HomeMy WebLinkAboutBuilding Permit #984-2016 - 21 LINCOLN STREET 3/21/2016PermitNO:
Date Issued: �'� 11A V\
TOWN O-F NORT-H ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCAT I ON L i(I C' oln-
T
Print,
PROPERTY OWNER
�,eoA;,,eT (_CLVQ*V�3
I Print 1 00'Year Old 8iru�tu
-MAP NO.. _PAR6EL--' ZONINGDISTRICT: Historic District
Machinq Wop Vil
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yes
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TYPE OF IMPROVEMENT,
PROPOSED USE
Residential
Non- Residential
0 New Building
[I One family
El Addition
El Two or more family
11 Industrial
0 Alteration
No. of units:
0 Commercial
0 Repair, replacement
0 Assessory Bldg
El Others:
11 Demolition
0 Other
I ptic, El Well
E ",to
�O Floodplain 0 Wetlands
-0 Waiter�hec!7 �hiCt,_
11 Water/Sewer,,
DESCRIPTION OF WORK TO BE PERFORMED:
131061 n - I A Ce- I / L' / ws't_ ; A Ue.-ils C-flot XTT4'C-
Identification Please Type or Print Clearly)
OWNER: Name: kent);e7k Phone: 4/237U-77_�'S
ArIrIr,=.q-,-
J
Address -111 k. Ep
'0' 1_9 1, c>_
$upervis f'sCo- struction License: 01,11-33-- E)a e: 9--7
0 h
H'o m-airnplovemertt License:' ___I�-xp, Date.—
ARCH ITECT/ENGI NEER 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: $ �Z 0 3 0 - 0 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting !y�th unregistered contractors do not have access to the guarantyfund
Plans Submitted FL] Pla'ns Waived Certified Plot Plan Stamped Plans
Submitted -11 -Plans-Waivedfl _..-Gertified Plot Plan Stamped Plans' F1
TYP
%-OFSEWERAGEDISROSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools 0
Wel * I
Tobacco Sales
Food Packaging/Sales .11
Private -.(septic tank -etc
Perm*an6nt:E��ster n* -Site El
THE, FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED.
PLANNING & DEVELOPMENT- El
COMMENTS
DATEAPPROVED
CONSERVATION Reviewedon Signature
COMMENTS
HEALTH Reviewed on Sic
-inature
COMMENTS
- Zoning Board of Appeals: Variance, Petition No:
anning Board Decision:
Comments
Zoning Decision/receipt submitted yes
,,onservation Decision: :Comments.
Nr7'& Sewer Connection/S ure & Date
DrivewaV Permit
DPW Tovv;! Fngineer: Signature:
Located 384 Osgood Street
DEPART -�W �,Temp Durnp.ster on sit
W
e. yes., no
.Lbcated-bt'11�4MariStrdet:
h"ID6
A-re Pa ]V§1946WWOW� 4A,
COMMENTS
-Dimension.
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
..Total land -area,- sq. ft..
ion,, t -or service drop requires approval of
ELECTRICAL: Movement of Meter,locati* mas
No
Electrical Inspector Yes
DANGERZONE LITERATURE: -Yes No
7- MGL-Chapter166 Section 21A,.=F and G min.$10041000fine
NL)T[=S ancl DATA — (For cie
I
0 Notified for pickup - Date
Doc.Building Pen -nit Revised 20 10
entuse
Building Department
—The fohlowing1s'a-Iist of the retluired.forms to be. -filled out.fortlTeappropriate permit to. be obtained.
Roofir,g, Siding, Interior Rehabilitation Permits
13�,jilding Permit Application
Workers Comp Affidavit
-S' L- Licenses
Photo Copy Of H.I.C. And/OrG.
Ej Copy of Contract
ci Floor Plan Or Proposed Interior Work
u Engineering Affidavits for Engineered products
NOTE: All dumpsterpermits require sign off. from Fire 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
Lj Floor/Crossection/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 cas,�s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building Permit Revised 2012
Location .2— 1-4
No.9 N — 1('0
I
Check # � (-) V�I
'07 8
I-A�� 1
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL
/ I
Building Insliector
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CONTRACT
GREATER LAWRENCE COMMUNITY ACTION
COUNCIL, INC.
