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HomeMy WebLinkAboutBuilding Permit # 4/11/2016 1 OORTH BUILDING PERMIT ° TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION , Permit NO, „ Date Received Date Issued: i � AC I PORTANT:Applicant must complete all items on this page CICATIOI` Y ' P, EF ► ERTY4W1_ P�rlr1� r. MAP N,O PARCEI: � CUNI�If GI�TtIT: lstor' DIstr'� t 'Y' Mach ne Bhop Village yep TYPE OF IMPROVEMENT PROPOSED USE Residential Non® Residential ❑ New Building 2,6ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial aRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 1 ,ept'ic' ❑1l1%elI ❑ Fleaodplain ❑;WetlandsQ Watershed District '❑1lte(/ewer ra Identification Please Type or Print Clearly) OWNER: Name: . '° o �o������1 ,� , . �� � Phone: . 7. , 10 Address: A 'of 5,1 F?hn „ � . per ior" Cristruotlon l.linse :Exp. Date: °� �m„„ � � . i . om a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.RULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST RASE®ON$125.00 PER S.F. Total Project Cost: $ 9, , FEE: I,�. ` ' �.� Check No.: Q.a.A Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to aryffun, ,, t Signature of Agent/Owner I �ature of contractor r � Flans Submitted ❑ Plans Waived ❑ Certified Plot Flan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiunming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS fCONSERVATION Reviewed on � — Signature 77� / f i' COMMENTS �` L H ALTH Reviewed on �Iture COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature Date Driveway Permit DPW Town]Engineer: Signature: Located 384 Osgood Street FIRE PA� T ®EME9�T Temp Durnpster ori ate- yes ,no Located t",124 ain Street Fere,®e��rt "aunt sign ure/,ate COMMENTS FORTH Town E r, ®ver O to No. V C, LAKh ver Mass // 2JA 0 COC WICK y1. ®S II OATEO 7 ll BOARD OF HEALTH PER T Food/Kitchen Septic System • THIS CERTIFIES THAT BUILDING INSPECTOR ... . . .. .. .... .. . 0 has permission to erect ......... buildingsop .PW. Foundation 40 0 ..................................... Rough to be occupied as .......... ... ...... .. .... v... .... .............. .... ... Chimney provided that the person accepting this permit shall in every respect confor o e 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 ONTS ELECTRICAL INSPECTOR UNLESS TION ARTS Rough Service .................. ....... r:............ Final ILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz 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. Paul's Handyman Services Estimate CPL Associates LLC 282 Center St Date Estimate# Groveland, MA 01834 4/11/2016 1534 Name/Address David Evangelista 28 Morningside Lane N Andover,Ma Terms 1/3, 1/3, 1/3 upon c... Item Description Total New Entry Details: Therma Tru Fiber-Classic Mahogany Factory Finish 36 X 80 Single LH inswing,6 panel with clear insulated glass in upper two panels Dbl Bore Oil rubbed bronze ball bearing hinges W/Dble Sidelites both full Clear insulated Glass Crated and delivered onsite Drawing of entry provided Payment Schedule 1/3rd of estimate required to order materials and schedule work 1/3rd of estimate due upon project start date Final payment due upon project completion Estimate is good for 30 Days Subtotal $9,420.00 1/3 Deposit required to order product and schedule projects rJ%Tax 6. Final Invoice not to exceed+/- 10%of estimate unless work order changed Sales ) $341.25 Total $9,761.25 Signature Page 3 Paul's Handyman Services Estimate CPL Associates LLC 282 Center St Date Estimate# Groveland, MA 01834 4/11/2016 1534 Name/Address David Evangelista 28 Morningside Lane N Andover,Ma Terms 1/3, 1/3, 1/3 upon c... Item Description Total M&S Required materials and supplies 5,250.00T Fiberglass Entry with twin side lights/stain kit application$4200 Primed 2 1/2"colonial casing Primed baseboard Primed exterior brick molding Blueboard/Plaster Azek trim panel Primer/Paints misc materials and supplies Entry Delivery Materials Procurement 25 Cleanup Cleanup&Restoration 