HomeMy WebLinkAboutBuilding Permit # 6/28/2016 i BUILDING PERMIT 0 %AoRry s TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ � � o Permit No#: Date Received �'�s RaT�o PP�RS Sus Date Issued: �� IMPORTANT: Applicant must complete all items on this page LOCATION 1-/ H e- fb Rd . Print PROPERTY OWNER 196e�!j P nt 100 Year Structure yes no MAP 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 ❑/ Iteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ".:.c ,..� ® eptr Ulletl� :,p FloodplainghWetlartds � k �Wafersed;®stncty A ' ���a euue� r � x x DESCRIPTION OF WORK TO BE PERFORMED: PA,),/(2 C` ���c Ski o i rubL,2� v-30f; ,O1k6� Sc 3-ge ci #UcAed cQ. Q fa(,(ej ars osaV( . u �A � 0 Identification- Please Type or Print Clearly OWNER: Name: Phone: 7 7Y-6 9S - 9 V 3 Address: - oz-a` A . Contractor Name: a�f- Phone: 9 `?S -- 63`)- A-Xc/7 Email Address:3E' r- vi ot o vP,,r. rn Supervisor's Construction License: GS- /®a �3 Exp. Date: 0� 017 Home Improvement License: t Exp. Date: V zjai 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: $ - 70(9. 0 0 FEE: $ a Check No.: Receipt No.:_"5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r7,1 i gigna a r. .,, ""'Jr, Ao... RTH Town of - 0% No. q4, 7 `, LAKE VeY', aSSy IAie, COCnlcnewlc. U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THATD ........................ BUILDING INSPECTOR has permission to erect buildings on .. CFoundation Rough to be occupied as ...J .. ... .. ...... . .... .Fveryy .............................................................. Chimney provided that the person accepting this permit shall inrespect 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS Rough Service .. .... ....:. .... Final y UILDIN EC R GAS INSPECTOR CcupancE Permit Required to Occupy By Rough Display in s Conspicuous Place on the Premises — ® Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. �AJRJGHTI GUTTERS 360BeffY Street No. Andover, Ma 01845 Company C .0 1 ;11 0 Guk*ers '—'rk nU�301u C:�s(do rot use.Fcst Offf Awl rev C.0 Qy[YON-ii st at e Zip cc:li AedM(,—,,'�3t irCL'to �'Zdc. -IS) (gy 5- Ao-clfh- S+ Sato Zip Code i ir,C ph 13 C eta: naA:c:e -C-951M 3G 5 5 rt 61r, t ;ET- 8 15 'Cho Conti-actor agrees to do the followingwOrkfOr the HOMCG)Veri a^cjgalaof rrite.rials!o be tj-iadd tio—J, move c rep(acz 12 (L e'* 6X-Y-C,C C�q e Proposed Start and Completio)i Schedule-V4a follovAg sclaledula Nvill and will be securej Jy t!,Q contractor as the agent: re cl.ariio (OWnel-9 rho secure their own permits Nvill be excluded from the Guaranty Fund PYOVISIOTIS Of VO� bete whea c on 1.1 a c 1�.,r vi i I I To-girt cou trac d w ork. jMGL chapter WA-) L Datp alien contrac!el vicrk will be substantially Completed, Total Contra ct Price and Payment Schedule T,jo contractor agrou to perform the Nvwk,furnish The material and labor specified above for(he total sum of oo, Payments willb-a made accordingto The- Alto upon 1;3 tl0cost oft,[`ecia1 Lever is greaser) by 5—by or iiperi completion.of S 0U01p aacomoletitmofthecontrect. (Law forbids demandingfullpaJ--entlintil.cozi-tTactis compIctedto Wit party's sat:15f?,CtQ:i) A8 � • .......... I"--ccn!rczi—1 v L*i3 j,r. NOTES: lac:4K,;al t%ataq dtitcsit or required by ta Cont.-aC.o.-before v,-),A bea,,s may jnade;m!flal cas C. C;derej In It!. - MINI—�0111 Y-- -Lr�ijitymaztbaattnxhad fathe coo.....ct) Subcontractors-To ccritrectcroglees tobssoteiyresponsible A r COT-PIC-,Ion of-.1h a re.gar4less oMaacjors ofxly 111ird the CWTU',Or AITtIlCr a.