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HomeMy WebLinkAboutBuilding Permit #545-2017 - 16 STACY DRIVE 11/21/2016 1V/' F 1Q4- 4--OL pORTI� 9 BUILDING PERMIT o tzl.Eo ,6 ti TOWN OF NORTH ANDOVER o - APPLICATION FOR PLAN EXAMINATION � 1 y Permit No#:5'x!5 'x�7 Date Received °RTEo "�cy 9SSACHUS�� Date Issued: a- 6) (o IMPORTANT: Applicant must complete all items on this page LOCATION wl D'.. c/y D it J - Print PROPERTY OWNER _ /YSGc__ e,f r4 7 (� Print 100 Year Structure yesno MAP _PARCEL: CIE:," ZONING DISTRICT: Historic District yes o !Machine Shop Village yes 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 ❑ Floodplain ❑Wetlands 0 Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: t� e © 1tic e 04- �fi2u r hac4 W .fncfAwS Identification- Please Type or Print Clearly' OWNER: Name: L J rz 1:23 g- r ry Phone:9 7C F fG Address: Zia 5- 'a c e— Contractor Name 4ri, Phone: E u Address: J/ Iva a /_;)r 1-e;, � d LHome.improvement pervisor's Construction License: .� g 7-11 , Exp. Date: License: / S Exp. Date:, /7 _- 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: $ 73 --- FEE: $ Check No.: 4f 3?7 Receipt No,: 3 I a-a' L NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund Signature of Agent/Owner Signature of contractor; ° Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ [Well YPE-OF SEWERAGE DISPOSAL blic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent 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 t- HEALTH Reviewed on Signature r 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 limension 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.sloo-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doe.Building Pen-nit Revised 2014 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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 VOTE: 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 Location l 0 c kj' r Ali No. S-qf JO 1:7 Date /`' a l' ,v" O / 6 • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ • o- Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ I � y Check# `� �� Building Inspector <r , NORTf� ' - i. .c . . ver No. 11 * Z h ver, Mass, � // • a / d? 0� coc"ICHIWIcw �'►• �qS RATEC) 11 BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT 0r.ATTAe J...61W&Iv� o!�q..� �.I. N.....S Steel .... BUILDING INSPECTOR .... ..... .........y. has permission to erect buildings on Foundation f��Of � Rough to be occupied as .........!..W &V.�0A .......Of..........V..... N. &W�............. 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 GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Salem,NH 03079 Phone# Date Invoice# 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 Garabedian Home Improvement Invoice I 1 Matthew Dr Salem,NH 03079 Phone# Date Invoice# 8/28/2016 818 603-235-4005 Bill To LISA BERRY 16 STACY DR N.ANDOVER,MA 01845 Terms Project Quantity Description Rate Amount WINDOW ESTIMATE THE CUSTOMER HAS ASKED FOR A PRICE ON REPLACING THEIR WINDOWS. THE WINDOWS WILL BE A NEW CONSTRUCTION WINDOW AND BE ALMOND VINYL ON THE INTERIOR AND THE EXTERIOR. THERE WILL BE 908 BRICKMOLD TRIM AND COMPOSITE SILLS ON THE EXTERIOR. THE INTERIOR WILL HAVE 1X4 FLAT TRIM AND EXTENSION JAMBS. INTERIOR AND EXTERIOR TRIM OF WINDOWS ARE TO BE PAINTED AS WELL. 1 HARVEY ALMOND TWO LIGHT ROLLING WINDOW:UNIT SIZE:62.5 X 53 583.00 583.00 FIBERGLASS SCREEN,ENERGY STAR PACKAGE,DOUBLE LOCK HARDWARE,NO GRIDS.LOCATION:LIVING ROOM 3 HARVEY ALMOND TWO LIGHT ROLLING WINDOW:UNIT SIZE:62.5 X 45 1/4 490.00 1,470.00 FIBERGLASS SCREEN,ENERGY STAR PACKAGE,DOUBLE LOCK HARDWARE,NO GRIDS.LOCATION:BASEMENT/BEDROOMS I WINDOW TRIM 250.00 250.00 1 WINDOW FLASHING 80.00 80.00 1 SPRAY INSULATION 25.00 25.00 1 DISPOSAL OF OLD MATERIALS 100.00 100.00 4 INSTALLATION LABOR 450.00 1,800.00 WINDOWS ARE SPECIAL ORDER AND ARE NON-REFUNDABLE. PLEASE ALLOW 3-4 WEEKS FOR DELIVERY. A DEPOSIT MUST BE PAID BEFORE ANY WINDOWS ARE ORDERED.(1/3 OF CONTRACT) ANY UNFORESEEN ROT OR DAMAGE DURING THE INSTALLATION PROCESS WILL BE CONSIDERED AN EXTRA COST.IN THIS EVENT WE WILL QUOTE A PRICE FOR THE MATERIALS AND LABOR TO FIX THE PROBLEM. I PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR-COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS. Total Page 1 The Commonwealth of Massachusetts Department of IndustrialAccidents M T _ 1 Congress Street,Shite 100 M' d02124 20X7 Boston,HA ~: www mass.gov/dia OiM 5��y Workers' Compensation Insurance Affidavit.Buil.ders/Contractors/Electxicians/plumbexs. TO BE FILED WITH TRE PERML.ITING AUTHORS)'Y• please Print Le 'bl A • licant Information 'r Dame(Business/Orgariizaiion/Individual): 688 /a13 )r 1 Address: Am >T146� O"L y S il I�--% ,-,v I+ Phone#: 6:s City/State/Zip: :. ... .. : :...;_:,, p - pp p Type of project(required): Are you an em Ioyer.Check the a ro nate box: em to eel full an part time).'