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HomeMy WebLinkAboutBuilding Permit #198-15 - 3 LINDEN AVENUE 8/25/2014 TOWN OF NORTH ANDOVER I� APPLICATION FOR PLAN EXAMINATION Permit NO: I ° ✓`J Date Received Date Issued: v IMPORTANT:Applicant must complete all items on this page LOCATION' Print, PROPERTY°OWN:ER 8 - = _ - -- _ Print100 Year old Structure s' no . MAP NO: PARCEL. ZONING DISTRICT: Historic District yes: no• '- - Machine Shop;Village es a no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic:, ❑Well' ❑,Floodplain, ❑Wetlands. . D Watershed District .Water%S:ewer DESCRIPTION OF WORK TO BE PERFORMED: - A LL 1 5 O Identification Please Type or Print Clearly) OWNER: Name: GL. ,4 r,V /-1A96Aa- Phone: q78 Address: L -,,q-r)-P--, A"4�p CON�iRACTOR Name: �.�,e�v_G`b ti-Y.=.C_ .,..�— _P_hone: -- - -- _ s_ - _ - - Supervisor's Construction L__icense: . ��_� _ Exp. 'Date: Home Improvementlicense;, b 6 2 Exp., Date; ~-2 (C. 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. = I Total Project Cost: $ FEE: $ a% ,W� — i. Check No.: �721 Receipt No.: -7, -7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund `SI nature_of A en Qwner` o.. gnature of contractor Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ 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 HEALTH Reviewed on Signature COMMENTS �1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments t Waer& Sewer Connection r /Sig nature& Date Driveway Permit r DP)W Town Engineer: Signature: c V Located 384 Osgood Street ' FIRE DEPARTMENT -Temp Dumpster on site yes, no Located at:124 Main:Street- Fire Depart'rrient-sigriatu"re/date COMMENTS t Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, roast 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 2010 i 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) a 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: Doc.Building permit Revised 2012 Locations No. Date 1 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ "S TOTAL $ . Check* 27942 Building Inspector � c10 R TFr Town of � _ ndover No. h ver, Mass 9J► �' ��20 o� 7 COCNICHI WICK ��• S S V BOARD OF HEALTH Food/Kitchen PERM LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............... ... I.......... . . + . ............................................... Foundation has permission to erect .......................... buildings on ..3... Aq.e.w.vj................... • Rough to be occupied as .... ........ l . &"t....�........................................................................ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final o PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S S 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. A�Ro® CERTIFICATE OF LIABILITY INSURANCE DATE(MhUDD/YYYY) 08101/2014 THIS CERTIFICATE IS ISSUED AS AI 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 PGlicy(ies)must be endorsed. If SUBROGATION IS WAIVEDsubject 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 :cT Edward F Sennott Insurance 99 16 South Main Street .a• 1: � .N Topsfield,MA 01983 ss: INSURED A.I.M.Mutual Insurance Company _ 26168 Len Gibely Contracting Company Inc INSURER El' 2J Winter Street Roar INSURER C Peabody,MA 01960.6941 IN§URER E: COVERAGES 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 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, N EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER WAITSGENERAL LIABILITY EACH OCCURRENCE ; CONwERCIAL GENERAL LIABILITY 1MA(,�f6R'EN1 E^ CLAIMSMADE OCCUR PR s MED EXP(Any one parson) S -� PERSONAL b ADV INJURY S - -•-- GENERAL AGGREGATE $ -- PJJ'L AGGREGATE LIMIT APPLIES PER; —I � UCTS•C.OMFYOP AGG S _-- —pollcr —.U�. oc PROD AUTOMOBILE LIABILITY ANY AUTO ALL OANED SCHEDULED BODILY INJURY(Per person) s AUTOS AUTOS BODILY INJURY(Per accident) s HIRED AUTOS NON-0VrNED - AUTOS 'G $ prit) UMBRELLA LlAB =OCCUR sEXCESS LIAR MADE EACH OCCURRENCE __- AGGREGATE s W_opKDERDg RRE�gTI NTIIONN s _ AND EPLOYERS LIABI�ITY 5 .T_ 1Hpp �7�R�pq MEACHACCIDENT O �. A O� ICER/Mrer1�pt�Itl�� ECUTIVE�Y I�N� s ^600,000.00 (ManoutoryInNH) l�J N/A VWC-1006010979-2014A 8/3/2014 8/31201$ -� PLOYEE $ 500,000.00 PERATI N bwY LIMB $ 600,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Sclwdule,H more space la 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 a ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CORD CORPORATION.All r g is reserved. ACORQ, CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDD/YYYY) - 02/06/2014 I F iODUCER 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 P. 0. Box 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Topsfiel d, MA 01983 INSURERS AFFORDING COVERAGE NAIC# I INSURED Len Gibe y Contracting Co. , Inc. INSURERA Catlin Specialty Insurance Co 23R Winter Street INsuRERB: 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 POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CONDITIONS OF SUCH sa�aDa _ _ TR (NSR TYPE OF INSURANCE POLICY NUMBER DATE MMPIOMY FDWYYYY DATE MM/OD/YYYY LIMITS GENERAL LIABILITY 3700302145 01/29/2014 01/29/2015 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea Eoa urrreence $ _ 100,000 CLAIMS MADE TX OCCUR MED EXP(Any one person) $ 5,00 AI — -- PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE II Z QUO,O0 GEN'L AGGREGATE LIMIT APPLIES PER — I PRO_ PRODUCTS•COMP/OP AGG 3 2 OOO UU POLICY JECT D LOC -L AUTOMOBILELIASILITY 6221693 COM 01 01/29/2014 01/29/2015 ANY AUTO COMBINED SINGLE LIMIT ldant $ (Ea ecc ) 1,000,000 I ALL OWNED AUTOS BODILY INJURY B X' SCHEDULED AUTOS (Per perypn) $ X HIRED AUTOS ---- jBODILY INJURY X NON-OWNED AUTOS (Peracc4ent) $ ----' PROPERTY DAMAGE -- (Per accident) $ I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ j ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ � EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ — 17 RETENTION $ 'I WORKERS COMPENSATION $ _ AND EMPLOYERS'UASIUTY ANY PROPRIETOR/PARTNER/EXECUTIVF TORY LIMITS ER OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory In NH) It yes,desabe wider E.L.DISEASE-EA EMPLOYE S SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMrr $ OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS roof 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. 