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HomeMy WebLinkAboutBuilding Permit # 11/8/2016 `dORTy BUILDING PERMIT vF�q�ra TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Na#: i.. Date ReceivedTED p 4 SgCHU$�� Date Issued:__ i Lo _ :[M)l ORTA N I:Applicant must complete all items on tb_is'page LOCATION , , r � Pri t PROPERTY�OWNE'R, ,, ., .,; ,, f Print „' 100.Year Str`ucEure yes no MAP PARCEL-. , ZONINO`blSTRICT: Histo c District yes no Machine Shop Village,_ yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building CI One family rJ Addition ❑Two or more family F Industrial D Alteration No. of units: ❑ Commercial Repair, replacement D Assessory Bldg — _ 0 Others: ❑ Demolition ❑ Other D Septic Ci Well E Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO DE PERFORMED. - ° � . i �dentifieation- lease Type or Print Clearly OWNER: Name: - Phone: Address;__ - ----- --- Contra�etor Name: �4 Phone: . . Address: Supervisor's Construction License: " _ Exp. Date: . �n. Name Improvement License; µ Exp. Date;, ARCHITECT/ENGINEER Phone: Address; Reg. No. FEE SCHEDULE.BULDIN PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. - Fatal Project Dalt: $ �. ___--__FEE: $ '. . Check No.: ? Receipt No.: NOTES Persons contracting with una-egistered contractors do not have.access to the gu arcanty fund Signature_of-Agent!O her` Signature of contractor - hir w2 _ � , Andover O .ti.. 0 zh ver, Mass, coc KIc"t wic k SATED ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ... .� .,�, • BUILDING INSPECTOR ...,......., ................. .... .........,.,............ ..... ........ ...... .. ......... . Foundation has permission to erect...ZIA . ,..... buildings on ................................. .. ___®®®,,, ...,.. ... .......... 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-taws 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 CONSTRUCTIORTS Rough Service ............... .....tk.­ .,. .................. Final BUILDING INSPECTOR GAS INSPECTOR to Occupy BullClln Occupancy Permit RequiredRough 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- Kim ' i I0.4 FIN .. Rut Estimate r a' Date Estimate# 10/19/2016 1:455 148 Minot tit. Dorchester,MA 02122 617.331.58 f5 info(l,)port,ulovtu.00ting.com wFvw.porlanovarooting,com Name 1 Address RCO t;ric Giangregorio 17 lvaloo St. Somerville Ma 02143 Project Description Total F.SkInatc for.39 1ligh St. remainder al'bay rool, We will strip rubber of roof cxiwsing old insulation.Rcpineing any wct pieces anti then installinWe new rigid.5"insulation over, I hoof will have a 20 year Ill ILIfitcturers warranty. I lopellully this will reduce debris that kvill U1€hrough 63,750.00 e 113 of YaymenfSu4 Upnn,G immencement ..: _ .-�, Second 113-Due at Tl ay Point Total [sinal lf3 1';�JIIWA Uue on 0041 lotion oC.lol> NORTy fl�o"`4i•fe,����`� Town of North Andover k Machine Shop Village Neighborhood Conservation District Cotrtrnission 1600 Osgood Street Nortli Andover, MA 01845 �s$ACHI}`'p4 A licatio>n F©� EXCLUSION From Certificate to Alter Certain alterations are excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects must fill out the form below and submit to the Commission Cliaii person(contact info below). I Date: d Contact Name&Address: a GG•r--• L L- G t�L�IG'rT ..S'�'ez•-� Project Address: Project Description(attach