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HomeMy WebLinkAboutBuilding Permit # 10/27/2016 BUILDING PERMIT 0* t%O�aoRrk o "'{•o TOWN OF NORTH ANDOVER o�g � ,- APPLICATION FOR PLAN EXAMINATION z Permit No#: 1JQd Date Received I Q " 7 0� ��S�gC1itISE��y Date Issued: I )IMPORTANT: Applicant must complete all items on this page LOCATION 6�21CI- Print PROPERTY OWNER ,5e,"I �0 () _ Print 900 Year Structure yeswo MAP _PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others.- El thers:❑ Demolition ❑ Other %' Sept[c ❑Well l ❑Floodplain C1'wetlands Watershed Dtncf DESCRIPTION OF WORK TO BE PERFORMED: J-.-1s/GG i® s nr,4*11 �Dae-Avff*e e,947.4:7 Tdentif tion- Please Type or Print Clearly OWNER: Name: Phone: Address: Le IF �Idl 1/61,Af-e,e ,L�r Contractor Name: 9 Shoo o Phone: Email: 'Fi�-; v ® (2o e_oy,- e Address: ee '1 Supervisor's Construction License: G S - Exp. Date: /4 Home Improvement License: /8(le Exp. Date: /417// ARCH ITECTIENG[NEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$725.00 PER S.F. Total Project Cost: $ 021 (?1 FEE: 23 a Check No..-_6Receipt No.: 3 / 09 Y_._ NO rsons cont g wit registered contractors do not have cess to the nty fu -------------- ----------------- ................ .................................... T V40RTII own of Andover NO. o h ver, Mass, 7 1 IKE _40 1b c0c.41C04aWACK N_It. "�ATIED P�V U BOARD OF HEALTH Food/Kitchen PERMIT. T LD Septic System THIS CERTIFIES THAT ............ .5..r............ ptibl.......... ........................................ BUILDING INSPECTOR has permission to erect .......................... buildings on ...... ......V.1 4.4. Foundation Rough to be occupied as ............Krobsest.... kc A$. le,j............�A... ............. 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®4STAR Rough Service ............ ............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. 0 CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDlYYYY) 10/5/16 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 endorsement(s). PRODUCER CONTA T NAME: AMY ROBERTS M.P. Roberts Insurance Agency PHONE (g78) 683-8073^ FA)78) t97e? 683-3147 1 060 Osgood Street HDREss: AMY@mproberts.iinsurance,com North Andover, MA 01845 .m INSURERS AFFORDING COVERAGE NAIC N ...S I,IR ED S . ENSURERA:ESSEX INSURANCE. - IN - - KEY LIME INC -_W- INSURER B:Associated Em to ers Insurance — _ -- _ 10 HEPACTICA DRIVE INSURER C INSURER D_ NORTH ANDOVER, MA 01845 — INSURER E: INSURER F: ... f .._..—__ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE 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 — ACDL SUER — POLICY EFF PAIJCY FXP — LTR TYPE OF INSURANCE R D POUCYNUNI6ER MMIDDrY (MMIDDIYYYY) LIMITS — - A GENERAL LIABILITY 3EE0820 6/15/16 6/15/17 EACHOCCURRENCE $ 1,000,000 }{ COMMERCIALGENERALLIABILITY OA! MGETORENSEUI �TED $ j0 D00 CLAIMS-MADE OCCUR MEA EXP(Aryone Person) $ EXCLUDED _.I . PERSONAL&ADV INJURY $ 11000,000 GE —"-G — GENERAL AGGREGATE S 2,�_f 000 I POLICY LIMITAPPLIES PER PRODUCTS-COMPIOP AGG $ XG`LppEja _,_, POLICY OCT };i LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaacci&M $ ANYAUTO BODILY INJURY(Por person) S ALLOWhED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aWdenq $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE S per accidonl S UMBRELLA OCCUR EACH OCCURRENCE $ EXCESS LIAR - .-- CLAIMS-MADE AGGREGATE $ DEO RETENTION$ — --°—,- B vNDRKERSCOMPENSATION PWCC50050075812016A x/15/16 9/i5/17 WCSTATU- OTH- $ AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNFRIEXECUTNE Y!N OFFICE RIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 _ (Mandatory in NH) Ifes,describeunder E,L.DISEASE-EA EMPLOYEE S 1,000,000 O�SCRIPTION OF OPERATIONS belaw _ E.L.OISEASE-POLICYLIMIF S 1 000 000 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requ red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SAMPLE CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MICHAEL P ROBERTS ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and Ingo are registered marks of ACORD Phone: Fax: E-Mail: Office of Consumer Affairs&Business€iegu€ation -' NOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type. Corporation beforethe expiration date. If found return to. Registration x iration Office of Consumer Affairs and Business Regulation T86T86 10�Q712Q1g 10 Park Plaza-Suite 5170 Boston,MA 02116 Key-Lime, [no Benjamin osgood , 10 Hepatica Drive North Andover,MA 01845 [_ Undersecretary Not valid without Ognature i i n 0 4 n 0 i I i f w, Massachusetts of Pujj��c Sjfety Board of Bu0ding RcgWat�or�s and Stand (.(ais°4i'Fkd:Noa supok'',ism- i1 irr91 UceI se: C&075302 BENJAMIN C C)S�UiD 69 Old Village Lane North Andover m MA p w Commissioner 12/04/2016