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Home My WebLink AboutBuilding Permit # 7/9/2015 ary „iv v •.,a® <iORTy APPLICATION FOR PLAN EXAMINATION Permit NO: ''�- Date Received �SSgcau5E4 Date Issued: IMPORTANT: �kpplicant must com Tete all items on this p2ge LOCATION Print PROPERTY OWNER te 6k co,f rn ti Print MAP NO.: i PARCEL: bgg �� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving relocation ther ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED ��:�� 6"C, i �tJ✓-�. r o ;ye,� ��{� C,.� �� '°dal� �Mr�e 1��1 �b 1� i Identification Please Type or Print Clearly) OWNER: Name: CcL maz Phone: 41) -T4?--'f Y2 Address: CONTRACTOR Name: f1da (--o CwaA L n Phone: � � dO`• -7,,)� Address: ��v r �� ! t Supervisor's Construction License: U � � Exp. Date: � ' l Home Improvement License: � �-�� Exp. Date: ( ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BSD ON$125.00 PER S.F. Total Project Cost :$ rs x12.00=FEE:$ d Check No.: 4 1 Receipt No.:-,P Page lof 4 ,T J �, Frans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ FTYPEOFWERAGE DIS OS Tanning/MassageBody Art ❑ Swunming Pools ❑❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent 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 j � ..�4 �w � , Si nature �` � ,�� ❑.��` G0 11"�' HEALTH Reviewed On � � 1 (� �,,,, COMMENTS = .a ❑ __ ❑ ❑ '„ .. , 4w Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i i Conservation Decision: Comments Water& Sewer ConnectionlSignature & D9te Driveway Permit DPW Town Engineer: Signature: 84 Street FIRE,DEP,� TNIEIV T, Temp;Dumpster on site yes n❑ , Located 3 Osgood Located at 121Main Fire Deprfiment signature/dale ; APO,,, . COMMENTS NORT►1 Town of . sE _ �, . n over No. ih�' ver, Mass, COG MIC Kf WICK 1' ��A�RATEO ►'P�`,�'�� S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System i THIS CERTIFIES THAT ::`:. ............Lot r wL 4� ..... ................................... BUILDING INSPECTOR ........ ............... ...... 7 7 �- has permission to erect .......................... buildings on .�.r/1.. ........ ..... .... ............r.. .................. Foundation.. 1 Rough to be occupied as�!' . .H,.(.(.... ^... .. ,C.OJ.�.1�....�Od.h-...-....................................... Chimney provided that the person aepting this perm 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 UNLESS CONSTRU I TARTS Rough Service ................................................................................ Final BUILDING 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. North Andover MIMAP 110 Russett Lane July 1, 2015 rT Boxford t r 110 F2USS�TT SEW �� i ID i Ya i l �1 6 BUB 104.A-p05�3 � Interstates _.t —SR Horizontal Datum:MA Statepiane Coordinate System,Datum NAD83, Meters Data Sources:The data for this map was produced by Merrimack — Roads AORTH Valley Planning Commission(MVPC)using data provided by the Town of Easements O� `�p , 'qy North Andover.Additional data provided by the Executive Office of MVPC Boundary ,t ge l"IO Environmental Affairs/MassGIS.The information depicted on this map is tar planning purposes only.It may not be adequate for legal boundary Parcels Odefinition or regulatory interpretation.THE TOWN OF NORTH ANDOVER F .~ .� MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING k * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION ATIO NUSgt V 42 ft "� %ocrt i 11'ItoA i C VI" LIADIL1 1 T 1N*U "1AN%r6 05!20/2015 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(les)must be endorsed. If SUBROGATION IS WANED,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 R tUti Company Inc Phone:781-729-9200 cNAZTEACT 19 Mount Vernon 4Ge t Fax:781-729-9500 PN°"E VAX P.O.Box 1000 E-MAIL Winchester,MA 0189048300 ADDRESS: Vincent A Gallse PRODUCERMMER ID rMAYOT-1 SURER(S)AFFORDING COVERAGE NAI;# PO Bax 3054 INSURED M.T.Mayo Corporation INSURER(S)MSURERA:MESA Underwriters Specialty Woburn,MA 01888 INSURER B: INSURER C 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 LTR TYPE OF INSURANCE RDDL BUSH POLICY NUMBER POLICY EFF PO Y EXP L1167S GENERAL LIABILITY EACH OCCURRENCE $ 11000, A X COMMERCIAL GENERAL LIABILITY SCOOM25(i001503 11/17/1014 11/17/2015 PREMISES Ea ocaarer>ce $ 50, CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,Omd PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000, GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,Wo X POLICY PECTRo LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea acdderd) BODILY INJURY(Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per acddent) $ HIRED AUTOS PROPERTY DAMAGE $ (Per ac ident) NON-OWNED AUTOS $ $ UMBRFIL r r n LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC STATU TH AND EMPLOYERS'LIABILITY YIN TORY U RSI E ANY PROPRIETORIPARTNERIEXECUTiVEO $ BE ISSUED DIRECTLY EL EACH ACCIDENT OFFICERIMEMBEREXCLUDED? ❑ N/A yes In Nr FROM CARRIER EL DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1 .