Loading...
HomeMy WebLinkAboutBuilding Permit #426-2017 - 273 GREENE STREET 10/20/2016 NORTH q BUILDING PERMIT 10�4ru5 o �tLED ,641.0 TOWN OF NORTH ANDOVER t -: APPLICATION FOR PLAN EXAMINATION -JE nO# �" Permit No#: ' Date Received �ySs kyrD �c5 Date Issued: Y�6 + IMPORTANT: Applicant must complete all items on this page,3?� riK$,u tr -.. �,r i l7r'`•>L+L�s.+ess � T -f{i f-r ttr } � '+C. " TM4 rt.,,,,•y,,{,�*'� sK�„ ,�i f.r.�'�i�t' ��a..wf a v .. r reR T tUe�_T C fJ r , r x t y f ®C'ATION �- 3 .�. l��� q+, - rs7�6't �i �c��' r;s 't st trsn,x !f>• 4"' tN S.`t 'T�}.�a�F'S 'tC{� ^nyc V. ` (' `PyR�OPERSTY;®WNER � •'a�• '+ + ��* r O 4` - rrktf " ` � Pnnt ` '�f 100�fYeStructue ,:4 es ar r [�r �`� «. ;e '� y .. +�ffi'+- ^ [..; .{"a p,., .-_ 3±v='ra• i"f c"s Y1• r5a yes . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family Addition 4gTwo or more family ❑ Industrial ❑Alteration No. of units: [ICommercial ❑ Repair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition ❑ Other i epi 'W . , �'FI. doo .lanWetla; �-' te Vied twit ate Seu�Ie _ DESCRIPTION OF WORK TO BE PERFORMED: abDv'� �dd. 2�` �Z-�' Twv S tr`�.\ a�,,.,._q� �...►�. 1..:...,�.� S Dirt c...Q ,I r Identification- Please Type or Print Clearly OWNER: Name: �c�f.,�.► Sw.ra-rt-�+�o Phone: aZ� 00(. tbg� Address: -t 3 ... Sri,..--f N a r �f .,. �a •. > -...r -.1... .-:•tY xJ: r �l s'r�`n YsYg-,�y 1-a 7 .4�. r 'x f t u .r �� 1L-tit-J ��.^�^ -J.i t...L*'.l..s,. ,:-.�±.-•r f. ^r-1.�'ts� f�l•t'�7Y" � r� - �r, Oak Phone a ��, Baa �...� * sir• ik , �,t- ) � � �'�+.• i ' 'tnplt.hkv a...:.. Email-��C ��w..,,• �.., b..• �� x � .• �~Yf �"=`A�cltl�reSS" a,�'gie� .bFO,�+—J �s-,•.y. ��J'��=��.+w �,��'4'ra...t�..W�..`�i�M�"-s-�...-� gg����'�` �'•r ��` �i?;�'tz ,,�r^.. it '���i � ±,r e ye4' [• .�ts4'k�;d.+! a.'T.Y�� $ ��r { z�7 .' i+` _� �w'rf s t xq.t Y�r4�4 SupervisorsConstructionLicense ( S3�°l� T� � sExp ©ate ��'L��}� r � �' - ' ense .�b.� �!'? z.. 5._ .�•".. .,�:Exp ._Date a.�..��b'�z�`�8_:�f, me`Im rovem ARCHITECT/ENGINEER 5�• r Phone: �� g bI B S3 3S Address: K Reg. No. I: FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ ? 65- 2- I 1 "I Recei / � Check No.: t No.: !©69 p NOTE: Persons contracting with unregistered contractors do not have acc ss to the guaranty f d ;• 4 Plans Submitted f Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art ❑ Swmmung Pools ❑" Well ❑ Tobacco Sales ❑ Food Packaging/Saes El Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM i PLANNING DEVELOPMENT Reviewed On Ib ILI Il o Signature_ � 1 COMMENT'S fv I CONSERVATION Reviewed on `-` b Si nature " COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I - Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgoo Street FIRE DEPARTMENT Ternp ®ucnpster Located at 1►24 ain Street *.t z '� �,.x'="� x- _ a . rx ,r ` C®MMENTSR ax•,„ �� f 4 ' 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 s . NOTES and DATA— (For department use) U Notified for pickup Call Email Date Time Contact Name - Doc.Building Pex7nit Revised 2014 Building Department artment { I 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 45 Floor Plan Or Proposed Interior Work 4� Engineering Affidavits for Engineered products ®TE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Jess ► �� Building Permit Application _ -0 ,� S Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit 4 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 i I Location. 