sewer :
DESCRIPTION OF WORK TO BE PERFORMED: „ .�—
►&io Exs i 1,-JG Deck ^A tL J NEW 10 SJ:�A f VB-E5
T DEC r _
-6 V fL3 1qCJ4 10 P1 Dc-(/<, to E?�IS
:ER.P ►JOWName: � �� !���iA Phone: �3`T
�2 RAPwm,f)
Address: t �
Contractor Name: 1 1 (NExt.6) Phone:
Email: --p-o t4axvs bjiA
Address: ' j, ALS 1V4A
Supervisor's Construction License: C S 0-7 3 ' Exp. Date:_ - `9 `
r
-7 Ex Date: 7 '
Home Improvement License: p
ARCH ITECTIENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.'$12.00 PER•$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER 5_F.
Total Project Cost: $ 3m° 30 FEE:
Check No.: Receipt No.:_
NOTE: Personas contracting with unregistered contractors do not have access to the guaranty fund
Puns Submitted ❑ Plans Waned ❑ Cerfified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DZSPOS
Publzc Sewer Taming/MassagelSody Art ❑ Swimming Paols ❑
Well ❑ Tobacco Sales ❑ Food.Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpstez on Sate ❑
THE FOLLOWING SECTIONS FOR orFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewer! On ���� ��� Signature
COMMENTS
rONATION Reviewer[ on � Signature
COMMENT �..
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals.,Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water Sewer Connection/Sr naturo &Date Driveway Permit
]DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DOP .TMEENT - Temp Dumpsler on site yes,
Located at 1:M main Street -
Firb oelaartment signature/date
COMMENTS
NORTH
owe. of = : rAndover
No. 04-2% 17
_
VKL.I. hver, Mass, -O :; Z6 TD�6
ll BOARD OF HEALTH
PERMIT T LDFood/Kitchen
Septic System
THIS CERTIFIES THAT 44.0091C . �., ..,,..lei .��.� ............. BUILDING INSPECTOR
.... Foundation
has permission to erect.......................... buildings on ... ...... �..g.wvw......�
r
... Rough
to be occupied as -W-41....... !! �
. .���.....500% ..... ......� 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
Fina[
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR_
UNLESS CONSTR TION S Rough
--Service
... . . ............. .BUILDING.. IN.......
CTO Final
GAS INSPECTOR
Occupancy Permit Re uired to Occupy Buitdin 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.
F N TH
Town of
1dover
O ..-,• y`
No.
ver Ma 30 A I
�F a L A : 9
•QA coc"I ewe ti
TE 0
S
BOARD OF HEALTH
Food/Kitchen
PER T Septic System
r
THIS CERTI S THAT 1 � UL ...a. BUILDING INSPECTOR
.................... ..................................... ....... ...0..... . ....... ...... ...........
ekFoundation
has pe ission to rect................ ...... buildings on .. ,.,..., ..1,, ..,....... ..................
to be/occupied .. ..�. :�!. .Q.,..... .41n sh ,.!,._... ... ..,. • Rough y
oCCU led aS ,... . ,..... . Chimney
pro 'ded that the person accepting this permit s I in every re pect conform to th terms of the a licat n Final
on file in this office, nd to the pro isions of the odes and By-Laws relating to the I pection,Alter ion a d
Construction of Buildings in the Ti n of North Andover. {.p,�� +J�..� ,rp 64ek PLUMBING INSPECTOR
.lIMW,.A* styes.
VI0!CATION of the ZoI�ing or Buildin Re ula ons Voids this P rmit. 1 J Rough
Final
PERMI FIRES N 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CO T 10 T R Rough
rvice
, .. ........ .. .. ...... .. ........... Fin
BUI G I ECTOR
\ \ GAS INSPECTOR
ccu ancy Permit Required to Occupy Buildin Rough
Display in a onspicuous 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.
