Loading...
HomeMy WebLinkAboutBuilding Permit # 9/26/2016 a I �' BUILDING PERMIT of"0 aT 6'9� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONP0. Permit No# 3 `fat" Date Received rb SSACHUSE Date Issued: ORTANT: Applicant must complete all items on this page LOCATION _ .. � Print PROPERTY OWNER_.,, ,, t ( Tint 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resikfftial Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑SeptEc ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed >Jstr�ct4 Q,l?VaterlSewer s DESC ,JRT40 1-0F , . K BE ERFO MED: i Y . ,LdeuAfica io =- Please Type or Print Clearly OWNER, Name: Phone:l , Address: Contractor Name: 1 017r Phone: Email: Address: ` Supervisor's Construction License: ► L� —Exp. Date: Home Improvement License: Exp. Date: _ '5RI/I 1 ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i i Total Project Cost: $ FEE: $ Check No.:. ..... � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund F FORTH '9 own of _ b ndover ® to IL C, h ver, Mass, b _ - �„KE - - b I� LOCNICHEW.CI[ 4 1. �p0 ATEo BOARD OF HEALTH PERMIT T L D Food/Kitchen Septic System THIS CERTIFIES THAT �1+1�C. ..... r' ,,,,.,, BUILDING INSPECTOR has permission to erect .......................... buildings on ......�J�...�,...... ...���.�....qfT................ Foundation Rough to be occupied as �. .Qa. V 'I A� 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 s VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR . LESS CONSTRUL&J [ON ST TS Rough � Service .......'frF`,./• ............................. Final BUILDING INSPECTOR GAS INSPECTOR Qcfy2ancE Permit Required to Occupy 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. L IA�Z9 1 q I 14 Ij It J 14 11,.7v?s I 14 ftp rut'+J MWPHU N / — f 11011le Improvement saltations if 7r)14l1�,illYAi(VjJ w",n—Ur..,J,:u "IGS( 'I MAIX I 1F X4 T ,! V4, VJ 4.64 M-1,04IRV Ewititiv nsimcs vim it%vi�l,Irl-we f,):i; Vini,11 W)�.Irlor and 11,11livir'l I.,iu�ljllfnfruy 11:u;JC(A; a"i t:rdar.:C. vtilln ll-c�!"I".d—lAil:011-111 fi,r,frond earl tl,,! of ffir�;.rqM07!'­1 JLC Az WC 1t,k'A'lloommiC).1 lh�� lClIWd M: ................ ------- - ------ I he job address IS a omdaminiuti­T, (A)b Atfdrvus) sp3oiflcrflions 'I" n.)I �,IANIL, Pi FASF.RE An CAFZUVILV Oil LY ClUel Cl I ECK Fit­(FS'ARF.LIC I.0DFn iq youltonl1r1l, y _5i ; YES No .T rinl D 0,4YL t D .3- 4AM3 w';10 1v111!al-pr UIUJ YPT(i Cl AT)AU)MIM RA "I kn g 2U C111, '41`11�CPVTERSlVOWNSPOUTS(eniuvill ex!skl -rv7pk,,-MRI tew,;051vjrll S,_amfu,}n tiLille",and Biovin Omer 2 J SILT ­k L,, O"ly 17 L4,_, D(',.'I voveb ....... pr�yfdij 6 u1slah PJlr app tyiai -7777 sluillors G- CV0 L:T-"L" lb '111--�1_1Z,&TCjke,irs 'Z05% El 0>­ Dqc,v"'ll 4 CQ'o, J� U t-JAJL);l IQ lsn r1e,VY.Vi ili"I RINDA T1011 SJ GAHILL V"ITS pivv,de and in:Fal! of 114.1,01V'k-T, 'u,'C s:,ftq.(tl,:lC.L LANkJl,Vrci)L.rJy at carupjut:u:t.0 vein, 13,<;�JWRAtiCF M VA,ku,eu'6 .0"..d W X722 Z MtiHAWY Mail To c—pl.1jh 2.hAJ pi),m6ffl is Lia cwerl, ip 23 J _10<11 9xi DIDOr tr 'M kvclf, no5 ;,P0 J ---------- 27 :1 Z) Ra-,ov 0-R",L7cQ 0,11,[CilUmng SVIINEld-EX-liplad OA !,'.I i cc cok,r L_ J..LJ "7 C:- 7- 12 Vol ,J, ik,,026 N.,a u t o r incv., C,,sh PRICE It. DEPOSIT WITH ( /C !J J 1z r(WAL c. DuE Al 'ifAfll Custom.,toldiust'in'LIZ U114 1.01, TOTAL sli-I vitc. eJ Est.C.O.O.0�1 DUCC14 Owner has read and agrees to the terrns and condilirulf on Vic front and tire triverso of this Agreement.Owner-specifically agrees to the(1)Total CiMi ('rice',(2)work being performed;and(3)work not hearig perlorrovd.Owner understandis that tills Agreement and any attictimatI15 iiantuln all of the 13101111',,Il8 made by NEWPRO.Owrier has beciti otully advised of his right to cancel this prior to midnight of(lia ildrd busfriess day after tho date of WE; transaction and awiwr was provided with two(2)copies of a cancellation form explaining this right. 