305 Essex Street
Lawrence, MA 01840
Phone: 978 681-4956
A&M GENERAL CONTRACTING
119 R. FOSTER ST
PEABODY MA 01960
Email: mikefltz@amgeneralcontractingine.com
Phone: 978 741-7777
Cell: 508 726-1058
Kenny Laughters
21 Lincoln St
North Andover Ma 01845-2701
Job Number: 20150246
Work Order Date: 312/2016
Ownership: Owner
Auditor: KeithVoung
Email: kyoung@glcac.org
Cell: 978 857-7841
Phone: 978 681-4955 x4793
Columbia Gas
Total
$7,030.91
$7,030.91
O.MaienO
. ....................................
flil w/cellulose --- r . 1V4j1j0.UU J60 1 $558.00 slopes and floored area
R-30 restricted - slopes/floored fill 300 $1.59 $477.00 300
w/cellulose $477-00 Flat slope
R49 unrestricted - settled eTIlulose 502 $1.80 $903.60 502 $903.60 flat in knee- wall
Basement inslaaji6n ----------------
Sill two-part foam w/flberglass baft-- 143 1$2-.46 1$351.78- 1.78 1
Nors.
Fixed Sweep 3 $17 64 SS2.92 3-- $52.92 attic/base.int./ba . s . e. ext.
Thermax (or equivalent) on -door 2 V57-00 $114.00 2 $114.00 attic/base.
. ........
Weatherstrip S/Q-Ion or equal 3 SSI -30 $153-00 3 aftle/base.int./base.ex-t.
Date: 3/2/2016
^uinor-izea
Actual
Meaiu..re�Descrlptjon
Total
Attic/Kneewall Floor Transition
Dense Pack w/cellulose
53 $149.4- 6--
---- -
53 $149.46
R-11 FGB in open rafters/walls/
kneewalls
175 1$1.47 $257.25
175 $257.25
R-18-20 restricted slopes/floored
$7,030.91
$7,030.91
O.MaienO
. ....................................
flil w/cellulose --- r . 1V4j1j0.UU J60 1 $558.00 slopes and floored area
R-30 restricted - slopes/floored fill 300 $1.59 $477.00 300
w/cellulose $477-00 Flat slope
R49 unrestricted - settled eTIlulose 502 $1.80 $903.60 502 $903.60 flat in knee- wall
Basement inslaaji6n ----------------
Sill two-part foam w/flberglass baft-- 143 1$2-.46 1$351.78- 1.78 1
Nors.
Fixed Sweep 3 $17 64 SS2.92 3-- $52.92 attic/base.int./ba . s . e. ext.
Thermax (or equivalent) on -door 2 V57-00 $114.00 2 $114.00 attic/base.
. ........
Weatherstrip S/Q-Ion or equal 3 SSI -30 $153-00 3 aftle/base.int./base.ex-t.
Date: 3/2/2016
Mize Mm
ures
attic air sealing
.4 -_ - 1.5—r-00 $105.00 1.5 $105.00
Blower door set-up with pre &—post 41-$45.00 $45.00 1 $45.00
tests
1.5 $
7smt ;ir sealing 11.5 $7C.00 J$10s,00 11-5 1$105.00
Permit
Other
Double nailed asbestois/aluminum
(dense pack)
Drill rough plaster patch or finish
wood plug (dense pack)
[$0.00 J$0.00-- [$0.00
1382 J$2,59 1$3,579.38 11392 1$3,579.38
____J
88 J$2.04 J$179.52 188 $17-9.52
_-7-77 7777777'T'! -
Seal chimney,plumbingtiectrical and all air
penetrations to the living space.
Seal under sinks,plumbing,electrical and all
air penetrations to the living space.
side entrance
Total
$7,030.91
Contractor Instructions:
Ref'-- Starting the Job.
1, Please notify us 24 hours before starting or scheduling a job.
I - Incorporate lead safe practices as applicable.
2. Obtain required building permit. 2. Total for Heath & Safety and Repairs cannot exceed $2500.00.
Additional Contractor Instructions-.
Certificate of Insulation posted? Yes No (Circle one) Arne inspection form attached? Yes_NTA__(C—jrcJ—eV7e)—�
A&M GENERAL CONTRACTING hereby certifies that this job was supervised and completed in compliance with all
Department of Labor Standards and Lead RRP regulations.
CBnt81viature:
1�a
ate. OIL _Date:_RRP License
Page 2
A OA QEINER A
JMGL� - L CONTRACTING -
119: R�- FOSTER ST.
PEABODY, MA 01960
978�741-7777
To whom it may concern.
I Michael Fitzgerald CSL #099933 give Neil Moore authorization to
drop off and pick up permits on my behalf. From 01-10-2016 to 12-31-
2016 for A&M General Contracting. If you have any questions or
concerns Please call me at 978-741-7777 Thank you.
Operations Manager
A&M General Contracting
Michael Fitzgerald
Sined on' -*,..d
�q 2016
Notar
EXP: 04-01-202'0
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov1dia
117orkersi Compensation Insurance Afridavit; Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THEPERMITTING AUTHORITY.
Anollicant Information Please Print LeL),ibly
Name (Business/Organizationfindivid,al): A&M General Contracting
Address: 119 R. Foster St.
City/State/Zip: Peabody, MA 01960
Are you an employer? Check the appropriate box:
Phone #: 978-741-7777
1. 0 lam a employer with 20
employees (full and/or part-time).*
2.M 1 am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers'comp, insurance required.]
3.[3 1 am a homeowner doing all work myself [No workers' comp. insurance required.]
4,[] lain a homeowner and will be hiring contractors to conduct all work on my property, lwill
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees,
5.0 1 am a general contractor and I have hired the sub -contractors I isted on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.:
6. n we are a corporation and its officers have exercised their right ofexemption per MGI_ c
152. § ](4), and we have no employees. [No workers'comp. insurance required.]
Type of project (required):
7. D New construction
8. 0 Remodeling
9. Demolition
10 Building addition
I I.E] Electrical repairs or additions
12. (] Plumbing repairs or additions
13-MRoof repairs
14. E] Other Insulation
t� I ly apJAILokint Mill L;nC/ZKS DOX FF I must at so it I I out tne section below showing their workers ' compensation policy information.
. Homeowners who 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 -contractors and state whether or not those entities have
employees. If the sub -contractors have employees. they must provide their workers'conip. policy number.
I am an employer that isproviding workers'compensation insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name: TGA Cross
Policy # or Self -ins. Lie. #: AMWC345622
Expiration Date: 03-20-2016
JobSiteAddress: J1 4T City/State/Zip:VA/)di5,/rP_kV oiiiqs-
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL 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 WORK 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.
I do hereby certify
._pnder thepoins andPena rmation provided above is true and correct.
Signature:,." 4�� Date: -3 -1'1-16
9- 41-
-phone-.#: 1<-7 '7777
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone# -
21 2016 09:54 HP Fax page 1
CERTIFICATE OF LIABILITY INSURANCE
juwowym)
F
b --.—
PERIOD
3111/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INF ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
CERTIFICATE
THIS
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
13SUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER,
IMPORTANT; Of the certificate holder is an ADDITIONAL INSURED, the 1111011CY(Ift) must have AD0171ONAL INSURED provisions or be endorsed,
If SUBROGATION IS WAIVED, subject to the terms and conditions
Of the P*Ilcy, certain policies may mquirs an endorsement. A staternerit on
this certificate, doeag not confer rights to the Certificate holder In lieu of aghAVroernent(s).
PRODUCER TGA Cross Insurance. Inc.
401 Edgewater Place, Suite 220
�:— - -- - insurance. Inc.
P14ONE
Wakefi,61d, MA 0 1880
FAX -246-2601
781
OAMAtETOREfirrb
MA -
www,tgacroSS-com
"C 0
INSURED
E celsior
X. -W . ... . .— . ... . . . � . .1 . ..1-1.0.4.5 ...
A & M General Contracting. Inc
J14SURER 8: Peerless Insurance Co
119 R Faster St. Bid 14
..tN§u.rt.P..c:.-.A.mG.ua-rd'In.suran.c.e...
