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HomeMy WebLinkAboutBuilding Permit # 1/12/2016 BUILDING PERMIT o11i �i�ED ;b�tie TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit No# Date Received �R°°RATED PPa' �y gssAiCHus�C Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION f61 Print PROPERTY OWNER 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 ,igAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: 8rT10IItI0nWl [] Other pu a i�soiidpi,,;t' 'ql " eyed ulAfRkIVRlisrt �ii 'vi DESCRIPTION OF WORK TO BE PERFORMED: Identitic n- Pl se Type or Print Clearly OWNER: Name: 2 , �( Phone: G/ — Address: C k Contractor Name: 22P c✓ � Phone: Email: 6i ✓ Address: I " Supervisor's Construction License: / Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.-$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ ' Check No.: Receipt No.: p NOTE: Persons contracting with unregistered contractors do not have access to the guaran ,Fund r r l l7/r r r r rrrlT; ridi uu » uii,fin),r �,ir,r rrrlr rr�� -„g,rf'� /%��P�/�/eAj irl�i/i�j/ij/r�,ll/� � � ?�� ” ,r� �� i���fir�r�����Jl��� �l�f��%%/ .; r � rig �� ��f1�, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Flans ❑ [TYPE-OF SEWERAGE DISPOSAL ublic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dmupster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - N FORM PLANNING & DEVELOPMENT Reviewed On l Signature , COMMENTS IN21-tor CONSERVATION Reviewed on Signature COMMENTS ►LALTH Reviewed on Signature N COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments j Water& Sewer Connection/signature� Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street re f - o- _ i FIRES DEP,4R�TMEIVI' r �,. , lrl/ i Streef ,/,< i r///f '�J ,, /�/ �/r,✓ l / / /�, 9 ,��% / , //, 1 �„�.nrHF,w wlernrr l , ;�U 1 - ,;�1,� ,/ r ❑f r /� 1 /,� ., /r/ o J�r,! ✓1/ 1 c , D Flre e artrnent�l atUreJcdate/�i/r � f/ /�r/rD//� v, y /// � ,,r, ❑1 i//// ,�� l /�"� �, h G,Jrrt/Ay,F✓rlvy,%l,/%„�l//� i/' i,/r,�i�a �i., / .li ��ji,/�� �/ �f❑ ���// J lr. �i � � I AM NORTH ",,ver_t own of2 Anu' %j O 0 No. T' CO • LANE h very ass to A_ COCHICHEWIC,( 7i9 q�RA'rE 0 NP A=Wh� P ANIONk S V BOARD OF HEALTH AW Im Food/Kitchen ER T Tw L �u Septic System —!b ri THIS CERTIFIES THAT .... BUILDING INSPECTOR ................ ... .... .... .... .... .... ........ ..... Foundation has permission to erect .......................... buildings oros.q � . ...:............. ................... Rough to be occupied as ...... . .. . . ......tPermi . ... .. . ........a....A............................................ Chimney provided that the person acce ting this II 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 IN 6 MONTHS ELECTRICAL INSPECTOR ® UNLESS CONSTRUCTIO Tugz) , Rough op Service ............... . ...... ... ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 6rj w is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S 150 A. - Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) Sigil4re of Permit Applicant Date ree- I 11-K;A 1 L U1- LIABILI1 Y 1 -U 01108/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERSALTER RIGHTS THE UPON THE CERTIFICATE BY THEDER. T EIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR BELOW. THIS VECERTIFICATE OF INSURANCE THE DOES NOT ATE HOLDER. UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED OR 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). CONTACT Branch 4066-1 PRODUCER 04066-001 NAME: Fabri&Rourke Insurance AICONNo.Ext: (978)352-4990 (AIC.No.: 0978)352-9991 2 Central Street 1st Floor EMAIL ADDRESS: Georgetown,MA 01833NIC u INSURER(S)AF O DING COVERAGE INSURER A• A.I.M.Mutual Insurance Company INSURED INSURER B: Seven Star Builders Inc INSURER[: 211 Seven Star Road INSURER D: Groveland, MA 01834 INSURER