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HomeMy WebLinkAboutBuilding Permit #396-13 - 59 ELM STREET 10/28/2013 TOWN OF NORTH ANDOVER // APPLICATION FOR PLAN EXAMINATION qq6Permit NO. b Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page ;.. LOCATION v rt PROPERTY OWNER !Q L VC- Print 100 Year Old Structure es no MAP NO::::�� PARCEL: ZONING DISTRICT: Historic District es no Machine Shop Villag ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ZVRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer pESCRIPTION OF WOR TO BE PERFORMED: ylre� 3 lv vt-s 1 40taw. SS-e 5TH\&A Identification Please Type or Print Clearly) OWNER: Name: ,- Nk e C u c Phone: Address: CONTRACTOR Name: .5"- Phone: CJ Y? Z o Add ress: 3 R -- �1 0 Q-yx C C% � c r Supervisor's Construction License: g6 J 5 Exp. Date: Home Improvement License: 1 3 Exp. Date: t t P 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: $ ` 0, Sao . FEE: $ 1 0-1-C;, Check No.: ` S�3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Sigature of contractor �-- Plans Submitted 0 Plans Waived 11 Certified Plot Plan 11 Stamped Plans ❑ Plans Submitted'[] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF SEWERAGE:DISP.OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc..- ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE_APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments .r Water& Sewer Connection/Signature& Date Driveway Permit DPW Tow;2 Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT --Temp Durrlpster on site yes no Located-at 124 Mair Street Fire Departmwit signatureldate COMMENTS J. Location G5% N Date/© ® TOWN OF NORTH ANDOVER e e Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ � 'D TOTAL $ w p , r Check#. TS—') d j - • Building Inspector AC(MTEP 10/15/2013® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD013 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 CONTACT Sarah Brussard NAME: —.._. CTOSS IrisuranCe-PeabOdy PHONE (978)532-5445 q/C.No:(976)112-2217 AC_139 Lynnfield Street ADDAIL RESS:sbrussard@crossagency.com INSURERS AFFORDING COVERAGE NAIC Peabody MA 01960 INSURER ABerkle Risk Administrators Co. INSURED INSURER B-Merchants,Mutual Iris CO 23329 _ JNR Gutters, Inc. INSURERCA I G ai 1 38-40 Lancaster Street INSURER D: _ INSURER E: _ Haverhill MA 01830 INSURER F: COVERAGES CERTIFICATE NUMBER CL1310994770 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. ILTR EXP I TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DDfYYYY MM DDEFF Y/YYYY LIMITS LTR GENERAL LIABILITY _ EACH OCCURRENCE S 1,00 ,00 r3AMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABIL11 Y PREMISES Ea occurrence $ A CLAIMS-MADE Fx—1 OCCUR CGLOO50174 7/20/2013 7/20/2014 MED EXP(Any one person) $ 5,0001 PERSONAL 6 ADV INJURY $ 1,000,000' GENERAL AGGREGATE S 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,0001 X POLICY PRO- LOC II S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY(Per person) S B ANY AUTO 20 L.000, ALL OWNED X SCHEDULED MCA7015134 6/21/2013 6/21/2014 BODILY INJURY(Per accident) S 40 000" AUTOS X NON--OWNED Pe a RTY DAMAGE X $ HIRED AUTOS AUTOS PIP-Basic $ 810001 X UMBRELLA LIAB , OCCUR EACH OCCURRENCE $ 5,000"0001 A EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION$ U0050684 7/20/2013 7/20/2014 S C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500 OOC OF BER EXCLUDED? NIA C009774192 9/20/2013 9/20/2014 (Mandatory in NH) E.L.DISEASE:EA EMPLOYE $ 500 1 OOOl If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 '000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Refer to policy for exclusionary endorsements and special provisions. 