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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 ... ............ .. .. ................................................... NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER = -' APPLICATION FOR PLAN EXAMINATION * . Permit No#: E9 `� Date Received ! _ - �- 0€ 7���NATE. app'c5 Date Issued: t �` _ � �`c a � IMPORTANT Applicant must complete all itexn.s on this page .,. �.u7�'°'z�Y� = y, _ � r�-a, �y ^� � �, �e� •r� e.t x ="v. � � � � <,v err "�X" �,�,, �r.: LQ.I+AV GN''''�n,c'�„„w� - i`'�^` v e.0 �:, a u Tr waw-.,z-".` r ..M ,� tt,!, ,.r .m"rx` '�' '+^ .� ��•,,fus.. '�� v x a .c ,.:, L ger „.. - r ;; ., _ -6 ,� .rv"»sar -y ave 7^'� d4M• ;., ".Y 'x x F"a A. "0:", PROPERTY 0111NER � - � � F �u r � �.M.hAP .✓ PA"RCELS^' .Fi st � HD t8oEri tCCIC5 tUF CE Ia* eGsON1NG DISTRICT l x TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building l(One family [i Addition Ll Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition AJ Other �� c ❑;Septic ❑1Nell ❑ Flaodp[a�n D Wetlands LI Watershed Dtstr�ct �.:11llaterlSvire DESCRIPTION OF WORK TO BE PERFORMED: 0- 1 l 1 Identification- Please Type or Print Clearly OWNER: Name: Phone: S�)C�C) Address: Q� Contractor Namet�rr�ri � ' 5� one 77 fr r fr y KI Su :erv�sor's Cnnstr€action'L�cerse tExpb Dater p r Nome lmpro�ement License 4. Izp, Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ �_L � C�(� FEE- $ 0 ClZeck No.: r �� Receipt No.: 1 7 Ll NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - -- Signature of contractor innafi�re of Anent/Owner ¢ �ORT�{ 'Town of 2Andover . 0 : ^ W No. 4Vj61 _ T A�t! % ;NAh ver, Mass, _ + ` R4 Co[NIc"t WIC"`4 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .j*!VAA.Jft ....1i��i 1..........s .514I.Pom...... BUILDING INSPECTOR has permission to erect ........... ........... buildings on ,... ....... .. ,.....,. . .... Foundation • Rough tobe occupied as .................. .. ................. ... .w ,. .. ................ �.. ................ 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 T IS A Rough Service ................... ......... .. ... . .. . " Final . BUILDING INSPECTOR GAS INSPECTOR Occupancy, Fermat 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. RISE 60 Startwmut Road, Unit 2Canton, MA 020211339-502-6335 E�C'�GIN �:�1'�6NG www-RISEengineering.00►r► OWNER AUTHORIZATION FORM r (Owner's Name) ownon of the proporty located at: (Property Address) . �r (lDrc►perky fa,ctciresu) merrl23A Sulgvan Rd insulation Billerica,MA 41862 tiercwtxy authorizca (Sut.►c,olltrac.tor) all 1(ltticariZ(1°;i SUbc ontractcar for RISE Erlgine(;,aring, to nct (M rlly lkCh alf to cAat8iil r1 bi.lilciinc,E petraait aaai to perform wrok carl my property his forl n irk only v alicl With .a r>ic.Ened c,raratraet, l.tic f1(,r1rlit will i)e secured by the incl.►lratic�ara r;c.Mtrartor, at rro radditi+►rta1i cost, It is tiar,-, ticrmeowner°s responsibility to Close Out this pownit by c.ont"Ic,ting thoir° municipality iipality at tlac� c,car ple'tion of alis work. (1,'ArJr Dato 6 24}16 The Commonwealth cifMassachtisetts g Depat-tment of Crzdustfial Accidents vY '�: p�k � I gffice ofinvesligattons b � 600 Washington Street Boston, A 021.11 WWW.Muts5.gov1dia Worket•s' Coinpensation Insurance Affidavit: l3uiltlers/Coatracto>rs/Elects°icians/Plattttlaet-s A .li cant Information Please Pt'jttt I.e iibl Na.tx e (Business/Ot•gatriantion/Individtaat): Merrimack Valley Insulation Corp. Address- 23 A Sullivan Ind. City/State/lip:,tlyBiller,ca,.MA_01862 _._ _..