-e,,5 to be solely resoortsiblo for all pay-inmt3 to all a.ntract s'tall not bqlly that any 116a or cfjers,.;.,arfty irteresthas baa placed 0a 114s rezidei,:ca, Carefiffly before,6-1*62cint,thl--s contract, * Doricbapre;sLi:eafnto coz-.acf.Take f1mata read iisad fully undeTsiand if. * Make 5ura !Lritr lite I av;zequlio s rcoahc rre improven-'ent con tractoys an I �e subcontiacfcY5 to be regktercd w1fli.tb e Director ofHome fmpt-ovement Contractor Registration. registration by wrilt Iftlig to the Director at 10 ParIc Plaza,Room 3170,Boston,MA 02116 or by calling 617-973-8787-or 869-23M75 7. * Does the C)ntrac!ol havo iris U fance? A,;k*.L-o Contractor for h15 insura:,ce Company inforwatioa so-jin y0a --C' conf:rm covezag-�,0,e.3.,-u Read teIrrijovant Inform-tion rn the raveisa side oftliis fb-ni and get a copy ofille Cons,,uccr a stsuelat,a Place other thaa the contractees normal place of business,prmided you notify na ` N oz he notify t", or branch offlca by or&aq mail posted,by telegam sent or by delivery,not later tbau III-idni riot ILtLsdbusae Usa To en t. S c e tte attache d ri ot ic a of cancel I a lion forita.for a—explap a,"U Loll It—Of th JP DO INTOT SIGN Tfff S COIN TR A- C T IT`THERE ARE' ANY BLANK SPACES!! -A X or, oW11 smmn d J D,--fa -- PROPOSAL coristrurdon Supervisor RE 'S E IMMT Lic.4 rCS102663 F,LLL Y IATS URED H.I.C. Reg, # 135569 VnUGHTROOFING-GUTTERS AND HOME LUPRUVEMENT All Types af Roof1mg& Gutters 350 BERRY STREET o NORTH ANDOVER, MA 01845 TELEPHONE: 978® 7-2247 PROPOSAL SUBMITTED TO �a PHONJE DffrE 681 IP13t, STREET �_ - JOB NAME I LOCATION CIN,STATE AND ZIP CODE JOSSTART DATE r d : (. /y� u A til r4a � ✓ c) e' '°- '0.r. ` t.'_ k 2� 0 ( 'p ka" i'-- @ t, ,� Cau t. ,�! Y it�:� t'y (� t✓` ' ( (?.. /,° �'fdis (' r CL rte et', �� � a N t aj' 6 r6pn C, M9 4 �B f 00 We Propose h�feby o furnish and labor complete in ` ordance with above specifications,for the scam of:$ ^ � �� Payment to bpZacla as foil All material is guar t to be ass ecified.All wo�Io pI in a substantial workmanlike p e °m Authorized ✓' ✓ manner according to! cifica io"� iTR&77; �slantlartl practices.Any alteration or deviation from p above specifications involving extra costswill be executed only upon wAtten orders,and will become an Signatufr extra charge overand above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tomado and other necessary insurance.Our workers are fully NOTE: This proposal maybe covered by Workmen's Compensation Insurance.Non payment by agreed party may result in litigation withdrawn by us if not accepted wit 111 days. with penalties including court cost and compensation both real and punitive. cceptaam Of PTO OSal - The above prices, specifications and conditions are satisfactory and are hereby accepted,making this a valid contract. Signature 'ou are authorized to do the wort:aS specified.Payment will be made as outlined. Date of Acceptance: tt (, Signature The Commonwealth of Massachusetts 44 Department of IndustrialAccidents 1 Congress Street,Suite 100 " tl Boston,MA 02114 2017 .t www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEp-WTT]NG AUTHORITY. Please Print Le 'bl Applica. Information Laine(Business/0rganizafi0n/Individual): W t Address: 250 6 Ci /State/Zip � U %� /q Q 18 VS Phone#: Q 7Y-697-42 Y7 Areyou an employer?Checlt the appropriate box: F12 . roject(required), em to ee fiill or part-time).* ew'construction l,�am a employer with 2 p y 61 2,❑I am a sole proprietor or partnership and have no employees Working forme in modeling any capacity.[No workers'comp.insurance required.] Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ilding addition 4.