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Home My WebLink AboutBuilding Permit # 8/4/2016 yg ��{p Sao RTh BUILDING PERMIT ®�gYLEP TOWN OF (NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION P� mut�o : Date Received s�CHU ' Date Issued: PORTANT Apphcant must complete all items on this page `�. r � � ��-. ��.?'r��Pf �.��°/h^c^-`' " c w�J��✓✓s °� � z C _,"✓� �y'� _ y�✓ ,��'e �k f t e ., M �. °� ,.:�''a rx,•.�, a.L-; �'.rte�' G'. - ��.F"� ' � .5 f r�o� RP PARCEL ZONINGS®ISTRI'CT F H�star�c Des#rictf y `�'I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building cd-One family ❑Addition ❑ Two or more family ❑ Industrial ,O-Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Sept�e ❑We11 �FOgloorlpla�n ❑Wetlands � �111atershedl7st �ct DESCRIPTION( OF((YORK TO BE PERFORMED: Identification.- Please Type or Print Clearly OWNER: Name: �:v� �'° � � 3 Phone: " Address: •a � 'C-C.a._ � _ N• 3 �. a��t" n-- Contractor Name Erna11 rIJ - � pss A. . � F F w W li t,<r ' - �� -xl ted✓kms` A�r'�k, �Lx�x✓r r Supervisor s��onstruct�on License E Da r ARCHITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.'$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Coit: _'1 191- � —FEE: Check No.: � � � -__Receipt No,: N®TE: e� � � e®nf�c�cti�ag rvah uc� fc�e� ® crct��d®�e�tthe � c��atyfundIgriat �� pf AgenlOrltilner Slgrture of_carifr. „ � t%ORT .q s a Town of ®ver An J No. . ��K� h ver, Mass, Z4 C OCMICf 1WICK l 4OOA r€� A ,�5 $ U BOARD OF HEALTH Food/Kitchen IJEKMIT T LD Septic System THIS CERTIFIES THAT ....... AV.CJE........ .......................... BUILDING INSPECTOR �j''�' Foundation has permission to erect .......................... buildin19rAgs on .......,..0, ......JVhV7XA.....,`j./"' .,......... Rough tobe occupied as .,,. � ... ..... AVF......................................................................... Chimney provided that the person accepting his 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 �a EXPIRESMONTHS ELECTRICAL INSPECTOR UNLESSC ST A Rough Service . . ... . ... ....... "' Final BUILDING IN CT GAS INSPECTOR OccupancyRequired u cZZ d.�l�L�l�2g Rough Permit lie ui�e� �® � _ .Y ,.,.,.,,... 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 wilding Inspector. Burner Street No. Smoke Flet. PROPOSAL/ESTI MATE 174 Main St,North Reading,MA,01864 e ,. 781-321-1991 Claudio Araujo—License CS 105185 1f V`I ''A T E � 1 -I L L www,winterhillgc.com �;r raFrenr, r..ClrlI RAC rctirz. ir-ar 131tUCESIIAINWALI Email: lo: —Orsf• T5'kAil,iV\W1.r, ! �� r.AM,Ei: The Commonwealth oflMlassachusetts Department of IndustrialAccidents Ofj rte of Investigations - 600 Washington Street r Boston,MA. 02111 lvfvfv.rnass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/E lectricians/Plumbers Applicant In,fnrmation Please Print Le iby Name (Business/Organization/Individual): J ✓�''T� 1 �— .- Address: City/State/Zip: r 16 Phone #: Ai you an employer?Check the appropriate box: Type of project(regnired): a employer with—:5L— 4. D I am a general contractor and I employees(fitll and/or part-time).` have hired the sub-contractors 6. 0 New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity, employees and have workers' Buildin addition [No workers' comp, insurance comp• insurance.l Building addition 5. We are a corporation and its 10.0 Electrical repairs or additions 3,0 I atn a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0,Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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 ofthe 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. ,l rrni ara errtployer•that is providing►vorlrers'conipensaflori insurance for•my employees. Below is the policy and job site information. Insurance Company Name: S .� Policy#or Self-iris,Lie.#: WC- 2c7. 