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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 %AORTH BUILDING PERMIT of�,(�eo O O,Z. ,r . 'a a Om I TOWN OF NORTH AN® VE APPLICATION FOR PLAN EXAMINATION f Permit NO##: " Date Received �gSS•vcHus���y Date Issued: MPORTANT: Applicant must complete all items on this page r f O I GDS RICT.,,r////, /iHsorc' st c �ue 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�,,,✓„ ,,.��/i, �.�/il /is //iii//..✓iJ/f;, �„ ;.,,; ,,,r / ,ir, ,„/ / „//r_ r //, ,,/// r///// , ,,�,/ ,, /lao lar; , /, o Wetla ds,/ //�❑, Watershed, stnct ;r , %,❑,Se trc ❑/Well. / ,// I,// ❑/F d n n ._ D r, /, //. „ice,/.,,,.,,.,.,,,,».,, „,,.,,»✓J��,�//,��������/I?���d%��1,�//����f� ,,,,��/�i///%,%, �/ /..�/c/�/� . ,.//��r�r 1����.���/r1/�����,J �//�/,//�//r/ DESCRIPTION OF WORK TO BE PERFORMED: P Wr- CJ/' / / ,� Identification- Please Type or Print Clearly �d 444 OWNER: Name: "� 'Vk?- II Phone: 7d Address: //' ' rd�n/�/,/eth�er//1/f a�s9�i1�;�,�s/i�s��.,o1 o/J',,�l�/�r,�r r 1/,/1r;,l���I��/�.yi,,i�✓�,ar/C�fi VIrnr,'o"i,�r i�i J1er�r,//s.i�//i,#J/,r:/>r��,�i/l«,1c y1/1ir'l/�t/o,I��,/l r�/;�r,r L/, �e,cv�,��e rr,/rJ,/r'��5�"1�s7 „ , /i1,r��/ir///�a,o�i,i INS,/ � > ilr„f///if�////,/�,„i,/i�/,//i,,�r�//,//��,/,//�i�/�r/�iw1/,,i„/,,/i,�r f�/r/,l�,,,�/t„�//,/�////r�1tir/���/��;,/l,�,0�/r rllx;,r�,,✓�/,,.rr 1,,�/,l/,,,r,�Y/�r/1//r/'�1rJ11%r��l r�YlJ��/ri�/a�/��,J,,i�/ielr���,,�/m//r/�/Hr�/l���,�, , , r 010 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: $ O/600 , 60 FEE: $ Check No.: "�2 00 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiend Signature'of Agent/Owner Signature of contrac �. i ..... ...... _ Plans Submitted.A Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer R Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS / / C HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street i "IM, /✓r r , r // / / /r a /.,!//it ., / p 9 / „�i„ : �f %1rr � �/'a/ /,rr r ,,,„,.r„/r ,ii..ui.//�<,.�/ r ..✓/,/L,i ,.,,, ,/ „f/ ,,, ,�,//�..r., � r �� ,, F N®RTH own of 2 . t E 1� ndover o - .:� 1 No. zy 6hzk o h ver, Mass, COCNIC04t WICK A�'�ATEO ►P�,�,�y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System I�N. THIS CERTIFIES THAT ....... //f...... .. ................................................................. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .&1. A1,4..... ..................................... ... Rough d to be occupied as .........,1..... ......... ..... .....�—J..l ...........rec� l.r .... V......�.. .. . Chimney provided that the person accepting this permit shall in'every res 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 CONSTRUCTION ST RTS Rough Service ........................ .... . :?-: r.................... Final B ILDING 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. l ® DATE(MM/DD/YYYY) .4coRv CERTIFICATE OF LIABILITY INSURANCE 6/9/2015 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). CONTCT PRODUCER NAME: Sandi Munroe M P ROBERTS INS AGCY INCPHONE (978) 683-8073 A/C,No:(978) 683-3147 A!C No.Ext): 1060 Osgood Street ADDRIESS:sandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:AMERICAN EUROPEAN INS CO INSURED D & H HOMES INSURER B. INSURER C: PO BOX 522 INSURER D: NORTH ANDOVER, MA 01845 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 ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 F_;�;­l DAMAGL 10 HEN 11717— CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 SKP2001014 10 06/30/14 06/30/15 MED EXP(Any one person) $ 5 000 A SKP2001014 11 06/30/15 06/30/16 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1-1PE� 11 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident) ccident $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY YtDAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEI'$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENT V ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD I k> Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-065128 SHAWN R DUFR NES„ 5 EQUESTRIAN WAY MerrimacMA OR60` ��7 Expiration Commissioner 04/01/201E Office of Consumer Affairs and Business Regulation 10 Par-k Plaza - Suite5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 161510 Type: Individual Expiration: 10/23/2016 Tr# 259843 SHAWN R DUFRESNE SHAWN DUFRESNE 5 EQUESTRIAN WAY MERRIMAC, MA 01860 Update Address and return card.Mark reason for change. SCA 1 20M-05/11 Address Renewal F-] Employment Lost Card ��e orr�r�w�iusea.��o���cz�oac�u�cfGi�i 9--Xp_1ratt,,atin: ffice of Consumer Affairs&Business Regulation I License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: egis161510 Type: Office ofConsumer Affairs and Business Regulation on: 10!23/2016 Individual 10 Park Plaza-Suite 5170 SHAWN R DUFRESNE Boston,MA 02116 SHAWN DUFRESNE 5 EQUESTRIAN WAY MERRIMAC, MA 01860 Undersecretary Not valid hout signature