HomeMy WebLinkAboutBuilding Permit # 12/20/2016 NORTH
BUILDING PERMIT 0��
TOWN OF NORTH ANDOVER
APPLICATION FOR
PL MINATION
Permit Nod: _ � � � � ate I�eCeived wC S `•
Date Issued:
OANT: Applicant must:complete all.items on this page
LOCA AT
Print
PROOERTY owN R
Prim 100 Yeartrct�re Yes no
MAP PARCEL: ZCINING DISTRICT: -, Historic District yes
Machine Shop`✓illage yes ( ra
TYPE OF IMPROVEMENT PROPOSED USE
-------- -----------.-.-..--
Residential Non- Residential
0 New Building Fe One family
Z Addition 0 Two or more family 0 Industrial
0 Alteration No. of units:— 0 Commercial
❑ Repair, replacement 0 Assessory Bldg C7 Others:
0 Demolition 0 Other
❑ Septic 0 Well 0 Floodplain 0 Wetlands ° Watershed District
11 Water/Sewer
DESCRIPTION OF WORK TO RE PERFORMED:
Identification- Please rype or Print Clearly'
OWNER: Dame: MUZI , Phone:UL01Z
Address: r a , ) i M � ,I� 9i
" l"
Contractor Nar�ne: � ., Phone.
Address: ° � ''k J ti ,
Supervisor's Construction License �
Exp. Date:
Home ImprcvXq ment Llcense: Exp. Date:
ARCH ITECT/ENGINIEER �� Phone:
Address:_ _ Reg. No.
FEE SCHEDULE.BULDING PERMIT;$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F.
i
,Total ProjectCost: $ If FEE:
Check Na.: e-,p �� Receipt No,: -
PeK onscontrcacting with unregistere contractors do not haavecacees toµ
the guaran,
Signature of Agent/Own m- -- Smgnatume of cori$ractor
NORTH
Town of +. ndover
O w.v.�• �y ~ R.`
oh , ver, Mass,LAKI
COC N1[KEwA.
1CK
�.9S�RATED
U BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT .......... K.L......0 AWA ..........................I......................,.... ............... BUILDING INSPECTOR
r r 'oT ow 6 Foundation
has permission to erect .......................... buildings on ..,,....V................�....................�............. �
Rough
to be occupied as .........�l.�0. 1......FrM/M Oft 14.0.4....�......VrA..�. 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 CONSWIT Rough
ae Service
..... ......... . .... ........ ... Final
BUILDI SPECJR
GAS INSPECTOR
Occupancy Permit Required to'Occupy Buildin Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Find
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Plans Submitted N Plans Waived ❑ Certified Plot Plan ❑ Stamped Pians ❑
F
F SEWERAGE DISPOSALewer Taus ng/MassageBodyArt ❑ SwiM111'ngpools❑ Tobacco Sales ❑ Foodpackaging/Sales ❑septic tank, etc. ❑ Petmanent Duanpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENTl
Reviewed On }} 5i 9 n1�tature V
1 f _6
-COMMENTS
CONSERVATION Reviewed on 00Si nature
4
COMMENTS
HEALTH Reviewed on l `yd Si nature`
i
i
I .
A COMMENTS ri'\Gi r Se er
B
Zoning Board of Appeals: Variance, Petition No: 2614-001 Zoning Decision/receipt submitted yes
Planning Board Decision: k"� Comments
Conservation Decision. ���! Comments
Water & Sewer Go n noctio n/sig nature.&.Date Drivewa Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT' - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
-imension
Number of Stories: Ok4Total square feet of floor area, based on Exterior dimensions.
Tota[ land area, sq. ft.: z0 S�
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector 'Y-es No
DANGER ZONE LITERATURE: Yes No
MGI..Chapter 166 Section 21A—F and G min.$10041000 tine
NOTES and DATA-- (For department use)
s
b6zr 4
o:
I'
5
i
0 Notified for pickup Call Email h
ate Time Contact Name :.
Doc.Building Permit Revised 2014 _. .
I -I
,
...
az
!
