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HomeMy WebLinkAboutBuilding Permit # 4/21/2015 BUILDING PERMIT of NO RTH q TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION yry Permit NO: Date Receivedrev il �, ��SSACHus���� Date Issued: 'r M ORTANT: Applicant must complete all items on this page LOCATION . t Pnnt PROPERTY C1 + Print MPT 21'C►':` PARCEL " ZONING;dISTRIGI' Historic District yes Machlre Shop°Village; fires no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ./One family Addition Two or more family Industrial V Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well ;Floodplain ,,, ,-,," Wetlands �a ltershed,'Distridt Water/§,6wer , DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: ;C1�1Y`1 . art Cl " " Phone: Address: I � Ct I ��t �l LGVMoi-HAoie`Qi CC), ITRP►CTOR, Narrre Ii(` Cts "c ` t '�t '"Phone: Address , �rto ' TJ Su ervisor's Ca;nstruction License p .;;Exp. Horne Improuernent,l"icense '� Exp. Date':'' 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: $ aa� �( FEE: $ Check No.: k Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the nd Signature of Agent/Owner Signature of"coriiractor t%ORTH ow'w'u f I E -"kVd-% " 0 No. oiAIK� h ver, ass, 2 COC KICKl WICK A04ATE® ®`Qa,`�5 S BOARD OF HEALTH Food/Kitchen PERIT T D Septic System THIS CERTIFIES THATrr BUILDING INSPECTOR .....Mtl...:�..... ............ ........ ..�,�r. . .n............................................ has;permission to erect .......................... buildings' on .:S ., ...... ......... Foundation ��. Rough to be occupied as .....r .Y. .(..... ,!��:�..,-....�.odl.L'rL... ... ..•A................................................... Chimney provided that the person accepting this permit shall in every res ect 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 LESS CONSTRUCTIONA 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 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. A�r.09.201E 13:43 PAGE. 2/ 2 Kw-'r /V",. t t 44,1v-V ),/-I C) 5 i himily OwnedAnd Operated t=! - '6 - 3�L,- L, X -.2 (WINDOW)SPECIFICATIONS D-,du T�,. r"6t7,1 FVC f�" TOTALS lxf ov"n-wc G"15 Ttq, T.,n Fit S Yes rl,� !_s Mf 7c., �jD I.S �'�B Pr.-tor 1/3 Deposit 4�L 113 Start of Job 6 1/3 Balance Upon C-Wftn Completion NCTES (SIDING)SPECIFICATIONS "I r tic 4/ "1 ,--over er body area of nouse.Type of insulation v Uri'-i'` �"u;c r-�,� Itams ,sulationita,13 1101 c61­d Q,installed: Y.a NO Yes -N. Yes No x -X- x >1 ecor Sjrfojn-,Iq Gu!tal 01f?I On Doo:VPI.,Mv.,("a-fig Fjt@j Pr,it 5"", Vino PVG Trim� TreditiOrsl Post 5i,4 ur &A4 Ofd START OF ALL JOBS-HOMEOMERS MUST REMOVE ALL ITEMS FROM WALL$&SHELVES Construction related pornills:1`the hommvnef obtains his own construction-related parmitt;for the mik described under thIs agreement,the homeowner 16 here by advised that ia the event of&pWe,)udjrnenl and rionpayrnm of the contraclortha homEoN'fier W111 not be entilled to make,,claim to of collect from the guaranty fund established by Chapter 142A,M.G.L. 2,0 ,'---WARRANTY-] _Year 6-. 1 'o, L .1W7,'-)' ,o !j I TOTALS Brooks Vinyl Siding Windom•Dvore 254 N.Otoadymy-Breckenridge Ma11 Salem,NH 03079 (003)894-4488 m-imbrookstswcf.com 101662 99730 N5 71 ?It yot'.1110 ouyarpuy-1 the t—acniN at any Wro intor to nIdnight of the WLrd buin55s a3y oflltr the oil,,of this bar mil m conctuation musl be dona inwirn,4.1,14e rcqrQ tW Pant DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN'1N,TNE3,%NHIE P­til,",hr.",t! 2C, The Commoniveafth qWcxsscdchu e tts Department (#,Industrial A ceidents ,4Wee of fitvest�gaProrts l r � f 60�0dht (d �ldrtt1.