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Home My WebLink AboutBuilding Permit # 2/23/2016 t&ORT 04 BUILDING PERMIT LID I TOWN OF N16ORTH AND 0 APPLICATION FOR PLAN EXAMINATION 0 1 All. A Permit No#: Date Received Date Issued: I P VRTANT: Applicant must complete all items on this page -t—I , P LOCATION Print PROPERTY OWNER J<,,�/vl voo",,c Le.-J I Print 100 Year Structure s MAP 06, PARCEL: ZONING DISTRICT: Historic District y yes Machine Shop Village yes Cnr'o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 11 New Building El One family 11 Addition Li Two or more family 0 Industrial F1 Alteration No. of units: 0 CqTmercial El Repair, replacement L1 Assessory Bldg a° Others: � 11 Demolition 0 Other e fi B, t Floodplain I, e a n s (11"Al f 1/1221 i A "u" 'T, , A DESCRIPTION OF WORK TO BE PERFORMED: ell Identification- Please Type or Print Clearly OWNER: Name: K "VI 10 Phone: 5'/ 1 ;Y/ Address: At" /v, Contractor Name: Phone: Email: Address: 3 6" Z_ rg Supervisor's Construction License: elle't"? 22,`�" —Exp. Date-, Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 7_7 1 Total Project Cost: $ 26lf) FEE: $ Check No.: Receipt No.: ealv t fi d NOTE: Persons contracting with unregistered c ntractors do not have accessto the rant un d M ------- 41 tra, 71 Fill �SianatL of i n n a tute-of V 'Town of ,AORTH q Andover ? ��, m h ver, Mass, �3 o CLAK@ 1. COC MIC M!w1C K S U BOARD OF HEALTH Food/Kitchen PEK IT LD Septic System THIS CERTIFIES THAT ........ BUILDING INSPECTOR ... .......................... ....... . ................ ................... ....................... ........ LAh Foundation has permission to erect .............. ........... buildings on ..... ® ....... .................................. • \ Rough tobe occupied as ............. .. ... ..... ... ......................0S....... ...&Yr.............................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS I RTS Rough Service ............... ..... ... .. l�............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected r ve the Building Inspector. Burner Street No. Smoke Det. Work Order INSULATE ATTIC AND WALLS USING BLOWN LIJL® GREATER LAWRENCE COMMUNITY ACTION Job Num9e OTGALS COUNCIL,INC. Work Order Date:2/9/2016 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone: 978 681-4956 DANETTI INSULATION CO Auditor:Keith Young 362 EASTERN AVE Email:kyoung@gicac.org LYNN MA 01902 Cell:978 857-7841 Email:danetti0l@yahoo.coni Phone:978 681-4955 x4793 Phone:781598-7043 Kimberley Pass Columbia Gas $3,195.52 110 High St Total $3,195.52 North Andover Ma 01845 813-902-8198 Authorized Actual:' Measure Description Cammeiits Qty Price Tfltai Qty Total Attic insulation Kneewalls R-12 cellulose behind 60 $1.94 $116.40 160 $116.40 Gable walls permeable membrane R-30 unrestricted'-settled cellulose 208 $1.53 $318.24 208 $318.24 attic fiat Reinforced poly/R-20 cellulose open 528 $2.06 $1,087.68 528 $1,087.68 slopes in knee wall net&blow rafters Basement Insulation Sill two-part foam w/fiberglass batt 87 $2.46 $214.02 87 $214.02 Doors Basement/outside door-door only 1 $412.00 $412.00 1 $412.00 Fixed Sweep 3 $17.64 $52.92 3 $52.92 Fr.ext./rear ext./base.ext Weatherstrip s/Q-Ion or equal 2 $51.00 $102.00 1 1$51.00 Fr.ext. Mise Insulation Domestic water pipe wrap 6 $2.95 $17.70 6 $17.70 Hydronic pipe insulation to 1 in. 158 $3.82 $603.56 158 $603.56 8 ft of 1/2 inch and 150 ft.of 3/4 inch copper pipe R-5 Date:2/9/2016 Page 1 Greater Lawrence Community Action Council,Inc. �f 9D Weatherization Assistance Program Gff i L� 305 Essex Street Lawrence,MA 01840 WORK PERMIT I k i M �3Ct2LEV PA SS hh Certify that 1 am the owner/authorized Agent for the property at: �� U Nook a r N'S (Address) I further certify that I have given my permission to allow work on the property listed above in accordance with the following provision: 1. Weatherization 2. Heating System Work and such other particulars as may be attached to this agreement. ned , - — - – gG 1Gt1.1 -I Date`. ''1 .. Si (. Owner/,authorized Ag nt K2 LA'')."i F i`,N AVE LYNN, MA 01902 �� DEC 0 1 2014 362 Eastern Avenue Lynn, Massachusetts 01902 781-598-7043 ® ' -101-n-Ilig Me o To:Building Department CC: Date: 02/152016 Re: permission for Neil Moore to pull permits To Whom It May Concern: I, Edward Champigny give Neil Moore permission to submit paperwork and pick up permits on my behalf in order to obtain building permits for Danetti Insulation Company. Thank you Edward Champigny 1 _ The COT1710nwealtll OfMassacltusetts Department of I"ndustrialAccidents -- 1 Congress Street,Suite 100 -- ' `'� www massgov/dia R"orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERR4ITTING AUTHORITY. Applicant Information Please Print Le bly Naive(Business/Organization/Individual): 0"Q-- / Address: 3 City/State/Zip: L /f 01402 Phone#: 7 �- �9�- 7 aft you an employer?Check the appropriate box: Type of project(required):[Are ama employer with employees(full and/or pan-time).