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HomeMy WebLinkAboutBuilding Permit # 8/8/2016 µ0 RTF/H BUILDING PQRMIT ~ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION , Peffnit NO:1? Date Received ` ��- ,s• Date Issued , k �sS;cmis IMPORTANT:Applicant must eom Tete all items on this page LOCATION Zts fi Print PROPb4TY OWNER,` 'I f � Primo NEAP NO:4 PAIRC1 L�ZC7NWG D1STRtCT. HistoricDi$Wct yes no Machine Shop Village .ye no TYPE OF IMPROVEMENT PROPOSED USE Resid inial Non-Residential 0 New Building ! ne family Aoition E Two or more family ❑Industrial Iteration No.of units: ❑Commercial o Repair,replacement ❑Assessory Bldg 0 Others: 0 Demolition ❑Other 0 Septic U Well ❑Ftoodptain D Wetlands ❑ Watershed District O WatedS fewer Identification Please Type or Print Clearly) OWNER: Name: jaEcE_ Phone: Address CONTRACTOR Name: Phone-ql T_Lel Z 2 za z Addrew. €� f SuPervisoes Construbtion License- 7 Exp. Date: rya Ll Home Improvement License: Ev. Date: ARCH ITECTiENGINEER (J E_IA Phone:g7K=97_'-,2349 Address: S,469_ A r z_5 Reg.No. 3� X5-1 FEE SCHEDULE:SULDING PERMIT.•$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BA ED ON$1 Z5.00 PERSA Total Project Cast: `5_' FEE:$ Check No.: A46 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature otAgentlOwner t,.�� Signature d contractor Town of = "QRT" � Andover O to No. ry * Ikl ver,Mass, A,., Ol�b/ ��QDaATED NPP'�,`y s u BOARD OF HEALTH Food/Kitchen PERMI T ILD 7*� Septic System THIS CERTIFIES THAT..................... .e...... ���� BUILDING INSPECTOR iJ i/ Old...elvw �. �'�I Foundation has permission to erect..........................buildings on.. ..... .....Old Ill... ,,.. F► w�►j /�� ....................................................... Rough to be occupied as.................tA.fw���......��.I...T.*.R.��/ 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 CONST TION Rough Service Final BUILDI INS ECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildin 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 Approved by the Building Inspector. Burner Street No. Smoke Det. t� DAVID GRAHAM CUSTOM BU z,,WG 66 i EDERAL S`i'. MA 01950 Hm FA°978,462.21 83 Cm L 979 479—2— T` s f RrE r ._ P'Gi . 6 D-. [-- DAVID DAVID GRAHAM.HEREi.NAF T ER CALLED THE CONTRACTOR AR-Ct c 1 SOOPF NF ill°-`?RK HE CONTRACTOR SHALL FURNISH,ALL OF-HE NIATERIALS AND PERFORM ALL OF THE r C_K _r� _ -_IT`-INFN PLAN)AS IT PERTAINS TO BE PFR ORMEo ON APT' 7H' F Cal" LET-()'d THE WORK TO BE PERFORMFC UNDER THIS CCN TRACT SHALL BE COMMENCED ON OR BEFORE DEC 1 5TH 201 C THE FOLLOWING ING C -1 STIT TF SJSSTANI HAI THE 4'li ER SHAC.L PAY THF CONTRACTOR FOR THE MATEMA.L AND LABOR-iC EE nE E R TE t Ct,'ti!4 T...i E S. 0 :._r i:. N D ,E r"E-FR ACT V.. i PE. r Al ',,F T!!. r. ll __05 . AR-nci E 4.PPOG,FSS PAYMENTS PAt r4.9 NTS OF THE CONTRACT PRICE SHA:E 5r PAID IN THF MANNER FOLLOWING:5, 'CO TC START 5.000 Ar ER ROUGH FIANIE,5,000 AFTEP EP DOUGH INSPECTIONS 5,000 AFTER?L `x ASTER .000 AFTER TILE 5.000 AFTER PASA ow AET�CLE AL- _IS'ONS ANY AlwWRATION OR DEVIATION MOM THE ABOVE SPEClFICATI<^_NS,INC=U:INC- ADDITIONAL MATERIAL AND/OR LABOR C:O .S.WILL 8 =:-CMFD ONI Y UPON R ' A W's FN r). .