E: 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. ILTR TYPE OF INSURANCE DSR S,UB POLICY NUMBER MM/DDNYYF MMIDD YY LIMITS EACH OCCURRENCE I S GENERAL LIABILITY —0-AMAGETO RENTED S COMMERCIAL GENERAL LIABILITY ( PREMISES Ea occurrence CLAIMS-MADE D OCCUR MED EXP(Any one person) I S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-COMPIOPAGG S EN'L AGGREGATE LIMIT APPLIES PER: — OLICYUE� OC COMBINED SINGLEUMIT AUTOMOBILE LIABILITY Ea accident S BODILY INJURY(Per person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS AUTOS ( PROPERTY DAMAGE S HIRED AUTOS NON-OWNED Per accident AUTOS Is UMBRELLA LIAB OCCUR I EACH OCCURRENCE S __ EXCESS LIAB CLAIMS MADE AGGREGATE S S DED RETENTIONS p7� N X WCSLIMT ER �'t� 55Y 807VallL4TYTH ORY LIMITS ER Ny R�PRIET R/�q�TNE�/EX Y/N E.L.EACH ACCIDENT S 100,000AC A OFFICER/MEM80ER EXCLUDED?ECUTIVE1 NIA VWC-100-6018631-2015A 5118/2015 5/18/2016 E.L.DISEASE-EA EMPLOYEES 100,000.0[ (Mandatory in NH) f S df0f N under E.L.DISEASE-POLICY LIMIT $ 500,000.00 biYSCRIPT�ON OF OPERATIONS below i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CANCELLATION _ CRINI ® SHOULD ANY OF THE ABOVE DESCRIBED POLICIES`BE CANCELLED BEFORE Iff THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Carpenter Buildeir, e, 'Contractor ��- z [ 97896868087(Cell) 211 SeveltStar RPM ©1988-2010 ACORD CORPORATION.All rights reserved. 978-469-5909(Fax/Office)_ GrOveland;MA 01834 and logo are registered marks of ACORD Ate' CERTIFICATE OF LIABILITY INSURANCE 1/7/2016 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 Heidi Shea NAME: Fabri & Rourke insurance Agency, Inc. PHONE Ext. (978)352-4990 AXC Not:(978)352-4991 2 Central St., 1st Floor E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC/t Georgetown MA 01833 INSURERA.Essex Insurance Company INSURED INSURER B: Seven Star Builders, Inc. INSURER C: 211 Seven Star Road INSURER D: INSURER E: Groveland MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER:Naster 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 SUBR POLICY EFF POLICY EXP uMiTS LTR D D POLICY NUMBER MM/DD/YY MMIDO X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( RENTED A CLAIMS-MADE ❑X OCCUR - PREM SES GE ToEa occurrence $ 100,00( 3EB6694 9/17/2015 9/17/2016 MED EXP(Any one person) $ 5,00( PERSONAL&ADV INJURY $ 1,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00( X PRO �LOC PRODUCTS-COMP/OP AGG $ 2,000,00( POLICY F]JECT $ OTHER: AUTOMOBILE LIABILITY Ea a dent)COMBINED SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE S OED I I RETENTIONS $ WORKERS COMPENSATION STATUTE ERH _ AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ N/A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) aCANCELLATION " ® SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7 _ 7 . ii AUTHORIZED REPRESENTATIVE r t C u,i ntrkt r William Fabri/HSHEA 3-968-8087(Cell) 211 Seven Star,Road ©1988-2014 ACORD CORPORATION. All rights reserved I-46q.S9f19'fFax/nfr®I r..wA:,.,a 11111 A102A ne and logo are registered marks of ACORD u�1 -S DRIVERS_ - LICENSE ;:s f,. d4a1SS 9a EN0 -0d.HUM13ER 4 201 NONE S45OV7,Q - } A9A�9 7 ss�.cciss ��REsr, ss sEx.M s '! Del',ii E 2 kEVI F 07"�:19;i`7 s a 211 SEVEN STAR RD GROVELAND,ir1A 01634-2309 DD 10.07.1013 Rev 07.15-2009 , a C7/3eatuano�tu+e�rll�a�'C �ruarc�risef \ Office of Cousumer Affairs&Business Regulation l� �POME IMPROVEMENT CONTRACTOR registration 138835 Type: '7 xpiration 5/21/2017. Individual KEVIN F.CUNNIFF i KEVIN CUNNIFF 211 SEVEN STAR RD GROVELAND,MA 01834 Undersecretary 9 Massachusetts -Department of Public Safety Beard of Building Regulations and Standards on.itruct-lon amu}�i'S-45ar . License:CS-069599 i KEVIN F CUNNIFF+ ;- 211 SEVEN STAN-RD' s GROVELAND iA Ot834 -' Expiration Commissioner 09/29/2016