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HomeMy WebLinkAboutBuilding Permit #702-2017 - 299 MAIN STREET 1/11/2017r VA BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATI N h7 Permit NO: ul�� Date Received Date Issued LOCATION IMPORTANT: c1 ✓34 to ),. /1 5� OWNER int must Cf�-M aplete all items on this Print -MAP NO: 5 %PARCEL:ZONING DISTRICT: Historic District Machine. Shop Village r1 rno) - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential tl ew Building Q ne family Nddition fit wo or more family ^a ndustrial 03 Ite No. of units: Ka ommercial t', aair, replacement flp Bldg --Mothers:ssessory Memolition nP ther epticEq ell loodplain etlands NJwatershed District . ater/Sewer ?'A�� psi -J�-��<e S �►,�. lam/ �i`-�/� �'—es1r Y N T ASk tl ,9r -z,`, s�, nr/e s t girls �i Identification Please Type or Print Clearly) OWNER: Name: ,°AJA C&m glh,eA Phone: F—Are re rim ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ka®O FEE: $ / O Check No.: u Receipt No.: r Y / NOTE: Persons contracting with unre§istered cogtractors do not have access to- the guaranty fund of .k, e C. — . - s , N Permit No#: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Ih+o loci iorl• _ 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 Se .ticFVVefI �-Floodplain n Wetlands` `' Waferstied Dsf�icf' _UVater/Sewer ' y DESCRIPTION OF VVUKK 10 bt FtK1-L)K1d1tU: Identification - Please Type or Print Clearly OWNER: Name: L\r4r4rocc- 0 Conttzactor Name::... - ;.-_ - Phone:. - Supervisor's Construct�on;Llcense,A�z4EXpDater �5-' Home Improvement License...: Exp --Date ARCHITECT/ENGINEER Phone: s Address: . Ko. _ FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. -- _.Total Project Cost: $ FEE: $ Check No.: Receipt No. NOTE: Persons c®hitracting with unregistered contractors do not have: access to thea anty fund �iririati iFr�: rif nP_r 8 cinature OT Contractor- Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ •TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swim,g Pools ❑ well ❑ Tobacco Sales - ❑ Food Packaging/Sales 0 Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS WEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plaoning Board Decision: Comments I ._. Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town. Engineer: Signature: FIRE DEPARTMENT'- Temp Dumpster on site yes Located at 124 Main Street Fire Department signatureldate COMMENTS - Located 384 Osgood Street no iimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop.requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine Doc.Building Permit Revised 2014 F Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Piot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 'VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy o CContr act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Location a qq V� A, N S No.—? 0') Check # 0 f -W- -, MMU Date i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $_J ' Foundation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector own of Noilh Af , er ayment Date �vk;,Jnesday, January 11, 2017 leposil Number ! 701111 )peratoi Goktnitwl; pc 1 ll�G INSPECTION) $105.00 Mal Paid $105.00 ;ash $105.00 �hange $0.00 �eceipt Number gov00005258 tl 112017 10:09:27 AM ;ashierld. treascoll-17 r . A 1 FE Plans Submitted (10 Plans Waived °f Certified Plot Plan °� Stamped Plans La TYPE OF SEWERAGE DISPOSAL Public Sewer 1 av 1Tanning/Massage/Body Art I on I Swimming Pools ¢� 4G E$ Well Private (septic tank, etc. °`' Tobacco Sales °� Food Packaging/Sales Permanent Dumpster on Site 1001 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMENTS DATE REJECTED DATE APPROVED a� as CONSERVATIONF1 F1 " oa COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED 1001 1 oa Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments ' Comments Wa$er & Sewer Connection/Signature & Date Driveway Permit • Looted at 384 Osgood Street FIRE`DEPARTMENT Temp Dumpster on site yes_ Located at 124 Main Street Fire Department signature/date COMMENTS no CD � Z CD O CLr C O 00 CD o- r r CD O �, tD —v CO CD N CDD O c� M tt m --1 'M V+ z Z Cl) C C 0 'O — = —I 00 = O rr cn cn 5m (D• C CD 0 CD �� 3 m 0 _ Z p O' O•� N O O in, rt . N• TI o o CL 0m Cph � CD cn m cn 00 �' (1)o —i ��N. CD CD v 1 5' Cao to cn p O Q7 (D (D C (D21 ,a O < (O CCD o Fy N?