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HomeMy WebLinkAboutBuilding Permit # 8/17/2015 BUILDING PERMIT �` c► `'°oT" � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: °� Date Received 7�aDRgTEDWPPP Date Issued: :�l IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes Cno MAP PARCEL: ZONING DISTRICT: Historic District yes 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 „f, ,F i. / �. / .,,e r ,/ //f / „/. , // ,..,1, .. i,//,•,. „ri �,i /, r.,/// �/� //.�.... .y /�/.//, �r.,, ,. / ,,., � G �. , , oad ai,.,, ,� ,Wet ands � /�, �❑ „Water'shec� s41ct //,❑ F l ❑ Se ❑ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Z LLC Phone:"7&2-qdQZ Address: Contractor Name: 6 Phone: Email: tz Address: 41 h(;,,,,h Supervisor's Construction License: Exp. Date: is h6 Home Improvement License: Exp. Date: 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: $ - FEE: $ _4 100. O 40 Check No.: 12-.- Receipt No.: 3A 20, NOTE: Persons contracting with unregistered c tractors do not have access to the guaranty fo i Plans Submitted W, Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Ur- Taiming/MassageBody Art ❑ Swimming Pools ❑ Well ❑ 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 �l5 Signafiure_, COMMENTS CONSERVATION Reviewed on J 7 ' _�l I /� Signature ,� ..��� kr COMMENTS 11.,E - n HEALTH Reviewed on- Signature/ COMMENTS Zoning Board of Appeals: Variance, Petition No: 1 ,_jr�'%f`. Zoning Decision/receipt submitted yes i Planning Board Decision: 11 I k Comments Conservation Decision: t ' Comments Mater&Sewer Connection/Signature& Date, _ Driveway Permit DPW Town Engineer: Signature:, - — Located 384 Osgood Street _FIRE.DEPARTMENT -Temp Dumpster o site yes �` no Located at X124 Main.Street Five Departrneraf signatureldate COMMENTS L t%ORTH --& ver Town of 17" -0 L-AKE h " ver, Mass, + lid 2,0(s COCNIC"t WjC9f *- S � BOARD OF HEALTH LD Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ................... BUILDING INSPECTOR has permission to erect ....... buildings on Foundation ` ................................................... Rough to be occupied as ........ .1.�`!.. �r....... ... V.�t�. .......�!�� chimney provided that the person accept) this p ' shall in eery 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service Y .. ........................... Final BRIG 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 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 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(, F� �t 3tF v¢ t+.rs �h �. ,.i� �{ �. !_!a"��T;=Ep,, h ?fdT��'P.�tl.�,''EF+�.►�1"�:=,. •.a s i s t C'ATE.7.128 15 SCALE. 1°-M)� tlE, '' L,ISr'W;� `;iH�-FT, H,�l;,+P.,HI „;, wA'V « t_ 1,7KR , ¢ T17L 11.5 arJtJ_li' A), 10WI-1,M)-1:61�4 CAll" 0`4 ® DATE(MM/DDNYYY) ACOR® CERTIFICATE OF LIABILITY INSURANCE 8/17/2015 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 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 NAME: Sandi Munroe M P ROBERTS INS AGCY INC PHONE FAX 978 683-3147 (NC,No Ext: (978) 683-8073 A/C,No:% ) 1060 Osgood Street E-MAILD DRSS:danielle@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAICN INSURERA:ESSEX INS CO INSURED TKZ LLC A/O TLD LLC A/O INSURER B:ASSOCIATED EMPLOYERS INS CO TOM ZAHORUIKO INSURER C: 78 GREAT POND ROAD 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 LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE F_x1 OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A 3DX4936 07/13/15 07/13/16 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000_ X POLICY 1 PRO JECT ❑LOC PRODUCTS-COMP/OP AGG $ EXCLUDED OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) ccident $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMA E $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE ER B AN OFFICER/MEMBE R/pARTUDEDE'XECUTIVE Y❑ N/A E.L.EACH ACCIDENT $ 1,000,000 EXCL (Mandatory in NH) WCC5005006517-2014A 10/01/14 10/01/15 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE L M ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Depar;rnent of Public Safety Board of Building Regulations and Standards Construction Supercisur License: CS-055417 " Phomas D Zahoruilco r 78 Great Pond Road North Andover NfA 01845 Expiration Commissioner 04/05/2016