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Home My WebLink AboutBuilding Permit #394 - 255 BLUE RIDGE ROAD 12/11/2008 X10 R TF1 BUILDING PERMIT of OOR TOWN OF NORTH ANDOVER 3? 4�.,, °0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 05-15 FLUePA31? Rd PROPERTY OWNER E lfN UONAZ4'Print Print MAP NO: 5 PARCEL:I/ZONING DISTRICT: Historic District yes Pno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildingne famil Addition Two or more family Industrial Alteration,—, No. of units: Commercial Repair, replacement AssessorY Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 1 iNsWt a P-t6ce)VIeNt Dovble�,oN9s AN a PVLAcemen�- C�SemRt UN,Its /da PX 1 IN WIN4ws, co\rep A 1bK O( C e0fYQl 1 d S w A Azek Cbm Q) -MI►'V\, Oiemdye All fUS-// , Identification Please Type or Print Clearly) OWNER: Name: E;CeeN 4,e0Az4kd i Phone: 978 6W-X61 Address: 0?5 5' �FLuekld Q CONTRACTOR Name: A 4b>0e V1er.1" 4LC Phone 6tJ 9749 Address: 0?7 1rnW,0a6 AW Supervisor's Construction License: CS 63-107<? Exp. Date: o 7X Home Improvement License: ' 40776 #�2116�?5 Exp. Date: 10211-71.2w? ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P, RMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. �! ZO Total Project Cost: $ �� FEE: $ Check No.: ��a r Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access po the guaranty fund Signature of Agent/Owner Signature of contractor Location Q)ve 4 if _ No. 39V Date �q MORTM TOWN OF NORTH ANDOV9R O Certificate of Occupancy $ 7s1,k ,.t Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check # �7 2 � 7 � 5 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. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS D 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 - Date Doc.Building Permit Revised 2008 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/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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Proposal Friday,December 05,2008 Client: Eileen Leonardi 255 Blueridge Rd North Andovey MA,01845 H#979-"2-2864 C#978-314-1759 5—MM Of Wodc Install and insulate 2 Harvey Classic DH replacement windows,filly welded,Low E/Argon, '/z screen%grids in glass. Replace 2 ezzisting front windows in garage. Install and insulate 2 Harvey Classic replacement 4 unit casement windows,all units venting,LowE/Argon,fully welded,grids in glass,full screens Replace 2 existing windows in front of house.Replace existing exterior trim with azek composite tam.Install inside stops Remove all trash We Pwpose hereby to fiunish materials and labor-complete in accordance with above specifications,for the sum of: $6150.00 Payments made as follows: a. $2,650.00,Deposit is required to begin wank b. $1750.00,Once materials have been delivered and work has started c. $1750.00,Once allwork has been completed Checks are to be made out to Stonepost Home Services,LLC. Marling Address,29 Elmwood Ave,Salem,N.H.,03079 All material is guaranteed to be as specified_ All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra Costs will be executed only upon written orders,and will become and extra charge over and above the estimate.All agreements contingent upon stakes,accidents,or delays beyond our control Owner to carry fire, tornado and other necessary insurance.Our workers are fully covered by Workman's Compensation insurance '1 Authorized Signature f Note:This proposal may be with drawn by us if not accepted vzffiinL days Acceptance of proposal-The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will �be made as outlined above. Date of Acceptance L'd� i bore S. NORTH c 0 of r.��, t. 0 No. _ o over, Mass.,0 LA • COC HIC ME WICK y1. �d A0RA7E D P' �5 3 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT................ ..,L,,,�wft............. .1�� t. r. lM.1.......... ..................................... Foundation has permission to erect........................................ buildings on ...41)•re.......18\#11.0 r... . ... ...... Rough to be occupied as Chimney provided that the person accepting ris� permit shall in every iespect conform to the terms of the application on file in Final 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 CONSTRUC TS Rough .............. ..... ........................................................................................ a ce BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Dom Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1lassachusetts- Department of Public Safet-, Board of Buildin-1 Rcttulations and Standards Construction Supervisor License License: CS 55078 Restricted to: 00 u ALFRED A DIPRIMA 111 29 ELMWOOD AVE ,R SALEM,NH 03079 Expiration: 6/30/2010 [',nnau..i„ncr Tr#: 268M —\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Ro&Aation: 140996 Expiration: 12/17/2009 Tr# 261835 Type: Individual ALFRED DiPRIMA III ALFRED DiPRIMA 29 ELMWOOD AVE. �,,Q,,,�,` SALEM,NH 03079 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U A_�, 1;`' ;` 600 Washington Street Boston, MA 02111 ' www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): y�0�ll°pOSt � (� LLC Address: o29CLl770_1660 AVC City/State/Zip: s��n� A8 0307 Phone #:_66S RFO 1667 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. t 7• M Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself[No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.7 Other . comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who subniit iiiis aiiidavii indicating ti7ey arc duiiig all work acid hien hire outside contraciors 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 their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: 0/4 1Ak3t'14A 1C-e C-0, Policy#or Self-ins. Lic.