Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Permits - Permits - (17)
.. ... ........... NORTH , _TONM Of No. Qa . oll -0 - - - C1 _ L0. Clover, Mass.,o;-0-3 �. COC HIC HEwIGK V ADRATED �s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT6.05bYX �f BUMDING INSPECTOR ..... ...... '...:. Foundation has permission to erect........................ .. buildings on o�0, �avo .......... ..... ...........�.y. .......----. ............................. Rough to be occupied as-- +..... ....�.... ... . ...... . . . . .. . Chimney provided that the person acre ing this permit s�h II in every respect conform the terms of the application on file in Final 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 _ PEBIVUT EXPMS IN 6 MONTHS ELECTRICAL INSPECTOR LJNNLEss CONSTRUCT. STARTS Rough ................................................................ Service INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit NO: 6 ( Date issued: r IMPORTANT: Applicant must com lefe all items on this age LOCATION C S Print 0 )k&- " PROPERTY OWNER pint MAP NO: ZONING DISTRICT: Historic District ye n Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Non_ Residential Residentiai ❑ New Building o One family ❑ Industrial ❑Addition ❑Two or more family No of units: ❑ Commercial ❑ .Alteration ❑ Others: IRepair, replacement ❑Assessory Bldg ❑ Demolition [I Other pSept�c ❑'Well ❑F)oodplauft ❑Wetlands ❑ Watershed DF�frict D WalerLS evaer DESCRIPTION OF WORK TO BE PERFORMED. h +r z 3a Identill ation Please Type or Print Clearly) pVNER: Name: T e G-,ti, Phone: Address: Phone: CONTRACTOR Name: [ +t w e, wF Address: - i supervisor's Constructio n License. v�l Exp. Date: 7 ( Z,1/ Home Impxavement License: c) 3 Exp. Date: 1 rt Lz 6y z_ ARCH ITECTIENGINEER Phone: Reg. No. Address: FEESCHEDULE.RULDiNG PERMIT.$12.00 PER$1000.00 OF-THE TOTAL FSTIMATFD COST BASED 0�5A0 PER S.F. Total Project Cost: FEE:uJ �L31 Check No.: ( l Receipt No.: NOTE: Persons contracting With unregistered contractors do not have access to the guarantyfund - -- Sign&re;of._calitraetor, Signature of_Ag_enOwner Dimension Number of Stories:_ Total square feet of floor area, Lased on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 16B Section 21A—i=and G min.$1oo-WOO fine NOTES and DATA_ For department use Lj Notified for pickup - Date Doa:,Building Permit Revised 2008 i I The Commonwealth ofMassaeltuse€ts �n} l ; Department of Industrial'-A.ccidents i F1 3 Office of Investigations ` 600 Washington Street A / Boston,MA 02.111 wmv.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contracto>rs/Electricxaxis/Piumbers Applieant Information, . Please Vrint'Le ibl Name(Business/Organization/Individual): Address City/State/Zip: Phone A: Are you alt employer?Check the appropriate box: Type of project(required): 1.V1 am it employer with 2 cD 4. ❑ I am a general contractor end I 6. ❑Now construction ernpioyees(full and/or part-time).* have hired the sub-contractors 2.ElI am,a solo proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its refi 10.❑Electrical repairs or additions quired.] officers have exercised their 3.El am homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers' comp, c. 152, §1(4),and we have no 12. 00f z'epairs insurance required.]t employees. [No workers' 13,❑Other comp. insurance required.] *Any applicant that checks box 41 must also fill out tl'e section below showing their workers'compensation policy information. t l-omeowneis who submit this affidavit indicating they aro doing all work and theft hire outside contractors must submit a new affidavit indicating such. tContraators that check this box must attached an additional sheet showing the name of the sub-contractors aild their workers'comp.policy information. X artt an elYl,ployel•tllat i,v proviClhtg ipollretwl coltlpeflsation hisnrltltee for•rtty employees Belo iv is the policy and job site information. Insurance Company Name; vl- C Policy#or Self-ins. Lie.#: W C:©0 4 7 L Expiration Date: zol2 0- Job Site Address: 2 i -_T u n .