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HomeMy WebLinkAboutBuilding Permit #1112-15 - 18 EQUESTRIAN DRIVE 6/29/2015 4CU 1" BUILDING PERMIT NoRT" ��, O� t�eo $a6t6'9q. TOWN OF NORTH ANDOVER O2 O� PLICATION FOR PLAN EXAMINATION Permit No#d ` Date Received gSSACHus�`��y Date Issued: �^ TANT: Applicant must complete all items on this page LOCATION G a.�e t_.R,-, RD Print PROPERTY OWNER Yt17-0.4— HC 20 Kn t Print 100 Year Structure yes MAP�PARCEI,,I't?k_ZONING DISTRICT: Historic District yes Cno Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building dg-Qne family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial impair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: L Ac--s, K,-,,�—�;, 9 fig, r1 '2.c W 1 C —11 'P, D_AlyAe;:�o tf A! t�41 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: LEO..� �- Contractor Name: Phone: Address: �'� �'c., L-)t c.;z 4-A- (3-c ��.� 6o -a V` ��1 C� 1 4 6 Q Supervisor's Construction License: '-4`'76 "S Exp. Date: Home Improvement License: 0 C) 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: $ ?r 3 2- ®p FEE: $ Check No.: d d Receipt No.: NOTE: Persons co ratting with unregistered contractors do not have access to the guaranty fund -- - -- -- _ ---- ----- - - -T __....�.. e_ 6-f-c- o-n- Signature of Agent/Owner Signature of contractor Location No. / Date . - TOWN OF NORTH ANDOVER ' s D''$ • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check# �' ' Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw"nlning Pools ❑ Well ❑ 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 HEALTH Reviewed on Signature COMMENTS Zoning Nard 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 3.84 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Town of E 1., ndover O No. l 2-- I5 Y Cver, Mass, CoCNICHIWICK 1 A- 7�AD'4ATED P'PP`,`'�5 S u BOARD OF HEALTH Food/Kitchen PERMIT T r, LD Septic System THIS CERTIFIES THAT ...` BUILDING INSPECTOR ............... /�� Foundation has permission to erect .........:................ buildings on ...I ......�r.. ..f/.. �.�i.Y..L.�..... 4. • I - Rough to be occupied as ........ ........ .. .!r... t�......�. . ..... ........ '..!�4................................ Chimney provided that the person acce ting 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 SR 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. 01 LEN GIBELY CONTRACTING CO., INC. Page No.—)—of _Pages 23R Winter Street 26890 PROPOSAL PEABODY, MASSACHUSETTS 01960 All home Improvement contractors and subcontractors (978)531-8234 Fax(978)531-9304 engaged in home Improvement contracting, unless www.lengibelycontracting.com specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered Submitted1 '����O ��% with the Commonwealth of Massachusetts. Inquiries To: U Q t J 14_ about registration and status should be made to the Director, Home Improvement Contract Registration, v6sr�1�N �2 One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own NWA �ANpo u�2� /4,� 018 Y construction related permits or deal with unregistered /y 1s- contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. P�IONE DATE REGISTRATION NO. Y— Z�/ �S' MA.REG.100811 JO NAME/NO. JOB LOCATION hereby submit spepifications and estimates for work to be performed and materials to be used: - - --------___ ------ ---- -- - - - --- -___9_ s - 9 x � s v 5 00 -H Z t Al 77/s WORKSC D E / _ Contractor t49Cjirl �. k r �rtm(�/riaals before the third day following the signing of this Agreement,unless specified herein writin C�ac willJ+qq/i 'or,on or about EEE/// (datrring delaq caused by circumstances beyond Contractor's control,the work will be completed by alh r hereby acknowledge and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall pCso i red as violations of 1 5 Agreement. Hidden rot or conditions not seen at time of estimate that are required to be repaired in order to complete this contract,will be completed at$ .7 per man hour(MA HOUR). WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of wing completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,his su o ors, mployees or agents,is discovered within one year after completion of any job,including clean up,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replac,or cause to be remedied,repaired,or replaced, such damage or such defect In materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:n / q 3 Zd dollars($—.5 64F Payment to be made as follows: /r 7�^"q O Remove all job trash. J L—1 All guarantees on all products from manufacturer. is )upon signing Contract; Add permit cost if needed-we pull permit. ($ )upon completion of ZA N tice: agreemet f r hom improvement contracting work shall require a of n p nt(adv ce epo t)of more than one-third of the total contract ($ )upon completion of pri or total a unt all os or payments which the contractor must ma i ance, o order a /or oth ise obtain delivery of special order ($ )shall be made forewith upon mat I aqui nt, completion of work under this contract. Note:This proposal may be withdrawn by us If not accepted within days. AuthorIzjJValuAr Fae nce of Proposal I have read both sides of this document and aCC pt r s,specifications and conditions stated.I understand gning,this proposal becomes a binding contract.You are authorized to the specified. Payment will be made as outlined above. Buyer,may cancel this transaction at any time pri r to n ght of the third business day after the his transaction.Cancellation must be done in writ' g. DO NO SIGN THIS CONK/TRACT IFTHE E A NY BLANK SPACES. - r Dale IMPORTANT INFORMATION ON BACK A/ The'Commo>rwealtfi'ofMas tachusetts Department of Industrial Accidents Office of Investigations 1 Congress SjrjA Suite 100 Boston,MA 02114-2017 www:m.ass goy/dia., Workers.'