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HomeMy WebLinkAboutBuilding Permit # 11/21/2016 tkORT BUILDING PERMIT 0. TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Kermit No#: -;0-c''i Date Received ... I 9 �4y°aA 4 Date Issued: .I1W11"(J KfAl' T: �pplicant must complete all items on this'page O-ATI ON Win„ PROPERTY OWNER Print Print/ 1010 Year Structure , yes C2) MAF? -- PARCEL ZONING DISTRICT —=His taric District„ yes ' Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential _.._.----ential Non- Residential ---------- 0 New Building ❑ One family 0 Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ------------ mRepair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain 11 Wetlands ❑ Watershed District LI Water/Sewer -- DESCRIPTION OF WORK TO BE PERF R MEQ .. Identification OWNER: (Name: �. �t'e or Clearly _ Phone;� . ,, - 'lease T p'r'int Clear°l f F04, Address: �� ' i° r��mm. µ Contractor Name 'Y Phone; Address; �m µcc) y "� or's Co strr'ction';License. �� � Ex Date: Suprerv�s r, n _ �.:.... � p -' Home Improvement License Exp-ppateM ARCHITECT/ENGINEER Phone: Address- Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. notal Project Cost: $ � FEE: $ Check No.: Receipt No,,: 3 i NOTE: Persons contracting wit/i unregistered contractors civ not have:access to the guc army. ind Signature of Agent/Owner _ Signature of contractor , v ........... 1-.......... ................ ................................­­....................... ............. ............................ T tAORTH own o Andover 0 fi& A "k No. 1� : �_ 546h ver Mass, d? 0' rED 0r L) BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....r!"ATTA&IJ...&AW1191pek............I.... leev.... BUILDING INSPECTOR has permission to erect.......................... buildings on ....14.....S.r.#*.;.v. .........P ................. Foundation Rough to be occupied as ......... .........011 . .........V......V10Y.49WA....... 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 CONSTRUCTION STARTS Rough Service .................................................................. Final BUILDING INSPECTOR I GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Garabedian Home Improvement Invoice 11 Matthew Dr Date Invoice# Salem, NH 03079 Phone# 8/28/2016 818 603-235-4005 Bill To LISA BERRY 16 STACY DR N.ANDOVER,MA 01845 Terms Project Quantity Description Rate Amount X DATE: x DATE: I PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR-COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS. Total $4,308.00 Page 2 ne Commonwealth of Massachusetts _ Department of IndustrialAccideSts r X Congress Street, Suite 100 02.1,X4 2,017 Boston,MA www.n2assgov/dia U, actors/B Wgvkers' compensation Insa•anedAi id��Br, uilde���TG AY3TSTC+ItII��e%cia�sfE'�nxnbers. TO BlLla17 WITS S,lease 1r'riut Legibly '`liCant fu formation Na]72f;(Business/CJxgariizationllndividual) �"fit' Address; hone 4. City/S�ate�Zxp. .__ =�——� .---- =—{:;r— Type og project(Jrequ•red.); .reyou an employer?Gr1.ecTc the appropriate box: 1.Lj i am a employer wifh__�___--.eXnplayees(fuIl andlor Part-time).* 7. ��NbVd6xzstriio .On warlang far me irx 8. 2. i am a sole proprietor ar partnership and haveno employees }t.elnOdehug any capacity.[Nowarke 'rcrop.insurance required.] 9, l_1 ..)emolition 3.Ej i am a homeowner doing allwork myself.[No workers'comp.insurance required•] 10 r—I.�t��ji hiring contractors to conduct all work on my property. i ding atiditioA 4.L�i am a homeowner and will be hwlll I 1 l,l.�Electrical rep,4ixs or•additic�irs have worccrscopensatin rrsruance or are sola ensurethat an contracts either or additions � S proprietors withno en[ oyees, 5.�i am a general cantracfaz and i have hired the sub-canfracfors listed oil-the attached sheet. 13'.rl i.ero£xepairs <.;-. These sub-contraatars have employees and have workers'camp.insurance. 1�.,n Other 6, We are a cozporati ol.and its.ottcers have r tercised their right of"exempfiorx per MGT G. 152,§l(4),and'we have no employees.