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 •4f ( d \ The Commowealth!.of Massachusetts Department oflndustrialAccidents U•fj`lce of lmvest gationsess I Con Sire`` Suite I S�" � 00' Boston,MA 02114-2017 ' www.massgoy/dit� Workers.'Compensation Insurance Affidavit: Builders/Contractors/Electrician As lumbers licantInformation Please Prin Name.(Business/Orgmizaaon/Indivldual): �.. Address: - Ci /State/Zi o Phone#: 8.. 5 3 Are you an employer?:Check thi appropriate boz 3 1.�(,I am a employer with 4: I am a general contractor and I Type ofproject.(required): employees(full and or part-time). have hired,the sub-contractors .(]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have`no employees These sub-contractors have.: working for me in any capacity. employees and have workers' 8. []'Demolition [No workers' comp.insurance comp.insurance t 9. []Building addition 3.❑ �1�) We are a coipoiation and its 10: Electrical repairs or additions I am a homeowner doing.all work _ officers have exercised their 1 Lc Plumbing repairs or additions myself. [No workers' comp. . right of exemption per MGL insurance required,]t_ c. 152;'§1(4),and we have no 12,�Roof repairs . employees [No workersME)E)Other comp`insurance required *Any applicant that checks box#1 must also fill out the section below sl owmg then workers'compensation policy information. t HomeownEts wh6 submit this affidavit indicating they are doing all work and then hire outside confractois must submit a new affidavit indicating such. :Contraao.s that checkthis box iniist att Indic- 6 additional sheet s all �PIoY If tliesub-contractors have employees,they must.provide feu wothe e comof el � r and state whether or not those entities have ,. , am an employer that Is providing workers'compensation insurance for my employees. Below Is the o information, p lacy and job site Insurance it: Policy#or Self-ins. tic. # C-1 dd- b 01 C3 q'7 t���Expiration Date: — i--- Job Site Address: :, r. 9 � City/State/Zip Attach a copy of the workers' compensation policy declaration page showin the otic Failure to,secure covers a as P g. $ poll y number and expiration date). $ required uuder.S.ection 25A of MGL c. 152 can lead to,the,imposition of.critninal penalties of fine up to$1,500.00 and/or one- ear ' Y 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 thq.DIA for insurance:coverage;verification Ido hereby certify.un4er the. pros andpenglties.of..perj#ry that the inormahon p : rovided.above:is true,and correct: .f. Si Dat Z Phon Ojjicial 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical 6.Other Inspector 5.Plumbing Inspecter Contact Person: Phone#: Y. LEN GIBELY CONTRACTING CO., INC. Page No. _of _Pages 23R Winter Street 26166 PROPOSAL i 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 1 / with the Commonwealth of Massachusetts. Inquiries Submitted: _ �lOCC,S I y� da r about registration and status should be made to the // Director, Home Improvement Contract Registration, 3 L One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered r `ilo/ J JA/4 -C)(914S - contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. HONEp 1 DATE REGISTRATION N0. Ci ff l h6Z-6 q 3Z I&IY& MA.REG. 100811 J S NAME/NO. JOB LOCATION We hereby submit specifications and estimates for work to be performed and materials to be used: lzaol 0 r )104s CP ZL Q(!__ _a '_c, � s....�--'���.C,�.� WORK SC EDULE Contractor ill the work or order the materials before the third day following the signing of this Agreement,unless specified herein writi g–c r will egin the work on or about—�(date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by to.The Owner hereby acknowle gas and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall t cons'dered as viola io of this Agreement Hidden rotor conditions not seen at time of estimate that are required to be repaired In order to complete this contract,will be completed at$ per man hour(MAN HOUR). WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects In material and workmanship for a period of lollowing 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 clean up,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. We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars($ ). Payment to be made as follows: SCG Remove all job trash. J All guarantees on all products from manufacturer. Z.Ih,� on signing Contract; ` Add permit cost if needed-we pull permit. ($ upon completion of Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract )upon completion ofe'l price or the total amount of all deposits or paym is which the contractor must make,in a o order and/or otherwise fain delivery of special order shall be made lorewith u n m sen -1pmenl, 7v.;, m,, realer. )completion of work under this contract. �- o may be withdrawn by us it not accepted within days. Auth Zetl re Acceptance of Proposal I have read both sides of this document a accept the prices,specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are author' d 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 of the third business day after the date of this transaction.Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature�� Lk� Date /� Signature Date �7 IMPORTANT INFORMATION ON BACK OP- I ......................... Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuprrN ism. t License: CS-094763 THOMAS R DOBBIN 19 Cedar Hill Drive s Danvers MA 01923 Expiration Commissioner 05/1412016 .a �%�[• ��[+arinair[uPn�/�r/r;.�IN.�Jr[[•�a.l r•//J r Office of Consumer Affairs& Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 100811 Type: Office of Consumer Affairs and Business Regulation expiration: 6/23/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 LEN GIBELY CONTRACTING CO., INC. Brian Dobbins 23 R WINTER ST. — PEABODY, MA 01960 Undersecretary Not valid wit ut signature