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HomeMy WebLinkAboutBuilding Permit # 1/4/2017 V%ORTH BUILDING PERMIT ` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. " Date Received bap Date Issued: ., $s�cwus� IMP`OI2TANT.A licant m�rst com lete all iterras on this a e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition 11 Two or more family I..] Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other J I Replacing 2 patio doors; no strurtural change Identification Please Type or Print Clearly) OWNER: Name: Jufiana Jones Phone: Address: III ul �I IIIIIIII��IIIIIIIIVIIIIIIIIIIIII � � �� ��iiii"'Yi ir! i" ' iil ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$42.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Check N0.' � � �% � FEE: $ � "°�" Total Project Cast � Receipt No.: m: =7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund g rit/ wra l , , g r t r tTi ra 01too .fain r NORTH own of 2Andover 0 No. , h , ver, Mass j &) o 4 COC.49CHEWO V U BOARD OF HEALTH Food/Kitchen PER I Septic System THIS CERTIFIES THAT R ows . 4064 ...... BUILDING INSPECTOR Flo' has permission to erect..................... buildings on ...... . ..... ... . .. Foundation .• Rough 16 to be occupied as ...Aj: , ....Ag . .... .. ....f!7 .. ..... . . .......................... chimney rovided that the erson acts tin t ermit shall in eve reonform to the terms of thea licationP p p � p rY 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 CONSTRUCT S ART Rough Service Final....... �.... .. .... .. .. . ................................ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Re uired to 0ceugy 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. Mal Agreement Document and Payment Terms erre n ttlejullwo lanin Ic A 17091 a ftr,all)C(M, BU V cl 0 Nanic,J01i"a 100" Colonic[ Daw. 11104116 11L1111C." 81 Peachtree Laine, North And vet, MA 01845 (979)828-902 himav ",?Lqnlk6,T" Email- AgivvS to j,UYLhJ14 411k:-III 0&to,,-1jjkVor,,,,mite"of 14tioval 6y Aitdct,�,,-r! 'ileil -)OLUMMIMIK Y Littlijnj&�, jj, III I I I Al acMdaWx With dw uzllt�and VI'll - 140m ltrmiml Orilvt ftoeeip.I rm%1nJ:CntwbTinn,;-if-Ar,IR-ad8ife V TM,)XIiMT, If Ii5i I)p Chhq a 'Pif" C-Lim's-ml, MA Go Gv� reenlcot,Joao A.fbiroulJol,WairaKtY, T Siv'np, Rdc-,I-e Ag U111CM, the urins of whial err:'IR agro-A to by dic plltiv.5 arta i1iLUlj1tlt1t4:d h'-Artil lsvd w jjjLj Akj4,,XVj2L1,:llt DO, =J miy udik-t&MMICIA AtIJ hx'i L�ajll&red all.wo�- bv com 111critin crrii facKar o�Afr rhik.Agreenim, ih iln BY ligning this aptTzlivr1l, tke kit fljce, mw Attici !t -1'4AA1,job Atl[41,11.111.: 81 so $6,815turttatcefl F%kilitaLd(AX11joM Wit: 0-10 weeks 2 days Melhod of Vapmew.. Credit Ca.rtll Wc yKl,�Muk-iowllalkpv,5 Kmctl cm ik daw of the 4gfl,,LN1 OMUAI MId retia llsbljlk"rm A itic-�i , rim'Ibc imiallath)n&tte that tile .1 j3gt:,ill wilicit we complac thc icihn c. Urville Vi v arc P.Mtnidin gat this tifwl,ii 0AYol olirluiv,We will,o"mmunkate At)olikii]61:: mid,tivm�at jd Laur thie. Rain Artj cQffi7rJV WUjiLhet an;11VC MOM 11:0111 IM M UADt N tLlB Nous: Amex Exp 11119 113 2,271,' Start 113 $2,272,* Sub COMp 1f3 $2,272 I�Uvkl-,W Api-vi and kindtflund-,(hak this Agrem.,olt, U,,,).stkk1(Cs the earifc bo-wevi the Jjd.tela 1110-k!AM VV) , M MN 1 AI11S AllY 04),he tcrrfti,vfthus Agwonerit.No AwmiklICS H)(it ki'Mallum'.frueti thas Ap-cillunt w4lbc void voth"m dw'OIM,wrirron ')mcnt(Obr;lb the 1,jyw!t� pn. rK hrLad p kc r knd hit, 141is . ,f i A k:.