� �— cQ v, C CD OZ O IL O " D o N O 0 � �. o � _ `U) Q < � o y O C O Q O O a CD C (D r N CD Dd O � 00 )vat r � A�� •5 ] r • C C CD CD N O rt — O � >m r fu As o" � o CL Ln 3 O X- K N �s O z p W C r m M m z T j' 61 O C Oq czi� m n O a 3 N < O 0 N S m m f� rn— z N m n T 7 N O o 3 r C z G) z N m T �' N C7 3' N < 0 p C S 9 T O O d f °M :3 W C m z z N m 0 (D '6 _ n Ln T O O 0. 7\C =- W G O „ m x 0 0 ow 0 c Timbedine HCP Shingles Help improve your home's resale value With Timberline 'HDD Shingles from GAF. TimbeflineO.High, Definitiono Shingles with Advanced ProtectionO Shingle Technology are the #1 -selling shingles in North America. Timberline HDO Shingles will not only protect your most valuable asset but also beautify your home for years to come. Calors Av4able In Your A ­ em Wrong COY? Changs Location Timberline HD - Borkwood Timberline HD - aiscayne Blue Timberfrie HD - Charcooi Timberline HD - fox Hollow Gray Timberline HID - Hickory Timberline HD - Hunter Green I imbeAne HD - Mission Brown rmkph— 14r) - r A.crer rz—, NORTFI SS�E� �2 g` °p Town of North Andover 7-7 Machine Shop Village Neighborhood Conservation District Commission 5' A C;H •PP,�O' 1600 Osgood Street North Andover, MA 01845 SSACHUS� Application For Certificate to Alter Instructions: Fill out the form below and submit to the Machine Shop Village NCD Commission Chairperson(contact info below). The goal of this application is to provide a clear understanding of the proposed alterations, and how they vary from the existing conditions. Your application must include photos or plans of the existing conditions, and plans or drawings of the proposed changes. Include product & material descriptions for both existing and proposed conditions. Discussions with the Building Dept. or MSV NCD Commission are not a substitute for filing an application. Date: Contact Name & Address: 3� HJIA**n 57 T� 00 ,..., ,ter Iq 01874 Project Address: « C17 /)? 19"'t, St A oder Project Description (attach additional pages, if needed): s+fc0 q-6®�- id s rte,l�. fi3 3 i4C4 Pd-cLect-,,,C fay.a� R,Qp�4Ct �.S,o°- tJL"A-- OZec j4lid 4.4. &xds InfXormation Provided: Photo/Drawing of Existing Conditions Photo/Drawing of Proposed Conditions Description of Existing Materials Description/Catalog Cuts of Proposed Materials to be used Other Information (describe): tLsc ft CL46o its a taro a of &W �7" —t-^ L&A, 4,Co_ C-A&V Aa &. A i M f+nY GdoVc tar 1"6 le Tk MSV NCDC Current Chair: Liz Fennessy, 77 Elm Street, lizettafennessy@yahoo.com, 978-688-2915 PROPOSAL - iia PROPOSAL SUBMITTED TO: NAME L(nd C �cl ADDRESS PHONE NO. 5'7g�s s3 WORK TO BE PERFORMED AT: DATE OF PLANS ARCHITECT PROPOSAL NO. SHEET NO. DATE 02 We hereby propose to furnish the materials and perform the labor necessary for the completion of S2c 81Z A,6, --c ex V c S All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of Dollars ($ with payments to be made as follows: �T Z&J �pw✓� G vvv A w t�/��yr0� Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents, or delays beyond our control. Note - This proposal may be withdrawn by us if not accepted within L—p—days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature J - Date Signature _ MADE PROPOSAL adarre MADE IN USA Massachusetts - D epartment of pu, OGTT lauilj- ,,-;r"g Rle.&_ fie Safe, ..t mens Ly ard- License: CS ra.-j-11uh- f FA-O7O432 DAVID E Sr 4 LWool) IRIS , TE -AVEg 'UR-Y WA Jt'I 411` CO Mm'sSiOner Expiration 91123/2017 J::jnCA Re off. ce Of ECO ns X 80M14prerAtfairs Busir Type:roEWENT C0V ;e. "u'�"n lndjddui 3ACron SchRe 12 -660 -660 L)aWcf a D ufu aWd chaufu S 121021261,9 4 Hazelwood S - Tewksbury 'p 0 -Z Un�de._ rsecre lary North Andover MIMAP December 23, 2016 (042:0 001'9'; 0421660 W 31 0 ;0,019 031' Q 0007 r a042:0 0026' 9 ELM ,SST X28=MA :SI-? v 31:0=00201 rs _.. -- 031001=" 0411 9 RiCHARDSONgYE " "°" "�'� ^� 10$EL�M S 30000021 s042,_0,�,002 (042_'0 0_027 26'�P�ILGRIMJST . 9 ELM ST 031:0 0040 031'0 0039 f32�P�ILGRIMtST� 295 MAIN 5? � �,i'j 6PILGRIM 3TTT --@RIM/_ -.. 