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Home My WebLink AboutBuilding Permit # 4/14/2015 11 I NORTH BUILDING PERMIT °F�t, C TOWN OF NORTH ANDOVER m - :,:: . APPLICATION FOR PLAN EXAMINATION _T _ ` `� Date Received Q°RArED�4�yRy Permit No#. gss•�cHUS Date Issued: IMPORTANT Applicant must complete all items on.this page 1 P '10D lea tr c �r .e DISTMA"ICHts or► ®isfinct es no ,� - .��.Pcm.�,.�.�'�-•5v�^e�,,.G 5�i:,.,e=rg Ss��rr,�'ad,�cc'�'..,,.,�;r..x,,,. o ,,,,_ .�+rs^,�'l.�ur�r- .:oma.. .. � „�., t.� .s.�n�,�x , 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 ,u ain kWetfantls , ,',rrl f,� UUafie shedD[st�ic d< , , SM ®Well rw Flaodpl r `s d ar DESCRIPTION OF WORK TO BE PERFORMED: Identificati Plea$e Type or Print Clearly' p OWNER: Name: � ✓ J' vs ('�)C Phone: ``�/ Address O �,�"'� a� t� � �e�''"�` ,�JZ�^,` �;S �✓�r .v,r 1 f r�'r ,^ray`�-r F �' � � r�rr��,� h e a f e: �Phone r •Sup'eru s•® 's ® str e c'®=.Lice�:se. _ Exp , ®ate:. �,' F 31 e I mpro�r�e•u.en�t�� ce=se � -- _ - - ARCHITECT/ENGINEER Phone- Address: Reg. No. FEE SCHEDULE.BULDING PERMIT;$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTtB(A ON$125.00 PER S.F_ Total Project Cost: $ ' C�r, FEE: $ At. q'(Check No.: Receipt No;;:'- -NOTE:---Persons contracting-with,unre ered contractors do not have:access-to-the guaranty fund _ ignature _ i nature of contractor Sof Agent/Owne .� �,� � � Arlh %AORT'H ' town oft EAndolver ® - : zh ver MassAmalN i ir 0 LAKE ' COC HIC04EWICK y1. BOARD OF HEALTH Food/Kitchen ERMIT T L I�D Septic System THIS CERTIFIES THAT ............... -..... ��'�; ....... BUILDING INSPECTOR . . .. .. ....... . .. . Foundation has permission to erect .......................... buildings on ... ........ ......... ....*� Q .. ... .. ... Rough tobe occupied as ............... ... ...® ......... .......... .. ................................. Chimney provided that the person accepting this ermit shall in every respect conform he 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT E IRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESSR CTI S Rough Service ................. .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ROOFSMITCHELL SAAB SMOKESTACKS INSULATION GENERAL CONTRACTOR TOWERS PAINTING 7 Bridge t r e tl rn, N li 0 3 0 7 9 POINTING PAIRING 603-893-6332 g Tel/Falx: 603®693®3466 WATERPROOFING SIDING PROPOSAL N CONTRACT DATE:.... ...... . ............................................ � �^� .., Type of work........ ........ ............................... ................ PROPERTY.... .... ,.... ..... LOCATION- We OCATION We propose to furnish all necessary labor, material, and equipment (except as noted below toerf� orm the following work in First Class workmanlike manner. Roof maintenance is required annually. Not responsible for water back up caused by snow and ice. Scope of work. .... . ° a ... ,� r . . .. . ... ................ . 7. ......��Y-d '',... , �..... °. .. ....... m 1,611V �' ...... ..... .,. "C+".rw' •,, 7' /f` jflea, n y .. d ..................................................................................................... Fort e Sum of ..... .................................... ° ✓` Signed by _. E... ......... ...,.......... _. /" , The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 wwwmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. A Iicant Information Please Print Legib Name (Business/Organization/Individual): Address: e City/State/Zip: Phone#: Are you a5t employer?Check the appropriate box: Type of project(required)' 1.E I am a employer with -: employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 El Demolition 10 ❑Building addition 4-❑I 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 11.