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Home My WebLink AboutBuilding Permit # 12/9/2016 v;0RTy ................. BUILDING PERMIT TOWN OF NORTH ANDOVER t APPLICATION FOR PLAN EXAMINATION - Permit NO: Date Received Date Issued: l)—ti - IMPORTANT: ) yti -IMPORTANT: A licant must complete all items on this a e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential C-' New Building ❑ One family /E ddition L Two or more family h Industrial Iteration No. of units: ❑ Commercial E Repair, replacement E. Assessory Bldg 1-1 Others: Demolition ❑ Other IBM c,T.. c..r, Identification Please Type or Print Clearly) OWNER: Name: Phone; Address: ARCH ITECTIENGINEER Phone; 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 Cost: $ 1 o _ a o FEE: $ ---� Check No.: 2 (r / Receipt No.: NOTE: Persons contrac ing with unregistered contractors do not have access to the guaranty fund " �� G.�� CJ�� ' r x .,; � n-'<"C..r�.,:�.�� F, �?r��w�� ,�,� 6�``�'', ?_��..�vr.�� .rG,4•z,�:s own of A No- 62,1-260 h ver, Mass s �! _ /� O coc"ic"twicw y1' RArFo L) BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ...I.N.5. C.-O-N-M.•..•• ...... BUILDING INSPECTOR .......*S1.�. .bit,%. Foundation has permission to erect .......................... buildings on .`.. ..�........ ...•.....�. ugh t0 be occupied as .... �.....N� ... `.... ........... ... himney Il in every respect conform to the terms of the application provided that the person accepting this permit shall ry p pp 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 RT 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. AUTHORIZATION TO PERFORM SERVICES INSURCOMM CONSTRUCTION, INC 3510 Lafayette Road,Suite 4 �. Portsmouth N1103801 603.430-7 01 3-373-6214 Fax herein referred to as "Customer," authorizes Insurcomm Construction, Inc., herein referred to as "INSURCOMM" to perform any and all necessar restoration services on Customer's property at: 1 r- �! c t Customer authorizes __ Insurance Company, herein referred to as "Insurance Company", to pay INSURCOMM solely and directly. Customer requests Insurerrpp to finalize all resWnsurance fation costs on and estimate and submit a copy to e r' � ~f ` <""��«s.'°f � � Company's Adjuster for agreement. Once the Insurance Company and Insurcomm agree on a figure for restorations, the Customer will be notified of the agreed amount and a date will be set for repairs to begin. It is fully understood that Customer and it agents, successors, assigns and heirs are personally responsible for any and all deductibles, depreciation, or any costs not covered by insurance. Any and all costs for services not reimbursed by the Insurance Company are the responsibility of the Customer and are to be paid upon completion of work. However, additional work will not be performed unless approved by the customer. The liability of INSURCOMM is expressly limited to the total amount of the services authorized herein. Insurcomm agrees to acquire all necessary demolition and construction permits as needed and to have all necessary inspections completed before any walls are closed in. Property is to be restored to its former state, allowing for modern construction techniques and current building codes. If INSURCOMM submits this account for collection, Customer agrees to pay interest at 1.5% per month or at the highest rate allowed by law, court costs, reasonable attorney fees and all costs of collection. Customer agrees that INSURCOMM is working for the Customer and not the Insurance Company or agent/adjuster. Remarks: 0 4 F a � ' .' e � � �: �� r" liP Customer Sign g u e Date` Insurcomm Signature Date m r Printed Name Printed Name Kitchen 151811 15' Kitchen ON 71 1 7 it 1 1 6!4 1 �'F T 7' 11t _ t 611 J 511 F A X41 1 11 € = kitchen the PRESCOT`I` CROSSING 11,`16:=2016 Pale: 12 Main Level 261 9" 2611" Garage K u Main T eVej PRESCOTT—CROSSING 11/16/22016 Page: 11 ACC>R" CERTIFICATE OF LIABILITY INSURANCE PATE(MM10 DlYYYY) 12/8/2016 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(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 CONTACT NAME; Emma Pankey Kane Insurance PHONE FAX C A!C Nol: 242 State Street -MAIL ADDRESS:emma@kaneins.com INSURERS AFFORDING COVERAGE NAIC q Portsmouth NH 03801 INSURERA:Ohio Security Insurance Com an 24082 INSURED _ INSURERB:Peerless Insurance Co 24198 Insurcomm Inc. , First Response Cleaning And Restora INSURERC.The Ohio Casualt Insurance Co 24074 290 Heritage Ave Ste 1 INSURERDNetherlands Insurance Co 24171 INSURER E: Portsmouth NH 03801 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1612815160 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 TYPE OF INSURANCE AODL 5 BR POLICY NUMBER MM1DY1YYYY MMIDD✓WYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A �X OCCUR DAMAGE TO RENTE€l 300,000 PREMISE CLAIMS-MADE S Ea occurrence $ EKS56439740 11/7/2016 11/7/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY[]JECTPRO- ❑LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: 6wners or Lessees $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B v ANY AUTO BODILY INJURY(Per person) $ ALL OX AUTOS SCHEDULED AUTOS BA8999876 11/7/2016 11/7/2017 BODILY INJURY(Peracerdenl) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS _(Peraccidenl) $ ___ Individual Employee Extension $ X UMBRELLA L€AB OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ 1,000,000 DED X I RETENTION$ 10,000 uso56439740 11/7/2016 11/7/2017 $ WORKERS COMPENSATIONX STATUTE pTH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT $ 500 000_ OFFICEWMEMBER EXCLUDED? y NIA D (Mandatory In NH) WC8999776 11/7/2016 11/7/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under ._ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Activities usual and customary to fire, water, and mold remediation and restoration with construction build back. For work to be done at, Prescott Crossings, 8 Stacy Dr, No. Andover, MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Chad Hancock/CHAD _ O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2w4n11 6"j _YY C//,(i(,j em Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02110 Home Improvement Contractor Registration Type: Corporation Registration: 145192 Insurcomm Construction Inc. Expiration: 12/21/2018 290 Heritage Ave. Ste 1 Portsmouth, NH 03801 Update Address and return card. Mark reason for change. •a.�.oc r7 D F—ni-yrnent 0 Lost Cara Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 145132 12/21/201810 Park Plaza-Suite 5170 Boston, MA 02116 lnsurcomm Construction Inc. Neil Robbins _ 290 Heritage Ave. Ste 1 �, Portsmouth, NH 03801 Undersecretary Not valid without signature n f Public Safety S a l ul a-Mons and S-tandards ISO \\\\ \\\ \\ \ \\ \\ \\