I
:
I i I
I
I i I II
I I
_
1 :
s ,
I
s
f
�� I
r
_
I
a �
ZTO
BLS•
E„
— - -
t •
E f
I
�
OM
� I �_— g I
I ,
I
i
i
,
1,
E
f
j ... , as� _._.
3� ti
I
' T-f7 ,15-a C:•a � 4 q.E7.S 4 'b.a r � ... 4
--------------
t IA
N �
I �r lE1 6ati: os,.2 :.5 HfiStCR¢�2aeJ -� .
elm
ij
0�
N
d up
t 1
{f x x
I M' N I.1BRhutlf FLEX lruFs'Y'
A ac " Fara��, cwvwd
° I LI—p
g<t14 r-
3-3,.,,..__.-�
ptns�C4occi toso SF
I&agobee o esu s t 7'Z s
2S�
Ta"�Iry SF
Cr1
SITE
LEGEND:r
GREAT PO
�� Nt+'�.) E:Osnxa corrrcua eeur.ttiRt6uafiareFM NORTH AND(
�1 � l
2W TRRI@SlrARr PROPOSED CONTOM dM
; PREPARED FOR:T€CHNICAL'
\\ @ n+:Ratms NIL QSC LE-- 1'thD8, 2013 Rev
�� EllWATER AAI
115 wam E7¢51M^u SSYE7t Aamb
--W— COMO WATER {�F/ atTGIOVQ[
NORtc \ t pada' momomommiPROPOSED MAY BALM Alam+'oTCet!' C{N�1S`Ul4aRl
—PS— PROPOSED MIIER I East Rivet Place
—PW— PRBPOS@WATER �athuea,e*&01W
y 7 \
�C �„, �' \\\ \ —•.�• .— 40
PROPOSED Di61ENAY 20
^�•s). A >♦.nza x 0210) PROPOSED SPOT GRACE
\ =5 V .r'YYY� PROPOSED LNtT OF Wel AiYAL,
3 da rux
kAUREEN A. b \ YLp \\ 7 4Y Oiu1E5YAY P Y
�21
mE—t
\�
TDP A\V\ _
y 3
PVC
4 1 eL¢
jY F ¢NG
��Tc>r ? \ sutctrr¢aR txuw. Il M
\ \ dem Ass DRIVEWAY CROSS SECTION
u+ pD¢ LOCUS PLAN
-RNu saa �\ SCALEs1'-800`
INV
�� rt`A [tEv..13a:3 ���\y Aq„`V -iYevfaad dune u',2013. culvrat weHabd tleg
- \ B.jDat{F>m.) �� N \ ypz3 erase-Dae#iun,odd
NORTH ANCdOVER \� Tow or NDRR ANDOVER �'� IL
pQ1� ,ANNING BOARO \ `�. A �A\
CLEAN
OA GA31 l9 tdt o \ Rol ORlvEV1AY \\\ \ A23
f��riAs POND IL
\\
Uyat �� t? ® �-.A 1 Jr�ust+cSosmrte A, All,
QATE C1r HEAF:ttiG
a AlI ,
$
OA vAL ` \ pzt A, AS. A1.
\ \V
A, A6. A, ALL d Ail
C"CAi NAfid �ti. - ,A. DAY IO FT D.C.&
9n i`�++t#-ei' ii }.1a��i� r, ....3 _ �' _ t $.e �_ \\\, w Ata A@` /•.
Mill
1.W_ r �:_t�E•d r£Ohc
usT
ux A \ r V It. sscrDar
FCLLt;OA?IDN TR \� TO GRADE \ .
