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HomeMy WebLinkAboutBuilding Permit # 12/22/2016 BUILDING I TOWN OF NORTH ANDOVER Permit NO� ed Date Receiv _.� ,. Pt y J t: s» t� ill rrem s o i i rnye777777711�- r/. rii r�lji j //�i%�Jf'�''/.' fy .% iG*',F/ l� w it rl: 'rJ ;u� N' G^�' mirrryw r, ✓«mn n ry+ , n•;� //�/� � 0 r/ r/i �% r�Ali/�/✓�r//%�ri r/ �/ / / {� i � ,. u' im ,/,;�a,/..✓.'r,r/�/�//i�/,.�vrr/,��'j✓�ii��:�%lw,/G/l�//r/ �, Of L� % 2, ' �j �..�,...�..,.,,,,�,...J,....,.�.._._. PROPOSED _ ate a�r�enfial on r side nta�rl _ .._ __... _. ..,._ _,,. _ New Buidng One family Addition Two of cri re farnil'y, lndustrl l Alteration No. of unites _._ t on)r ercial Repair, replacement Ase ov)f Md �.�.��.__ � � tears: Dernolition Other W/2/' y Idend ficathm tyle ase type or Print Clearly) ) ZI �... . '... .� . ...._.. .� _..,. ..��. Phone: .. Address: 77" '7' -7, f roy Nrt1✓7, e- r/r/r rr//✓ �!rl il/ r /,/r/ / r r --, 1 r / 1 N ;, � ARCHITECI FL-az SCF,EDULErULDI G PERMIT,$12.00 PFR$1000.00 Off"'THE TO A L ESTIMATED COSTBASED,ON$125.00 PER S� . 'Total Project Cost, ,. R .. Check No.:. ._. �"' .� ._.�.wm.. �..�_ Receipt No.: ` ,, . eek','V0Jr.a Crontractingwith r r° r;° rvr^ed contructors rfc not rr access r)the guaran(yfimd va,of IAORTH awn of ndover . No. p : ��%� h ver, Mass 'QA COCNC nE wCu y�' ArIE S U BOARD OF HEALTH Food/Kitchen PERMI LD Septic System Q1eS t It 4THIS CERTIFIES THAT 1�� �r1 ! Irl,,,,,,,, , BUDDING INSPECTOR 7.1. ,.., . . .. . .. Foundation has permission to erect...... ................... uildin s on5 . .., +...,..,,.,,.,., . .... �, ... .,., Rough t0 be occupied a ........... .. .....bctwt .. .. Chimney provided that the person accep this permit shalt in every respect conform to the terms of the applicatior 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 CONSTDMION Rough Service ... .. . .. ... Final BUILDING 1N T GAS INSPECTOR Occu anc Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. pProq,,,,�,gjs Sweet Contracting Corp. dba AND ESTIMATE 5, �� Bill Sweet ChimneySwee eart� PROPOSAL SUBMITTED TO: DATE: ,M_ Wayne Neem! 12/12/15 STREET PHONE 275 Abbott St. 61 7-680-9494 hdA CSL:#106967 CITY,STATE,ZIP CODE PHONE 'MA H[C:#1z5338 North Andover, A 01645 Q.O.Box 253 Swampscott,MA 01907 EMAIL 617.469.4528 or 80o.W 49oo waynelnlem! rubywines-com 781.595.1110 fax - Pull a building permit with the town of North Andover. * Seal the gaps between the stainless steel liner,the fireplace flue and the smoke chamber. TOTAL(includes labor, materials, waste removal and cleanup): $2,500.00 Coast for rmit time to ac dire Permit and final insipection of work with the building ins ctor added to the final pigyment. See payment schedule below Billy Sweet Chimney Sweep guarantees all labor and installations for one year. If we come back each year to do a sweep and inspection of the chimney, the material warranty and the company guarantee stays intact. Take advantage of bur annual 20% Spring Discount for inspecting and sweeping your chimneys during the months of February and'March. The first annual sweep and inspection Is free, if done during the months of February and March 2017, The National Fire Protection Association, the Chimney Safety Institute of America, the U.S. Consumer Product Safety Commission, the U.S. Environmental Protection Association and the American lung Association recommend annual inspections of your heating system chimneys, flues and fireplaces. WE PROPOSE hereby to furnish materials and labor-complete in accordance with above specifications,for the sum of: *****a*****+r v **Two thousand five hundred and 001100'k'k*k*"********* Dollars 2,500.00 113 de osit in advance — PAYMENT TO BE MApE AS FOLLOWS p _ ce ($830.00), 113 payment ;�t the stark of work ($830.00), balance due when the work is complete plus permit cost ($840.00 - $200.00= $1,040.00). Advance de sits are iron-refundable In case of cancellation h customer. All material is guaranteed to be as specified. All work is to be completed in a substantial workman- like manner according to specifications submitted,per standard practices. Any alteration or Authorized / deviation from above