Loading...
HomeMy WebLinkAboutBuilding Permit # 4/25/2016 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ' Date Received Date Issued: 411PPORTANT: Applicant must complete all items on this page r LOCATION ,�i �.i��,�n Sly i r y Pnnt . �PROPERTY OWNER kL�tn� ��,,� ew�G► Pfint ; 100 Year Old Structure yes no MAP NO` PARCEL ZONING DISTRICT Historic District yes no ;, °Mae ne Shop„Village ye ' 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 ':❑WellD,Floodplain ❑,V1le lands ❑ Watershed,District �_ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Nvuun-in c�eaotos,- i n we.as ct.4 Af7i s Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name.yvki& Address 1;a `t"b5tcs' S Pec.,lbay Ali o(at 6 0, Supervisor"'s Construction License 0`fit 33 :: Exp Date (�C Home Improvement License �y1�a? l Exp Date I' �z°" ��, 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: $ 7®-3®. o c,- FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered nt actors dofund Signature of Agent/Owner g natureirntractor Plans Submitted Ll' Plans Waived ❑ ertified Plot Plan ❑ Stamped Plans ❑ t%®RTH Town of Andover &; ® z igkh &a.] 26 - LAKE ver, ass, coc Ml c.,..CK A. ®�RATE D 11 BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ......... .. ,,,,,,,,,,, ,,,,,,,, ,,,,,,,,,, BUILDING INSPECTOR ....... .... l.......... ....... ............................. . Ul�w has permission to erect buildin son .. Foundation p .......................... ...................... ............... :.. ... ...... . .. 0,0nRough tobe occupied as .. . ..... ..... .. ... ......................... .... . ..... . .. . .. ...... .... ..%.............. 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 Rough Service ................ .... . ...... ......................... . Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. ("i E N A I., C 0 N'Tj"?A C"riNQ 9 K,, . Fos"rER ST. ABODYI, MA 01960 To whom it tnay C011cel"11, I Michael Fitzgeral,cl C,�SL #099933 give Neil Moore authorization to drop off and j-)iCk til-? pm-nits on my behalf, Froin 01-10-2016 to 12-31. 2016 for A&M General Contracting. If you have any clucstims or concern; Ptease call me at 978-741-7777 Thank you. Operations Manager A&M General Contracting Michac.1 Fitzgcral.d S JO-I'led 017, 2016 N o t FXP: 04 -01 ,2020 Work Order GREATER LAWRENCE COMMUNITY ACTION Job Number:20150246 COUNCIL,INC. Work Order Date:3/2/2016 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone:978 681-4956 A&M GENERAL CONTRACTING Auditor: Keith Young 119 R.FOSTER ST Email:kyoung@gicac.org PEABODY MA 01960 Cell:978 857-7841 Email mikefltz@amgeneralcontractinginc.com Phone:978 681-4955 x4793 Phone:978 741-7777 Cell: 508 726-1058 Kenny Laughters Columbia Gas $7,030.91 21 Lincoln St Total $7,030.91 North Andover Ma 01845-2701 Authorized :. Actual Measure DescriptionComments. Qty Price Totai Qty Total Attic Insulation Attic/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 R-18-20 restricted-slopes/floored 360 $1.55 $558.00 360 $558.00 slopes and floored area fill w/cellulose R-30 restricted-slopes/floored fill 300 $1.59 $477.00 300 $477.00 Flat slope w/cellulose R-49 unrestricted-settled cellulose 502 $1.80 $903.60 502 $903.60 flat in knee wall Basement insulation Sill two-part foam w/fiberglass batt 143 $2.46 $351.78 143 $351.78 Doors Fixed Sweep 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. Date:3/2/2016 Page 1 Restricted To; CSSL-RF-Roofing CSSL-IC Insulation Contractor CSSL-WS-Windows and Siding 43553cerrs d° r CSSL-DMI-Demolition r1ar a1m� m .y mm.