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Home My WebLink AboutBuilding Permit # 12/29/2016 �}C?RTH 00 BUILDING PERMIT o1TYU�� TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION ` '` Permit No#. Date Received `ll Q ar��aWreS 44 SACHU Date Issued:_m_ `� 1 I2T2NT:Al plicant m st complete all items on th7.s page z8ATI r66 _ . .. _ w nn� PRO 10 cJWNER3�a,_.,Yj - - Print 1DOYear"St�uctiire yes no 1 lrstorrc District yes no MAP...._ _ P.P,ICEL ZCNIIVG C7lSTRlCT r Machtne.Shop`tlrlla�e yes no y _u„ TYPE OF IMPROVEMENT PROPOSED USE _ Residential _ _..__ _ _ Non- Residential ❑ New Building ❑ One farnily DAddition ❑Two or more family ❑ Industrial El Alteration _ No. of units:__,. ❑ Commercial ❑.repair, replacernent ❑Assessory Bldg _ ❑ Others: ❑ Demolition ❑ Other ❑ Se tic ❑ }Nell: District lood Tarn ❑Wetlands ] Watershed BE PERFORMED: Y, R.11'�'ld��d �9F 'UtJC�R C� „, � � .. _ E C i,� � ... ...��r, f. . e I��.. - � V . ? " . earli° Iden gat n- Please Type m�- �'rxaat �`1 i° OWNER; Warne: I Phone: ;° , . Address: .. t � 1 -- Contractor Nlrrre:.. I 'hone _ 4 . _..—. _ 8 enrisor°s:CcbAstructron License l-Iclme Irn rav�rr�enf Lrcense�- - �.:.�.��..� - Fxp_ dad ARCH ITECTIE1NGINEER_ _-- Phone: _ Address: Reg. No. FEE SCHEDULE.13UI.DIAfG PERMIT.$12.00 PER.$1000.00 OF THE TOTAL.ESTIMATED COSTBASED ON 925.00 PER S.F. Total ProjeGt C OSt: s 1.g, FEE: $ — Check No.: � � Receipt iNo,-� 3 7 - -' ---------- :N( TE: 1�ersons contracting with gilerod contractors t10 not have.access to the gmaranty fund inn iFtrt of I. cs ni/C1ioncr Signature of contrac`tor... own ofAV, n over. . ® . No. ;all - hlQ LAKE � ver, Mass � RA �ti �,QS�iTED BOARD OF HEALTH Food/Kitchen LD Septic System THIS CERTIFIES THAT TIGN,,.. .,��,. 1W BUILDING INSPECTOR has permission to erect ......................... buildings on ... ,� , ,a , Foundation Rough to be occupied as .,.. ...,.... Ire . Chimney ey. . .. . .. .5. ....... provided that the person acceptirTg 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 C® STRUCTI STAR Rough Service ......P... ... ........ ....................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Bulldrn 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. The Commonwealth of Massachusetts Department of fndust'zalAcc�c�e�at,� ,D a 1 G`ongr'eivs street,S�U�100 :, osftax2,MA 0.2/X4 20X7 www mas's.go-p1dia �6a yysP joex ' oensa iaxj Tixanca oda Btx �: ides/C A ACU CEJ[ ' trxcians/ Zwnbers O BE P�13 Wa-a .itlVlz please�x�xxt Le, APhIicant Wormatzorx -- Namo(J3usiness/Or"gavizatiozlftdividual): / ss: i — '--" — .Addy ". .. 14 ylxe ox' x oject Oxe�er3.)= Axe you an exnplayer'r Checttae apropxiatabox: 1, ern a axoployar with ' eznployaes(fall and/or part time)* �. 0�. 'c6nstriaafion g, U RomodeEng oprietor or padncrsbip eLahaveno employees'Working forma in 2.0 X am asole pr any capacity.[.C`[ovaorkers'comp.insruanca required/ g, DSIYlolitioxE 3.E]Jam aho�neownaz doing allwoxkrnysaif,[Na waxkers'camps,insurancarequired,]"� 10[l 13uildi g addition confzacfiarsto candnctallwarlconmyproparty. Swill �I1 leTtrie Tpj,ajs o-•�.c�ditigPs ¢, �Cam ahoxnaowner andwillbehiriug 1;J oname that all contraotbts eitherhaveworkars'compensation insueanae or are sole I2.�0'PIMu Ing repa#S O:r addition, proprietors with no emppyc6s• S_�T am a genezal aantz�ator aril Shave hiredthasub-contractors listed on.tba attaahad sheet" 1.3%LI Rbo:Cxslia:irs Those snb-canicaatozsJaav�a6ployaas andhavowadcors,comp,insurance. Other �-- s,E]We are a corporatioft and its,of&&S havo e�rcisc dtheixrigl�t of'exempfion perMG i G. 152,§1(4),aaq!,ahav6no e�mpl yetis.