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HomeMy WebLinkAboutBuilding Permit #314-2016 - 70 Main Street 9/8/2015 BUILDING PERMIT "°RT 6�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 7';���,� Date Received ` a� 5 gGATED ' SSACHt1sE4 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 67 �jl$,CIVI CRUS PROPERTY OWNER___ �`an1V +M/3 ' 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 )4Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i5wEll r �iffle Wlr DESCRIPTION OF WORK TO BE PERFORMED: Identification- Ple se Type or Print Clearly OWNER: Name: VLK��- Phone: gleb,q0q e Z7-1 Address: Cj'4 J I a A—A PIA Vtr tQ Contractor Name: :V LL-C,.- Phone: 121 43 •40 42 1 Vcieqj!s - Email: Address: P�1f Supervisor's Construction License:_r✓� ' 105- 18 �T Exp. Date: 7/4 1'7 Home Improvement License:___J �� `Z-- --Exp. Date: � /17 ARCH ITECT/ENGINEER �4�; Phone: Address: v1ti �jAkA04-r tiq Reg. No. L�j FEE SCHEDULE.BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ /Gra Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces to the guaranty fund A 111.A1. '„'� ;`+�`�!- ,� YRih.i z.� } r -."—" >9°. , e ,,'z"'—^_� x.• rtS, +vt'�`"s' f ' h�l x%ORTH Town of Andover 0 . 0% No. * �-t _ � IV ® am 20/i C' h •� ✓ ! ver, Mass, ZAOZI1:f7 COCMICNCWKK �1' p�RaT E o S U BOARD OF HEALTH Food/Kitchen PERMIT T LD/ Septic System �� �' f �A C BUILDING INSPECTOR THIS CERTIFIES THAT ...... .?.��?.r�.:s ... .......... �t'.......�yf. :C ........................................................... 'J �,,P�iF,.s• �� Foundation has permission to erect .......................... buildings on (.......6..f........................................ Rough to be occupied as .......... :...................../... s�svCy(!� �! O� Q ............. chimney ................................ ................ . provided that the person accepting this permit shall in every respect conform to the terms of the a�ication 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 1 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough �� Service ........... ......G��!�"o�' .....................,................... Final "-z--�rUILDING 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. !turner 1 Street No. � 1 Smoke Det. AC40_RO0 DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F 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 Lisa London NAME: FAX MTM Insurance Associates PHONE (978)681-5700 ( .(978)681-5777 1320 Osgood Street A DFILSS lisal@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERAAtain SpecialtV 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 POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE Fx_1 OCCUR CIP159979002 /17/2015 /17/2016 MED ERCP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7X POLICY PRO-JECT 17LOC $ AUTOMOBILE LIABILITY EMBINEa .den LIMIT_ 1,000,000 JCOANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 5057753 /17/2015 /17/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU-LIMITS OTH- IR AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA E.L.FACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. AUTHORREDREPRESENTATIVE N Andover, MA 01845 M Laorenza/STEPH — ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn95 oni nnst m The Arripn Homo­i Inns aro runicicrort mar4c of arnpn A CERTIFICATE OF LIABILITY INSURANCE 7/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE"OT 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 c Drtiflcate does not confer rights to the certificate holder in lieu of such endorsements(s) CONTACT PRODUCER E: MTM Insurance Associates,LLC (A/C.Na No. (978)681-5700 FAX No.:) 1320 Osgood Street ADDRESS: North Andover,MA 01845 PRODUCER CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Atlantic Charter Insurance Company VDAC 44326 Verdeco Designs,LLC INSURER B: 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 suBR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR WVD DATE(MWDDNY) DATE(MWDDNY) (In Thousand) GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ Ee occurrence CLAIMS MADE ❑ OCCUR ❑❑ MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIDPAGG $ POLICY ❑PROJECT ❑LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . $ (Ea Accident) _ ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Par person) SCHEDULED AUTOS ❑❑ BODILY INJURY $ (Ea Accident) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNDED AUTOS (Fa A ddem) IUMBRELLA OCCUR EACHLIABILITY EACH OCCURRENCE $ EXCESS UAB❑ CLAIMS MADEEl❑ $AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WCV00951304 03/04/2015 03/04/2016 X STATUTORY OTHER A EMPLOYERS'LIABILITY LIMITS ANY PROPRIETORMARTNER/DIECUTIVE YIN EACH ACCIDENT 1,000000 OFFICERIMEUMBER EXCLUDED? NIA policy Coverage State:MA $ Mandatory in NH It yes.describe under SPECIAL PROVISIONS bak. DISEASE-POLICY LIMIT $ 1,000,000 DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER ❑❑ DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(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 1600 Osgood Street 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. North Andover,MA 01845 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. UTHORIZED REPRESENTATNE ACORD 25(2009109) AZ? JIL-M% . 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 Construction Supervisor MARK J YANOWITZ ONE ELM SQUARES ANDOVER MA 01810 Expiration: Commissioner 07/11/2017 I , I