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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 NORTH ^9 BUILDING PERMIT ��®`Tf�eo L TOWN OF NORTHANDOVER //ry APPLICATION FOR PLAN EXAMINATION Permit NO: ex Date Received q �AATFo APP` �GJ 7 Ao SSACHU`�Date Issued: ' I ORTANT: Applicant must complete all items on this 2age tx LOCATION G� Print. PROPERTY OWNER Print MAP NO: PARCEL:_ ' ZC+NING DISTINCT: Historic District yes no I�lachine Shop'Village, ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition mor more family ❑ Industrial Ji.Alferation No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well d Floodplain q v1/etlerzds ❑ Watershed District 11 Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: �0t-j Ca SU CL Phone: -,(®k 36 5% 32 tll-4 Address: w U CONTRACTOR Name; Phone:;--, Address: Supervisor's Construction License: .Exv , Dater 7,7 Home Irnprouement'Licertse ; Exp:;Date:: 1 /C'lZU1 JZJSCP ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. , Total Project Cost: $ L40V" � FEE: $ Check No.: 11 g.,o Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i Signature of Agent/Owne a44, QL01g, ature of contractor ' FNORM _t 01wn oi �' ®ver L Jill O p+ ® IL�c - C, lA.(E h ver, SSS, %2 '0z" COCMICHEWI[K �• �d p�RRTEO 7S V BOARD OF HEALTH PERMIT T� Food/Kitchen Septic System THIS CERTIFIES THAT �°��'G� BUILDING INSPECTOR .. -/Ci &! — f"' p"""' 6/ Foundation has permission to erect .......................... buildings on ............................................................................. Rough to be occupied as .. .. �: �......:...fi�� �� ,...� �`::.7. y 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 PERMITl MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTAON STARTS Rough Service ....... ..... '`':"�..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathin or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. �..:•;�CaS ilii i11 i�' P Jr L_�l This k,-Sa,7•�cs alI ----�L11. .;T� iI�. t {{'�� r';7 I g=tapra��hnm `4tQtzm©t>ofthcs�t l; UYM)�L ivt2s:ushtt:xtwC Gaide,ney gcrtl=-aFadvic_ onaia!FrovementContractoriat7 OfnceoFCcas>ae andED 'Otnelmnrovtm?eni bef,ti tinyp npl�Lung ome ^h terI42h},ilaida aa:BJeE`s� •t a LmCSSP tl2ion'sCo , ��ing{o yworitoar.o rm�,o�etnents�touIa obL�in2c4o n a. nszmainfo on Patnnc ' d nca-you •+y btain - yCi 2tG1197�v1 of 1 .8g._2.0 c0tPs'byc2Uingtha Z�rame ,3 3757 Oran ow)c .` - Ccm Strrt s J tiCiG� PanyZa:•n. ddrz s(do not uszn?test OTnce$a;• �Contr-{oils l ?ziy tl.rr` fJ}i_ / 5!ata > , mCcdB. nLSFiddrt;(>�tin?I _ W Deytimz.hcan "�L - cs,r falfr 6j) - $renins! one ttaiiin V/ r Cihjflarn ^� Add-res.(hdiIIcreottion / Cts Su ttpCedc rvphonc -�-'----_iZr j--'E t�--___�mPtclerIDarS.S_NUnb- tD -g• � D Go 10fbilnrv, c:ibeindewilLT;et.;oli_tocomotctc3,_ arl;for=he?oma.,. etltet }p.,bray,and L-^dc of r...tcias to b_ I�/�(/j.� 'U,Zd,nsc additional sh ' efollo)vin C4,m s ardt;i[Ibeseuredbytbeconr2o �s?'mniu�n (:•.?•��, ,s �sa � ��stberaomeaYners Sent: be o-sea5�taueCcmpicot��.. L r:. 0 4`a^ _ 3 1-_F-:,iti �> dne-dtotnilessci �! a rte-ThefoU _-�Dsbsyond{he oO Sscltroulcen•U _t17{3J:`c'ri3Sc?z tonLzcorscanbuIatia —`_Datervencon�e_ott:allbL;utconL'cte.j ark �:11112 1,234ha ----Date:;ven ccnLzc L..ctor2 - -uCz1lQe ted car;,t,;Ubcw 2;f, osr`nu'.Ily completed_ o-m the t.or,r, Lam•;t���d labatsrxifted n Pa}mcn,�)vi I ba n?ed•,ntxa jin•to - S [befoUat.ingsehc�i bovcfotthetoat� y tde: - o; I- - �_ fir=canttnc=fnottee„c_'zd_13 eFthetow c on._„ , rL cost 01 p, _ an of Izor ncms tvnichm: • 3 - or w.cor aietion of upancamnicdouofthc canL�tb (i.nr-fa crd�,�.ttr iagre��riJ�tdr'ncat r7i!as dz--°mgfaIIAS'.nCi[m[t'lcon atl._ rausthz� int fc>iscamotetcdtoboth tar„ clilac.Tp1=.7•onsdedula(n)J'ir�ino.'d �Lf�n a°rdin: pal'Ss= s>nclion) to btrrtid or_�i ss:rich zu.sc�:iJofdC.a a a.