042:0 0032r �. c031' 0,x0043' "' `. - `: E 3 fLM 5T _./ (031"0=0045' �s +042 O 0029 :�-•�, 299 M. AI NJ S j �`�. STSMAIN S MI6T-0- 62 N ?0420=„0033a R'4_: 9 ,6-6 1 —ON - r? r ;043rOT=0035 3'1 0"0 364 MIDDLE ESE CTf 4340-00341 03`f 0 00444 il$GREENEjUT .y r `031;:0:0047 , i43 MIDDLESEX S�Tj M�aa�ese .O MI�DpLESEX T? r Sir 032'0r,000"1 043'U=004'41 eek f31�rMIDDLESEX>fST�' 1�1�,GREEME; STS - 1,2 M�,IF�FUNNDRQ, t043c0 0032 F032:O e000Z 23 MIDDLESEX$;T� 032 0 0008 443iOm0001 ^ 0,43 0 000 15� DDLESEXTTTTTTTTT p125 MIFFLIN DR JQ' ;0321 003' �� 1144�MTF�FaLIN,(DR�(n N 7'MIDDLESEX St b 28 MIDDLESEX ST (0-63,0;7, 002" c �`��C 03_2:0=0_009' 032`0 0030'1 20 MIDDLESEX ST" �- SO WESTf BRA�DS�Tr�RDp / U 03,2:0 0048 (.0320 0049, f 043:0=0003 ,_ 1�2MIDDLESEX ,032'0 OOb4, F40�WEST BRADST RD= S 043!0 0004 0 MVPC Bo Zoning Overlay Zoning © Adult Entertainment Dlsuic O Busine Municipal eountlary 0Machine Shop Village Ove d Busine s 1 District s 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, --Rail Line 0Watershed Protection Dist O Busine Interstates 0 Historic Mill Area O Busine Interstate 0 Medical Marijuana O Gene — Major Road 0 Downtown Overlay DisMx G Planne 0 Historic District a Conid s 3 District s 4 District �►ORTH Business Distrix Of «tt° '�� Commercial Dev r e�< ' •e 00 Development Dist Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affaim[MassGIS. The information depicted on this map is - - Roads 0 Osgood Smart Growth (40 O Conid t r Easements O Hydrographic Features O Conid Industri ,; L Development Dist O .--- •'” - A Development Dist p I 1 District i for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY Parcels EI Streams tl Industd 12 District i L ^ ♦ OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT =: Wetlands O Industri 13 District i o'+ "A M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF O Industri O Exempt Lands Reside 0 Reside I S District ce 1 District 4A,°+♦ri° •�t49 -2D istrict SSACMU$8 THIS INFORMATION O Raside ce 3 District A de 1" = 106 ft ^q }<de YYY de ce 4 Distrix ce 5 Distrix fi Dis[rix ,„ege ce esidential Distrix The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, Mf102114-2017 ,Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Lf lectricians/Plumbers. TO BE FILED WITH THE PEI21V1ITTING AUTHORITY. Annlicant Information Please Print Legibly Name (Business/Organizarion/lndividual); �� ,�-1'►�`E- � ,g S C 4 S.0 a Address: V I/ t'J,._v A.---- City/State/Zip: T 3 � �t= P1 * p�'?i Phone #: 7?oo els' 5-S Y3 Are you an employer? Check the appropriate box: Type of project (required): 1 �Yam a employer with employees (full and/or part-time).* 7. ❑ New construction 2.❑ 1 am a sole proprietor or partnership and have no employees working for me in 8. [] Remodeling any capacity. [No workers' comp. insurance required] 9. [] Demolition 3Q 1 am a homeowner doing all work myself. (No workers' comp. insurance required.) t 10E] Building addition 4Q 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 1.1.[:] Electrical repairs or additions proprietors with no employees. 12.E] Plumbing repairs or additions 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13oof re airs 'These sub -contractors have employees and have workers' comp. insurance? p 6.0'We are a corporation and its officers have exercised their right of exemption per MGI; c. 14. Q Other 152, § 1(4), and we have no employees. [No workers' comp. insurance required.) *Any applicant that checks box HI must also fill out the section below showing their workers' compensation policy information. } homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing ivorkers' compensation insurance for nay engVoyees. Below Is the policy awd job site information. Insurance Company Name: f % r, Policy # or Self -ins. L'ac. #: W C C SOU — S-0 � 5— ..