specifications involving extra costs will be executed only upon written orders, u nature and vole become extra charge aver and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. owner to tarty fire,tomado and other necessary Rote; his proposal may be ? insurance. withdrawn by us if not ccepted within 30 5. ACCEPTANCE OF PROPOSAL: The above prices, spaa-ficatlons and conditions are satislactary and ane h4eby accepted. You are authorized to do the work as Signaturc, specified. faymentWilbemade asoutiinedabove. Signature: Date of Aeoeptanee: r�- i i C:\DocslCustomer Reports 20161n-plNiemi 275 Abbott St Chimney Proposal 161212.docx The Cornmortwealtli of Ajassaclittsetts Department of IInrlttstrial Aecitle►rts Of of Investigations a 600 Wa.slHugton Street Basion,MA 021.11 www.mass.gov/lin Workers' Compensation Insurance Affidavit: Builds;rs/Contractors/E lcctricians/Pl>i mbelrs Applicant Inlormationl Please Print Legibly Name (Bttsiness/Organizationilndividual): R, /t/ .71?cilr[ City/Stant/Zip: ��1_. aPhone#; 3 3 Are you an employer?Check the appropriate box: Type of project(required); t z I aryl a employer with._&) 4. ❑ I aryl a general cuntractor and t 5 ❑ New construction employees(full andlor part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t T ❑ Remodeling ship and have no employees These sub-contractors have & ❑ Demolition working for tree in any capacity, workers' cornp. insurance. R. ❑ Building addition (No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10•❑ Electrical rViflrs or additions 3.❑ I am a homeowner doing;all work right of exemption per MGI. 1 I.[] Plumbing rcpuirs or additions myself. (No workers' comp. c. 152, §1(4);and we have no I2.❑ f insurance required.]t employees. ITfo wRoorepairs -workers' oo COMP_ insurance required.] — *Any applicant[liar checks box 111 must also till aul the section below showing their workers'em»ponsation polir:y informhlion. t l onteorvners who submit this affidavit indicating they are doing all work and then]tire outside aanlraetots must submil it new atridavit indicating such. tCoalractors that cheek this box must attached an additional 51wo showing the name ot'lhe sub-contracltm and their worker,'comp.policy information, I ant art employer titai is pro Piding workers'compensu don Insurance for my employees. Below is the polkV and job site rttfartnation. Insiminee Company Name: Policy#or Self-ins. Lie.#: G[� ( ' � ®�� Expiration Date. Job Site Address: citylstatc/ziP __ _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), ©r 7.5 � ('allure to secure coverage as required under Section 25A of MGL,c. 152 can lead to the imposition of criminal penalties of 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. 13e,advised that a copy of this statement inay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I rto hereby certify under lite pains and penalizes of perjuty that the inf motion provided above is tare and correct. 5j"n tore: [date_ C� Phone U: Official ase only. Do not write in this area, to be completed by cite or town offleltd. City or Town: Permit/Lieense# Issuing Authority(circle one): _ I. Board of Health 2. Building Department 3, City/'Town Clerk 4. Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#3: DATE(MMIDDNYYYI AC"RV CERTIFICATE OF LIABILITY INSURANCE 12/2212016 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 13Y 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 have ADDITIONAL INSURED provisions or 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 NONT�ACT HeatherATenney Thomas St Jean Insurance PHONE 978 531-8053 FAX 978 531-8653 484 LaWnII St No Extl: fAIC,No): Suite 1-C ADODRESS, heather@stjeaninsurance.com Peabody,MA 01960 INSURERLS)AFFORDING COVERAGE NAIC# INSURER A: ATLANTIC CASUALTY INS CO 42846 INSURED Sweet Contracting Corpdba BillySweet ChimneySwa INSURER B: CHARTER OAK FIRE INSURANCE CO 25615 P0Box 287 INSURER C: NAUTILUS INSURANCE COMPANY 17370 Swampscott,MA 01907 INSURER❑ 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR Y EXP TYPE OF INSURANCE Almqrl UmL SUER POLICY NUMBER MM!