00 NOT 81GNTHF5 CONTRACT IF THERE ARE ANY 13LANK SPAQFS (Rhode Island Sates Only): Notica to buyar:(1)Do not sign ilirt,A(jreernent if any of the spaces ititoodrid tar the agreed forms to the extent of then avaLlable Nnforniation are left blank,(2)You aro rin0tled to a copy of this tit the Mile you sign It.(3)You may at any tunic pay off Ilia full unpaid halonce clu(under thin Afirtienletil,and ht so doing you may UQ unittlild to recelvti a partial tutrate of the finance and Insarrince charges.(A)The sriller has Fio rit,Ilit to unlawfully enter your prnminas or commit any breach of the peace to repossess goods purchased Linder this Agreement.15)You fully camel (his Agreement it ft leas not been signed at the nialril offire or branch office of the heMor_provided you notify the saftir at his or her main office or brunch ofilve shown 14F the Agreement by registered OF Certified mall,Which atiall be posted tiot litter than inidnIght of tho third oalertdaf day after the Hay oil 19 which the litryor Signs the Agreement,UXG)Udinq Sunday and any holiday on whirls regular rimil deliveries are not made.See the accompanying. no U ti t of cruirolloilcit form for an oxplarrintion of buyer's(Ighli). (Rhude kiload Sales Only); Owner acknOiNfi)(1908 10GOPt of t'liqUiNd Contractor's Registrattoit and Ucensk)g Board can sumer aducal 1011 materials. Owner's Initials By "J" p, ,>,- Li ,i Nk_-WP470, LO o �?7 7W,MIZY&g 9 Idig A:)-'D E amr,t Lq fo r M a t i On- TIV Address, C4 Ar':yrs an employer? Check appropriate ben: TYPe of project Crtquired). 11 &M�a Mvployl�r with 4. ❑ 1 am a general cautmmr gnd I z=zpkyY=(&H and/or paw#me).r. 6. haivo hired ,ab_,contm=j-, ear constmctioxt 2. 1 i=a sole propriemr or partner listed on to attached shoot: 7. ❑ Remodebg ;h# and have no =Ployees These sub_wa&a=m have Yo war' s' oo�.in. 8. ❑ E)emolition dCmg for me in my cap acity- Q'T'o wre=' corip. bz=mce9. ❑ Building addition5- F7 Te aM a MrPoration and it . ' i offc=have=ezcised their1 10.7 Electrical mairs.,or additiom- 3. 1 am I bLomeawn=doing all wo-e4 right of=eMptim per MOL 1.0 Plumbing repairs or OxyseL FN0 workere corm. c 152, §1(4). and we hxre no Azy ell zhacj=boli'[M=&LSO anaoxthe b40 Hai="'.M=;Oto Mb=zjt psislffida'�*bmdicsl�mq icyim claing MU VUt �a4z�c�xs Jx Sus bac 4Md d= tense mtqchtd=344t=4 3h=,4zawg 6,j, OCT]-=b-=MW=CId amman employer rAaz j!S DrQvLd_,-%rg-,v0rh:eTj.P c8rr:pensartian Ln.(ornuwiom LruUranceformy=Tployzat .3dow is tAepoacy amdjo&site imnaanoe Comm any Name: Policy#or Sa-ins.Lic, Expiration.�Date E�Xplradon.Date:— Tab Site Address: -Ir_7 � '�t --_�— A Ajqi�o-tj- _.' WcAY)d Utach a copy of the workt-rV col., POU `-a Page(Showing the cY amber and exph-adon Faih=to Ste=average as required Mder SecdonZ-A ofMGL c.152 can lead tine up to$1,504.00 and/or out-year icTrIsojIm 10 the*OdtiOu Of Mhnin2l PieuaMes of a ent, as well as civ-9 Penalties in the form of a STOP WORK ORDER and a fmc ,if up to S250.00 a dart'against eae AoUator_ Be advise&tw a copy of-tis Mtementmay bo forwarded to Ibe,office of avestiptiow of the,DLA for ftmumce average vMif=tiOjL 7,pe", do