'No. Date ` %'`' • - TOWN.OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ 1 TOTAL $ y. Check#. o� 31069 Builcii g nspecto�ro, Plans Submitted-6 Plans Waived ❑ Certified Plot Plan Stamped Flans ❑ TYPE OF SEWERAGE DISPOSAL :. Public Sewer Tamiug/Massage/Eody 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 PLANNING DEVELOPMENT Reviewed On)bl H 20o Signature COMMENTS CONSERVATION Reviewed on FLCA Signature COMMENTS HEALTH Reviewed on_ Signature COMMENTS 9 Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/semnature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgoo Street FIRE DEPARTMENT:- Temp Dwrnpster on sit- yes t Located at 05-W I1/IMENTS .t ' ' f . `t : r. ,. •fiu: �° , . Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 2213000.00 m $ - $ 2,652.00 Plumbing Fee $ 331.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 331.50 Total fees collected $ 3,415.00 273 Greene Street 426-2017 on 10/20/2016 add 20x28 two stall garage with living space above pORTH '9 Town of _ over p No. 2(p aw �? AKI�o h ver, Mass, Zc9 <oc«Ic"IW1C« 1' pqoIL RATED 01,P S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......................�...�r .N....... ...�l�l�:�t... .T..!��.��.................................. BUILDING INSPECTOR has permission to erect buildings on �' .. . 3.. .. . . . Foundation Rough to be occupied as ......... .zg ....... .... ....... ,�. .�4�!' ... ...,F.............. ..l�' Chimney provided that the person accepting this permit shall in evell 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 CONSTR ION RTS Rough Service .... ..... .. . .................. Final / BUILDI INS ECTOR 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. 'i -�•� t i • 98 Forest Street Keav1 n,, ux'p y, North Andover,MA 01845 78-688-5335 FAX:9978-688 7207 Building Contractor Proposal To: John Savastano 273 Green Street All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma. 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Room 1301,Boston,MA 02108.(617}727 8598 CC: Date: 10/12/2016 Job: Inlaw addition/garage Date of plans: 9/16 Architect: Steve Foster Location: Same Section 1-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specked here in writing contractor will begin work on or about 9/30/16. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 1/30/17.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. -Section II-Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following 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 subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall, at his own expense,forthwith remedy, repair correct, replace,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. Section 111-Scope of Work Page 1 of 5 Kevin Murphy Page 2 of 5 Building contractor 98 Forest Street North Andover,MA 01845 PH:978688-5335 FAX 978588-7207 General Proposal is to add 28'x28 garage with rooms above as shown on plans. Building permit will be obtained by contractor. Owner to provide plans, plot plan, and any variances/structural engineering that may be required by town. Excavating Excavation required to install foundation / driveway will be provided. Any additional fill will be removed from site. Back filling and rough grading will be provided. No allowance has been made for relocation of any underground utilities, removal of ledge, landscaping or lawn installation. An allowance of $5000 has been included for retaining walls. New driveway will be paved. Foundation Poured concrete foundation will provided as shown on plans. Footings will be 10'x20", walls will be 10" thick, grade to be determined in field. Foundation will be coated to code. Five inch thick concrete floor,will be poured over crushed stone base. Concrete cutting will be provided to gain access to existing basement area. Doghouse to existing basement area will be removed and blocked up. Building All frame, roof, and siding materials will be supplied and installed to match existing / meet code/as