--` FOR SAME SIGNED By OWER AND CONTRACTCM.AND IF THERE IS ANY CHARGE FOR At ICH ALT ERATIOMN OR DEVIATION.THE ADDITIONAL CHARGE Fy=R RF ADD_C'TO THIF GONTRWT, RI=".F Ow T05 CONTRACT 3F PAYMENT IS NOT MADE WHEN DUE CONTRACTOR MAY SUSPEND WORK ON THE jOP;_Ira ,-H € AS A. PA . UE PAVE EFIN A t=,Ah URF TO MAKE PAYMENT FOR A PERIOD IN EXCESS OF 't?DAYS FROMI THE , 1, At L WORK SHALE BE COa:?P-ETEU IN A WfDRKFIAi I;KE MANNER IN n THE OWNER SHALL FURNISH A PLAN AND SCALE DRAWING ING -`O ING SPECIFICATIONS FOR HOME CONSTRUCTION,A DESCRi`=',!ON OF THE EQUIPMENT t,._.t BE USED OR INSTAIlLED AND THE AGREE '.. ZONSKIR�TIQN FOP RK, a TO THE EXTENT RECIOREt BY LAW ALS`.b'OW SHALE SE PERFOR,RtED BY IDDIAMOM--S DW Y,!C N,Fr- I yS€!PFP AND A OR17 F)BY:.-AW To PERFORM SAID WORK,_ i 5-- v- CONTRACTOR MAY A.A ITS -.N., SCRFTIONGA 51_0OOT ACTORS TO FEREORM WORK-HEREUNDER,PROVIDED CONTRACTOR SHAM FULLY PAY QMm SURCONTRACTOR ANP IN At! INSTANCES S -- FOR THE PROPER COMPLETION IRE THS C 'T,RACT, TwCOF-RA=CTO HAL-LI<__. OR TO MOVE ANY POSSESSIONS O N?FIE PREMISES. ;'F s,, ti RDt ,S, _AI R f <.�,''E moi, __ ,,,v F,_l AND SHALL BE INCORPORATED IN,AND BECOINIE APART OF t,. '.. 7. CONTRACTOR SHALL OBT AIN ALL PERI-ITS l'EcIE SARY EMIR THE WORK,, .=Z- CONTRACTOR AG EES TO REMOVE ALL DEBRIS AND,LEAVE THE PREMISES IN 9. IN€HEEVENT OWNER SHALL FAIL TO-PAY ANY PERIODIC OR INSTALLMENT BREACH PENDING PAYMENT OR RESOLUTION ANY DISPUTE. k nim ..F F r r S. V ,Ry `,',".- B9!T .'CU' rN A CORDANCE WITH€HE RL'I ES OF THE AMMIC -.A : B TR A IO A5500AMON_ 1 ,,C O„iCIRCUMSTANCES T RAC T OR SHALL NOT BE LIABLE FOR ANY DE€AY DUE.TO CIRCUMSTAN CES BEYOND ITS CONTROL OCLUDING,STRIKES, CASUALTY, CF PA,.UNAVAqAPIt,ITY O FIAT RAi_S OR PROI_Cnf E , 't.'_FP..F T WEATHER. -. sowrn s < : S,0116 N A M r 0 F o W NE, : r FNN A � F, . wrorceF)Ammm Dvo GRAHAM CUSTOM BUILDING - 'ra + , ma 01950 978 »»8 CONTRACTOR STATE uCEM7»cs 046604 HOME e' ry T CONTRACTOR« 01+4 P¢ It 17,t+uCT;I'E aw�y . w 2#w mee h ro CS h _ .. ..._...._....._....._�._._ 0 -- _ ... _ _.__„_ � o #328 ....... f �� h v r w ,548 j #59 54] v v $ � 11 � /#34 4 i. Y. #� 1 Revirione:,� 541 #as - San 4II yIl YII 1651 F na v m a+s =� ,G 1651 Sheet 1 ® G:ajecYeel(Ae NJ toad) ® Approved 5'rgna Cm+re 5 ttis ' - d u � ---- __ w✓ Y�3/ o z F p T Q c � �" q z P �f' (3 . fi f d 25 � pz #28 tt30 _s r"'][3` q26 oF C usa r L /4I 52 .,._._.............n._ .... �� ttA�� x47 P,4] 5 x51 {f 53 55 ' 1 -77 35 f C d �v 940 941 / / B"-.. 37 7 5 x n,i 4G x44 \ Flll ,, �r �r�✓''`'ppr.'�r I ��,r` ,o7l aheet'9 'S�,} Rejected(A9 Noccd) 'S,,,.J ARprnvcd Signa Gure VaGe °`° 4 O M ij z „s, ,9 -- a, a t p sne�s+��e u�,e nr,e ##228 #30 M �( 32 #24 #� (\ j - 517/8 fq 0 � _ W4 i ( � #33 rJ w ® — { Mike&Jodi Fina 52 Island base B #48 E I }' #51 #49 ,� #47 Addreoe: j W 124 Old Yllla e lane � I 69 13 s Citr:5/16 34 State: N Andover !,4A n I' 53 #5 Island Base A I. #50 i I- 42 r^e a —z a ——I # #41 #40 , /tea \ 6 #37 # I i Job TIve: #45 #44 i 1651 Fina —i _ 7 _ Print Date: kitchen 06113/,6 z,r+rz x�a4 ,sz as 'z,ae DWG.By: Tom 3/8"=1 Job#: 5he„t#: 1651 Sheet 1 ❑ Rejected(Ao�Noted) ElApproved Signature Date ADVANCED CUSTOM CABiNETi Andersen Andersen Windows-Abbreviated Quote Report Andersen. WA Project Name:D GRAHAM SWA Quote#: 136 Print Date: 06/29/2016 Quote Date: 06/29/2016 iQ Version: 16.0 Dealer. Customer: Billing Address: Phone: Fax: Sales Rep: Administrator-DO NOT REMOVE Contact Created By: Trade ID: Promotion Code: Item Oty Item Size(Operation) Location Unit Price