2.c7 VPO,-3 I u _ t7�j Expiration Date: l 1 �� 14— Job Site Address: City/State/.Zip: Il ("fiA t .X Attach a copy of the workers' compensatiion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c. I52 can lead to the imposition of criminal penalties of a fine rip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eertif taniYeer tthee pp a_ins and peaaalties ofperjiny that the infor,wation provided above is tj•ne and col'l'ect. Date: Phone#: 7 I I Official Erse only. Do not write in this area,to he completed by elty or town official: City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.10nilding Department 3. City/Torun Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone# WINTE-2 OP ID: JJ 1R0 FUATE(MMlUDIYYYY) `,.,� CERTIFICATE OF LIABILITY INSURANCE (MMi2016 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 io 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 NAMEACT Crown Insurance Agency, Inc. Y Brads S.Michals Insurance PHONE -- -- ' -_ -- .—..,....__ -.__._........ FAX__.. _._,-__........_, Agency,Inc. AI�N�Ext;t117-8241100 AIC tt, 617-926-2 162 85 Main Street E-MAIL - _.— —. -- Watertown,MA 02472 ADDRESS:. Crown Insurance Agency,Inc. INSURER(S)AFFORDING COVERAGE NAIC a INSURERA:Acadia Insurance Company INSURED Winter Hill General Contractor _.. ... -._._..... INSURER B:Northland Insurance Claudio Mcuhna Araujo __._--_---- --- _- 170 Main St INSURER C:Arbella Insurance Co. 1-7. North Reading, MA 01864 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI IF 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 POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN5R B POLICY EFF POLICY AXP---- -.-._......_.. .-..................---...._ LTR TYPE OF INSURANCE INSO IWvD POLICY NUMBER MM1DDlYYYYL MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 - CLAIMS-MADE [_X]OCCUR W5274235 0211312016 02/13/2017 DAMNOE'TO'RENTrDPRrMISES(Ea�ccurr�nce)_-_ _ 1()0,00 MED EXP(Any one person) PERSONAL BADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGRLUA LE $ 2,000,00 X POLICY El PRO U LOC PRODUCTS-COMPIOP AGG..... ....-._.....-....2,0,00,0.-. ttO- U, O OTHER. $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY eccidonlZ - $ 1'0 0, 0 C _ ANY AUTO 1020001551 04109/2016 04/0912017 BODILY INJURY(Pe(pei San) $ ALL OWNED �( SCHEDULED BODkLY INJURY(Per acct'_..... ._.....__.___.,_._._....-................. AUTOS ACUIOS den!) S X HIRED AUTOS X ANO OWNED j ROPiRTeY[ )AMf1Gl= $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 9 EXCESS LIAB CLAIMS-MADE AGGRFGATF. $ DED RETENTION$ $ WORKERS COMPENSATION X PEROTfT- AND EMPLOYERS'LIAWLny A ANY PROPRIETORIPARTNERIEXEC UTkVE Y�N 1 A WC-20-20-003174-03 03/26/2016 03/2612017 F.L.EACH ACCIDENT $ OFFICERIMEWHER EXCLUDED? - -- (Mandatary in NH) E.L.DISEASE-EA EMPLOYE $ 500'00U It yes,descriN under - .----. —_. 0 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT' $ 500,0() DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space is required) operations of The Named Insured CERTIFICATE HOLDER CANCELLATION XXXXX ti SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE OR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY r FOR BIDDING ONLY FOR BIDDIN (01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -M" �� rpdrrearr4rrrnnall/a��'�a.��tc�rr,nlls t -office of C.onsu Ener Affairs.&Business gegulatinn — 4~ n —1 OClIE IMPROVEMENT CONTRACTOR a Massachusetts -Department of Public Safety registration: 168583 TY Board of Buitding Regulations and Standards Cor oration r____ .•_-_ I Expiration 3/812017 P .'on�`uu:dr,r, ,�.��c,L. .�, y I License: CS-1fl5185 WINTER HILL GENERAL CONTRACTOR, INC.-. i .. Claudio M Araujo�- OLAUDIO ARAL) 163Hancack Streirt-N� 170 MAIN ST �� — Fverett MA 0214 NORTH READING,MA 0.1889 .Undersecretary:. �. ✓' � �Ex irati 07I1312017 Commissioner Y i i i