200.00 Remove and dispose off all debris Daily and Final Clean up Please Note: Condition sub-floor under the entry is not known.Estimate does not provide for repairs if necessary. Existing storm door is to be reused if it fits the new frame. Since these door frames are cut to fit,it may not fit new opening.If so,it will need to be replaced. Estimate is good for 30 Days Subtotal 1/3 Deposit required to order product and schedule projects Final Invoice not to exceed+/- 10%of estimate unless work order changed Sales Tax (6.5%) Total Signature Page 2 Paul's Handyman Services Estimate CPL Associates LLC 282 Center St Date Estimate# Groveland, MA 01834 4/11/2016 1534 Name/Address David Evangelista 28 Morningside Lane N Andover,Ma Terms 1/3, 1/3, 1/3 upon c... Item Description Total Repairs to Foyer exterior wall and entry 02.10 Demo Demo 960.00 Remove Storm Door Remove Entry with side lights-60"X 84" Remove wallboard(veneer plaster over blueboard)and trim work Remove Insulation 17 Insulation Insulation 60.00 Install Faced R19 fiberglass insulation with vapor barrier 18 Finish Walls Install 1/2"Blueboard 250.00 Plaster 2 coats 20 Millwork&Trim Millwork&Trim 2,100.00 Install new entry and all required hardware(re-use existing lockset if possible) Install existing storm door if possible Install exterior brick molding Install Azek kick panel Install interior colonial casing 24 Paint Painting 600.00 Paint all Jamb and trim 2 coats BM SG white Paint Entry frame and trim(white)2 coats Prime and paint all new wallboard to match existing walls Customer request 2 tone jamb and trim-Exterior break cream I plus 2 coats on outside plus sealer/white on inside as planned Estimate is good for 30 Days Subtotal 1/3 Deposit required to order product and schedule projects Final Invoice not to exceed+/- 10%of estimate unless work order changed Sales Tax (6.5%) Tota Signature Page 1 The Commonwealth of Massachusetts Department of XndustrialAcciclents " X Congress Street,Suite 100 ' Boston, MA 02114-2017 wwwanass.gov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/Li lectricians/Plumbers. TO BE FILE WITH TITi+;PERMITTING AUTHORITY- Applicant Information Please Print Le ibl Name (Business/Organization/Individual): ;� 4r , Address: `.�.,. City/State/Zip: ­2Phone#: mm Are you an employer?Check the appropriate box: Type of project (1'egttit'ed): 1.❑1 aim a,employerwith employees(full and/or part-time).* 7. Q New consti action 2.E^T am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition In I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 10[]Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Fl Roof repairs These sub-contractors hale employees and have workers'comp,insurance.l 6.0 We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.❑Other 152,§1(4),and we have nu employees.[No workers'comp.insurance requited.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Ilomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-coriiracJors have employees,'they must provide their workers'comp.policy number. X am an employer that is pr'ovidhig ivor'Ieers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§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 WORD 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 DTA for insurance coverage verification. X do hereby certify iindei-fli e pins and enalties of perjury that the informcrtian provided above is true aratl correct. Sign re: Date: 4 Phone#: Official use only. Do not ivrite in this area,to be completed by city or town official.. City or 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#: AC R ® CERTIFICATEF LIABILITY INSURANCEDATE(MMIDDIYYYY) 3/14/2016 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(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 NDNTMIE ACT Sullivan M K Sullivan insurance Agency (SAN Group Member) PHONE Ex (978)346•-7200 uC Nn:{978)3A6-4846 30 Grove Street AbOREss: INSURER(S)AFFORDING COVERAGE NAIL# Merrimac MA 01860 INSURERA:Utiea Hirst INSURED INSURER B Paul Lecesse INSURER C: 282 Center St INSURERD: INSURER E: Groveland MA 01834 I SURER F• COVERAGES CERTIFICATE NUMBER-CL1631401147 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 SUBJE=CT TO ALI.