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HomeMy WebLinkAboutBuilding Permit # 11/22/2016 BUILDING PERMIT ° �t�E° " ,m o � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION # � x m � Permit NI#: w Date Received w k° �-� �.acwu� Date Issued: IMPORTANT. pplacant must complete all items on this page / r ✓ / r r r r a r ,r / ✓ v o �� / /,r /� s, / /r iii.,,/ri/ ,-; ,> ,,, ,,,. .A .✓. i, / r..../ .cr/ /. /../. /%i ,.../ � /, ,,; �ONIJO;DISTRIC Ta /� / , a ry'. %'O Machane Shap age s na ,. TYPE OF IMPROVEMENT PROPOSED USE _ Residential Nan- Residential C:] New ilding ❑ One family Ll Ad ion 0 Two or more family 0 Industrial 0 erationNo. of units: LiCommercial epairm replacement __. 11Assessary Bldg 0 Others: [3 Demolition Ii Other Cl epttc [��I�,I II Flaodplain 0 Wetlands i] Watershed Dlstnc� / %r r ",ie--/ 77"""s�/��/rr�//ii/i a/In' U Wate / e�ruer' /G / DESCRIPTION OF WORK TO BE PERFORMED: V'+ t f c C:..'g, 4- l r 1 .0 ted dentifie tion - T'leAwe y IV , rint Clearly OWNER: Name: Phone: Address: %/ V v�, " : q Contractor Name. " �, Phone ' I � �� `° ��� ` � � ,err rig,r r Address , uier~;r�enr' Ca'nstructlon'Lense f ' / 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: $ , -- FEE: Check No.: t o Y 77 Receipt No.:`3 r NOTE- Persons contracting with unregistered contractors da not Have access to the guaranty.fund 'signature of Agent/Owner Signature of contrectorM !�( -vlly ............................... 'T t%ORTH own of Andover ® 0 A— --n No. ff.12 4 m- -w- 663 ft-oU 17 �7R4aa` - h ver, Mass, Ago/ C5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .M.W...M0..../....rVA .......IFAA D - .......... ­.....tr BUILDING INSPECTOR has permission to erect .......................... buildings on ....A_Y...... ............................... Foundation to be occupied as ............I *#o*#VbOW...........& I ..,................ Rough ..... ......P ....................... 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 CONSTRUCTIONLSTARTS Rough .............. A/4. ............ Service Final BU"I'L"'DING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Oecupv Building Rough 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. -3 AIn1 I _ f IC7rl+l t x Inirr,r rn pit 1 i ns 704-27 .,:;�i,::" 4. .-rl.,ti.i,`� —1 f , - I _,. .1•:. I, ��r J C)e ry i3,3 t4:`Ni',ll __.,_.__.... C c — { i-,, J:vn�• arra�:�V+lPr,3��t.,=alert, � �."slEti(rP=t'. . (c-Nfai1} �e ,. ,rsr: �r{1;— t=r•':Ons,JQ'rior rte;;.ii;,es''uarK sal the pf�mise�in^-rsd at of Add WINOC M ��NERIESR Y� x Vdl OFTIONS: - -.- .VIFlC5nYf5 � SERIES;i ��..M� Girls; 1�.ti a is I iNindow-nlor t]f Y j 'Ntndow color QTY r [ SS:MGns: IC Poin;3wrior:&IC)� � DOORS VSO!) L CITY PLfuscinrral VC rna th i,_J N (Aar Capping SIf tlnq class haur M EL NAME I `f UDE1.4 QTY Cour 1== �,,: 11r Lite�i,7 _.__.._� __.__—._._._ HP'JJf?_. ;;•! 'L,_ E til, .-_ :�9 .r; .,.r; _,. Entr/Doar Style 3 L SE Ira. C.Olpr n', - C r:. f - r� Hl)'YP s`. a'- - G �i�; - ' - r,3- .,�tl�::_:rl.i r:y .{ in- ❑�=c m=rtt Sidelites sly!e 5torm Doo _ r IIP VI3 tG 4. Snsh Jell.... .� W 3 r in—, Rr�I ii-❑ ; - i rl A 111i Efltry 00or Style TOTAL — - —�-- _ _ Ii EleNk: Sld 3s .KLFa :3 X123 GASf't y .:;r.,J_'. .- _� ,.• _ ._ ....._—Other Door S la ..._.� f ;- tY PRICE _ - ,J r Go€or n CLi DEPOM IL)_y( .r =_/ .:.K.,;! 1,o�i.,�r r_,cfr ORDER } TOTAL �'l�" ��♦ �� J�"L'..J %� l r' r t7LIEA �.L._ �'or!D ff,: j _IVYks!.C•m:.f rZt, 1 RW''f� h� r :Grastarr:rrUrsands INS Is an'e t,rnalp—d clam: Owner fids read and ayrG(,s to the terms and conditions on the front and the revers.,)of this.Agreement, Owiier spechic:atly agrees to the(1)Total Cash P lua;(2)work being perforrtrect; and i3)work not being performed. Owner UnderstanJs tliat this Agreemt nt and any atiachs-nents contaili all of the premises made by NEWPF10. Owner has been orally advisod of his right to Cancel thla transaction at any tfine prior to midnight of the third business day after rho (late of this Ira"saction and[Ohne was provkdod with two(2)copies Of n cnncallation form explaining this right. DO NOT S#CN 7,-113 CONTRACT IF THERE PPC AIJY PLANK SPACES. (Rhode Island Snics Only): Notice to buyer: (1)Do nut sign this Agraortien,if any of the spaces intended for the agreed terms to[hie extent of then availaf.)le irlforniation are left!)lank. (2)You are entitled to a copy of this Agreement at the,tinir;you sigli it. (3) You rii,ay at any time pay off the fuH unpaid balance do,under this Agreement= and in so doing you may lie endfled to rece#ve a partial rebate of the finance alit insurance charges. (rsj The seller has no right to unlawfully enter your preniis=s or,Onlmit any breach of tho pewee to repo:,15ess goods lJurrlrlsad under this Agreement, (5)You may cancel this Agreement if it Lias not been signed at the main office or branch office of the seller,provided you notify the seller at his or her main office or branch office sho`Nn in tho Agreement 1}y registered or cortlfled mail,which shall be posted not later than midnight of'the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday an which regular marl dellverios are not made. Soe the accompanying notica of cancoilation form for an explanation of buycr's rigtits. (Rhode Island Sales Onfy): Owner acknowledges receipt of required Contractor's Registration and Lier,nsiog Board consume:education Inaterie3ls, (C7,.vner's Initials / �t 0 - -.. . Pr�rjtitt SNec�!r�st f'rtrrlerl N.�,er� � � •,vner ._m.m-..._ �l Qvntrr __E-LrD4%' K i f NEWPRO MANUFACTURING >vnac SERIES G fVBWPRO 2000 _ AQU�Li=N�JiVQ . Cellular PVC frame,Triple glazed, NetlonalFeaeauedan Low E wating(e=0.027,82 i 5), —• HetlngCwnena Krypton/air fIIled,0Ividers DF-M-27-00091,0000t EN5RGY PERFORMANCE RATINGS U-Factar�U.5.11•P) Solar Heat Gain Ca !dent 0,18 ADDITIONAL PERFORMANCE RATINGS Visible Transmi•itance Air Leakage(U.S,A-P) Condensation Resistance 7 MenuhschtrMsOAWdat th�enitno nlatm4ra�[c�LlBHFRCPmraQurs tarda�em�nlww�o�e ppmduGtp�dum�r�ct.NPROrttlAgeated9�eslt0nG4tat�hl�edie alem�iinnman�oGllCl1£m�pli�e . dp1pm4protivttalraNtAGdaaanat[aaammeadut/WaCsxt deatnCtwer>antthaiU1�.4161tr[wly - Wit[stCttc3rnYs�aaitsoue0�0�al��tt0.RnufaW�hf�ntDttdlmtprads�rotpetlomtanceGdarmetlaa. M The Commonwealth of Massachusetts Department of Industrial A c cidents office of Investigations 1 Congress Street, Suite.100 �7 Boston,AM 02114-2017 www,mass.gov/dia Workers' Compensation Znsur•a,nceAffidavit' Bujlders/Coniractors/Electrici PrPlum ers Appticant]<nformation P I r:,- Pte© Name (Businessl0rganizarioo/Individual}: Addiess: .I 0 F D/ Phone#: City/stat �aAN Are you an employer? Cheer the appropriate box: Type of project(required): 1_( L am a employer with SQ 4 ❑ T am a general corxtractnr and 1 6 ❑New construction Save hired the subcontractors employees (full and/or part-tame).* listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have 8, ❑Demolition ship and have no employees employees and have workers' g. Building addition working for me in any capacity. comp.insurance.t No workers' comp. insurance 10.❑Electrical repairs or additions 5. ❑ We are a corporation and its required-] officers have exercised their l I.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all wax's right of exemption per AMGL 12,❑Roof repairs myself. Rro workers' comp. 7 d we have no l 1 4 an insurance required.] f 13.❑Other employees. [No wor�ers' comp. insurance required] ",kny applicant that cheeks box I 1 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 ken hire outside conu-WWrs must submit a am affidavit indicating sach. tContractors that check this box must attached an,additional sheet showing the name of the sub-contractors and state whether or not those entities havo employees. If the 3ub•contraetots have cmp3oyees,they must provide their workers'comp.policy number. Y am an employer tfrat is providing workers'compensation hrsurance for my employees. Below is the policy and job site information. tN'Gt./v e-e— Policy#or Self-ins.7..ic. � --- Insurance Company Name: , ��1 `` 0 a'M 00;51 -06 " 01;2 Expiration Date: #. V Job Site Address: -G 1.... dL� City/State/Zip: 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 NIGL,c, t 52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year hnprisoumerrt, 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, Y do hereby cern under the pains and penalties of perjury that the information provided above is true and correct Date: �� l 5i attrre: Phone If r opclal use only. Do not write in this area,to be completed by city or town ofl>:ciaL Permit(License City or Town: # Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Cather Phone Contact Person. # ,. -� 0ATE(MM1DD-Y'!