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HomeMy WebLinkAboutBuilding Permit # 3/2/2017 BUILDING PERMIT of`�or sRr TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � permit No#= Date Received SA ? Date Issued: IlY ORTANT:Applicant must complete all items on this page LOiAT,I@N oil ! PROPERTY OWNE-`R s f YPnnt �L Print JOE)Year Structure 1z, no MAP PARCEL:- ZONING DISTRICT: Historic District s no Machine Shop Village no TYPE OF IMPROVEMENT 'PROPOSED USE Residential Non-Residential ❑New Budding D One family n Addition Rfwo or more family ❑industrial ❑AlterationNo.of units: ❑Commercial I ❑5epair,replacement —�D Assessory Bldg D Others: V'Demoliuon i E Other _ I ❑Septic ❑Well 0 Floodplain E WetliD Watershed District L7 Water/S�ewer I DfSGRIPTIOJ OF WQRK TO BE PERFORMED: MJJ(n J Gt r it Yg t} k YN d ty 7 Identification- Please Type or Print Clearly OWNER: Name: �?o .rl tA�• ( 3 u l Phone: ;? -�;-'�`L�`�>'� Address: Contractor Name. D;Vt,-t Phone Z, -e- Address: ! t, ✓� y Supervisor's Gonstruction License: CS 022.9.7' Exp. Date.- Home ate:Home Improvement License;._ 1C� `�z Exp. Qate l/ yJ ARCHITECTIENGINEER jea/ y �',?W4/ Phone: Address: ft1e-)`9J'aV Reg. No. r FEE SCHEDULE:BULDING PERtAIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. frotal Project Cost: Check No.: Jos Receipt No--__X NOTE: Persons contracting 1vitlz unregistered eantractozs do not have ss to the auc c ttty fund __ .. - _._.__. Signature of AgentlOwner Sig nature 6f contract Town of 2 "°�T" � Andover wi— * h ver, Mass, 3 W a 4/ �s,9 A°pareo rpa�w0`i S U BOARD OF HEALTH PERMITTO I L UP"k Food/Kitchen Septic System THIS CERTIFIES THAT 1 ,]R ,, ,V BUILDING INSPECTOR has permission to erect, buildings o ..,..9.�.... „!,.�'�,x,T �� Foundation wARough to be occupied as,....,,..` .0.......,....Q�•�1..R.'.C........... . .►�.[.. ........ 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. ` E v Rough Final PERMIT EXPIRES ITHS ELECTRICAL INSPECTOR. LESSCTI A Rough Service ................ .... .. .. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t4 Rough Display in a Conspicuous Place on the Premises—Do Not Remove Final No Lathing or Dry Wall To Be Dune FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector, Burner Street No. Smoke Det. sn.+o Ktrc-E.. n�dL �D ! DEMOLITION NOTES: Y. __ e , r ttl °»e Pie A ��1�1�WE��Y rwE voRc sHaaL Be PeRPorsHeD auoeacNG TO THE R QUiREMEN S WHICH A_AE STATED ON THIS SET QP DRAYf2NG5 \ 1 [INSPECTOR 1 t GAix f B.PAY REQUIRED FEES AND 6 CARE PERMITS. � $$ - C.SE LEG-IV LY DEMO ISH AID COM'E.E'Y �DATE REA.OVE ROIE b TE I ENS 5CH Di,e0 ON TkE F qat p C {{}} eticO_3 \ ORAYfiNG SPEOIPInO HEREIN,DEBR 5 YD INSPECTIONAL SERVICES N K \ ITEMS IDENTIFIED BY OWNER THESE 1���/A� Cn�Flt] ANDOVER �a� ITEMS RECO E THE F,111ERTY BP HEU'llGENERAL TVYYI•Q!'Itl6t(`iTl°1 HltlpOVER n 3g FOa LIQa�A5 ReOO .. CON'Rk .QR NCL'JOES INTERIOR AND EX. R!OR. �. D.REMOVE S R4 AND PROTECT FROM D—AGE, NOTE �1 A GC,TO CT ONCE S A D-I Qe ARE'111THRI- REL C IO NOTED ON THE ORA;•[NQS FOR RELOCATION OR RE-DSC ARCH.-EC OJCE WA_LS Ati0 GES_lN9S ARE R.yOVeD. [ t9NfiN2 y .?