Loading...
HomeMy WebLinkAboutBuilding Permit # 12/9/2016 BUILDING PERMIT �a D .aaq TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ` ' ! r,:• POPCT"tCt N0�3#: - _ :. ''� bate Received E f�1 —. �.� ___._._ �` •�-a'rEo mew 'i � �AC14135 Date Issued: 1 _ _..___ _.._._...-._.._... _ __ IMPORTANT:Applicant must complete all items on this page LOCATIC7N ::_. `" u �Peint PROPERTY Print 100 Year 5tructu�e yes rio MAP __. PAdCEL: _ ZC)1ING C71STEtICTHistoric District yes no Machine shop Villagey,Z no TYPE OF IMPROVEMENT 'ROP SED USE Resi ntial Non- Residential C1 New Building ne family 0 Additi h ❑ Two or more family E Industrial El Alt ation No. of units: Cl Commercial epair, replacement 0 Assessory Bldg D Others: [7 Demolition ❑ Other E Septic 0 Well E Floodplain rl Wetlands EJ Watershed District P Water/Sewer M --- DESCRIPTION 'WORK 1-0 BE PERFORMED: ;'Ide tifiic tion-- please Type or Print Clearly �w OWNER: game: " Vk ,, Phone: - Address: .k•. • rwr . � .",M - ontractcr Name:� ' v Phone, w w .. w Address: N ° L._� � a "",. � r � Supervisor's Oonstructiori License: . " �°; c" Exp. Late: t lcime Improv rnpht License �y i N - p' Date i4' '40 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 Oast: $ � � FEE: $ I _ fi ,. Check No.: Receipt No.-.----.L0 NOTE: Persons contracting with unregWer^etl contractors coo not have.- x g Sc "'nature of,�\ ent/Owner nature of contrarto _ own of And No. �Z — I -� �O LAKE h ver, Mass, / • • d7 W(0 COMIC M!W1CK �� U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....ZW.#Ab..... �.1lif .�r. � rawl............................. .................. BUILDING INSPECTOR has permission to erect ..�.,., ..0: 000061LFoundation p .......................... buildings on .... . ............... ..,.............................. . �.. Rough to be 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-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 CONSTRUCTIO TARTS Rough Service ............. .. .. ... . .,....,.... ........ Fina[ BUILDING INSPECTOR 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. home owner. Job Description cont: J. Install vanity and linen cabinets according to design. K. Install 2 %" colonial trim to window unit and door unit. L. Install 4 '/4" colonial base boards to bathroom area. M. Install shower glass door unit. N. Install towel bars and toilet paper holder. O. Vent out new fan and light unit. P. Disposal of all construction debris. Electrical segment E1. Move GFI owlet for new cabinet layout. E2. Remove old heat light unit. E3.Install new fan/light unit. Plumbing segment P1. Remove fiberglass shower unit. P2. Disconnect vanity sink and toilet unit. P3. Install copper pan to shower area. P4.Install Kohl mixing valve(supplied by home owner) PS.Install new toilet unit(supplied by home owner) P6.Install new faucet fixture to sink(supplied by home owner) All items listed above are in the total construction cost of$13,700.00 Permit is an additional charge. p e T Ho ow er WoR Finoo(hiaro D.B.A g� e 1 C Lw OP ID: LANK DATE(MMtQD1YYYY) CERTIFICATE 4F LIABILITY INSURANCE 09/08/2016 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(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 quire an endorsement. A statement on this certificate does not confer rights to the the terms and conditions of the policy,certain policies may re certificate holder in lieu of such endorsement(s). CONTACT RODUCER Phone: 978-688-6921 NAME: acdonald&Pangione Insurance PHONE Fax Fax:978-688-5350 A1C No Ex[: AIG No A Main Street EMAIL Orth Andover,MA 01845 ADDRESS: ichael Pangione PRODUCER RONAL-6 CUSTOMER ID#; INSURERS AFFORDING COVERAGE ISURED Ronald Finocchiaro INSURER A:Preferred Mutual Ins Co 15024 295 Merrimack St INSURER B;Safety Insurance Company Lawrence, MA 01843 INSURER C INSURER D INSURER E: INSURER F; :OVERAGES 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. ISRADDL SUB POLICY EFF POLICY EXP LIMITS TR TYPE OF INSURANCE INRR VVVD POLICY NUMBER MMIDONYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 11!15!2015 11/151201fi AMRGET ENT 100,000 � X COMMERCIAL GENERAL LIAB€LiTY BOP 0100 71 59 14 PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ (Per accident) HIRED AUTOS NON-OWNED AUTOS UM8RELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ V $ DEDUCTIBLE $ RETENTION $ pC S IMIT OER WORKERS COMPENSATION AND EMPLOYERS'LIABILITYY!N E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE NIA A OFFICER/MEMBER EXCLUDED? E.L,DISEASE-EA EMPLOYEE $ (Mandatory in NR) B If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS helaw. