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HomeMy WebLinkAboutBuilding Permit # 2/3/2016 1 LIILDING PERMIT a� �a,araI R�,�p TOWN OF NORTH ANDOVERS �b APPLICATION FOR PLAN EXAMINATION n -' '" Date Received / Permit No#: °' w Date Issued: ]2 l[IYd ORTAN T: Applicant must complete all items on this page LOCATION ICW U)O ) f'o Print PROPERTY OWNER \ Sew Luc 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 ❑Alteration No. of units: ❑ Commercial _ E'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r /r'i r rn ri�, 1""' �', `, r„ „r�;c r ,.9 /1 i,. �%/ r;,.. ,..�; ,... //:///f rn o. e r /% /i/i ;i% ers,i g�.�.r7.rc ,J� lain,,,,�� ,❑,Wetlands ❑ Wat h D t � �,,,�v,,, ,,..,. ,,a, / �/ ./�//i� / ,1, �%,%r r/i ✓/t/r >// r r iL„s /.. � � / r., r�...,/ rr a/ /i1 ,. ,Of�V Uf�tPi,r1�S ewe.r/f%,I✓//�„/r/i/rj%�i%�%�,i��i�/,„�i//i,�,:/ �/�/% '„i,!� „�.,,,r///G ii,r� ���i//�i/�/�i. �, r�r/,z„/i,,,,�!%/e�/,c, /.,.. DESCRIPTION OF WORK TO DE PERFORMED: treyno66Y \ CAM Identifica io Please'Type or Print Clearly OWNER: Name Phone C � p Address:dW N1 C C , \0 -- Contractor Name: \use ' i , ”` hone: Cqig) (Yuli -- q300 Email:= a Address: Ani 1 Supervisor's Construction License- 1 W690 Exp. Date: 041 f 'l 1,.qo Home Improvement License: Exp. Date:07 ARCHITECTIENGINEER W 1A Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cast: $ 30D FEE: Check No.: Receipt No.: NOTE: Persons contract g with unregistered contractors do not have access to the guarani 'red.. _ nat.ure_s�fL�.gQ�nt!(7inrner "�'d w canat�,re of .on ra tg � NORr9 L Town of ­. .. I, An ®ver O - •;'` fr C% h ver, Mass, COC HICK[wICK RAnD P-V U BOARD OF HEALTH PER ITT LD Food/Kitchen Septic System R ® BUILDING INSPECTOR THIS CERTIFIES THAT ........ . ...................... ................ .... ........................................................ ` � Foundation has permission to erect .......................... buildings on ....... . ........... Y.�IR �............�.................... to be occupied as ... . �.Y.!�+..........:...�... ..�....... . t!`: ..��V�E�... Tr.. . .. ' �� ..... .. Chimney Rough 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 MONT ELECTRICAL INSPECTOR LESS CONSTRUCTION ST T Rough Service ............................ ... ..:.... ..................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Firwl No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � Proposal 325 Main Street North Reading, MA 01864 (978)664-4300 PAINTING RESTORATION HIC#169554 ADDRESS Jason Chute Swift Sell 241 Waverly Road North Andover, MA PROPOSAL# DATE 1108 01/21/2016 PHONE NUMBER (603) 793-7292 DESCRIPTION AMOUNT Carpentry _ 68,800.00 241 Waverly Road Andover, MA 01810 General Conditions$2,750 -Includes Porta-Patty rental, snow removal, pressure wash exterior, permitting, and dumpster Roof$9,250-house, two car garage, and small re-pointing of chimney Carpentry$19,350 -Basement stairs and railing, bathroom closet, bedroom wall, interior doors, kitchen install and vanity install -Material includes studs, drywall and plywood $1,350 Plumbing $3,500-Kitchen and two bathroom fixture install Electric$5,000 -New service, bathroom GFCI, bedroom arc faults, 8 dedicated kitchen circuits, new dryer line, new stove line and hard-wire smoke detector upgrades Windows $8,000 -All house and basement windows (6 over 1 grids with screens for house windows) Total of 23 house windows and 4 basement windows Insulation $500-As needed throughout project Heating Boiler Rebuild $200-(budget item for boiler tune up. Price is subject to change) Tile $2,500-Entry way, kitchen and two bathrooms Hardwood $3,500 -New hardwood installed in kitchen. Sand and three coats throughout rest of house Painting $11,900 -Patching holes as needed (not skim coating entire walls) -Paint garage and exterior doors -Paint basement walls, basement floor, and sewer pipe -Prime and paint all interior ceilings,walls and trim l -Epoxy paint garage floor _ We propose to furnish labor and materials in complete accordance with the TOTAL $68,800.00 above specifications. Accepted By Accepted Date -he Commonwealth ofMassaechusefis Department oflndusirla Aceldents M _ X Congress Street, Suite 100 .Foston,A.02. 14 2017 b www.mass.gov/dia ' I�t •, S�4V Workers:,Compensation 0l3 MF,D`�r ITH�TMP RM-LTrTIi.`TG.A•DTROS�ITY t�icianslPlLum]bers. Please Print Le ibl A.pplicantinformation -- , Na1, o(Business/Organization dividual): l , �.C�:C�xeSS: c.�---�— M�9_Y_U� City'/State/Zinn: hand#: Are-you an employer?cliecktlio appropriate box: Type of project(fequired): 1.H 1 am a employerwith • employees(full and/or part time)4' 7. El Now construction 1 am'a sole proprietor or partnership and have no employees Working forms in 8. emodeling any capacity.[DTo workers'comp.insurance required.] 9, Q Demolition 1 am.homeowner doing allworlcmyself:[No workers"comp.insuraneexequired.]t 1.0 Building addition 4.[]1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either haus wozkszs" 11.0 Electrical xepaixs or additions compensation insurance or ars sole , proprieforswidinonmlileyeos _..----.-- _.. ___-.