HomeMy WebLinkAboutBuilding Permit # 1/3/2017 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
permit No#: � ''� Date Received �,�5�nr�a�qR�
SgCHUS
Date Issued:
ORTAN T: Applicant must complete all items o-n this'page
--
Pnot
PROPERTY OWNER -
nn# 1 DQ Y ae rr Structure yes ri,o
PARCEL_ ZDNWG DISTRICT Hisforic ®i,strict yes no
-.ac s e hop 1/illag .. . y rho.
TYPE OF IMPROVEMENT , PROPOSED USE
Residential Non- Residential
❑New Building One family
❑Addition ❑Two or more family ❑ Industrial
-Alteration No. of units: ❑ Commercial
❑ Repair, replacement >❑Assessory Bldg ❑ Others;
❑ Demolition ❑ Other
Tari wet r4
F ° b WAfershed District..
Sepe ❑Well _
❑Water/Sewer --- -
- DESCRIPTION OF WORK TO BE PERFORMED:
t
Identification-- Please Type or Print Clea'.rly � � c�G� ' r tog
OWNER: Name: t Phone: D S �-t
Address:
ra e: Phone:
OQptracto N m _
ess: Y�
5upervisorsConstruct�ort LIcerise __6"�� 5 Exp: DafeSQ `
Home Improvement Licenses
ARCHITECT/ENGINEER Phone:
Address: Reg. NO.
FEE SCHEDULE.BUL.DING pERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED N$125.00 PER S_F.
_ FEE: $ � -
E �rotal ProjoGt Cost: $
�1 � eceipt No': 3131
Check No.: `"
NOTE: Persons contracting witIz unregistered cont act rs ;n ve:ace e guaran f4H
SiQ' UCf3 D
own of ndover' . .
An� 0 . 7611
, LAKE h ver, Mass, S11
[O[NICME W.C4 �
�qs RRrEto)
U BOARD OF HEALTH
Food/Kitchen
PERMI Septic System
i 1 ��� • ps THIS CERTIFIES THAT �.� BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on ............ . .............. ..... .....................................
Oft
.� .. .... .... � ........ . . A.. . Rough
to be occupied as .. 40
.,, Chimney
provided that the person accepting this rmit shall in every respect conorm 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 M® THS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI® RT Rough
.... ...................................... Service
.,......... Final
BUILDING INSPECTOR
GAS INSPECTOR
®ccuanc Permit Required to OccupyPuildin Rou'gh
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.
,,1 ,�"� '�/�.+'1.. � /���,r� ✓� �j (�, � f:'19RiAk 14.,
SHEET lqo�
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WCiKTUk;L 't .. CtM )O
PROPOSAL UMI CIE3 O: . .. ..
F7tiN � ... ...�,.
�
1
V"I.IC)NE�l�t.
1
t
ADDRESS
EINFE OF PLA
ARCHIfECT
p� ,�pu ......... .
C*herebyherebyl'�DY"OprJSk,'�U YI"I'aIG'tV'1thea 'I`1'c1t0t'I"ailS and pe
the labor 1'1Ct��"w�uNf'�for'tll�I:;raraalala;tlnrt 1:) .._. ..._..__. _..._...__. _.. __._........
Cv
....w.... ......... ��rte°
_.._ _. .._. . .w. _m .._.
All nl,atrrlkal Is guaranteed to be a,4.,laa , � n kluu rrapr6�ance vuilla ti'ar f18�awings and at�ara lllr�attarllc�pc�laultfttttr4 tral above wank an
r llll ct, un(l flat.above work to lac,p l c k�r� � ca
I mannerfor,the Sunil of ..... _. �...
I;C',tIT1 al�^tG,t!Ila ra,rlala�atidnllcMl 1fiPltlt4lYauaC'kllkG"tal�ansac ..
......Dollars ( _. _. ........)wltta Ialattrtur;uditk to bu rkaarlr,a,a trullruwS.
oma C� c
Any mufl�atuon or rtrtvia&larir fiorn aoove ,t4s r°68Io6aUprrus involving oma costes �
Will kris oxr,r.artHd early ulrm wkkin oolar,and will Ire coma.an r xha aolrarr P, Respectfully _ .... .
� aavod°tatitca,aPrrrvez 91ro rFsYintpa9u, All r.grcur ots'V C,?G,
acatami lrlal _ ... ..
