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Home My WebLink AboutBuilding Permit # 11/14/2016 TOWN OF NORTH ANDOVER 000TH APPLICATION FOR PLAN EXAMINATION , a-0fe,- Date Received- Permit NO:—S /-Q --a o 1 1 '0 3 A C OWWO) Date Issued:_._ 1—I IMPORTANT: Applicant must complete all items on this page ........... LOCATION--- PROPERTY OWNER q Print MAP N PARCELZONING DISTRICT: ( HISTORIC DISTRICT YES TYPE AND USE OF BUILDING "TYPE OF IMPROVEMENT PROPOSED USE I Non Re Residential Non- Residential nd ne,family ew Building La u� [Jndustrial �diti family[addition ETwo or more family No. of units: 01, EkIteration �®rnmerciaT replacement ssessory Bldg Elemolition 71 3�o--v 71 n-1relocation [7jCher thers: ' 'ounda 101 OnLy OF ;WORK TO BE PREFORMED —76 LA&k 162 N Identification Please Type or Print Clearly) Phone: OWNER: Name 6 ta�j�\ Address: S Rhone: CONTRACTOR Name: Address: IL9 et-3 o Supervisor's Construction License: -Exp. Date: Home Improvement License: JYExp. Date: ARCI IITEC'f'/ENGINEF,-R--------,Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$I000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F. x I 2.00---FEE:$--;l Total Project Cost Check No.: Receipt No.: Page I of 4 [Public YPE OF SEWERAGE DISPOSAL Sewer �" Tanning/MassageBody Arty Swimming Poolsa Tobacco Sales ell c��y Food Packaging/Sales o0 p 5t� Permanent Dum ster on Site o:5 Private(septic tank,etc. 1-21-1Electric Meter location to protect NOTE: Persons contracting lvith unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor .f Plans Submitteds� Plans Waived Certified Plot Plan E5� tamped Plans }r� "a � 0 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT n`v FEF ater Shed Special Permit F3ti '" ite Plan Special Permit E0 'JL' ther COMMENTS DATE REJECTED DATE APPROVED E Ek; CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH LLDIJL-211E COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments y Conservation Decision: Comments Water&Sewer connection/Si k nature&Date Drivewa Permit Temp Dempster onsite yesno_ Fire Department signature/date txORTH own of 2Andover No. ph ver, Klass, cocMi[r.[w.c,c 4�' S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ta.., .�l�.!4 ... ...�.p , •.,, ... t„� I BUILDING INSPECTOR Foundation has permission to erect.......................... buildings orti...r�.�...ff....Compa ... ........... .,..... . Rough to be occupied as ..... fv v��.". .0.1k..........It!®...�.4p.........0 .M�AC 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 UNLESS CONSTRUCTI TARTS Rough ....... ... .. ..................................... Service Final BUILDING INSPECTOR GAS INSPECTOR OccupantOccupancE Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Miall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Revise Energywww.Rsvi�sEnergtr.com 1101ar Ptdbrmanee Coutract(w 5 South Summer Strom,Bradford,MA 018 918914-22t4 VAX 1401)7W710 CONTRACT Pope i PROGRAM CMA-HPC Moa Dli nam cwar. woRKONKN rostino (978)681.5617 10/1812016 441999 00001 sem eiaeei 54 Coventry Lone 9 nam 8"n 54 Coventry Lane 9 North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALdNC:Provide labor and materiels to Seel aches of y-wour agaiffit Wasteful,exons air Wom ed in Concert with the use of filwiaf tools and dl feelcsge Phis work will be air cxdt and indoor air uel' acrostic tats to aSitRO that your velli ba lafl with a heslthiui Leval pf �° q sty.lNeteriets to be uand to nal ytqu luune cpn inclu�cwlfm.ti�a Mrd aches produas. Primary areae far seating include atr Icakage to aEtitx,beromrrks,ahachod and aahr�utt>rmt�arras(windaw3 ane situ generally Ad dressed.) his will require(4)wofking Ire.A reduction is Cubk tbq pas minute(c6n)of ek inflttratimr will occur,but Lha actual number of cfm tg not guaranteed, As the oompiotiat of the weatlwrim6w work,and at no addidonel cm to tM Wowmw,a hotel Nowa door attdfm Combustion safety