_ _ _ A\ xsv.11$.!O PROPOSED
ron
2''WOE X u IV DEEP
" —
m \ a \ PRoros@ n
_ - acAsrenE sHi,CK ON ID PUN'Aa
DAN?O PT O.G (YtET.NOOEDB3
ga .j may' 2i
1 HEREBY CERTIFY THAT THE PROPERTY UNES Fi \ s'T.. /tI!
SMBti"OWN TNIS PLAN ARE THE Ut,R:S OF EXISTWD ._ �._\_ s obs
ONNERSF€PS,AND THE UWS OF THE STREETS AND
NAT
ARE THOSE OF PllEUC OR PRIVATE I _. L�3D@ -`
STTiE€T'S flR WAYS ALREADY I ASLESO All
- .iE1tl S""c.• s
THRT ND NEW UN6 FMR E)2STIN0 OWN€RSHIP OR "� apt-txa �g �_ w=txa•. /•
FOR NEW WAYS Atm ST--AND THAT TK-PLAN r7 uat�t1B l
CO*FORNS TO THE RULES AND REGULATIONS OF ® �
T}?€Fffia
OF DEEDS OF MASSACHUSEM s i ° ecar.r -e —Fz;— $ ~E >
.d/llrSf r
REG.PAF.LAND SURVEYOR
. r 5 I 4k=}xs.2i" M _
— -- — It1
Ra zoNlNc o€sDzecT GREAT PC} D ROAD
" -
ZGNING �yALySjc .�--'- -
PEII49a@ FRONDED .. -. } rEO¢E OP.4E3LlrFr\
CERTIFICATION PLAN � OF
1661 GREAT POND ROADdover3 PED
NORTH ANDOVER, MASS. �CC}C15U��qYl tS � G00OWN �
NO.48133
Prepared for inc. �rSTE��°
s
TZ, LLC ' 1 East River Place
r� 3'
SGALE:1"=40' DATE:6-13-16 Methuen, Mass.
THIS pLAN WAS SHOWN ti f SURI HEREBY VEY, CONFORMS�TTHAT THE O THE SE*1BA K nON OF THE REQUIREMENTS OF THSTRUCTURE NORTH ANDOVER zaviNG BYLAWDETERMINED AND ISOT A
n LOCATED IN A FLOOD HAZARD AREA.
OREG. PROF. LAND SURVEYOR
� d6
.97 �' `LSC P u
\ j
Rl .�OR �. . . 7.5
LOT B
57358°E
42,720 S.F.
030,01
Rp Ap
05. PO
VAR
P:\1 2\1 2-32\dwg\CERT.dwg
NOTICE z NOTICE
TOH TO
R
EMPLOYEES `'nf� V`@r� EMPLOYEES
a� gy9
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900
As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give you
notice that I (we)have provided payment to our injured employees under the above mentioned
chapter by insuring with:
Associated Employers Insurance Company
NAME OF INSURANCE COMPANY
P.O. Box 4070 Burlington, MA 01803-0970
ADDRESS OF INSURANCE COMPANY
WCC-500-5006517-2016A 10/01/2016 - 10/01/2017
POLICY NUMBER EFFECTIVE DATES
1060 Osgood Street
M P Roberts Insurance Agency North Andover, MA 01845 (978)683-8073
NAME OF INSURANCE AGENT ADDRESS PHONE
TKZ LLC 4 High Street#201 North Andover, MA 01845
EMPLOYER ADDRESS
08/04/2016
DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
NEAREST AND BEST MEDICAL FACILITY
HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
oww®v VVIIGUII I-IC IV-UU mivl bdyollw-
<
,if Inbox s (2) '° r P
Sent from my Pad
yd I UATElNWIDIYYYYY) i
CERTIFICATE OF LIABILITY INSURANCE Ifl
. 6/2i/16y
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 1
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(iss)must be endorsed. If SUBROGA11ON IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement, A statement onthis certificate does not confer rights to the !
certificate holder in lieu ofsuch endorsemont(s),
PRODUCER CONTACT
NArrE: Sancti Munroe
M.P. Roberts Insurance Agency PHOFiF_.__.-------------___.._
ts�r, (.978,) 603—B073 _ ;to rzr�n97&) 6d3-3147
1060 Osgood Street E.,IAeL
North Andover MA 01895 aGDRESS sandi@Rkprobe_rtsinsurartce..com,,
Andover, IN9UBEr?I5I AF FORDING COVERAGE NAZI:A
INSURERA:Essex Insurance Co
INSURED INSURER D:Associated Employers Insurance
TKZ, LLC INSURER C:
C/o TOM ZAHORUIKO INSURERa
78 GREAT PONOS ROAD _,.__....
NORTH ANDOVER MA OIB95
INSURER F:
COVERAGES CERTIFICATE NUMBER: ----- REVISION NUMBER:
TLIlS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR'THE POLICY PERIOD
C INDICATED, NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION Cr ANY CONTRACT OR OTHER DOCUMENT WIT 14 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 SHOV,W f IAY HAVE BEEN REDUCED BY PAID CLAPAS.