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PleasePrint Leeibly Name.(Busine*Organizadon/Individual): L 4.�.v .�_ b L.� u�..'i .�C r.v'c�✓ �n Address: i-j ..>r' -e rr✓ $ Ci /State/Zi , r.4> o Phone#: a $ 5-31 FMI .employer?,Check the appropriate box. g a 3 I. employer with / c�1, 4. (] I am a general contractor and I e of ►roject{required): yees(full and/or part=time).* have:hitW'the subacontractors �. �]New construction sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling `'ship add°have`no employees These-sub-contractors-have; working for me in any capacity; employees and have workers' 8' 0 Demolition jNo workers' comp.insurance comp.insurance•, 9 ❑Building addition requi ded5: [jWe area corporation and its 10:0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers Have.exercised their 11• Plumbin myself. [No woikers' co . right of`exem tion MGL $reP�or additions mp. . , . . . .P P 12.. Roof insurance.required..]t c. 152,'§Y(4),and we have no' ❑ repairs emplo ees o workers'' 13.[]Other comp insurance;equued.]' 'Any applicant that checks box#I must also fill out the section below showing.their workerscompensation policy information. t Homeowngrs whb submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the sub�ontiactbts'and state whether or not those entities have employees. If the subcontractors have employees,they must.provide their workers'comp:policy;nurtrbet: ''. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and Job site information. Insurance Company Name: rvcrl Q,Ac, � a �_ Policy#'or Self-ins. Lic. 4�Exptrati6n Date: Job Site Address ,! City/State/ZipAK p Attach a copy of the workers'compensation policy declaration page(show(n the olic y Failure to secure covers a as. g P .. J'.P4mber and expiration date). g 1► under.S.ection . A ofivlGL,c. 152 can least to..he imposition o crimi�oal penalties of a fine up t$$1,500.00 and/or one-year imprisonnxent,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 a Investigations of the;DIA for insurance:coverage;verification. I do hereby certify Antler,the pairs and enalttzes.o . p fper,jury that the information.provid/ed above is due.and correct Si Date UJJicial use only. Do not write in this area,to be completed by city or town official City or Town: Per•mlVUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Tovvn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE f DATE(MMIDD/YYYY) 01/30/2015 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 Topsfi el d, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Len GT e y Contracting Co. , Inc. INSURERA: First Mercury 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. IN DO LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MMIDD LIMITS GENERALLIABILITY , _ MA-CGL-0000051263-01 01/29/2015 01/29/2016 EACH OCCURRENCE $ ..1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 A _ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ Z,000,00 POLICY PRO- JECT LOC AUTOMOBILE LIABIUTY 6221693 COM 02 01/29/2015 01/29/2016 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TWC ORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Proof 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. ,3(1 AUTHORIZED REPRESENTATIVE Robert Sennott/RP ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ` " DATE(MMIDDIYYYY)� '/ osrguzola 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 01634-001 C2NTACT NA►IMNEE: _ Edward F Sennott Insurance A/c.No.Ext): Inc.No.: 16 South Main Street EMAIL Topsfield,MA 01983 ADDRESS: INSURED INS RER A: A.I.M.Mutual Insurance Company 26158 Len Gibely Contracting Company Inc INSURER B: 23 Winter Street Rear WaURER C' Peabody,MA 01960.6941 [HaURER INSURER COVERAGESCERTIFICATE 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. IN TR TYPE OF INSURANCE I S' � POLICY NUMBER MVCD/YWY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY MA E TO REN ED. $ Ea owurrenc CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ --- ---- GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG $ OLICY F_rARE_JL_C AUTOMOBILE LIABILITY O BIN 1 GL UMIT $ JEA accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWN® SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident) $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE ^A $ DED RETENTION S WpRKERg ENgq pN y�� �� S ArN.IDy pEMPLo3'LWBRITY X TORY LIMITS OER A AOFFICE IC PRIVal gRTNSRIPECUTIVE Y� NIA E.L.EACH ACCIDENT $ 500,000.00 (Mandatory In NH) EXCLU E VWC-100-6010979-2014A 8/3/2014 8/3/2015 UM ff �s�! ride E.L.DISEASE-EA EMPLOYEE $ 500,000.00 DESCRIPTIO C�F OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super�i�ur License: CS-084763 ``s ter.r THOMAS R DOBBIN i i w s Expiration Commissioner 06/14/2016 V/l8 ((/(YIINIiO'IK[/CG{[IL 4�'�I�GCl9JG4YtlWBC�if fiice of Consumer Affairs&Business Regulation VRegist ness e License or registration valid for individul use only 0ME IMPROVER #NT CONTRACTOR before the expiration date. If found return to: . Office of Consumer Affairs and Business Regulation rati ILType: 10 Park Plaza-Suite 5170 Explr�� ,'' Supplement Card Boston,MA 02116 LEN GIBELY CON ,,INC. THOMAS DOBBIN 23 R WINTER ST „ ✓ �.•.�-.-yd _ PEABODY,MA 01860 Undersecretary Not valid without signature 1 !