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Home My WebLink AboutBuilding Permit # 10/7/2016 %40RTH BUILDING PERMIT 0. TOWN OF NORTH ANDOVER 7 APPLICATION FOR PLAN EXAMINATION C, � � Permit No#: '� o i -7 Date Received 7 °nR,rEo �SSRC}iLts�� Date Issued: / 7 ' )-0 IMPORTANT Applicant must complete all items on this page , K r a., ✓ � eHrDTIJGllf2a2S5 !70 MAP- ,, PARCEL ✓` ZONI'NG DISTRICTS�stonc �stnct eyes � no ` Machine Shop Village t YeS . :-.no .._'... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ industrial ❑Addition ❑ Two or more family [I Alteration No. of units: [i Commercial mRepair, replacement [IAssessory Bldg Ll Others: ❑ Demolition ❑ Other ❑ Se tic well ❑ Floodplain ❑Wetlands ❑ UVatershed District P ❑U11at®r1:Sewer DESCRIPTION OF WORK TO BE PERFORMED. Identifikation- lease Type or Print Clearly 9 OWNER: Name: ," Phone: Address: Phone Contractor Name Erman , Address r Superulsor's Construction License Exp Date Horne,Irnpra�ernent License ARCHITECT/ENGINEER Phone: Address: Reg. No. FEF SCHEDULE:BULDINC P R!f?!T:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.0 PER S.F. Total Project Cost: $ FEE: $ p _ Check No.: ( Receipt No.: i / - NOTE: Persons contracting with unregistered contractors do not have access to the gu Fantyfund Si nature of contractor. St nature of A entlwner` 9 g - -.. VkOR H T. of z y � 6 n over owti No. aoil 4 rp iwraa ver, Mass, �p coc"Ic"aWICK v `S L� BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �' BUILDING INSPECTOR THIS CERTIFIES THAT L# d N S ��ry ....... ......... �'..!......................,. �. Foundation has permission to erect ... bui dings on ...........,O.•••• ..,.. .. ....I••....•.....•....•..,.. ... p ...............ti...... .., Rough R. d0p Chimney to be occupied as . r .... .........R` �.>..............,..............,.... .............................,.. ....5.....K.... !... .., 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 PLUMBING INSPECTOR Construction of Buildings in the Town>of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESST CTI ST S Rough -- .. Service .... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. CERTIFICATE LIABILITY INSURANCE �TE(t�I,DD,YYYYY) IF 10/6/16 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 policyQes) 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 endorsements). PRODUCER NA6RE: LTB Insurance Agency PHONE I(781f 365-1800 FAx N ; (781) 221--0031. 85 Wilmington Road ADDREss: lisa@ltbinsurance.com Burlington, MA 01803 INSURE S AFFORDING COVERAGE NAIL# INSURER A:Nautilus Insurance INSURED INSURER B; Lion Services Inc. INSURERC: 11 McDonald Road INSURER D, Wilmington, MA 01887 INSURER E: INSURER F: 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. IN T% TYPt OFINSURANCE ADOL UBR POLICY NUMBER pmtwfyEFF POLICY YYY LIMITS GENERALLIASILITY NK636510 12/1.1/15 12/11/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENE PAL LIABILITY DPREMISES AMAGE ( RENTED $ 100,000 CLAIMS- MADE ®OCCUR ME D EXP(Any one person) $ OO PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 G ENTAGGRE»GATELIMITAPPLIESPER PRODUCTS-COMPIOPAGG $ 000 OOO —x POLICY PRO LOC $ AUTOMOBILE LIABILITY (E DSINGLELIMIT aacctder�) $ ANY AUTO BODILY INJURY(Per Penton) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS _For accident)___ A UNBRELLALIAB ][ OCCUR AN031346 9/9/16 9/9/17 EACHOCCURRENCE $ 5.000 000 X Ex, LJAB CLAIMS-MADE AGGREGATE $ 5,0 0,000 DEQ RETENTION S $ WORKERS COMPENSATIONWCSTATU-'FORY QTW- AND EMPLOYERS'LIABILITY VIN ER ANY PROPRIETORRARTNERIEXECUTNE NIA E.L.EACH ACCIDENr OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EW LOYEE $ Urs describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT DESCRIPTION OFOPERATIONS/LOCATIONS IVEHICL.ES (Attach ACORD 101,Additional Rem3ftSchedule,Ifmore space isrequired) ,lob Description: Roofing Repairs Job Location: 70 Martin Ave, North Andover MA The Workers Compensation certificate has been ordered and will be sent to you directly from the carrier. CERT#FIC �/ CANCELLATION ` SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TFiL.