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HomeMy WebLinkAboutBuilding Permit # 9/8/2015 N®ery BUILDING IT TOWN OF NORTH N APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ��p0R TQp Sscwuse Date Issued: IMPORTANT:Applicant must complete all items on this page r LOCATION r � TII7� PROPERTY'OWNER , rrr ' /r rl r err///i r PC / / h %r%�� Print r r N MAP;NO' �% PARCEL r ZO I DISTR ICyT Historic Dastnct des no IVlacShop VilNage ye 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 G?Ui4VrZF IAIC e06 Septic ;. Well Floodplain �aNetlands Watershed Disteidt. 1Nater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: X `CP604. a e l'- 6"Li 14lred Identification Please Type or Print Clearly) OWNER: Name: .`J'I< ` .® L-L—c- (LA4 k Phone: .. 7 Address: % 4- 1 c .. r, r CONTRACTOR Phone. ' 1 / �/ / r i 7 / r r Address f r>a �r rr r, / ' 'r.�r/ / r ✓,: r rr r r j // r j ri r Suerursor's Co strucfiron Lrcense ft r r, i'i r r/� ri m/0 �/ ' //ir p „ „ Exp Date. ; l '" Home.Im rQuement Licenser ": 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: $ 56 FEE: $ Check No.: � � � Receipt No.: -k � NOTE: Persons contracting with unregistered c tractors do not have access to the guaranty fund Signature of Agent/Owner .�: Signature of contractor oORTH 140.w n i liduvull ® .:ti•: to . h ver, Mass, ,9- COCNICNEWIC. 7,95 4ATED U BOARD OF HEALTH Food/Kitchen PER MIT T D Septic System THIS CERTIFIES THAT ........ .... BUILDING INSPECTOR haspermission to erect ............ .. ., buildings On...... ............ ................. ......... .................. ........ Foundation p ..... ........... g ...... . s .., Rough to be occupied as .......... .... .... ....... ..... ..: Aaol.... ....................................... Chimney provided that the person accepting this permit sha ' 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 IT EXPIRES IN 6 NTHS ELECTRICAL INSPECTOR UNLESS C S T Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Puildin 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. GREAT LAKE LN. _ S 0.0' 0 0 N •� t 275'-11" La — w i Fence with Self Latching,Self Closing Gate MICHAEL �0 to meet all local and State Codes s ) J. tiN 78'8" 2 SERGI m 234'8" \ o o No.33191 �~ OFESS10 N (Pool EXIST.FND. NOSURVe /22'x 38 TOF=198.20' 100'BVW I SETBACK 16T-2" 377.6' I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO FOUNDATION LOCATION THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. CLIENT: TKZ,LLC (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS,WETLANDS,EASEMENTS, THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT ORDERS OF CONDITIONS,ETC.)THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED LOCATION: NORTH ANDOVER MASS. ABOVE,EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN &SERGI INC.FURTHERMORE THIS DRAWING IS THE COPYRIGHTED DATE: 7/10/15 SCALE: 1"=100' PROPERTY OF CHRISTIANSEN&SERGI INC.AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISTIANSEN&SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFORMATION CONTAINED HEREON. PROFESSIONAL ENGINEERS & LAND SURVEYORS CHRISTIANSEN & SERGI INC. 160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830 WWW.CSI-ENGR.COM TEL. 978-373-0310 FAX. 978-372-3960 DWG.NO.:13114.001.014 North Andover MIMAP September 8, 2015 096:0-0083 037.0-OUO #391096.01-0080 096.0-0082 037.0-O 0 037.0-0006 R� f ` 096.0-0003 ##134 #601096.0-0079 0 #150� O? r #100 W 096.0-0048 #72 239" 096.0-0004 R2 #411096.6-0078gCt #56 1`�0, 393. 97 � :GreaC Rond;Roadl * s 037:0-0022 w 096 0-0077 t "^" r -096.0-0092. .„,w 4wM' r aJr }51dr � # #101 "q� x f 096.0-0088 \ ` 096 0 0005,E s r.l, t, ),. 037:0-0018 1 096:0-0055 r "r 096 0 0091 m 96.0='0420 4, It 096:0-0089 096.0-0006* 47 #4501> 4) m #451 +« # 55, #454' x,41, rtia tir R3. 9 to wltiJ 96.0-0090 .I 37ft #460 t ax #110 096COQO56- 096.0-0007 aI W. #f 465 i -.09&.02 i r 0058 w 09,6:0-0008 #469 #4`89 dr " 096.0=0009 #490' , 4 096.0-0,0,W--'-----"--'-'-"" _ 75 #474 tM� _ rlUate n 096.0-0047 „ 096.0-0010 096.070052" 096.0=0057 j #40 096.0=0041 #24 037:G-17020 096.0-x0111 096:0=O`a'62 096.0=0060 9 T-09-610-1 _ 0 9-6.0-o0a 096:0-00!63 096.0-0061 096.0-g059 03Z.0-0019, #29- 097:0-0097 ' El MVPC Be Wetlands Zoning Busine s 1 Disldcl 0 Municipal Boundary Exempt Lands H Busine s 2 District Hodmntal Datum:MA Staleplane Coordinate System,Datum NAD83, Rail Line IS Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack R Busine 5 4 District OR111 Valley Planning Commission(MVPC)using data provided by the Town of Interstates H _I R Genera Business District Of aur 'ay North Andover.Additional data provided by the Executive Office of SR N Planne Commercial Dev2. 