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Home My WebLink AboutBuilding Permit # 8/26/2016 BUILDING PERMIT C TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#:a,4 �Evg- Date Received o CHO Date Issued-.Oj�Z� = IMPORTANT:,Applicant must complete all items on this page LOCATION " Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no -TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 1-1 One family 11 Industrial []Addition F1 Two or more family Li Alteration No. of units: rcial ibpair, replacement F1 Assessory Bldg [1 Others: El Demolition 0 Other DESCRIPTIQN ®F�lORFC TCS ED: Identification - Please rype or Print Clearly OWNER- Name: Phone: 7 1 _' 9 R 2 Address: 4 Contractor Name. ,, : _...., Phone: e.5 0 e Email: Address: Supervisor's Construction License: Exp. Date: 6 A Home improvement License: 11' 2 '2 Exp. Date: ARCH ITECT/ENGINEER 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.:_�Q NOTE: Persons contracting with unregistered contractors; do not have access to the guaranty flip ature....of Ag_ent1O_wneL -----------Signature-of-rAmtrac.io,r; IA®RTH Town of a _ s ndover 0 �. No. a L.K� h ver, Mass, 2 COCMINCWICK P � S L) BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........4A.. ........ , •.*r%000-F. ................. . . BUILDING INSPECTOR ..`'...�...... has permission to erect .................. . buildings on .....7.'.......I��t�........*.. /.... .,............ Foundation Rough to be occupied as .... 11.c.X..... ... . .... ralil�in ................................................................................ Chimney provided that the person accepting this permit s 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 ® ® nn �g Final PERMIT EXPIRES I 6 MONTHS ELECTRICAL INSPECTOR LESS C ST N S Rough Service .... .. .. .............. ... .. ....... ".. Final BUILDING INSPE OR GAS INSPECTOR ccu aucy Permit Required to ®ccupy Building 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. Plans Submitted ❑ Plans W'aivecl,❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanniug/MassagaBody Art T" Fo ing Pools ❑ 'Well ❑ Tobacco Sales acIcaging/Sales ❑ Private{septic tatzk, etc. ❑ Permanent Dumpster on Site ❑ TIME FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On � � Signature l� COMMENTS Zs I, 0if r�(d W /L'U.AI CONSERVATION Reviewed on Si nature r COMMENTSAn HEALTH Reviewed on Si nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection DrivewaY Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp DuCi mpstr on site yes .3840 na Locat, at T24 MainStreet_ F�reaDepartMen t srgrtafiu.reldate 777 COMMENTS Town of North Andover, MA August 26, 2016 , o P 1 r l i f �i Nr rV a /r 1" 96ft Property Information Property 210/018.0-0001-1000.0 ID Location 39-41 MAIN STREET Owner L. CARLSON REALTY TRUST MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and li no warranties,expressed or implied, concerning the validity or accuracy of the GIS data presented on this map. i y I�ELIAI3LF CI SSITUUCTICN u"CLITICN Remodeling All Professional Carpentry Sun Rooms Richard J. Morrison • 803-898-0984 Kitchens • Finish Work 84 Lake St.,Salem, NH 03079 PROPOSAL SUBMITTED TO PHONE DATE STREET JOBNAME 76 Zq_l -3 !2 CITY,STATE and ZIP I JOB LOCATION ARCHITECT ©ATE OF PLANS JOB PHONE We hereby submit specifications and estimates for. ---•------------•..............•--•------------_...... -•--•-----•-------•---•--•--......._....•---_._._.....•------............-----.._........._.__...........__..._...------......----._..._.......------..............................•.._................................._..... . .: ...---.C' = __ �' . 7 a ...4 ... n. ._ .... u.e_� ... c z i. ?..__ ' h ----------- ----------- .. 1 .... ..._ � .-.../. J.-, 'at j _------- ............................. ...................•--.._._........---------.-_... ..--......••--•-.