#: 6S5708-3/07851-3-09 Expiration Date: Job Site Address: 06S e ocm&(PAO City/State/Zip:A16kA�KOrDl_vMA 0� 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 of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: W 990 Ji5 � 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#: 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 defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the 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 of the 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 be 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 required." 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 certificate(s)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 an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be 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 required 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"Job 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 Office of Investigations would like to-thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder Stone Post Home Services LLC Address of policyholder 29 Elmwood Ave Salem New Ham shire 03079 Location of operations Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is sub'ect to all the terms exclusions,and conditions of those policies.The limits of liabilit y shown may have been reduces by any paid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date at beginning of policy period) Comprehensive BODILY INJURY AND 9 4 BLO 3 3 5 8 F Business Liabili 04/01/08 0 PROPERTY DAMAGE This insurance includes: Products-Completed Operations ❑Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ 500000 ❑Personal Injury ❑Advertising Injury General Aggregate $ 1000000 ❑ Explosion Hazard Coverage Products-Completed ❑ Collapse Hazard Coverage Operations Aggregate $ 1000000 ❑General Aggregate Limit applies to each project ❑ POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggpggate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers'Compensation and Employers Liability Each Accident $ Disease Each Employee $ Disease- Policy Limit $ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date at innin of policy period) If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives.} • Name and Address of Certificate Holder r �� Eileen Leonardi � 255 Blue Ridge Rd Signature of Authorized Representative North Andover, MA 01845 Title U 558-994 a 2-90 Printed in U.SA. Date ACORoCERTIFICATE OF LIABILITY INSURANCEDAT MMr„ ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brian M. 13osie.S Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE State Farm Inswance Com meies HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 220 Ruin Street PO 13ox 665 Salem, New Hampshire 03079 INSURERS AFFORDING COVERAGE _- NAIC# INSURED INSURER CNA_ Insurance(.V. _ _ ,_- Stone Post Home Services LLC INSU ER B! 29 Elmwood Ave IN$URER C; Salem, NH 03079 INSURER O: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTJO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMfTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _! iNSRADD'L —• y- POLICY EFFECTIVE POLICY EXPtRATiON S TR i POLICY NUMBERDATE GENERALUABIUTY I EACH OCCURRENCE I S -_ A�G COMMERCIAL GENERAL LIABILITY I DREMrit: (E�gccuronee S CLAIM$MADE L!OCCUR I MED EXP(Any one Pam* I PERSONAL&ADV INJURYYSS GENERAL AGGREGATE GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPrOPAGG S — - -- PRO- POLICY MI 1 I LOC AUTOM081LEUABILITY i COMBINED SINGLE LIMIT IEa eoc denD $ ANY AUTO r. I ALL OWNED AUTOS r,8ML Y INJURYSCNEDULEDAUTOS non) HIREDAUTOS I I BODILY INJURY i$ NON-OWNEDAUT03 �(Perecddenl) i --� i PROPERTY DAMAGE $ (Per accident) GARAGE UABILrtY �AUTOONLY•EA_AC(IDENT ANYAUTO I (OTHERTHAN EA I S AUTOONLY: AGG $ `EXCESSIUMBRELLA UABIUTY EACH OOCURRENCE S OCCUR __.-CLAIMS MADE AGGREGATE $ S DEDUCTIBLE � s _... ... RETENTION E b WORKERS COMPENSATION AND WCSTATU• DOT14 H• EMPLOYERS'LIABILm hS59UB-31071354-i-08 05/11/08 05/I1/09 rE.L,EACH ACCIDENT E Iffl)!!L�M _ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICEWMEMSER EXCLUOED'? I E.L.DISEASE.EA EMPLOYEE $ 11 Yes.descnt*under SPECIAL PROVISIONS below ( E.L.DISEASE•POLICY LIMIT S100000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLESI EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL -3_0 DAYS WRITTEN Eileen Leonardi NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 255 Blue Ridge Rd IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover, A fA 01845 REPRESENTATIVES. AUTHORlZEO REPAESENTAYIVE, j` � :'•. � ACORD 25(2001108) W'4C(5-RYCTMRATION 1988