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HomeMy WebLinkAboutBuilding Permit # 10/6/2016 V40RT" BUILDING PERMIT 3r ,°:• "a °� TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION * - Permit NO: µ 9 ' 1 Date Received !b * a .,.._ . ^J AT.. Date Issueda �Ssacr�us�� : !J " IMPORTANT: Applicant must complete all items on this 2age LCCATIQN € �t PROPEI TY O1 VNER' tit MSP 1v10 "` PARCEL f C N[l G DISTRICT H staric t3rstri t r s na Ship Vrllag yds iVlachjne rio TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building cL/-One family i Addition D Two or more family 1 Industrial ' 'Alteration No. of units: - Commercial "Ll Repair, replacement 7 Assessory Bldg - Others: I Demolition Other C'Septic "l lllfe#I D P[bodpl0iri C1 Wetlands Watershed District © ilatrlSewer . o _ 6 Identification Please Type or Print Clearly) OWNER: Name: - Phone: t7._e7f_ 7 Address: CCITC�`Ol"ale Pl�t�ne. l Address: .. . Suer�lsc�r's Ortstrctron License Exp Cate . , Hartle Ir prouement ::Melfi se Exp Date s ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. `,Total Project Cost: $ W7 FEE: $ Check No.: _ Receipt No.: a i cit NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of gen wrier " ': ignature of contractor thORTH Town. of ndover No. otiAKE h ver, Mas 0 s, �'S1 COC+r1[e4E w�[K 1' E 0 J Lir S U i BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THATH.Oft..- ..,. . .,..... .... .... .. .....,. BUILDING INSPECTOR . .. 4,Qx Foundation has permission to erect .......................... buildings on :�24... ....� ......,........... .. 7 &/f Rough to be occupied as .............2...p.. t.�........s.......�+Lrr.......w........�+....... . w o..w..... 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 PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI® T k Rough Service ............... .... .......... .. ... .. ................................. BUILDING INSPECTOR Final GAS INSPECTOR 0ccupancy Permit Required to occupy BuRough 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. Page No. of Pages �1 I F n �"� P4W r,� I rmr rrrc rliom ark 9i� P ,, �",ft � �� ���a9�'i�t� aC I � �"°��°t it �i I�,�1'�° U 6 E dgen,wf e Ave, Bf,IRLING"ON, MA 01,8 (617) 272-1252 PROPOSAL OSAt SUBMITTED 7 « � PHONE —�—�DATE Nom' r l STREET JOB NAME r t" CITY, STATE.. AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS. .fOH PWt>Nt We hereby submit specifications and estimates for. r '1z" e" � 9 � „ r f ^e„^” ,r,o f,r,� ° �",r� ,. .,� ,mr%. A � JAI li r 111pwif' hereby to furnish material and labor ._... Complete in accordance with above specifications, for the stern of, ....... :: ,: �,�_ f � �� .?. ..__ - t �I .�m �m r __._...._...do I f (� Payment to b made as follows: f f«lam° �— N. _ __� ^..__ E....a.�r�J'f..... r..��A �,,,�..t,.�«r .... All�nat dual is guaranteed to be as specified All work to be completed in a workmanlike C i m.anr7e:r according to standard practices. Any alteration or deviation leerier above sfrc�c,rfar,a� Authorized buns involving extra cosh will be executed only upon written orders,and will become an Signatnr( ...... — , extra charges over and above the estimate.All agreernents contingent upon strikes,accidents or delays beyond our control. Owner to carry tire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workrrre n's Compensation Insurance. withdrawn by us If not accepted wiff7ln__.___.—___.___......_..._.........__________........._days. t � aztr The above prices, specificrtions ° and conditions are satisfactory and are hereby accepted. You aro.* authorized Signature to do the work as specified. Payment will tae made as outlined above. � Date of Acceptance: Signature.._ ____ ____ ._.,,,_.__..._. _............... ... ... ..._..._..._.._w__......... l �armuri rias /w+.ra.JiNr o,atiEer�n�rewu:ars rmrrrmrrveao+r rani rcdrtu+eeoatses�e r Paychex, Inc. RF 8 7/15/2016 3 : 28 : 52 PM PAGE 3/003 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDYYYY) 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 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 t0 the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Paychex Insurance Agency Inc Er PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE PHC NO.EXT: 877.266"6850 FAX o: 585-389-7426 ROCHESTER, NY 14620 EMAIL Certs@paychex.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: NorGUARD Insurance Company 31470 HOVASSE CONSTRUCTION INC INSURER a: 12 COLBURN ST BURLINGTON, MA 01803 INSURER C: INSURER D: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSIR WVD (MMIDONYYY) (MWDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ LA€MS-MAD , CUR PREMISES Ea occu MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/DP AGG $ POLICY =PROJECT=LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY Avco (Ea accident) $ ALL OWNED SCHEDULED BODILY€ $ (Per personn}) Avros NON--OWNED BODILY INJURY $ HIRED AUTOS =AUTUS (Per accident) PROPERTYDAMAGE $ (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIABCLAIMS-MAIZE AGGREGATE $ DED I I RETENTION(; $ WORKERS COMPENSATION ANP X WC STATU- DTH A EMPLOYERS'LIARtLITY HOW0645726 12/15/2015 12/15/2016 E.L.EACH ACCIDENT $ S00,OOA.00 ANY PROP RIET0R/PARTNLR/FXCCU13VC OFFICER/MEMBER EXCLUDED? Y�N- E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory In Nh) NIA E.L.DISEASE-POLICY LIMIT $ 500,000,00 Ir yas,des cri6a urdar DESCRIPTION OF OPERATIONS haloes DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1600 OSGOOD STREET DATETHEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY SUITE 2035 PROVISIONS,BUT FAILURETO MAILSUCH NOTICE SHALLIMPOSENo OBLIOATION OR NORTH ANDOVER,MA 01845 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ..y ..k '. ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD