HomeMy WebLinkAboutBuilding Permit # 10/6/2016 (2) BUILDING PERMIT OaRrH
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TOWN OF NORTH ANDOVER 0 ' in
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APPLICATION FOR PLAN EXAMINATION JK
Permit No#: K"'7 - .:;� Date Received I �$ arED F
Date Issued: t " '"�
—. IMPORTANT: Applicant must cownplete all items on this page
LOCATION �� °
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QCI�a`ear,Str�ue$ure ,i,
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Pi'ARCEL ZONINU C7STRICT i ,��,yes „� no
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achenecap;;,..: � age ,,,,,yds; no,.,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
F] New Building E One family
R Addition ❑ Two or more family ❑ Industrial
1-1 Alteration No. of units: F] Commercial
F1 Repair, replacement ❑Assessory Bldg 11 Others:
0 Demolition D Other
[lept�c Ll Well 0 Floodplain ❑WetlandslUatershed Dastnct
i
DESCRIPTION OF WORK TO BE PERFORMED:
..
TR 8T
---------------
Identification- Please'Type or Print Clearly -
OWNER: Name: Phone:
Address:
Contractor,blame
.r* r
Email
Address
ri 4”
S0 ,6N sot's C6nstructI'm,License
Ho Impro�rernent cense �,E
xp Dat
ARCHITECT/ENGINEER Phone:
Address: Reg, No.
FEE SCHEDULE:BULDIMC PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $...777"-, FEE: $
Check No.: o Receipt No.: 1
NOTE: Persons contracting wvitla unregistered contractors cla not leave access to the guaranty fund
;Signature of Agent/Owner Signature of contractor � °
.........
t4O R Tiy
Town o _ ET. 6Andover
®
o �xE h ver, Mass, /o qb rp
COC NIC+fEwiCN y1'
�ATEO
U BOARD OF HEALTH
PERMIT T L
Food/Kitchen
MM Septic System
THIS CERTIFIES THAT ...........4 T �111M!k�!I .Q'. ", Irt.C.E.,,..... r0. , ,.C,!���,} BUILDING INSPECTOR
. . .... ....
has permission to erect .......................... buildings on .....�.� .�... .�....... ...... Foundation
Rough
tobe occupied as ................................................................................................................................... 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 IN 6 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRU XCTNSTAZo<�� Rough
Service
............. .. ......,...... Final
BUILDING INSPECTOR
GAS INSPECTOR
OccupancV Permit RCauired t® 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.
FP6(reV.3/00) m2g,
APPLICATION FOR PERMIT
®OG SAFE »UM13i=R
City or TawnC�
Date /'- � Start Date:
In accordance with the provisions of M.G.L. Chapter 145, as provided in Section application is hereby made
by (Full name ofperson,Firm or Corporation)
7 6
Address
{Street or P.O.Bax){City or Town)
For permission to (state clearly purpose for which permit is requested).
j,
Cert.
S hi .
�
Name of competent operator(if Applicable) Cert. No. � aC �
Date issued-rejected By �-
(Signature of Applicant)
Fee � ` _._ $ Paid Due
CIV- —
_Date of expiration _—� _--------------- —._._— — _— _ — _-- ---
� �
QC--V �ve"
g"W X75
FP6(rev.3/00) �✓ C%• '1 Off' �0�5� { LY�� �
PERMIT
City or Town
res EDate:STart
DiIG SAFE INILU !BER
Date
Permit Number (if applicable)
this permit is granted
In accordance with the provisions Of M.G.L. Chapter '148, as provided in
to
25� �.T - 5 ST�I�s lr►�z
(Full name of parson,Firm or Corporation)
Oct
for `u
Restrictions:
Ar-
at
Give focatidn by street and no.,or describ in such manneras to provide adequate identification of location
)
Fee Paid $_ — This Permit will expire on
Title A '
116
Signature of Official Granting
i
EXISTING MEN'S EXISTING MEAT CLE
i
DUCT
-
i
�� — DUCT — DUCTS TO DE REMOVED I
1 Ise Ta
EXE STING WOMEN'S - —— — -
- r�j- ---L7
DUCT I
A.H Al
114 OFs
DUCT I DUCT -T—; r� g° NATHANIEL N
— / gg g PHILLIPS my
/ f ( CATWALK — / 1 FIRE PROTECTION co
a
NO.39850
=_-----------_-_ �
...................... .
NOTE: - Mammoth Fire Protection Systems, inc.
EXISTING DUCTS AND AIR HANDLERS TO DE REMOVED AND 1-978-569-1111
NEW ROOF TOP UNIT TO DE INSTALLED: _
176 Walker Street Lowell,'MA 01854
_...._............�............................................. .. .
EXISTING SPRINKLERS INSTALLED UNDERNEATH THE Scal.e,...l/4r ................................. ....................................................
:...................._..... ..::Approved By: .Drawn...By...KA:Y...