hereby Ce 8 IteP IN-Yandpenalties OfP49ry then'the InfOrmation provided above is'true and correct. M'j= Iona lk=� Off IcW use only. Do not w1*0 In this area, to be completed by city or town grxZg City or Tovvu, pexmwucease# Issuing Authority(drele one): 1-349rd Of Health I.Building Department 3. cftylTowa Clerk 5, Other 4.ElectrIcRI laspwtor 5. Plumbing Impector Phone i i -� ® DATE(MMIDDNYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 9/912016 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 j BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 'p 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 9 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 AME, T NMelissa Pflug g Mackintire Insurance Agency Inc (ACPHONE (508)366-6161 FAC No; (508)366-5202 11 West Main Street ADO Ress :melissap@mackintire.com INSURERS AFFORDING COVERAGE NAIC# Westborough MA 01581-1931 INSURER A:Netherlands 24171 INSURED INSURERB:Libert Mutual./Peerless 24198 Newpro Operating LLC €14SURERcAcadia Insurance Co. 26 Cedar St. INSURER D: INSURER E: Woburn MA 01801 INSURER F: p' COVERAGES CERTIFICATE NUMBERMaster 15-16 REVISION NUMBER: N 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. c INSR POLICY EFF POLICY EXP LIMITS u LTR TYPE OF INSURANCE INso WVD POLICY NUMBER (MMIDDIYYYYI IMM11301YYYY) �{ COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE S 1,000,000 n A DAMAGETORENTED $ ],00,000 CLAIMS-MADE OCCUR PRE=MISES Ea occurrence CnP3S89577 12/31/2015 12/31/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO- ❑LRC PRODUCTS-COMPIOP AGG $ 2,000,000 JECT S OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED gp 8589174 12/31/2015 12/31/2016 BODILY INJURY(Per acc{dent) $ AUTOS NUTOS ON OWNED PROPERTY DAMAGE S X HIRED AUTOS X AUTOS accident Uninsured motorist BI spit Eimit $ 250,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000'. 000 13 EXCESS LIAB CLAIMS-MADE AGGREGATE S 5,000,000 DED X RETENTIONS 10 ODO CU 8562576 12/31/2015.12/31/2016 S WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY OFFICE EXCLUDED? N!A OPRIETER ECUTIVE Y� E.L.EACH AGODENT S 500,000 C (Mandatory In NH) WC-20-20-003506-02 5/1/2016 5/1/2017 H.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500 000 DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace Is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Ando'v'er THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE T Moynaah/DORRIE ©1988-2094 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD IN 5025(201401) I f MassaciTusetts Department of Public Safety ai Board of Building Regulations and Standards, License: CS-029090 Construction Supervisor - THOMAS PAUL FOXON 230'WA:LNu r ST e4 : READING MA 01867 r '" ✓�- Expiration: f Commissioner 11119!2017 ce oQ�Se Affairs d Rusi ess eta x�n UserLs 16 Bosto ��. �I4eaprvv �actoTe�raox� �, �{�glsttat3on: 140MO { Type: 6upplement Card t� m Fcplratlan: fif5�017 NEWPRO OPERATING, LLC. THOMAS PQXON 26 CEDAR T. WO@URN, MA 81881 " ,� a„v`� �palafe�Ldd�tces and return cam Mark ressna fox ch"r— Add1 esB ❑gZei, ❑*nploym g ❑Last Carta 4 $Ci11 IAMB I ti kiSB O]!�T fneanfCtsnsunYar s&gastae3�Regutettaa Veanagarrel7airaflauvet��tro elmnddriaw ts: before the44iret[ondot$. f ME IMPEL . WT 00NTAA=R gffico of C naumor A$eira and Rus[ne9s S9gufat�v , egist[a lo„ TYpe: 10 park ilexo-sulba � >rxptraf Supplement card Baslon,KA0 16 NEVVPRo Opor1Tl di F THOMAS F0X0i; qty �t3 26 CF-DAR OUT. 1 Not valid withOt B.'W un +h10BURN,MA 0601 tFnd�r�er_tarf 1