additional pages,if needed): i Exclusion From Review Requested Fox. (3 1.Interior Alterations existing conditions including materials, design and dimensions. U 2.Stone windows and doors,screen © 9.Replacement of existing substitute windows and doors. doors,substitute siding or substitute l ❑ 3.Removal,replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the exisltng condition. ❑ 4.Removal,replacement or installation of window and door shutters. ❑ 10. Replacement of original fabric windows or doors with substitute ❑ 5.Accc ssnry buildings of less than 100 windows or doors that maintain the architectural integrity with respect to square feet of floor area. form,fit and function of the original ❑ 6.Removal of substitute siding, windows or doors. (5d Gl 11. Reconstruction,substantially sitxiilar in 7.Alterations not visible from a public exterior design,of a building,damaged or `vay destroyed by Circ,storm or other disaster, 8. Ordinary maintenance and mpa-it of provided such reconstruction is begun architectural features that match the within one year thereafter. Page MSV NCDG pa e 1 Current Chair:Liz Fennessy,77 Elm Street,li7ci cniles4 C!� ah.;Y i1tl,cc»n. : : s The commonwealth of Mass"ehusetts Department of IndustrialAecidents Meet �S`r Ui Y 00 � Congress S "= - = d Boston,N9 02114-2OZ7 www mass.go-vldia W . ke&Comp ensatiiou bsarance A�THE PT�� NG AUTHO s Y� ci�a�sl X mbexs. TO BByXGBll W T ',leasaPrint Le 'br ,A ''lieant Znfoxmiation. �® �( � Name(Business/Olga-dlz atRon divict,w)' r Address: �'�� C Phone#: Ci /Statelzip: C� Are YOU an employer•?Checkthe appropriate box: Type afr-pxoject Oregidrerl.); I I am a employer with.,_ ..employees(fall audlor part timo)-* 7❑�@y7'COI15tx1ICti0Il $. Rernodeft 2.0 I am a sole proprietor or partnership and Dave no employees working£oz ma in 9. Demolxtlon any capacity.(No-Workm,comp.insurance icquired-I 30I am ahomeowner doing all workmyselt[Nnvaorke-le comp.iusm—cexequixed"t 10❑Building addition d will be hiring contractors to conduct A work on my property, I will 11.❑Elec#ric�l xepaaxg or additiogs ¢.❑I am a homeowner an ansUrothettall contractors eitherhaveworkers'compensation insurance or are sole �– :p birig xepairs or additiow pxoprietorswitb.no employees. d tha suh-contractors listed on the attached sheet. 13.rj Roofxeairs 5.❑I ani a geriezal contractn{and Dave hire These sub-contzactoxsi�awe eavployeea andhayeworkers'comp.insuzance.� 14 Other $❑We are a corporation and its•oWodrs have exercised their right of exemption per I GI a. and eve have no empla`yees.prio workers'comp,insurance required] 152,re a o app lrcantthatc3aeaksbbie�€13uustalsofinoutthesecti,,belowshowingtheirw'-'kers'oampensationpo3icyinformation: indicating such 1. i x meowners who submit•this afdidavit ind3eatingthey are doing all wark�e name of the b contras ors and state whether oz nkat those entsti have tContraetors that aheckibis boi.must ataoho an additional sheet showing olio numb5r_ employees. Ifthe sob-contractors have employees,they must proyide their workers'camp.p Y elortv is the pa2icy S am an employer tliat is pro-P0,19 WorkepS,compensation WuFancefor my employees. 