HomeMy WebLinkAboutBuilding Permit # 8/2/2016 Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans r]
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Dody Art ❑ Swfi`nming Pools
❑
well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc.. Ll Permanent Dempster on Site L1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING DEVELOPMENT Reviewed On X/7010 Signatur
COMMENTS (Ycc FIA i 2_0 "Q D UL 0+ \XCA'StZA k-U!;
CONSERVATION Reviewed on to .S�Jnqt�ure
COMMENTS
HEALTH Reviewed on y�1 -
COMMENTS �Jr
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Zoning Board of Appeals. Variance, Petition No: Zoning Decisionlreceipt submitted yes
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Planning Board Decision: oh".IIJSS?- Comments
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Conservation Decision: tD Comments
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Water & Sewer Connection/signaturo Date DrivewaPermit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT�
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'Located at 1241"Main,St t
Fire Street
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COMMENTS .
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BOARD OF HEALTH
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PERMIT T D Septic System
THIS CERTIFIES THAT ......... ...V'S.ZL .. BUILDING INSPECTOR
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has permission to erect ..... buildings on A1.1.... r.. . ..... ...... ..... . ..............
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to be occupied as ............. �A .....�. . .... ,.......................................... Chimney
provided that the person accepting this permit shall in every respect conform the terms of the application Final
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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
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PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTW^I ST Rough
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... ..... ........... Final
BUILDING INSPEC
GAS INSPECTOR
Occupancy Permit Required to Occupy By 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
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AC CERTIFICATE OF LIABILITY INSURANCE
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(5), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
INSURED,_010 li6ficyl[les) InUst"""iR(f6rs0d- If SUBROGATION WAIVED,subject to
IMPORTANT: If the certificate-176ki-e ADDITIONAL 7lt,�t
IMP � I is�an
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 stich endorsement(s), .... ....
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CONT
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PRODUCER �CT NA SanMunroe
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M.P. Roberts Insurance Agency PNONE.OE-
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1060 Osgood Street EWAIL
--andi@Luprybertsinsurance.com
NortIT Andover, MA 01845 lnSURg.R[SjAFFORDR1r,COVERAGE NAIC a
lN50RERA:r,SSeX Insurance Co
INSURED INSURLRH.Associated Emplovers, Insurance
TKZ, LLC INSURERC:
c/o TOM ZARORUIKO INSURERD
78 GREAT POND ROAD INSURER E!
NORTH ANDOVER, MA 01845 INSURM C:
COVERAGESCERTIFICATE NUMBER. REVISION NUMBER: ,
_IClI_ E W ISSUED I- SUED-F6 711EINSURED NAMED ABOVE FORT I IE POL ICY PERIOD
rbllS 5S 7"D JlF� FIAT 11 If,
INDICATED. NOTWITHSTANDING ANY RF-*QLIIREMFNT,TERM OR CONDITION OP ANY CONTRACT'OROTOER DOCUMFNT WrI`IIRFSPFCT TO WHICH MIS,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTFT? POLICIES DESMIBLO I W-RFlN IS SUBJf`,CT TO At.L 1111 TERMS.
EXCLUSIONS AND CONDITIONS OF SUCI-I POLICIES.LIMITS SHOMi MAY HAVE BEEN REDUCED BY PAID CLAIMS
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POUCYEFF
POUCYEXP
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LITS
LIRGENERALLIABILIfYVAamMP POU Gy 4L !LMyyy M
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PREMISES(La S .5.0. 000
NIT D 1Y1 lA111 11,11115-) S 5,
CLAIM MAUL X occuli
PERS014M.&Avv IMURY S 1,000,000000
GUNG
HIAl Ac GiAu �:i 2,000,000
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AUTOMOWLE LIABILITY kk
B011a y INJURY(Par TIr-nn) 1l
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AUTOS AUTOS
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MESSOMCLAVAS MADE AGORF6ATE
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Dk 11 ul ILM11 �tsTA10 (yril.,
B �WCC'500500651_7_2014A� 10KYLIMMI; Lit
AND riMPLOYERYLIABILITY Y/N
t AGH ACCHCUT y 1,000,000 1
NIA L 1.DIS I AM: FA I UPI OYI I"S 1,000,000
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED Pol.ICIFS BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE 0FI.IVFRED IN
TOWN OF NORTH ANDOVER ACCORDANCE WITH 1HE POLICY PROVISIONS,
1600 OSGOOD STREET
BUILDIN(1, DEPT
NORTH ANDOVER, MA 01845
OF 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD
Phone: Fax: E-Mail:
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-055417
ConstrueHon Supe®visor
THOMAS D ZAHORUIKO
4 HIGH STREET SUITE 201
NORTH ANDOVER MA 01845
-^� Expi ration:
Commissioner 0410512018