�n-r, :e'lCon,r-�a3y � c;d�fl7-P--ynentr,.geiIcontr dt� a cwtaf�., e+=ra:tar�t;�dcbeansraay me-::1`:ar::nt•--; tome_t• _Waal=aea sctr hr:.a.:tn I 3 sPaiil equiPn.r - s.nnG^n�.:rnrMnic•i:�nCcrnvE�cd t:: 'cUsl om m aa- :;�heo :-_..,eta; -rizterial Pam}/;:� � caatrctara•. 't?'=tin;::ra,? •- c,qI- n ate ia�;n. 1b t!a cant-,.cecr'u1 1:'synan�oie Fe,-ca ,ietion of i citJt r , n3th❑::a -n v m�thaa _ �dlabnrtmdarNlr>a yment =naecn�tariwate:- cr t_ul; e desc!ic;d ='^-nc -Uocn.' 2greastobeSolcly c dl o° canl,�ctsl!`tlnot?mpl•.- "'•�in-t' lum! _ resperstalefa,-- tha,n�, third C-5 Il}-befe2 ',to an F arki en�oLt as c to lint r?t_s m 9 r2o-tnndr7. `112 Wiens to yl o� :or,fw- S this �• nctn P1ac_ed on the resid n U�c n�1zv*a noted;rithin once.3cvi�:lhaFoU tlrsdnenment uSc k'D--- din; m%ngr-u17 asiaiugthar,u L 1td_ot a ctasav211 smetar�det!drull• ba,-,iabez Nc d. ulna mrc(--:nn S unde,�dit Ast a�.Unit bJ..,; r i,i h tl_Dit�{prof�o n �zciorAc sL21an. 4u?n7onS!fsoSe�I ino isuuci r aas. Sto n Di�aor cir�oro= =Beta:;•�m r�r Jecvnt Lc:or- sL nse?nca? r r PI ��Zenmdi7t L'-on�ciorPto,� fauu�Ljameitnptar meat as i se e cap,.c a L,the Can{r to an,t,1,02i IG of 1 iariui aabout c nLaaror ca_afinse-ea"data acterfortisdr,'y`n-j;: oJ`c=llingGl7973 o ' cur- ;u n="aa_,`•-•�_- meaL ccmont r' G7S7orSSG2 Gdd t wrr lr�_, . J mfan25oasa�at`.on 533757. - osreio-�eun :aWer<tCon _``helmportnt!tl�roraa5onon �conr!cave. oras;_to age, t, dtc-evc;c ode of this io m-and get a Fibil-Ob ctc:i `-meniitithsbPYo-tltcConsumer'n; etlti_tcr,, �Snecstapl�_!!SI�eS5 dcl�•"Cilatiinf,>'••,tea ai ICC Cr LicPCI?Q.r�C4'.,OST LI< R:c , `�'-`--=--_.:. u.esien• u;o ar's�or<nn1 1-» r^� ?ngci'ths n 4 -aittpo_'•c by tele P-w ofbt�na3s PIatld^r r `il ! n ttnrtt 3�adc a conceit ata ig'dIive, }than o�ltna Y notlma ___,1- _ 7`n r m.�Imta on midnighto.the L�:a'� "h t ell 'tri`=c2::i :aL '_c�14'Iy r',.,, ,�-�I 1.n Iom ro:u Sze )r 501 3i cc 'lot Con tr„lo- De!e tm:ase - TIM,Corsa=goinveofti of1ua-qsac 211sei`es L DepaFt2;?eI2t of-:?dlPse2•irllAcc:ge;<zl,� Con ess 01,yraez"s i>�`d:Ite 100 Q 1LjQi?f 1 '� 67—M41-'201 j I41I"Jl�i1 i�s"eO_s.S.Bi)31/:?'ZCe ��rorice.s'Compensation insurance Asda=rit:BuildersJrOt31ra£torsl Iect::cianslPlum€�ers. TO BE FILED girl T H THE FEI.'aIHT T IMC AUTHORITY. �`. Ao IiCan%Inforniatinn Tease Print Le21bIv Name(Busialess/o ganization/Individual): P.-tiMue ii1j& Address: Cit}/State/Zip: a! Phone 4: q,7 e- Are you ars employer?Check the appropriate hes: I.6 r am a employer with b� employees(hall aatd/or part time).v hype of prOject(required): ?.0 I am a sole proprietor or partnership and have no employees working forme in New Construction anv capacity-[Aro workers'comp.insurance required.] o- Cl Remodeling 3-01 am a homeowner doing all work myself[No workers'comp.insurance required.]T �• ❑DeInolitiOri 4.f7tam a homeowner and%will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers compe»sa6on insurance or are sole proprietors with no employees. 11.�Electrical repairs or additions 5.0 I am a general contractor and I have(tired the sub-contractors listed on the attached sheet. 