Ext Price 0001 1 CN136(L) $ 374.73 $ 374.73 RO Size=1'9"W x 3'S 3/8"H Unit Size=1'8112"W x 3'413/1 6"H Unit,White/White-Factory Painted,L Handing,High Performance Low-E4 Glass Insect Screen,White Hardware Pack,PSC,Andersen Classic Series-White Zone:Northern U-Factor.0.28, SHGC:0.32, ENERGY STARO Certified:Yes 0002 1 P5535(F) $ 647.40 $ 647.40 ROSize=6'63/8"Wx3'5318"H UnitSize=5'413116"Wx3'413/16"H Unit,White/White-Factory Painted,High Performance Low-E4 Glass Zone:Northern U-Factor.0.27, SHGC:0.34, ENERGY STARS Certified:Yes Quote#: 136 Print Date: 06/29/2016 Page 1 Of 2 IQ Version: 16.0 gndersen Andersen Windows-Abbreviated Quote Report Andersen. Project Name:D GRAHAM Quote#: 136 Print Date: 06129/2016 Quote Date: 06/29/2016 iQ Version: 16.0 Dealer. Customer: Billing Address: /^✓/'a' Phone: Fax: Sales Rep: Administrator-DO NOT REMOVE Contact: Created By: Trade ID: Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext.Price r 0001 1 CN136(L) $ 374.73 $ 374.73 ROSize=1'9"Wx3'5318"H UnitSize=1'81/2"Wx3'413116"H Unit,White/White-Factory Painted,L Handing,High Performance Low-E4 Glass Insect Screen,White Hardware Pack,PSC,Andersen Classic Series-White Zone:Northern U-Factor.0.28, SHGC:0.32, ENERGY STARS Certified:Yes 0002 1 x (F) $ 647.40 $ 647.40 RO - ROSize=5'S 3/8"W W x 3T"5 318"H Unit Size=6'413116"W x T4 13/16"H Unit,White/White-Factory Painted,High Performance Low-E4 Glass Zone:Northern U-Factor.0.27, SHGC:0.34, ENERGY STARS Certified:Yes Quote#: 136 Print Date: 06/29/2016 Page 1 Of 2 iQ Version: 16.0 \ The Commonwealth of Massachusetts Department oflndustrialAeeidents 1 Congress street,suite 100 Boston,MA 02114-2011 www mass.govldia Workers'Compensation Insurance Affidavit Builders/ContractersXlectricions/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY, ApulicautInformation Please Print Legibiv Name(Basinasdo genua@on/individual): p" {V'D Address: City/State/Zip: /99-6/6-0 Phone#: Are you an employer?Check the appropriate box: Type of project(required): t.❑l -armloyerwith employees{era andtor partdima).' 7. ❑New construction 2.- lamasoleproprictm or partnership and have no employees working forma in S. E]Remodeling any capacity.[No workers'comp.insurance required] 9. ©Demolition 3.Q I am a homeowner doing ail worts myself.[No workers'comp.insurance required.]t 4.F]I am a homeormerand will be hiring contractors to conduct all work on my property.I will 10 E]Building addition ensure iha[all contractors eidwrhava work¢rs'componsaiion insurance ar ere solo 1LE]Bleciricnl repairs Or additions proydetma with no employees. 12.F1 Plumbing repairs or additions 5. am a general contractor and I have hired tine sub-contmetma listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insursaccl 6.0 We are a corporation and its ollicere have exercised thekdght of'examption par MGL c. 14,Q Other 152,§I(d),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#t must also fill cut the section below showing their workers'compensation policy information. t thmn wnarewho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicatingsuch. tContractors that check this box most attached as additional sheet showing the mune of tiro sutreontraetorsand state whether m not those entities have employees.If the subcontractors have employees,they must provide their workers'comp.policy number. lam an eurployer that ds providing woi hers'eonipensatdoit Insurance for my employees.Below Is the policy and job site Informattom Insurance Company Name: - Policy#or Self-ins.Lie.