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HomeMy WebLinkAboutMiscellaneous - 21 HEWITT AVENUE 8/3/2015 01 %AORTH .1 BUILDING PERMIT %_F.D TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No# Date Received Date Issued: IMPORTANT:Applica inust complete all items on this page LOCATION 1'4 PROPERTY.Y OWNER aeA k 6LD I Print 100 Year Structureyes (69- MAP PARCEL: q V� ZONING DISTRICT: Historic District yes ?fro) Machine Shop Village yes r5p TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Addition El Two or more family El Industrial Alteration No. of units: El Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other ua Strict lfili is 65 IS, J1 ff,6,1 VVInv Il, t I d Tr 1 C, el L t�FE Nil, V MEN, 11 DESCRIPTION OF Wo TO BE PERFORMED: rel 11 c�A r-) e-4 k Identification- Please Type or Print Clearly Ie 0�-� K-eev-, Phone: OWNER: Name: (<e 0 Address: -C oj V,)- Contractor Name: I Phone: Email: Se'd(15 KeLc,)ull Address: A vt Jc-vec- Supervisor's Construction License: C5 — CD L L 9 Exp. Date: 73 Home Improvement License: 3Z 3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ,2 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the ar ty f na ' 'Opt Qwne�77 ignatur& § g tAORTH. own ofE 1,, Andover 0 �. , " .. 0 ® IF)D 201 I r5M . 11 _ ® C LAKE h ver, Mass, AS 3 2-60 5 COC ��. S U BOARD OF HEALTH PER IT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ......... 4W, 4 Z7 W BUILDING INSPECTOR ............. ...................................... .......... ...x.......................... . ... . has permission to erect .......................... buildings on e- Foundation ............ ....................... . r.:'!.......................................... Rough t® be occupied as .. ��!!��...................... Chimney p' ....aim....a tom.............. .. �..� y provided that the person accepting this permit shall in evespect c rm 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 ` C S CTIO rAGiRL/TG..S Rough Service ............ ..... . .. ......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. a w 0 1 " 2 sg� ti a; z t.d vx F _ 101/2 Uses I H P SV (267) G direct vent pi direct vent pipe Vent Framing—Top Vent J with One 901 Elbow 51/8 7(178) ZIC—V (11 121/8 Blower (308) Access Gas 0 Entry ® M .o L E C N Ii C A D B Junction GEMIN133 GE (35 GEMINI 40 GEMINI 45 Gas Box Access K 33-3/4" 35-3/8" 40-318" 45-318, Entry L 34-1/4„* 36_114„* M 36-718” 38-314" 43-314" 43-314" o.. N 14-112" I$" 1$" 1$° 17 0 1g-518" 23-318" 28-114" 28-114" 'Includes 4"for fold-up standoffs GEMINI 33 GEMINI 35 GEMIN140 GEMINI 45 A 30-118" 32-118" 37-118" 37-118" EIMMM SOMEONE= B 26-1/4" 28-314' 33-i14" 33-1/4" MODEL FUEL BTU/HR AFUE** P4/ENERGUIDE" c 18-5116" 22-1/4" 27-1/4" 27-114" GEMINI 33 NG 14,000 65% 6o.o%/63.o% D 0-112" /8" 18" GEMINI 33 LP 13,000 65% 6o.o%163.o% 3 32-3 37-3 42-3/8" GEMINI 35 NG 16,000 66% 61.o%163.o% E 33-518" 35114° 4o-i14 451/4 GEMINI 35 LP 15,000 66% 61.o%163.o% F 21-7/8" 25" 30" 35" GEMINI 40 No 20,000 66% 61-o%163.o% G Io-15116" 12-1/2" 15" 17_112" GEMINI 40 Lp 19,00066% 61.o%163.o% GEMIN145 NG 21,500 6q% 61.0%/63.0% H 31 I. 32 718 37 q/8 42 7/8 GEMIN145 LP 21,500 6q% 61.0%/63.0% 1 1417" 17" 17" Intermittent ignition systems.Millivolt/Electronic. J 5-314" 6-718" 6-718" 6-718" "Annual Fuel Utilization Efficiency(AFUE)is the recognized U.S.rating system for the total efficiency of heating products. On the cover: Gemini shown with Black Pointed Interior I r lace, IMPORTANTNOTES: + �feVATC9 't As with any fireplace,this ani"- dvl�`a p5e pe'e , t Local conditions,such as A •• instructions before usir '161 1 1 Px+�1''� `r, O'ig30 ;', _ •, .___ t V y,1117 A1'�f1'fFl e / Na nrnrno} fir., heating performai'• xaye"r g115type EUROPEANCOPPER f; — C HIMNEY C LASS IGS- 8 372- Ge•C0111 of fuel fuel used,appliance Iota 9 1 geBvelp .