shown on plans. Floor joists and roof rafters will be 2x10. Exterior walls will be 2x6. Interior petitions will be 2x4. All floor, wall, and roof sheathing will be fir plywood ( 3/4 on floors, 1/2 on walls, 5/8 on roof) . Ice and water sheild will be installed at all roof edges. Roof shingles to match existing. Exterior walls will be wrapped with Tyvek or equivalent. Vinyl siding will be supplied and installed to match existing ( as close as is available ) . Harvey, all vinyl windows, will be supplied and installed as shown on plans. Insulated fiberglass exterior doors will be supplied and installed as shown on plans. One insulated steel garage door and opener will be supplied and installed. Harvey all vinyl replacement windows will be supplied and installed in existing openings in main house. Hopper windows in basement will be replaced with new Harvey units. Plumbing Plumbing required to add new kitchen, three fixture bath, and laundry connections will be provided. An allowance of$4000 has been included for fixtures. A separate gas fired hot water heater will be supplied and installed. Any new water or gas meters required,will be provided by owner. Electrical Electrical work required to wire addition to code will be provided. Twelve recessed lights have been included. General layout to be approved by owner prior to rough. Panasonic fan / light will be supplied / installed in bathroom. Any surface mounted fixtures ( ceiling fans, vanity lights ) to be supplied by owner, installed by contractor. Phone/cable/computer lines to be roughed in by electrician, to be connected by service provider. No allowance has been included to provide any high def TV /surround sound wiring. Existing electrical service will replaced/upgraded with two meters. Heating/Air Conditioning A separate gas fired, forced hot air heating / air conditioning system will be supplied and installed to properly heat/cool addition. Insulation Kevin Murphy Page 3 of 5 Building Contractor 98 Forest Street North Andover,MA 01845 PH:9788885335 FAX 978&8&7207 Fiberglass insulation will be installed to code. Plaster Addition will be blueboarded and skimcoat plastered. Ceilings in first floor will be smooth. Garage will be textured. Interior Trim/Doors Pre-primed interior trim and doors will be supplied and installed to match existing. An allowance of$15,000 has been included to supply kitchen and bath cabinets/counters. Painting Interior painting will be provided. One coat of primer, and two coats of finish will be applied to all painted surfaces. Flooring Hardwood floors will be provided in living room, bedroom, and kitchen, to match existing house. Three coats of oil based urethane will be applied. Tile floor will be provided in bathroom. An allowance of$6 per square foot has been included for tile materials. Waste Removal All construction debris will be disposed of by contractor. Items Not Included No allowance has been made to provide any applainces. Kevin Murphy Page 5 of 5 Building Contractor 98 Forest Sheet North nrdaver,MA 01846 PH:9786886335 FAX:978488.7207 Section N-Price Schedule We hereby propose to furnish material and labor-complete in Accordance with above specifications for the sum of.....................................