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HomeMy WebLinkAboutBuilding Permit # 2/10/2016 .............. BUILDING PERMIT ok ,tAORTH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Ca t Date Received Datelssnedl- � .......... L IMPORTANT:ApplicaYntmustco lete all items on this page LOCATION Print PROPERTY OWNER JMMe 1 ?)U4, 4, Print 100 Year Structureyes'°�""? 0 �t06 LZONING DISTRICT:. Historic District ye no MAP PARCEL:. ye:C, as Machine Shop Village TYPE OF_IMPROVEMENT PROPOSED USE .......................-_-—------------------- Residential Non-Residential ............................­_...—------.................................................................. 0 New Building l^C1ne family 0 Addition Ll Two or more family 0 Industrial Fj,Kiteration No.of units: 0 Commercial ....................... -–-—-------------- ❑Repair,replacement -1 Assessory Bldg 0 Others: 0 Demolition 11 Other DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: /J'a l1ml�s Phone) Address: �'S­ SC-lelkv) lvc"46t 0"Iciev'e" MY4 ........... Contractor Name: jqco,,: 61 k^ = Phone L,4_2 � ?,: Email: ZA0-u(lj?l 4 3 ill eo" Address: Supervisor's Construction License: L��.Exp. Date: i,� Home Improvement License: 1'7 4 1 'F Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDIAIGPERMIT:VZOO PER$1000.00 OF THE T07-AL ESTIMATED COST BASED OJV$125.00 PER S.F. Total Project Cost:$ FEE:$ Check No.: Z. —Receipt No.: NOTE: Persons contracting tqih unregAm-ed contractors do not hive access tot ego nd .................. Town of; 2 "°RT" L Andover o �, leo. _ h ver, Mass,f 79 �aATEO 10,2a 1 U BOARD OF HEALTH P od/Kitchen PERM11 T ILD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....J.16n..1 MWMIJ..... -Om.......4......... ................... ................. Foundation has permission to erect..........................buildings on...)UP.6......&b..M. .......... Rough to be occupied as... ..................................................................... Chimney 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION QTARTS Rough Service ................. �....... 4-...................... Final.�B6UIiLDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. ------------------- Jaime Flores L t1-a o s� Salem St. _ North Andover Ma Jaime flores a nhiliRs com Basement/Playroom Renovation Scope of work Frame exterior walls,strap ceiling,insulate walls with Refectix. Frame small closet for water pipes. Frame utility room with louvered door. Create storage in walls. Hand blue board and plaster all walls and ceiling. Install prefinished hardwood floor(supplied by homeowner. 350sgft is needed). Install 3''/a"colonial base and trim out any storage created in walls. Remove existing stair treads and risers. Install preprimed riser's. Install natural read oak treads. Sand and apply 4 coats of urethane to treads. Install preprimed white square balusters and red oak handrail on staircase. Electrician: Install new sub panel in utility in utility room. Install 8'light in utility room. Install outlets approximately I every 6' throughout basement. Install 13 recessed lights with switches to operate. Install in-wall heater/blower. "unknown plaster repair of stair well to be determined and not included in cost of proposal Cost of Job: $17,200.00 Permits: Cost to be determined and paid for at that time. Payment due as follows: $5700.00 due as signing of contract $5000.00 at completion of rough framing and rough electrical $3500.00 once plastering is complete $3000.00 due upon completion Homeowner Signature Date F ' Contractor Signal6re oe Commonwealth oplurssachusetts . h _ Depr�r'€�entof`i'ndasf�•ial�ccac�eFaa`s Congress Street,Suite 100 Rostop,I A 02J14-2017 - —; wwfv.massgotlrlin lVorlrers'Compensation[Psura ce,Alddadi;a,WjTfj TW, PU dd�T17NGA.UT3dOItI`TSt. icianslPluntbers. TOMEffPleaseprrint Le'bl Ao Iieant7nformation _ Name(SusiuesstOaganizationttndividual): -_ ArldSeSS: •t:-x`y V C it= City/StatelZip ' #t Phone#' esmoIg eIpoy roeprrYzeCto$zeocrkgt'a7rre(naegrship alrdehsav(efunIl o employeestiPorki.n'g e '$pZ,y.p POP []eaNfpewroCjeOcntSf(rleGgtnfOiA 70 = emodelhigmnd(°rparne) fsmin re d}: any capacity.[Nowarkus'eomP.insurance required.] 3.El Demolition 3.❑Iam ahom mer doingaU.vtorkmysel£Lao vroxkars'F°u-'P•msurancazequired.]t 10 E]B��g addition $.❑I sm a fiomeocner andwAl ho hiring conhnctars fo conduct allworkonmy property.S Vlil1 11 eetrieal rapan5 or additions ensuzethat att eonhaefors cit(terha4ewrorkers compensation inssanca or a[c soIe _ 1 LE]-P`llumbingTepahmr-additions__ __ -- progncorstvichnoememp 5.❑Iamageneralcontracformd2havehnedthesub""tracforsh fedofoe attached sheet. 13.0 Roof repairs fhese sub-contractors nave eurploTe mdfiaveworkars'comp.insnraace. 14.El Other 6.❑Weareacoxporatignandifs gfficershave=Nlsodtheirright ofcnolp6onperMGL I52,§i(4),endure havennemgloYees.[ivroworkes'comp.inswanea required.] -1 yapplicantthatchwkstiox#Imust else fill outth.se¢fiontx=.IoWshow�gfheizvrorkes'¢ompensafionpolicy information. Con acfo sihai oheckLls boxmsE aztfaeh den ad ¢r. dt'ei on2lshegshowingfhenu°e oftuoe r''ahconfracto sand sfatawmhefhrer, hosaenfitieshaw h. employees.Lithe sub-contractors have employees,IIieymustgmsidefheiz 4rorkecs'comp.policynumb �EZO I am ou erliployer that ispioviding 7VOftceog,eo7 pensa don lnSllF'QnCE Bt tj EN ZPy V S t722�0ZtC R 2 ZfOr1 SFiE Nformmation. 't Tnsuxance Company Name y to 4l(A . Expiration Date Policy#or Self-ins Lrc',t.{ ' p ,$ City/StatelZF . b lob Site Address: 0,V,V.J A.tfach a copy of the workers'compensation porky deelaratlon page(showing flee policpnnnrbar and expiration data}. Failure to secure coverage as required under MGL o.152,§25A is a a urinal vinlation,punishablo by a f e, f fa o$250 a "0 and/or one-year imprisonment,s Well statement may be forviarded to the Office ooffmQ fagatlons ofiho Df far insurance day against the violator.A coPY Y coverage ver)flcat[on ` - X yo Ise eby cerci del mr s itt a ejYmI that the znfor trafiotz nt ouided a ove%s true ane correct _ , Si nature:f Phone# i* t Of Official use onty.Do notwrite in this area,to be completed by city aFP town official.. permialcense# City or Town: Issning Authority(circle one): 1.Boardofffealth 2.BuildingDepartmeAt 3.CitYlTc'mCloy" 4.plectricallnspector S.pIumbngZnspector 6.Other phone#: Contact Person: Rightfax C2-2 2/2/2016 7:56:47 AM PAGE 2/002 Fax Server Ai4= CERTIFICATE OF LIABILITY INSURANCE DATE(MMlR D/YYYY) T RTIFICA7E 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 NOTCONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE b b D do :he It 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: CROSS INSURANCE PEABODY PHONE FAx 139 LYNNFIELD STREET (A/C,NO,Ext): (AtC,No): E-MAIL PEA-BODY,MA 01960 ADDRESS: 72CKF INSURERS)AFFORDING COVERAGE NAICq INSURED INSURER A: HARTFORD UNDERNMI'MRS INSURANCE CONTPANY HAYDEN,JASON 5 INSURER B: INSURERC: INSURER D: 5 GUNSTOCK DRIVE INSURER E: KINGSTON,NH 03548 JINSURCRF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: LSDC IFY THAT THE POLICIES OFINSURANCE LISTED BELOW HAVE BEEN LSDUED TO THE QISURED NAMED ABOVE FORTNE POL0.`Y PER IODINDlCA7ED.NOT WRHSTANOING IR ANY ReDUEMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY RE IRSUEO OR MAY PERTAW.