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Home My WebLink AboutBuilding Permit # 8/10/2016 V&ORTH " 6Town of Andover O 0 No. - h ver, Mass O LAKE 7 � coc"Ic"a— A Pr �R s U L D BOARD OF HEALTH Food/Kitchen �Tuc��6A@j P MIT Septic System;�&f THIS CERTIFIES THAT ... .............. �+— BUILQIIVG INSPECTOR . ..... ............. .... Foundation has permission to erect .................. ....... buildings on .. ... ,... .. . .......................... to be occupied as ..........��+ w1.....a-.... e.0j...A��3 ...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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLE SSC T IATPr4 Rough Service .. ........ ........... Final BUIL G INSPECTOR GAS INSPECTOR Occupancy Permit Rgquired t® Occupy Building Rough Display in a Conspicuous Place on the Premises a 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. d � r U � CS 0 Cfl � UL �uw � 6 {= L 15 IIIA uP � I � x a 4 vy E k y FF (ri N 1— JONATHAN ZAPATA FIRST FLOOR ENTRY N9 v*tater Andover,MA.Street North AndNEYSI DIV15ION VV %LL � ) J » a § a� 2 , m§ e ea = « . . ��. \ » �! -. UP s , > , \ -.A r� } U ,mn" ^ k \ A \ . # . . z u0NA ma APAA BASEMENT Ham+ &e 2 North Andover.MA PARTIAL FLOOR P AN The Commonwealth of1V1asffaehusetts x Department ofindustrialAccidents - _ 1 Congress street,Suite 100 Boston,.A 02114-2017 , www.mass.govfdia Workers,Compensation Insurance A-fidavit:Budde.&ContractorsCEIQc�rXcaianslpi 1)ors. TO M, FMF,17 W1TR TBE PURMTTING AUTROR[TY A l:cant1(nformation l?leasal'xint La 'bl Name,{Busimess/orgauizati.onlfndi-dduat):n�� L A�, .F ddre= l City/State/Zip: phone#: Are you an employer?Checkflie aQpiopriafe box: Type of project(Vgquired): 1. am a employer with_, =employe cs(£uii and/or pari time).* 7.• Q Now cozistmotion 2. I am a sole proprietor or partnersbip and have no employees working for me in $. E]Remodelift any',paoity.[No worirers'comp.insurance required.] 9, ❑Demolition 3.0 I am a homeowner doingall work myself"[NO workers'comp..iusuraucerequi�ed,]i 10 ElBuilding addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all.contractors eitherhave workers'compensation insurance or are solo Electrical repairs or additions proprietors withno employees. 12:�]Plumbing repairs or additions s.❑I am a general contractor and I hays hired tha sub-contractors listed oath-,attached sheet, I!.-E]Ro 6f r'ep airs 'Show snb-contractarsiiave employees and have workers'camp.insivance.� 6.0 We are a corporation end ifN pr�gers,have exercised theirriglat of exemption perMCrL c. 14,f J Other 152,§1{4),andwehaeenq,eznpi.loyep.[Nnworkers'comp.insuzancerequired,] *Any applicant that checks box 41 must also M out the section below showing theirworkers'compensation policy Wannation. t Sloratawners-who submit 11vs affidavit indicating they are doing all work and thenhirs outside contractors must sgbmft a new affidavit indicating such tcoafracfors fiat cheek fids box nn st•attac ed an additional sheet showing the name ofthe sub-contractors and stats whether ornotfl?ose entities have employees.'If the sub-aodiraciors liana amployees,i,iey must provide their workers'comp.policy number; I arca an employer tla at is providiiag workers'compensation insurance for my employees.'Beto7v is,thepolicy andjob site inr f`onnation. Insurance Company Name: Policy#or Sold ins.Lic.