$ 221,000 Payment to be made as follows: Percentage/Item Description Amount 1 Permit obtained / deposit $15,000 2 , Foundation poured $25,000 3 Roof frame complete $35,000 4 Windows / siding installed $30,000 5 Rough plumbing /electlic complete $27,500 6 Plasteling complete $25,000 7 Interior trim /cabinets installed $25,000 8 Painting /floolling complete $20,000 9 Job 100% complete $18,500 i Total 9 $221,000.00 "Notoa,No aweerrent for Hornment oontrac6rlg vocx Shah revoke a dmn paymed(advance deposit)d more twt one4frd of ft tool oontW pike of the total amount of all deposes or I pane*vhch to contactor vast make,In advance.to order ardor oter*ise obtain dOvery d special order materials and eWpment,MhldreNar Is greeter I Contractor. Kevin Murphy 98 Forest Street No.Andover, MA 01845 Registration No: 101874 I Section V-Acceptance Acceptance of Proposal—I have read this document and accept the prices,specifications,and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this l transaction cancellation must be done in writing l DO N SIG HIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Date v Signature Date p� kb p6 N83'00'00"E IP FND 148.38' LOT AREA= 17,595 S.F. ss>s 90x3 90x6 ­ 9328 /E. Spot Grade (Typ) 49.5' .:SHED 58.3' 0 i 90x4 ROOFED U g X; BULKHEAD 94x.5 91x2 93x9 //// /L// 14.6' W 26.5' 'Oo EX. 2 CAR I Q g6 i o 90x9 y PROP. ADDITION x/ TOP of Foundation GARAGE / ^O 3 2 CAR GARAGE j Elevotion=100.00' 16.0' ro p Nw/LIVING 0 9 1 x9 AREA ABOVE / EXISTING / u) n 96x8% STSRUCTTURED %/ ECa Bit. z Z 24.8'# 273 89(6 28.0' Driveway — ni ?aOp• Bit* 95r Conc. r 91x0; 36.9' 328' Driveway I 30.2' 77.8' 17.7' 14.2' _ 1 1 94x5 S81'1 T'52"W SBDH N81• Se CTR 141.15' FND 9.25'�44'W BACK FND �Q.t,P G R E E N E S T R E E T 90x1 Edge of Pavement . PLAN PURPOSE: 32x3 DEED REFERENCES: OWNER INFORMATION: BK: 2851 PG:313 (N.E.R.D.) TO PERMIT A TWO FAMILY DWELLING LORRAINE M. SAVASTANO PLAN REFERENCES: ZONING TABLE: 273 GREENE STREET NORTH ANDOVER, MA 01845 PLAN# 2469 ZONING DISTRICT: R4 ASSESSOR INFORMATION: REQUIRED PROVIDED �gt1aO ASSESSOR MAP 16 PARCEL 62 MAX. HEIGHT 35 FEET < 35 FT Ir J MIN. FRONT SETBACK 30 FT * 30.2 FT i699� NORTH ANDOVER ZONING MIN. FRONT SETBACK 20 FT ** 16.0 FT*** BOARD OF APPEALS MIN. SIDE SETBACK 15 FT 24.8 FT MIN. REAR SETBACK 30 FT 56.3 FT MIN. LOT FRONTAGE 100 FT 150.40 FT I CERTIFY THAT THIS PLAN HAS BEEN PREPARED IN MIN. LOT AREA 12,500 S.F. 17,595 S.F. ACCORDANCE WITH THE RULES * SETBACK REQUIRED OFF OF GREENE STREET AND REGULATIONS OF THE REGISTERS OF DEEDS. ** SETBACK REQUIRED OFF OF TRINITY COURT PER CORNER LOT REQUIREMENT IN R4 DISTRICT DATE: _______ *** EXISTING RESERVED FOR REGISTRY USE ONLY PLOT PLAN OF LAND #273 GREENE STREET NORTH ANDOVER, MA PREPARED BY: SULLIVAN ENGINEERING GROUP, LLC P.O. BOX 2004 WOBURN, MA 01888 GRAPHIC SCALE 781-854-8644 SCALE:1"=20' 0 10 20 SCALE: 1"=20' DATE: 7/12/16 E'111_,RGY CONSERVATION A.PFLICATION FORM FGR L&W-RISE RESIDENTIAL NEW CONSTRUCT ION and ADDITIONS 780 CMR Appendix J Applicant Name: �Ca..:.. `-�„ $�.,a Site Address: 2.-1l awn. NV Use Group: s�.�.,._d�,,,�1 Date of Application: kvl k- A - \6 Applicant Phone: sn oi - b 5 3?�� Applicant Signature: Compliance Path (check one): ❑ Prescriptive Package (Limited to 1- or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.1 b): Heating Degree Days (HDD65) from Table J5.2.1 a: (For items d. through i., fill in all values that apply from Table J5.2.1b:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area sq.ft. g. Floor R-value R- c._Glazing %000 x b_a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE ❑ Component Performance: "Manual Trade-Off' (Limited to wood or metal framed buildings only) CIimate Zone(from Figure J6.22) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if applicable] ❑ AL4Scheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate (HERS rating score must be 83 or higher) ❑ Systems Analysis vR ❑ Renewable Energy Sources Attach Mass Registered rchitect or Enaincer Analysis A-1 TERN_4TIVE FOR ALDDITIONS ONLY: .a. Gauss vdall T Ceiling,'Leal jLt sq.ft. b. Glazing Areal V1,5 sq.ft. c. Glazing % (100 x b-a) ADDITION with Glazing % (c.) up to 40% may use.780 CMR Table J1.12.3.1 below: MA`:IlI1iM ii-v-,lue MININfUM R-V21ues 1 Fenestratior-� Crilinv3 I Wail I Floor I Basement Wall S!ab Pcrimeter De to i-0.392 ( R-37 R-13 I R-19 R-10 R-10.4 ft t Glaring Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC Iisting. 