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HomeMy WebLinkAboutBuilding Permit # 6/16/2016 ..... .. .. t%ORTH ' ��K�4ea GILDING PERMIT 0 TOWN OF Wt T " "SER �: 5 13 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page r,/ ✓ f f / /„ i r, rf /// / r / r , / l r,Y ✓ ✓ / r // / l ✓1 ,.e ,J. .�. n ,r. �rrrv, /�f, / f /. / , ,, o/„/ „v✓a//%r,�//✓%,,/„L////,,:G�,rra"ia✓1� Y/.�✓�//vr,,,�' rr,l„/�a,D,r�,F,e�ei, / ,,r,d✓fr�,/l/+amr/!/r'ouLr,,rr/r„//'r,r�''r,rf /(/,� b/ /iy / r ,,/ r Y/° /, � ✓, r r r rrMel r / it /✓ i r /� i S /. Orr, ,:r ,c� / /,” „/, 9✓ / r ,r/ / ,s r",/ /i / / ✓ /, fir' r �' /, l l i, i, r, �. i r / r rrv✓,�, 1. a / /r r / / / r z ✓, r, i r � /. /,k�.,.,�5/� ,-r -.O o ,Y ,,:r�,✓,,,, rr,.,,.ro )fi`„rn„r/,,.r-,r�i'�,.,,-.✓hi,,,,1,/f!%rrr /'2,/r..ruu/i✓irrr;,✓//i.ar,r,f,:J,a(r/✓-rf,✓fry„ri,✓,,..//,�/.,✓,/,,,/O✓P// r ✓ff„/ /,ir r.,. ,/ ✓ r r, f � .1. ., /r r,/ /�, ,r.,1 //, ;/`"//1 ,r/r,,,://r/ ror / ..r ,,r,, i, f ,!„ � r .,, f ✓ r. (. //%� ./ ,/ . /�,-J�� ,.�„ � /i 2'r „�Pi,/ �- cr., v, .'/ -e/ r,//rn/. ///f„ r ca /, co,�/:/ ✓ fj./„/! /,.r.,e,i///, //..J/�/ �/ /, ./, ✓ ;/,. / fir r, /�/ ,�, 1r/, /,,3 �ri„ / 00' /✓, ,// r.r ., /r.. -/'/ / /, / f t r,t /, // c /�/ rr r/r /rrr/,r,. „/✓ ,/ ✓ i r � r / / ✓,r,,,,ii! r////„-k„ ,,,,,ri,✓ ,( r r!>j�6/1/�/�„r�,fi�/�%/ /%„/,/.6i,r fr ///,J/r//r it;,;r///.t GG��//�/��f/%,/,/l�i„ ,:;<; „r' „Hi� ,✓/„,�r, rF/, rr f /✓i r../r/,/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential o New Building ] One family ❑ Addition [.- Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ki Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other /r. , /i,r,. r „/,,,,✓// / . / // ,%i/%i ri-�/ /, ,e.(jr ,,;'',✓,J r/L,,f// �/ ,r„o r/ y///l, /i /,,a// //. „r/ „ r !' r^r f✓.///,/ r !i 1. // � ✓ r, /.. ✓. r ✓ c / r f // / �yg / /%fi /% (/ rG r r� / r /// !f./ s // rrr. /ii// ✓� f/ r- /l�i��?`�i.�1r���, A,�i, //.tel„i i/,”/�✓, ////'r,r�,✓r/,r r,./,f„i✓5/,.,/.,ri t�./,.,✓/�:/✓r.),G/ r✓,/,r,,,//1;.�.,�iir ,r,.,v�f,,,� �y✓r,r, �1„/rte% e�,i,r strip and re-roof asphalt shingles- 20 sq Identification Please Type or Print Clearly) OWNER: Name: 7eremy Young Phone: Address: 29 south Bradford St. North Andover, 01845 ✓, , ,,; / ,,, ., -,/ r ✓ v- / J;r., rr ,/ r r r f_r 4J fT t /,, f/(/ / /-///i rj/rr /%Y,f.,..// r�/,:.:/r„c//�,1�/r%,.r//�i,/o r �r�Yfi/„s,Cl i?.1,r i/✓r/„/, , .,.r//r ,r,/sl ii/i i //i/ /,� ., /„ ✓ / '„ a, r / r� :,;, r//�i/i✓/(f/'///`r/j jr a/ r(✓/...:%i Gj„//, / /p, j/, (/ / rr' % /-/rr//;,,. / ,.r... ,Lr, .�/ ri. /. // / // ✓. 1 . / f ./ /.. ,..%/ //fir/// / /�/ /7 f f//.. /7- /r✓ / /i �, ///r/i, /c' / 'rt lJ /;/ f/ �f/r a //f// s //�/. f rl //./jj / /o / r✓ / / / / R / ,/// r/j.//i r/ :../ r //- ///,p/ � �//;r, j,,,rr/,�r ri ,,.lfiJ,,,.,rr „r//.:erf///, ,/, o / /: ,�, i.,:,✓rr rnn..,.,,..,. / n,..e,relr,.,nr✓, „rrr r. / ,;:; / :,,, r / r r // r/✓ r r r r / . / /k%// /i/��// / rr/ / /✓ r, � /,✓/:,tr ,�„ ;,,„c,/ rr.r` Y*r�(,,ier;/l, rrr,../ /,,,/ar/r�,/ fr r lj. rL it ,/✓, � �r'�r„P. r/r 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: $ 8000 FEE: $ Check No.: Receipt No. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund -•DocuSigned by; igratir ofAgntiO , r ign, tr 'ofJcc6fr -•60212AA3A46A4C5.,, i Plans SuOrniO, ❑ flans Waived ❑ Certified Plot Flan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming P001s ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OF'F m D FORM PLANNING & DEVELOPMENT Reviewed On Signature-—a COMMENTS f10V , �n f( njf VOM Q()� 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/SIgnafure & Date Driveway Permit DPW`gown Engineer: Signature: Located 384 Osgood Street FIRE DEPARIFNIE T - Temp,Dumpsfer on:site yes no Located,at 124 Main,street Fire Depa ,, thent signature/dale COMMENTS '` F t%ORT#i Town of Andover 0 ® - `'o '.K. �1 ver, aSSy �jcocti.cH.w.c.c y1. lips TED p.PVL P AIF M U BOARD OF HEALTH E RM I ][ T %S; LD Food/Kitchen Septic System THIS CERTIFIES THAT ........ ............................. BUILDING INSPECTOR .. ... ......... .......�.Yvv.. .......... ...: ... Foundation Jft Ir has permission to erect .......................... buildings on .. .. ........... .. . ... . Rough M.-A-1*04kto be occupied as ... Q*Jwvp ..... ...... .............................................................. 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 B -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 UNLESSI Rough Service ... .. .. .. .. . .............. .... Final BUILDING IN EC R GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Displayin 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. Certified Safe Electric, Inc. Proposal BOnging the cmifi'a Saf, June 14, 2016 pywefofthelup MinecMifteA S"Myt Nv., Roof Scope of Work MAIEUM cerfiflej sotay To: From: Jeremy Yc)Ung Bruce A. Davis 29 South Bradford St 50 Tower Avenue No Andover, MA 01845 Marshfield, MA 02050 License #CS-104740 7811-500-9358 Roofing Scope of Work - Approximately 20 Square X Strip, remove and dispose of existing roofing shingles and materials Lip to 2 layers X New Owens Corning Lifetime Shingles Duration Estate Gray Gaivanized nails installed per hurricane requirements ovens corningweatherLock 6 Granulated Self-Sealing Ice and Water Barrier entire roof X ADE34817 rearn drip,edge on horizontal edges X-Ventsure Ridge at Rolled Ridge vent and caps New pipe boots for all vent pipes Includes all labor, material, clean Lip and disposal of ruttish X Wood underlayinent replacement additional, if required. X Adding of Soffit Vents additional, if required. Total Installation Cost $8000M Ovate 4. Vagaj ._tomer torner Ac . tance ® DATE(MMIDD/YYYY) AC®R® � CERTIFICATE OF LIABILITY INSURANCE 01/14/2016 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(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Darlene Mulcahy MALCOLM & PARSONS INSURANCE AGENCY INC AICONN Ext; (781)344-3200 FnAic No: E-MAIL dm malcolmand arsons.com ADDRESS: G P 6 FREEMAN ST. INSURER(S)AFFORDING COVERAGE NAIC# STOUGHTON MA 02072 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: CERTIFIED SAFE ELECTRIC INC INSURER C: INSURER D: 50 TOWER AVENUE INSURER E: MARSHFIELD MA 02050 INSURER F: COVERAGES CERTIFICATE NUMBER: 24268 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 ADDTYPE OF INSURANCE INSD W D POLICYNUMBER MM/DDY� MMI DWYY LIMITS Y EXP LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RNTED CLAIMS-MADE D OCCUR PREMISES (E.Eoccurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ '.. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 11 POLICY F-1PRO JECT [7LOC PRODUCTS-COMP/OPAGG $ '.. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON--OWNED PROPERTY DAMAGE $ '.. HIREDAUTOS AUTOS Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ '.. DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER H AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNEP,/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A NIA N/A 7PJUBOG17773815 08/01/2015 08/01/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bldg 20 STE 2035 AUTHORED REPRESENTATIVE North Andover MA 01845 Daniel M.CroW' y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) AC40R" CERTIFICATE OF LIABILITY INSURANCE 6/10/2016 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(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jaime Gonsalves NAME: Malcolm & Parsons Insurance Agency PAH/ONE Ext. (781)344-3200 A/CNo: (781)344-1925 713 Washington Street ADDRESS:jll@malcolmandparsons.com P.O. BOX 527 INSURER(S)AFFORDING COVERAGE NAIC# Stoughton MA 02072 INSURER A:Northland Insurance Company INSURED INSURERB:Sentinel Insurance Company Ltd 39098 Certified Safe Electric, Inc. INSURERC:Nautilus Insurance Company 50 Tower Avenue INSURER D: INSURER E: Marshfield MA 02050-5131 