❑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. ❑ $ 13.❑Roof repairs • These sub-contractors have employees and have workers'comp.insivance. a 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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. tContractors 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. Iain an employer tTiat is providing workers'compensation insurancefor my employees.•Beloiv is the policy and job site information. ' Insurance Company Name:_ �' ,1( s� f s Policy#or Self-ins.Lie. Expiration Date: Job Site Address: //o 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 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 DTA for insurance coverage verification. I do hereb certify under thgpa'ras amend-penalties ofpe iy that the information provided above is true and correct -i Si nature: Date: Phone#• l� 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.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ✓fie�a�n?na�cuc�clf/r.a�C�/��isucfu�clf.; Office of Consumer Affairs&Business Regulation a ME IMPROVEMENT CONTRACTOR gistration: 171835 Type: iw piration: ,:4/24/20:16 DBA MITCHELL SAAB GENERAL CONTRACTOR zl MITCHELL SAAB 57 BRIDGE ST g=am o SALEM,NH 03079 Undersecretary a. i u Massachusetts -Department of Public Safety r Board of Building Regulations and Standard Construction 5upenisor License: CS-020864 iA. MTTCHELLLSAAB ` 57 BRIDGE ST SALEM NH 03079 } �L n 1%, Expiration Commissioner 07123/2015 s - 11-ee-eu!dtU•t1)) I;I:,_ t.rvx11yi dtitilifI=iu r UU1/UUI SAASM-1 OP tit:,1Y DATE[WttlDWTTrY7 I CERTIFICATE OF LIABILITY INSURANCE ! 10122/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIN UITIVEI.Y OR NEGATRIELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THF-POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOFF NOT CONSTITUTE A CONTRACT SEPh7-EN 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 anderm d. If SUBROGATION IS WAIVED,subject to the terms and conditions of the poUcy,cartaln policies may require an endorsemertL A statement on this cartific2te doss not confer rights to*,he certlflcate holder In Ileac of such+andameman s. PROnIICER Phone,STS 688 88290205-1—T.- Michaud,Rowe And Ruscak Ins [-FAX P.O.evz 18 Fax:97$557 2130@n:E:t 1. h - ---- _- North Andover,MA 011145 i ADDRESS, 1 Mark S.Rowe.CIG INSu S AFFO INGCOVERAGE T rui� �_• 'I116UB'_'RA:Travelers insurance CotrlpahV _1"SURE Mitchell Saab 111SURER e 576 Bridge St Salem,NN 03879 wsuaEaC: WSUWR n wsumRE: -- -•- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:^ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTf O 6ELOA,H.KvE BEEN ISSUED TO THE INSUR90 NAMEO AROVc"Y1rL TW;-:oOUCY PERIOD INDICATED. NOTVt'ITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO tVHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESL'REED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS QF SUCH POUCIF.S-LIMITS SHOWN MAYHAVE SEEN REDUCER BY PAID CLAIMS. iISR•!