13arzd jo�i site irxformation. -�V rC(V-Q- insurance Compan)'Name: f �1 T'oiiay 4 or Som ins.Lxc. : rel Expiration d ~ City/State/Zip: JY c ��•nQ d-tl�l� lob Site Address: ` ch a co a£-the'v�arl?;exs' comp atxonpalxcy declaxatinxxpage(sb.o�vSngtbepoXicynumberafinae�p o$,d�5Q0AQ). Acta copy §25.A.is a criminal violation punishable y � _R and aF pa uxe to sactxre covexage as requn,ed under N1GL a. 52, ear i rlsonmant ast�e11 as civil penalties in the fox-in of a STOk'WO ORDations of the DTA.for ixasuranO a and/or a e�+ p o£this statement may bo forwarded to the Offlc day against the violator.A copy coverage verit=tcatxon. I do Izerehy certify izndei tliepairis aridpenaides of pexjuly treat the inforrrtatiori avided wave is u_e and correct. Date: Si at im: hone 4. Official xise only. Da riot write in trzis area,to be completed by city or to7Vr�offxcittl • PexmitlLicense�` City or To'n: IssuingAuthority(circle one): i Board ofl[ealth �.SuxldirtgAepaxtnaent 3.City/TownClerk 4.LslectxicalXnspectox 5.Rlurnbi>xgbnslaectox G.Other phone##- Contact Rex son: Oct 25 16 02,29p The Insurance Store Inc 6173257892 p,2 CERTIFICATE OF LIABILITY INSURANCE oarE(.Wbs7DDrrYY1 al/la/2o16 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. TKIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the ce f€cafe holder Is an ADDITIONAL INSURED, the pollcy(EeS) must be endorsed, SR ?I N IS WAIVED, sab]ect 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 Ilou of such endersernontls), PRODUrER NAME, THE INSURANCE STORE PN°rte (617) 325 - 6952 (0.7C.ie (617) 325 - '7892 a1C,Ha,SFS]; ol: 1D6 SPRING STREET E AIL A oDREss: WEST ROXBURY, HA 02132 INSURERt5lAFFORDINGCOVERADE :alto 1NsuAER AWESTERN WORW INSURANCE COMPANY '.. INSURED INsuRen D SAFETY INSURANCE - PORTANOVA ROOFING INC INSURER C; 50 Elm $tree t INSUREA D: Cohassot M; 02025 INSURER I- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TEAT THE POLICIES OF ASURANCE LISTED BELOW '-[AVE BEEN ISSUED TO TYPE. INSURF.0 NANIED ABOVE FOR ThF POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUREMIENT, TERM OR CONDITION OF ANY CONTFACT OR OTHER DOCUNENT WITH RESPECT TO WH]CI- TH[5 CERTirICATE RIAY BE ISSUED OR NiAY PERTAIN. THE INSURAHCE AFFORDED BY THE POLICES DESCRIBED HEREIN 13 SUBJECT —0 ALL THE TERUS, EXCtUSIONSAND CONDITIONS OF SUCH POLICES.L MITS SHOLVN U Y'' VE SEEN REDUCED BY PAID CLAIMS SElB POLICY EFF O ICY E LIMITS LTR TYPE OF INSURANCE INSR wvD POLICY Numurr( IMWDDIYYYY) IM.VtDD7YYYY) OVIERALLIADUM EACH CCCURF,ENCE S 1,000,000 COMMLRGAL GENERAL LIABILITY I PREMISES(EB o,calarw} 5 100,()00 a CLA€Ms+rtADE OCCUR =8184354 11/04/15 11/04/16 MED EXP Ony one pen; 5 5,000 y PERSONA'.,S ADV INJURY c 1,000,000 GENERAL AGGREGATE 5 2,000,000 V GEN'L AUGREGa.TE:IMIT APPLIES PER: PAIXJUCTS•C�M1iP�OP ACC E 2,000,000 FOLICY 'RT LOC T At"OMOe1LE LIABILITY (Ee etc den[) i 1,000,000 BODILY IMURY(Pgr parson, $ ANY AUTO ALL CWNEO SCHEUUEDg23g g30 05/06/16 05/06/17 BODILY INJURY(Per aaiden:) S A.Uros X AIJTGS NON.OwN=o s 100,040 BIRED AUTOS ?C AUTOS (Fac act daMl X s U3,IBRELLR LIMY OCCUR EACH OCC:IRRCNCE 5 EXCESS LIAR �A}IAS.F,IgpE AGGRZ.GilAr S 4E0 RETENTION 5 5 I� WORKERS COMPEIISATION I TORY LirAtTS ER AND EMPLOYCRS'LIABILIrY Y!H ANY PROPRIETORIPARTNEWEXECUTIVE ❑ EL.EACH ACCIDENT 5 OFFICE."EMBER EXCLLDM? is Ildandatery In HHI L. MSEASE-EA EMPLOYEE s Yvao.deacriba undo- VESCR€PTI7N O=OPERATIONS bolo» E.L,q}SEASE-POLICY LINi•T $ I I DESCRIPROHOFOPERATIONSILOGnONSi VEHICLCS(Anach ACORD 501,AddNone[R-rNa Schodu€a,it mom 5F av Is