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HomeMy WebLinkAboutBuilding Permit # 6/28/2016 p 5 p� y%®RY}a pBUILDl ® PERMIT �® ® \ TOWN OF NORTH ANDOVER ua O APPLICATION FOR PLAN EXAMINATION ® _? Y f Date Received Permit No#: r '. CHUS Date Issued: �� I PORTANT: Applicant must complete all items on this page LOCATION 7rOs4T,�C- Sfz y 444 V (YV nn Pr nt If PROPERTY OWNER /4etV, Qo Print 100 Year Structure yesMAP ( PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑gferation No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ SepticWell ❑ Floodplain ❑Wetlands ❑ Watershed District C]Water%Sewer f DESCRIPTION OF WORK TO BE PERFORMED: 1C /-2,p(.a-c Q- ota►v,G��,zd S I'd t 1� #�X1 e'-P- /o`er.,/- A O"e Get Identifica 'on- Please Type or Print Clearly OWNER: Name: 4d(-(.,a V t A 9-C& Phone:(1 S-509 ® 363 Address: ?0 (b t�S' �'� � nc�� ,�►r� 0 r9(ys-- Contractor Name: Gc� ,`'q h�- Phone: Email: civ °c��'� rS`C G t _Ca � Address: Supervisor's Construction License: C 0,166 Exp. Date: 311d-Ld-o®�? Home Improvement License: / 335-6 Exp. Date: y f y 2�1 7 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: $ 2V00,C0 FEE: $ Check No.: Receipt No.: NOTE: .Persons contracting with unregistered contractors do not have'access to the guaranty fund tiOR'T H Town ofAndover 0 � A 0 ® _ uAt 4 . 2610 LAKa ver, ass, 0 I� coc"Ic"[WICK �1. RTE® J'?�,`�� BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............. .. .. .. .... ...... ..... ....... .................................................... ......... amil has permission to erect ............ buildi gs on Foundation Rough to be occupied as ........ ..... ... ............. .... ...... .. ... :..ViArflpke... ...R"O.... chimney provided that the person accepting this permit shall in eve pect 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 CONS TIO CT Rough a"& Service ..... Final 4 BUIL INSP TOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display is ace on the Premises — ® ®t Remove Final No Lathing r all To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 360 Ekffy SAM18k l io, Andover, Ma 0184,03, _i.rJ1"8"A"�4"k'ttk7�.dl!„�,t.uu�i,�vpAr`.l�rrslr.irro11,-�, ,}1_ 1 wi 4 l t w q V✓. p COriI7 i i\:7 a a,W(c” fi'§4 t( -�r�(i'' Me.I .... /..,_....__..........a.®.v................�_,.,, 5.[e_tIA r'cess(do r aat'c>tOtticcFSn Gd,�sc a) Co.,r�0/5,.4 z; JO.r ,. 170(1- All I a}'.i naPha c >c� r,Pr ar,a Crt/ro n 8' c Zip Ca e zit r e hUi erj'1 ,A i) Lrder 2) Fra!riL7o ` c SvG7o c La 1 ;i,72 - "y�r�..,�tta�:C�.S(.t Glt{C C'1 r[rl 2 U C ms,;.ow+,.�,m�,.,�,�zn..mow. ,.mm,Wzmyc�.�.,�.e�.:w��m•m �.�a lasrcgttres l?:k rr,,;t tc:c� / Q / / :5'n;i.1 fiem:s�n'...,,....k,r e ✓S B/ fd AhoContractor 3pkcestotlntile following ttotkfor thcltotuaattiler (DtskL�:n3ctailt n„c;4 tocetp'cted,:pea°r+it'3o-,3_.9,.,�a d dA ado i ,^IIs oe +_set e 'mit?11 2 ts,�r ;v yS)C c ,2n rt; C f�V`ttrt X d rrwt.v n ✓' p' , pg- borA kdegwirer3 J)euolts T.)afollowing inulElLvP°nnits are VNI4rad proposed Start and 4'omitiction 5ctiadulo•Me folloviug schdniornll andtaill be sect;zQd`ry tho Uatfcctor as t eI;ar:eo"•vsars ai.':tt; bo zdbered to tet:css Cireu�,;.!�,:,ces,. a.ti,1.he coxtt,acior s Ca,:trcl;tris” (Owners who secure thein owls Vernilts)Valt be e ctueded x`orrt ttrr:Guar'araty Fund�lYGASIOns r3 i\l:GL chapter -1004-1) „q ��l /4 Iraev.h:a ccrttrac t t substaaa;tlly cornp;eted. Total Contract Price and PaymentScltedule `�d(�af�, �� T,,to Ccn:ractor agees to perform the York,firrtfsh tbo material and labor specified above for the fatal sum oi'. � 7 n ayments will bomad-,accord�ug to ilia fallos;na:Chzc:ulo: g (✓v, �� ;ova;!grids c0a” ,,(:-,7t to exceed 113 cz tu.1 c t p c er c;e c _t of sl;ecial a.dc; e. ,v, ichevec is g ez:3r) by _ / or upon congAtioa of 5��i 9q.a l7 upaa completion az rite conkract, (Lexi forbids deea.trx36:,g idi pays+cnt until coatiact is compicted to both party's sadsfact;oct) , ' ...L.,.tip.,/.:.) .� •.1 t,e�:IJ« ,._...._._........ I"vOTES: t`atanydepcsitc;ulos";t;st: rmy a crceed i`:og,caterof(a)c,.c lbW oft.:o total cor�tractpdcc or(b)tired,tu.1 cc.t o£z:y sptw!al r q ip;,,a„Cr ca:tc n I-,,ado .:cri_i v,;..:'.i;-as.. .,zte:cera3inrli4er.�..:oir,.ett}sco-pie:irns.a.cn:a .in-mes,i n'7nt ;,Ts, n„L.Pins-'4arrniiGv,,,(r {,!.i,y`t hvkhncJ}4tnr,t c „_ i Sfcr nll rr�nsafth ti�:r�iify.,7ty bea4tvcP2[df�tParp'frnul '... Subcontractors-'l7rr<:tn iee,or CErCC3 to ba solely rwspotasibla£os crn,plerion of rlie tit n,rlt describcd xagardless u£4 a'icf:ai s o£aay Hurd vWcty/subacat;ar;rrn!ilizeclbytiteaontr.ctvr, 'il,eaaatractarfl•zdter:4iyre.sPalraxcyalyxcK,,en 'b.a.arp,11; rfstarlls'.'.�etrzc'ora:�:r )_173ieri 2ls er.d l�suGr liu c__r LOOrt G antract a.cceptance-Ul on sicsting,dzis doctunaat becotttes a biud"utrg eoatract und,r ia% 'Unlet"otuertcis;:noted,ci liln tit!;cec.a;;en9,:::4 C;ntr?Cisilall net inlplyOntanylienerr 61l rse;-arhyintere'tIll sbaraplace doa111-.le 'ti:G , Rt yiu- iiiefolio 4l�a cr:tlfiCa3uCdr:ilcas :rsendtyUr:farr;sigrJnt;tttis contract. lac?ttcUcfrr iiatosigningO;vre act.Takoflmefaseadexdfollytm3e:siandit, 1�R mestiensicsemct;atigSstmclezr, �i^kasute e �lz c 1_1,�s= a�5 3cyi_,Tni r ein—siatCurltraetorRe2isrrztluu, ;;tel,r c,niresls:esti:carainproveutanteoazc".or5er9 subcrr�nactcrstalsoteiastore;Itvithrita77scttosof:domaT�:Apra';euctttCcatraetozltegistratCon. �"auni,^�yi<�tquireabautco trac;ar xeaistration by tir:itinp to tLs DilaaPor at 10 Parlc Pl�u,St.00m 5170,I3aston,lfr3,0211G or by catliu f:67.7•p73•x797 ar 069••253-375 i. '� Dasstitacur.tractcrl!ar;eiast;r2nca7 As..tLeCcntr,;etcrferhisins,uz:cecamgaayinfotn!acioa:rsot;;a.tyu.ke^nconi'.nncMt•e;a;c,or=:sftr. e a co;;y o:r."p.acfot instuancd'dont-tent. ICs;as�y'itnr r wltts t�;ti respcnsibitiries, head f:o Eno cru:at fj-, ,nraion o;t the roe etso std-,oftais fcari and Uta copy of the Cccsr:kner tui c r to th W.Ih:ne 13uF rovemeut Coraractor.l atiy. Xaa may c nrcl t,is aazzca nt ifitn�s E e n slgLed at a Mace o ber th3nttto cor.trzc!er's Lom:alplace oitrus nes",provided yet notify f`_e _ conzzctoruawritingatlttxg tmainoat orb,�utc:rotzicebyatdiaaryztalgnate2l,bytelegrarns-at orbydel May,notlatertpaauuoniobtOfthe tbaxdbueinessdaytirllo.,ra S osigningoftLisagxv uent. Se t eattacheduoiiceoJcattcellatioufoinxfor all erplzaatlanoftlangitt, E ANY.6$LANX SPACES FAEE ESTIMATES PROPOSAL consiTuctioll Supervisor Lic. 4 CS102663 FULLY INSURE,D H.I.C. Reg, # 138569 WMGHT R001FING-GUTTERS AND HOME IMPROVEMENT AM Types of Roof1mg& Gutters 350 BERRY STREET ® NORTH ANDOVER, MA 01845 TELEPHONE 978-687-2247 PROPOSAL SUBMITTED TO PHONE PATE AIAX�an plrie-oka 16 6 16 STREET JOB NAME/LOCATION '70 (> S+, CITY,ST ,,.IIE AID IP CJIDE J OBSTARTDATE A 0 <� rj o f 17, anibL C'Ituea a VAJ s , oo We PrOPOSC hereqtp.furnigrr-rhffd-rfaTa—nd-ra'�ol�--Gonxlete in accordance with above specifications,for the sum of:$ ` Voo a as ll�ws: Ct Payment to be mad e(71391 f , All material is guaranteed to be as specified.All work to be completed in a substantial workmanlike manneraccording to specifications submitted,per standard practices.Any alteration or deviation from Authorized above specifications involving extra costswill beexecuted only upon vMffen orders,and will become an Signature,, extra charge overpnd above the estimate.All agreements contingent upon strikes,accidents ordelays beyond our control.Owner to carry fire,tomado and other necessary insurance.Our workers are fully NOTE: This proposal may covered by Workmen's Compensation Insurance,Non payment by agreed party may result In litigation withdrawn by us if not accepted within days. with penalties including court cost and compensation both real and punitive. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted,roaking this a valid contract. Signaturl- You are authorized to do the work as specified.Payment will be made as outlined, ILI Data If Acceptance: 6 7 X(A K A(9/ Signature The Commonwealth of Massachusetts F Department of IndustriaZAccidents X Congress Street,Suite 100 Boston,MA 02rZ4 2017 •Y G� yY. www.nWs.gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le 'bl A licant information Name(Business/organizatiou&dividual) Address: 0 city/State/Zip: ��C�o v`��✓�1/� 0 f8�5 Phone#: Are�11-' employer?Checic the appropriate box: Type of project(yequired); em to ee/fig: nd/or part-time).