�RY REMOVE—t AL EX15.USE OR AS 4EGHANtCA d Fll4DNG O. $N JSE QR Afi IhDiGATE V REM VE€ .NG CE INN AND LIGHTING LI FtR 'WHERE INDICA ED. _ aYace G.DISPOSAL S4ALL BE DONE LEGA LY,IN y Vl1 \\ € "N,._ .i• D +SGT s COM iANCE WITH LOCA ORDINANCES AND NOLSTATE NYIRONh EN`A- R GULA:OASY. . \\ H.GC.TO FIELD VERT A• ExIBTING CONDITIONS PRIOR TO CONDTRVCTION. -9 yL REMOVE ANY EGUiPd_NT AND DEBRIS PROM LI Pe.¢ R_PAunr_ xP MES EXISTING HOUSE AS INDICATED . P vA_.? ------ REM B i0 c s As v_Oo JREMOVE PORTION OF EXIST.4.'ALLS AS IN G De �y <.ALL TRADES TO PROV-OE EAf e CONDITIONS -rt¢KO 4.RSP=, a RING PE40. (TTrt P"I 1 i REPLACE ALL EXISTING WINOOYfs i T0 FOR NEW LAYOUT AS SHAWN 1AYOUT-11P - x ,u• na xD 9EQYO45LL _- — Venn . seuove exts csme AN Il�AS LAYOUT PRRA �oR Rm P N.AA t S:­ Y -.. kE t.A6Q13Si I 7r[ f I— I �� • q w ac c ove < i W i ? u. O o H tiB. I O 1 SECOND FLOOR PLAN -__PAwam �' b Z o W 4 ({j I .j •• ( 5_29A4�f. 1 z C4 SCALE,Mr-r-w IALL C01-111 Ce^ICE I :i it ANP =POT ( I= 'C#Pi91G TIAS � i � t55UE f4R R43GIkG el—el Al I LS'.f9<ffi CRSR{TICY A E. ORA G5 Rk9n .:oa v0_ i>c9.P� P_. PIR,P fAAve M2 THIRD FLOOR PLAN o-1 SCALE V4NN RA,N No D- 1q The Commonwodr h of Massachusetts .Department affgdastr ial ccideents X Congms S`ttteet,Shye 100 Boston,MA 02114-2017 www massgovldza . �axkers'Compensationlnsuranee.t�.ffcd�PIIuYIITTL�O,AUIECOTtTr�'-f rxcians/Pl¢mhers. . TO711M 'am EleasePr3nt T 'bI A WirantwormationnA 6 (Vt (BvsinesslOigariizaizonllndiva-dual: l Y I[JCA PVt t W, 1!If Address: C 1 !�6 u o,r�� Mfg Phone#: hisp—V6ra�71¢�l cxtymtatar�z : t Typo of project(FeQoue -Arepon xn empioper?Cpecktiie agyn'opriafebnx: 7 i—i j�e",id6natrWfton z,�Tam azmpioper wife emplo3'ees(iuA anatorPflT(:-tial;'� t—t 2-❑Tam aso]zProPrietororp:-r7ne�sbiP andbaveno employees Wodrmg formein 8.0Fume deivig arty eanac�.jNaworlm-m'comp.innsmance ragaixed] 9.Q DeIItoli7.ort e` owarkzrs'comp.msnranczreyaired]t I o 0 Bading addition 3.❑Iam ahomzmnnea'doing allvrozkmYs lx.� ro twill oracyrs to conanet all�vndc onm}'F PzY• 1L❑Elec�i.cairzp�irs ox additions 4.QTam zaomeotvnr aadw.dlbelxi*+ngcssdan sole t7xzf all co�xayNi's eidserhaveworkexs'aomp -giTmbsng repa}rs or additions I���r�ricmmwhhm effii!T°3'� 13.[]Rooirepaits 5, amageneraS conhaetor andTt�av ers andhaveu�uzxs'co p,nsmancv;atiacdred sheet ��❑Other Theszsab-confr�xslxaYe employ tnfmxemFSonaerMGI.m 6,❑'V+.e axe acorpersliop.andis.afficesharc axeraiseatbeisrigh . Y52,91(4},and'S�lxave no emploS'�-(�'a�rortZzs'comP.msfuance tegiired-] - *dnpanpicarsthatcheo��oz�S snst 21so 5ll autffieaactionbrSow$ow;nS�eswo-rke-*s'c:-+mpensafionpalicy']rfom-'ano.r"" a;fd�vitindiceting tSzeY are doing atiwxkandthenhire orJsida contraztozsmxrst s¢bmiEanew a$ida��dieA„tyvg yew i Bomcoftves who su'b this,- ?Cox�tacfors 5xat cheek'�:,istiozrimsE atta%lied'snamtio�P a'n s,-P.policynrm�brrandsfstewhethet aFgaifhos entif .-. .- emnloYaes.Tfthn subrcaNssckars bane earploy..s, `S' X ttm an employer that is grovid ngtvorkers'eompmNat on znsurancefor my employees.Betow is LYzepoZr y¢ndjob s is information. insurance CompauyNaate' _ gxpirahonDate• Poficp r1#or Seif-ins.Lia#:. City/StatefZzp: Job Site Address' olicy number and expiration date). Attachacopy o£thev�orkers'eompeosA.:r oLo, deelar5Ai gaga{sho'wingtmp ablob aerie to$1,S00.00 Pa lure to seouxe coverage as requu�du n1erMC i o enaW152,_,nth,forra is a cra ST violation punish Y and(or ane-year hoi6sonmont o£lus-woRasfa eraent may be fosw ded to the Office op o In est ga ons o£the DTA£or nsurau 0 a day against the violator.A cops coverage verificatiau. Elie awns and nal' afperjury diet t7 e srzforrraatior,protri-dsdttltave is true crga correct. I do hereby certify p f Data Si ature: S'ra — Yot�—73 a g Phone#: Dfjac3al use only.