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HomeMy WebLinkAboutBuilding Permit # 6/15/2015 i �� 00RT11 BUILDINGMIT -1 �o TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION _ Permit No##: t ?� o Date Received �1�A��nrevWrP"'R5 �SS�ICHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 7& Prin - PR OPERTY OWN ER Print 100 Year Structure yes no MAP PARCEL: f ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 / .� / , , / i //I// / rf ,/ /r�, ,,r, � a�ershed•D tact, r /� / I r ,,./ r/ ��' /%/ � /� l/ f�„ ;, �/� ❑,UUetl nds�/ /r,/ / t c( r !/ r 6 ,. _ ,, � ,rtr >/ �//,i /1� ©Flood IaN r / / a / ✓ i a 1 �% DESCRIPTION OF WORK TO BE PERF MED: Identifi ation- Please Tyye or Print Clearly OWNER: Name: Phone: Address: Contractor Name:1 Phone: Email: cp Address: t' Supervisor's Construction License: `�� Exp. Date: � — Home Improvement License: , Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P $92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund / Town of Andover So- ® �O LAKE h h ver' ass, COC N1c.t.1c. RATED P•PP ��.�y UL D BOARD OF HEALTH ERMIT T, Food/Kitchen Septic System THIS CERTIFIES THAT ...f.../. �f ...... - � .t`:1 ................................ ...................... BUILDING INSPECTOR .... . .......... �•--� � Foundation has permission to erect .......................... buildings on .. �.....�tr. ..—�? {^� ��.. ........................... Rough tobe 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS T RTS Rough a Service ............. ., .. G�`"..'�/`/'�h� ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final NoLathingor Be® Wall To Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Fra eo Enterprises LLQ` dba European Quarry Imports 326 South Broadway Salem NH 03079 603-894-6888 fax 603-894-6887 w 1vi, qua, ��'trlrprrr~ts ("0117 __. E-mail Iref�cm � qtr rarl `c ?a).ttalc�t_t ;�cr Date: June 15, 20.15 To: Matthew Wolstromer 73 Forest St. North Andover, MA 01845 Subject: Contract for remodel of second floor bathroom. Scope of work: Remove toilet, vanity and existing flooring. Install cement board and the bathroom floor. Install new vanity and granite countertop. Replace toilet and hook up vanity sinks. Total cost of project is $ 5,783. � eorge Kenn Matthew Wolstro er CERTIFICATELIABILITY I , _ 19/9/2014 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. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). RODUCER NAME: Amy Martineau COMMERCIAL INSURANCE SPECIALTIES LLC H�AIO No,Est: 603 566-9519 FAX,No):603-232-185 855 Hanover St PMB 268 ADDRESS: amy@ ahm-cis.com Manchester; NH 03104 INSURER(S) AFFORDING COVERAGE NAIC#: INSURER A: First Comp Insurance Co ISURED European Quarry Imports INSURER B: 326 S Broadway INSURER C: Salem, NH 03079 INSURER D: (603) 894-6888 INSURER E: INSURER F: :OVERAGES 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. �REFF PO TYPE OF INSURANCE ANSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE CI OCCUR PREMISES(Ea occurrREITrEIIence) $ MED EXP(Any oneperson) $ RSONALBADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: [ZE NERAL AGGREGATE $ POLICY F-1 JERK F LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY $ '.. Ea accident '. ANYAUTO BODILY INJURY(Per person) $ '.. ALLOWNEDSCHEDULED (Per accident)AUTOS CI AUTOS BODILY INJURYPidt( ) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE s '.. EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ '.. WORKERS COMPENSATIONIN XPER - '.. AND EMPLOYERS' LIABILITY STATUTE ER ANY PROPRIETOR/PARTNEMEXECUTIVE Y❑N/A WC0157097-01 9/9/2014 9/9/2015 E.L.EACH ACCIDENT $ 100,001 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,001 '.. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) :ERTIFICATE 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. AUTHORIZED REPRESENTATIVE 1 ©1988-2013 ACORD CORPORATION.All rights reserved. 1CORD25(2013/04) The ACORD name and logo are registered marks of ACORD f /(P-///J�IC�r�, , ! Office of Consumertf irs&Business Regulation tcense or registration valid for.mdividul use only I 1OME iMPRQVE4I(Ef T CONTRACTORhpfore the expiration date,If found return to: egisi. tion: ' 10648 Type: [_ Lffice of Consumer Affairs and Business Regulation - �, xpiration: 7/2 /2015, Individual10 Park Plaza-Suite 5170 f Boston,MA 02116 DONA!.D R. PERKINS � r . DONALD PERKINS t- F 4 MEADOW ST.APT#B• ' g - VATICK, MA 01760 Undersecret- ary Not valid without signature Massachusetts -Department of Public Safety 1 �. J I Bo d of-Building Regcj14ticn tad 'Q r v, Rw' c ion C��i ti u . u�ierpsi or ' License: CS-042333 4 MEADOW ST#B Natick AM 01760 fi Expiration Commissioner 08122/2016