6,pplies either to every unit, or to area-weighted average of all units. R-30 ceili'n- insulation r.;ay be used in place of R-337 if the insuiation achieves the full R-v,due c�cr the entire ceiiin area r,vF.Lr e::t::rior wails,and Including any acccS_openings.) ❑ L'SU1 -JZO ;1" addition (treater Than 40% bla link-to-Fall and ceittng;rosy area) Lacil �.�On..urner iiZ;Oi:i,<.00n fill irCnl %c p,- i P". Official's Signature: - The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 UV www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE]FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business!Organization/lndividual): Address: City/State/Zip: �,)v , 4 md•vvq-,,, o pt Phone#: Are you an employer?Check the appropriate box: Type Of project(required): I.o l am a employer with - employers(full and/or part-time).* 7. p New construction 201 am a sole proprietor or partnership and have no employees working for me in 8. Eg Remodeling any capacity.[No workers'comp.insurance required.] 301 am a homeowner doing all work myselL[No workers'comp.insurance rcquimd.]t 9. F-1 Demolition 4•❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 a Building addition caaue that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 22.❑Plumbing repairs or additions 5 1 am a genal contractor and I have hired the sub-contractors listed on the attached sho=t 13❑Rf airs These subcontractors have employees and have workers'comp.ins,rance.t oorep 6. We are a corporation and its officers have exercised their right of a El Other ❑ rpo gh exemption per MGL c. 14. 152,§1(41 and we have no employees.[No workers'comp.insurance required.] Any applicant that chocks box#1 mast also fill out the section below showing their workers'compensation policy information- t Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicating such. iContractors that chock this box mast attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer that is providing workers'compensation insurance for my employees. Below is the policyand job site information. Insurance Company Name: £ Policy#or Self-ins.Lic.#: lL l: 1...� '1 Z.b SO Expiration Date: Job.Site Address: 7-'13 City/State/Zip: 1,J V, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder MGL c. I52,§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 5250.00 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,certfy ffoder the pains and penallies of perjury that the information provided above is true and correct. Sip-nature: �' �- �.`� ���� - Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# 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 It: DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F711112016 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELYOR 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 REPRESENTATN®R PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certiftcateholderis an ADDITIONALINSURED,the policy(les)must have ADDITIONALINSURED provisionsor be endorsed. If SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policiesmayrequirean endorsement.A statement on this certi0catedoesnot confer rights to the certificateholder In lieu of such endorsement(.). PRODUCER NAME CONTACT Sandi Munroe M P ROBERTS INS AGCY INC PHONE FAX (978)683-3147 A.C,Ne.E.t: (978)683-8073 C. 1060 Osgood Street AOESS: sandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING & REMODELING INSURER : GUARD INSURANCE 98 FOREST STREET INSURERC: NORTH ANDOVER, MA 01845 INSURERD: INSURER E INSURER F: OVERAGES 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 POUCY 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, EXCLUSIONSAND CONDITIONS OF SUCHPOLICIES.LIMITS SHOWNMAY HAVESEENREDUCED BY PAID CLAIMS. a POLICY EFF Y EXP TYPE OF INSURANCE POLICY NUMBER MMIDD/YVYY MMIDMIDDRMEDE.XP(Anyompemm) LIMITS X COMMERCIALGENERAL LIABILITY EAC $ 11000,0010 CLAI.