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HomeMy WebLinkAboutBuilding Permit # 10/19/2016 QF BUILDING PERMIT OORT� �tL�, rb'9ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION permit No#: `, _um , - Date Received � � ��A°rtnveo FP��gS _ ACHLISC Date Issued; _. L- R T NT: Applicant must complete all items on this page 44 LOCATION Pant PROPERTY OWNER` PrintStructur:Ae o MAP. PARCEL: ZONING DISTRICT': Historic Districo Machine Shopo TYPE OF IMPROVEMENT PROPOSED USE Residantial Non- Residential ❑ New Building it)ne family L'Addition ❑ Two or more family ❑ Industrial 0 Alteration No. of units: U Commercial U Repair, replacement ❑Assessory Bldg ❑ Others: U Demolition 0 Other �__---- ❑ Septic Li Well ❑ Floodplain ❑Wetlands ❑ Watershed District D Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED, I mo .._-. ----- -- - Identification - Please Type or Print Clearly OWNER: fume: 2AM _ Phone: _ Address: r Name: t,k441 Phone: Ernail: A, OKI Address:, Supervisor's Construction License Exp. Date: ° � � m . � ;,.�,�, ���..w Exp. Date: a� _ - 4 ARCHITECT/ENGINEER Phone:_, r, ,t1 Address: Reg. No. _. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Oast: Check No.:_ ry " _ Receipt No.: :3 NOTE: Persons contracting with unregistered contractors do not have access t �'a�uar �i_ rnd �A tor Signature of Agent/Owner - _ - Signature of contrac ................ ............... .................................. .......... ................ .................................................................................. tXORTH Andover Town of 0 . No. 4n ver, Mass,aw2a (7 ATE L) P,V Ll BOARD OF HEALTH Food/Kitchen PERMIT . T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ................. .............................. 00 1 ...... Foundation has permission to erect .......................... buildings on Rough 15 & x ............. Chimney A ...................... .. ... to be occupied as .......... ...... ..................* 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MOELECTRICAL INSPECTOR ® THS ELE1 UNLESS CONSTWiCION [Rough -i-' Service A',IiCT iiig ... ..... . r .................. BUILDING IN T06R Final GAS INSPECTOR occupaner Permit Re guired to QccuRLBuilding Rough - Display in a Conspicuous Place on the Premises - Do Not Remove Final FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Burner Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. Commonwealth of Massachusetts Sheet Metal Permit Date Perriiit# Estimated Job Cost: Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License# - Business Information: Property Owner/Job Location Information: Name: �i�G 1„?a� I C. Name: Street: Po Street: City/Town: 6va-L City/Town: Telephone: � �" -..- — — Telephone: -roll Zy'jif�S-fa7 Photo I.D. required/Copy of Photo I.D. attached: YES / NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. V/ over 35,000 cu. ft. Sheet metal work to be completed: New Work: ✓ Renovation: HVAC V Metal Roofing Kitchen Exhaust System chimney I Vents Provide brief description of work to be done: . �lze �ua�zrtarcwea�h of�crs�ac,Fu�e� _ • DePutfirrtettt of�rtria�,�ccid�s - Ofjrce of ffv toga" - 600 I3=fd7rgfm Street Bost;j4 M4 02M Workers' Compexmdan rasurance Mdmt:Bu �l�ou r x�e ci�as�P�i e Apgnnt Tnformatfon rlmft Prht l Nine C 'cam: &4&w—anw X56: 19• 7 . PhmeA ZX/ Axe pgu an employ=?chackfte apprugrWz bo Tgpe of prolert(rte a ): L I errs a ea�loyrry 4 1 ma a gniwnftadormttdi 6 Q N6w=stra *m. c plow(:nu MNCIP�).* brm Email e Mlb-GM±Mct=. 2 Q L a ar psttz a listed as&o affarlud Bbeet 7.'Q l3=Ddca-mg . sigp and lie no empIngees Them a baao g_ Q raapinpccx wt► DFmmitn frsr me in any -..9.- �:•. .. _ .. �I S.Q_We am a cx�x i=m6an and its 10,E]$fes zvpaus or adds . 