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HomeMy WebLinkAboutBuilding Permit # 2/21/2017 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 � t Permit NO: Date Received i Date Issued: I1IPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Pint 7 QQ Year Q!d Structure yes no MAP NO� PARCEL: 'DISTRICT ��Histonc District' yes no Machrre Shop Vlliage yes no TYPE OF IMPROVEMENT PROPOSED USE 1 Residential Non-Residential D New Building I D One family D Two or more Family ❑Industrial D Addition Alteration No.of units: D Commercial ' D Repair,replacement Assessory Bldg Others: I D Demolition D Other D Septic D Well D Floodplain D Wetlands D Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: l Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: �� � �� - one a a € Address: > -,upervisor'sConstruction License: Exp. Date: Home Improvement License: Exp. Date: ARCH ITECTIENGINEE R Phone: Address: Reg.No. FEE SCHEDULE:BULDINO PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEL?ON$125.00 PER S.F. Total Project Cost:$ FEE:$ Check No.: t O� Receipt No.: 315:qF— NNOTE: Persons contracting with unregistered contractors do not have access to the guaraaEt}-fund �V s SignatureofAgeritl0stner� Signature of eontractoi�� r � _. r Plans Submitted❑ Plans Waived U" Certified Plot Plan ❑ Stamped Plans ❑ Town of00RT" Andover 0 No. o h ver, Mass, Oq 0/ 7 �•9 p°`+wren APa� ti,� S U 4 BOARD OF HEALTH ILD Food/Kitchen PERMIT T L c Septic System THIS CERTIFIES THAT..... Tr y....j.L04A4 lei BUILDING INSPECTOR ............................................. Foundation has permission to erect..........................buildings on........�.VI.Q�.......Q.S�II".!�..r1.......sr Rough to be occupied as...C...q .l.d.es......4!!!!t. ..... ,VA! ...,.,... .G'.. 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 V Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST S Rough Service ....................... .... .... ..................................... BUILDING INSPECTOR Final GAS INSPECTOR (.occupancy Permit Required to Occupy Puildinz 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. cubicle connection inc. Estimate 127 Conant Street Date Estimate# 212112017 1089 Name/Address Mentor Networks 1600 Osgood Street North Andover ma. Project Description Qty Rate Total Labor Reg rate 14,000.00 14,000.00 Quote to build out cubicles and private offices in new space located on 3rd floor TOtal $14,000.00 - A PNBDATR--11CERTIFICATE OF LIABILITY INSURANCE R022 2/6/2017 THIS CERTIFICATEIS 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,ANDTHE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 ri hts to the certificate holder in lieu of such endorsement a. PaD ER PAYCHEX INSURANCE AGENCY INC (Acrm.E<IF tuc.Nay ($$$) 443-5112 210705 P. F: (888) 443-6112 PO BOX 33015 NURER)ATORu ccovEPAGE NAa SAN ANTONIO TX 78265 A:xa,tf—d Casualty ins Co 29424 arsvRm ERD- CUBICLE CONNECTIONS INC 127 CONANT ST DANVERS MA 01923 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 BY 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. FNS- r}P£OFLVSVAM'C6 L— POLrCrAT+# - CrEF'F' FbVJSS OLDD COMMERCIALGENERALLMUNUTT EACH OCCURRENCE GtAIM&MADE❑OCCUR DAMAG£TO RENTED PREMISES EB asunaoce MED EXP(My orepersan) PERSONAL 6ADYINJURY GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY a—❑LOG RODUCTS-COMP/OPAGG OTHER: S COMBINED C AUTOMOBILE LIA91LnY O !NGLE LIMB $ MBINED ANY AUTO RT(Pee person} OWNEDAUTOS LED 60DILY INJURY(Pee accident} AUTOS ONLY AUTOS HIRED NON—F. --G,AUTOS ONLY AUTOSONLY IPara .) UMBRELLA Dan do OR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE NrroNA _ X ANY PROPRIETOWARTNERtE)( 1-1— YIN EL EACH ACCIDENT L 11,000,000 F-1 1A IOERtb1EM@ER EXCLUDED? A I.NH) 76 BEG ED1185 G7/30/2016 07/30/2017 E.—ISEASE-EA EMPLOYEE 1,000,000 (DESCRIPTION OF OPERATIONG blow E.L.DISEASE-POLICY LIMIT 11,000,000 DESCRlPitAN OF OPERAnONS/LOCATbNSf YEwcLE$(ACORD taf,Atlditlonal Remaeks Schedale,may 6a aHachail it more space is regWretl) Those usual to the Insured's Operations. 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. Mentor Networks atJTHORIZED REPRESExramE 1600 OSGOOD ST NORTH ANDOVER, MA 01845 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ., w Sy 5q 41 771 a ; y� 3 sl , qz Y Y r p � P s 1 <9 s t � 6z