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HomeMy WebLinkAboutBuilding Permit # 9/13/2016 fl OF N`O o�b SRO BUILDING PERMIT 3= g' " '° 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION { e� Permit NO: �1� Date Received ��ss�c►+us��.c`� Date Issued: I I PORTANT:Applicant must complete all items on this page LOOATIOI I 17 Abb€�tt St�ee -fora f�r�d r� f} 84 Pr�r PRCPERTY OAR 4llrrt oe Pn�t MAP NO"62) 1ARCI�t � ON11G ll IfCT Htsttttc Its yeso TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building x One family ❑Addition ❑ Two or more family ❑ Industrial []Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 1-1 Demolition ❑ Other ❑ eptrc D W1 l=1or� plaatrt ❑ ids ��shjd l�llt ❑ ati � r Cellulose insulation in garage ceiling Identification Please Type or Print Clearly) OWNER: Name: William Lovett Phone: 978-208-0929 Address: 171 Abbott Street North Andover, MA 01845 COI TRA TOI ' N +twJos liA Ryan, M rr�rnacl Vale 'Insuia ►€t P xcrtt - 0 7 Address 2�A uCl�van Rd l �lfca,6A�'11I "Q4- r� Super rsor's ,'ia"r'�trklt tr�rl I�rcerxs j' .: - � Horne Irrtr�rteiertrcert E Dade 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 S.F. Total Project Cost: $ ' _. FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the ranty fund tgr a bre of.A iOWrter see a ached'. Signatrare of c rttractor tkoRTH q Town of 5 ndover ® =ti 0 Ild h �( C h ver Mass, 4 LtlCNICMl WILK V ItU BOARD OF HEALTH Food/Kitchen PERMI LD Septic System THIS CERTIFIES THAT ............. U1. ., . . BUILDING INSPECTOR has permission to erect . ........... buildings .I-1.1,,,.,. ,, Foundation on . � � Rough to be occupied as ... 41 ,.,.. ,..,. ...,.�. l........ .. .. . ... ��. .. ....... Chimney provided that the person accepting this permit shall in every respect confo�to the terms of thea liclion pp 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 LESS CONS TI® Rough Service ..,... ... ..... .............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit RE aired t® 0ccM 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 Street No. Smoke Det. 3 3 RISE60 Shawmut Road,Unit 21 Canton,MA 020211339-502.633,6 ENGINEERING• www.RISEengineering.com OWNER AUTHORIZATION FORD ,, William Lovett r+e(' L...;`i--, l- (Owners Name) owner of the orooerty located at: 171 Abbott Street (Property Address) Noah Andover, MA 01845 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. ers Signature Date J The Comxnoil.'ivealth of Massachusetts Department ofIadustrial Accidents OfT-Ii;e:of Ln:vesfigatii}ns 600 WiiAin tort S t. Bosto 7 rV-Li 022111 Worltier's coxapensation insurance Affida-vit: 13EdId8rsICG-,ztractorsrT-lectriciansfPlumbexs Anpl;catimn lnforl--latiol?—Please PrivtLegibly - a-me(liusi esti!{�r�an at"nul�rE�z��iaaa�/O��ner:,L � ikGil` l� Address-_ a3 A 8::._.I. 'A;A tJ' V Citcl tatz i :`'b+t���tc:t+ E�ir2 C; spa- Phone Axe t pprop-% to nur'ilber= -Axe you au e�»la;�er_ e t+ail �h..,homeowner? Check the a - i aai an sinfll©vt r with�er�ipiuvees(itlll a�tddor tlar��irne. ar a sole praprictor or parmersbip a ha-:e no employes,fort ilzg for me in any capaci _ l "a. ^ I ani a honlea�'ner doing, :vorli, (f rjself. a vv orltiers compeasation Insurance required.) .r r aha-a generaE cararaccor&f have hireed the su';-eortr actars lissted on the attached sheei~ L`jIEQSe CoiEi�+aCtOta lIBYE�c"workers camp,Ii'i5i3r311% 2r1d T h, We e=ched.a coni n:their ins.) We:are a CArp or8tion£LIId iti officers Tuve E:2TC35Bd illi^clr right of S>err-P?toll Dpr VI ••CISS i t,a ur_n,:e hh, a e u employees.C4G ymrkers Corp.Iusuraric'r required,) l i v a:applicant tita[:chee;:s bo�=1.q ts=also RH vvut the seCiioa below sbowiog th^ir orkars-Con-a polis ip?Orolfliion. i f E = who submit this-0-daviilrsfflc:E:I"i11�V�!