#: Expiration Date: ;"-.jobSite Address:f� ��� LLA!Me 1A City/StatdZip: (' 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 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 up to$250.00 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 hereby certify under the pales and penal8es ofpeiJaiy that the information provided above is trite and correct. Signature: �..F T— �.rL„ttw✓ Date: dS�17�`lb Phone#, ���1?`�"�� Ofjlcial use only.Do not write in this area,to be completed by city or town officdaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -^1 GRAHAM OP ID:CA CERTIFICATE OF LIABILITY INSURANCE OA DDff08/08/201 Y) CE �..�� 6w9za1s 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(fes)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 endorsemen s. PRODUCER NAME C Michael C.Howlett Chase 8,Lunt LLC PHONE 978.462-4434 aC NO::976-465.6204 Newbulib Parker Street AtC No Exi M.cha.yppOrt,MA 019b0 E-MAIL Michael C.Howlett ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC9 INSURER A:Merchants Insurance Group _ UisuRED David Graham Custom Building INSURER B:Safety Insurance 000773 66 Federal Street — Newburyport,MA 01950 INSURERC: INSURER D: INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: 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, EXCWSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF bNSURANCE R 'POiICYE F POUCV P LTR i D POLICYNUMSER MANDDtYVYY MWMJ LURTS A I COMMERCIAL GENERAL LIABILITY E: ( EACH OCCURRENCE $ 1,000,00 ❑X # BOPI087046 0911612015 C191161201b DAMAGET RE TE 500,00 -. .. ,. 4 CLAIMS-MADE OCCUR PREMISES Es omsrenos E , X Business Owners ( MEDEXP(Anyoneperson) $ 15,00 PERSONALSADVINJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: t GENERALAGGREGATE $ 2,000,00 X POLICY D PRO- LOC PRODUCTS-COMPIOPAGG $ 2,000,00 JECT OTHER' $ 3 AUTOMOBILE LIABILITY Ea BII tl DISINGLE LIMIT $ 1,000,00 BANY AUTO 235556 10113120151 1011312016 BODILY INJURY(Per person) $ AU OVw`!ED )t AUTOSICHEQUIED ( BODILY INJURY(Per a AIm) $ [JAUTOS AUTOS X HIRED AUTOS X AUTOS�JED i # �O_Ff_ttiDAMAGE $ IDC UMBRELLA LIAROCCUR EACHOCCURRENCE $ i EXCESS Lute CLAIMS-MADE ) AGGREGATE $ ?DED I I RETENTION$ $ WOR ERS COMPENSATION PER OTH- ANDEMPLOYERS'LIAMUTY YIN STATUTE ER _ ANYPROPRIETORlPARTNER/E%ECLRIVE ELEACHACCIDENT $ OFRCERNEMBER EXCLUDED? ❑NIA (M.Ma"in NH) I I I D . ISEASE-EA EMPLOYE $ bentl ity;descriuer — '- DESCRIPTIONOFOPERATIONS WM -E IE.L.DISEASE-POLICYLIMIT $ I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORDIOI,Addntonsl Rem,ks Schedule,mybeaaacbedifmorespace is regWrM} 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. Attn: Building Department AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD OOict otConsomer Altaira @c Business Rtgoia8oa Massachusetts Department of Public Safety -..°J3E IMPROVEMENT CONTRACTOR Board of Building Rea I tions and Standards + agistraNtlb, 1 40t4 Typa: License:CSFA-046604 �EW171 itis: 97!2016 -DBA €:'€c 1 _ ' _v _ _ ., DAVID GRAHAM Ott'Tek Or;1!TING DAVID M GRAHAM 66 FEDERAL STREET \ DAVID GRAfJAM NEWBURYPORT MA 6po 66 FEDERAL ST NEWBURYPORT,t�j#A 61950 r cr,sary � ZZW CA— Expiratlon_ -- Commissioner 00/0212017