IN5R1 `ALDL SUDRI ` POUCY EFF i POUGY EXP I
LTR TYPE OF Irl5URAffGY:. rl .- POUCY HUNSER Ilt„1R1lWVY YYYI IR4AlUlYYYY'Y IIA7T5
A I(FM1ILrTnLLIAHIDIY I I 3DX49 6 7/13/15; '1/13!16,CACKoc(uluiLvcE 1_ 1,000,000
DAl:nGF t0 RENTED
X c
amnu+hstnoE 7SIIcoCCUR i �rEDsorausnnv r)tuR1,00
oin IY s 500..
000
0,000
CLNLIOL Ac CdnCATi S2,000,000-. ,
I_
!
T
_. ...T APP1Ir 11'G rt PRODUCTS Ulf '101 Ac( S
r(,LNL AGGREGATE L 17411 ;
...._., .. ..... . .T.
i 1t
7 X ICY �f POLLt7C
AUTOMOBILE LIAHIIITY -f v (OYfRM4 li hiNl:4.rl lo.Ri
AiJYAUI0 11.ol LY INIURY tPnr f✓„nnn) !g
MT.)VOI;D SUILDULLV nen1CY 1NIURY 1P,r ,rlf.tni7 a
AUTOS AUTOS
Nr)N.0WTIFD `PROPEfrfY UAJ.VkGr 13
....__ 111REDAUTOS ADIOS r (Perf,cursnlS I
uMaRELLnLTnu n(rure t � L�cNncruertrucr ;a
ExCESSLIAa C(nILYS(Nrr.:'. , fftE L✓tL
;
_ RLI L'NttOM Sc __�....._....
VMRKERSCotdPERSATION I �WCC5005006517-2019A 1D/1/1, 1011116!f.r r:AGUALKIIIS r LR
'-”' I 5VlC STAID Orth
'ANO ELIPLOYERS'LIAHILITY YIN 9 ..-. .___..-.-_.....
ANYPROPRIElOR1PARTNCRAi-XECUrNi.� Nr Ai :s 1,000,000
frFrICCTON711rTCn EXCI 1000')
If.Inni.n Lery m NRS r.1. ills is GL-cn rur I e)vrl s 1,000,000
i
II *s Ansrrlin rrndef I -'
r>�sCRIPNONC:EUP4.Nnticrwsc�+�`` __�.. _ � r:L.alsEnsE-rol.Irvuralr s ,,0
1,400, 00-1
_ _
I
L"eSCRIPTIONOFOPERAf1OI1Sf LOCATIONStUEMCLk3(nnnch ACORO 1a1,ArkGGnn.tl Rnnnrks Schexltrte,Irma,n wfncn is requrvl) 6
I
J
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWN Or NORTH ANDOVER ACCOROANCEWITH THE POLICY PROVISIONS.
BUILDING DEPT - --
1600 OSGOOD STREET nunlaRlz n EPRBSENTA
NORTH ANDOVER, MA 01895 /� !
V ,I
u` O 1908-2010 ACORD CORPORATION. All rights reserved,
ACORD 25(Z01 0105) Tile ACORD flame and logo are registered marks of ACORD
Phone: Fax: E-Mall:
Massachusetts Department of Public Safety
19 Beard of Building Regulations and Standards
License: CS-055417
Constry ion Say - Wisor _
z
THOMAS D ZAHORUIKO
4 HIGH STREET SUITE 201
NORTH ANDOVER MA 01845 -
Expiration:
Commissioner 0410512018