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED RENEW S SUBJECT TO ALL THE TEAMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NOR Abu SUB POUCYEFFDATE POUCYEXPOATE LTR TYPE OF INSURANCE L R POLICY NUMBER twuUD1YYYY) (MMDD\YYYY) LIMP GENERAL LIABILITY ACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY DAMAGE TO RED $ CLAIMS MADE OCCUR, PREMISES IE.occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY 0PROJECT LOC PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY CMBINEDSWGLE $ ANY AUTO LIMB(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per Person) HIRED ALROS BODILYINJURY $ NON-OWNED AUTOS (Per accident PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS7MADE AGGREGATE S DEDUCTIBLE $ RETENTION S $ A jWORKER'ScofBPENsA-nON ANDwC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UO.6SD67430-15 06=015 06/22/2016 LiMRS ANY PROPERITORIPARTNEHIEXECUTNE ©WA E.L.EACH ACCIDENT $ 500,000 OFFICEMAFMOER EXCLUDED? (MandMAry In NHI EL Z.1" DISEASE-EA EMPLOYEE$ 500,000 111- .1"undo OESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMrr 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACBS ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE BOLDER AFJECTING W ORKURS COMP COVERAGE. THE W ORKFRS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR HAYDEN,JASON S. CERTIFICATE HOLDER CANCELLATION !AIME DIAZ AND ANA LIAMAS SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED 2b5 SALEM ST BEFDRE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks at ACORD' 1988.2010 ACORD CORI?ff$ TifTf.'�A7I Zj�fits reserved. CERTIFICATE OF LIABILITY INSURANCE ­DATE Y)ZEDl6 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(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 endorsement(s). PRODUCER CONTACT NAMLauren Goldman E: Cross Insurance-Peabody PHONE (978)532-5445rax N,(97e)ss2-2217 AIC . 139 Lynnfield Street AonA ss:lgoldman@crossagency.com INSURER(S)AFFORDING COVERAGE NAIL p Peabody MA 01960 INSURERAMain Street America Assur. Co 29939 INSURED INSURER B: JASON S HAYDEN INSURER C: 5 GUNSTOCK DR INSURER O: INSURER E; KINGSTON NH 03848-3469 INSURER F: COVERAGES CERTIFICATE NUMBERCL162162508 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 AD L SUBR POLICY EFF POLICV EXP LTR TYRE OF INSURANCE POLICY NUMBER MMIDD MWI)DtYYYYI LIMITS X COMMERCIAL GENERAL LIABILnV 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE EMISESSEa occurrence OCCUR DAMAGE (E— ED 500,000 PRS W045991 2(2/2016 2/2/2017 MEDEXP(Anyoe:eperson) S 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 2,000,000 X POLICY❑J—ECT- LOU PRODUCTS-compmP AGG S 2,000,000 OTHER: I 5 AUTOMOBILE LIABILITY I EOMBINdEeDLIIS G! IT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(PeravJwt) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS aca'Z' S UMBRELLA LUIS pCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MAOEI AGGREGATE S DEDRETENTION S WORKERS COMPENSATION PER O AND EMPLOYERS'LIABILrrY YfN STATUTE ER ANY PROPRIETORIPARTNEWEXECUT11F JNfA E.L.EACH ACCIDENT $ OFFICER,MEMSER EXCLUDED? (Mandatary In NMI El.DISEASE-EA EMPLOYE $ R yes,desai6 under DESCRIPTION OF OPERATIONS below ( E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS!LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jaime Diaz and Ana Llamas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 265 Salem St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Lauren Goldman/MDI A4.101if--dW —^ ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSD25,, am inrestricted-Buildings of any use group which ontain less than 35,000 cubic feet(991m')of nclosed space. ailure to possess a current edition of the Massachusetts tate Building code is cause for revocation of this license. x DPS ucensinginformadon visit: v .Masskov/DPS Massachusetts-Department of Public Safety Board of Building Regulations and Standards Omstrucunn sup€r,-isor License:CS-076189 JASON S HAYDEpt 5 GUNSTOCK DR rte_ KINGSTON NH 03&1 ;may Expiration Commissioner- 12/1312016 -2al—I'll c— Z6� !01 ova `�\ Office of Consumer Affairs&B smess Regulation r �n HOME IMPROVEMENT CONTRACTOR JU Registration: 174188 Type: Expiration: 1/712017 Individual JASON S.HAYDEN JASON HAYDEN - 5 GUNSTOCK DR. a��,�.e KINGSTON,NH 03848 - Undersecretary License or registration valid for individul use only before the expiration date.If found return to: office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 g Boston,MIA 02116 {�f �Not tth signature