-in p4tuj, �i� al id 4ji,del% . I v q: , I r id klaied cup� ,Itl)kl,,,jhc jtrn)s ofthi s Agf< im nr FIAL11by'r's vincri rltk N`ofivc-,of(amclilliall,oil qlw c6tv first U1111c, Lixve:inn ,nwa5F onffly W'Cirimcd vi N01-R.A.—R)OWNER: IXC not.kipl tlli5 u)l1trj,-,t it bilank,Ymi mc entitled to.9 tupr 011 11'r the cilli c',Ciel 6pl. YOU,WE BUYER, MAY CANCE1THISTRANSA MON AT AINYTIMF NOT 1,ATER THAN MIDNIGHT OF 11/0812016 OR' HETHIRD BUSINESS DAY APTERTHE DXrE OFTHIS TRANSAC'FION7 60MG&WAADMURLATER.SEES E ATTACI I ED NOTICE OF CANCELLATION FORM FOR AN "H IS RIGHT. switi'lure tif Saks lk-ywn David Barry Juliana!$*nes ['6111. Mine Renewal itemized Order Receipt julixna Janu I�AMersen vo�,ofsloav kf Ufg,V HIC #17G810 M�Kpow. IM,Lf.Cb PNI 101 I'Aan Ca4e Hardwaee'. Ani'l; Mist: ratio 000r 2 101 Kh,,ZlTen 11 ;j1! — Hardware: ji A Si r o ti; Gi flP,* e a WINDOWS:0 PA710 DOORS,2 SPECIALlY. MISC.0 TGTAL EPA. �.,do and bAd The Commonwealth ofMassachuseitYs ]department of Indast'rkl AccrWnts J Ofce of Investdgatlons 600 Washbwton Street Boston,MA 02111 www.mass.govfdia Workers' Compensation Insurance Affidavit:Builders/Contracton/Electrlcio ns/Plumbers ARP11cant bhrmlftase Priv Name(Business tlodlndiVAW): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD Ci /State/Zi NORTMBORO.MA 01532 Phone M 608-351-2214 Are you an employer?Check the appropriate box; Type of project(required): 30 4. (] I am a general contractor and I 1.� I am a employer with � �,�hired the sub-contractors 6. ❑New construction etnploym(full and/or pert-time). 2. I am a sole proprietor or pardicFr- listed on the attached sheet. 7. ,K]Remodeling ship end have pr a for o par These sub-contractors have 8. ❑Demolitkm employees and have workers' I; woilCiag for me in any capacity gyp,insurance.$ 9. ❑Building addition [o kers Comp.insurance 10. Blcatrical or addition S. [] We are a corporation and its d repairs 3.❑ I qu a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself[No workers'comp. right of exemption perMGL 12.©Roof repairs insurance required.)1 c.152,§1(4),and we have no 13.0 Othor employees.[No workers' crump.insurance required.] 'Any spa Hc1nt that checks box#1 must gteo till out fine section below showing their wodm'oompo setion policy ink mu don. t Iiomoownm who mbmit ffifa gtfidgviit indicating they aro doing allwoatk and then hire outside actors=at mA tett it new affidavit Wicsting such. klontraetors that check this boat most attached an additional°hoot diowing the name of ft sub4ontzwtors and state whether or not latae anitim have employees. if'the sub-contraotort:brave Fane,they must provide their workers'comp,policy number. Lane an efiNdeye r dw its provtdbtg workers I comrlpe nsa&n Awarmee for nV a Nrkyeaal, lidos+h the po ft andiob site tq fbrmatto». Insurance Company Name: OLD REPUBLIC INSURANCE COMPANY Policy#or self-ins.Lie.#: MWC30823100 Expiration Date. 10/01/2017 r Job Site Addmg. 