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 401,Additional Remarks Schedule,If more space Is required) Zvi.dence Of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Osgood St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE !' ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD The Comnlonwearth of-Massachusetts Department of IndustrialAccidents r T C egress Street,SOt .TDO Boston,.IIIA 0214 017 p; www.mass.go�v/diu O� 1 v Wq kers' Compensatio)afxugu:r.•ance Affxdavlt:B•ail-dere/ContKactoxs/H lectaczclaans/P exs. yoDLj:UfED'W:C7 RIM TEI?MT.'�"L�N'o"• U"'01I':X' * �?�easeX'xiut lJe •Tol A-6licant hrf'oxxnation r ' . atxlo(Businass/Qz'gariizationl.[udividual); city/state/zip .t �VTpe-O--�:—-,(.3�ez:c.> urC( ) ( ec1 tTeappra rlafobox: Are you an emp ; m with_ employees(fall and/or part-time).* ❑ �, 1.0 a employer consfxiicon 2, $. Eon a solo proprietor or partnership andhavenoemplayeosWorking fozmein eanodelilag any capacity.[No workers'camp,insurance required.] 9• Domohti94 3.[]1 am ahomeowner doing all work myself~[leo workers'comp,insurance required.]T, l Q` Btzilding addition erandtx✓i Iamahomeownllbehiringcontractorstoconductallwork:onrayproperty. Iwill 1l,��ElectricalYepaixsor•additipps $ en%wothat all contrac`bis either have workers'compensation insurance or are sale « 1?lu aabixrg xepa rs o additions proprietors with na eni0ayees. listed ol3% Rbofrepairs 5.�I am a gonaral eontrrictor and Ihavahired tlrosub-contractors on attached shoot. These sub-oontractorslrav€i e6ioyees andhaveworkers'comp.insuranca.$ 14.'[1Othex _ - -- 6.�We are a corporatioi'i and its,officers have exercised their right of axernpfion por MOL c. 152,§1(4),and we}cava na employees.[No vtorkers'comp.insurance required.] Iioantthatcheaks ox#lmusfalsciiillouttheseoti°n belowshavaiugtheirworkers'compensationpolicyiriibrmatian: �:�y apP . . �.tlidavitindicatisrg such klomeownexs who submit•this aIN—ffidI avit ind�icatfngthey are doing all work and then hire outside contractors must submit a new tContraetors that clisokihis Bomh t atemployeeadditional sheet showing s they must provide theirtwo he name of comp policy number.ctors�d s��awhq�er ornatfiia' se,grrtifies have employees, if-the sub-contractors loyees, Below is t/zepolacy aridja �.X am oyer't<zat zs providingworIcets'eo,-npensadon insurancefor my empb szte inforination. insurance Company Namo:____� ExpixationDOoA Policy#t or S off ins.Lic.#/: - lt � ,. �P' Of tlae 4POxkex$ CaaTa e l5aea0n ORey de-- _ City/State/Zi lob Site Address:, _ :c ww !. r .A.tiach a copy p s � claxation page(sbowing alae policy nnmrbex anal espixatxozr.date). Fail�ureto secure coverage asrequiaed-r a:dorM 2i,§25the is orim alf'aWQEt7 C7 tD and �oC.p to $250.00 a and/or one_yea:rinapxiso enc,as well as a penalties day against the violator.A copy oftfris statement may be forwarded to the office ofl_uvestig�itions of the IATA for�siu'ance coverage ver`...cation. _ - -- — — — __ --- .Z 1cl rzo ee cerci Un r e pa ar enalties ofpetjury that the information provided alcove is true an carred 77ate: �"- Sa Official use azeZy. -Ua not ter ice irz t/iis area,to be ca y city ars town off tial Pexmit/fAcense _-- City or JCOWJa' Lssuinpg Authority(circle one): iIns ector 1.Board erfl calth 2. t3rxildingBepaxtanexat 3.CityrC wn Clerk 4.:C lectxicalTnspectax 5.�luxnloixig. p 6,Other Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-077344 Construction Supervisor RONALD E FiIVOCCHIARO, JR 187 OLD GAGE HILL.ROAD PELHAM NH 03076 � - Expiration: commissio er 0712312018 Xe 601j71-;aao0xlllca1M0 � .31�acJccta��Ci�, - - Office of Consumer E1(fairs&Business Regulation =';i - License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,, 171995 Type- Office of Consumer Affairs.and Business Regulation ExpirationF 5/10/2018 I`ndi+iidUal` 1 ;T-A -,. ?��. Boston,RIA 02116 RONALDFINOCCHIARO 1R. . RONALD FINOCCHIARO '-. 187 OLD GAGE HILL RQ - PELHANI, NH 03076 - Undersecretary i Not valid without signature r