—•... ----•-'--AD51S9Iis •-- ' .' -'--- --- ----' PaU � Ct - --- _ - - - - 1 TYPE ep INSURANCE , - POLICYNUMBE.R rtMO , at11.1CY EYP Llrrl't5 It GENERAL tJAHIt3TY i } � ! EACH QCCURREVGe ib ' j CZ1MPdERCtPU.UENESv1LL'491LtTY ' l I1 PRGSiISCS(Caoccvzcncl I S 1 � i CLAI6+):4Yit)C 17 OCi.UF ! � �M=DEXP(AYWorn_pa1y3L i S { i � PCRSO 'tuSL 8 hDV INJURY - ''. _..i G;alsM AGGFnGATr_ iti SEKL AGGREGATE L VAT APPI•IFS PER i PRL:OItCTS-GOuF'QP:_.C•G!S , POLICY 11 l PP.oi t LOC 1 i AUTOAAOBILELIL9I1.I7Y 'CMIZ3 ltrt9WGI-EL1:AIT I i i i EaaC ' - ANYAUTC I - k BQMLYIU•IURY(Fr_��-an—�-S : ALLOWNCQ 1 SCHEnul-EQ ' AL?OS - AUTO' : i I II01}1LY INJVHY 11'c'f dGCF.RnI) S .. _ NON.DWNEDROPFRTYI gX13-F i HIRED AUTOS DaDPfl `A 0AB j—]OCCUR 1 EAC t OGCtIrtRENce t 5 -- MESSUA3 1 CLAI\ts.lvflGl � � �R[Gr\TL `'s 5Ct] 1 RETENTIONS WDRKERSCOMPENSATION WGSTAfU• 'QTFI•+ ANa 68PLOYWV UA31LttT A I4.�!YPROPRIE[ORPMIRTNSFI=XECUTIVEY�/y�j 6KUBBB666127-14 1=i14 ; 1012WIS Ei�Hf+CCEENT !S X00,00 OFFIGEWMEt�F>ER 6XCLUAtO? I Y E I NIA i(Niandiroo In NH) t I E_I-DISChSE-.0%CA OL9YCCI F _ 100,00 f y�rrs. I1xi6a unrd . I DLSCtY1PT18N Or OPERATIONS helms r t ;EL_OISEaSE.POLICY f.Wl1'f;g SIlQ,t7 I i , F gfa3CxIPt14N 4F QPF,fiAT1QN$t LtaCAY1pN5 t VI?HICLE&IAtbcfa ACORD VH,Addhi-W Re,nedn.Sthedula,If.no space U F gLdmt) tchCal Saab i f 1 s CERTIFICATE HOLDER CANCELLATION ---------- i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DP_t.IVERED iN ACCORDANCE WITH THE POLICY PROVISIONS. 1 : AUTHORIZES RaPR S011AMVE t 1988-2010 ACORD CORPORATION. All rights reserved ACORD 26(2010105) The AGORD name and logo are regiswred marks of ACIRD CERTIFICATE OF LIABILITY INSUIUNCE DATEJMM*DNYYV) 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 13Y 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 on ADDITIONAL INSURED,the policy(les)must be endorsed. If SU13ROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policlee may require an andorseinent. A atatement on this cartificata does not confer rights to the eartHleats holder in lieu of such andorsament(s). PRODUCER CONTACT LjrryCowan _ CovlranInsurance Agency,Inc PHM NOONE ��I(978 372.145( {AJ 178 5Z 4669 359 Main Street ys. iasT cawaninsurance.com _ Hsvarhill MA 01030 I RaRIS)AFMROING c v X%MAj-.A92—y1t1C CA INSURED Mitchell Lea Saab 57D Bridge Strset WSURER D- Salem NH 03079 INSURER FL WSURi r: COVERAGES CERTIFICATE NUMBER: _ REVISION NUMSIER: 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,TFRm CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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 SHOW4 MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR I TYPE or-IkSURANCrE ADDLSUOR POLICY EFF POLICY EXP LIMITS GENERAL UAGILRY I EACH OCCURRENCE 1,300,500 i DAMAGE TO REN7Sfl AX OAMUF.RGIAL GBNBRAL LIABILITY l G , s 500ofl cLAI(s woe F OCCUR L11800099! Od10212015 1041oZ'2018 I MED Exp(myane wMe ; -S-1-000 000 PERSONAL a ADV IN1UBY a 300 OOU j 4 Q9NERAL AGGREGATE S 600 000 GEN'L AGGREGA7 E LIMIT APPLIES PER: PRODUCTS-CwPIOP AG' I S I3OO 000 x O ICY FRO. '00 ' i$ AUTOMOBILE LIABILITY GOMBiNED 3WGtE LMT -------- — - ANY AUTO I BODILY INWRY(Per Deleon) $ 9ALL 4IM1N8a n SCHED LED AUTOS E —7 AUT08 ff ; BODILY INJURY(Par a dent) $ HIRED AUTOS A�OQWNED I I P OPEC AMA(IE $ S I S UMERELLA LIAOQCGUR Excess UAa I iGfJ9GUHRENC" E _ - _ _CL41MS•MADE GREGATE kms--- - non i WORKM COMPENSATION WC STA U- DTIT AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIV E.L..EACH ACCIDENT OFFICERIME►AWR EXCLUDED? NIA 1 — (Menda"fiNH) ( If ELDL4EASE-EAciAPLOYEF . oA d**c'Ibe larder _ '..... E.L.DISEASE-POLICY LIMIT,f: , I I i DERCRI"ON OF OPERATIONS I LOCATIONr I VEHICLES(Attach ACORD 101.Addl8onol Ramarir9 Snhnoula,V more*Paso 1*requlrad) 603893.6332 Rasidandal remodeling contractor. 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, AUTMUE ATIVE (01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2090/05) The ACORD name and logo are k4istered marks ofACORD