—Expiration Job Site Address: o2 9q M,44 S- 40.144 City/State/Zip; 17 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifict. I do hereby Phone #: EY " el. = ;7-1/3 that the information provided above is trite 71,11 d correct. —` nater Id -1 o?2 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): ; 1. hoard of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: OP ID: WC A� o° CERTIFICATE OF LIABILITY INSURANCE DATE(M3/20 6 12123/2016 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 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 lieu of such endorsements). PRODUCER Se reve & Hall Insur.ASSOC.Inc North Main St Andover, MA 01810 Patrick D. Hall CONTACT NAME: (A/CNE, Ext): FAX PHO305 No): E-MAIL ADDRESS: PRODUCER JRCBU-1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED JRC Builders, Inc. INSURER A: Commerce Insurance Co. 34754 PO Box 911 Tewksbury, MA 01876 INSURERB:AEIC 11104 INsuRERc:Arbella Protection Ins. Co. 41360 INSURER D: INSURER 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 CONTRACT OR OTHER DOCUMENT VVITH 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. TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 rA X COMMERCIAL GENERAL LIABILITY WE PREMISES Ea occurrence $ 100,000 CLAIMS -MADE 1XI OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 BGPPZQ 0610912016 06/09/2017 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) C X X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS 1020020157 0410812016 04/08/2017 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (PER ACCIDENT) $ X NON -OWNED AUTOS X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ A EXCESS LIAB X CLAIMS -MADE CP417301-15 06/09/2016 06/09/2017 DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N 1 A WCC -500-5011685 01118/2016 01/1812017 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NONTI{ Ot,,.ao y�MO 0? ' ' to Town of North Andover ' Machine Shop Village Neighborhood Conservation District Commission �,s •��� 1(100 Osgood Street Nordi Andover, MA 01845 S�cNuse Application For EXCLUSION From Certificate to Alter For Items 9,10 or 11, provide the following documentation: Photos/drawings of existing doors, windows or siding, as applicable S<,,Description/Catalog Cuts of proposed materials to be used for doors, windows or siding Plan and elevation of reconstruction for Item 11 Determination: This project is determined to be exempt 0 not exempt from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects that are not exempt must complete the Application for Certificate to Alter, available from the Building Department and be reviewed by the Commission. Determination madf by: Signature Neighborhoo C servation District Commissio C� Date Page 2 Current Chair: Liz Fennessy, 77 Elm Street, lizettafennessv@yahoo.com. 978-688-2915 Scanned by CamScanner NO�T1t Ot ,ao y,ti0 O �� ' `; Town of North Andover •� : Machine Shop Village Neighborhood Consen+ation District Commission 1600 Qs ood Strect North Andover MA 018,1~5 sAtwusf� g r Application For EXCLUSION From Certificate to Alter Certain alterations are excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects must fill out the form below and submit to the Commission Chairperson (contact info below). Date: Contact Name & Address: .,1 R -C. 6o dd-&( s Project Project Description (attach additional pages, if needed): Exclusion From Review Requested For. ❑ 1. Interior Alterations existing conditions including materials, design and dimensions. ❑ 2. Storm windows and doors, screen windows and doors. ❑ 9. Replacement of existing substitute doors, substitute siding or substitute ❑ 3. Removal, replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. ❑ 4. Removal, replacement or installation of window and door shutters. ❑ 10. Replacement of original fabric windows or doors with substitute ❑ 5. Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area. architectural integrity with respect to form, fit and function of the original ❑ G. Removal of substitute siding. windows or doors. ❑ 7. Alterations not visible from a public ❑ 11. Reconstruction, substantially similar in way. exterior design, of a building, damaged or I IJ 8. Ordinary maintenance and repair of destroyed by fire, storm or other disaster, provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCDC Page 1 Current Chair. Liz Fennessy. 77 Elm Street, lizettafennessv@yahoo.com� Scanned by CamScanner