�ciense CSSIL-09"33 MICHAEL P FIT E' Failure to possess a current edition of the Massachusetts 119 R FOSTER STR)&wtvPeabody MA 01966 State Building Cole is cause for revocation of this license. For OPS Licensing information visit: www,Mass,Ciov/DPS 0611 W20 1I 6 �n 4 0111 �, c��`�C�ansurter Affairs � cl 1^3Ll�,ri�r,�� �t��� �.c�X,ulatlon 10 fork Pl,= - SUite 517"0 Boston, Massachusetts 02116 Homo 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 01004 Updaate Aslalress and return card. Mark reason for change. Address Renewal Employment Lost Card The Commonwealth of Massac'hus'etls Depurtment of Industrial Accidents I Congress.Street,Suite 100 Boston, M4 02114-2017 w www.nrass.govIdla 'til orkers,Corripensatioll Insurance Affidavit: Builder•s/(,ontractors/Elertrichatrs/I'lutnhcrs. F0 BE FILEI)WITH'1 HE Ixl?RMITTINC AUTHORITY, A)Ulica M fo'matiort Please Pant I,e�ibly Name t(3trNiricsylC)rgarnixatiorlilrrdividtrralGA&M General Contracting Address: 110 R. Foster St. Cit /�t��tte,l�i�) Peabody, 01080 � 9 City/state/zip:r @/tone :978-741-7777 i,re y^ou oo employer"Cheek the appropriate hox. � � � �_-- 'Type of project(required): 12)(turf a ell1t,iiyer wrti 20 .,,eInill oveas 1 full and/or part-tirney 7, ❑New construction `i El I arri a side prol-Curr or lrartneiship and have no emlrloyees working torr me in 8. ❑ Remodeling any cI nvw hi hrm wii eity' (Nrker,'comp Insurance required e) . ED I till) vo . ❑Demolition homeowner do ,all rk m self [No vrk.rs'vonip iosurance rcrltwcd.l" I 13uilclingacldition d till a halneaivnar and mill be Kirin¢ uoritructors to conduct all walk art 111N,Irroperty I will El I e11SUre that till contraetors either'hove wrirker'�5 compar isat)on insurance or are sole ❑ aectrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions S M I ani a general contractor and I have:hired the sulr cotaractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have cmpk>yees and have workers'Comp insnranee.4 14.�✓ Other Insulation (+,�Wa are a cerrperratu�rrr acid its olTicer�s have-e-sed their right of exemptii,n tier Mf;l.e= IS?. I f4),mid vve have urr olnlricryees 1No workers'o)ml) insurance.rextuned,l 'Any applicant that checks hoc;U I must also till out the section helow showng their workers'compensation policy information. °homeowners W o submit this affidavit Indicating tho an;doing;all work and then hire outside contractors must submit a neve affidavit indicating such. aC'rrritr;icurr�s than check this box must atttiehed tin additional sheet shtmNm6tire name of the suh•contractors rind state whether or not those enntitics have employeeslithe sub•coritrtrctors have employees,they must provide their workers'rump poliCy number I atit art emplotver that is pro riding workers"eompensatian histi rance for nTr,employees. Belon,is the policy and job site information. Insurance.Company Name:3"GA Cr11 oss policy 0 or Self=ins. L,ic. fit AMWC345622 1L`xpiration L7aate:03-20-2018 .lob Site Address: Sr _ C'ity/',tate/%ip PO4b ,�)o6Ver- Jiiw Attach a copy of the workers"compensation policy declaration Frage(showing the policy number incl expiration date). Failure to secure coverage as required under MC:L 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 WORK ORDER and a fine of tip to$250.00a 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 heretht,c ertifrV oder the pains and penalties o perito lr that the inforniation provided above is true and correct. �t.g.tralttltC,�._ ,... .-...�"'..��_._......_..._...._.._._ Date: 'IrC?1tr978-7 1-7777 _ ...._ Qlfieial use omit, Do not write in this area,to be completed by Chir or torten off"icier!. City or Town: Permit/License# Issuing Authority(circle one): 1, Board of Health 2. Building Department 3.Cityll'own Clerk 4. Electrical Inspector 5. Phimbing Inspector 6.Other Contact Person: Phone#: Community Software Consortium Page I of I North Ando, ver Board of Assessors Back to Results I Search for Parcels I Search for Sales I View/Print Record Card .............. Parcel ID: 210/070.0-0033-0000.0 FY: 2016 Community: North Andover Photo(Click on Photo