HomeMy WebLinkAboutBuilding Permit # 10/24/2016 BUILDING PERMIT
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TOWN OF NORTH ANDOVER F='t Eo Eva op
APPLICATION FOR PLAN EXAMINATION `
Ferenit No#: Date Received
4SSACN�ISES
Date Issued: r` % Z--i
INIPORTA\T Ap licant must complete all items on this a e
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
New Building \One family
A�Idition \Two or more family Industrial
Alteration No.of units: Commercial
Repair,replacement E Assessory Bldg E. Others:
\Demolition Other
��eptic �Well E Flaodplalri : Wetlands ,� Watersfied I?astrlct
Wat�rt�EYilet'
!1 f DESCRIPTION OF WORK TQ BEPERFORI!&ED: .
St11Sv 7£c- f�X(� �frC C5 tic tet ,
Lit �r
Identification-Please Type or Print Clearly
OWNER: Name:3ViityP 1t9'S hw*A ='oc j II f t41,t( Phone
Address: 6 eN kc 4 Cbz;V a III I Yee
ContractoName� i Phone \
Ernallrl kzjtEv v ov vyvv y
SiielsorsOars#rust�aliLteense
Bore lfnproueTnerat License:
ARCH ITECTIENGINEE R Phone:
Address: Reg.No.
FEE SCHEDULE,BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$ ! FEE:$
Check No.: Receipt No.:
NOTE: Persons cantracting ivA unregple7d contractors do not have access to the guaran •fund
Signature o A ntJOwne Signature of ntractor
� No�ry q
Town of Andover
No. _4Z * _
h"" ver, Mass,
�..rjs�RATED ne¢,t.4`�
ll BOARD OF HEALTH
ILD F ood/Kitchen
PERMIT TO Septic System
THIS CERTIFIES THAT..... +4�l .44f.54.w.vf0..... u .......I... BUILDING INSPECTOR
•' ` '"`w, „, .... Foundation
has permission to erect..........................buildings on...... �F /,�F! ."
Rough
to be occupied as........ 44i..00w.C.oQMiIL4!4/., *ArAtIrs.�,��N��� coney
provided that the person accepting this permit shall in every respect conform to the terms of the applicatl nal
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
LESS CONST
Rough
ServiceService
BUILDING INSP TOR Final
GAS INSPECTOR
Occupancy Permit.Required to Occupy.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.
-- STATE ENERGY CODE{20091ECC}Notes:
t.Pater to RE3CHECK for C-11—Report. -
4=duc+a In amts mrlst 6e insulated to P-8 mlr;mu - -
3 Retum ducts In amce must tIo In Idad to R-o minknum
A.Supply and renin,duv`Is in_wi spocea,Unnaeted bane -.,
� Baregas entl otlleriocaHons oulgde of cantlftioned
vebpa shale 6e hlsuatad b R-e,
III_
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5.Ali Ouca rnimt bo seeied. -
S.All ducb wrti+Jdo of oc-Boned bukding1d,(FraN spaces, exr�:ox snn wAu.'miu eAir u�>. �,
unheatetl baso
ments.gar retested. ranmtoa Worn sc'murp wvu am.� =Akin-Awes ova
y Fipng for hydronio haeiing syaitc} ust 6eF tvAmailav eamlae -
nrast 6a 1 I ted W A-3. - axrsxw sx>.� ata wow savocrt -
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Al�71FOi1NOATlOi�1 PLAN -
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facorrnr CERTIFICATE OF LIABILITY INSURANCED"1"10Y�Y//116
�.,�-
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(tes)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 ACT
NAME, AMY ROBERTS
M.P. Roberts Insurance Agency PHONE 1978) 683-8073 FAX No: (978) 683-3147
1060 Osgood Street AooNRess: AMY@m robertsinsurance.com
North Andover, MA 61645 INSUMNEAFFORDING COVERAGE NAICB..__
INSURERA:ESSEX INSURANCE.
INSURED INSURERS:Associated Employers c
Insurane I 1
KEY LIME INC _iNsuRERC: _. ----
10 HEPACTICA DRIVE INSURERD:
!
NORTH ANDOVER, MA 01845
INSURERE:
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 .._.- ADD1 SUSR� .. -___—. -POLICYEFF :-OLCY IXP-
LTR TYPEOFINSURANCE 'IN POLICY NUMBER MM)DDIY MM)DD'YYYY LIMITS
A GENERALLIABILnY 13EEOB26 61151161 6(15117.EgCHOCCURRENCE I$ 1,000,000
TCO1,,,"1R,CIA11ENE71_,LIA5I1_lTY
[ ; 5O 600
MSMADE OCCUR
MED EXP(AM ots Rasml -1$ EXCLUDED
PERSONALS ADV INJURYiS 1,000, 006
_GENERAL AGGREGATE is 2,000,000
GEN'L AGGREGATE L6'dITAPPLI_ES PER
PRODUCTS-COMPtOP AGO II s EXCLUDED
POLICY PRO- I LOG S
AUTOMOBILE LIASIUTY
EOeBcert$INGLE LIMIT $
A_ T BODILY INJURY(Per pe_rs _) 1$
ALOVED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per occtlenf $_
_
NON OWNED i PROPERTY DAMAGE $ '
HIREDAUTOS AUTOS I I Per e. den1
$
UMBREU.A LIAROCCUREACH OCCURRENCE $
_i EXCESSLIAS CLAIM$�MADE. i AGGREGATE $
DED RETENTIONS I i
B MR!(ERS COMPENSATION WCC50050075812016A 9115116 91151171 1 V40 ,OTH-
AND EMPLOYERS'LIASIUTY -—'--
iN
ANYPROPRIETORtPARTNERlEXECUTNE Y��N/A iEL-EACH ACgDENi S 1,000,000
OFFICE RUE MERE 1_DEED:
(Me..bry in NH) i EL DISEASE-EAEMPLOYEd$ 1:000,006
DYyes,descr 6o OF O I
ESCRIPTION F£RATIONS beaw IE DISEASE-POLICYLSd iTI$ 1,060 600
I t
I
DESCRIPTION OF OPERATIONS t LOCATIONS)VEHICLES(Attach ACORD 101,Addifionei Reoerks Schedule,Ifrumspece I—eldred)
i�
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SAMPLE CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
<9
MICHAEL P ROBERTS
D 1988-2010 ACO RD CORPORATION.All rights reserved
ACORD 25(2016105) The AC ORD name and logo are registered marks of ACORD
Phone: Fax: E-Mail:
f
-- Ih�n� ,,coeaGt I,tf.�dRrlr���rrs
=k\ Office of Consumer Affairs&Business Regulation
__ HOME IMPROVEMENT CONTRACTOR Registration
the expiration date-individual
before found return to:
Type: Corporation Office of Consumer Affairs and Business Regulation
•:� �, R ffgL ratjon Expiration 10 Park Plaza-Suite 5170
`'KSS 186186 1010712018 Boston,MA 02116
Key-Lime,Inc
benjamin osgood �/jJ _��.10 Hepatica DriveXNorth Andover,MA 01845 '-
Undersecretary
License:CS-075302
t_FI:
BFNJANM C OSC,,-b T
64 Old Village Lade 7,:*,N
Nortb Andover MA o1&}5
�cm::tsssiener 12!0412016