anatyais will be oonduCed by tM jWKwmW to MM the aa"of theindoor elf quality. Li 6A / l7 $340.00 KNEEWALI.5LAPE:Provide Mm mrd m*dals to iuWl 2"FSK faced smti rigid f6arglnss baotd iasrdal�n to(103)square feat of kneowall rafter arca, / [ I�1nrtry ` /os $367.54 rNUE-WAUS:Provide labor end matmiab to install 2" PSK fieeed ao .Mdsil id fiberglass board lead to(IO)squeaa feet of kneewali arra 26 � OC- 2rr A,6 5- bte W11 If $7o.00 A .n TIC ACCESS:Provide labor and materiels to in wwa the back pf dw attle dtwr Whb 2"rigid Tha mat board mrd wel the downs od8e with weati mtrippinS to restrict str Ltd. II d doctz wI ` 573.91 vENTILA PION:Pravwe 1 materials to in"veatilat�n chutes in(u)ram bays to rtteintsin air flow. $44,04 OARAOE CE[LMO:Provide Mbar add mum*to into IV R 35 dmsely pad Wi glass 1 Celham inatation to 300 square too of garage ceiling located below a basted floor area,by ddiling hotas in the o ams tlom below. Holes drilled will be phapd, plop w111 be spacklod and WR in s relatively moo Condition.Finish anding and touch op priming/palnting will be the co>sWra s rospanalbility. tJ (L/l $1,035.00CPAWLSPACE;Provide laorbLard tod maah to install (75)square feat of R-10►ig-W Nnnnac iasnledart to fhe a wtspeee W,rimeW wail up to the sitl and�VAirmt the bend joist. ) n $277.50 R (A I r s Revise Ertere www.FtW*oEnerqy,@0m now PalarmMate cominct(w 5 youth Summer$Wtet,Bradford,MA 61W CONTRACT 978-914-1214 FAX 1401)79"716 Page 2 PRWRAM CNIA.HK Mutt D890stinD nx" Imirs C"N WMORM (978)681-5617 10/10016 441999 00001 UROW j;MjgT__ 54 Coventry Lane 9 MUM 8TRW 54 Coventry Lane 9 m ip ULM am SUM to ...... ........... North AndOvOr,MA 01945 North Andover,MA 01845 JOB DESCRIPTION Total: $2,207.911 Program Incentive: $1,740.93 Customer Total: $466.98 Wl"'Al HLMYYO PJRMWURMN-COMM IM AMM AMM AMM WBWMML MRMsalt(W *"Four Hundred 8131dy-SIX&88!900 Dollars $468.90 MM YM COMPACT MAYWVfi"6R#4WWftMjF VffMWM g %WM DAU OP A00UVMke__Z VAM CK I tic "1119111"ItwCuttit "j Department of IndustrialAccidents Office of In vestigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 WWW."fass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Oi-gatiizatioti/Individtial):. Building Science & Construction Address:300 Trade Center Suite 3690 City/State/Zip:Woburn, MA 01801 Phone #:781-353-2455 Are you an employer?Check the appropriate box: Type of project(required): 1.NO I am a employer with 8 4. E] I am a general contractor and 1 6. F New construction employees (full and/or part-time).* have hired the sub-contractors 2,❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. F Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. F] We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.F Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.FM Other Weatherization employees. [No workers' comp, insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I mrr trrr employer t/rcrt Is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name. Hartford Underwriters Insurance Inc Policy#or Self-ins. Lic. #: UB-9F620983-16 Expiration Date:4/11/2017 Job Site Address: 54 Coventry Lane City/State/Zip: N Andover MA, 01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Kyle Martin 11/4/2016 Sjpnature- Date: Phone#: 781-353-245 Official use Do not write hi this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone ® DATE(MMIDDIYYYY) ACCOR v CERTIFICATE OF LIABILITY INSURANCE 6/28/2016 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT NAME: Mark D'Agostino FAX D'Agostino Insurance Agency Inc AIC No Ext: 5085860414 AIC,No): 7 Christys Dr Suite 1 AODRESs: markd@rfdinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Brockton MA 02301 INSURER A: MARKEL 34754 INSURED INSURER B: COMMERCE INS CO 25496 BUILDING~SCIENCE&CONSTRUCTION INC INSURER C: TORUS NATL INS CO 300 Tradecenter Ste 3690 INSURER D: INSURER E, Woburn MA 02181 