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HomeMy WebLinkAboutBuilding Permit # 1/5/2017 BUILDING PERMIT yo�rry oF�T�e� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION = ,� n e i Date Received �,p Permit No#: -s ,r.o r �� SSRCFU Date Issued: IMPORTANT: Applicant must complete all items on this page �oCATIo>u � Print Pent 1�o Yearsfructure Y no MAP t P�RCEL�� ZONING DISTRIGT�H�sforac;Distnct ' r�o .. . ._ . . .. Machine Shop ViElage .....yes , ,. na TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se tic ❑Well I Flooc! Iain ❑Wetlands ❑ Watershed Distract p 0,'INaterlSewer .,.. .:. . `` D SCRIPTION OF WORK TO BEP FORMED: e�e`s.¢Q r,q�t` 4.&S4 T'a,' wd., ee �roc e- e r~ ie;?,o tads *It C( r�c • a2 j ~ Identification- Please Type or Print CleaIy OWNER: Name: e G L t —1 + F e (�,��ove r- Phone: 7cf- �,Sj - Address: © � eY 87te (Vo Vit K�ove4eWL14 oi��s Phone Cor}t'ractor Name . Super�7so�'a Construction License � �� �� Exp Date � � ,� ` Horne Irnpra�emOil Ltcertse ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / 60 FEE: $ C Check No. Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S1griature'of Age nY0wn ` ,r gna ure of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swinnzning fools ❑ Well Tobacco Sales Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF W U FORM LANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS �Q ° CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FI"RE DEPARTMENT Temp Dempster on site yes no Located at 124"Main Street Fire DeparEment sgnatureldate COMMENTS ' FORTH Town of �2 n ove 0 f No. AA 11 s p : L^K. h ver, Mass fOC Hl i NQ WIC.I V U BOARD OF HEALTH Food/Kitchen PER Septic System w T LD THIS CERTIFIES THAT ..... Q#J „ ,,,,', ......... BUILDING INSPECTOR has permission to erect ....,. buildings on . .. +a � Foundation .................... ....... , .. .. ,........,........,.,........ . ............... , , ,... ... ...,.. Rough to be occupied as ... ..... ;. .. .. G�.�....., Chimney provided that the person a e tin this permit shall in eve respect conform to the terms application p P p g p rY pFinal on file in this office, and to the provisions of the Codes and By- aw relating to the Inspection,Alteration arlid Construction of Buildings in the Town of North Andover. Owe'v4 4 4L PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T TSRough r Service ............... . . ... ............ ... ....,........... ........ Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Ruildin 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. NORTH ANDOVER OLDE CENTER HISTORIC DISTRICT COMMISSION Certificate of Appropriateness y This certificate of Appropriateness is issued this Third day of January 2017 to Center Realty and Trust for 20 and 20A Johnson Street in accordance with Chapter 40C of the General Laws of the Commonwealth of Massachusetts as amended and the by-laws of the North Andover Olde Center Historic District Commission. I_7�€' —144 t, I�z X ( {,v��l� S r t 1 ANS} t�e.p t A CP ,n� lam. r7r r12- x c, HAQ-0i 19zArvK sib INC 3 Ni N��1 2t- -SP /IVJ1►rvc, 0�' wI o kooc-. 3 P-em ew u, 0,F- U c� /14 s P_6A4UVb4L -A PVL F ® DATE(MMIDLYYYYYI ,4ee© CERTIFICATE OF LIABILITY INSURANCE 10/5/16 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, Ge policy(ies) 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 -CONTKCT NAME: AMY ROBERTS M.P. Roberts Insurance Agency PHONE FAX (978} 683-8073 Ai Nu: (978) 683-3147 1060 Osgood Street E-MAIL ADDRESS: AY@ mprobertsinsurance.com North Andover, MA 01845 _ INSURE R(S)AFFORDING COVERAGE NAIC# INSURER A:ESSEX INSURANCE. T INSURED INSURE.RB:Associ.ated Em to ers Insurance KEY LIME INC INSURER C: _- 10 HEPACTICA DRIVE INSURER D: NORTH ANDOVER, MA 01845 INSU RERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 ANDCONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . . __ NSR Y ILTR�T TYPE OF INSURANCE ADDLSl1BR POLICY NUMBER — MNOE7pD1YEFF�NpM1D�VYYYY LIMITS A GENERAL,LIABIUTY 3EE0820 6/15/16 6/15/17 EACHOCCURRENCE S 1 ,000,000 X COMMERCIAL GENERALLIABIUTY DAMAGE TO RENTED P S 50,000 I I E „9.4k4fQe_f.IL@ V CLAIMS-MADE Fil OCCUR MED EXP(Ary one person) $ EXCLUDED PERsoN4L&ADV INJURY $ 1 000_,-000 GENERALAGGREGATE $ 2,000,000 1 GENTAGGREGATELIMITAPPLIESPER PRODUCTS-COMPIOPAGG $ EXCLUDED POLICY PRO- LOC - S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) ANYAUTO BODILY INJURY(Per person) S ALLOWPED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS —AUTOS Per accident I S UM13gELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION$ S E WORKERS COMPENSATION WCC50050075812016A 9/15/1& 9/15/17 WC STATU- OTH- AND EMPLOYERS'LIABILITYR ANY PROPRIETORIPARTNERIEXECU3NE Y!N E.L.EACH ACCIDENT $ 1'.000,000 OFFICE PJMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 if Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Rermrks Schedule,if more space Is reqs red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SAMPLE CERT'IF'ICATE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE $ si' %iA MICHAEL P ROBERTS ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Office of Consumer Affairs&Business Regulation .f. HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporation before the expiration date. if found return to: Registration ExpirationOffice of Consumer Affairs and Business Regulation _- 786786 To/Q7/20T8 to park Plaza-Suite 5170 Boston,MA 02116 Key-Lime, Inc benjamin Osgood 10 Hepatica Drive C�. 1 North Andover,MA 01845 Undersecretary Not valid without Ognature s 1 y�. b i Mass,)chusetts Department of Public Safety Board of Building Regulations and Standards License: CS-075302 onstructi011 SUF30*°Visou° BENJAMIN C OSGOOD 89 OLD VILLAGE LANE NORTH ANDOVER MA 01845 Z�� CA--:— Expiration: Commissioner 12/04/2018