[No workers'comp.instivance required.] *AnY applicant float cheeks 6ak4l davit indicating gthoy are doingout the section lall work andthen hire aufsiderkers'cocow showing their worontract 4s mustubmit a new*aftidav tindieatiz�g such, Homeowners who submii•this off, . Confraafors that check this tion crust at additional sheet showing the name of the sub-contractors and state whether or not fhose entities have employees. if tho sub-aonixacfozs have raploycos,they mast provide their workers'comp.policy nunihcr. loyer�that is pr�ovidingwar'lcers'compensation insur�ancefor°my en2ployees. Below is t/ie policy and)0h site f am an em p information. Insurance ComparayName: — Expiration)Date'._______ Policy l#or Self-ins.Lic, Tob Site Address:_ __ -- —_ _ _ _ _ City/State/7ip: ­ -�. Attach a.COPY a:f-thevwgx°l�ers' Compensation policy declaration ps a age trrrS IOv violation punishablebya Policy ��upfa$_1 5Qb 00 Failure to secure coverage as required under MGL o. :152,§25A r and/or one impz'isoxlrnent,as-well as civil pettaltie aybD foxrwaxded to the Otlie form of a STOP ceof vORKfJlr'DBarts of the 777A faxirrsuranc0 a day against the violator.A copy of this statement M vexii.-rverification, _.--- _ .—coverage da l2erelcertify undcrr tlaepains andpenalties of perjury tl2at the inforrnatian pr�oidded above is true and correct; Date: Si nat<rxe w. ------ —�—=- f Official use only. Do not-Evr°ite in 112x.5'area,to.fie coml.7leted by city or tatvn actaC. f • Permit/License _ �_----------_ City or TO-n. :[suing A.uthorlty(circle One): ' -1.Board Of ealth 2.13rxildingl)epartrneut 3.Cityjrovwtr Clerk 4.l;lectri,cal Inspector 5.Pluxxrhinglnsl3eCtor 6.Other Phone ConlactPerson:_. CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDlYYYY) 11/3/2016 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(les) 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 CONT CT Barbara Souza, ACSR, .AAI __... FIAI/Cross Insurance PHONE E (603)669-3218 FAX Nol. (603)645-4331 (AIC- 01100 Elm Street E-M ADAILDRESS: � y'bsouza@crossa enc com INSURERS AFFORDING COVERAGE MAIC# Manchester NH 03101 INSURER A:Technbl Ins. Co. 42376 INSURED INSURER 13: Matthew J. Garabedian, DBA: Garabedian Home INSURERC: 11 Matthew Street INSURERD: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER CL1621163448 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 - ADDL SUER POLICY EFF POL TYPE OF INSURANCE ICY EXP W LTR POLICY NUMBER MMIDDfYYYY MMIDDfYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,00D,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X❑OCCUR PREMISES(Ea occurrences $ TPP1065426-17 2/8/2016 2/8/2017 MED EXP(Any one person) $ 5 r 000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D JECT PRO F-1 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 _ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S �- ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PROPERTY OacEctRde DAMAGE HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDRETENTION$ $ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY YIN „STATUTE ER ANY PROPRIETORIPARTNERIEXE=CUTIVE ❑ E.L.EACH ACC$DENT $ OFRCERIMEMBER EXCLUDED? N/A ° (Mandatory In NH) E.L.O$SEASE-EA EMPLOYE $ If yes,describe undea DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedula,may be attached If more space is required) Re: Lisa Berry 16 Stacy Drive Andover, MA. Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCELLATION phutchins@northandoverma.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover, MA THE EXPIRATION DATE 'THEREOF, NOTICE WILL. BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. N. Andover, MA 01845 AUTHORIZED REPRESENTATIVE B Souza, ACSR, AAT/BS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 ranunli i .,�--..n�•.,, a\..OEficc of Consumer Affairs&Business Reguiution „a =(GNOME IMPROVEMENT COIVTRACTTy e. `n C Registration: 157753 oBA Expiration: 11!2!2417 GARABEDIAN HOME IMPROVEMENT I MATTHEW GARA13EDIAN 11 MATTHEW DR. [Tndcrsecretary SALEM,NH 43479 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-091797 Construction Supervisor MATTHEW J GARABEDIAN 11 MATTHEW DR SALEM NH 03079 b, Expiration: Commissioner 03/26/2018