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HomeMy WebLinkAboutBuilding Permit # 8/31/2015 BUILDING-PERMIT. o* NORTy�.� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ` �'���• °' �SS�CF0US Date Issued: IMPORTANT Applicant must complete all items on this page 7,,-rte C�v f L c '.1 }l,r,( f.`AN-•.-r, r i_ i %- I iz'T'Y 1--fi r. t s_'`51 ..3 ati Z; �' - f a-. .12 .1 7 rn�-=r`'' i r�r, f `�,.s� n-'A t t 1"�•s.r n,t5� rte ,,E,y -f��.k(+r„1-"P1�1'L 3 � .5.�ar1r WIN, � -Ifz I�z � -x...... ,�i�'�-sr•'_-`_ .�• �-t{� a-o�� r r. _�w�_ �,r�. s`.�^. _ .-1f a}�i�t�T,,r,IE"�•`{`;S��r ,x s(>:,:.'S2�A, ���'-�.� �1.--4 .' k-a a � '-*�c *z I,yL -� s-, +'��'� ��• �'z-; �'r?��S'i..r�•�`� •.t � �u-sl .�'�•' �}T�+ir`L";/i�t°,crr "�.5• ;IJ) r5 11iS�L �-��� f�T-r'��- T._7.,r�'-Cj ��F1=, 11 � T�_,�_"�1�: -T�1- `d�,i 4 _ ,�,.�r a-� •.t I. - Y l'�-`I?d a� br`;jt- .Edft--rT�,G- 3IrJ 'fii,� 37�r� r.J rd � ,PG�����:�- _ '� �/��`� r p�,_,•f,•t �,: � "N��i'G �{7!ST�1'--�T� ,J>a `,-�;.�. r o.�'-�-�- r'113:^ _L?.'y�^,r^"_�v�ti.:yx� •;3gr�:,;=✓�9"r(lr�•rtiz�;u:r�%� .7N q-.>r: ,'rs;r,�v:i�;+ri'a.^,tTS;�• r qr 3- ,t^ 5_5.s z-r } _ ,�,l t,r trr r•„i'9 Y:',�ttf.-^iLy-'c�iir-,L.r,-T•'�L'n3'1i r"h•rr Gam:_, ^-p.-. te�f,.; J-. �.i- )+� 14 .,.tr., _ v.: ,� �zr.� -`�f'1_ Ir-. 1�'7.,.v{�,pr`"1-5 - �_�..� �. r:r��., fir. "tai a�E,,..r- 3�� � i7 I � .Y •.I- .C,4_. d.,_ �.e _. �:..,;,,,..,.�•.7.�,.�- � v' r t r._j,F,�a..'-,.:T S _�s .rz��-� u�,�`C�i 111��:fa}�p �Al�,ge'-�i I�-�*/ r��z r 1� .r- 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 w� ��t,,,r_�� � 1�r. I y�hts-r"�-urt�.. 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Y ) N } C` T^ 1 ht T ly, �_ Tiles} h µkb�.c M .`>�•° 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. F Total Project Cost: $ FEE: $ Check No.: , Receipt No.: , NOTE: Persons contracting with unregistered contractors do not have access to the guacanty.fund S�n�tur��f�A enfiJQwner �-.. ._ ;• .; ::: ; Y Sln-'nature of�co�'nraet."- ,: :'� �. -�-'��- r"11111111179111 A" t%O R TH ]Fown ot Andover ® . nff-- h ver® ass O LANE .� J S COC NIG NF WICK ®S0RR7'ED P' �� U-S Ti u BOARD OF HEALTH PErxM1 Food/Kitchen LD Septic System THIS CERTIFIES THAT . . ., BUILDING INSPECTOR has permission to erect buildings o Foundation Rough to be occupied as ......... ........... ....... .4ft;,4 ... .......... D. ...... 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 I IN 65 MO0 N S ELECTRICAL INSPECTOR LESS TIO Rough Service MOAN 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 ToBe Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. .......... Joan Larisey 781-315-3909 Addiem t1V I N G INDOWS - V00 S 101 Edgelawn Ave, Unit#8 North Andovei, MA 01845 himis y(hom,dAtid Qpt,veacel vvr,,thr,(vdnwt:,f M tNrmrrms munkkxw�1T0m'/hver)Y cnfit�a,,,t w I tIk and authorIzo ycm I Pu I(j I I!maiej+Kf I a'XY'p I If a'ij;I,I I I I m�, Io fISMIG fnstruct tInd tflnci,the irupx to im° iem) I0 nijn0ition:; (o perm$6 u b�duva dolcubi-d Fim 10NS id (WINDOW)SPECH9CA1 BuIld T[e It[(o Low-i: Metal PVC Nem,InsIdO TMAL,`t, I4cul Overhang Argan Scveens Giidt-, Tr / ltinn Him3h 'A" Color Yes Jo Yas W Yes No la,,s No Yes No Yes bk:, Yes No Vee I ito . .. ('Mbk,,Hung 3 p. & of,fab arden 113 Bah"Ice Upon Csu c NMES s A (MMNG�SPECROA71ONS Apply ovc-r body aroa of hmsFi '11ye-'*ofn,,'m.jIaficm Hems not covenid or instaHe& Yes P40 Yes NO cele No Shp off Exisfing Siding vinyP&Iutters' rovide Cantanurand Window Martwis New GuU,jng Govw Finda&Sofffl Dom wrounds Gum.'r off at on Doof Windov,Casing Ceiling Hufrd Pos�6Y, Mny[RxItiree Accpsscin. 4 needed PVC1"61m FIaditional rloM ............ M4 STARTOF ALL JOBS MUST REMOVE ALL MMS FMIM ALL &SHELVEIS Conskudlan Iatatvd perInIts:ff the horneomer OUIns hIIs own pamb fof the vmk deswH�ad urift"k homeovongr is here by adAsed Ihat 41 the evoIl of ffisrMe,pudgmmd and nonpappent M the contractm,tim hieneownex will nut he enfiflod to 111111MI0 a q'i'IlIm to or Ixftcl from Me gumunty fund ciftbUrhed by Mqitw MA,MAM. WARFIA a P X, Yp 1 U 1%0) Pax 0,A'T I, Or"k '0 1 1 1['t fw!r l I I'd r�pull ',Pr UJ I r"I t' L N",'d i, IU��n')';I,rxni,i, t I; to, Ida ,,Ij me; 4 j I If. V,no I ",I v'M,r h"I I m" "'I nq ro' it, w K &dmavl 11 ..... It, A�j 0' ':WMl "it r rp"of,,I I, t i j 0i IC,k'. a° 1,2 u%r'I i 4N I I �Xt"' Or toboo "ilti"To Y, Io pliM5 0"(xlhl" 0'�C,;1,F", llw,u ip6t WNAT'� I, h'��Wrra�,wl rvy"', XW;' TL TAL$ d- L WIndows Doom ILL-L-2-2-1-2........... I Ee;"pmod 41 a 2.54 K Broadway- BrecktamIdge MaIl n srgninq it hac(; ...........__j Upi, /3aBal,nco titm compIutiori 01682 99730 IAI 110' i u l -Hol'vW m' Ijo I N, I S A �'Itj:",)IM'd�j I �11�1 M111 0 a,d"i"NA, [","MH ,' .........I, 11V� It r,I ir"I"! 3"'�ir'"'L,j"I"�1)-Vr�( ON! iMji I 0V,:xf If ii.l-d r"fj�r A Vp11 mf" Arl 0 ,-pf' kcapUnce M F'opor'A t%zpl I I"'ov m,,,'u,I,m',p a r,M 40'"f I u r f+I I)hf III a U'm'1 1 q I! ilc""'iQr, ,e 1 ""fI'<4� PI"C"V/11 1"rIdIR 11, Tfl !'o-I You'ffie Buyermay cismaq Oils tmns vbotl M any ttme prim Vi mIdItIght et ffie thWd bushiam day after Hie Ma'rt Ihts 0 ansmfiam Cancellafion alam 68 diam N wr Mfiy�We rwaIrm Itto tlVMhBd4 tacheckparer c'WIL DO NOT VGN'N,HS CONRACT H"I I IERE ARE ANY BLANK SPACES, day of it) Y", The Commonwealth of Massachusetts Department of Industrial Accidents ' Office oflnvestigations . 600 Washington Street Boston, MA 02717 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electi icians/Plumbers Applicant Information Please PriuLflegibly Name (Business/Organizationfindividual): k—u�o 6 C11�C , .�d. 1 c- Address: J _sjf-`(, C: �vG �/, C. > L Clay/State/Zip: t �� "via LJ .��vi _ Phone #: 1' Are Pu an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with _ 4. ❑ 1 am a general contractor and I b. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I 7. Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3. El am a homeowner doing all work right of exemption per MGL 11_❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.) t employees. [No workers' I3.