Loading...
HomeMy WebLinkAboutBuilding Permit # 5/24/2016 _ _ 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ` Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION "j0 ® I R Print PROPERTY OWNER � gik I Z- Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village 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 k -� (] Septic ; ❑Well ❑Floodplain D Wetlands ❑ Watershed District ❑Water/Seaver � �. - _.h �t.= _..----- -- DESCRIPTION DESCRIP N OF WORK TO BE PERFORMED: t� ..._ ._ ' tea, Identification Please Type or Print Clearly) OWNER: Name: a C0 one: t1`7 Vr <52, Address: P� 1-117 CONTRACTOR Name: t<' Y-'V1 L--- Phone: °'7 9 s I Address: t eq c �� �' i 9 , 4 t � -2- Supervisor's Construction License: Cf-5' C) ;17 Y- Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER, / t/4 �`c�k?5k �'�� Phone: �'���.� •����� �'t � Address: 1) et(, Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_6, FEE: $ ` Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty4qn�_-_) Signature of Agent/Owner ignature of contractor t%O R TH town otndover '� ? _ 0 •�w y' ti it No. r _ h ver, ass •//yc O LAKE \ 9 ' /f coc"Ic NEwIcK 1' U BOARD OF HEALTH Pr= RMIT I Food/Kitchen LD Septic System THIS CERTIFIES THAT ......../ A ...... �.. ..�..✓ �S • - BUILDING INSPECTOR ..... . .......................................................... has permission to erect buildings on �` , �4 �� 1 Foundation g ........:^t:'... .................... �-- Rough 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ...... ... .. B. IFinal UILDNG INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry WallTo Be Done FIRE DEPARTMENT til Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. I�Nifl`�4�'@1�VI11��14�N�WUO!N'd�V�1�11�imIVd§�1�N��@II��S4i�n�NS�SMn6C�idIn��Gfli�'RII�4�WI�I�I�NB�I�II�@IINiIS�llpl�9� 9!I��&'�4111ttI����IIi���p�111�I�I�BI��U1n1�I1flP�Wd1�III�1�p111iflNV!�IVII�Ol�i�9�V��1Ma+SVM(i�@�I�InWIG�Y�II�ICI�W�MIR�MI�!'�V@bWNlul10��VNWltlfat�Itlo�li�IP�I�Ift�I�I��01�115ti�INWhN1fi�I41nitl�lpli�lV'iq' �VIVIIIIkNhn4�flR�IIIVIi�llliNIII�NI�1111N4�1�11�llfillli�Y111�011d6iSNiS1115titi�P�S�wSSN��1w1�1�A�1�4�yp1�NlV�ppplaM�YbX�±NY�VX��NI�IVIWk�dYf�n! East Coast General Nq1\1111�4nRU����11ltlIWi161\IIN���llllll��Ii��1NIlIII��US�(li��Il�IIiCIUlgb41�!Ipfi�4i�V1�fi�i��lB�pII�CN1{�p�yy11VI��11�1N���{h�1111101�1�1N11@�91�1�St�i0��4�liIdII�INI�IU�hW���1�IW�INIT\Y�IR'��uW�IMpp11h'��541119VY�11�("M0 �1�1�11���1110�\R11�1�01�'S�MVtl1�fWt��iMU1t4��91tlNNlm��1�11ti}y�IIIBIttl��1611�101sW1' Yq�1111I�11IIIIIN�T1��11117n�11111VWIIIV��N1�ll�l@V�0�1�6V19WINmlir4��pp�IjInlgN�i Contracfis2g PROFESSIONALSBUILDINGRESTORATION 286 Broadway Haverhill, Ma. 01832 Phone 1-978-360-0051 Fax 1-978--372-4.215 4/28/2016 Tlorth Andover°13Ida, elrrtrical °Dona wall Remove existing door frame. Remove existing block wall to accommodate new wall. Remove existing concrete lintel. Provide and construct new wooden 23(4 wall with header as necessary to meet existing;sub floor above. New wall shall be framed to accept a new 6 0 x 6 8 steel Pre rated door unit. Interior ceiling and new framed wall shall be have a double laved of 5/8 inch fire coded drywall installed. Exterior wall to hallway shall be a single layer of 5/8 fire code sheetrock. All new drywall to be seamed, sanded smooth,primed and painted to match.existing. New steel fire rated door shall be provided and installed in new opening. Door unit includes self closing hinges. Transfer existing door lock set to new door unit. Door shall be painted to match existing. Wooden baseboard shall be provided and installed to match in dimension and color. Newly exposed floor shall be free of defects and painted to match existing. Provide 1 new shallow hallway light fixture to match existing and allow door to swing open. Project shall be completed to meet Aimco standards. 'lean up of all job related debris. Project includes necessary permits and inspections. Total. Labor and Materials For the Sum of; Six Thousand Seven Hundred Twenty Dollars. $ 6,720.00 Sincerely; Tom Inal CD -' - - REMOVE EXISTING SINGLE DOOR AND DEMO INSTALL 72"X 8O"1-9/2°' - CONCRETE WALL TO TO FIRE RATED DOUBLE ''I 4'-1 O" ALLOW FOR CLOSET DOOR UNIT EXPANSIONS INTERIOR WALLS OF UTILITY CLOSET INSTALL 9 \ 2 LAYERS OF 5/8"FC C° DRYWALL EXTERIOR WALLS OF UTILITY CLOSET INSTALL- 1 LAYER OF 5/8"FC _= y = EXISTING WALL TO REMAIN DRYWALL EXISTING WALL TO DEMO oM-77-2-2-7 PROPOSED 2'°X 4'°WOOD - FRAME WALL Utility Closet Expansion Detail SCALE: 1/4"=1 FOOT NE C cc _ rs r Civil Engineering•Land Planning•General Contracting 61 Main St.