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HomeMy WebLinkAboutFOUNDATION FOR 15 UNIT RESIDENTIAL APARTMENT BUILDING PERMIT T%0RT11 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No : 51-11-iew Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 7 5-7'etvAckl-S �3 I_,,pin, ne - PROPERTY OWNER. Vzr+ 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 [I Addition Two or more family I] Industrial El Alteration No. of units: El Commercial El Repair, replacement El Assessory Bldg 11 Others: El Demolition 11 Other "Ar ng R �,'SQ i 16, WE DESCRIPTION OF WORK TO BE PERFORMED: Vo V Vtku+il 0-11� 7 L6W 0114;Vkv-,�* e.A+ OWNER: Name: Identification- Please Type or Print Clearly Phone: q"Ib� 401, -7 Address:Contractor Name: V"Cvl- skK-isa LLC- Phone: .410q 122-1,1 Email: Mj VPL,-A 71�z.cj M<j��,t6 t-2E4n Address:- Supervisor's Construction License: Ce-7 Exp. Date: 71h Home Improvement License: --Exp. Date: ARCHITECT/ENGINEER .1 1)4647k 1), Phone: q 0 Address: �q V&,f, Ak"- 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: le�>0 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acres to the guaranty fund ----------- --------------- F FORTH Town of ndover Q .',,tip "�'` •` t1! No. _y 2 � _0/ Z o h ver, ass, COC Nl WICK ��� ZLIOZI �.9 A�RITED rp���y S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .... . .�.�r.r�.s �� ..�..... '.�. ^. `�fc: ....' .... .............................................. .— has permission to erect buildings on –�uv`�c�F`s Foundation Rough to be occupied as .......... v..ec? :�T':.....................! 7__0 C '�owe"�E .�� � ............. chimney .......................... ....... . provided that the person accepting this permit shall in every respect conform to the terms of the aication 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C STRUCTI TARTS Rough Service ........... ...... ... . ... .. . . ......................................... 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 To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/8/2015 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(ies)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: Lisa London MTM Insurance Associates PHONE . (978)681-5700 FAX No:(976)681-5777 1320 Osgood Street EDD ILSS•lisal@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA.Atain Specialty Insurance INSURED INSURERB:Safety Insurance Company 9454 Verdeco Designs INSURERC: 1 Elm Square INSURERD: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 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 SUER POLICPOLICY NUMBER MM DDY EFF/YYYY MM/DD EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 NCOM GE TO RENTED MERCIAL GENERAL LIABILITY PRAEM SES(Ea occurrence) $ 100,000 A CLAIMS-MADE ❑X OCCUR CIP159979002 /17/2015 /17/2016 MED EXP(Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 JFCT X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea acrid DISINGLE LIMIT 11000,000 ANY AUTO BODILY INJURY(Per person) $ BIx ALL OWNED SCHEDULED 057753 /17/2015 /17/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE $ LXHIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WCRY STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood St. AUTHORIZED REPRESENTATIVE N Andover, MA 01845 = ' M Laorenza/STEPH - ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INRn95 r9ninnst m The Arnpin Home-l Innn ire renictererl mnrire of ArnPn CERTIFICATE OF LIABILITY INSURANCE 7/15/2015 THIS CERTIFICATE ISISSUED 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 endorsements(s) PRODUCER CONTACT NAME: MTM Insurance Associates,LLC (A/C,No,,Ext): (978)681-5700 FAX No.:) 1320 Osgood Street AD RIESS: North Andover,MA 01845 PRODUCER CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Atlantic Charter Insurance Company VDAC 44326 Verdeco Designs,LLC INSURERS: INSURER C: One Elm Square INSURER D: Andover,MA 01810 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 BYTHE 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 BURR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR WVD DATE(MMIDD1YY) DATE(MMIDDfyY) (In Thousand) GENERAL LIABILITY EACHOCCURRENCE $ DAMAGE TO RENTED PREMISES COMMERCIAL GENERAL LIABILITY (Ea_—n.) $ CLAIMS MADE ❑ OCCUR ❑❑ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY ❑PROJECT ❑LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea Accident) $ ANY AUTO '.. BODILY INJURY $ '.. ALL OWNED AUTOS (Por person) SCHEDULEDAUTOS ❑❑ BODILYINJURY $ (Ea Accident) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNDED AUTOS (Ea Accident) NMBRELLA F-1OCCUREACH OCCURRENCE $ LIABILITY _ EXCESS LIAB❑ CLAIMS MADEAGGREGATE $ - DEDUCTIBLE $ El❑ $ RETENTION $ WORKERS COMPENSATION AND WCV00951304 03/04/2015 03/04/2016 X STATUTORY OTHER A EMPLOYERS'LIABILITY LIMITS '.. ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICERIMEMRER EXCLUDED? � WA Policy Coverage State:MA EACHACCIDENT $ 1,000,000 Mandatory in NH Ifyes,describe under SPECIAL PROVISIONS below DISEASE-POLICY LIMIT $ 1,000,000 DISEASE-EACH EMPLOYEE $ 1,000,000 '.. OTHER ❑❑ DESCRIPTION OF OPERATIONSILOCATIONSAIEHICLES(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 Town Of North Andover EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Osgood Sheet 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 1600 O North s ood S MA 01845 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. UTHORIZED REPRESENTATIVE ACORD 25(2009/09) Page 1 of 1 CERTIFICATE HOLDER COPY ©1988.2009 ACORD CORPORATION.All rights reserved. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-105187 y' Construction Supervisor MARK J YANOWITZ ONE ELM SQUARE ' ANDOVER MA 01810 Expiration: Commissioner 07/11/2017