__.._. ...._._.... Phone ii,': 978-888-3495 Are you aaa l.® 1 am eemployer?C,hecli the appa-opriate;box: Type of projjcct(requh-ed): �ployet with 18 4. (� 1 am a general contractor and I � have hired the sub-contractors 6. F-1New construction employees(full and/or part-time).* 2.❑ 1 aaaa a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees 'These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. inSt ranee comp. insuranace.1 p required] 5.S. We are a corporation and its 1.0.❑ Electrical repairs or additions 3.❑ l am to homeowner doing all work officers have exercised their 1'L❑ Plumbing repairs or additions inyself. [No workers' comp, right of exemption per MG1,, 12.❑ Roof repairs insurance required] J' c. 152, §1(4), and we have no employees, [No workers' 13.0 Other, Insulation comp. insurance required.] "A applicant that checks box#1 must also fill out the section below showing their workers'compunsation policy information. ltomeownea.s who submit this affidavit indicating they are doing all workand then hirc outside contractors must submit a newaffidavit indicating sueh. Contractors that check this box must attached an additional sheet showing the name of the stab-contractors and state whether or not those entities have employees. If the sub-contractors have employees,,they most provide their workers'camp.policy number. I stiff art employer that is providing,,workers'compensation insurance for my employees. .Below is the policy and joli site information. Insurance Company Narne: 5Star V3 AAIC American Alternative Insurance Policy#or Self-ins.Lic.ft: V9WC749118 Expiration Date: 6/18/2017._ .fob Site Address ,��ld)----- C;�4'�1 f'1 Y.1�'l'.. ..._�� _. ._..___....____._._..._City/State/Zip:1 hw�1C��1 Attach a copy of the workers' compensation policy declaration page(showing the policy number~an(] expiration date). Failure to secure coverage as required finder Section 25A.ofMG1,c. 152 can lead to the imposition of.'criminal penalties of a fine up to$1,500.00 and/or one-year imprisontnent, as well as civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfify urttler the pains and penalties of petjtu y that the injim nation provided above is true and correct_ Si ,nature: ' Phone It: 8-888-349 C9fficial use only. Do not rvr°ite in this twea,it)be conalrleted by city or town ofeial City 01-Town:� _ __..._._Pea•anit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact:Person: Phone#: JS The Com. z-zoiinrea�lih Deuvrtaeut 0-flyrdustria!ljoddsOn (Ave of RNISWASS S'--a- I limius 600 7001jagun -oa—Mease?---rt rmj= -L f'xLdadh"�C: Nddresm ZION A U3 Mgj nix nn-bex- Axe pu an YMT ihe-homea=,aexl Check the ppropalate lumad r fj3r me�m arT. cap',-i jty� ar:-,asole r--rOpr7---CtZr-Qr-part- rS'M:0 411100 nc Mu qYM 1v C don ul T:1 a ms-t,-nrr=re i re Llrea- L-A7.Sidb-C Ustea on the aouftract6=-have warli-ers iz a m�)D-iustir a a i---a-aLS I�jak-re--�LLathed'a MU-7 Dl ih6 VUe ars--CO0 ---ad ft 0TU-ce a E;�:ar d"?tmw too of per 1-T G-L Cl�*' 1-,r--t h E-Sea 5 V,b r 7t W."