[No workers'comp.insuranceregrired _ a rani at ch c`y p st also fi l outthesectionbelov shovZgtheirworkers'compez�sat3anpolicpir�#ozmation; x yy PP th era doing all.work andthon hire arciside contractozs samt submit:a now affidavit ind such. i Homeowners wha s�rbznittivsdavitindicating aY G'onfxactazsthatcheoktl?ist7nki-.tattached'au additionalsbeetshowingthonameof coniractorsandscat vrhetherarnatflzose.en es ave do their woilcers'comp. olio number. employees. 7ftho sub-contractors have-mployees theymustpYovi� — = tlzczt isprovidingwo ex;s'eo" en=scztian instzrancefar^nzy ern,�Zayees. l3eZary zs tliepaiicy rzrzdja site _ram axz enz'PLaye�^ 1 . Sxasurauco Company-Name: --— _ expiration D4.te= _ Policy or Sel f itis.Lic. V VVI _ City/Mato/exp:_ rob Site,Addxoss: — --� e sb o zng the P o c i'ne er and e ixafalo date}. Attach a copy'Offhe'wrkexs' compensat%on.pol cy deelaxatioxxpag � Failure to sec tx e coverage ogre qunerl`uadex•MC C. x52,tlxe form.of S7n'O�'�WO .C7�D1 R a Ld a flna c��li to $250DAO a and/or one yeaxlmprisonwant as we11 as civil penalties xn day again t the violator.A copy Of this statement may be forwarded-to the Office o 7nvestzgations ofthe DIA:Cox ix surancr coyerageyexrfication. cern r�xzcier�tl`ie�l an�pen�r�es af.�Pz•�ar}r fleet tIze znfasmatian�x'a�xd`eci above is t�u�e and correct 17 Si atuxe: Phone —= y -1czal �Jf tical zc se onLJx. .7.�a rzot wx rte in t�zis arca,to he eorapkted by d off'fawn Off • Pexxnit/L%ceuse�_____�...�-_--_ —____T. City or'S'o`waz -- ss'w Yxg A.n tTaoxfy (cxx ole one): L Poe rd of�F.:altb. 2.$y��gZ7epaztx�xent 3.G'ity/'l�"o'svxx Clerk �,l+'lectxi~calXnspector 5.P'luxx+h�xg�xspectox 6.Other Rhone Contact Persoxx:._.__ OP ID:OUJA Aco�rr� CERTIFICATE OF LIABILITY INSURANCE DATE(MM 201YYJ 1212s12o1s 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,subjedt 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 NAME CT Hannah Courtemanche,AAI,CISR Macdonald&Pangione Insurance PHONE 978-688-6921 me No: 978-888-5350 104 Main Street (A/C,No ext North Andover,MA 01846 E-MAIL ADDRess:hannah m Ins.net Donald Schemack ER DGCON-1 C STOMER ID p: INSURERIS AFFORDING COVERAGE NAIC q INSURED D G Contracting,Inc INSURER A:Travelers Prop&Casualty CL 25674 428 Pleasant St INSURERB:Safety Insurance Company 39454 North Andover,MA 01845 INSURER C:Nation al Lialsilit &Fire Ins INSURER D; 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 13Y 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. BR POLICY EFF POLICY EXP INTR TYPE OF INSURANCE POLICYNUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A X COMMERCIALGENERAL LIABILITY 680-15631318 06/17/2016 05/17/2017 PREMISES Ea occurrence $ 300,00 CLAWS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS�COMPIOP AGG S 2,000,000 POLICY Fyl XPRO- $ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per parson) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS 3116638 07/12/2016 07/1212017 PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) $ X NON-OWNED AUTOS $ S X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,00 /17/2017 - DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- I JOTH, TORY IME AND EMPLOYERS'LIABILITY R _ C ANY PROPRIETOR/PARTNERIEXECUTIVE YIN V9WC704642 0313112016 0313112017 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUOE09 F N I A (Mandatory In NH) E.L.D€SEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ A Property 680-1663R18 06/17/2016 05117/2017 LsdlRent 20,000 Equip DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace is requiredl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Attn: Building Dept 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD i P Gid'�Z�Ai 43SL�ASANT 5TIn y {UN #Ntqult M d Am