DUCTS WILL DE REMOVED AS THEY ARE N LONGER ::.._. ..................................
:Date% 10/4/16� Job No:
�E ESSARY, .....................-............ ...,...................................,....,......
_......................................_..............................
MARKET BASKET
350 WINTHROP AVE, NORTH ANDOVER, MASSACHUSETTS
Drawing No,
....................................................................................... .... ...FPl..............
MAMfV0 4 OP ID: GQ
CERTIFICATE F LIABILITY INSURANCE PATI ( YYYY1
991118f118/1}
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THI
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: It 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 canter rights to the
certificate holder In IieU of such endorsement(s).
PnODUCER Phone:978-459-8689 CONTACT
NAME:
Francis proven(;her Insurance Fax:978--454-9343
Agency, Inc.
530 Rogers Street E-MAIL -. --
Lbwefl,MA 01$52 ADDRess: _.
IN WkR(5 _pQRNNG COVERAGE .^...._ NAIC tr
....— INSURER A:W£SCQ InSLIre'TnCe Co.-
IrisuR�r, Mammoth Fire Protection INSURER 8,Gotharn Insurance Company25569
Systems 9na,
176 Walker StreetINSURER C:MerchaMtS Insurance Group___-- 23329
_.._ _
Lowell, MA 01854 INSURER D:Preferred Mutual Insurance Co. 15024
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUM13ER:
TH15 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
CPRTINCATC MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI.)_ THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS.
Y ...., i YpE bFuN, ati�C 5Ut3 _...--__._.. ._ POLICY EFF POLICY EXP `—
INSURANCE POLICY NUMBER MMIDDIYYYY WMIDONYM L1MF7s
OEN61RALLIAEILITY EACH OCCURRENCE $70
i,00@,000
8 �X CCMMLNCIAL GENERAL LIABILITY GL2016FSCO0959 11/17/15 11/17/16 PREMISES fro accurrernco � _ 100,000
CLAIM$-MAdE I A I OCCUR MED EXP(Any one person) $ S,0001
/-� PERSONAL&ADV INJURY $ 1 r000,000
I YrQlfS�!OMIF38ian GENERAL AGGREGATP _ & 2,000,000
0E NIL AGGKoATE LIMIT APPLIE8 P8R; PRODUCTS-COMNOP AGG S 2,000,000
htlLICY �' PRO' LOC �� $
AUTOM013ILr LIABILITY COMBINED SINGLE LIMIT
g 1,000,000
Ea aCGidBril
iv ANY AUTO CsAP1047971 12/02/15 12102116 BODILY INJURY(Ferperson) $
AUTOS ALL NED ` AUTOSULED BODILY INJURY(Per actidoni) S --
HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
AUTOS Per auldant
s
IIMbRELLA LIA15 X OCCUR EACH OCCURRE'uCE S 5,000,000
t3 K EXCE5sLIAB CLAIMS-MADE UfUi2015FSC004AS 11117/111 99/97/16 AGGREGATE s 6,040,000
PED X RETENTION$ 90000
WORKERS COMPENSATIONWO STATU- OTN- --
AND EMPLOYIERS'LIABILITY _1_
•ER
A ANY PROPRIETORIPARTNER/EXECUTIVE YIN WWC3166264 41/01/15 11/01/16 E.L.EACH ACCIBENT S 1,000,0@0
OFMCERIMEMBER EXCLUDED? N N 1 A - .-
(Mendatnry In NN) E.L.DISEASE-EA EMPLOYEC $ '1,000,000
"yns,"'""ba ander --•
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
E= Insts1181:idn GPP0120599407 11/20/15 47/20/16 Property 20,000
Floater }Dad 500
DE NOMPPON OP OPERATIONS t LOCATIONS I VENrCLES (AttNah ACORD 104,Additional Remoras Sthedule,if moro space is required)
SPFtsN#C ZR 5YSTrN
08RTLPICATU HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION 13ATE THEREOF, NOTICE; WILL. BE UELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUT'HHO^R^IZFII)REPRESENTATIVE
C7 1988-2070 ACORD CORPORATION_ All rights reserved.
AGORD 26(2010106) The ACORD name and logo are registered marks of ACORL)
*� Commonwealth of Massachusetts
Department of Public Safety!
,�ro811"'9➢'IlCaa;e s.,a''p e7 r.'d it fi:`e,�ro�"
License: SC-003065
5 RIVLRBEND LN 6 MOUSf
GARY C ROBB0—M r.
PI.]C,Ii1A:tVY PTH 0007
Expiration:
Commissioner 0610412017
E
Comm on we alth,of Massachusetts
Department of Public Safety
License: SJ-004054
Sprinkler Journeyman
EDWARD L VERLOOVE
10 MOUNT PAUL ROAD
TYNGSBORO MA 01875 _
i
�-MCA— Expiration:
Commissioner 11/08/2017