--�a0t.[rL th.1r%01 a rs7 La-p. a t f�a f-1 at i 0 7, so===ttrs M-3 S!jb=- It -v-z T r;R=G! bay me jA4 Aft s;;b -,z Cont-acLars t1rat eneek-_hi-:,o:rnus=a�tt:i-an aaditEonaj Rhee, zs-me:LI2 tizz: u-,-f CQU. Struic.,7 Dem-ujition 9- R"13 13- i -UM-er an eruplb:yar-dzat is immmoze or am sm"W14 130MV is thit.policy Job situ itzfb- sy Solon-law 4= OR Site MUnryss: Aunh-q copy 4i co aapiGnEat�uzzt p arlizur deet antior-page(5b o-'virig'01 P,T, a;reTnu:d u.Rdu-r Szc�,Hoa, 25-.k Off AFT iWoFj ORDAR and a Uraze-'?zft--p to 1250-00 a L7 Barad7uhieE the_ coppy oFflf-s or i-imurance ua�?UL�p-vE--'lj2- lOP x,pseut on,;he brunidad W Ke Whe uf mves -rum-ler zLe ps"a an 4-1 U CO n - rute ia WS o,a b-3 E 1PIC;Lej b1F 6tY i: DGnut 1 Mare I= -a. -PLffldir DE�-,-- h Ckw7kc-um COW i ENKA&MV. G;z a/ p p n n }�spa MERRVAL-03 WEJE CE���� CA 11 E OF UABILITY 11�SURA11 CE DAT3 1312016 � 619312D9& THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO}TIGHTS UPON THE CERTIFICATE HOLDER. THIS CEPTIFICATE 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 1S 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: Automatic Data Processing Insurance Agency,Inc PnONE—� FAX 1 ADP Boulevard c Fxt Arc,Nn arsAIL Roseland,NJ 67068 ADDRESS: INSURERS)AFFORDING COVERAGE NASC ,NSUREIZA:5Star V3 AAIC American Aiternafive Insuran. #NSUREO Merrimack Valley lnsUlatian Corp _IqSWJ ERB: . 23a Sullivan Rd INSURERC: North Billerica,MA 01862 INSURERD: INSEfft_E_R E- INSURERF' ----._-------------__.. _. j COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: Ttilb 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO-fHE 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-LIN41TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ------ - —=--- T--- --�. -. _ iiNSR!! �AD"rJL�S�UE�R �'"------� -Pt7LECY EFF T P01-ICY E7CP ALTRI TYPEOFINSURANCE IIHSRIWUD POLICY NUMBER I h1PAlDDIYYYY 1 h1P.T1DnlYYYY URTFfs 4GENERAL.LIABILITY EACH OCCURRENCE Is OA 3R S OWAERCIALGENERALLIABIWY EaaPREP.SISES ccurrrnc_t CLAR.154AADE L_._..I OCCUP. MED EXP(Any one parson) i } f" PERSONkL&AOVINJURY 'S I I I GENERALAGGREGATE S __ GEN'L.AGGREGATE[3h117F4P((PLIESPER: ! i rPRODUCTS-COPAPloPAGG 5 POLICY i�EC l—E LOC AUTOPJO81LEUABIUYY I i I COl1BIMFDSINGLE LINIIT j Eaaccldenf s i ANY AUTO i RODILYINJURY(Perperson) 5 ALL OWNED SCHEDULED i BODILY INJURY(peraccidegl)�S ! AUTO5 AUTOS ttt3 j NON-OWNED 3 I PROPERTYOANAGE 5 HIRED P&RUS AUTOS I 1 Perarr_iden1l ._-- Ii _.._--- --- -- s UFAaR@LLA LIAR QCCUR s ETCH OCCURRENCE 5 EXCESS LIAB CLAIMS-iJADE I I AGGREGATE--�-- S ��— DED RETENTION 5 I I S WORKERS COMPENSATION X WCSTA'W- OTH- AND EPAPLOYERS'LIABILITY TORY LIAh1TS ER A APFYPROPRIETOMPARTNE1 RIEXECUTI� Y� IV 9WC74911B 6P[812616 611812617 E.LFACHArctDFNTT� s_�— 1,000,000 OFFICERIME{'ASEP.EXCLUDED3 Y NIA I(Afondnlory!aN"I E.LINSEASE-_EA_E_MPLOYE 3 IF yyes,desctihe under - r E.LDISEASE-POLICYLredrim S 1,00E1,t3© i i � 1 DESCRIPTION OF OPERATIONS ILOCATIONS IVEHICLES(AttachACC)A01Qi,AdditionlRenrarisSchedule,ifrnorespace Isrequired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T14E ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN Town of Norlh Andover,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 