mqulmd) ROOFING 6 CARPENTRY: CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANTDOVER, BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBEO POLICIE5 BE CANCELLIED BEFORE 120 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCEWITHTHE PMICYP.RoVISIONS. AVT I2E REPRESENTATIVE "A C 1 0 -ORD COFTOR9TEON. AN rights reserved. ACORU 26(20'10105} The ACORD name and logo are registered marks [ACORD 25 16 02:29p The Insurance Store Inc 6173257892 p.1 DATE(AIMJDDIYYYY} A4C D> CERTIFICATE OF LIABILITY INSURANCE 10125/2016 THIS CERTIFICATE tS 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(ies) must be endorsed. If 5U6ROGATION IS WAIVED, subject to the tenns 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 NArAS• Ann Ga Ela her PHONU; 1 FAX INSURANCE STORE INC. C) No: B q IL ainsur@aol.com 106 SPRING 5T. INSURER 5 AFFORDING COVERAGE NAIC A WEST ROXBURY MA 02132 INSURERA: TRAVELERS INDEMNITY CD OF AMERICA 25666 JN5URE0 INSURERB PORTANOVA ROOFING INC INSURERC: mm INSURER D --------------- 50 ELM COURT INSURER E: COHASSET MA 02025 INSURER F: COVERAGES CERTIFICATE NUMBER: 96994 REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLECY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER ROCUPAENT WITH RESPECT TO'A'H€CH 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 SEEN REDUCED BY PAID CLAIMS, INSRTYPE 01=INSURANCE ADDL SUER POLICY EFF POLICY EXP j LYR PDLICYNUMReR lAWDDIYYYY # MW()DIYYYY i LIMITS COMMERCIAL GENERAL LIABILITY l=ACHpCCURRENCE 3 CLAIMS-MADE 17 OCCUR PhMA REM. Ea ocarrrencE7 5 ME EXP(Anyone person) S NIA PERSONAL d ADV INJURY S GENFLAGGREG.ATELIMIT APPLIES PER: G ENERALAGGRE SATE s POLICY jEcT 17 LOO PRODUCTS-COQ^.MOP AGG S OTHER: 5 AUTOMOBILE LIABIUTY I COMBINED SINGLE LIMIT S i Ea aoOsIeMl ANYAUTO BODILY INJVR"(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS NIP. I BgpILYINJURY(Per acrldent),$ NON-OWNED PROPERTY DAMAGE HIREOAUTOS :AUTOS Wer amideni) $ S UMBRELLAUAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE NIA 'AGGREGATE S DED RETENTION S _ 5 - WORKERS COMPENSATION X 57n UTE OTH AND EMPLOYERS'LIABIL(TY �,fN — EA NERIEX A OFF G RM1 NBEREXCLUDE EXCLUDED? [NIA1.NIA NIA 6HU88D80784116 10126120'16 1 10126/201 7. 15,L.EACHAccsoENT $ 500,000 ANYPROPRIETO(Mandatary fn NH) E.L.01'EASE-EA EMPLOYEE S 500,000 If yes,descdba under OESCRIPTIRN OF OPERATIONS below El.pISEASE-POLICY LIMIT S 500,000 € NIA I DESCRIPTION OF OPERATIONS 1 LOCATIONS!YE011C1.,ES (ACORD 101,AddMonal flomarka 5chedure,maybe anachad IS more spa w Is required) 0 Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 2003 06 B,no authorixalion is given to pay O cfalms for banefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of MaSsachuselfs. p This certificate of insurance shows the policy in Faroe on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this eels€ticat'e of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verilica:ion o Search tool at ivww.mass.gov/fwd;workers-compensalfordinvestigalions!- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W fawn of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, 120 main street AUTHORIZED REPRESENTATIVE r r no th andever MA 01845 Daniel M.Cr4j-, 'CPGIJ,Vice f'residen:—Reslt4ual lAarket—bYCR16MA I ©'1988-2014 ACORD CORPORATION. All rights reserved. f ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I