3-fl l sxfz a met dr}ing all wank offims bay amrdm&fitirII-0 Pbrmbmg xep=or aditow MYSCE 0 PeaMfr�. Q �I fi camp- m 32,§I(4),m dwbzfema - =PIDY=S-190 w 13.Q OffuC hmam a xcT*e&I_ .4 YrbrZ]rsbaxiRnv3tAm:Mmrtficz=ffimbckmsfinftfficirwaftoe P6EzY f H wbn—b-ItfEosmgry sm drringaJtw+ aud�Cntbcc made muttsof��aa�v¢mag s ekaCs£ r cA-Alhj xrmuts�ausdmdi�aldv�si�nwmgf4e aur Eoc �udrr �thet5anr tf�sea firs have cnmSapces. fEibcsb����eFas�pncsvi��Or PAY - - . I rim urt ern�pl'vperffi�t ispravuTurg•tQarkers'carrt,�rensatiort irtsrm�cefar any easPlv3'e� Belrrw r"s�•pa&cy artd�ob sife TnstuanceEjamgauyNa� �.r"� � " Policy#r�Se�ix�s.Lic.� _„_f�S�' j�}L`�C�-7 �'�•2.Z ,.._.Ea�irxo.Da#c: -ZG' - - fob 5`itc Address: /.�Pi�� t.9i�v (�fpl�lTap_ r- � 1�r,1� Atbp.h a copy of tim workers'comPensaton pAcy dedmrafi=Page(shuwmg the policynumber and esPit4mx dates}. Paz�;tn sec crkve�agc as��•�tdQ�c+c#�25Anfl��fzE r.1SZ t�Icadiu� ofralp�es nfs. fine up in$UO0-DD m&or one-yrs i=dK=mit as WeR as elvAp=ah im ktbe fzm ofa STOP WORK ORDER azul.a fine ofi3p tri$250.00 a day agai3dt'rvioladrm Bc adgisc3fl�a#a cx aftl�is�kx aybsa�#o tbz Dffire of ofthm bTA ft E-EM922 co M Pdo h4reby redly f FwP -Ma Pmffh%w ofPe17mY tithe ixformz*VXPrvPisW ubow is true rrnd con-ad i � Daft: use oar y_ Do rot wr&as fids area,fo be dam ktzd by dTy yr taws gffxZ City or Toww ]?ezm�slta x,c� A>rffiaxf•(dMle GMe): - -L•$uard a�€Heaiiir. Z.E�dmg UeparEmeut�.{Tig1To�Qerk 4.]�[erfx-ir�laspeetztr S+Pl�mabiog� r G.Otter Oa�r�Pc-rsoz Phone AC CERTIFICATE LIABILITY INSURANCE DATE{MM/DD/YYYY) 8/4/2016 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME NCT Emily Costello Costello Insurance Agency, Inc. PHONE l� �8)3+74-6352 FAX a:ts7e)522-x127 (9 2 S. Kimball St. DD RIL ecostello@costelloinsurance.com PO BOX 5248fNSURERJS)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURERA:Sentinel Insurance Co. LTD 11000 INSURED INSURERB:Hartford Actc & Indemnity Co. 22357 Duct Works Engineering, Inc INSURERC:Hartf'ord Insurance Gr9pp 00914 Po Box 372 INSURERD• INSURER E: Burlington MA 01803 INSURERF: COVERAGES CERTIFICATE NUMBER.CL1671200622 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN$R TYPE OF INSURANCE S P C NUMB POLICY EFF P4 1) EXP LIMITS LTRMMIrponm X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED A CLAIMS-MADE �OCCUR PREMI TSES O(Ea occurrence) $ 1,000,000 OBSEANN1752 7/28/2016 7/28/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,OOD X I POLICY El JECf FI LOC PRODUCTS-COMPIOPAGG $ 2,000,000 rlOTHER: $ AUTOMOBILE LIABILITYE a I dent]I G LI IF $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 08UECAX9145 7/28/2016 7/28/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE S NON-OWNED X HIRED AUTOS X AUTOS P I sIn to limit $ X UMBRELLA LIABX 'OCCUR EACH OCCURRENCE_ $ 2,000,000 C EXCESS LIAB _ CLAIMS-MADE AGGREGATE S 2,000,000 DED I X I RETENTIONS 10,000 08 SHA NM752 7/28/2016 7/28/2017 $ WORKERS COMPENSATION X AND EMPLOYERS'UABtUTY STATUTE ER _ ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA E.L.EACH ACCIDENT $ 500,000 OFFICER/MC (Mandatory In H)EXCLUDED? OBWECCT8122 7/28/2016 7/28/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 (Mandatory In NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Soo 0 O DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER ...-. ....- CANCELLATION „ .. .,. µ. 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 - -...-_.-..--. . Emily Castello/HOYECl - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS026(7014011 �AS'SAC�IJ�E7C'S' DRIVER'S- 2 ticE�IS� 9a END: Jd NUMB �I zoaa NONE S5469,315--', 4 V—?019 1; 72 9 66 7Tsr R Ss sic M i�Kit O OD ss°sa� NONE TREMBUY 2,JoHN E f e 8 RUTHVEN AVE' BURLINGTON,MIA 01803 4349 k 5 Wf2-022D74ReY0T4¢2Qp9 ,COMMIv?N W LTH OF_`M ,S$i4 USE., SWEET I' AL IIUOR1=1 , ISSUES THE 1=0LLOWING I iD ASE A _ MAS`CER UNRESxTRICTE[3 �g ,JQI4N E TREMBLAY � 8 RfJTWVN AYIt, ' $ BURLINGI*MA 01803�AM! 4 ry � 2556 10128120$7 < 2216