-Donot this ,,,to be completed by city or town officw.. PerznitJt,icense# City or Town: fsgujugAuthoxity(eircleone): ector 5.Plumbinglnspector 1.Board of Health 2_Build agDepart Dent 3.CRYMown Clark A.ElecEzicallnsp 6.Other Phone#: ContactPerson: �1 MODERA OP ID:RC ,a�oRv CERTIFICATE OF LIABILITY INSURANCE QATE(MMIDDVYYV) 03/0212017 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(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 NE O er CT Cif[rIS1hE.i3rown Durfee Buffinton Ins.Agcy,inc MAPNONE —� 377 Second Street tAtA�,Na,E q,508_67S-8486_,. Wc,No}: Fail River,MA 02721 p0pARL RE5S Christopher E.Brown -- - ---- __-- --_ _. i INSURERS}AFFONOING COVERAGE �_NAICa INSURER A:Travelers Insurance Co. INSURED Modern Construction Services InsuRERa _ _ _ 91 Elmicrest Road -INSURERS:--- No Andover,MA 01845 - INSURERS: I INSURERE _ IMSUREft 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 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. INSR1 -- TVPEOFINSURANCE �7AUDI.SUer1�- --�iMH/DDY YYFY�MM/1CDtYVYY LIMITS LTR' POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY t EACH OCCURRENCE IS 1,000,00 _. JCLIUMS-MADE(�ocLDR s80-70295143-17A2 0112112017=01121/201a �� � } 30D,Da S 6,00 PERSONAL BADV INJURY IS 1,000,00 I IGENt AC RFGATE LUAIT APPLIES PER. € GENERALAGGREGATE I5. 2,000,BB _POLICY _ I . ECT LOC I t PRODUCTS COMPIOP AGG I S 1,QDBrDD OTHERS , t AUTOMOBILE LIABILITY i COMBINED SINGLE Lruhr ;ANY AUTO I BODILY INJURY(Per Pe ) Is ALL OWNED j SCHEDULED BODILY INJURY(Per ql5 AUTOS ( AUTOS _ i IdREDAUTOS ;NON OWNED PROPERTY DAMAGE �- -- AUTOS 1P deny ,S .. is UMBRELLA Lige I I I T OCCUR i t EACH OCCURRENCE S EXCESSLIAB CLAIMS MADEtf_AGGREGATE DEO= TENTIONS i 1$ WORXERS COMPENSATION - ' AND EMPLOYERS-LtABiLITY YIN I ,STATUTEL ._.. RH ANY PROPMETORIPARTNER✓-tXECUTIVE I �LEAGH ACCIDENT I$_ .OFFICER IMEMBEREXCLUOED? ❑NIA! :(Mandatory in NH) ' ! I EL DI SE-_E.EM LOYEEI S it ycs tlescr:Cu under � _-_..E. DESGRIPHON OF OPERATIONS helox ! E.l,D SE SE-POLICY LIMIT 5 1 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,AddItkuhu RemaNd,Schedule.may be attached II mora space Ia required) CERTIFICATE HOLDER CANCELLATION TOWNONO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of No Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street No Andover,MA 01845 ALITHORRED REPRESENTATIVE Christopher E.Brown ©19 8.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ® OATEIMMIDOlYV- A�O CERTIFICATE OF LIABILITY INSURANCE 03!02!2017 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 CERTIFICATEOFINSURANCE 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,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 flea of such endorsement(s). PRODUCER "CONTACT NAME: Kathleen GBNBIhO j PRONE DURFEE BUFFINGTON INSURANCE AGENCY INC. x Ems. (508)67M486 AIC No: A nARESs; kcarvalho@durfee-ins.Com 377 SECOND ST. INSURER(S)AFFORDINGCOVERAGE NAICd FALL RIVER _ _MA 02722 INsuRERA: TRAVELERS PROPERTY CA5 CO OF AM 25674 INSURED INSURERB: MODERN CONSTRUCTION SERVICES LLC NsuRERc: INSURER D: 91 ELMCREST ROAD INSURER E: I _ NO ANDOVER MA 01845 1 INSURER F: i COVERAGES CERTIFICATE NUMBER: 131130 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. _ INSR TYPE OFINSURANCE ADDL SSD .n.-BER MMA) EFF MWID EXP DMRS LTR COMMERCIALGENERALLIABLLDY EACH OCCURRENCE Is DAMAGE!" REQ NTED CLAIMS ADE �OCCUR j.PREMISES(Ea o«u ! $ !MED FXxpUny ama , NIA PERS ONAL&ADV INJURY $ GENL AGGREGATE LWIT APPLIES PER t't GENERAL AGGREGATE $ POLICY 10 JECOT LOG i !PRODUCTS-COMPTOPAGG $ _ t_$ OTHER: i COMBINED SINGLE LIMIT AUTOMOBILE LU181DTY Eaa dm! $ ANY AUTO ' BODILY INJURY(Per penin) $ ALL OWNED r�SCHEDULED NIA i BODILY INJURY(Per acckmm) $ AUTOS TOS I t ;NON-0WNED r(Pa,ac TI'DAMAGE ;$ HIRED AUTOS 'AUTOS Perawtlem7 UMBRELLALIAE, OCCUR 3 EACHOCCURRENCE EXCESS LIAR CLAIMS MADE( NIA 1AGGREGATE $ DED RETENTION$ $ WORKERSCOMPENSATON v PER OTH ANDEMPSCOMP'LIA&LDY I 1X's STATUTE ER _ ANY PROPRIETORrPARTNER+EXECUTIVE YJNI EL EACH ACCIDENT A I OFFICERIMEMBEREXCLUDED? wAi WA WAI 7PJUB4330P98A16 07/2312016;0712312017 E sE-EA EMPLovEEi$ 1601000 Ltaimalia.",oeNHaar I C E _I _ DESCRIPTION OF OPERATIONS beiaw EL DISEASE-POLICY LIMIT $ 500,000 NIA I DESCRIPMONOFOPERATLONStLOCAMONSf VEHICLES(ACORD 101,Additlonal Remarks saimoule,may bea MaIR more apacela required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuantto Endorsement WC 20 03 O6 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This Certificate of insurance shows the policy in force on the date that this Certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationiinvestigations/. 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 No Andover 120 Main Street AUTHORIZED REPRESENTATIVE —'� t i 0; No AndovarMA 0'1845 Daniel M Crow ey,CPCU,Vice President–Residual Market–WCRIBMA @ 1988-2014 ACORD CORPORATION.Ail rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Fire Services Office of the state Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT nate: � / (!�Permif No 7� r/ L' of Town) 1f Applicable) Dig Safe Nnffiber� ,rdance with the provisions of MG.L. Chapter 10as provided in section 5 2 7 CMR 34 '" Stzsc Date emit is granted to: Full name of person,Firm or Corporation ;ionto locate dumpster for construction/renovation/demolition of structure dumpster be 25' from structure or covered with tarp or plywood cons: at end of workday .�,,,C.Crive location by street and no.,or escnbe i such neer as tM�adequ enon Ion ra location) G0 w llep re (SignaRtte of afical granling perm tpermit (Title) �"' TWI_q Pr-*mIT MI IAT R;:t r)MCPIf_I 1('11 I.q1 V Pn-QTP:n 1100M THF PPFMICFR '� Massachusetts Department of Public Safety ,. Board of Building Regulations and Standards License:CS-092297 - Construction Supervisor - DAVID W PAUL 91 ELMCREST ROAD NORTH ANDOVER MA 01843 M..nn I.JL— Expiration: - Commissioner 09/24/2018 /ec. uuen/ff lr:u�rcla;etl, Office of consumer Affairs&Bu ness Regulation License or registration valid for indiretul use only -ROME IMPROVEMENT CONTRACTOR before the expiration date.If found return to: Registration: 1MENT Type: Office of Consumer Affairs and Business Regulation i - 10 Park Plasa-Suite 5170 expiration: 7/8/2077 LLC Boston,MA 02116 - MODERN CONSTRUCTION SERVICES - DAVID PAUL 91 ELMCREST RD. - NORTH ANDOVER,MA 01845 UW rsecretary Not v li rithout signature