HomeMy WebLinkAboutBuilding Permit #289-13 - 335 CHESTNUT STREET 10/11/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ® / Date Receivedle, Z_
Date Issued:
I ORTANT:Applicant must complete all items on this page
LOCATION' E3 S ��- S �•��i t -
- -- Print,
PROPERTY OWNER O h„� C.C. ✓F - --
_--- _ -
Prinf 1oo}YearaOid Structure, yes no,
MAP NO: 1PARCEL: Z-ZONING DISTRICT: 'Historic District ye no;
- Machine:Shop Village ye no'.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building kOne family
❑Addition ❑Two or more family ❑ Industrial
'Alteration No. of units: ❑ Commercial
.'Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Ll Septic: ❑Well -d--F-,,l oodplain F]Wetlands ElWatershedDistricf
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: '�`�•� :��� c,-S Phone:
Address: 33 S
�: . �L� �c `% _ Phone
CONTRACTOR Name: b
�-- � . l
Address, a1,---ZN rz" ( . } � -t--- -1�' �A �o�� -qA_ y 2 9r
Supervisor'isZonstruction License;: t--4"a1, - Exp:. Date:.
Home..Improvement License:; j a CJ g Exp; pate
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: $ 1`45cllz FEE: 0i
Check No.: /Y- Receipt No.:.2!ro
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/gwner Signatui-e,of contractor, , n
ni--- C-..1,_;44_A n Dlnno 1AIn Carl I1 rcrtifiarl Pint Plan F] I;tamnpri Plans F1
�j ;:
Location
No. 3 Date tJ ! \Z-
f
• • TOWN OF NORTH ANDOVER
sTYD',6� ` .
e
• Certificate of Occupancy $
iiyBuilding/Frame Permit Fee $ •
' - Foundation Permit Fee $
Other Permit Fee $ '
TOTAL $ s
Check#-114 11
25812 BuildingInspector
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
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 Os ood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at'124.Main,Street.
Fire Dep6rtment.si1§hatu`re/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.$10041000 fine
NOTES and DATA—(For department use
i
® Notified for pickup - Date
Doc.Building Permit Revised 2010 .
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
❑ Copy of Contract
a Floor Plan Or Proposed Interior Work
a Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
j ❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o 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: Doc.Building Permit Revised 2012
r 1 NORTH
_ � . . .. . ic . " ve'
No. -
t� i
o �^�, h ver, Mass, /0
COCNIC Nl W.CN
044r
S U
BOARD OF HEALTH
�PE IT T D Food/Kitchen
Septic System
THIS CERTIFIES THAT ...... ..��G.4�..��/!G%�! .:........................ .................................................... BUILDING INSPECTOR
Foundation'
has permission to erect............................ buildings on ...............................................................
Rough
.....
/�
to be occupied as ...............�/.'/„�:....��:l:f'...0.1.-�.1,? ................................................................. 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO STARTS Rough
Service
............ ... ..c.Z.ra�./.. ... ....................... '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.
SEE REVERSE SIDE
r 7 NORTI-H -
, bIL .c . : ve." 'o
0
No. I T *_,
h
h ver, Mass, /0///C.
COCHIC"f WICK y1.
X1,9 A°RwrEo ►Pp,��S
S U
�1 T TBOARD OF HEALTH
Food/Kitchen
. PE L D Septic System
THIS CERTIFIES THAT W.. ...... BUILDING INSPECTOR
has permission to erect ... buildings on ��.. Foundation'
Rough
to be occupied as ..............._1`,.;,Q.....Rcn�.�..ao ...................................................................... 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO STARTS Rough
Service
............F.... . ..................................... 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.