� �t City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Sedtion 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOIC WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuranco•coverage verification. X do hereby cet•tify under the paths anti penaltles of pefjuty that the information pro vided above is true and cotrect Si nature Date: Phone#: 3 7 Z o Official use only. Do not tvrite in tltls area,to be completed by city or torvrc official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2, Building Department 3.City/Town Cleric 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: phone#: a'aua, Oro UUc ccJ_r• G1tU7�i 11'gNLIKA1NC%E �E73 CERTIFICATE OF LIABILITY INSURANCEDA/TE{rAt+vDDrwrY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E)cTENn OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL. INSURED,the polloy(Ies)must be endorsed. If SUBROGATION IS WAIVED,sa bjDct to the terms and conditions of the polioy,Certain polleies may require an endorsement. A slalervleni on this certificate daas not confer rights(G the certificate holder In Ilou of suoh endorsement(s). PROpUCEq CONTACT Dea3.s9' Cimetti_ NA:17E; Cross InOuranue-Peabody PHnNE Arc . (978)S3a-5445 FAX`Na).(9ae)saa-aaa7 139 TryunfiEld St feet noa L .draxmettita�aro9saga�Cy.com PRODUCRft 00079g22 GU$�oh1>:R Io a. �e Od 1v1A 01 �0 INSURER(S)AFFORDING GOVERAOE INSURED - NAIC 9 INSURER A kterchants Ins G�CUp INSURER®3lational Union Fire Ins Co of 9445 J31R Gutters, Inc. - 38-40 Lanoaster Street INsLIReRC: INSURER D. Haverhill INSURERS: - PEA 01830 I SURER r COVERAGES CERTIFICATE NUMSER:CL1042436348 REVISION NUMBER: THIS IS TO CERTIE:Y THAT THE PQ41CIE3 OF INSURANCE LISTED BELOW HAVE BEEN 18SUED 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 1S$UED OR MAY PERTAIN, THE INSURANCE AFFORDED QY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT€ONS OF SUCH PQI,ICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAI€?CLAIMS. LTR TYPEOF,IN5URANCE .!SUER -• .. F'C7LIDTEFF o POLIC�Exp •• - •-- POLIGYNUMBER rr1MllfOIYYYY ratmppAYYY LIMITS GENEr�iL LtAt3]LITY EACH OCCURRENCE g COMMERCIAL GENERAL LIABir.ITY dh1M11Ca EJ PftEM15E o uurrenco S CLAItiS$•MADE OCCUR MEO PJfP(4nY�,o persotl} 5 -- PrRSONAL&ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LINRT APPLIES PER - pOLlr Y PRO- LCC Pi70DUCTS_COMPIOP AGG S 5 AUTOM081LEL1ABILITY COMBINED SINGLE LIMrr ANYAUTO (Ea0cdlenl) $ i000 000 A ALL OWNED AUTOS 40A7015134 6/21/20I A 5/2 t/2011 _500ILY INJURY(Per p:�oj) 3 SCHEDULED AUTOS BODILY MJURV(Par accldent) S HIRED AUTOS PROPERTY OAIAAGE 5 (PerawdarK) NON-OtiVNED AUTOS PIP-Bss',o s LA LtA6 Medital pymert]; E S NCE&I OCCUR EACH OCCURRENCE g XCESS L1Aa CLAIMS-MADE -' - AGGREGATE 5 DEDUCTIBLE g RETENTION S 1YC RICERS COMPEN$ATION $ AND EMPLOYERS'LIABILITY w1C OTFi• ANY PROPPJPTOwPARTNERIEXECUTNE Y!N RILLIMi-11MI1$ _ QFHCERMEMBER EXGLVDED7 © N/A E.L.EACH ACCIDENT I g _ 50 0 O (Manda(orylr]NHI CO09774192 9/20/2g10 9/20/201i 500,OQO If yes.deecrfaa under E,L,DISEASE-r-A EMPLOYE S DESCRIPTION OF OPERATIONS he1-1 E.L.DISEASE-POUCY LIMIT 5 500 000 )L=RIPTION OP OPERATIONS 1 LOCATIONS f VEHICLES (Attach ACORD 1111,Additional R@Marka Sthoduto,If more epaea Is requfrod) 7efer to policy for exClusionary BadorOemonta and special p4ovinions. ,ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN SAMPLE CURTIFICATTS VOR ACCORDANCE WITH THE POL(GY PROVISIONS. INSURANCE PMPQsrs ON=,Y SAMPTaIy' COpy AVFHORIZED R12PRESFNTAME Timothy Tramonta/DC4 cK �. ,CORD 25(2008109) ©1088-2009 ACORD CORPORATION. All rights resorved. IS025(zOngoa) The ACORD name and logo are registered marks of ACORD 1 , t, • f.tu►a.laas.ianii(� _ -f 0£$�tl vN 'Illula^eH ll SIOWJ:J MAN auaW61ddng ZLOZl6l18. 1r'ol t?aldx� :adAl :uoljvj jslfie�l U0.10"A001N9W'JAOU1 wl91h0 kl01tgi2ll au SSaiiI5111[7s 5llk:,i1�1.1�lilAS[iDa 30 aa0,tp � iYI;issach$isclls- I)tvartilleill of,Public Sa#'cll 1.31ralc# nl' 1311ililing Re"(11alions and St. a#•cis Construction Supervisor License License: cs 80515 Restricted to; 00 KEVIN M FRANCIS 35 WANNAIANCE7 RD HAVERHIL:L, MA 0.1830 Cxpiralion: 7/2112011 Co 111111 ISAI Niel, TO: 18422