-----. ..............------------.--------------------------------------------------------------......................----.................. .................__........._...................... ............................................................................................................................................................................... •-•--•------ d i a-�— 9 -........ ..... ..................................................................................... -------------------- � , .... a.. ��'�f . ............................................................................ l- ....pr................................... ------------------------------------------------ ............ .................... _......... - '_.- ..._. r3z._ci.................................. ............................................................................................p.......------......................................................................................................................................... ................... /Y-------------- -- l!� ...__ eJ�C_.,�_c�_ _. . �lt.i r1`,?.. - ' 7'/!...... /. {11 t. 1.. __n .�.�I .................... .. PCO41105 a hereby to furnish material and labor-complete in accordance with above specifications, for the sum of: Payment to be made as tallows: �( dollarsr,$— —✓ ,,•• 60 J`� 6 Com• 2& 22, All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized manner according to standard practices,Anyalleralionordeviationfrom above specifications Signature Involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreamonts contingent upon strikes,accidents or Note:This proposal may be delays beyond our control.Owner to carry fire,tornado and other necessary insurance. withdrawal by us if not accepted within da S Y 91cceptance Of V rOPOMW - The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to signature An the work as specified. Payment will be made as outlined above. Dale of Acceptance: Signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-071037 Construction Supervisor THOMAS A DEFUSCO 23 DUTTON ROAD PELHAM NH 03678 >c '►�=/t"�'� CA, e=xpiration: Cornniissioner 06/16/2017 /te�praox�rru>rmerrl!/r.a�G��u;;rre/rr.�etf.; �\ office of Consumer Affairs&Business Regulation ."OME IMPROVEMENT CONTRACTOR egistration: 117756 Type: xpiration: 1 111 512 01 6 DBA TOM DEFUSCO GENERAL CONTRACTING THOMAS DEFUSCO 23 DUTTON RD PELHAM,NH 03076 Undersecretary P TCA DEFC15C0 CONTRACTING Cm. i Iyas sarccessf ally completed a Uaining sewinar and other requirementstobecome a Roo rjig Products International Appyd—A tf ry o'es J r r _:: 1 Date ,''Authorized Signature and Title AC R" CERTIFICATE OF LIABILITY INSURANCE PATE{MMIPPfYYYY} a/24/2016 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 1S 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 NANEACT William Tarpey _ ._, __.. Ta ® Insurance Group, Inc. PHONE (761 665 1034 FAX (781)662 0301 xp Y p .(AfC.NQ,,.�Mr)_.,_,. ) _.............__.„_,._,__,....._,._._„ A!C No: ...... 109 West Foster Street E-MAIL ADDRESS: rpy hill@ta a insuranCe.com INSURERS AFFORDING COVERAGE NAIC# Melrose MA 02176 INSURERA:ESSaX Insurance Company INSURED INSURER H Liberty..,Mutualns Co Thomas DeFusco, LLC, RHA: Tom DeFusco General INSURER C: Contracting INSURERD: 23 Dutton Street INSURER E: Pelham NH 03076 INSURER F: COVERAGES CERTIFICATE NUMBER:2016-2017 GL / WC 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ........._,..