SEE REVERSE SIDE
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.niass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Len Gibely Contracting Company
Address: 23R Winter Street
City/State/Zip:
Peabody, MA 01960 Phone.#: 978 531 -8234
Are you an employer?Check the appropriate box: Type of project(required):
I.® I am a employer with 12 4. ❑ I am a general contractor and I
employees(full and/or part-time),* have hired the sub-contractors 6. ❑New construction
2.U I am a sole proprietor or partner- listed on the attached sheet.. 7. ❑Remodeling
strip and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. ❑.Building addition
required.]' 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.[1 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.LJ Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#1 must 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 then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A.I.M. Mutual Insurance Company
Policy#or Self-ins. Lic.#: 6010979012012 Expiration Date: 08/03/2013
Job Site Address: 3City/State/Zip:_
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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 1 / �r �.•. Date
Phone#:
Official use only. Do not write irr this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone 4:
5ennott Insurance
,. CERTIFICATE OF LIABILITY INSURANCE .
THIS CUTTYICAT>f Ie ISeva A$ A 1YLTTRR 0/ 401"aIOR wilt x90 C01MRSR0 RIGHTS poll TSL C6RTIr2 MOLDIR. mra CTSSTII'IGTR
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Agenoy Inc
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Topafield, MA 01983—
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Len Gibely Contracting Conpany Inc II[OYRA;A.I,N, Mutual Ineuranco Co 33758
23 Winter Street Rear nevYa 11
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COVERAGES CERTII`ICATE WJMXR: REVISION NUbMA:
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M1AIH, TPIC INSVAANCL ArtORDla 9Y IHL poLICILS DGSCRLUM FOSIEIN IH SUBJECT TO ALL THE TERM, Z=V$I0P$AND CO9DITI0191 Or $VCR POT.ICIr6. LaUTE SN"
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Evidence o f Insurance SH vm ANY or TM Ae DYt OtSq a=POLICIM BE GNCZLLW Bauer rim
G<DMAI'109 DATE TiOI=f, NOTlQ WILL or DCLrAM 19 ACCOPDTJICC PMH Tr¢
POLICY PROVISIORB.
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JAN-24-2012 14:35 Sennott Insurance 978 887 2484 F.01
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01/24/2012
�• PRODUCER 915,887.4900 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. Bax 451
Topsfield, MA 01983 _ INSURERS AFFORDING COVERAGE INAIC0
,Nsumu Len Gibely Contracting Co., Inc. - INSURERA Catlin Specialty Insurance Co _
23R Winter Street INSURER B. '-- ' 19038
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 INDICAYEO NOTWITHS rANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEO 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,
ILTR N&A TYPE OF INSURANCE �• POLICY NUMBER POLICY EFTECTIV POLICY EXPIRATION
DATE IMMIOOrTYYV DATE tMWDCIYYYYI LIMITS
GENERALUABILrn 3700301015 01/29/2012 01/29/2013 EACHOCCURRENCE 6 1,000,00
X COMMERCIAL GENERA.LIABILITY TO RENTED
PREMI E6 Ea occurrence T LDQ
CLAIMS MADE a OCCUR ME EXP(Any orw Pinion) 1 51000
A PEASONA4&ADV INJURY $ 1 000,00()
—„_... GENERAL AGGREGATE t 2 1 POO,00
GENT,AGGREGATT;LIMITAPPLIES PER: PRODUCTS.COMPIOP AGG $ 2 000 00
POLICYF-j iEC7 LOC _ L.�'-_--
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AVIV AUTO COMBINED SINGLE LIMIT Y
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OTHER
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DESCRIPTION OF OPERATIONS/LOCAnONS I VEHICLES/EXCLUSIONS ADOEO aT ENDORSEMENT I SPECIAL PROVISIONS -
VIDENCE OF 2012 RENEWAL COVERAGES.
I
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCR(BEO POLICIES BE CANCELLED BEFORE THE EXYIHAYIONI
DATE;THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WWII LN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 60 SMALL
IMPOSE NOOBUGATION OR LlADILTTY OF ANY KIND UPON THE INSURE&Iib AGENT&OR
REPRESENTATIVE&.
AUTHORLZED REPRESENTATIVE
Sennott Ins. Agency
ACORD 25(2009101) m 1988-2009 ACORD CORPORATION. All right9 revarvad.