to Enlarg ------------—----------------------------------—-—--------------------- -------- "''" ------------ i View SUrninary, LoCafion: 21 LINCOLN STREET Property ------------------------- Owner Name� LAUGHTERS,KENNETH Card Residence Owner Narne2: Map View Owner Address: 21 LINCOLN STREET Photo E ck 0.Photo to Erilarg Land City: NORTH ANDOVER State: MA Zip: 01845 View Abutters Segments Neighborhood: 5 Land Area: 0.12 acres Properties Use Code: 101-SNGL-FAM-RES Total Finished Area: 1628 sqft Detached Tax Class: T Pct-Exempt-Land: 0 Structure Pct-Exempt-Bldg: 0 v 21 LINCOLCOL N STREET Sales Sewer: Road Type: T Sketch(Click on Sketch to Enlarg History Water: Road C o n d it ion: P --—----------- ----------------- ----—----------------- Value Assessments Current Year Previous Year History Total Value: 273,700 290,500 Building Value: 119,000 141,100 Land Value: 154,700 149,400 Market Land Value: 164,700 Chapter Land Value: ............. ------...... ...................... Latest Sale Sale Price: 303,500 Sale Date: 1111212013 Arms Length Sale Code: Y-YES-VALID Grantor WINTERS I MORRIS Can Doc: Book: 13698 Page: 0259 Ce*y v 4M 0)015 C'Des *wsre AN F001%Fwaorvad http://epas.csc-ma.us/PublicAccess/Pages/Parcel Summary.aspx?Menul D=3&1,in1dD=18 23... 4/8/2016 A`pR ►' CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.ITHIS 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 poltcy(ies)must have ADDITIONAL INSURED provisions or be endorsod. 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 rl hts to the certificate holder in lieu of such endorsement(s). PRODUCER TGA Cross Insurance, Inc. 401 Edgewater Place, Suite 220 --"-AMEA T_- TGA Cross Insurance Inc. PHONE _ Wakefield, MA 01880 _tA1C -.-.. NvFAX _Exq: 781-914-1000 1-246-2601 E-MAIL -- __ LAX Not: 781 - -ADDREW.,_-_ switchboarda@tgacross.com www.tgacross.com -_ _ INSURERISIAFFORDING COVERAGE NAICk - -- - -- INSURED -. __ INSURERA,; Excelsior - _____-___ _ - 11045 A& M General Contracting, Inc _INSURERp: Peerless Insurance Co 24198 119R Foster St. Bldg 14 INSURER.c.;,AmGuard Insurance Peabody MA 01960 INSURER D: - INSURER E: - - - - COVERAGES INSURER F 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 SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTH TYPE OF INSURANCE POLICY EFF �--PtlIICY EXP --- --- ' ------- POLICYNUMBER MM/DOIVYVY ' MMlD /YY LIMITS MMEROIALGENERALuaealTv CBP8947488 3!20/2016 ;3(20/2017 _ A CO EACHOCCURRENtE 5 1,000,000 _ CLAIMSMAf7E �/_ OCCUR DAMAGE TO RENTED - - -------- PREMISES(Ea occurrences j 8 100,000 ✓_ ISO dorm CG0001 -— - MEDEXP(Any one person) 5 5,000 ,Contractual Llabillly ___ - : - PERSONAL EADV INJURY $ 1,000,000 tSEtJ'L AGGREGATE LIMIT APPLIES PER ' ' --- -- ------ POLICY JE --- LGC ,GENERAL AGGREGATE_ S -,...-. 2,000,000 OTHERPRODUCTS_ -COMP/OP AGG S 2,000,000 . ' -.. ... --__ B AUTOMOaILE LIABILITY ',S _ BA8947688 3/20/2016 3/20/2017 COMBINEDSINGLE LIMIT ANY AUTO IEaaccldenll _ --_ ;-s 1,000,000 BODILY INJURY(Per person) 5 �---- -- OWNED SCHEDULED ._ HIRED ONLY ✓ AU705 BODILY INJURY(Por accident) S AUTOS ONLY TOS IaIRCD NON-OED __ AUTOS ONLY '�. PROPERTY DAMAGE - LPer,accrt7entl- S -_ S B UM13RELLALIA6 !✓ GccuR CU8947888 312012016 3I20I2017 EACH OCCURRENCE 5 - 1,000,000 EXCESS LIAB --.- _.-.. _- CLAIMS-MADE! ------- -. ..-.__-- AGGREGATE ..5 1.000,000 DED : ✓ RETENTION510.000 ..-_. C WORKERS COMPENSATION AMWC572468 3/20/20163/20/2017 PER OTH- $ AND EMPLOYERS'LIABILITY YIN ✓ STATUTE - _ ER �;iN'iPROPRIF I"ORrpARTNER/EXECUTIVE r� � -- ----- �' E L EACH ACCIDENT i s 500,000 OrPICERIMEMBERE (Mandato In NH) If yd describe kinder EL NIA E L DISE_ASE EA EMPLOYEEI,S _ 500,000 UCSCRIPTION Or,OPERATIONb lo b= .v - "- - E L DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i% Thomas I Gre o � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD