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HomeMy WebLinkAboutBuilding Permit # 3/21/2016 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: i Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page r > nt PROPERTY OWNER I'�er►r ��T� �.ay �� Pont ! 100 Fear Old Structure yes no MAP NOPARCEL_ ZONING DISTRICT Histor�cDisfnct yes do II ; Machine Shop Vi age: 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 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic" `❑Well p Floodplain 1Netlands Watershed District ,. ater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 131 A Cec�Jose `>\ tje,IIs e,A t Th'e. Identification Please Type or Print Clearly) OWNER: Name: en ie_6\ 5 Phone: 4/23- 71Y- 77,;"8 Address: CONTRACTOR Name Mlc��e( �" Z,c�irrc:Ion Phone: Address =1"osl'rY ► Supervisor s Construction License ���? q�3� � " Exp Date � fY, /d'� Homelrnprouement License l`�//oY Exp 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. Total Project Cost: $ 7Z 030 , ® FEE: $ Check No.: d Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne -.- __ _ Signature of contractor Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ � t%ORTIHI Andover Town of ® ® - h VAI°' ass, °gyp Coy Ie 1-6 te 2AI (75 ewIC� y1. `s V BOARD OF HEALTH Food/Kitchen T LD Septic System .,,.. BUILDING INSPECTOR THIS CERTIFIES THAT .. ..................! T ........ ...................................,....... .....P" ERR . . Foundation has permission to erect .......... . ............. buildings on ... ...... .... 1. .. .. . ...... ... ........ Rough to be occupied as .... . ......... .... . . . .... .® .. ............................................ Chimn y ' e provided that the person accepting this permit shall in every respect conform to the terms of a applicationFinal on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough Service . . ..., ^................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy By Rough Final Displayi aConspicuous lace a remises — ® of Remove at i r allBe one FIRE DEPARTMENT ' Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. CONTRACT GREATER LAWRENCE COMMUNITY ACTION Job Number:20150246 COUNCIL,INC. 305 Essex Street Work Order Date:3/2/2016 Lawrence,MA 01840 Ownership:Owner Phone:978 681-4956 A&M GENERAL CONTRACTING Auditor:Keith Young 119 R.FOSTER ST Email., kyoung@glcac.org PEABODY MA 01960 Cell:978 857-7841 Email:mikefltz@amgeneralcontractingine.com Phone:978 681-4955 x4793 Phone:978 741-7777 Cell:508 726.1058 /71 ........... Kenny Laughters 21 Lincoln St Columbia Gas $7,030.91 North Andover Ma 01845-2701 Total $7,030.91 A t o ed utho Aci;an Measure'Description QTY T Qtr price AttW"s " ' Affie/Kneewall Floor Transition 53 $2.82 $149.46 53 $149.46 Dense Pack w/cellulose R-11 FGB in open rafters/walls/ 175 $1.47 $257-25 175 $257.25 kneewalls -18-20 restricted-slopes/floored 360 $1.55 $558.00 360 $ss&oo slopes and floored area fill w/cellulose R-30 restricted-slopes/floored 1111 300 $1.59 $477.00 300 $477.00 Flat slope w/cellulose R"', R fl; and floor =slop"a=floored Flat'I. it slop e R-49 unrestricted-settled cellulose —502 $1.80 $903.60 502 $903.60 flat in knee wall Baseanent Insulation, Sill two-part foam w/flberglass haft 143 $2.46 $351.78 143 `$�351.78 Doors= FixedSweep 3 $17.64 $52.92 3 $52.92 attic/base.int./base.ext, Thermax(or equivalent)on door 2 $57.00 $114.00 2 $114.00 —attic/base. Weatherstrip,s/Q-Ion or equal 3 $51-00 $153.00 3 $153.00 attic/base.int./base.ext. Mtf'.- Mise Measures . attic air sealing 1.5 $70.00 $105.00 1.5 $105.00 Seal chimney,plumbing,electrical and all air penetrations to the living space. Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests bsmt air sealing 1.5 $70.00 $105.00 1.5 $105.00 Seal under sin ks,plumbing,electrical and all air penetrations to the living space. Permit Other 1 $0.00 $0.00 1 $0.00 'Wall insulation Double nailed asbestos/aluminum 1382 $2.59 $3,579.38 1382 $3,579.38 (dense pack) Drill rough plaster patch or finish 88 $2.04 $179.52 88 $179.52 side entrance wood plug(dense pack) Total $7,030.91 $7,030.91 Contractor Instructions: Before Starting theJob: Durimg the Job& 1.Please notify us 24 hours before starting or scheduling a job. 1.Incorporate lead safe practices as applicable. 2.Obtain required building permit. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. Additional Contractor Instructions: Attic Inspection form attached. Yes N A (Circle ne) Certificate of Insulation posted? Yes No (Circle One) A&M GENERAL CONTRACTING hereby certifies that this job was supervised and completed in compliance with all Department of Labor Standards and Lead RRP regulations. CBntra lf2Sj�tiature: Date: RRP License M ate: 12// Uib Page 2 AAM CON '1 19 R,, FOSTER s"r. PEABODY, MA 0 1960 To whom it may concern. I Michael Fitzgerald CSL #-099933 give Neil Moore authorization, to drop off and. pick up permits on my I-xhal.f*. From 01-102016 to 12--31-- 2016 for A&M General Contracting, If you have any questions or concerns Please call me at 978 741-7777 Thank you, Operations Manager A&M General Contracting Michacl Fitzgerald "Z/' Signed on iq 2016 Notar EXP: 04-01-2020 The Commonwealth ol'Mussuehusetts Department oflndusfrialAceitlents I Congress Street,Suite 100 Boston, MA 02114-2017 ",;v",.mass.gov1dia Mot-kers'Compensation insurance Affidavit; Builders/(,ontractors/tlectricians/Plumbek-s. F0 BEFILLD PI-I'l[I'MITTING AUT110RITY. ADIDUCant Information Please Print LeLyiblv Name (Btisiticss/oi-gaiiiz,,itioil,iiiidi%,idi4,il):A&M General Contracting Address: 119 R. Foster St. City/State/Zip: Peabody, MA 01960 Phone 4:978-741-7777 ............... Are you air employer?Check the appropriate box: "Type of project(required): 1,E]I am a employer witli employees(full and/or part-timet* 7. n New construction Z.El I an,a sole proprietor or partnership and have no employees working for me ill any capacity INo\voikers'cornp.insurance required 1 8. E] Remodeling .1-®i urn a homeowner doinwork all ork mysell' lNo\%orkers'camp.insurance requiled.] 1). El Demolition 4 El I all)a honrcoNvner and will he hiring contractors to conduct all work oil my property. I wilt 10 C] Building addition ensure that all contractors either have workers'compensation insurance or are sole I J.n Electrical repairs or additions proprietors with no employees. 11[]Plumbing repairs or additions .5 1 ani a general contractor and I have hired the sub-contractors listed an the attached sheet. 13.�Roof repairs These sub-contractor;have employees and have workers'comp insurance: 14.MOther Insulation 6 we are a corporation and its officers have exercised their right ot'exemption per MG1.c ....................... 152,§1(4),and vac have iit)eiiiployces iNi)\\,4)rkers'camp,iiistiraticeicqLlireci.I *Any applicant that check,,,box 91 must also fill Out the Section 1)00w showing their\\orkers*compensation policy information t Homeowners whosubrinit this affidavit indicating they are doing all vvork and their hire outside contractors must Solana a new affidavit indicating such, 'Contractors that check this box must attached all additional sheet showing the name of the sub-contractorsandstate whether or not those entities have employees ll'the sub-contractors have employees,they must provide their workers'comp.policy number I(ins an eniployer that is providing workers'compensation Insurance far my eniplc�vees. Below is thepolic.),and job site information. Insurance Company Name,.TGA Cross --- ................. Policy#or Self-ins,Lic. #:AMWC345622 Expiration Date:03-20-2016 .............. ------- .Job Site Address;_kL_Ug.,Lq C'ity/State//`­`ip:jv,.A./)dov-e—j"-M-4,,, Attach it copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder MGL c. 152,§25A is a criminal violation punishable by a fine tip 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. Idohereby certify inder the pains an d penulti5s_�sjart-thraa Me—injin-niation provided above is true and correct. Signature: Date: —3 -e - ­__— 1) 9- lione 4: ?r741-7777 Official use only. Do not write in this area,to be completed kv city or town official. City 01-Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#:— ® 21 2016 09:54 HP Fax page 1 ■ `` CC>Rbr CERTIFICATE OF LIABILITY INSURANCE []ATEimwDB'Y'"'!' 