❑ Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'cornp.policy information. t ant an employer that is providing foorkers'contpensation insurance for my employees. Below is the.policy and job site information Insurance Company Name: E xcc!.�_Sidi' G c Policy##or Self-ins.Lic. #: �/ �,-J E;piration Date: 1 lob Site Address: CJ Choi City/State/zip: 1iiry�� �JV 1�)� J Tj ktta.ch a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). �ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ane up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine )f up to $250.00 a day againsf the violator-:-Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA-for insuranc-coveriagq verification. do hereby cert, under ains and penalties of perjury that the information provided above is true and correct ;i. ature: correct- Date: Offecial use only. Do note write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1- Board of Realth 2.Building Department 3_ City/Towu Cleric 4. Electrical Inspector S.Plumbing Inspe-ctor 5. Other Contact Person: Phone#:_ (� ® ACCERTIFICATE OF LIABILITY INSURANCE D/ E(MM0D1D/YYYY) 5672 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 CONTACT Linda BO danowicz NAME: g Insurance Solutions CorporationPHONE (603)382-4600 FAX (603)382-2034 A/C No): 60 Westville Rd Ep AIE :lindab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC It Plaistow NH 03865 INSURERA:Peerless Indemnity Insurance 18333 INSURED INSURER B Brooks Construction Co. of Lawrence Inc, DBA: INSURERC:EXcelsior Insurance 11045 254 N. Broadway INSURER D: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1552621745 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. ILTR TYPE OF INSURANCE ADD S BR POLICY NUMBER MM/DDnYYY MM/DCY EXP D/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000 PREMISES(Ea occurrent© $ r A CLAIMS-MADE a OCCUR BP8945793 /16/2015 /16/2016 MED EXP(Any one person) $ _ 15,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 21000,000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS per accident Medical a ments $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY y/N - ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? C8836275 /16/2015 /16/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 Joan Larisey ACCORDANCE WITH THE POLICY PROVISIONS. 101 Edgelawn Ave, Unit 8 N. Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/CLS : --- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(20t005).01 Tha ArORr)name and Innn am ranicfarafl markt of Anndan Massichusetts Department of Pubhc Safes Board of BuRding RegWations and Standards uun0rucapuaaa Suapuea0wr Spedah Ucense: CSSL-099730 MARK DIPRIM A 18 HAWK DRIVE SALEM SIH 03079 "a a ama���x 6 ro ua�a 02/20/2016 Office of Consumer Affairs arc Business Regulation �a rf ME IMPROVEMENT CONTRACTOR ',"Registration: 101682 Type" Expiration: 6/29/2016 Supplement BROOKS CONST C0., INC,OF LAW MARK DI PRIMA 2540 N. BROADWAY STE 1161 f SALEM, NH 03070 tJudecsccretrtry