�� �� 1 n StreetX 1 411rH)"111(1,S 5q0v1d is Workers's' ::rrrrr perrs®rdmi Insurance Affir avH: Huff crmOCon lr°rrr:°trrr•A+;lee r° clan0l"Itrrnliers t a Iaine (Busin a,(1rt; nir,�tia:rruhulivioad):Addmsy � r ✓t�.� � f ! taw � ° q ` i A Gi jf ,W f.atC'/ ✓Sj_�..:_.t a } i ..qt q0, 11 11�"tl) e 0X �,i tt a a - n Are a y �la nra�z as employer?ralar ��Cheek tlre:� a r sr°<a �ar a-. � e>x; 1�°l�rax c71 larwca,ga'c t (r°e�elrrrr�c^a:!). r.rte� L��-_" _�. } am a g� ict-jai t�c�irfrrrs or�;rnd } 6> �� New ct�tz�,tr'tar°trt�rz } Y att�Ci �._] employees (fuH and%car Ire " T. have trhvd die ,trlr�t°cantr� �rc�tc,ars , ... '• .EJ 1 arae ;r sue }ar�calatrt�tc,rr�c:rr 17artrrc,r- }r�,ta,ra oiloilthec attached lre°c�t. ,� � }��rnalitilc�>rnc ;,hila and haiv^ no earn}alo c es C he sc�., Sub-c crrrtrttt.~tram, lrrry 3, r � working for rasa in any c rp ac rt.y. wcrrkerscorp. insuranacct ). ("� L�r.rilrlr`n��; crcli:}it'ic:rr�t [No workers' co rr}r, rr sunanc;c, 5. [ ...� We are a corporation oration and its rti ttt.rirc°t}.'p officers Ir.rvcc exercised ised then I A Idec;trica,l rep airs or additions 3 � 3 �'° � } �r ��at�,t��(�r�a r�rrrcclraac lr��'c°arra I � �_ � � }arra� c' lrkarrt� c7rrrctcliticar�r:Ma (�__I 1 orn a horneownc r doing, call w°cark d l l �- rn c'9 . ,dcr evc,nc�r c�rrrrr Roof ra 1a,.arrs rrrsruancvr required'] ' employees. [tvcr t~ orkt.;rN 110 Ot}w^r p comp in,rrr rnca rtclrrrrcci } __ ",'Any opplicanr threat r,lrawcks box to l runt alsu H on Tv utcmbn below stw hers ttwd warMf cont�wnsmon poky inhnnn,atiarn. I[aytaru.cw�a arc,rs wvihar�,r,rfarrrtt Haas afE"ictav rr arldiGrarir7g rlar.;y rrrc ctrrtnf!,calUrM and Ytra',n ftiea;crtrft,utr,aa^rnratwarua mutrr stomb sr rrcw ta9fira6rti'it iruiwsrren}, array. Conu,,wtots that(dicck to Wax atuasr mwAW an.'tdc'iitoun,al shed tsacru.a!q the narucnwo sub..et.antw[ft7rs and wor u,wmi r,ccanalr, pow) inr'wn'rw,on. rr,tae"lcr P� c rrrrr,rr'rr.�rrtartrr rrrsrrr°rerrc c� r�r raz aArrr,rlr��r a� J�rr��� �. ...�� ..�.� ..�..�..� ,..�„� ..�.. lam rtmr�rrr�rCcr°t��r°rda�r'e:���r°r�av� ��r � � � , 6, ' l y".. Coo,is the par&y and,Wb sPe irr�rrr°rrr rrrr°rrrr. lnstrrtanc e Company hArny Wal v, Policy #or Se Wins. t:.,ia r(: °�"` a �,�_na_���? __�_._t.�_. 1s"xhairation C�atc lute `5itc° Address: _...._ _. . _ .. C1 .: _. _ �.CD AMA ra copy of the wor°kcan' compensation poiky deac6ar%tlon page (slaaaAng the poHe°y number- rrnd e xplrratlon elrrto. FsaiW to sectue cover<aga, as rc,pired undea.r Srrct.ic�rta 25A c>t'XIG1_, c, 152 can Rod to the imposition of criminal peti altic;s ora, fine cater to SI,"1500,00 0 ancl'rar can-yr rar irrr}Ksonrnent, as w`Call as ciAl }aenahies in Me forni ofa S`tOP WOIC K_ t;)R171- k.and ra Alto of up to $25010<a dlar, agodnat We vicaltrtor Be early sed Herat sa copy of this statement may be Kwaardecl to he C)f1"i x o1" lrraestif.atirno oraw, m/\ iar insuiant e Coverage vxeril'zc;ratic:rn. I rltr he relat eertyj, unel( rd r',.lrr ins-and pen A&rr/lea wgaaaa tdrrrr`the r'rrfrarrrzraPiarrr lrrrrvr"r/ d rrfiera'c*k to°r,te rxrtrl corava'f, „rrrrtrlr�r� >) _ . ------------- l.'hrrnt l��r: t fWvM1 use r n(j,u Do nol write in this area, eo be ccararl)laeteri Av ritt'or town rrl`,lac°i<rf CHy or ,h,e wn: pcnaaltft.,lrrerme ii Issuing 10..0tority (a h-cle c kkv). 