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HomeMy WebLinkAboutBuilding Permit # 9/3/2015 A,AORTH BUILDING PERMIT TOWN OF NORTH ANDOVERCS APPLICATION FOR PLAN EXAMINATION o $ Permit No#: '�" Date Received '4S`a1CHt15�R Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION � Print PROPERTY OWNER u' b. 1z Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no 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 /r �r rr,r,rrrr,, i'-r, ,/,„r,,,�<,„,�,.r,. „r r/.;r/,,,r,i/i�,/, „r, „-i,,.,,r,%;/�r/; /l, ,r,.,.r;r r,/�, r,i.❑,,Wetla�cn./od//s/J.!/rr,,%//r rr,ri�//iJi o//G l<//i,,/,//fr r , „/, rilo %i,,re t� /r l ewe, r �l � ` / // / ✓i%��//,r/// /u/iii///i,f 2/, �����I�����II�����i� DESCRIPTION OF WORK TO BE PERFORMED: C4 V q b Tv Iden ificatio - Please Type or Print Clearly'~ k�d OWNER: Name: / ����� ��:�'�� a�l oma Phone: Address: Contractor Na e:AP( ti Phone: � � Emai1 , (1 f eo vv? Address: /Pp // r i�vi cl Supervisor's Construction License: r� Exp. Date: (� / Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the rants fund �ORTfi Town of �' E ,, Andover U. M61 h No. h ver, ass, X;� coc"Iche wIcPC A�R�{TED S ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...........�® �. ��:.. d:?�?cs .:: 01.'x............... ......................... BUILDING INSPECTOR //��� �� _�/ ' has permission to erect .......................... buildings on z 10eL .. .... .oil. . .... . .............................. Foundation Rough CJbs�rs L,.�G Dom?':..Gt; �. tobe occupied as ............................... ......... ......... ...... .�U�..�..:............................................. 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 EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .......... ........ . ........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Ruildin 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. OP ID: COHA DAY)CERTIFICATE OF LIABILITY INSURANCE07124/2015 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). CONTACT PRODUCER Phone: 978-688-6921 NAME: Hannah Courtemanche,AAI,CISR Macdonald&Pangione Insurance Fax: 978-688-5350 PHONE 978-688-6921 Fax P.O.Box 428 ac No Extl: A/c No:9?8-688-5350 104 Main Street E-MAIL m hannah Ins.net North Andover,MA 01845 ADDRESS:hannah@mpins.net DGCON-1 Donald Schemack CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED D G Contracting, Inc ID 646648 INSURER A:Travelers Prop&Casualty CL 25674 428 Pleasant St INSURERB:Safety Insurance Company 39454 North Andover,MA 01845 INSURER C:National Liability&Fire Ins 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 680-15531118 05/17/2015 05/17/2016 DAMAGE TO RENTED 300 00 PREMISES Ea occurrence $ , CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULEDAUTOS 3116538 07/12/2015 07/12/2016 PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNEDAUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A CUP-0090153321 05/17/2015 05/17/2016 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVEY/N V9WC640862 03/31/2015 03/31/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/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 Town of Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 36 Bartlet St Andover, MA 01810 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD r. S 01821 F l ah i 1 I