�tYYYY POLICY EFF POLnD1YYYY LIMITS A COMMERCIAL ENERALLFABILITY MPOO20000500177 04/12/2016 0411212017 EACH OCCURRENCE $ 11000.000 DAMAGE TO RENTED 50,000 CLANS-MADE F,21OCCUR PREMISES Ea accurrence S MED EkP{Any ane person $ 5,000 PERSONAL&ADV NILRY $ 1,0w,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 171 PRO- LOC PROR I-S-COMPIOPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BA7167M153 11/30/2016 11/30/2017 COMBINED SINGLE LNIC $ 106D0p0 Ee accident ANY AUTO BODILY IN,AIRY(Per person) S OWNED / SCHEDULED BODILY IN.UJRY(Per accident) $ AUTOS ONLY V AUTOS / HIRED / NON-OWNED PROPERTY DAMAGE S V AUTOS ONLYV AUTOS ONLY Per aocldent UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAW"ADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EM PLOYERS'LIABILITY PER ER ANY PROPRETORIPARTNENENECUTNE YIN NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER E)CLUDED7 {Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ it yes,describe under IDE SCRPTON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C CPLO40000906-POLLUTION 04112/2096 04/12/2017 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tawe Of Andovar ACCORDANCE WITH THE POLICY PROVISIONS, 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©9988-2015 ACORD CORPORATION. A I rights reserved. p ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 3 i i i DATE(MMIDDr YYY) A Ro CERTIFICATE OF LIABILITY INSURANCE 12122/2016 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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: Thomas St Jean THOMAS ST JEAN INSURANCE PHONE 978 531-8053 AJC No: ADDR ESS: tstjean@stjeaninsurance.com ADDR 484 Lowell St. Ste 1-C INSURERS AFFORDING COVERAGE NAIC 71 PEABODY MA 01960 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B; SWEPT CONTRACTING CORP INSURERC: DBA BILLY SWEET CHIMNEY SWEEP INSURER D: PO BOX 287 INSURER E: SWAMPSCOTT MA 01907 INSURER F: COVERAGES CERTIFICATE NUMBER: 113171 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMID©Y ENYYYJ FF MMIDD CY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDA AGE TO $ CLAIMS-MADE FlOCCUR PREM SES EaEoccurrence) $ MED EXP(Anyone person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO ❑ LOG PRODUCTS-COMPIOPAGG $ JECT OTHER: $ AUTOMOBILEI_IABILITY COMBINEDSINGLELIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I STATUTE ERH AND EMPLOYERS'LIABILITY ANYPRE OPRIETORIPARTNRiFXECUTIVE Y f N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? NIA NIA NIA WC231S351551036 05/07/2016 05/07/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 it yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) Workers`Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(Unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www,mass.gov/lwd/workers-compensation/irtvestigationst. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS, 120 Main St AUTHORIZED REPRESENTATIVE D" North Andover MA 01845 ��9 Daniel M.CrO,rn{ y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD C�ot��triicti�n 5uperui:��r Pestricted to: UOesidvtod w Bulldhigs of onyx uiso g!,oup whicli eontnin lass t€ran 35,000 CUblC klet(901 cubic:•rt el rq)of it a��irtrs��it D Ppar�i�ei�C of�'u b9lt,St�lcsty onclosod�par;r�, frd cif f,,utIdlrz5 i F talnttOns and tmhd�rdo i lr two; ,8-9613 y , 4�NEW OPE AN STi, F'. tarp to ctrrieri[etli€ion of ii��149c3i4� EY3 Stag oviiding Code is caust to revoeasid€r of 011;i#r,,e"ge. DPS Licert log 101*r oQ7on visK: WYM-V AM,�CiVli PS ExplrMIQw Of-floe 4)f CansliM k Affillrl m u 1Fl s's RoPladon ston,M "vacli ett 021.1 5 ' ' d `Vpaa DDA P-xpirmjb:i; 1112AI2117 Tr# 27M1 BILLY SWEET CHIMNEY SWEEP WILLIAM SWEET po Box 287 AMPSCO , MA 0,1907 Viper Adt:s s and vmum q.Ard,'Mark mmon!fir donge. p�� j add-eds omycl.t [11 ftployMrt I tt iir;tl Mar OCooumr Afti s�ua�`rs l uiAllare Uter.sn 6I`miltstlmbil"Ild ftr iDdIvidal uto rr�iy F' #kl ill d P�Ri>T MMOM i e yr Hite i= it ll d e3 t2, i tduizd d`tUrri totRgltzm lom' 1P61�3 Type; Offla or Nmuwtr Affhlrqaild u,�ie� as ga i 4i n Is tiu t , aft Park Pim-�ziitu x'170 {''rlr;" SILLY svisgrr Ghlwtil up;?;. WILUAM SVIfE)MT ;fF7 r,j iia NEW 4}ta`SAN S'i'E CM» '';,f SWAMi`SCOTi',MA0190T��:`;.. --�ei��reiae� ��. NotVAtidmillru9siguotam� j Y Z.. � y