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HomeMy WebLinkAboutBuilding Permit # 10/13/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER 0-�^ 0� APPLICATION FOR PLAN EXAMINATION Permit No#: �� Date Received AChbl1 � Date Issued: / " is IMPORTANT:� �'ippl>!c,ant rnu�t complete all Mems on page �... • i /i /i, � ,, . , //r.. r sir r„ ./i / / r / i r it / v //,✓,,, r, /, // ,,, ,,, ,r...., ✓,. ,, �,,.,,r/, �../ /„ r r �. r, � 1. r i✓ i, ,, .,. ,_ ,,/�, i /, , is i/, r /� ,� -////. ✓, 1. �i � r ,.r < ,,„ri... / l/ � // e PF�CIPERTY O'"+l'►1N1 /��,,,/ ,� � / ,r,,, ii /r ,a, / „// / r r // f i/ EL.;r'�< %;''%;ZOtIIG DIBTIT r�ii,l �s orio,Dtr► est MAP PARC ,/r / ,e 1 0 %, r, „!\A - ht ed hdp U'Iha Y TYPE OF IMPROVEMENT PROPOSED USE - Residential Non- Residential __----- �__ New Building . One family f_:7 Addition ❑Two or more family ❑ Industrial _❑_Alteration No. of units: ❑ Commercial 11 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [J Septrc ❑1lllell ❑ Floodplaino �i;Wetlands. D UVatershed„DJ Js rip / /I i%%ir�rr�r �/rri /i __ C1E�CRII�TION OF �l”©RK T® �E PERFORIVIECI: Identification - please Type or Print Clearly OWNER: Name: 'TK-2, LL Phone: 1 ” Address: nr ContraCt6 N me Phone Email r �e­, AddCess &A jA / r r �riia///ter i/ / O %r/%/%ri✓ "/ D t % ��/r �Opt ��� �r�/ Suprulsor's Canstructior Llcer�se �Exp a %/ / ARCHITECT/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: $ bfvTap C FEE: $ Check No.: Z,. �w., Receipt No.: NOTE: Persons contracting with unregistered cactors ria not have access to the guaranty a ci or Signatureof Signature of contract .mom Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning[Massage/Body Art ❑ SwimMng Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Du npster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed OnSignature_ COMMENTS% � �j} 1 Ll CONSERVATION Reviewed on Signature _ LA, COMMENTS HEALTH Reviewed on10 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: "' ' Comments Conservation Decision: Comments �S ✓ Water & Sewer Connection/Si natur6& Date !©rivewa Permit DPW Town Engineer: Signatur Located 384 Osgood Street FIRE D�EPAR�TMENTY �T-emp Dumpster on suer y �, r ,r: �v k , F�re�gDepartment s�gnat�areldate� t�� �,� � �5��:�� � fr . Dimension Number of Stories: 7— Total square feet of floor area, based on Exterior dimensions.?- Z Total land area, sq. ft.: Z 5 ,3ti2- 5 ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G rnin.$100-$1000 fine NOTES and DATA-- (For department use) v cosi Z SW deer 6,,P D�9 c Q Z 1 b Iwo x Q- ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pei-mit Revised 2014 t%ORT Town of :� _ ndover O ~ ~" 0 No. LAKE- �1- � ph ver, Mass, t0cw1c„ew1[K VA. q�J/ATED S U BOARD OF HEALTH PERMIT .T D Food/Kitchen Septic System THIS CERTIFIES THAT ... � ..... �.,.... .................. .......... ..... BUILDING INSPECTOR has permission to erect �.� � � Y ..._. Foundation .......................... buildings ., ..,. ..,... .. .. Rough to be occupied as .,. .... ., ....Q .�i�+ ................rk ye.IM............,... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit, Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C®NST TION Rough Service ..... .......... ...,. .. Final BUILDING I CT GAS INSPECTOR Occupancy Permit Required to ®ccugp 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. ................... •••�Verizon LTE 13:02 AM 74% c ccs.google.com -7 Vol LOT 2 f I 1< `�- # = zasp. vim;. e u n F } F E z _ F � i r� 26,x:�F_• _ , r AJ 1 y r 7 zea = t- � PRC3t)F PLAN NANDOVERkmssAcll, 7E prFpApEl�ma i b , ZEC j7 a„ SZkLz MEN= OMNI= il; NOTICE NOTICE TO TO N 1 4 � C T EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress street, Suite 100, Boston, Massachusetts 02114-2017 9 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give you notice that I (we) have provided payment to our injured employees under the above mentioned chapter by insuring with: I Associated Employers Insurance Company NAME OF INSURANCE COMPANY P.O. Box 4070 Burlington, MA 01803-0870 ADDRESS OF