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. For Insureds Purpose AUTHORIZED REPRESENTATIVE Timothy Tramonte/MD1 r,?-- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. iNS025l9ntnn5l m Tho Ar.OPr)name nnrl Innn arc ranictararl markc of Ar'r)Pn Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-080515 KEVIN M FRANCJS 64 GROVE STREET Haverhill MA 01$32 •J,,�„� � Exptrat:on Commissioner 07/21/2015 ss ulation off-lee of Consumer Atfairs&BustnCTCRg HOME IMPROVEMENT CONTRA Type: Registration: 108503 private Corpor.`.c 3 Expiration 8/1912014 GUTTERS,INC. Jonathon Raymond ` _- 38-40 LANCASTER,$$ Undersecretary ' iiaverhill,MA 01830 OORTH Town of ndover O - 0 No. 6_ 1� Z oLAK h ver, Mass, 10 a8 13 C OCMIc Nl me K �.9 AERATE D S U BOARD OF HEALTH Food/Kitchen PERMIT T . D Septic System THIS CERTIFIES THAT ...*4W... 6.:4,. ..................................................................... .. BUILDING INSPECTOR .......... . .. .. has permission to erect .......................... buildings on .59......Ofn.....5'T.................................. Foundation Rough to be occupied as ................ ... .......!'...... !! ? . ....-r.................................................. Chimney provided that the person accepting thi permit shall in every respe t 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT I N S ARTS Rough Service .............. ..... .. ... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE • 7777���1111 JJJJJJ - J*No GUTTERS INC. HIC#108503 All Types of Home Improvement www.jnrgutters.com t 38-40 Lancaster Street•Haverhill,MA 01830 k k Haverhill,MA: (978)372-4088 Nashua,NH: (603)595-2272 ' Andover,MA: (978)475-3723 Portsmouth,NH: (603)433-1811 Woburn,MA: (781)937-4212 Manchester,NH: (603)666-5502 Natick,MA: (508)653-2200 Dover,NH: „ (603)740-30Q9 Boston,MA: (617)423-3559 Rochester,NH Lakes Region: (603)335-0068 Toll Free Nationwide:(800)966-9238 (74741 Fax:(978)372-0360 PROPOSAL SUBMITTED TO PHONE DATE I —• STREET JOB NAME +�: C ULl]LiJlf�i:tlll L TY,STATE and ZIP CODE JOB LOCATION i C prayaSie hereby to furnish material and labor-complete in accordance with specifications below, for the sum of: i l'Icit i1"foo';attd l -1 :Ft L)'%I1.II`• and `" 1k,l) dollars($ ). Payment to be made as follows: i CD. ,I Authorized c � Note:this proposal may be Signature _ withdrawn by us if not accepted within days. Scope 01 wor C We hefLby submit specifications and estimates for: r Tarp and cover all areas :9t wor:(area to l.31p striping. a Rennov(. oxi.'Aing roofing syst:ern fi7t3'oin to ro.?i,.t , rT _, 4 Check existing sheathing and replace unci ; zr ri install 2 rww s of Ice and `J Ai r SWCld alnng 00­:a. I minimu!y) Of 12" V-0 411 o6joirimp %,vall-, ncvj stt p fl.,hing A 31l ( f tIe'; linAali a" white aluminum drip edgeto all e',,2crios I--- water Shield over exposed etdg, of drip edges. Inr,011 3' ic-- i#id pntvr slit c,d or'nt)nd at' In,:'tall i.^.'%. ripe Flanges itYSL nd t Snicit I;10 xatwto rcri.-ming roo, :,urfi.:vc ",ta## r. i� t= Tir, b'�t:t '_t. ttf'IG .:lila,: �i •;r•'11it�t::Lfr4�) !�'-'-tf+it'"�''v`,t tO rCi�'t �'U'"f2ci t ;i;i1^;f r:; ii' .�_ 1. - ... � I ^t`','Ck ridge . Vgnt Ioi )3;opc, ".nti#si:lC n anll.: C. ik I i e J -it-R•'Guttzav;t„in't b,_ 41old rasponr-ibi-. for 6c'-, . j rc:orom,'7nd ie'rl ovj,' and or COV:3Ving any %la'? Orr. : lc in job Ac 01 d d-H!", aSi'-. 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