❑I am a homeowner and will be,hiring contractors to conduct all work on my property. I will ectrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sola lumbing repairs or additions proprietors with no employees.5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. o f repairsThese sub-contractors have employees and have workers'comp,insurance.t ther ke M 0 V e E' V Qp 1 A C Q 6.0 We area corporation and its.officers have exercised their right of exemption per MGL c. r 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicantthat checks box#1 must also fill out the section below showing their workers'compensation policy information. icating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. I 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 I Homeowners who submit this affidavit ind employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. - 'compensation insurance for illy employees. Below is the policy a X am an employer that is providing workersnd j'ob site information. `i Insurance Company Name: � M C r LAa ( ( 315, �`1�8`7 O 1 S Expiration We: 4 3 0 �0/6 Policy#or Self-ins.Lic.#: 11J . • S�l l l o ra�, c� f�;���,'►1/D� M ►� City/State/Zip: ��f Al k V.-Pr>T /nl� ©1 2 V� Job Site Address: R Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). -00 Failure to secure coverage as required under MGL c. 152,§25A rxraof criminal TOPzWOion punishable by a fine Up to RK ORDER and a fine of up to $2050.00 a and/or one-year imprisonment,as well as civil penalties in the f day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the AIA.for insurance coverage verification. - I do hereby certify n�ler the ains and pe Iftes of per;jury that the information provided above is Erne and,correct. �• �1'�`"� Date: Signature: - f 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): L Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: 1/15/2015 7:37 :05 AM PST (GMT-8) FROM: 100005-TO: 19786889542 Page: 2 of 2 A ®® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/15/2015 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). CONTACT PRODUCER T A SULLIVAN INSURANCE AGENCY INC NAME: 135 MERRIMACK ST PHONE 1FAX METHUEN, MA 01844 M IL e` "° ADDRESS: INSURERS AFFORDING COVERAGE NAIC f/ INSURERA: LM Insurance Corporation 33600 INSURED INSURERS: SCOTT WRIGHT DBA WRIGHT GUTTERS INSURERC: 350 BERRY ST INSURERD: NORTH ANDOVER MA 01845 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 26936592 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 SUER POLICY EFF POLICY EXP LTR INSD D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE 1-1OCCURPREMISES( aENTEoccurence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRC JECT [7]LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED)SINGLE MIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccidenl UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I RETENTION $ A WORKERS COMPENSATION WC5-31 S-387187-015 9/30/2015 9/30/2016 ,/ STATUTE PR AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE YIN N E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? FY-1 N/A (Manda(ory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe allached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. THE WORKER'S COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SCOTT WRIGHT. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. 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 ATTN: LOCAL BUILDING INSPECTOR ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE J 11 cL 0, ,,,11lKKK LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD :936592 1-387187 15-16 WC shankar.gada Le@Libertymut°a L.Com 10/15/2015 7:34:59 Am (PDT) Page L of 1 S ogv aaud� jo r CS-102663 SCOTT W WRIGHT 1,60 BERRY ST NORTH ANDOVER MA1�19'4,,� 0 8112/2017 Unrestricted-j3ufldislgs,of atly use group whid contaw less thaji 35,000 cubic feet(9 9 1 In)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license," For DPS Licensing information visit: wwv/,Mass.G0v/DPS Office of Consumer,affairs&Business Regulation 'ROME IMPROVEMENT COAITRA'ss � ,Registration: •138569 Type: ; Expiration; 4/14/2017 DBA WRIGHT GUTTERS SCOTT WRIGHT 350 BERRY ST, NO.ANDOVER,MA 01545 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza A Suite 5170 Boston,MA 02116 Not valid without gnature