81 Peachtree Lane City/State/Zip: North Andover, MA 01845 Attach a copy of the workers'compensation polky declaration page(rhowtag the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c.132 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year impel mment,as well as civil penalties in the form of a STOIC 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 JnvegtJgatio5AfAhQIA for insurance coverage verification. I doh card,& ar&eparban a nd penaides of pffjury that dw rmadon,proWed ub~1111 fs tore anti'corral G D : 11/08/2016 8-351-2214 offl d d aaw on&. Do not warts tint this area,to be comptatad by chy or town offlo aK City or Town: Parmfit/License# Inning Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 3.Plwenbiing inspector 6.Other Contact Person: Phone M. ANDECOR-01 DLIBE:AA ,� Rv CERTIFICATE OF LIABILITY INSURANCE DATE(MIdIDbIYYIIY) 9/29/2016 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 INSURFR(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cereflcate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain pollclaa may mquk'e an endorsoment. A statement an this certificate does not confer rights to the co"I tete holder In lieu of such endonseme a, PRODUCSR Nom; Wlllla Towers Watson Certificate Center Willis of Minnesota Inc. P °Na 67 94.f'-7"378 No):1808467-2378 do 28 Contury B174 PD.Box 305491 ADDRE :ca:rtiflcate9 pls.Com Nashville,TN3723DZISJ s AFFORTNNGCOVERA01111 NAIC0 WSURERA:Old Re ublle Insurance Company 24147 INSURED INSURER e: Renewal by Anderson LLC INSURER C- 104 Oils Street NSURBR D: Northborough,MA 01532 NSUREA 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 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 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS. LY TYPE OF INSURANCE POLICY NUMBER YPSMAD!'lYYY Y E>W LIMITS A x COMMERCUILGENERALLIABILITY EACH OCCURRENCE s J,ODn,ODO g CLAIMS-MADE r OCCUR NiWZY a08234 10101/2016 10101/2017 MISE8 oomm S 500.000 MED EXP(An one parson S 10,000 PERSONAL 6 ADV INJURY $ 1,000,00 eENLAGGRMATEUMITAPPLIESPER GENERALAQ6REGATE $ 4,000,000 x POLICY❑JE i ❑ toe PRODUCTS.COMP/OPAGG S 4,000,00 QTHER AUTOMOWLELIAINUTY CDfiakI D L...... S II,D00,0 00 A x ANYAUTo 308232 1010112016 1010112017 BODILYINAIRY(Parpermn) $ AUTOS SCS LED SOMLY INJURY(Per am Mont) S PER AGE HIRED AUTOS AUTO$ r $ i. UMBRELLALIAS DCCt1R EAD}IOCCURi;ENCE S 3 JXCESS UAB CLA1MSfiAAOE AGGREGATE $ DFD RMNTVNS i WONOTIS COMPENSATION X ER ANO eMPLOYNIS UAeumWC30B23100 1010112016 1010112017 e,L,eAcrl rrcclDENr ; 1,000,0 A ANYPROPRIETORMARTNERIEJfECUTIVE YIN OFFICERNEMSFREXCLUDED? NIA 1,0OO,On (Man"ryTnNH) E,L.DIFiEASE-E14EMPLO b ff d w110 underPERA ealow E, DSEASE-PoucYuurr S 1,000,00 a DESCRIPTION OF OPERATIONS 1 LOCATMO I WHICLES(ACORD 101.Addlslonal Remarks Schadula,may he alt Obd if, apace la rmqulmd) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Town of North Andover AUTHORIZED REPRESENTATIVE I i2oMain Street North Andover,MA 61845 r a JOBS-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r Massachusetts Department of Public Safety ; ., Board of Bu11ding Regulations and-Standards PF License: CS-MM Construction Supervisor f% JAIME L MONN 86 0ARDINER STy LYNN Mil 01806 YV W k �:•,:, � Expiration: CoMmissioner 1810120/8 1 Construction Supervisor Restiided'to: Unrestricted-Ruildings of any use group which contain less than 355,000 cubic feet(991 cubic mfrs)of enclosed space. 3 d i�aiiura to possess a Current edition of the iAessadusetfu State seeldias Code is a mse for rovewet m of this 110"te. Oft Licensing information visit:WWW.MAG&A011tM u —QQM e ee of Cousamer Affairs&Business Reguiation ME IMPROVdENT CONTRACTOR Reglstratl A '.b , L, ` Type: Expi Supplement Card RENEWAL BY AND y .JAIME MORIN 30 FORBES Rt} :•�'fv t .t a a� fix--. NORTHBOROUGH,MA 01532 Underseeretary i , 1