-E �X OCCUR _ $ 500,000 $ 15,000 A BOPI068945 1/22/15 1/22/16 PERSONALS ADV INJURY $ INCLUDED GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D JPEEC E)LOC PRODUCTS-COMP/OPAGG s 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINEDtlenl SINGLE LIMIT $ 1,000,000 Ea accl ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED MCA7013608 01/23/16 01/23/17 A AUTOS ONLY X AUTOS BODILY INJURY(Peraccitlent) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per,= , $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 H A X EXCESS LIAB CLAIMS-MA E AGGREGATE $ 1,000,000 RET DEC X ENTION $ 10,000 CUP 9145304 1/22/15 1/22/16 $ WORKERS COMPENSATION X TUTE ER PER Ell AND EMPLOYERS'LIABILITY STA _ YI" 500 000 a B orrssansevesnaEescecunvs D NIA E.L.EACH ACCIDENT S / (Mandatorlln NH)ru F(EWC726509 7/01/16 07/01/17 E.L.DISEASE-EA EMPLOYEE $ 500/000, If yes,describe under 500,000 DESCRIPTION OFOPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if rrnre space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER 1600 OSGOOD STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Oou jLF- panel CS - pF Header to extend 1/sailePony ll/al/refs'to11 to extend Table R602,10,4,1,/end over f!/ai/Panel over fU6/l Panel Figure 8601.10.4,1,1 For To of Pets Double Top Plate Pony 111611 height, opening with 2 Rows tad m 3"o c. 0651 end required tension str�p t k k k t L Ul N N N ' Connect Plate to N with 1 rows !Oil Halls ®11"oc, h L57A 36 n 6 - 16d Sinkers ,» + II stud to Meador S/ '•��••;; •••« son Strt�GIVAlS7 �•: ♦♦ r ♦ * `ray iii .. mp �o I, •Y. Nor �q a. - .. - - T 0 at each end or opening I n,�` —3'owe tad valla on Inside face of wall w �' N v 1?"o,c, etyp,J m extend to top or wall • •" Q�1 connect 6herathiple to Header 11 I� 0 4 „ ` Con»acE Plate to Naeder Wr i z 1j 'I with Bd r�alls3"a,c. 'I " with 2 rove /6d S/nke' f h Id I,I II U Nalls B-9 o,c. ° "U I C IF Jj :a�d ar/d as shown ° k Blocking for sheathing o i y j �¢ 9hsath/ng Bpllee Q 4'above top of 4 c O Ct cation Within m/dd/e 24" 0 Q foundat/ori ComeSinker U j N Halle -,411 Studs,Platen, with(3>- !6d Sinker N6Ile Q3/11s I aloekirg ag, o,c,;42.) nnect Studs with 1 rows II u 10d valla 14 a o.c, I - l/?" 4nbhoraas,e with 1 1/1"x?!/?"x 3/l6"1(/seher Plat® 4307 Bolts, 7"embed fm/rtJ ;heAthtnc.� JE'tst�utrtsmentg "4 Dowels at corner 'b M4 Reber, U110 /5"46p T!B of wal/� r 0pe L n/ 2 Ov(m/n.J-lB�.0 (max.) (546r4c7e Door Method CS - )OF t t FPrepared SSl: continuous Portal Frame 5� utrsment$ R60?,10,4.1//RC 1009 r S/mIlar> Ler O den ry 9' Cond/t Iona �L lmttat Ions . Ogden Eng/veering Note, 978-502--69?! Can only be used with 3 continuous sheathing r'hls dt°tal/ /s schematic, � E-mall: lhogen�comcaat,net see Foundat Ion Plan f car o� M/n/mum Panel length L= g " Wall PaneM/n/mum PanBl Length L! lengths and location o'NL? a:o°openingheighe/6'" or ST8trapa and Anchor Solta " q O�i� � � , 9=0"opening helam la„ 0 Each panel length L counts pR btoward the toga/required of " NA ��\ l'. _ Bracing in the well Line, l`laximum of 4 Pamela Q In Braced"If Line � ]PROJECir: ID LAVWN 004D P. F'A"JeL 19s. ,T' Sr T G-hRAc-M 'Poon •t.4o GO]t 't) 1; .®1�$3 SAVASTANO RESIDENCE US sTMEEr C 5 ZZ (1(. 978352-83;8;cell 97S-50,21-5921..• NOM ANDOVER M