* '7. E]NeW'coristrttctlOn i. a employer with employee 2,❑1 am a sole proprietor or partnership and have no employees Working for me in 8. F1 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition In I am a homeowner doing all work myself.[No workers'comp,insurance required]t 10❑Building addition 4,❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will JI.E]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12-[]plumbing repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.Q Other 6.0 We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box 41 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. 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing wor•Icers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date: J'(7 / Policy#or Self-ins.Lie.#: / 5'7 3 � City/State/Zip: '70 jaN&— � l�'Y Job Site Address: (� 1u Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date. Failure to secure coverage as required under MGL c. 152,§25A isaWOton punishable by a fine-up to$1,500-00 ItK ORDER and a fine of up to $250.00 a and/or one-year imprisonment,as well as civil penalties in the form of a STOP 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 dert1 ai Sall p realties ofperittry that the information provided above is true and correct. �. Date: 6 kV-16 Signature: p 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): i 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Pelson: Phone#: /15/2015 7 :37 :05 AM PST (GMT-8) FROM: 100005—TO: 19786889542 Page: 2 of 2 ® DATE(MMIDDtMY)A � CERTIFICATE OF LIABILITY INSURANCE 10/15/2015 0/15/201 5 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 MERRIMAC K ST PHONE FAX METHUEN, MA 01844 E-MAINo,L Ext A/C No: ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: LM InsuranceCorporation 33600 INSURED INSURERB: SCOTT WRIGHT DBA WRIGHT GUTTERS INSURERC: 350 BERRY ST INSURER D: NORTH ANDOVER MA 01845 INSURERE: INSURER F: 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 OF ADDL SUBR POLICY EFF POLICY EXP TYPE INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD(YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE—TO _ CLAIMS-MADE �OCCUR PREMISES( aENTEoccurence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ Ea ac AUTOMOBILE LIABILITY Co BIcidNEent D SINGLE MIT $ BODILY INJURY(Per person) $ ANY AUTO '.. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION $ A WORKERS COMPENSATION WC5-31 S-387187-015 9/30/2015 9/30/2016 SPER TATUTE I ERH_ AND EMPLOYERS'LIABILITY —' ANY PROPRIETORIPARTNER/EXECUTNE YIN N E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBEREXCLUDED? ❑Y N/A (Mandatory 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 attached 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 I } Uc ( ' 'rtVl;.G ilii1lJJJ,,,yyy{,ytt_ 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.gadaLe@lLbertymutual.com 10/15/2015 7:34:59 AM (PDT) Page 1 of 1 SC 0 T T W IN R I G H T M BIERRY ST NORTH ANDOVER MA 01845 0,7 p 08JI212017 I) D41H(I A-i3gq of I I ly LIS 0 gm.)up 1"'W ch con-41W lessiban 35,60M cuNc fc u (991- rn') of Failure 10 possess cwrr-2nt edition of the Massachusetts Slate.Building Code is causefor rp -vocat, r, of this license. For DP,5 licensing information visit- of ee of GaRsursic€•Affairs a Busi€sess acguigi-ion r P IMPROVEMENT CONTRACTOR (00 ei�trtl�€�: •1385&9 Tye; exp itioii: 4/14-12017 DBA WRIGHT GUTTERS SCOTT WRIGHT 350 BERRY ST, NO,ANDOVER, Mfg 01845 Undersecretary License or registration valid for individul use-only before the expiration date. If round return to: Office of Consumer Affairs and Business Regulation 10 Park plaza A Suite 5170 Boston,IIA 02116 1 9, Not valid without d.-aatare