___..._._ ADDL SUBR -._._--_..._-.............,__„_...,..,,_, POLICY EFF POLICY EXP �...... LTR TYPE OF INSURANCE POLICY NUMBER LIMITS X COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA13E TO RENTED A CLAIMS-MADE F]OCCUR PREMISES Ea occurrence $ 50 r 000 3EG2744 8/3/2016 8/3/2017 MEO EXP(Any one person) $ 1,000 _ PERSONAL&ADV INJURY _ $ 1,000r000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATF $ 2,000,000 POLICY 17 PET :71 LOC PRODUCTS-COMPIOP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AU FO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTI= ER ANFICERIMEIMBER EXCLUDEII?ECUTIVEI _"-I N 1 A E.L.EACH ACCIDENT $ 100,000 H (Mandatory In NH) WC5-318-604860-016 5/14/2016 5/14/2017 E.L.DISEASE-EA EMPLOYE $ 100,000 UyyS,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General Construction. CERTIFICATE HOLDER CANCELLATtON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE William D. Tarpey ©1989-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ' The Commonwealth of'-Masss�chusetts Department ofIndastrialAccidents h 1 Congress S'tr'eet,suite 100 s„ Roston,MA 02114-2017 wwly mass.govfdxa Workers,Coxapewatzonbsxxrance. i.davit:)3uffders/Con.tractors/k:Iecticzcians/�'k bars. TO B.l''I{f D)WffU THIS PE' M:lTTJNCAUTHUB:CT''SZ. Applicant Informa.tion Please Print Le 'bl NaMo (Business/Oxganization)ladividual): ,a-3(6 .address czty/state/dip: �� ,�' IPhone a/ . . . -. , _. Axeyou an employer? Cb ecktlio ap�ropriaio box: f W e of project(z equ x4.' 1.El1 am a employervVitla.—e..-,!employees(hill and/orpaxt time). J. New. GaxistAt]Gtia7� 2, -I I am a sole proprietox or partnership and have no employees warking for mo in $. P ezxtaclelirig t_ any capacity.[laa workars'comp.insurance required.l Demolition IF]I am a homeowner doing all work myself:[Nb workers'comp."M-fiance required.l t 1 0 El y B.��g addition 4.E]I am a homeownex and will be,hiring contractors to conduct alt-Work an my property. I will i�l ll, ensure that allconiraofaxs eitherhavewarkers'aompensationinsurance or are sale P Electrical repairs or.additions r pzopiietors withno employees. 12.D Plumbing repairs or additions 5. ai a general colatractor and I have hired the sub-contractors listed on the attached sheet. l l aof rep airs ` cso sub-oontraotorsliavg einplayecs andhaveworkers'comp.insruance.$ 6.0Waareacarpazatnrrpnzlitsof cershaveexezcisedtheirziglrtofexeupfiionporlvlGLa. ME]Other ` C%__ 152,§1(4),andwehavpgo.,7p1' s.fNpworkers'comp.insmancorcquired.I "• - _- FAny applicautthat check�box#1 must also tilt autthe sactian belay showingtheirworkers'aampensatian policy information, Llameownerssvhosiilittiif affidavitindicatingtheyarodoingallworkandfhonhizeautsidacontractorsmusts4bmitanet+`affidavitindicatingsuch. tC;anfractors_fhat checkthis bmnr must attacberl an additional sheet showing the name ofthe sub-aantraafors and state whether oxnot those entities have employees. Ifthe sub-cazi a.c(ars have employees,§lacy must providetheir wozkois'comp.policy number.' lain an eniployeP tli at is pr^ovzdiizg7vorkers'compensation insurance,far^my employees.'J3'eloiv is thepolicy and jab s^rte inlomation. 7nsuxanco CompanyName; PaliGy#or Self-ins. Cic.#; " "' ` v ationDato: ; - Job Site Addrass; � '"°� � / �� city/State/Zip;Attach a copy of the WO coxulaensation laaliey declaration lamo(showing the policy:1UM er and expzratian date). Failure to secure coverage as required mderli OL o. 1.52, §25A is a criminal violation punishableby a fine up to$7,500.00 and/or one--year ianprisonrnent,as Well as eivilpenalties in the form of a S TOP WORK ORDER and a fn o of up-to$250.00 a clay against the violator.A, of this statement xray be forwarded to the Office of Investigations of the DLA-for insaran.ce Coverage verifacatioxz. fp f..y 'o p _. may^ X do ZzeNe�y fy acxzrCer tlze,pains andpc�rzatties o� er'rtr^ Haat the informai rovr`.d"ed alcove rs�fr�e and cox Beet. hair—s: QJ)Mal use only. _V0 not write in this area,to he completed by city or tatvn affxciaL City or Town: xssu ug Authority-(circle one): i :f..l�3aardof:kl:ealtlra.2.:E3uildiragDepartzazenL 3.City/';�'o�vnClem �.:LlectrzGalxnspectatr 5.�'luanb�ingSnslfectox 6.0 er Contact Person- Phone#: _ _. _-