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HomeMy WebLinkAboutBuilding Permit # 2/2/2017 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: i Date Received 411 t Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION �.. PEnt PROPERTY OWNER 1'rmt 490D Year Old Structure yes MAP NO PARCEI_:�ZONING DISTR[CT �� Historic Dlstrlct yos Mach�re op,:. illage yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial 'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well Flabdplain, ❑1Netlarids ❑ .Watershed Disfrlct ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: s. b Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: v = c� . . s CONTRAC°T4R Name. . � . . Phone Address r 5upervlsor;s Construction License r . ,_ Exp Date. _ Howie Improvement License. T Exp Date: 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: $ L< 06a3 - FEE: To r Check No.: CA-5SReceipt No.: " NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5lgnafure of AgetC4wner Signature of contractor .. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stam wd Plans ❑ ta®RTH own of :, Andover O 0 No. � �� ._ _ L�KR h ver, Mass, 092 0p/ Co[7f[nRwK[ 1' U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......4r..r:.P.s s9........C%01,Ali ' �4h1/ G r0ss10 BUILDING INSPECTOR has permission to erect .......................... buildings on .....1�.'..�.,`'......� AWf., t+„ �L....... Foundation Rough to be occupied as .......4 4-C.*Y........ .M.!�!.� �.. . ...... .....rr.�.N! /1".!�..•t.......,. chimney provided that the person accepting this permit shall in every respect conf m to the terms of the applicationFinal 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:.. UNLESSCONSTRUCTI STAR Rough Service ......... .. ...... .. ................ BUILDING INSPECTOR.. Final GAS INSPECTOR Occupancy Permit Re uired to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Grasso Construction Co,, Inc. General Contractors-Develoj2ers 865 Turnpike Street (Rte.114) North Andover, MA 01845 Tel (978) 688-8895 Fax (478) 685-0049 January 30,2017 Paul Pollano 202 Marbleridge Road No. Andover, MA 01845 PROPOSAL We propose to furnish Labor& Material at above address to include the following 1. Remove existing kitchen cabinets 2. Install new kitchen cabinets (labor orily—cabinets by owner) 3. Cut door opening from kitchen to dining room 4. Refinish hardwood floors 5. Paint walls & trim Total Labor & Material $15,000.00 Note: Kitchen plumbing fixtures and appliances by owner GRASSO CONSTRUCTION CO., INC. ed by: John ss Po an President Date: --L/13) 117 JG:sg a i i I ® DATE(MMIDDIYYYY) ACoR® CERTIFICATE OF LIABILITY INSURANCE 02/01/2017 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 CONTACT plane KUlick NAME: HUB INTERNATIONAL NEW ENGLAND LLC PHONE (781)792-3238 NC Nu): E-M ADDAIL RESS: diane.kulick@hubinternational.com 600 LONGWATER DRIVE INSURERS AFFORDING COVERAGE NAIL it NORWELL MA 02061 INSURER A: LM INS CORP 33500 INSURED ^.— INSURER B: GRASSO CONSTRUCTION CO INC INSURERC: INSURER D 865 TURNPIKE ST INSURERE: NORTH ANDOVER MA 01845 INsuRER P: .COVERAGES CERTIFICATE NUMBER: 123564 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. €NSR ADDL SUER POLICY EFF POLICY ERP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER IMMIDDNMI IMMIDDIYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMA NTED .- CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) S N/A - PERSONAL&ADV INJURY $ rEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY[7]jE 0 C]LOC PRODUCTS-COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY Ea accideDIS4NGLE L€MIT $ ANY AUTO BODILY INJURY{Per person) S ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accldenl $ UMBRELLA LIAR OCCUR EACHOCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A - AGGREGATE $ DED RETENTION$ $ 10 WORKERS COMPENSATION /� STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? NIA NIA NIA WC531S382148016 09/30/2016 09/30/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY L€MIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more apace 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 too[at www.mess.govllwdlworkers-compensationlinvesligationsl. 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, 120 Main St AUTHORIZED REPRESENTATIVE No Andover MA 01845 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1968-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Z Department oflndustrialAccidents _ n 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia ` Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WIIM THE PERMITTING AUTHORITY. Applicant Information Please Print Le0b Name(Business/Organization/Individual): '1 cJ9 C Address: 91V PJ AJO , f /✓D "� City/State/Zip: D )1 0 �l one#: 7r 6 Are you an employer?Check#lie appropriate box: Type of project(y equired): 1.61 am a employer-with ._employees(£utl and/oz part-time).* 7. ❑New construction 2Q I am a sole proprietor or partnership and have no ernployees working for me in $. Remodeling any capacity.[No workers'comp.insurance squired.] 9. El Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 1.0 ❑Building addition 4.❑lam a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I bave hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have Workers'comp.insruance.$ ❑ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL G. 14.❑Other 152,§1(4),and we have nQ employees.[No workers'comp.insurance required.] 'Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information. Homeowners who subarii#this affidavit indicating they are doing all work and then hire cutside eontractbrs must submit a now 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-cWract6rs have employees,lliey must provide their workers'comp.policy number. fain an employer that is providing workers'compensation insurance formy employees.'BeNv is the policy and job site information. Insurance Company Name: K U'1 Policy#or Self-ins.Lie.##: G "' "3 hS — 'e,2).-Q Expiration Date: �� 1 Job Site Address: f l%Xn� R 1 L,&-e at�, City/State/zip: /1 nY a 019, Attach a copy of theworkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGI,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 WORD 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. Ido hereby certify u er the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permita icense# Issuing Authority(circle one). 1.Board of health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 1/31/2017 22:23 FAX 978 685 0049 GRASSO CONST Q001 Massachusetts Department of Public Safety Board of Building Regulations and Standards License. C"22988 Construction Supervisor r JOHN GRASSO 965 TURNPIKE STR NORTH ANDOVER CA— Expiration: Commissioner 1013112017 01TIC00tConsumer Afrairs&Business RegqI(LtI4)n OME IMPROVEMENT CONTRACTOR 09IStrBti0n-' . 113130 Type. Expiration: 5/18/2017 Private Cwporatior GRASSO CONSTRUCTION CO.,INC. JOHN GRASSO 865 TURNPIKE ST N.ANDOVER,MA 01845 Undcrsecretary