` 7. ❑N&'constriid on 1.[l I am a employer with P Y 2.A I am a sole proprietor or partnership and have no employees Working for me in 8. Remo deliiig any capacity.tNoworkers'comp.insurance required.] 9. ❑Demolition 3.Q I am ahomeowner doing all work myself(No workers'comp.insurance required.]' 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical re airs or additions -. p:: ensure that all contractors either have workers'compensation insurance or are sole 12 [Plumbing repairs or additions proprietors with.no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11 Q Rb6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14.0 Other 6.❑We are a corporation and its,offices have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees. [No workers'comp.insurance required.] cY *Any applicant that chdoks box#1 must also fill out e az doing lall showing den hire outside eir-workers' oonira os mns ILoult submit new affidavit indicating such Homeowners who submit this affidavit indicating Y !Contractors that check this Box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entities,have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. vidingworkers'compensation insurancefor my employees. Below is tliepolicy and job site X am an employer that is pro information. Insurance Company Name: Expiration Date: -ins.Lie.#:. policy y#or Self -ins. Job Site Address: compensation policy declaration page(showing the policy number and expiration date). Attach a copy of the workers' Failure to secure coverage as required under MGL c.152,§25A is a criminal violation puuiskable by a tiiri e up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form orward d to the Officeof a STOP ORDER 00 a ations of DIA for insuran day against the violator.A copy ofthis statement may be f coverage verification. X do Hereby certify under tliepains and penalties ofperjury that thiorma e nftion provided wave is true and correct Date: Signature: Phone#: FOf_ Zcial rose only. Do not write in this area,to be completed by city or town official. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is d'efiued as"an individual;partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'or trustee of an individual,partnership,association or other legal entity,employing employees.,However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage requi)red." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." "Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If au LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are xequi ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"rob Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617.727.7749 Revised 02-23-15 wwwmass.gov/dia AC40® DATE(MMIDD/YYYY) 11.� CERTIFICATE OF LIABILITY INSURANCE 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(ies)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 Barbara Souza ACSR AAI NAME: FIAI/Cross Insurance A/c NN Ext): (603)669-3218 FnAIC No:(603)645-4331 1100 Elm Street E-MAIL y ADDRESS: enc bsouza@crossag com INSURERS AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURER A:Technology Ins. Co. 42376 INSURED _INSURERB: Matthew J. Garabedian, DBA: Garabedian Home INSURERC: 11 Matthew Street INSURER D: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FX OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ TPP1065426-17 2/8/2016 2/8/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F�PROJECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PeOaPER ccidentDAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F—] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,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, AAI/BSS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(9014r111 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTTy Type- Registration: 157753 Expiration: 111212017 DBA GARA13EDIAN HOME IMPROVEMENT MATTHEW GARABEDIAN 11 MATTHEW DR. SALEM,NH 03079 Undersecretary } Massachusetts Department of Public Safety ja Board of Building Regulations and Standards License: CS-094797 Construction Supervisor MATTHEW J GARABEDIAN 11 MATTHEW DR SALEM NH 03079 ak ( -jZZ &,,--- Expiration: Commissioner 03/2612018