•RO.Box 657•Pepperell,MA 01463-978-433-8100 to REMOVE EXISTING SINGLE DOOR AND DEMO INSTALL 72"X 80"1-1/2" CONCRETE WALL TO TO FIRE RATED DOUBLE I 4'-14" ALLOW FOR CLOSET DOOR UNIT ;i EXPANSIONS INTERIOR WALLS OF - UTILITY CLOSET INSTALL 2 LAYERS OF 5/8"FC G° DRYWALL EXTERIOR WALLS OF UTILITY CLOSET INSTALL 1 LAYER OF 5/8"FC - EXISTING WALL TO REMAIN DRYWALL 0 2'-2.. EXISTING WALL TO DEMO PROPOSED 2"X 4"WOOD FRAME WALL Utility Closet Expansion Detail SCALE: 1/4"=1 FOOT CORNERSTONE A Civil Engineering+Land Planning•Genera!Contracting _ G-� ;_ 61 Main St.•P.O.$ox 657+Pepperell,MA 01463•478-433-$100 rInvestigations 600 Washington Street 'ton, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name: %/Z6;11 _�; lel )4J d (Business/Organization/Individual): ,g5?"C O4-5r"(«4?,4•0-At-6 Address: 2,1? o- City/State/Zip: Phone#: 27 5 - 5 6 0 --&0-5- 1. I am a employer with `� _ 4.❑I am a general contractor and 1 6. ❑New Construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet.These sub- 7• E]Remodeling 2.F-1I am a sole proprietor or contractors have employees and 8. ❑Demolition partnership and have no employees have workers'comp. insurance. working for me in any capacity. 9. ❑Building addition [No workers' comp. insurance 5.❑We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their right of exemption per MGL c. 152, §1(4), 11.❑Plumbing Repairs 3.❑I am a homeowner doing all work and we have no employees. [No 12.❑Roof Repairs Myself, [No workers'comp. insurance workers' comp. insurance required.] required] t 13.❑Other *Any applicant that checks box#1 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 the policy and job site, information. Insurance Company / Name: Policy#or Self-ins. Lic.#: Expiration Date: 41 z_e 1-7 Job Site Address:2_6_,'-LW r I © (4 'n t Y5 City/State/Zip: e)1 f' q 5- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceriffy nder the p6ii, d penalties of perjury that the information provided above is true and correct. Si ature: Date: 5 Phone#: �W) —00- Official -O ficial 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#: Existing Building Checklist I EBC 2009 W i MA Amendments q. CERTIFICATELIABILITY 1F02117/2016 DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE /:NOES 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 Kathleen Marchitelli Fred C.Church,Inc. NAME: 41 Wellman Street ONE 978 3227172 FAX (978)454-1865 PH Lowell,MA 01851 o Ext AIC No): (800)225 1865 E-MAIL kmarchitelli@fredcchurch.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC If INSURER A: Peerless Insurance Company 24198 INSURED INSURER B: LM Insurance Corporation Thomas H Kinnal DBA East Coast General Contracting INSURERC: 266 Broadway Haverhill,MA 01832-29(3 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:571 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 W1.Y BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANE:)CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /LTR TYPIi:OF INSURANCE POLICY NUMBER ADDLSUBR MM DIDY EFF DM /POU pY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 XDAMAGE TO REN ED COMMERCOL GENERAL LIABILITY PREMISES(Eaoccurrence $ 100.000 CLAIW3-MADE M OCCUR MED EXP(Any one person) S 5,000 A CBP8384091 2/15/2016 2/15/2017 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2•000•ODO GEN'LAGGREGA3"ELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2.000.000 POLICYPRO- LOC $ AUTOMOBILE LIA3111TY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO BODILY INJURY(Per person) S A ALL OWNED X SCHEDULED BA8382891 2/13/2016 2/132017 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUT .S X AUTOS NON-OWNED PROPERTY ea den DAMAGE $ S X UMBRELLA I-AB X OCCUR EACH OCCURRENCE S 2' '000 A EXCESS LIAR: CLAIMS-MADE CU8979279 2/152016 2/15/2017 AGGREGATE $ 2,000,000 DED I X I RETENTIONS 10'000 $ WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYER:I'LIABWTYYIN I — ANY PROPRIETORMARTNER/EXECUTIVE -- E.L.EACH ACCIDENT $ 500,000B OFFICER/MEMBEI i EXCLUDED? ❑ N/A WC531S353816036 128/2016 1282017 — (Mandatory lnNH; E.L.DISEASE-EAEMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500'000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Apartment Investment and Management Co.(Al MCO)and any AIMCO subsidiaries and affiliates that may directly or indirectly own or manage any property or properties at or for which the vendor performs any work are named as Additional Insured on the general liability,auto liability and umbrella liability policies if required by written contract CERTIFICATE HOLDER CANCELLATION AIMCO Properties LP clo c 51744 McGinnis SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 51nnis Ferry Roar.Suite 133 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Alpharetta,GA 30005 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Client n Met u- Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(20101435) The ACORD name and logo are registered marks of ACORD �,°s�'u'a��aa¢aRffiapan �rerm�aa^r�,uaaak �rri�,.> Lice w CS-082747 r 2116 BROADWAyC f% I38verhill MA 01932 ,. r e r r"amcaa� d. 061201201,