* 7. ❑New construction -❑I am a sole prop fetor or partnership and have no employees working forme in any capacity.[No workers'comp.insurance required.] 8. [J Remodeling 3.®I am a homeowner doing all wort:myself.JNo workers'comp.insurance required.]` 9. ❑Demolition 4-[:]l am a homeowner and will be hiring contractors to conduct all work on m re 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 will proprietors with no employees. •�Electrical repairs Or additions 5.®1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.-* 13.[]Roof repairs b-O We are a coon and its officers have exercised their right of exemption per MGL c. 14.U Other_14, 1 t 6 /U✓N 152,§1(4) drid we have no employees.[No workers'comp.insurance required.] , *Any applicant that checks box 41 must also fill out the section below showing their workers'.compensation policy information. t Homeowners 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 sheet showing the name-of the 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. I am an employer that is providing workers'compensation insurance for my employees. Below is tite policy and job suer information. Insurance Company Name: Policy#or Self-ins.Lic.#:_01 t' (; Expiration Date:_ Job Site Address:1/,� G/ fes` City/State/Zip: Attach a copy of the workere compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. I52,§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 the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage`verification. Ido Izereby certtff under the pains an naldes of perjury that t/te information provided above is true and correct Slanature: p-- Date: Phone#: 7el FBoard only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: DATE(MMIDD _ZXORD, I I AT F•LIA ILI IN U` N 06/2%20 s) 1S CERT)FICATE 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 A BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESEYTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,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 WNIAUT NAME: Duffy Insurance Agency, Inc. arCONoExt: 791,593.1200 AIC,N1:781.593.7260 317 Broadway ADDRESS: Wyoma Square INSURER(S)AFFORDING COVERAGE NAIC',£ Lynn, MA 01904-2602 INSURERA: Endurance American Insurance Co INSURED Danetti Insulation INSURERB; pilgrim Insurance Company c/o Edward Champigny INSURER C: National Liability & Fire Ins Co 362 Eastern Avenue INSURER D, Lynn, MA 01902-1626 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:00 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. R TYPE OF INSURANCE INSR WV LTD POLICYNUMBERMMID MIDPOLICY EFF POUCYEXP LIMITS GENERAL LIABILITY CBC1000199400 06/22/2015 06/22/2016 EACH OCCURRENCE - $ 11 000,0 X COMMERCIAL.GENERAL LIABILITY PREMISES Ea w-amence $ 100,000 CLAIMS-MADE �OCCUR MED EXP(Anyone person) $ S'00 A PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2;.000.,000 GFN:LAGGREGATE,LIMIT APPLIES PEF y PRODUCTS-COMP/OPAGG $ 210.001000 X POLICY JEI� LOC $ AUTOMOBILE LIABILITY PRC00001004242 07/08/2014 07/08/2015 EaINGLE:LIMIT $ 1,000,000 ANYAUTO 07/08/2015 07/08/2016 BODILY INJURY(Per person) $ OWNEDALL AUTOS rX �UD BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED $ AUTOS (Peracadent) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR \ CLAIMS-A1ADE AGGREGATE $ DED I I RETENTION$ = $ OTH WORMRS COMPENSATION V9WC64369 04/24/2015 04/2412016X TORYUMfTS ER AND PROPRIETORLIABILITY YIN EL.EACHACCIDENT $ 500,000 ANY PROPRLETOR/PARTNER/EXECUTN�—� C OFFICERIMEMBER EXCLUDED? 1 1 N/A (Mandatory In NH) LJJ E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,dbe unde DESC �TION OF Or RLPPERATIONS below E.L.DISEASE-POLICY LIMIT $ S00,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insulation contractor CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIE BE CANCELLED BEFORE TUI&WIRATION DATE THEREOF,NOTICE WI E 4UVERED IN I rcorANCE v,",,,, ITH THE POLICY PROVISIONS i A p 2ED REPRE ENTATNE x A R O N. F ghts reserved ACORD 25(2010105) The ACORD name and logo are egis ed marks of ACORD = i Cone` and Busmess 0 Pa&P - ate 5170 Bos`LOIL Massachusem o2 16 Home Impro-v,-n2c= - - fYW- DSA --3ANE-111 M LATION CO- yrs l# cpN AVE LYN#s MA€ 1902 =_ Less andc S,A I C� Al `I��ew� '.. e er nosauliva vakd Apr :clrwFACTOR befilre the . T Of&=sfsmd � £3? Vaud FarkP - Sf?� i Massachusetts-Department of Public Safety A aq Board of Building Regulations and Standards n„ Construction Supervis(1C Sllti:3alty License: CSSL-M738 q' EDWARD W CHAS 362 EASTERN AVE LYNN MA 0190Y •�. t a J � iii i4� Expiration Commissioner 0411712016