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HomeMy WebLinkAboutBuilding Permit # 5/6/2015 BUILDING PERMIT0f"O DT a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION }® r f / A*ry (`O l H"'" Wtl Permit No : Date Received SACHU5���� Date Issued: t° PO TANT:Applicant must complete all items on this page LOCATION � �/� 6SccyA 4 ..A14- 1014 rint PROPERTY OWNER r �, Print 100 Year Structure yes no MAP PARCEL:c ZON G DISTRICT: Historic District yes no Machine Shop Village yes o 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 r DESCRIPTIONFrORKTO BE PERFORMED: ovG r•''t V 11 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: r` Phone: Email: COQ 7 'C; CC -1� , C Address: c-✓ ►r C C� Supervisor's Construction License: 06 OT 7 Exp. Date: ' Home Improrvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING P MIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ oov Check No.: Recei t No.• > NOTE: Persons contracting wi u regi d contractors do not have access to the guaranty fund WORTH - town ofa E , over Do- ® of ,16 a* N 1 �AK� h ver, Mass, �� COC NICN@WICK *_ AoOATED L! BOARD OF HEALTH RMIT D E T Food/Kitchen �M �T✓ Septic System THIS CERTIFIES THAT f:.a.�: ✓... ./....��.,, ?. .. BUILDING INSPECTOR ............ ................................................ has permission to erect Foundation .......................... buildings on ..l f�.............. ...�ego 5 ............................... Rough to be occupied as .......:................................................... Chimney provided that the person accepting this permit shall in every respect 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 OTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS 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. SCOTT-3 OP ID: KAG A�ORD CERTIFICATE OF LIABILITY INSURANCE DATE05105/201 Y) 05/05/2015 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 Kim Giambrone John J Doyle Insurance AgencyPHONE Fax 85 Constitution Lane Ste 2H a/c No Ext:978-777-6344 A/c No):978-777-9804 Danvers,MA 01923 a Sean P Doyle IEss:kim@doyleinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:A.I.M. Mutual Insurance INSURED ScottCogliano INSURER B: SC Contracting Inc 4 Milan Ave INSURER C Saugus,MA 01906 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 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. INSR TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MWDD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE T RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY n PRO- LOC $ AUTOMOBILE LIABILITY EO e'."dED SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N AIM 07/17/2014 07/1712015 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED' Di N/A (Mandatory in NH) CC-5005013640-2014A E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/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 Loft THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1140 Osgood St North Andover,MA 01845 AUTHORIZED REPRESENTATIVE Sean P Doyle ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD IfMassachusetts Department of Public Safety to�jrd of B=uiiding R;.gulations and'Standards CODOructiorA SUI)VII1sur x Li(,ense: CS-061507 SCOTT A COGLIANO r 4 MH AN AVE. Saugus MA 0190 Jly Iq4 Expirador Con),missionei .10/201201!