-FT- 1 7- 1 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,AdditkxW Remarks Schedule,I more space Is required) CERTIFICATE HOLDER CANCELLATION CITYWOB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORRED R EP RESENTATIVE ®1988-2009 ACORD CORPORATION. All rights reserved. 1. From llndelwritlng Dei,,,Fax: 61�488 6501 To,781721670QrCfaX con•FaX1 296670 pa 2 f�4-O6ASR015 t 07 PM A�C0/2C� S, ' Y c��c ✓i.A�7� �r� I � =n` t'� *""k r 1H 6/5/2015 ANIS CERTIFICATE IS ISSUED AS A MATTER OF W FORMATION ONLY AND CONFERS NO RKaFfTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AOT COt4 1VELY tNR NEGATNElY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INS CERTIFICATE OF INSURANCE DOES NOTCONSfITUTEACONTTtACTBETVIE@ITHEISSURIGNNSURER(S)AUTHORIZEDREPRESENTA7IVEORPRODUCEMANDTHECERTIFICATEHOLDER. fiNPORTANT:Kthe certificate hotdPf is anADDITI0NAL8NSURED,the policy(ies must he artdoraed If SUBROGATION IS WAIVED,slflject to the terrrlsa id condtions of Sr1r. certa>oe.I polices may require an eradorserrlert A staternerlt on NrS ficate does not coder rights to the certificate haider in lieu of such mss) PRODUCER CONTACT SCOttl&Com n ,Inc, PHONE FAX Pay (AAC.No.EaO (781)729-9200 (AICNo.:i 19 Mount Vernon Street EADDRss Winchester,MA 01590 morvlrFR rUSTOMFR In 0 -- _--__ INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Atlantic Charter Insurance Company VDAC 44326 MT Mayo Corp INSURER B INSURER C: PO Box 3054 INSURER D Woburn,MA 01858 INSURER E: INSURER F COVERAGES: CERTIFICATE NUMBER: REVISION NUMBER: 7M ISTO CE RTWY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD IN INDICATED.NOrWnMSTANDG ANY REOUIREKENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS CE RTIRCATE MAY BE ISSUED OR MAY PERTAIK THE MSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRIONS OF SUCH POUCES.LIMTT S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AOOL SueR POLICY NUMBER POUCYEFFECnVE POLICYEXPIRATION LMtlTs LTR INSR IYYD DATE VAMMONY) DATE(INUADONY) an Thousand) GENERAL LIABILITYEACH OCCURRENCE COMMERCIAL GENERAL LIABILITY ad DAMAGE RENTED PREMISES S CLAIMS MADE ❑ OCCUR El El EDD(P("One Posen) S ERsoNALaADvNwRv s NERALAGGREGATE GE/IAGMEGATE LAlT APPUES PER ROOUCTS-COMPS ' POLICY ❑PROJECT ❑LOC AUTONOBILELIABam COMDINEOSINGLEUMT ANY AUTO (EaACddeM ALLOAMEDAAITOSEl❑ Ipef P—m)BODLYIWURY SCHEOUI,EDAUTO$ BODILY INJURY S HIREDAUTOS 05"o Idem) PROPERTY DAMAGE NON-ONM�DAUiftS (EakcKlaa) S .0-ILII[A F-1OCCUR UABRm EACH OCCURRENCE S EXCESS LtAe❑ CLAIMS MADE AGGREGATE S DEOUCTI E f ❑❑ S RETENTION '.. S A oR OYEEW��noNaND WCV00938804 11/220/2014 11/20/2015 X STATUTORY OTHER PROPRIETOPoPARTNERiFXEwTNE YIN OFRCERAIEMeEREXCLUDED7 N NIA P011cyCoverageState:MA EACHACCIDENT t 500000 Mafllatpyin NM ifyes.deacrftuelerSPECIALPRMWONSbOM USEASE-POUCYUMtT S 500,000 DISEASE-EACH EMPLomr: s 500,000 '.. 07HI32 ❑❑ '.......,..., DESCRIPTION Of OPERATNINSLOCATIONSNEHCUES(AOacAACORD 101.Add Umal Remnas Sche*Aa if more space Is repd,ed) G1�t1FISpA a�k ` tze,14.-c..p zS .x.t - i s�.:�_..�t SHOULD ANY OF THE ABOVE MbL"UED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY W LL ENDEAVOR TO MAIL 12 DAYS WRITTLN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAIU)RETO 00 SO SHALL INPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. UTHORRID REPRESENTATIVE ACORD 26(2DOSW) Page I of T CERTIFICATE HOLDER COPY ND 11988-WO9 ACORD CORPORATION.All rigtlts neerved. I he (;ommonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit 6� Please Print Location: City \42 U`� O -E 4 14 Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers'compensation for my employees working on this job. Company name: In .A . Maio Cap Address Y c, L,2�c,51 City: W A O s f\ /1A O Phone# Insurance Co. *`k��L �� Policy# �69 � / Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature 1 Date Print name - Phone# Official use only do not write in this area to be completed by city or town official Building Dept E]Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone A Health Department r_1 Other FORM WORKMAN'S COMPENSATION s Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173259 Type: Corporation Expiration: 9/20/2016 Tr# 260577 MT. MAYO CORP MATTHEW MAYO 96 CAMBRIDGE RD WOBURN, MA 01801 Update Address and return card.Mark reason for change. SCA 1 Co 20M•05/11 Address 7 Renewal ❑ Employment F-1Lost Card .C—'\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 173259 Type: Office of Consumer Affairs and Business Regulation xpiration: 9/20/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 MT.MAYO CORP MATTHEW MAYO 96 CAMBRIDGE RD WOBURN,MA 01801 Undersecretary Not valid without signature 3ass ,us ftg CS42925 MATTHEW TMA,Y® a i 96 CAmRIDGE.ROAD WOBURN MA 018€►1 - it 071111261'�15 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11Tanning/MassageBody Art ❑ g Public Sewer V Well Tobacco Sales ❑ Food Packaging/Sales 11❑ Permanent Dempster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ' , Signature of contractor 41L.— Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TRE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes no_ Fire Department signature/date