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HomeMy WebLinkAboutBuilding Permit #329-15 - 15 COLONIAL AVENUE 10/1/2014 BUILDING PERMIT "°oT"qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONto Permit No#: 3 Z 1 r( Date Received �SSAC HUS��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION f J C D La .,,r,4 L- A v� Print PROPERTY OWNER t2�A► CQ�`, Print 100 Year Structure yes no MAP/07Z PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Ane family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name:_ �,.eA c._o z Phone: R 1 .2 c;-7 5 283 Address: 1 .5 C q, ' U /L-'oi ti• Y'� 0,7, � Contractor Name: ,bv`a b w'yPhone: -7 R S•3 ( 2 3 ,�:t Address: D-3 f:zl wc.-y t ��c S c Fr,-4 Y A-" Supervisor's Construction License: `7 '-4 - 3 Exp. Date: .5---t 1 I L Home Improvement License: f 00 & t t Exp. Date: - =Z 3- Ito 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. I� Total Project Cost: $ c?� FEE: $ ) Check No.: 1�r /�3 Receipt No.: V Cl NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ownerm _ _ Signature of contra cto Location 145� C4,n, 1 ' rlyr— No. 4M i t Date . - TOWN OF NORTH ANDOVER , • �rpt, • Certificate of Occupancy $ v Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check CIr� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ' Date Time Contact Name --.-._..._._. _----- — --------- - ----- Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH own of E ndover No. 32,1 ".115 - h h ver, Mass, lco> t �. COCMIC"a WIC" y1. 7S u BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT ....... ........ ...... ...................................................... BUILDING INSPECTOR has permission to erect .........................Cuildings on ......... .......00140wA.4na......Atew Foundation . Rough tobe occupied as ... .. ...... ........!r.... . ... .. ...... .. ...... .. ................................................ Chimney provided that the person accep g this permit shall in every r ect 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 THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough Service ................... .... .... ...... .............. Final BUILDING INSPECTOR 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. The'Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigadons I Congress Street;Suite 100 Boston,MA 02114-2017 www,mass govldia. Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plmbers A licant Information Please Print Lberill6hr Name.(Business/Organization/Individual): L Q.N .�.j. L� r Address: -a--I, t? i.j Ci /State/Zi ^to Phone Are you an employer?Check the appropriate box: . 1. I am a employer with j c�.. _ 4. ❑ I am a general contractor and IType of project(required): employees (full and/or part-time).* have hired 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and haveno employees These:sub-contractors have working for me in any capacity.. employees and have workers' 8' Demolition [No workers' comp. insurance comp. insurance.: 9. ❑Building addition required.) 5. ❑ We area corporation and.its 10.❑Electrical repairs or additions 3.F-1I am a homeowner doing.all work officers have'exercised their 1 I. Plumbing myself ❑ g repairs or additions y [No workers comp. right of`exemption per MGL 12.[]Roof repairs insurance required.] t. c. 152,§1(4),and we have no employees. [No workers' 13.[DOther comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showm�their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractois and state whether or not those entities have. employees. If the sub contractors have employees,they must.provide their workers'comp.policy number. I am an employer that Is providing workers'compensation Insurance for my employees. Below Is the policy and job site information. Insurance Company Name: ty , " f y� �] `7^V.A 4- Policy#or Self-ins. Lic. #: °(/WC 6 O 1 (1 ct'7 4--2C`1t4aExpiration Dater Job Site Address:1L City/State/Zip A •e,t- Q�t/� v Attach a copy of the workers' compensation policy declaration page(showing the policy number,and expiration date). Failure to secure coverage as-required under.Section 25A ofMGL c. 152 can lead to.the ' fine up to$1,500.00 and/or one-year imposition of criminal penalties of a y 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage;verification. Ido hereby certify under the pains and penaides.of perjury that the information provided above is true and correct t lure' Phone#: F6Other use only. Do not write in this area,to be completed by city or town official. Town: Permit/License# r Authority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing In Person: Phone#: DATE(MWDO/YYYY) ACo-ORQ CERTIFICATE OF LIABILITY INSURANCE r02/06/2014 PRODUCER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfiel d, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Len Gibely Contracting Co., Inc. INSURERA: Catlin Specialty Insurance Co 23R Winter Street INSURERS: Safety Indemnity 33618 Peabody, MA 01960 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER LK Y EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE Y DATE MWDD GENERAL LIABILITY 3700302145 01/29/2014 01/29/2015 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea o=unce $ 100,00 CLAIMS MADE a OCCUR MED EXP(Any one person) $ S,00 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PET F LOC AUTOMOBILE LIABILITY 6221693 COM 01 01/29/2014 01/29/2015 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ rXXX SCHEDULED AUTOS (Pere-) BHIREDAUTOSBODILY INJURY $ NON-OWNED AUTOS (per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ S DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTNE(� E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ if yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS roof of insurances. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robert Sennott RP ACORD 25(2009101) 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ate^ A CERTIFICATE OF LIABILITY INSURANCE FX081 1120 YYYY) L---�' � E osro1r201a 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($), 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 01634-001 JACT Edward F Sennott InsuranceNo t; A 16 South Main Street Topsfield,MA 01983 INSURED A.I.M.Mutual Insurance Company 26168 Len Gibely Contracting Company Inc INSURER B 23 Winter Street Rear INSURER C' - Peabody,MA 01960.6941 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 VftCH 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. ITR TYPE OF INSURANCE I & POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERALLIABILnY )0TAi5-VURENi�= $ �CLAIMS-MADE OCCUR MED EXP(Any ons pe,son) E PERSONAL&ADV INJURY S ----•— - . GENERAL AGGREGATE S 3EN'LAGGREGATE LIMIT APPLIES PER:T PRODUCTS-COMPYOPAGO S - )!a,CY O' OC AUTOMOBILE LIABILITY COMBINED SINGLE UMff— ANY AUTO BODILY INJURY(Por person) s ALL OWNER SCHEDULED - AUTOS AUTOS BODILY INJURY(Per accidenq $ HIRED AUTOS NON-0WNED s AUTOS PROPERTY DAMAGE s k ELLA LIA8 OCCUR EACH OCCURRENCES LIAR CLAIMSMADE AGGREGATEs RETENTION 1i s X T AT o A (wino��Py in NH) ECUTIVEr� N r A VWC-100-6010979-2014A 8/3/2014 8/3/2015 E.L.EACH ACCIDENT $ 600,000.00 �(ffManeatorybbinNnMc)1e� uu E.L.DISEASE-EA EMPLOYEE $ T 500,000.00 D6�F (OA�F OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 10I,Additional Remarks Schedule,N mere 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 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD � --f------ LEN GIBELY CONTRACTING CO., INC. Page No. ofPages 25776 PROPOSAL 23R Winter Street m PEABODY, MASSACHUSETTS 01960 All home improvement contractors and subco]ed rs (978)531-8234 Fax(978)531-9304 engaged in home improvement contractingss f specifically exempt from registration by Provof www.lengibelycontracting.com ,\Q � Chapter 142A of the general laws, must be rred l (� VV with the Commonwealth of Massachusetts. ies I 1 submitted 1�n n about registration and statun us should be mathe To: f�l( Director, Home Improvement Contract Region, tbOne Ashburton Place,Room 1301, Boston, 108Cn t Cv `T Ve^ ' (617) 727-8598. Owners who secure thwn N\ {"i�r iconstruction related permits or deal with unrredC-\7 l contractors will be excluded from the Guaraund l� � Provision of MGL c-142A. DATE REGISTRATION NO.PHONE MA.REG.100811 -7 X33 JOB LOCATION B NAMENCY. S 11M� n We eby ubmit specifications and estimates for work to performed and mr(Is to be A'P 1� / j Sr der Cc'� j °/►� !�'i— �P 7� C'cm p os" r CQ-4 C'� c�GC Gr pons, �b - .OY Du�IJ lurn�aw St 1�S 1/Pl r rr C�Aan �� ro�-ti /Z"o e7 Ca b �r�ckw Consl�ction related perms n me WORK SCHEDULE rry<fFlayj.The Owner hereby sid Comra for will begin the work or.order the th delay materials cause re Ica tum se cesllbwing t Co nea torts'eonreal, he worklwill be colmp Bed eed by r m r ctor M)begin the work on or about ackno ledges a d agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be o following acompletiorsand shal9comply with WARRANTYwith The Contractor warrants that the work furnished hereunder shall be free Isom defects in material and workmanship fort period of aterials,oi ohneryearrafler comp'hi on Agreement. l inthe cluding event de up,the he Cont ac oisshello,rarl his own expense forthwithcemedy©pair,tcor, alt's replace,o�cause eebe erred ed�repah�ed,or replaced, such damage or such defect ian I n meterrals or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. tete in accordance with above specifications, We Propose hereby to furnish material and labor—c m r the sum'Df: ollars($ ) I Payment to be made as follows: %($ 7L Jam/)upon signing Contract, Name of Contractor/DesB tiled Registrant i($ )upon completion of Street Address %($ )upon completion of Chy/Slate Phone shall be made forewith upon Phone Fed. I ID No. ($ )completion of work under this contract. Notice: No agreement for home improvement contracting work shall require a down Na sa{�man -- payment(advance deposit)of more than one-third of the total contract price or the oozed Signatwe total amount of all deposits Or payments which the contractor must make,in advance, to order and/or otherwise obtain delivery of special order materials and equipment, djys whirQMver amount is ar?M9f ote TThis proposal may be withdrawn by us it not accepte=wt,,,n authorizedprices, conditions stated. understand Acceptanceon OProposal I have read tt. ldocumentrttemadeaoutlined above insposal becomes a binding are o doheworkas specified. Payment will b You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Cancellation GNTHIS CONTRACT IF THERE ARE ANY BLANK SPACES. Dale Dale / Signature Srgnalure IMPORTANT INFORMATION ON BACK Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperN i.+urY�` License: CS-094763 ��,r s ,j, THOMAS R DOB)IIN �' I j. Expiration Commissioner 05/14/2016 (62. amin2oarureuL a�C�/t/lau�etld ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: b Office of Consumer Affairs and Business Regulation Registratig�n-�`-f0�0$11.j Type: 10 Park Plaza-Suite 5170 Expiratlgn /2 t26 ¢j� Supplement Card Boston,MA 02116 LEN GIBELY CONT,+ IN. INC. JyTHOMAS DOBBINS`;1'j .� w 23 R WINTER ST — PEABODY, MA 01960 Undersecretary ` of valid without signature r. r'