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HomeMy WebLinkAboutBuilding Permit # 8/20/2015 NORTIJ �• BUILDING PERMIT O`4�Leo I 4v. TO OF NORTH A �� y�'`` 4 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received TED pPpy cS �SSACHUSE t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP6A��&ARCEL. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building W One family ❑Addition ❑Two or more family ❑ Industrial ` Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ` ❑ Demo lition 0 Other ,, DESCRIPTION OF WORK TO BE PERFORMED: 'k- Identification- Please Type or Print Clearly m "' OWNER: Name: a ° - a c !"Y" Phone: Address: G5P Contractor Name: A- ,JPhone: Ci Email v � r ; Address: t` s � ► """ Supervisor's Construction License: Exp. Date: Horne 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: $ Check No.: �� Receipt No.: Alp NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund m m ... ,,�, r r �-�,r ro -!� 7i ;ai/ iir�r !./mil/� ,�, �� i � ! n,,. r, ir:!ra�li%! �'le,�!M/lltmr�t,e r,'�1, �t t�ii��� ?� /l Rr,r,��ir/%t/�l, /J,lii„ ^/i Girl/ar/�!TAT////�.'r (� l/l7 iH,/ii'�'.�,T., y /r' WOMEN/ vtORT H Town of Andover , ® 0 ® C, h ver, Mass, ® LAKE COC KIC MI WICK y1. Al 11 BOARD OF HEALTH PF= R.M1T I LD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .......� ��� ...... Com' ........................................................................... ............ .�j7 �y Foundation has permission to erect .......... buildings on ........................ Rough ................. to be occupied as ... C: ... ... !..................................................................... ...... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final EXPIRESPERMIT IN 6 MONTHSELECTRICAL INSPECTOR UNLESS I STARTS Rough . .... .......................... Service ..........��....... .. ..�.�-. -- Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Oecupy 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. j I - - CAbCV— =267.24(CB15) .��� d�� /. - at =266.03(CB16) =267�77(CB17) 7)=265.91 Q 16 67.24 t O ' � L \ co 4 Al, ` VC5 y am'' � 49' • } \ \ tToa. North Andover MIMAP May 29, 2015 P ri7R r 0%La/ rii J r �/` i n r4Y,l *C l � o �I I a r oJj r Interstates ', —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack '.. Easements t pdRTFf'q Valley Planning Commission(MVPC)using data provided by the Town of O X71.6 D b'p O Environmental N4 North Andover.Additional data provided by the Executive Office of MVPC Boundary j. 4� AffairslMassGIS.The Information depicted on this map is Parcels3' G for planning purposes only.It may not be adequate for legal boundary O —• to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSEDOR IMPLIED,CONCERNING 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 �ssACHUS�'i 1"=46ft ° i North Andover MIMAP June 1, 2015 098.A`-0121' 72 PEACH TREE LN 098.A-0131 71 PEACH TREE LN 098.A-0120 ' fi 098.A-0132 p y 5 PEACH TREE L6V � R3 698.A-0119 ' I � P . 97.34i All.'" ,ltr*a1fE 098.A-4118 ssltr< 55 PEACH TREE LLQ ° ' q� 098.A-0117 Rail Line Wetlands Zoning Interstates Exempt Lands Busine s t District I p f=`:Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR WN Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack IN Busine s 4 District OORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads IUs GainersBusiness District Q'f Sao 'q� North Andover.Additional data provided by the Executive Office of Easements AR Planne Commercial Dev Corrido Development Dist O 61 ra sb Environmental Affairs/MassGIS,The information depicted on(his map is C1 } " V MVPC Boundary •� G for planning purposes only.It may not adequate for legal boundary f'%Conido Development Dist O --• ''" � definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 0 Municipal Boundary M Carrico Development Dist F ,• 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning Overay Industri 1 District * - * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Industri 2 District i= 't a •µ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Adult t—nntort in lay 11 Industri 13 District c ^��r ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Downtown Overlay District M Industri 1 S District ...... Historic District oNAtRo app+` THIS INFORMATION Reside ce 1 District �1 0 Water Protection Reside ce 2 District p'r+4gCNU5�� ❑Parcels R—Idlei 3 District •'+- Hydrographic Features de ce 4 District rict -- Streams ce 5 Disteams 1"=34 ft ttEde w8 District „age esldential District North Andover MIMAP June 1, 2015 0 098.A-0121 ti 0 p 72 PEACH TREE LN 098.A-0131 71 PEACH 'TREE LN a98.A-0120 - :>`.,af!: •.:ally:': .. 098.A-0132 65 PEACH"THEE Ltd 098.A-0119 197.34' Q 1 �I;• - . :��lt�•:::.:.t, = 098.'1!0.1-42:-")_1?1::::..... f '° `••Bair:{i:_',i��=`- 098.A-0118 :.6r '`°':::" 55 PEACHTREE LN 'iJ%r• i I 098.A-0117 - Rail Line '... Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR Meters Data Sources:The data for this map was produced by Merrimack pORTH Valiey Planning Commission(MVPC)using data provided by the Town of Roads Qf Gau q North Andover.Additional data provided by the Executive Office of U'u Easements t1 bbit A*pp Environmental Affaim/MassGIS.The Information depicted on this map Is MVPC Boundary •� L for planning purposes only.It may not be adequate for legal boundary Ll O -• In definitionorregulatory interpretation.THE TOWN OF NORTH ANDOVER Municipal Boundary F. A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING - Trails it * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY El Parcels # i * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT M °09 y y° ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Hydrographic Features ./� ao�^r�o..�""qy THIS INFORMATION - Streams SAC US ''....... Wetlands '... Exempt Lands V==34 ft ' WESTFORD INSURANCE Fax:978-692-0429 Jan 6 2015 08:35am P001/001 rCER, -I nvLLr—I yr Iv. InCERTIFICATE, ®F LIABILITY INSURANCE DATE(MMIDDIYYYY) 01/0612015 IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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). CON PRODUCER NAME: Eric Semple Westford Insurance Agency ac°No Ext: 978-692-3073 PO Box 308 FAX No): 978-692-0429 Westford,MA 01886 ADDRESS:Eric@Westfordlnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Liberty Mutual Insurance 24198 INSURED MarkHarOU16S'Dak"":1 INSURERB: Hollywood Interiors INSURERc: PO Box 486 Westford, MA 01886 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 I ADM POLICY EFF POLICYEXP LIMITS LTR TYPE OF INSURANCE INsn vtrvn POLICY NUMBER MMIDD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 _ffAMAED CLAIMS-MADE �OCCUR CB04592815 10/04/2014 10/04/2015 PREMISES (Ea occurrence) 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY❑PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PERT ERS AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE ElN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS l 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Bldg 20, Suite#2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 �Pacy .f—t/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD WESTFORD INSURANCE Fax:978-692-0429 Jan 30 2015 10:54am P001/001 ®36,01,2015 16:43:57 Guard IIISIIrwo Gumd Imurance Group 1/1 ACORO CERTIFICATE 4F LIABILITY INSURANCEDAl1=(MM100)YY(Y) 0106 2015 THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS i 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 CONTACT NAME: WESTFORD INSURANCE AGENCY PHONE FAx (At-N%Extl C No): 224 Littleton Road E-MAIL ADDRESS: PO Box 308 INSURER(S)AFFDRDWG OOVERAGE — N AIC i Westford MA 0 188 6 ....................___....---- 1NSURERA: AmGUARDInsurance Company INSURED —................._�_ INSURERS: Mark Haroules dba Hollywood Interiors INSURER i u _ PO Box 486 INSURERo INSURERE Westford MA 01886 INSURERF: 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, iEXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ LTIRTYPE OF INSURANCE POLICY NUMBER MMADrVYYY I POLICY EMP LIMITS GENERAL LUBILnY EACH GCCU;RENCE S COMMERCtAL GENERAL OADrIL:T'r pH _ ~ -EM§!EGJEaoa:urcarrce $ .A!_I i MEG FJP'An• oa: r;�r• PERSONAL S ADV iN-,L,RY $ ( ..... ..... .......... _ t .................._._ ._................... t ( :.E>4cRALA0 REGATE $ I G_ht AGGP•EGATE LIMIT APPLIESyPEP ( r'ROntl:TS-�0Y.P%:P AGI-, $ + $ .-................_.__ PDucr PRO '.;0c. AUTOMOBILE LUSILITY i�.: _ .hG = Ea aan.unl c::GDiL°:NtJ_Rt IPer_er:,on) f _ A1,;1 AUTO AL_CWNE •�BCH=Cx<L[G �kooi1_°i:,U:�Y(Peraccierd; s I AUTOS •AiT03 ir_,-;•w,i:E i y RO=ERTYDAMA = .c HIREDA::TO_ ?Ad_T0S (Naratt�d@nI1 t — } - I Ig { UMBRELLA LIAR ,_r'.U� I j EAi_H Oi:CUP.RE1cCE $ ;_t '----- _— 'EXCESS LIAe p;A1�-MJ+L'E I .AGGREGATE DED RErENTNVN$ S WORKERS COMPENSATION ?M ATU OT - A AND EMPLOYERS'UAB0.11Y R2WC512664 9/23/2014 /23/2015 Mrr^ ANiPPOPRIETOP.IPAATAgRtExEfJTIVE YIN `FL t-AGETACC IDE'J7 $ 100,000 CN=CIERAAE'A6fR E'CLUD=Cr.• Q N/A I ....... '.. (Mandatory in NH) I EL L;IEEA.SE--A LNIPLOYE-d S 100,000 If yes.describe under DE-SCRPn=OPEkA':ONS e.ow E L=•hcASD-P OLr r LlrnlT s 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES (Attach ACORD 101,Additional Ramrks Schedule,Ir more apace is nquir4d) The workers compensation policy does not provide coverage for Mark Haroules CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood Street Building 20 Suite 2035 THE EXPIRATION DATIE THEREOF, NOTICE WILL BE DELIVERED IN North Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD C/1mjmj Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 133806 Expiration. ••8/13/2015 Type: DBA MGH CONTRACTING MARK HAROULES I 118 CONCORD RD WESTFORD, MA 01886 Undersecretary %0Z1WL0 .tnuolsslwwo0 ' 9�810 2vw mdot S m 1 (I2I CIROJNOJ 81I S�'IRO HVH`J 3fav 1I 6VZ6L0-SO :as uaol-1 .[ost_A,-)dnS uuiljn.q�suoj i spaepuu S pue suol}eln&a)j fjulpllhH 40 pros •AI@ILS oilgnd 4o luempedoo- sllasngoesseLN