12-®Plumbing repairs or additions These sub-contractors have employees and have workers'comp-insuanca.- I3-❑Roo-repairs 6.�the are a corporation and its Officer--have exercised their right ofexemption per MGL c. r 152,§1(4),and we have no employees.[No workers'comp_insurance required.) 1�' Othel 1 -1Y�fl ~Any applican[that checks bol II mus[also fill out the section below showing theirwarkers'compensation policy information. =HOmeotVners 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 sheetshowing the name ofthe sub-contractors and state whether or not those entities have employees. If the sub contractors have employees,they must provide their workers'comp-policy number. 12[22 n_tz ernpfol�e[':J2C[I LS f7r OLi!/1[IgiVollfeiS'COIi2pL'i?S2t1o2211251-: ItCe QP i1t!2127 101 eeS. #L'IOtsr TS the)701k),e[2!1 job Site �,n f 1 TJ ' !;z/orirzat`ioiz. p , Insurance Company fume: z u ri ck Policy 4'017 Self-ins.Lie. -70 1 ? 1 Expiration Date: /Z/, Job Site Address: 7 -,OL' Dy�4 I Attachn,copy of Erse yo:I. M ' City/State/Zip: /�/+ N �,p� e.s eompensaLton policy declaration page(showing the policy nu,-.Iber and eripit•a ;ort date). Failure to secure coverage as required under avIGL c. 152,§25A is a criminal violation punishable by 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 tate violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i do[+o:,oF,,, ..f:,e:._lizaer tjte '. Errs rj3 ur3tt pehP[jzeS Offer f'1!}'1/2[Il['Ile 1r2J'o[[?IAt[oj2 p2071111ed above is trite and COl•YeCt Signature: s.., - '. -:vs :, •;,. Date: / / Phone A: C, 1,04- 74tD- - Official Ilse 01141: .-`�10 lzot l"ite 112 this area,to be COWpleted by eiz,a[•tolui2 o}jrcial. City or Tow::• PermlW—icense r rssuisg.Aut'LIM-sty(cirele one): - u0a.d Of ?anitd ?.l alidil?gDe�ta�-c e>at i.i? r�oi}i€�'Iei'i: tlecrl lcal unspecter .P It?rrtlsislg inspector �.Other. Contact Person: Phone r: Rightfax N2_1 3/10/2015 10:11 :37 AM PAGE 't/vim DATE AC ® CERTIFICATE OF I 0340-015 NO RIGHTS UPON E CERTIFICATE THIS CERTIFICATE IS ISSUED AS A CERTIFICATE AES MATTER OT AFFRMATIOVELMYTORNNEGATNE® AMENDS T ONLY EXTEND OR THE COVERAGE HOLDER. THIS AFFORDED BY THE POLICIES BELOW. ZED THIS REPRESENTATIVE OR PRODUCEREANDETHE CERTIIFICATE HOLDER�RACT BETWEE THE ISSUING INSURER(S), must be endorsed. It IM PORTANT: If the and conditions f the ADDITIONALpolicy, INSURED, NSpoliciesREDmay rgluirelan)endorsement• A statement oSUBRn this certificate does subject to the term not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT FNATICK, NAME. FAX INS GROUP LLC PHONE No A1C No Ext NTRAL STREET E-MAIL A 01760 NAIGlI INSURERS)AFFORDING COVERAGE INSURER A.AMERICAN ZURICH INSURANCE COMPANY INSURER B: INSURED ATLANTIC WEATHERIZATION LLC INSURER C: 61 REAR JEFFERSON AVE INSUAERD: SALEM,MA 01970 INSURER E: INSURER F: V I NU BE : COV GFq CE I ATE NU SE ES TO THE INSURED UED THIS IS TO POLICY TTHE PER OD INDICATED. SURANCE LISTED HIS NOTWITHSTANDING THSTAND NG ANYI RE RAVE UIREMENT,BEENSTERM OR CONDITION OF ANY 1 ABOVE R NSU ANCEOAR OTHER DOCMENT WITH F AFFORDED BYU HE POLICIES SPECT TO WHICH TDESCRIBED HEREIN SS SUBI ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADOL SUB POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE INSR WVD POUCY NUMBER (MM/OD/YYYY) MMIDDwYYY LTR EACH OCCURRENCE S GENERAL LIABILITY DA TO RENTED S COMMERCIAL GENERAL LIABILITY ISESI aoccurrence CLAIMS-MADE a OCCUR MED EXP(AnY onaperson) S pERSONAL&AOVINJURY S GENERALAGGREGATE S PRODUCTS-COldPIOP AGO S GENL AGGREGATE LIMIT APPLIES PER: S