Peabod y MA 0196T
-INSURERP-:--.-...-
INS�WR E: ........ .. -
COVFRAGF.q
INSURER F:
2012 1 or z Kt:VlbltJN NUMBER:
TNIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVT BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
INDICATED NOrAATHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT
OR OTHER DOCUMENT
PERIOD
NTH RESPECT To
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU13JECT TO ALL
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SMOM MAY HAVE BEEN REDUCED BY
VVHICH THIS
THE TERMS.
INSA AID bLiSveRl
1, TR rYPE OF INSURANCE
PAID CLAIMS
POLJCY NUMBER
A COMMERCIAL GENERAL LIABILITY CBP8947488 312D/2016
ImNyoorryyyl LIMITS
3120/2017
EICIOCCURRENCE
1.000,000
C-LAWS4ACE OCCUR
OAMAtETOREfirrb
100=0
V ISO Form CG0001
MED EXP fAny anepel.sqm� s
5�000
n d y
V Co iractual Liab it
. .. .. . I
PERSONAL & ADV INJURY $
1.000.000
GE N "AGGREGATE LiMITAPPjE PER.
GE NE RAL . AGGR EGATF
2.000.000
PRO- LOC
JEC-1 ...
- S
PROOUCTS-COM POP AGG S
2.000,000
OTHER
S
B A U TOMOSILIE LIAO LFTV BA8947688 3120/2016
W012017 COMB' S
1. 000, 000.
ONNED C- KULED
S HE
BOD;LY 04JURY (Pei perwr) 5
AUTO$ OPP_Y AIJTC5
HAED NON-CrAINEC,
BOOILYINJJRY�Perawderit) $
--C
AL;TOSONLY V.. AiJITOS ONO
006P k�'VDAMAGt
8 V UMBRELLALIAS / C)CCUR CU8947888 T2012016
3/20/2017
...
EXCESS LIAG
EACHOCCURRIENCE
1.000,000
CLAIMS MADE
1,000.000
DED V AFTFNTIONS10.000
0 WORKE 3 COMPENSATION
AND RLO AMWC572468 3/2012016
EMP VERS'LIABLIT'll
-3/20/2017 PUT OTH.
YIN
;RI,�PRIEroR�PARTNERIE-XECUTIVE
.__STA FR
CWF iCE R IM EMBER EXCLUCEIr NIA
EL-EA..Cf--*.ACc1,DE.N.T
500.000
IMandatory in NH)
b "yes under
L DISEASE - EA EMPLOYEE S
500,000
ISCRIPTION OF OPERATIONS bojoyv
500.000
DESCRIPTION OF OPERATIONS I LOCATIONS i VENICLES JA CORO 1011,Addiminai Remarks Schedule, M4V b9lirtachilid 1111`10raspwca Is requiradl
r-PRITIPIrATIC Ue%l r%=D
Town of North Andover
120 Main Street
North Andover MA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE FORE
THE EAPIRATION DATE THIEREOF, NOTICE MLIL 13E DELIVERED IN
ACCORDANCE MTH THE POLICY PROVISIONS,
AUTHORIZED REPRIESENTATIUIF
Thomas I Gregory
01988-2015ACORDCORPORATInIld
A%oUKU ZO (ZU1bf0;j) The ACORD name and logo are registered marks of ACORD
Restricted To: CSSL-RF - Roofing
CSSL-IC - Insulation Contractor
CSSL-WS - Windows and Siding
CSSL-DM - Demolition
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Ucensinginformationvm: WWW.MasS.GoV/0pS
Mass'a"usetts ' ()"anment Of 0U001C Safet�
Scara 04 j9UdaingqegU,,,,.,n, S'a'.2a.
"'ense: CSSL4"M
AUCHAILPMM
119 R FOSUR 0
sm;
Peabody MA 01990
EAztr3rrjor
COMMISSionef OWIGO18
Office Consumer Afffiirs d Business egulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 141124
Type: Supplement Card
A+M GENERAL CONTRACTING INC. Expiration: 1/12/2018
MICHAEL FITZGERALD --
5 SOUTH RIDGE CIRCLE
LYNN, MA 01904
Update Address and return card. Mark reason for change.
Address — Renewal Employment Lost Card