() At7C)R" CERTIFICATE OF LIABILITY INSURANCE 9/9/2016 1� 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(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 confer rights to the certificate holder in lieu of such eridorsement(s). PRODUCER CONTACT Melissa Pflug NAME: Mackintirs Insurance Agency Inc PHONa (508)366-6161 NC No. ISO 1)365-5202 11 West Main Street: EMA FA:oDREss:IL melissaP omackintire.com INSURERS AFFORDING COVERAGE NAIL# Westborough MA OL5B1-1931 INSURER A Netherlands 24171 INSURED INSURER a:Libert Mutual/Peerless 24198 Newpro Operating LLC INSURER c Acadia Insurance Co. 26 Cedar St. INSURER 0: INSURER E: Woburn M& 01801 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 15-16 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, NOTVVITHSTANDING 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. r A R POLICY EFF POLICY EXP LIMITS OF INSURANCE POLICY NUMBER MMIDl31YYYY MMIOOIYYYY L GENERALLIABiLiTY EACH OCCURRENCE 3 1,000,000 DAMAGETO REMTED 100,000 MADE a OCCUR PREMISES Ea accurrsnce S CRI?8589577 12/31/2015 12/31/2016 MED EXP(Any one person) 5 5,000 PERSONAL&ADV INJURY S 1,000,000 E LIMIT APPOES PER.- GENERAL AGGREGATE 3 2,000,000 PRO- PT20DUCTS-CONIP/CPAGO "s 2,000,000 JECT ❑Loc s COMBINED AUTOMOBILE LIABILITY E accident) BODILY LIMIT S 1,000,000 BODILY INJURY(Per person) 3 A ANY AUTO ALL OWNED X SCHEOUCED 8A 8584174 12/31/2015 12/31/2015 BODILY INJURY peraccidenl} 5 rX AUTOS NON OWNED PROPERTYDAMAGE S HIRED AUTOS X AUTOS Per accident Unlnsuredmoforist8le fit limit S 250,000 X UMBRELLAL38 X OCCUR EACH OCCURRENCE 5 5,0001000 B EXCESS LIAR CLAIM&MADE AGGREGATE S 5,000'.000 OED I X I RETENTIONS 10,000 CO 8582578 12/31/2015 12/31/2016 S WORKERS COMPENSATION X PER TI- JER STATIJTF AND EMPLOYERS'LIABILITY Y1NANY PROPRIETORIPARTNERIEXc"'IVE ❑ NIA E.L.EACH ACCIOEb500,000 OFFiCERIMEMBEREXCLUDED? Y •r7C-20-20-003506-02 5/1/2016 5/1/2017 E,L.DISEASE-EA E500,000C (Mandatary In NH}If yes.describe under E.L.OISEASE-POL500 000 DESCRIPTION OF OPERATIONS bebw DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES {ACOR0 101,Additional Remarks Schedule,may be attached If more space Is required} Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXP1RAVON DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, NA 01845 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION, Ali rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 3 t office Consumer Affairs � �usl�ess egr�la�i6n y_, W 10.Park-Plaza Suite 5 1 70 $OstoftI �huse s 02116 Home actor Registration � Ragistratlnn: 148609 Type: 9uppfement Card NEWPR' C OPERATING, LLQ, r �' �rcpiralior: 515/2017 w THOMAS FOXON26 CEDAR ST. OBURN, MA 41801 �Y tiY ir_.. UpdateAddxees,aad retarn card Mark reason for citauge. soAi o zamsrrr 0 Address ❑ Ilene"[ Employment Last Card fhb�09T7/I3dff7Elf/Bf.�LL.rb O�E,f/YGLIQd� ovs ee oycausnmerA mirs&livataees TtegufaRon LIcsase or rogisir"on valid forbndividui pso only ME IMPR011ENQ4.r CONTRACTOR before the expiration dfat% If found rettir to: Office of Consumer Affairs and Rusinees Regulation - egtefrittlo tT TYpo- 10 Park i"laxa-fikO 517`0 xpirat _ 3upplemant Catd Basion,to 62116 /i NEVVPRO OPE THOMAS FOX09 26 CEDAR ST, WOBURN,NIA 01601 Underseeratary 1'�a#t+affd�+ithautaignaiurtt f M issachusetts Department of Pudic Safety ' Hoard Of Building Regulations and Standards License: CS-029090 ' ��nstr:��tic�n S«�ar•yisOr THOMAS PAUL FOKON 230 WALNUT ST r READiNO MA 01967 f f - COrrtmissioner 11!1912017 9