PRO- S POLICY JECT LOC OMBINED SQVGLE LIMIT a aeadeN AUTOMOBILE LIABILITY BODILY INJURY(Per parson) S ANY AUTO BODILY INJURY(Per academy S ALL OWNED SCHEDULED AUTOS AUTOS OPEC-i t AMAGE S NON-OWNED S HIRED AUTOS AUTOS EACH OCCURRENCE S UMBRELLALIAS OCCUR AGGREGATE S EXCESS LIAB CLAIMS-MADE S DED RETENTION$ X Y,ICSTATU- OTH• WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPRIETORWARTNERIEXECUTIV YIN OFFICERfPodEldBER EXCLUDED? N I A 6ZZUB 03-20.2015 03-20.2016 E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatary in NH) 56270121 E.L.DISEASE-POLICY LIMIT $500,000 II yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD I D1,Additional Remarks Sctwdule,It mora space Is required) CERTIFICA HOLD R C C L A 0 TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 1600 OSGOOD ST RATION DATE THEREOF, NOTC'CANCE WD L BEODELIVERED NTHE i ACCORDANCE WITH THE N.ANDOVER,MA 01845 POLICY PROVISIONS. AUTHORIZED REPRES`ENTAT►VE ©198>I-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AC40RV® DATE(MMMDNYYY) -k.� CERTIFICATE OF LIABILITY INSURANCE 3/3/2015 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 CONT cT construction NAME Eastern Insurance Group LLC PHONE (800)333-7234 o: 233 West Central St 11L A012NEES: INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Arbella Protection Ins. Co. 41360 INSURED INSURERBNaut7lUS Insurance Cc Atlantic Weatheriza.tion INSURER C. 61 Rear Jefferson Avenue INSURER D., INSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBEROASTER 2015 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 TYPEOFINSURANCE INSR D SUR POLICY NUMBER POLICYEFFPOM/LDICp EXP LIMITS GENERAL UABIUTY u IEACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE ®OCCUR 8500042816 /20/2015 /20/2016 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICYMX PRO El LOC S AUTOMOBILE UABIUTY COMBINED eISINGLE LIMIT S ] 000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X /20/2015 /20/2016 AUTOS 020015871 BODILY INJURY(Peraccident) S X HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident PIP-Basic $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS 4600058654 /20/2015 /20/2016 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABILITY ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN NA $OFFICERIMEMBEREXCLUDED? r (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B POLLUTION LIABILITY CPL200378613 0/1/2014 0/1/2015 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 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 TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE John Aoegel/PMA �- ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 igninnst m Tho A('nDn name and Innn aro raniafororl marks of Ar`r1Rr1 Ma-ssachusetts -Department of Put�Hc Safety Board of BLAilding RegLflafions and Standards Comiruction Supemisol- nice of Consumer Affairs&Business Regulation Ucense: CS-087977 I ME IMPROVEMENT CONTRACTOR egistration: 142089 Type: ERIC WPALM xpiration: 3/12/2016 Ltd Liability Corpo:'.1 3 HILTON ST W Salem MA 01970 ATLANTIC WEATHERIZATION L.L.C. ERIC PALM 954— Expiiraflon 61R JEFFERSON AVE 04123/2016 SALEM,MA 01970 Undersecretary Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M)Of License or registration valid for individul use only enclosed space, before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts 00, State Building Code is cause for revocation of this license. For DPS Licensing information visit: wWw.Mass.Gov/DPS Not valid without signature