1. Hard of Health 2. Br.ailrliug Department 1 Uy/"1'c>wn C lcr k C Electrical Inspector S. PlkrrrrlAnyt Ins ectur- � 6. Other C:ontac.iPerson: Phone H: ACC>RD0 CERTIFICATE INSURANCE DATE(MMIDD/YYYY) 4/15/2015 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 NAME: Linda Bogdanowicz Insurance Solutions Corporation PHONE (603)382-4600 FAC No; (603)382-2034 60 Westville Rd E-MAIL-ADDRESS: MAILADDRESS:lindab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURERA:Peerless Indemnity Insurance 18333 INSURED INSURERB;EXcelsior Insurance 11045 Brooks Construction Co. of Lawrence Inc, INSURERC: 254 N. Broadway INSURERD: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:CL145716377 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 TYPE OF INSURANCE IR ADD S B POLICY NUMBER MMIDD%EFF FY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAGEO RENTEDPREMISES Ea occurrence $ 100,000 A CLAIMS-MADE ®OCCUR cBP8945793 5/16/2019 /16/2015 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 '.. [PR ERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: DUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRD-JECT F-1 LOC $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT ED accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS_MADE AGGREGATE $ DED I RETENTION$ $ B WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N T I S ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A '.. (Mandatory in NH) WC8836275 5/16/2019 /16/2015 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ronn & Kathy Coltin ACCORDANCE WITH THE POLICY PROVISIONS. 316 Raleigh Tavern Ln N. Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/KLM ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. IN302,rgntnnm m Thn Arr1R11 nnma nnA Inn^ara ranietararl morlrc^f Arnl7rn P Ek mid of Building Regia lafiautim and Standards glum'o uanon SuXNic`V: , a'"re gr a°'6.a lR Licer se. CSSL-099730 MARK DIPRIMA 18 HAWK DRNE� SALEM IYII 03079 C�ndrnw'¢eo~',v.�.eenrna*u' 0212012016 i "� ✓pAe 4�'"<.1�r Fr'/r.lt P'Plrrf AP�d� r� ,.��r n"�..iP'da",�a"Ade�'�'�� e' Ofrlec of COOsu IHel,Aff4liY'S&Business Regulation bME IMPROVEMENT CONTRACTOR Registration: 101682 Type. .!., Expiration: 6129/2016 Supplement BROOKS CONST.CO:,INC.OF LAW MARK DI PRIMA 254C N.BROADWAY STE 110 r — SALEM,NW 03079 t,hidersecretary TOWN OF NOR"I'll Office, oN"t.;I; M NITV Ili E OPMEW AND SERVICTS PttWiAryHealthDiw tit&:3G1,;lPa, ( �t� � N .VI C,MASaAClllSP171',titll+WA�-tFri 1'17onv: 97::.69N.9540 Fav 978.689,8476 i -,mait:&tc &t,t9c C(c la,a t1gi tti>tt],an (L-q_ e%ita APPLICA'riON FOR DUMPSTER PERMIT P URSUANT TO SEC TION 3IA AAD 3 1 B OF CHANTER Irl OF TUE GENERAL LAWS; AND RULES AND REGULATIONS OF TIIE NORTY ANDOTITAI BOARD OF HEALTH DATE: Application is hereby tirade fora permit to maintain a dumpster(s) on property located at in accordance with the tLtles anti t`egulations of the Board of l-lealth. Applicant:Zq�!WC-)�( '-Sin C'. Property O`w`ner: RQA 0 YON4 QQ�1✓� Name of Contact: R �f`� ' Owners Address:��j � IPi n �Z����f to �-`cA\A(i Adclress:,�)�{ J7tI,�C�Iu �T_ _ wo& IN �CkKs PA ol( �l` +' C'M Py�1 ( U lel Owners phone#: Telephone#:(, ` �1�1`�1� Federal ID or Sg#: Dumpster Company: NU IC2 Pick-Up Schedule: On the back of this form,please sketch an outline of property,showing the proposed location of the dumpster(s). Give distance front dunipster to other buildings and lot lines or boundaries. Annual Dumpsfer permit Fee: .'60.00 per establishment Payable to: Town of North Andover, LATE FEE AFTER JANUARY l"WILL BE DOUBLED-$120.00 *Please note that all contact information and the associated fee is required ttpon:application submittal. Pap I of 1