-- l plumbixrgxepairs-oraddrtlorls,--_ 5.Fl 1 am a general contractor and 1 have hired the sub-coiAractors listed onthe attached sheet, lg•a Roofxepaixs These sub-contractors have employees and have workers'comp.insurance. 1d, El Otb'ex 6.[]We area corporation and its of l9gs have exerolsedtheirzight of exemption per MGL c, 152,§1(4),and v{e have nu en'1' 'ees.[DTs workers'comp,insurance required.] :,Any applicant that cheeks box41 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submiti IFiis afCdavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicating such. tcoutractors that check this box must'attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have , employes, lfths sub-conttacors have employees,they must provide their workers'comp.policy number. X ane an eraiployer drat is pi'dvidirig vorlf< rs'compensation insurance for my ervtplcryees.'�'elow is trze policy and jo site information, Insurance Companyme: Policy#or Self ins,Lic.#: Expiration Date: City/State/Zip: oV r Iob Site Addxess , 'tion policy declaration (showing the policy numTOer and expiration date). Attach.a copy oftha w0ykers' coxnpe Failure to secure coverage as required under MGT o. 152,§25A is a criminal violation punishable by a Fine up to$1.,500.00 and/ox one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER.and a t"'mo of up to$250.00 a day against the'violator.A copy of this statement may be forwarded to the O:Eco of Investigations of the DIA for insurance coverage verification. ,_ _,. I do herevy certify udder thepains an penalties ofpeJftJ _rat the information provided above is true and correct Si nature: hone# Official use on y. Do not_Wplte in this area,to be completed by city or'toren affleial;, City ox Za�vn• Permitlli icense# ' Issuing Authority(circle one): i l..Board,of Realth. 2.BrriidingDepartm.ent 3.Cityl'I'own Clerk 4.Electrical.Inspector 5.PlumbingTospectar 6.Other Contact PerSOR' I?honte#: AC®R®O DATE(MMIDD/YYYY) IFI `T LIABILITY INSURANCE 2/3/2016 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 NAME: Linnane Insurance Agency Inc. PHOIC.NE (978)664-2000 AAC No:(978)664-0180 280 Main St. #101 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# N. Reading MA 01864 INSURER A: INSURED INSURERB-Main St. America Peluso Painting & Restoration LLC INSURERC: INSURER D 325 Main St Suite 301 INSURER E: North Reading MA 01864 INSURER F:: COVERAGES CERTIFICATE NUMBER:CL1313100854 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 ADDLITYPE OF INSURANCE INSR SUER POLICY NUMBER MM/DDIYYYY MMIPOLICY EFF DD POLICY LTR LIMITS B GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE ❑X OCCUR MPT0501H 1/28/2016 1/28/2017 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 '.. GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 '.. POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ''.. EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN L IMITS ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICEWMEMBER 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 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. 241 Waverly Rd North Andover, MA 01845 AUTHORIZED REPRESENTATIVE M Linnane/JUSTIN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 nn1nnFi w Thn Arr1Rrl nnmc and Innn am ronictcrcrl mnrkc of Arnpin l ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) A 02/03/2016 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 NAME: PHONE FAX Automatic Data Processing Insurance Agency,Inc. A/c No Ext: A/C No): 1 Adp Boulevard A DRIESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: AmGUARD Insurance Company 42390 INSURED PELUSO PAINTING&RESTORATIO INSURER B: 325 Main Street INSURER C: Suite 301 INSURER D: North Reading,MA 01864 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 444860 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 DD SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTE CLAIMS-MADE 1-1OCCUR PREMISES Ea occur ence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY E] PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ '.. HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ '.. EXCESS LIAB CLAIMS-MADE AGGREGATE $ '.. DED RETENTION$ $ H X AND EMPLOYERS'LIABILITY STATUTE EOR WORKERS COMPENSATIONPER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? I Y1 NIA N PEWC666045 07/09/2015 07109/2016 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1 000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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. 241 Waverly Road North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r��a t(o�rrr�rr»ruierrll�ca '<�/�� �rrJelft rra.trrc" Office of Consumer Affairs&Busi less Regulation License or registration valid for individul use only rOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 169554 Type: Office of Consumer Affairs and Business Regulation xpiration: .7/5/2017 Individual 10 Park Plaza-Suite 5170 THOMAS PELUSO Boston,AVIA 02116 - v THOMAS PELUSO 200 CHANDLER ROAD ANDOVER,MA 01810 e Undersecretary Not valid without sign e McIsse hUsetts -De art ent of Public Safa�tt Board Of BUilding RegUiations and Staridard aadu^:k6 NMIh License: t:�-10290 'ours b �OOW Pl THOMAS M1"EL �r g 200 Charndlew BoW Andover01gld t «l t JI`14f� t olro�ro issior em i iration 04!2017