-iL3F, NOTICE WILL BE DELIVERED IN "John Doherty ACCORDANCE WITH THE POLICY PROVISIONS. 70 Martin Ave North Andover, MA 018 AUTHORIZED REPRESENTATIVE --------- Lisa Tucker O 198802010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) .:,511stered marks of ACORD The Commonwealth of Massachusetts - :• Department of IndustrialAceidents M F 1 Congress Street, Surae 100 "' - Boston,AfA 02114-2017 qat www.mass:gov/dia b^M SJR ' Workers' Compensation Insurance Affidavit:BldaxslContl'actoxslEXectricians/;�itr_na� ers. XO BE FILED MITIaTH-pF_p- IY' T)VG AUTHORITY. -,please Priest Le kl A '•licant Tn£orm anon � NalTlle(Business/Oigaiiizationgndividual): 1t Address: CitylStatelZi Phone#: Are you as employer?Checictfie appropriate'box: Type o£pxoject Orcgxired); em to ees fullandlorpartthno).* �. pNe:-W,d6 str66flon 1.❑I am a employer With p y 2,E]I ain a sole proprietor or parineTship andhave no employees working forme in $. Remodelitlg any capacity.[Naworkers'comp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all workmyselt iN°workers'comp.insurance required.]t 10 Building addition 4❑lam a homeowner and will be hiring contractors to c°nduct all work on arty property. I will 11 E]Elec€�ICaI 1epaYY S or ddltiol7s ensure tbat all contractors either have wozkere compensation.insurance or are sole b repairs o additions proprietors with no employees. 12T Ls I�� ' p 5,❑I am a general contractor and I have hired the sub-coaatractozs listed on the attached sheet. 13,,E]Roof repaixs These sub-contractozs have employees andhave workers'comp.insurance.* 1� Other 6.0 We are a corporation and its,officers have exercised their right of exemption per MGL c. 3 52,§1(4),and we have no anhave [No workers coaup.insurance required.] penSation Policy *Any applicant that checks bb s l paa§tt insdicating they are dean$l out the Seetion lall work and then outside cow Showing their '178, monixa, a must submit affidavit indicating suds i Iiomeovmors who submit thi tContractors that check this&o roust attached•an additional sheet showing the name of the sub-contractozs and state whether o not those entities ave employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Z am an employer that is providing-workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � r Expiration Date• Policy 0 or Self ins.Lic. :. r� CitylState/dip: MAI— fob Site Address: D Attach a copy of '�e'vvorlt`exs' compensation policy declaration page(showing the policy numbex anal e�cpiratioxx date). Failure to secure coverage as requir ed civ" enalties in the form.of criminal punishable TOP-WORK ORDERand fin o£p to $200.00 a and/ or one-year'impAsonment,as well p map be forwarded to the OfFiDa of Tnvestigatlons of the DIA for insurance day against the violator.A appy Of this statement coverage verification. his andpenalties ofperjury that the inforrnationpr•ovided above is true and correct ado hereby certify under tliepa Date: Si azure: 7 Phone#: Official use only. Do nut write in this area,to be completed by city or torvrz official. z'exrnitlLicense# City or Town: Issuizrg Authority(ci)rcle one): E 3.city/Town Clerk �.Electrical Inspector 5.Plunnbinglnspectaz �..73oaxd of Health 2.B�rildingi7epartruent 6.Other phone#~ Contact person: 6assacn s.tis - CJt pa ro.ez t c r t fic SafFt� Board of Buifc9 Rejulatibns.agd 3tandarcE,3.., . t nlistructi: Siy}erris,.r ense: CS-108082 JAIME I LAYON -` I I MCDONALD ROAD., 'r 1 Wilmington MA 01887 Expiration. Gonimissioner 03/06/2618 . 'Office ofiCnnsumOP Affa�r3 iYc Businec5 t;egultu1� t3 MF_IMPR0VF-MtNTCONT RACTOR ogistrat�on 'i73813 i xpiration DBA LEON SERVICES JAIME LAYON 11 MCDONALD RD g WILMINGTON, MA 01887 Uidenecretar i Y