126 Main Street NTWORIZED REPRESENTATIVE North Andover,MA 01845 I ©1986-2010 ACORD CORPORATION. Ail rights reserved. ACORD 25(2010105) The ACORD name and logo are registered.marks of ACORD DATE(MWODNYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 11/07/2016 THIS CERTIFICATE IS ISSUED AS A NATTER 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 polley(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Carolyn A Coughlin Charles J Coughlin Insurance SHONE _....._.m. Ext. FAX 14 DinleyStreet E-MAIL 957-3588 FA C o X,No)_ __ P.O.Box 10 ADDRESS: carolyn@coughlinins.com Dracut,MA 01826 1INW.,RERS)_AFFORDING COVERAGE NAIC k INSURERA: Northland Insurance Company 24015 INSURED M errimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURERB: Safety Standard 39454 23A Sullivan Road INSURERC: Torus Specialty Insurance Company A0159 N, Billerica,MA01862 INSURERD: INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBERryOyLp€pYEFF Iy(aj ICDY FJCP LIMITS LTR A COMMERCIAL GENERAL LMiLrrY WS274182 01/21/2016 1/21/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � occuR PREEASESE RENTED e.._.m_.$ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENLAGGREGATELIMITAPPDESPER GENERAL AGGREGATE $ 2,000,000 POLI / .�, PRG- PRODUCTS-COMPIOP AGO $ 2,000,000 CY JECT LOC OTHER $ B AUTOMOBILE LIABILITY 6205006 11/25/2015 11/25/2016 COMBINED,SINGLE LIMIT $ 1,000,000 ................ Ea accident ANY AUTO BODILY INJURY(Per person) $ _ ... OWNEO SCHEDULED ............. 1 BODILY INJURY(Per accident) $ AUTOS ONLY V AUTOS / HIRED / NON-OWNED PROPERTY DAMAGE $ V AUTOS ONLY _V AUTOS ONLY Per accident),, C ✓ UMBRELLALIAB ,CUR 875931_161ALI 01/2112016 01/21/2017 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I RETENTION $0 $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN STATURE_ ER ANY PROPRIETORPPARTNERIEXECUTNE N IA E.L.EACHACCIDENr $ OFF)CEWMEMSEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 10i,Addftlonal Remarks Schedule.maybe attached If more space Is mquired) Insulation Installation 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,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street AUTHORIZED REPRESENTATIVE North Andover,MA01845 ""'^". O 1988-2015 ACORD CORPORATION. All rights reserved. AC ORD 25(2016103) The ACORD name and logo are registered marks of ACORD ctlxe wow, 0/'/ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'Contractor Registration Type: Corporation Registration: 180506 Merrimack Valley Insulation COrp Expiration: 11/23/2018 23 A Sullivan Rd Billerica MA 01362 Update Address and return card. Mark reason for change. SCA 1 0 200-05111 (r7 dtddren-s F-I.PA!jev�,at card ,...,. C,rfl/r ((,cr rrr�NFa�rrc,rrsrF✓f✓t r�AC';,ff�r,j;irrtl'/Ir.urrfl"i Office of Consumer Affairs&Business Regulation IF] 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 10 Park Plaza-Suite 5170 180506 1112.3/2018 Boston,MA 02116 Merrimack Valley Insulation Corp Joseph Ryan 23 A Sullivan Rd Billerica,MA 01862 Undersecretary Not V "hout signature fAass~uchuset s -Department of Pub€ic Safety IF Boa-,d of i::uiid r:� ac�G'aficr S as ac c License: CS-075541 3OSL?PH A RYAPJ 200 King Rail Dr-?apt:'I'01 I.ynufficld A 01940 CcM,' *;smner 0210412017