46+tom •+6 4O Environmental Affairs/MassGIS.The information depicted on this map is Corrido Development Dist 3 L for planning purposes only.It may not be adequate for legal boundary Roads 01 Corrido Development Dist O definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER q-t Easements 'dW Comite Development Dist A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Induslri 1 Disidct ,K * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ❑Parcels Ind tri 2 District y n OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Zoning Overlay l%l!Industn 13 District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Adult Entertainment M Industn I S District s4`asSa".:. THIS INFORMATION (3 Dovmtown Overlay District Reside ce 1 District �1 °pnn°��� 0 Historic District Reside ce 2 District �S3gCHU5�'S 0 Water Protection ' R-dej ce 3 District sf Hydrographic Features de ce4 Disldcl de ce 5 Disldcl Streams 1"=191 ft u fde ce6District n,ege esiden8al District The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 _ www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ /i1/f/eOAI" c ;�36 Address:� t/ City/State/Zip: (2w-,S Phone#: 9Z& Q%-6J Are youm employer?Check the appropriate_box: FED ject(required): 1. am a employer with 4. ❑ I am a general contractor and I onstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t deling ship-and-have-no-employees These-sub-contractors-have 8. ❑Demolition working- for me in any capacity. workers'comp.insurance. 9, ❑Building addition [No workers' comp. insurance 5• [1 We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I 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' 13,U tither comp.insurance required.] �irtiw�tt ��oJ 1 *Any applicant that checks box#1 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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. Iam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. /� , Insurance Company Name: it ! 1,[ I'l r6,-4&49eC_ /}�J Policy#or Self-ins.Lie.#:_5q VJ Q 1 Z(5' Expiration Date: f a I Ri �� 1. Job Site Address: City/State/Zip: t�,� yt��.�t`7� 6���� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cernnder the va' and pe ofperjury that the information provided above is true.and-correct 041 Sign ature: Date: 2z 1 S— Phone#: Official use only. Do not write in this area,to be completed 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#• FDATE(MWDDNYYY) AC40R ® -CERTIFICATELIA ILIT'Y I URAN 5/12/2015 k.1__1 INFORMATION ONLTHIS CERTIFICATE IS ISSUED IRTMETTER OF UPON THE TE AFFMI CERTIFICATE DOES NOT NEGATIVELY AMENDYEXTEND OR ALTER TAND CONFERS NOIRE GHTS COVERAGE AFFORDEDABY THE POLIO EIS IZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. he certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, IMPORTANT: If tsubject to the terms and conditions is 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). NT cT Service Team PRODUCER NAME. PHONE (602)635-4814181 A/No):(480)991-0634 AIMS Insurance Program Managers, Inc. Ex E-MAIL serviceteam@aimsinsurance.com 1418 N Scottsdale Rd ADDRESS: INSURERS AFFORDING COVERAGE NAIC>/ Suite 100 , Scottsdale AZ 85257 INSURERA.Hartford Accident and Indemnity22357 INSURERB:Twin Cit Fire Insurance Company 29459 INSURED Environmental Pools, Inc. INSURER C: 184R Riverneck Road INSURER D: INSURER E: Chelmsford MA 01824 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 DUCE EFF PPO ICY AXAID I PS LIMBS ITR ADDL S R POLICY NUMBER MM/DD MM/DD YYY TYPEOFINSURANCE 1,000,000 X COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE $ DAMAGE TO RENT D 300,000 ���� PREMISES Ea occurrence $ p, �CLAIMS-MADE XII OCCUR I 5,000 59DENOJ2180 5/14/2015 5/14/2016 MED EXP(Arty one person) $ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY F-1 jECT 7 LOG $ OTHER: COMBINED SINGLE LIMIT $ Fa accident AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ 1 NON-OWNED (Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE $ EXCESS LIAR CLAIMS-MADE DED RETENTION WORKERSCOMPENSATION I X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIEfOFVPARTNER/EXCCUTNE B OFFICER/MF-MBEREXCLUDED? _J N/A i 59WEOJ2182 5/14/2015 5/14/2016 E.LDISEASE-FAEMPLOYE $ 1 000,000 (Mandatory In NH) If yes,describe under I I E.L.DISEASE-POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) This certificate is only a representation of coverage afforded by the insurance companies noted on it. Terms of coverage are defined in the policies Cies] shown and those terms may or may not comply with the requirements of any contract entered into by the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. XXXXXXXXXXXXXXXXXX XXXXXXXXXXXXX AUTHORIZED REPRESENTATIVE Kimberly Birk/KAT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2ot4o1) vlaeootro�za�zac ea�C�d�Cvac�uaeCh - Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 107083 Type: Expiration: 7/29/2-W Private Corporate:;. ENVIRONMENTAL POOLS ING: Andrew Everleigh 184R Riverneck Road Chelmsford,MA 01824 Undersecretary