V(,OS MIN
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NEW ��C),Ji � �s�
North Andover MIMAP July 26, 2016
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L7 MVPC Bo
Interstates Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83,
-- I Meters Data Sources:The data for this map was produced by Merrimack
--SR tk011ll Valley Planning Commission(MVPC)using data provided by the Town of
f RoadsO `�.p � North Andover.Additional data provided by{he Executive Office of
s'ti'r rp yb Q Environmental Affairs/MassGIS.The information depicted on this map Is
t"a Easenren{s "�` OZ. for planning purposes only.It may net be adequate for legal boundary
j Parcels ¢ to definition nr ragulatory Interpretatkm.THE TOWN OF NORTH ANDOVER
pi
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
,l{ •! y THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
* y n * OF THESE DATA.THE TOWN or NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
poM^rro hit"",S�l THIS INFORMATION
AHDIS
1"=32ft W�`
V7/26/2016 08;34 FAX 978 532 2217 CROSS INSLTRANCE 1@001
CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIWYYI
ATE 15 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 pollcy(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 oertificate does not confer rights to the
certificate holder in lieu of such endomement(s).
RODUCER CONTACT L7t,,i� , Goldman
NAME:
;rns2 Zr,9Yxr3YYe6—E'6AbGdy PH (51711�532-5445ONEFAX
OLNa.EV)� .(979)632-2217Nd
.39 lynnfield Street E-MAIL s�,lgolcir n@croseagency.com
INSURERS AVFORDING COVERAOE NAIC 9
leabody MA 01960 INSURERA_Woatorn World Ins. Go. _
ISURED INSURER 14.-%ilfVtY inde=ity 33616
rexns II Servicas LLC INSURER C,
I.O. SAX 2823 INSURERD:
INBUREtt E:
robu=n MA 01.8AA rN5llRERF• �.� .-.-- .--.�.. --�
;OVERAGES CERTIFICATE NUMB ER:CL151022533131 REVISION NUMBER:
THIS IS TO CERTIFY THAT TME 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 SY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE: TERMS,
EXCLUSIONS ANE)CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
A13134 SURRI
TR TYPE OF IN$URANCU; POLfCY NUM9ER POLICY EFF PGLICY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCOURRENCE $ 1,000,000
ACLAIMS-MADE OCCUR (rrence $
NPP8290737 $112/2415 9/12/2016 MCD EXP(Anyonoporson) $ 5,000
PERSONAL&ADV INJURY S 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000
POLICY❑ PRD F LDC PRODUCTS-COMKOPAGG 8 1.000,000
JECT
OTHER, Damage to Rented $ 50,000
AUTOMOBILE LIABILITY Gf,arOM8cidnnINEDt 51NGLE LIMIT
i3 ANY AUTO BODILY INJURY(Por parson) $ 500,000
ALL
AUTOS ED X SA OEStlULED 3116632 11/10/2015 11/10/2016 BODILY INJURY IPereWaant) S 500,000
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS AUTOS Pere Iggl} S 100,000
Med ca( amen€s S 5,000
UMBRELLA LIA6 OCCUR EACH OCCURRENCE _ 5
EYCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION S $
WORKERS COMPENSATION PER
ER H-
AND EMPLDYER3'LlAUILtTY STATUTE Y 1 N
ANY PROPRIETOR/PARTNFR/P>tECUT1VE E,L EACH ACCIDENT $
OFFICERIMEM9d�R EXCLUDED? ❑ NIA
(Mandatory In NH) E.I..DISEASE•EA EMPLOYIEE S
1!yea,describe under
DESCRIPTION OF OPERATIONS below E.L.OiSEASE-POLICY LIMIT 8
ESCRI"QN OF OPERATIONS f L80A7tON$I VENICLES (ACORD 101,Addldonal Remarks Sche4ule,may 4a atwohod Ymore apace Is required)
UA- yonchak pto�act
:ERTIFICATE HOLDER CANCELLATION
978)688-9542
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town pf North Andover TFIE EXPIRATION DATE THEREOF, NOTICE WILL AE DELIVERED IN
ATTN• Don Belanger ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood St
North Andover, MA 01645 AUTHORIZED REPRESENTATIVE
Lauren Goldman/MX �Y --�
1988-2014 ACORD CORPORATION. All rights reserved.
1CORD 25(2014101) The ACORD name and logo are registered marks of ACORD
NS025(201401)
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