#: �rratzon Date: 2. /��l lob Site Address: 1 � City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number arzd expiration date). Failure to secure coverage as required under MGD c. 152, §25A is a criminal violation punishable by a fine 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 of up to$250.00 a dayagainst the 'olator.A,copy of this statement may be forwarded to the Office ofluvestigations of the DIA:For insurance coverage Ver, tion. I do hereh r�lify under tr aims and penaXties of perjury that the information provided above iiss�true and correct. Si atur Date: Phone#: ✓] . Official rise onXy. Da not7vrlte in this area,to he completed by city or town official. City or Town: I'ex mit/I items-,# issuing A.ut]'aority-(circle one): i 1..Board of Healffi 2.Building Departrne)at 3.City/'? o nn Clexk 4.Electrical Inspector 5.Plumbing Imspector• 6.Other Contact Person: phone#: 978-685-0319 Silverlo Ins. 11:54:11 a.m. 06-16-2016 2/2 AC -0 CERTIFICATE OF LIABILITY INSURANCE D"'�`�"'"°°"Y"'' 06/16/2016 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 AMSND, 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 polley(€es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,cartain 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 NAME; Johanna Gutierrez Silverio Insurance Agency PRONE 978)685-0209 FAX,N ; (978)655.0310 10 S.Broadway A p�LSg; info@silverio€nsurance.com INSLRER(S)AFFORDING COVERAGE NAIC t Lawrence MA 01843 INSURERA: WESTERN WORLD INSURANCE INsLPM INSu2ER6: LIBERTY MUTUAL FIRE CARLOS CASTANAZA DBA CA Construction INSURER C: CA CONSTRUCTION INSURER D 317 So.Broadway-Suite 154 INSURER LAWRENCE MA 01843 fNSURtRF: COVERAGES CERTIFICATE NUMBER: 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. IL7R TYPE Of INSURANCEADOLSLURI POLICYNUMBER PM!DYfic EF MPOLICYEXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,004 CLAIMS-MADE OCCUR DRAAPREM#SI S Ea occurrence $ 100,000 MED EXP(Anyone person) $ 5,000 A NP138326275 05118/2016 05/1812017 PERSONAL&ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JE"° n LOC PRODUCTS•COMPIOPAGG S 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINE LI IT $ a i n ANY AUTO BOD LY INJURY(Per pErson) $ ALL COLED AUTOS OWNED AUTOSS BODILY INJURY(Per accident) $ NON-OWNEDROPE72 DAMA E $ HfRED AUTOS AUTOS Par accident UMBRELLA LIAR OCCUR EACH OCCURREIJCE $ EXCMUAB CLAIMS-MADE AGGREGATE DED I RFTENTION$ $ WORKERS COMPENSATION PER 0 AND EMPLOYERS'LIABILITY YINANY STATUTE ER B OPFICERIMEMBER EYC UDED7 ClJn 11 NN N i A WC2-31 S-365147-036 02/24/2016 0212412017 E L.EACH ACCIDENT $ 100000 (Mandatory in NH) E-L.DISEASE-EA EMPLOY $ 100000 Tascrits under — IPT€ON OF OPERATIONS below E.L,DISEASE-POLICY LIMIT $ 500000 DESCRIFTION OF OPORATIONS I LOCAT1ON9I VE401_153(ACORD 101,Addit€onai Remarks Schedule,maybe attached If more space Is required) Additional Insured is added automatically as long as there is a written agreement requesting to be added CERTIFICATE HOLDER CANCELLATION /SHOULD ANY OF THE ABOVE DESCRIBED POUC158 BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of North andover ACCORDANCE WITH THE POLICY PROVISION& 1600 Osgood street AUTHORIZED REPRESENTATIVE North Andover,MA 01045 01988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachu' selfts Ank Department of Fine Services a Office of the State Fire Marshal P.O,Bax 1.025 State Road,Staw,NTA 01775 PERMIT bate: (City of Town) (If Applicable) Ilig Safe Nuruber In accordance with the provisions ofUG.L. Chapter 1 Qas provided in sectton 5 2 7 CMR 34 e SfiflI't�at� T1tie Permit is granted to: Full name of person,Farm or Corporation Permissioato locate dumps�er for construction/renovation/demolition of structure Combaents: dum ster be 25 ' from structure or covered with tarp or plywood Restrictions: at end of workday at f - (Diva location by street and no.,or describe in such,mannery to pprrlovied adequate identiffeation of location) Fee Paid ( This Permit will expire � U l d .{Signature of ofEcal grantingpermit) - OfGal.granting permit ( do) �°� TWIC PPRMIT MI IRT PtP r--nN-IQPIr--I InI ICI V Pr)CTI=n I IPnKI THF PRIFII111CPC '��