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632803667 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 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I D D POLICY NUMBER MMIDD/YYYY MMIDDNYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE A CLAIMS-MADE � OCCUR -PREMISES REM SESOEa oceur ence $ 100,000 WS256559 7/15/2015 7/15/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY[—]JECT 11 LOC OTHER: General Aggregate $ 5,000,000 AUTOMOBILE LIABILITY CEa OMaBINED dent SINGLE LIMIT $ 1,000,000 cci B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 08UECZJ8251 3/7/2016 3/7/2017 BODILY INJURY(Per accident) $ AUTOSAUTOS PROPERTY DAMAGE $ NON-OWNED X HIRED AUTOS X AUTOS Per accident PIP-Basic $ 8,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ AN021275 7/15/2015 7/15/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Electrician, Solar, Roofing Contractor CERTIFICATE HOLDER CANCELLATION certifiedsafeoffice@gmail. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Amne Parsons/DARL - �- `�-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 oouriT1 The Commonwealth of'Massachusetts Department of Industrial Accidents OJT. of Investigations 600,Washington Street Boston,MA 0-7111 40 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunibers Ap _Vlicant Information Please Print Legibly Name(13usine.,;sYOr&)ai)ization/indi,idual): Certified safe Electric, Inc Address: SO Tower Ave. City/State/Zip: marshfield, MA 02050 Phone#: 781-626-4258 Are you an employer?Check the appropriate box: Type of project(required): I N I am a employer with- 8 4. [:] I am a general contractor and 1 6. E] New construction employees(Full and/or part-time),* have hired the sub-contractors 7. Remodeling 2,F] I am a sole proprietor or partner- listed on the attached sheet.t ship and have no employees These subcontractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition [No workers'comp. insurance 5. El We are a corporation and its ME Electrical repairs or additions required.] officers have exercised their 3.r, I am a homeowner doina0 all work right of exemption per MGL 11.[] Plumbing repairs or additions myself, [No workers'comp. c. 152,§1(4),and we have no 12.nx Roof repairs insurance required.] employees, [No workers' comp. insurance required.] *Any applicant that checks box 111 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire oinside,contractors must submit a now afflidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name orthe sub-contractors and their workers'comp.policy information. I am an employer thal is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_, Traveler's Insurance Policy U or Self-ins. Lie.4UB-oG177738-15 Expiration Date: 08/01/2016 29 South Bradford StCity/StAte/Zip: North Andover, MA 01845 Job Site Address: 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 Lip 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 certify ander the pains and penalties oy*perjury that the information provided above it true and correct. S;gnaturc: _Qate. 6/13/2016 Phone It: 781-626-4258 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#: Efasnrtts Department of Public Softy Beard of Bandits Regdl,#ionu and StAndafft BRUCE A DAVfg 2 Gil 7R AVENUE `r; MARS LI)MA d 0111012,018w 0" MASTI 9 cl US f' fill , INC 5 T ASE f " � 020'0 N MAS 50 Til r� 12"'Y , ' fi r" < 1 `f -111 205 y ' 40146 } r/�,.Y" »> r+,rtrrn r/Il, ra rr lurttta License or registration valid for individual use only office of Consumer Affairs&Business Regulation before the expiration date. 1f found return to: HOME IMPROVEMENT CONTRACTOR W� Registration: 1613904 Type-, ©frIca of Consumer Affairs and Business Regulation r 10 Park Plaza W Suite 5170 r xpiration: 6126/2018 private Corporation Boston,MA 02116 CERTIFIED SAFE ELEC"T"RIC,INC, BRUCE DAVIS 60 TOWER AVE MARSHFIELD,MA 02060 Lnderseeretary Not valid w out signature