,pass ldorrtr,err rtt¢I,hyo rmyomj air control.
lr4.r.... ...... .. ... __ ....... .... ,.._ . . .. ...... .. .. ..,..
4 tl µ wittrnr d ny
_........ Nola....this aun rarr�A RMOW WMI(4 av n by to 't9 ir'p9 r[or r4r tt
......�.. .��.
CCEPTANCE OF
�att.trlrat u�an t are tu;lrtay aart,tklaletl.Pl° .. .. authorized In tlka lBkr vur�rk;a, p�ipr,Vtit;k. I',�ylrlr;ctt; twill G7t;lalulal: sb��
The above lal hoes,"�g7ucil lc at o os, ,and(;on.lk iola„w ata sab ��
ratutlined above.
;ti,wiatnre......... _.
..._..... _..... .. ...... .....
illnature-
Date _.......
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De
pu�'tment of Indu is
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Congr,,,,'Street,, AUt 100
AM 02114
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av iza�ionl.[ro divid-aal)'
Namo(Business/Ozg J
s
Ci /,St tete. - ,�
ro xiatebox: ype or�araject( eked)'
Are yon an emxpZoyer2 E tecI�tTie aPp P , ,...
1 aempxayerwi _. -- --- Pioyem(iAandlorparttime)•'
7. Q Ne`�car.sh'iiciion
2�asoleprapxie arorparinersiaipandhavewOmplayees4 Orl�g foxmaein
8. Ren�odehlh-
g. Q Demoliti?xl
MY capacity.ITo vrorkers'camp.ins�sranee r[NAwork-wo m.] insurance re ed 1
14�Bual.divg addition3.ElIamahOm-veer"'agallwaxk3nysel ers'comp. 'r e Ivvili
corrtzactozstocandnctaliworlcortauyP P ��❑ElectrLcaixepaixsoraddxtioPs
nlamahameowner andwilll:aig f
emsnrethat all coulrantais either have workers'compensation in u areae ar are snle n2 Plum big repairs Or ac diflons
praprictolswitb-no eml?ioyei s.
5_Q I ane a.general contracto e andllrave hizedthe sub-cordsaetors lisEed ozithc attached sheet.
T3 [ Roofzepairs
These snb-contractoz`s�a.4e cmployees andJraveRTozkers'comup,insuzance �p other
{❑we arc a cozporauo!i.and its.oi'Ccers�hava
152,§1(A-),andivehav�no employ. rsdthoght Ge
�ozvoeo ncreq d aMG�o.
-
a lioanttlaatclseol bort#1 must also fdi ont the sectionare dc3n eallorkandtheuhize outside oorrtrsctors moult submit anew affidavit indicaSng such
pP
Homeowners wha s€zb mithis affidavit izzd3catingthey g
must
progidethair vaorkars"wrap.poIicynumber-
tContractors that cheekthis U'o�inust attac�ied'arx additional slaeetshotivingthanamxe of t]ie sub-contractors andstata�thather orgotthase en es; ave
employees. Tftbo sul�comt[actars have employees iheY 212 la ee,� elar�l<4 tl22po&y alldyO SitE
.I am an emTZoyet'that xs proWding-pvoplrers'coxnpensadOn Msa?meefor rrzy 1� y
infos�natian.
ln5azanoe CompanyName:
E�pixatioaDate�
i'o]$.cy#or Self his.L7c. :.
CitplStatel�ip: ..
lob Site Address: the olky number fmd OXPi afima date).
A.ttaeh a copy of ie�vorkers' carnpexcsa' on oT cy deer 5A is ca n hal o atiox�p bab7e by a ve up to$1,500.Oa
FaUUreto secl:o covexago asrequXzedntzdeTMGZ a.X52,§
ear i isoramen as-well as o% l p MaXes Yn the form of a STOP�y E7RT�ORDER and a flue of up to $2,50-00 a
and/or one-y T? of this sfateme anay Tae forwardeci to the
O�ce of�vestigatloa�s af�e D7A fax i�sut ante
day agabist the violator.A copy
exriaegrelvayare flctaifyzon.cav
atllie zrforratarroideaaove trxe atd calTe
ofpzrluxy li
under i7eSdy
Ida c
Date:
Si Aare:
i'Tsone�#:
official arse only. Do Rot-Write in tlsis a"ect,to he ca�r�pleteti7�y city
ar tarp official
.to
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City or To-waz:
9 fssningAnnority(cireTa one): ' ctor 5,i'i bingerector
T.Boca cX ofeaZth 2.Rg DaFa7 tmeRt 3.CztylTo yen G'ieriZ �1.�Tectx tcai Tspe
6.Other
I?hone##:
Can-�act P erson.
C--20-2016 FR 1 10: 55 AM P. 001
�1 ® nage(bavlral:rYYiYI
CERTIFICATE OF LIABILITY INSURANCE 2/30/16
THIS CERTIFICATE l9 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 POUCIES
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 4ertifloate holder Is an ADDITIONAL INSURED, the policy(ies) must be endoroed. if SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain polloles may require an endorsement. A statement on this certificate does not confer rights to the e
Certificate holder In Ileu of such endorsements).
I
PRODUCER NAME: Joan Spears C
Joseph O Dancia Jr Ins Agey Inc PHONE 781 322-1322FAAIX N I (781) 322-9778
182A Highland Avenue mlganonur W11
Bs; oan@danaainsurance,com
Malden, MA 02148 INSURE 3 AFFORDINL3 GOVERAflE NAIC
INSURER A I WwstOrn World Ins, Co
INSURED !]USURER B
John Trulli INSURERC:
149 Cotuit Street INsuRELi n
North Andover, MA 01845
INSURER e1
INSURER F
COVERAGES CERTIFICATE NUMBER' REVISION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURER 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 AFFORDE=D BY THE POLICIES DESCRIBED HEREIN IS SUB,IEOT TO ALI. THE TERMS,
EXCLUSIONS AND CONDITIONS OFSUCH POLICIES,LIMITS SHOWN WAY HAVE BEEN REDUCED BY PAID CLAIMS,
L RRI TYPEOFINSURANCE PO€ICYNUMBER MMIM/YEYYY MMIDDIYYYY LIMITS
A GENERAL LIABILITY N N NPPS245955 4/24/16 4/24/17 C,AC4OOCURRENCE $ 1 ,000,000
X COMMERCIAL GENERALLIAUILITY DAMAC3ETORENTED
. a 100,000
X CLAIMS-MADE E1OCCUR MED EV(ArdorwPw5w) S
PER90NAL&ADVINJURY S 11000,000
GENERALAGGREDATE 8 2,000,000
GEN'LAGGREGATE LIMITAPPIJESPER PRODUCT'S-COMPIOPAGG $ 1,000,000
POLICY P LOC
AUTOMOBILE LIABILITY EB eccl rt $
ANYAUTD BODILY INJURYIPer peruon) S
ALL 0WflED SCHEDULEO DORILYINJURY(Par accident) $
YJREDSAUTOS
ALITOS AUTOS O
WNED PROPERTYAMAGE
H $
erarcldaN
S
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTION$
MAKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LFAOILITY
ANY PROPRIETORIPARTNEifEXECUTIVE 7 NIA E.L.EACH ACCIDENT „
Mond to En EXCLUDE07
DISEASE EA EMPLOYE
if y�ea desulbe under
0&SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIr
DESCRIPTION OF OPERATIONO I LOCATIONS I VEHICLES (Atlach ACORD 101,Addlflonal Rofmrka Sahadula,If nota apaee Ia mqulred)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THrz ABOVE 0K4ICRISEa POLICIES IRE CANCELLED AEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Andover ACCORDANCE VVITH THE POLICY PROVISIONS,
Sulding Department
120 Mair, Street AUhHO ti REPREEENTA VE
North Andover 'Ma. 01845
1588.2010 ACORD CORPORATION, All rights reserved.
ACORD 25(2010105) The ACORD name and logo are reglste marks of ACORD
Phone; Fax: E-Mail:
I
p .c. Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-090863
Construction.Supervisar
JOHN E TRULLI,
149 COTUIT ST
NO ANDOVER MA 01845
i
Commissio er Expiration:
01/73/2019
Masschuscis _i. pirtmextk of Pubic Safety
Icsard of f;U,lding Rcgulati6ns and Stan ards
.. .�,iRisttESCiiirli ou?i6:vi�ili=_-'
License: CS-090863 .
r IS o
TOIII�i E' RULLI
149 COTUIT ST,
NO ANDOVER MA O<�
' ,
Vit' ..
A%`` Expiratian
011,4312017 i
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Exoimtion 51120�r T'p�
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JOHN TRULLI ,�i,vieiva]
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JOhN TRUi i i..
749 COTlJl7 S) ,.
NANOOVtwR MA 0'i845 ---
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