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HomeMy WebLinkAboutBuilding Permit # 5/3/2016 BUILDING P �,,ED b MIT ®& y 14 4'o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: �� � Date Received "ArED•P" t5 �Ssgc Hus�c Date Issued: 224P-ORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER (21 rint 100 Year Structure yes bno MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition [ITwo or more family 11 Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition11Other e b,,61 :. *e IN ed J DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: -&( Phone: i X13 q 2 Email. 1-V,6 �� LG C ���aalp� � , .�•; } , Address: ' l y, ,�1z��o ��t Zet ,- Supervisor's Construction License: s9 ` �'� `� Exp. Date: Home Improvement License: l l Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B SED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he uaranty and Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F E SEWERAGE DISPOSALewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DEI?,gRTMENT Ternp Durnpster on site yes { "✓ / �w �'','°; i .x J r! r y t r S- n O a T! a'/s,!a "rte. a�'.� Located at 3124 Main Street f; x� G r -,!. Yea s fr, , S/ L ,✓ i r "rte �ietf f rryfr / 3 :. f rrlN[ Fire De artmentwsigr�atur /date rr r � � � 1;� l I COMMENTS � �" i� r i FORTH Town ofo. 2 .-N ,A1, Andover 0 ti. ver, Mass, , ® ' LAKE COC HICNC WICK A0R�rE® Cl U BOARD OF HEALTH Food/Kitchen PErx I T L D Septic System Mle.1 BUILDING INSPECTOR THIS CERTIFIES THAT ........................................... ............. .... ............ ...... .... ............. has permission to erect buildings on ... ... ...... .. ... ... Foundation .......................... ......... ...... . ............n.. Rough to be occupied as .... .. ..... ... .......f6.ft6.7kD ........ .......... ............. 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 l Rough Service . .. MPEC Final BUILDING OR GAS INSPECTOR Occupancy Permit Required t® Occu,2y Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe wilding Inspector. Burner Street No. Smoke Det. ISBELL GENERAL CONTRACTING 10 Korinthian Way Andover, ma CS#-081684 HIC#172105 March 29, 2016. Contract for the remodel of the back porch at 59 Salem st North Andover, Ma for Cathy and Glen Johnson by Isbell General Contracting, LLC. We propose to remodel the current back porch to a three season closed in and insulated porch for a total cost of$34,066..This project is expected to take approximately five weeks and includes all of the following. Framing:demo the current structure to the ground with the exception of the roof framing. Demo the current interior ceiling and floor. Reframe floor using 2x10 PT framing. The floor sheathing to be Advantec floor sheathing.The underside to be%"Zipwall coated plywood..Walls to be framed to accept Harvey Classic vinyl double hung windows spaced evenly around the porch,and an Anderson slider door.All interior walls and trim are to match the built in panel pattern inside the family room. Reframe the roof structure to accept two 2x5 skylights. Interior Ceiling to be 1x6 v groove primed pine beadboard. Insulation; Insulate the floor to R-38,the ceiling to R-38,and the walls to R-15 using fiberglass batts and targeted sprayfoam airsealing Electrical work;Supply and install four recessed lights in the ceiling, install one customer supplied fan/light between skylights. install outlets in walls to code,and provide one outlet up high Ui;uei —i it on the exteM for Christmas iignting. insrali one coaxiai cabie outlet. install one run of electricai baseboard heat. Flooring; Install vinyl plank flooring.color and pattern TBD,over the entire floor.. Roofing: Install new Architectural shingles over the entire roof around two new Velux skylights,up to the existing sidewali sheathing. Exterior trim;To be PVC board throughout the project,with vinyl siding to match the house. Paint; interior primer and 2 coats sof Benjamin Moore,color TOD. No exterior painting included. This contract includes all hermit and disposal fees.Thank v'ou for the opportunity to work on your home. �! ( 1 , Accepted: �t,�- - 2U((J ' Isbell General Contracting: r�!� �� �C �� ®ate. I i , II i i_ I i i i f i i ! i I - i � I 1 I 1 I I i i I I I I I � I I I I I � i I � I I -- I_ I I 1 i II 1, { V I r - Li II I i I 1 f : I I ! I I I : I i i I The Commonwealth of Massachusetts F Department of IntlustrialAccidents '-- I Congress Street,Suite 100 Boston,M9.02114-2 017 wrvw.mass.gov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEI RMTTING AUTHORITY. Applicant Information Please Print Lessibly Name(Business/Organizatiouffndividual): }�,4 h c?r' Address: City/State/Zip: 42,4,11'1' ^Yl °��l Phone#: ?/7 ' Areyon an employer?Che,k, appropriate box: Type of project()Vequired): 1.[I I aemployerwith t employees(full and/or part-time).* 7. 0 New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. [I Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 9. F1 Demolition 10 F1 Building addition 4.❑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.[j Electrical repairs or additions proprietors with no employees. 1A.[Jplumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof rep airs These sub-contractors have emploeesyand have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right o£exemption per MGL G. 14.Q Other 152,§1(4),and we have na,employees.[No workers'comp.insurance required.] tr7 *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. i Homeowners who subniif flus 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. Ifthe sub-corilractors t ve employees,tfiey must provide their workers'comp.policy number. X am an employer that is providiiig workers'compensation insurance for my employees.'Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins,Lia#i: / Expiration Date: nb Site Address: �� ��� ' ��`• City/State/Zip: ,Zl�l, itc, y ��JQZ d I e policy umber and expiration date). Attach.a copy of the workers compensation policy declaration page(showing th p lx y n p ) Failure to secure coverage as required under MGL c. 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 DIA for insurance coverage verification. I do hereby certify un der the pains andpenalties ofperjury that the information provided above is true and correct, SignatureDate Phone# Official use only. Do not write 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#: ACOR.®® DATE(MM/DD/YYYY) � CERTIFICATE ®F LIABILITY INSURANCE 5/3/2016 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(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 Jessica Reid Rep P Encharter-MA A/CN o ExO: (800)675-6695 �X No:(800)754-1602 Encharter Insurance LLC E-MAILADDRESS: reid@encharter.com 25 University Drive INSURER(S)AFFORDING COVERAGE NAIC# Amherst MA 01002 INSURERA:XS Brokers Ins. Agency XSB001 INSURED INSURER B: Robert Isbell, DBA: Isbell General Contracting INSURERC: 10 Korinthian Way INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632505706 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE TO RENTED 50,000 PREMISES Ea occurrence $ 3EC8449 11/25/2015 11/25/2016 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY-] PRO- [ILOC PRODUCTS-COMP/OP AGG $_ 1,000,000 PRO-JECT — 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 (PR Ei7ZEMAGE HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. Bldg 20, Ste. 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE /t � William Dowd/N01EB1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onlemt - Massachusetts t)epartment.of Public Safety Board of Building Regulations and Standards License: CS-081684 Construction Supervisor ROBERT E ISBELL r r 10 KORINTHIAN WAY ANDOVER MA 01810 Expiration: I Commissioner 10/091201' �\E?ffice nt Consnm':r.AffT..CdNTRACTOR ME IMBROV�t�I1ENT.. TYPO. gistrattion 1.7, 21-06' Individual xpiratid�� 5f2 2f20'16 ISBELL r,C)BERT ISBEL!:, � 111-01WRINTHI ,N VVAY �n�jersecretar . NfjOVER,MA 01844