-operated. _- Diagrams,illustrations and I aI'l;Vta -,.cons.Product designs, Approved for use with European Copper and Chimney Classics chimney tops,which improve performance and materials,dimensions,specii \AJW�" change or discontinuance without notice. add an elegant touch. a S M I a Visit us online Canada F I R E P L A C E S e R1 kid- FRI ENER&IDE Look for the EneTuide ©2015 Innovative Hearth Products W CCM Gas Fireplace Energy B- Efficiency hating in this brochure a m 785580M 04/15 Astria.us.com Cl US Based on CSA P.4.1-02 The Commonwealth of Massachusetts - -' Department of Xndustrird Accidents Office of Investigations 600)Washington=Street Boston,MA 02111 Uf www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Cone°actors/Electriteians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/fndividual): Ik Address: =0 r r\ i e City/State/ZiA_1 L 6&F I�� Phone#: 7 ` - 6 2 L-62_0 Are you an employer?Check the appropriate box: Type of project(required): 1.[ (] I am a employer with �- 4. ElI am a general contractor and I 6. []New construction F employees(fall and/or part-time).* have hired the sub-contractors 2.[l i am a solo proprietor Or Partner- on the attached sheet.-T 7• Remodeling ship and'have no employees These sub-contractors have 8. [(Demolition working for me in any capacity. workers'comp.insurance. 9. 0 Building addition [No workers' comp.insurance 5. ❑ We area corporation and its ME]Electrical repairs or additions required.] officers have exercised their 3.01 am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.QRoofxepairs insurance required.] ployees.[No workers' q ]Ti:. 13.0Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they o're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that isproviding worlters'compensation insurance foamy employees. Bellow is the policy and job site information. insurance Company Name:. Policy#ox Self ins.Lic.#: (� 1gFXPirationAate: 1.J Job Site Address: 2( e_cy ( Ave City/State/zip: s AIL*,- L)/7�5 Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as wellas civilpenalties inthe form of a STOR WORK ORDER and a fine of up to$250.00 a day against the violator. De advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert erg ill ains d penalties ofperjury tliat the information provIded above is true and correct. V3 Si ature: Date: 19 Phone#: _ (I.-) Ol 0 Official use only. Do not write in Mis area,to be completer)by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: ,1 RightFax C3-1 3/24/2015 9:51 : 03 AM PAGE 2/002 Fax Server DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE T IFICATE 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. D THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: GILBERT INS AGCY INC PHONE FAX 137 MAIN STREET (A/C,No,Ext): (A/C,No)- E-MAIL READING,MA 01867 ADDRESS: 246WY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA KEEN CONSTRUCTION CO INSURER B: INSURER C. INSURER D- 1175 TURNPIKE STREET INSURER E: NORTH ANDOVER,MA 01845 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DMYYYY) (MM,DD\YYYY) LIMITS GENERAL LIABILITY =-ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE [:]OCCUR. IREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY []PROJECT[—]LOC PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-999IM582-14 10/08/2014 10/08/2015 LIMITS ANY PROPERITORIPARTNERJEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under FL—DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE TIOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD STREET IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT&IVE NORTH ANDOVER,MA 01845 } 31 ry:r :: ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD . 1988-2010 ACORDD CORPORATION.�All rights reserved. Massachusetts -Department of Public Safety Board of Building Regulations and Standards LI/Ilstl UlLll'/U JUIIGI Vlll/1 License: CS-076691 4J-I ROBERT A KEEN- 12 E WATER ST;;� IF North Andover NfA 0 r Expiration Commissioner 08/16/2017 - ee t 111 n cwtveaNi o/�Caaaccc�ivaelta Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: ;108383 Type: xpiration:;._.8118%2016_=. DBA KEEN CONSTRUCTION CQ Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER,MA 01845''—'" Undersecretary