311112016 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 holderls an ADDITIONAL INSURED, the pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. (f 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 r1 lite to the certificate holder in lieu of such endorsemen s. PRODUCER TGA Crass Insurance, Inc. GVNIAVI NAME: TGA.CrDss.-Insurance.Inc_ 401 Edgewater Place, Suite 220 PHONE - — FAX Wakefield, MA 01880 IttLa.EaU:._._ .....781-914-1000 AJc�yoi:.. _ ._.781-246.2601.... Ae2rog9E.S�.__.._.--...�switchboard(t�tgacross.com -, ..... _INSURER(S2AFFOROiNG GOYERAGE _ __ NAIL N vwvw.tgacdoss.com .!ysut:RRA:. Excelsior_. 11045 INSURED iNsuaER e:._Peerless_InsuranCe Co..,.. 2a1_08 A& M General Contracting.Inc - - 119R Foster St. Bid 14 (NSUR�tC_-C: Peabody MA 0196 INSUREIiD_;_..,.... -.-- INSURER E.: INSURER F: COVERAGES CERTIFICATE NUMBER: 28931672 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 SUGH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR .... .._-...-_ --_.. _-AOOCSUBR'. P _.- .._......._ .-..._._ aiy 1 YR TYPE OF INSURANCE POLICY NUMBER IX CY EF mor EXP LIMITS A Y COMMBRCIALGENERALLIABILIITY CBP8947488 3/20/2016 3/20/2017 EACH OCCURRENCE S 1,000,000 CLA%IS•MACE v( :OCCUR OAMAG6Y6 RENTE6 "" . PRE1aiSES.(Ep.acc�rrancel. -_,S 100,000 ✓ ISO Fgrm.CG0001 MED EXP fAnyone.person) 5 5,000 / Contractual Liability_ 1.000.000 ... PERSONAL S ADV INJURY $ GENLAGGREGATELIMITAPP_LIESPER. GENERAL.AG_GREGATF. S 2.000.000 POLI^.t JEROT .. LOC PRODUCTS-CO MPIOP AGG S 2.000.000 OTHER S B AUTOMOBILE LIABILITY BA8947689 3/20/2016 3/20/2017 COMBINED SINGLE LIMIT S LE_.a,acaCpnL.. — .. ..__ . ..-1,000,000 ANY AL70 BODILY INJURY iPe1 peI5011i 5 TD SCHEDULED ✓:AUTOS BODILY INJ1RY'Per awde_n._l1 HIRED NON-OVhEC 00 6P-ER _DAMAGE_ .... .._ '.. _ ,/..ALTOS ONLY _AUTOS ONLY S B UMBRELLALIA6 ✓ OCCUR CU8947888 3120/2016 3120/2017 .EACH OCCURRENCE _ S 1,000,000 EXCESSLIA6 'CLAIM5MADE AGGREGATE S 1.000,000 DFM- ✓ AFT-NTIONS10.000 C WORKERS COMPENSATION AMWC572468 3110/2016 3/2012017 r '.srAR,ru7E ,._ ,ORH-. , AND EMPLOYERS`LIABILITY Y/N ANYPROPR1Er0R;PARTNER/EXECUTIVE r= E L.EACH ACCIDENT :S 500.000 (M.A ory In NH) E%CL"UUED'� I_I NIA - . .-.. I .. 500,000 IMendstory In NM .E L DISEASE-EA EMPLD'IEE:S Ir y05 CeScnbe under . .. - [i[SCRIPTION OF OPERATIONS bEdan E L DISEASE•PCLICY LWIT'6 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORO 101,Add tonal Rsntarke Schedule,may be attached II mote space Is nqulmd) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BE FORE Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 120 Andover t 01845 ACCORDANCE WITH THE POLICY PROVISIONS, NorAUTHORIZED REPRESENTATIVE I ' Thomas I Gregory ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • ...:' :' .' :'...:1,.t.. ::ni.n:'::... .+. _ F�v__�..... NvyaY„M. .... �... -...-.. A}: .qui. i-aW- Restricted To:CSSL-RF-Roofing CSSWC-insulation Contractor CSSL-WS-Windows and Siding ass "deo„trrr aa,, CSSL-DM-Demolition Soa,cj " � �„�aaraa r �a a�•� ,�aa�� a �� . erse CL,, . . Failure to possess a current edition of the Massachusetts 119 R FOSTER S Peabody State Building Code is cause for revocation of this license. 0140 For DPS Licensing information visit; www,Mass.Gov/bPS rt bma"knP�!p° - /191201 a” Office, of Consumer Affairs Ad Business egulation 10 Park Playa - SI_14C 5170 Boston, MassachusettS 02116 Home Improvement Contractor Registration Registration: 141124 Type: Supplement Card A+M GENERAL CONTRACTING INC. Expiration: 1/12/2018 MICHAEL FITZGERALD 5 SOUTH RIDGE CIRCLE LYNN, MA 01904 Update Address and return crud. Mark reason for change. Address Renewal 1'.mployment Lost Card