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. INSR AUUL POLICY EFF POLICY"If LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 50000 X MED EXP(Anyone person) $ 5000 A X 2CW9728 05/16/2016 05/16/2017 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 ECT LOC PRODUCTS-COMP/OP AGG $ 2000000 POLICY �J OTHER: $ AUTOMOBILE LIABILITYEa accident $ 1000000 ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BCCB81 04/15/2016 04/15/2017 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS Y DAMAGE HIRED NON-OWNED PROPER I $ nt AUTOS ONLY X AUTOS ONLY X UMBRELLA LIAR ( OCCUR EACH OCCURRENCE $ 5000000.00 G IEXCESS LIAR CLAIMS-MADE 73023TI60ALI 05/16/2016 05/16/2017 AGGREGATE $ X DED I RETENTION$ 5000,00 $ ORKERS COMPENSATION ND EMPLOYERS'LIABILITY YIN STATUTE ER NY PROPRIETORIPARTNERIEXECUTIVE❑ N 1 A E.L.EACH ACCIDENT $ FFICERIMEMBER EXCLUDED? Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ if es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE. MArk D'Ag 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2015103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCEf—DATE -1141an aJYYYY) =CERTIFICAME ICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY•THE POLICIES BELOW.ICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE IMPORTANT*K the cer0cate holder Is an ADDITIONAL INSURED,the pollcy((es)must be endorsed. If SUBROGATION IS WAIVED,subject to terms and conditions of the policy,oartain policies may require and endorsement. A statement on this certlticate doss not canter rights to the certlllcath holder in lieu aE such endoraemen e. PRODUCER CONTACT S tWEj RONALD P DAOOSTINO INS PHONE FAX 7 CMUSTYS DR SUITE 1 UVC,%WM: (A1C,No): ML BROCKTON,MA 02301 f DDRE ADDRESS: 26W'L INSURER($)AFFORDING COVERAISE LAIC# INSURED INSURERA, IiAR.'1AW UNDERWRr=3 DMURA'NCE COMBANY BUILDING SCIENCE&CONSTRUCTION INC INSURER B, INSURER C: 300 TRADE CE§mp, SUITE 3690 INSURER D. INSURER M wosURN,'MA 01,901 INSURER�, COVL'JiAGE8 CERTIFICATE NUMBER: REVISION NUMBER: ANYRkLIU:RE 8... 6t:i RBD 6D' RTN@PO PBRgDIND:s14TI"D.NOTlVYnHSTANDING TIENT,MW OR OONW01 OF ANYOONTRIW OR OTHER DMMENT IN=REBPEOT TO WHM TW OERTIPICATE NAY EE:SBUED OR MAY MUM THE INBI:RANCE AFFORDED BY THE POUCIN OMRUM HERAIN SSSUBJWr TOALL THIN TERM%EXCLUB[MAND 0ONW=8 OPSUCH POLiGiI»S. :.MrM BROWN MAY HAVE BEEN REDUM BY PAIDCLAWS. INSR LT $UB POLICY EFF DATE POLICY R.1IP DATE LR TYPEOPIMRANCE L R POLICYNUMBER IhllaiDDSYYYYI (MMIDDIYYM LIMS GYRAL L IABILF[Y EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR DAMAGETORENTED $ REMISES Ea Q=Mwce) ED EXP(Arty one person) $ (3EN"L AGGREGATE LIMITAPPLE$PER: ERSONAL&ADV INJURY $ ENERALAGGREGATE $ POLICY ❑PROJECT❑LOC PRODUCTS-COMPIOP AGG $ AUTOROBILA LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT Ea acoldonO ALLOWNEDAUTOS BODILY INJURY S SCHEDULEAUTOS er emn HIREDAUTOS BODILY INJURY $ NON-41NNED AUTOS (PweoWdvtQ PROPERTY DAMAGE $ (Per accldenq UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS UAB CLAIM84ME AGGREGATE $ DEDUCTIBLE $ RETENTION; A WORKER'$COMPENSATION ANDWO WrATUTORY oTriER EMPLOYER'S LIABILITY YM U"F820988.18 W1112018 04/11/2017 X VMMS ANY PROPERCERNeI'P M EXCTNERIEXECUTNE O NIA E.L.EACH ACCIDENT $ 1 000 000 OFF:CIrRA4EM8ER EXCLUDED? ( Y In NN) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 H ya,daaaihe under DESCRIPTION OF OPERATIONS heiaw S.L»DISl=ASS-POLICY LIMtr $ 1,000,000 DESCRIPTION OF OPEMMON&4.00ATIONBIVEHICLEM EMICTIONSISPECUIL ITEMS CERTIPICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRNMON DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVi$X) AUTHORIZED REPRESENTATIVE ACORD 28(2010!08) The ACORD name and logo are registered marks of ACORD 1988-2810 ACORD CORP falft reserved. r'�r�Iv.�b�l�trumn��l/r t f r'�r�idtew�+//,i dE49ee o��:oa�aaater A9��BuRe�;aMtlaw 9�PRO Rl 'CONTRAOMR WTI9AIMT 013A THS CARPENYEf3 PONELL JACKSON 23 CWPMAM ST. MCHOM BSA 92124 q r„