INSURANCE COMPANY WCC-500-5006517-2016A 10/01/2016 - 10/01/2017 POLICY NUMBER EFFECTIVE DATES 1 060 Osgood Street M P Roberts insurance Agency North Andover, MA 01845 (978)683-8073 NAME OF INSURANCE AGENT ADDRESS PHONE TKZ LLC 4 High Street#201 North Andover, MA 01845 EMPLOYER ADDRESS 08/04/2016 DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER sssso verizOn 1-117 < All lnk oxes (2) rh p 0111 G, s Sent from my Pad DAIF[LTtI1D0'YYVY) A CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED A5 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 i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IM PORTRNT: If the certificate holder is an JPIT] , I PNAi INSURED, U110 polic Iesj must be ertdarsed. If SUI3ROGA17ON IS WAIVED,subject to 1 the terms and conditions of the policy,cRrtaPn policies may require an endorsement A statement on this certificate does not confer rights to the i certificate holder in lieu of such endorscmentls). co"racr MODUCER NAraE: Sandy Munroe M.P. Roberts Insurance Agency vxo"E f978) &83-8073 �i�Not: t978) 683-3147 1064 Osgood StreetE15AIL ADazess:_ Sandi@mprabext t70rtt1 AITCtOvex, Mrd 41845 IN5UIR(SZAFFORPING COVERAGE._.-...-_. MAIC# t§URERA_:Essex Insurance Co._... ._ s3suREo nrsuRERD:Associated.Emplovers Insurance TKZ, LLC lNsungRC:....... .. . ..... . CIo TOM ZAHORUxKd trSUREEtO .......... 78 GREAT POND ROAD INsuR n t_..- ------- _-------..-. . NORTH ANDOVER, MA 018'45 IFA.URERF: COVER_AfsES CERTIFICATE N UMBER: REVISION NUMBER. _ _THIS IS Tp CERT)rY THAT THE POLICIES OP1 SuRAN LISTED BELDN7 HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR l'HL= POLICY P1 THIS INDICATED. NOTWITHSTANDING ANY RFOUIRE MENT,TERNt OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO SNHICI f THIS ' CERTIFICATE MAY 8E ISSUED OR MAYPERTAIN,THE INSURANCE AFFORDED BY TFE f OLIC)ES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERAS. EXCLUSIONS AND CONDITIONS OF SUC✓I POLICIES.LINIITS SHOWN tv]AY HAVE BEEN REDUCED BY PAIDCLAIMS, 'AWiJSUAR: ` POLICY EFF Ptll]GY pfP LJpy7S g ILTRi TYPE=OF IN6URNICL �[N5R_I'ND} _ POU LY-rtaER i 7ALlYi fY 1'YY ; rs,lJprVYYVY GENERAL LIAUIL1IY i ,3DX4936 i 7/x3/15• 7/13/16,EACH UCLUANtN9ce ,S 11,060,000 VVV I a+llf%4GE r0 RFNTEe X Cor.vsFRCIAtoiNmERALLESHILIT 1 IPRErAISL�+ilrrtwl 1 s 50_,000 r - } YrDl:)rd'IAr -r,.pusRl S .,.000 CiAIA�S�tJ1UE ' X OCCUR l t u a€RsorALsnAVrEJ RV 5 1,43,040 ` GfNI:wt lAccRI:cATa: s ..2,000,000 1 .._ ._ f .. ( 4 ! ' 1 PRITSIIrf r CAI.,-',slr nCG�: _ _ GFN'1 A4GREG+i_7i;LIAV iAPPr,IrSr£R I '-' _ - - �f • �( POLlGY PROf L(>r I E:ONEIINE,t1 SINUlt.Llr.517 ! i t1:1�ccH1`r7} i T AIJTtltAORI1.E LIANIUTY ' } I 1101aR-Y INJURY IPcr I—n n i, AHYAUIU I I nOP:1YIN,IIJRY1PI!1r I()E I N-L 0MILL) SCIIEUULfat - - - AUTOS AUTOS PRLNEIifY()AMAGE I NON-OV4TIFn [Pr':xuu:nr) -HIRF.DAUTUS AUTOS UF.IRREl.I..A LIAe OrLUR i. —. AGC MCA!F - fI 3 -eXCESSLIAra Cin11.15,14�Dr: r -- UEU )SE IENNUN _ - 1U/1J75- 10/1/16� 4lCSrAfLI 0111' } H VXtRltERScoMPEtESAT1aN WCC500506517-2014A rOlc LvnrE:. CN ANO€rAPLOVCRS'LrAUILirY i I _ r L r:Acl+Acc�cr,lr s 1,000,000 A?EY HZRPRILIQPWA1NLRIi_XFCJII� Y-"-l}tSJA ' '.nrrICCPAAcaAE3CEEr G[.iAEDo 141 - FI US.Skmu -I-f,1-In )vrr_s 1,400,000 Irl.ritala,y m NHI 4 uyes,ncsalM,Indrr I 1 FL.OISEASE-POLICYLRAIr 1.000,000 IJMfUPNnrda:UPL€L'WON,td..w 1 l i �SCRIPTIONUFOPERAI3OtISItolATIDNSrVoa CLES(Aftah ACORD T61,A,r�uuonns RnnssrNs Sdieuuta,rr mQra red) yp�w t}�t9� j 1 I i CANCELLATION CERTIFICATE HOLDER Slit]ULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED REFORE THE EXPMATJON DATE THERCOP, NOTICE WILL BE DEUVERFD IN TOW14 OF NORTH ANDOVER ACCOROANQE WITH THE POLFCY PRpV15lON5. E I BUILDING DEPT AUTtIaR¢ D ErRESENrnn -- 1600 osGOOD STREET NORTH ANDOVER, MA 01845 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 W05) The AC ORD name and logo are registered marks of ACORD Phtsne: Fax: E-Mail: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-055497 Cons�irui'Lion Seonesvisar THOMAS D ZAHORUIKa 4 HIGH STREET SUITE 241 NORTH ANDOVER MA 01845 .� &— Expiration: Commissioner 04/0512818