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INNS�R TYPE OF INSURANCE ADL UBR POLICY NUMBER MMIDD EFF MMJDD YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,D00 A CLAIMS-MADE Ix l OCCUR ESO RENT D 50 000 PREMISES Ea occurrence) � $ ART5040832--02 6/3/2015 6/3/2016 MED EXP(Any one person) $ 5,000 PERSONAL SADV[N.IURY $ 1,000,000 GEHPLAGGREGATE LIMIT APPLIES PER,. GENERAL AGGREGATE $ 2,000,000 S POLICY PRCOTT 7 LOC PRODUCTS-CO,V,P/OPAGG $ 2,000,000 OT ER: Employee Benefits $ COMBINED SUJGLE LIMIT AUTOMOBILE LIABILITY (Ea accident $ ANYAUTO BODILY INJURY(Per person) s ALLOWNEDSCHEDULED BODILY INJURY(per acddent) $ AUTOS NON- OS OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per ddant $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIABI I CLAIMS-MADE AGGREGATE $ DEP RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STA O ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA EL.EACHACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOY $ if yes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY UMFT I$ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 907,Additional Remarks Schedule,may be attached If more space Is requ[red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Groveland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3.83 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Groveland, MA 01834 AUTHORIZED REPRESENTATIVE SAN Group Ina by za I 5198 14 kCORD CORPORATION. All rig s reserved. ACORD 25(2014/04) The ACORD name and logo are registered marks raf ACORD INS025(201400 ACOPRU a DATE(MtAMDNYYY) CERTIFICATELIABILITY INSURANCE4/11/2016 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 pollcy(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 certlfIcate holder in lieu of such endorsement(s). PRODUCER CNAME:O T CT MK Sullivan M K Sullivan insurance Agency (SAN Group Member) PHONE (978)3A6-7200 PAS o:(978)3A6-4846 EMAIL 30 Grove Street EMP INSURERS AFFORDING COVERAGE NAIL# Merrimac MA 01860 INSURER A:UtiCa First INSURED -INSURERS: Paul Lecesse INSURER C: 282 Center St INSURERD: INSURER E Groveland MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1631401147 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE;BEEN REDUCED 13Y PAID CLAIMS, 1NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POSE EFP POUC EXP LIMITS LTR g COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED A CLAIMS-MADE FOOCCUR PREMISES Ea occurrence $ 50,000 ARTS040832-02 6/3/2015 6/3/2016 MED EXP(Any one pemen) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-1 ip& F�LOC PRODUCTS-COMPIOPAGG $ 2 r 000 r 000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY EOaBINED SINGLEllM1T $ A[SY AUTO BODILY INJURY(Perperson) S ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTONOON-OWNED PROPERTY DAMAGE $ HIRED AUTOS P AUTOS (Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS L1AB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER 1277 AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR(PARTNERIEXECUTIVE NIA EL EACH ACCIDENT $ (Mand tory to ER EXCLUDED? E.L.DISEASE-EAEMPLO $ ff yes,des I under DESCRIPTION OF OPERATICNS below E.L.DISEASE-PDLICY LIMIT I$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE SAN Group Inc by ©9988 0 ACORD CORPORATION. All rfpflts reserved. ACORD 25(2094101) The ACORD name and logo are registered marks WACORD INS025(2314011 _Office of Consumer Affairs&Business Regulation IMPROVEMENT CONTRACTOR Type. registration: 162376 _ �_�Expiration: 212312017 LLC Y CPL ASSOCIATES LLC. PAUL LECESSE 282 CENTER ST — GROVELAND,MA 01834 Undersecretary ------------- ' Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperN icor License: CS-106802 $; PAUL.LECESSE 282 CENTER STREET Groveland MA 0f834 , Expiration Commissioner 05/30/2016