=:1Ltfr.g. aE� ti vi :2 CVni'_u r,iaar'subm:i ant-t, 1 tit"j{�F?4lL l?!CilCi2t�u��1sCi�. i o Cfl EIt1 ictflcs i.Ei.^.t CCL'CeC this box RII3stitiu2Ci1.til diilOII:ki$tie➢t shol4bnc'he;Inml!ill the Z31 •Ct3➢iT2Ct�1 r5 and IiiC:C`efElX'S.�' cotnnertsarlon POMC?'Irl$orma tiro_ Type of project(required): Cheel-,appropriate I - eFt CGiai1l_CLIGzs 7._ r �` pg ai`=0??g._ L`iCinr zir3Glii?fl r ETL�Jt^� i? s7. � o__�� _Plumb.i�. moo=i3_i/offier , , rsc�[a.�t�.. f,tm an employer that i<providing n orlicre compensatinu insurance:or Inc empinyecs. EC19W is the police.S job sift:info. 9 Insurance company Hare_ 8 '?plie f oT self-ins-Lie.— fipf;�il4li7 Date' — 6b Site-A-ddress: _tacii n coli or-workerscovineasattonpolicy.declaration pagspali+_r RuTnber-aridexpirationdate. kail[ie��7 SuCL"�COV.Rra $as'r�gL4�vCt Inder Secdon 25 A of i!:i_s�c. 132 can lend to L e hu' 0!-E o i€2 Ll3 I per=_aLdas-af a fur-upto S31-5:001-00 arid:or one4 year iaiprisoaravrr.,as well as 6 Vil penaltiss in fhe fain of'a "TOF Vf0 ORDER afid a E re a E p to 5250.00 a.day against the:ioladoil. Be advilseq that a cop;ai'this &€3RelAeili=iTiay he!`,onvarded to ihw fJs.r<Cu of tmvestigg2ttons of the DIA for insura Ice Co",'IarF T/eritr3GatF4l�. F on ara.ided aimve is trite and zarmcr_ do her_-by cep�i - nder:las ltiits mid penalties rifperjn y that t 1e iem-ima« "hone 0 ff-iciat use o_mly: ]G mAtriiita in Es aruc.,to be coo-n-pleted by 6*1 or tovin E� �• City or i it fir �icc�se - j lSSlll:"I Lt��ROrI (chock©:fie) i l 1. BoardtofTlealth 3_c3itiicdiaa Dept- 3_�Cic,:�I1 n:t:t Clerti ' Eiectrrical hnsn. 5. Plumb&G:s 6_Other E ` °[Ione : ontacperson. (prin) l DATE(MMIDDIYYYY) c®�r® CERTIFICATE OF LIABILITY INSURANCE 611312416 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 endorsement(s). OCONTACT DUCER NAME: tomatic Data Processing Insurance Agency,Inc PHONE IDP Boulevard MAIL Ext ac No -seland,NJ 07068 ADDRESS: INSURER(S)AFFORDING COVERAGE NA€C# INSURERA:SStar V3 AAIC American Alternative Insuran CURED Merrimack Valley Insulation Corp INSURER B: _. 23a Sullivan Rd INSURER C; North Billerica, MA 41862 INSURER D: INSURER E: INSURER F: 3VERAGES 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 REDUCE=D BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUINSR ER POLICY NUMBER MMILD�1YYYI -POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAG TED COMMERCIAL GENERAL LIABILRY PREMISES Ea occurrence $ CLAIMS-MADE I OCCUR MI=D EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO-REl LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE L€MIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS AUTOS NON-OWNED FtOPERTYDAMAGE � $ HIREDAUTOS AUTOS Peracaident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATEH $ DED RETENTION$ $ B WORKERS COMPENSATION X TORY LATUS ER AND EMPLOYERS'LIABILITY ANY PROPRIE€ORIPARTNEWEXECUTIVE YIN OWC749118 61'1812016 6/18/2017 E,L.EACH ACCIDENT $ 1,000,00 ( OFFICERIMEMBER EXCLUDED? n N!A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,400,00 II yes,describe under 1 000 00 I DESCMPTION OF OPERAVONS below E.L.DISEASE-POLICY LIMIT $ , , :SCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) I. I i' i' RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORVED REPRESENTATIVE Q 1988-2010 ACORD CORPORATION. All rights reserved. -WORD 25(2010106) The ACORD name and logo are registered marks of ACORD A+i & CERTIFICATE OF LIABILITY INSURANCE nA02124/2016' lb. . . THIS GERTIFICATt_ IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-TI•IIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E.YTEND OP ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE C5RTIFICATE HOLDER. IMPORTANT- if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Carolyn A Coughlin Charles J Coughlin Insurance PHONE 1 PAX --•- --- 14 D[nley Street AIc Ext): (978}957-3588 c_.N . . G� gcoun P.O.Box 10rAAaL carolyn@coughlinins.com AUF?H>r55; Dracut,MA 01826 INSUREJtJAFFORDING COVERAGE MAIGO INsuRFRA- Northland Insurance Company 24015 114SURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURERS, Safety Standard 59454 23A Sullivan Road INSURERC: Torus Specialty Insurance Company A0159 N. 6[I[eTiCa,MA 01862 -- _. .. Y ENSURERA:� -- ' INSURER E INSURER F• 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TETE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSRPALIGYEFF POUGYExP LTR TYPEOFINSURANCE IN5O1WVDI POEICYNUMBER h1h1f➢OJYYY ! h1nVOO ---' UMITU A rGiNt � COMMERCIAGENFRAL LIABILITY I WS274182 0912'112016 '01/2112017 EACH OCCURRENCE g 1,000,000 DAMAGETORENTT DCLAIMSMOEMOCCUR PRI MISS 1Ea aceutterG e SMI~D EXP(Anyone person) S 6,000 PERSONAL&ADV INJURY SP _GENERALAGGREGATEIS 2,000,000GGREGATELIOrti'rAPPLfEISPER:ICY PRO- F-1 LDC I i PRODUCTS-COTAPIOPAGOj.5 �2�(JDa,Oflfl { JECT —__.— i I OTHER: S 5 B AUTOMOBILE 1 6205006 111/2512015 19125/2016 1 COMBINED SINGLE LIMIT i$ —�_—1,000,000 __ (Eaaccidenl) _ _ ANY AUTO i 130DILYIWURY{Perpersoh) S J AU. OWNEDSCHEOULED BODILY IN,IURY(Peraccidert)]5 i AUTOS Y'AUTOS —_-_—_ J.XON-01 PROPERTY DAMAGE I S HIR AUTOS _i AUTOS iPeraccFaenA.,.__,__T i 111 $ C UMBRELI.ALIAB accUR CLA[MS•MAD6AGGREGATE;87593L161ALI01/21/2016 0112112017 EACH OCCURRENCE -5 1,000,000 EKCESS L[AB i 1 — S_. - 1,000,000 W ; ! I � _ DED I. RETENTIONS 10,()00 i ! I $ D WORKERS COM ; I{ �I S ATUTE 1 I ERS AND EPAPLOYERS'UABIOTY ANY PROPRIETORIPARTNERIEXECUTWE YINNIA' E.L.EACH ACCIDENT S 1.flflfl,Qflfl OFf=ICERIUEMBER EXCLUDEO't {Mandatory in NH] I E.L-DISEASE»EAEfAPLOYE S 9,flQ©rdfl_a If y4es,descdhc under DESCRIPTiONOFOPERATIONS below E.L.DISEASE-POUGYLIMIT S p� I 1 DESCR[PTIONOFOPF-RATIONSILOCA`nONSIVEHICLraS(ACOAD ID1,Additional Remarks Schedule,may he allacbedif Moro SpaC*is MQutmd) 9 JOS DEITIES:Insulation Installation.Additional insured companies respectively are Action Inc.and National Grid USA,its direct and indirect parents, subsidiaries and affiliates in addition to Community Teamw ark,Inc.,ASCD,Inc.and f=vld 506k6E CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 'THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 3 /^ ! I ..Fi�pZ'':! f/•.3� 7'7J: 'y=F',:17/ ` /••"1 .ae!• 1 Office of CanSUmerAf�airs and Bu Business Re�ulatian i�• , '4 r.; 10 Park.Plazc.--:duke 5170 Boston;Massachusetts 0-9116 Hoare 1n pro`,ernezrt Coni actor_Registration Registration. 150506 T%p- GQiyrara5an MERRMACK VALLEY INSULATION CORP Expiration: 1;12412016 TrIA 2611524 JOSEPH RYAN 23 A SULLIVAN RD ILLERICA, MIA 05862 IFpdate Addressand return card_mari;mason for cliao e _ -• :.:� address `' RcnaisaI : %rupia}'ment `- Last Card --Office afCaasnncr_1tizirs&3aseness Regulation License Or re;istr::t3on r2iid For ind`n'idul use onty ACME IMPROVEiliENT CONTRACTOR before tate=piration date If found return to:. I rtegistcatian: Yg4�as Typo„ O"FtccofConsumcrAfi�-)irssuuBusiness Regulation t pi2tian: zYF?4120Y6 Corporation l9P.rkPla=-5uite557L rrERRWACIC t,A!LEY tf2SULfiilOht CORP Boston.Vf--t 02336 JOSEPH RYNpI 23a SULUVAPI RD 131LLERICA,?AA 0166? "f f£r' 4o•:'alid Oitlloutsignature �8�� .GSGJ3c.....i tt�[.:.,.,_ -... �c,'ul..^^..i.�L•.' t.J:iv iJ�:.i:.�' �. _ '''�-` _...uiC.^:, vwiit;t. _ , .wti,^_+•.J iS,iu.aiLY.4'.u., =—'n se: CS-075641 :ccn•,r' 200 Ding Rail Dr_Apf'291 :t:.yunfield Mp 01940 _ 02/0412017 i i I