The ACORD name and logo are registered marks of ACORn
t (
LEN GIBELY CONTRACTING CO., INC. Page No._of Pages
23819 PROPOSAL
238 Winter Street ,
PEABODY,MASSACHUSETTS 01960
All home Improvement contractors and subcontractors
(978)531.8234 Fax(978)531-9304 // engaged In home Improvement contracting,unless
www.langibelycontracting.com !� specifically exempt from registration by Provisions of
C40
Chapter 142A of the general laws,must be registered
Submitted v okw f�'I I s. with the Commonwealth of Massachusetts.Inquiries
To: I� - ... about registration and status should be made to the
Director,Home Improvement Contract Registration,
q1,9 _A/`�s- �T//I D12- One Ashburton Place,Room 1301,Boston,MA 02108
(617) 727-8598. Owners who secure their own
Tc Wks d U yr �� 0/8 7 construction related permits or deal with unregistered
---•-- ------�-----------------------.-.-- . contractors will be excluded from the Guaranty Fund
Provision of MGL c.142A.
PHONE DATE REOISTRATION NO.
g e- Sag - S 6 1 8 "! ' )2_ MA.REG.100811
JOB NAME/NO. JOB LOCATION A
33S C ye$7W U7 sr /U�lLTN
We hereby submit specifications"estimates for work to be performed and materials to be used:
---------'---- --__----—- - ...- ---' —'- ooh0/,a C,-11 eA77-
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h.f cl-ir _1/_G�/)l'OC-101j �Ylsa9�� �g J 1 CLZ-6
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j yy oG __-`�"-: _ ..__,Ltis •al/.._._._ _!-' 'F. ..-....���_...r%_a��,�._ S'...�fi ----Uc��S
Cjon�struct`ion relat permits:
_
/'�.11�_ �r.gl.rn�Ee j'__0 h.._.._/�_C(--•-n_4.o0�_uC�`5---.:�_'�/'_'t_----�-'�6
WORK S�r�71lLE ..
Contra�oeyB.hot n work or order the maldrkiS before me third day following are signing of this Agreement,unless specified herein wrW will begin the work on or
about aL.W (data).aarMg dofpy enuaed by circumstances beyond contractors control,the work will be completed by date).The Owner hereby
WARRAodges and agrees That Ula fUroOulstg dales ale approximate and that Such delays that ate not avoidable try the contractor shall be cents
on *r_*Id
d a tons of this Agreement.
WARRANTY
The Co naaaor warrents that Iho work furnished hereunder shall bo Iree hOm dol—In material and workmanahip lot a perlod of�tlowing plexal and chop comply with
Ilro roguiremOnW of Nb Agreement.In Uro event any defect IIt WOnunanaNp dr matefiB�,a danlaQO cau600 by the CpnUadOr,hiS SU Clae,Cmpl0ydB8 Or apOms.is discovered within
ons year allOr completion of any f W,Including seen up,the contractor OhAll,at his own p%p011ea,i.hwUh femady,repair,Correct,mala a cause to be remedied,repaired,a replaced,
such damage or Such decor In motedals of workmanship.The foregoing weNamfas shall survive any inspection performed In connecton with the agreed-upon work.
We Propose hereby to furnish material and labor-complete in accordance with above specifications,for
the sum of:
dollars($-7
Payment to be m de as follow - /�73 # /
—• J ..Jeeel�I/3/1.2— + 700 CC
(S )upon signing Contra ,
Name 01 Coafraclor/Deef9mad nepiranl
—•is 1'4' )upon completion of
__... .. .
SaC*I A(Wf095 -
%(S )upon completion of
I Ciry/smote pno
shall be made torawtth upon
completion of work under this contract. prn - - L_ID No.
Notice: No agreement for home Improvement contracting work shall require a down ria —
Payment(advance deposit)of more than one-third of the total contract price Or the
total amount of all deposits or payments which the contractor must make,in advance, _
to order and/or otherwise obtain delivery of special order materials and equipment,
Imo i ceve
nr amount is greater
j1.:: RyINn wlNtlraan by us it not a pled wkhin days.
Acceptance of Proposal I have read both sides of this document and Mpll 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 of the third business day after the
date of this transaction.Cancellation must be done in writing.
O T SIGNTHIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Sgnawm Dare i ��sensmre Data
IMPORTANT INFORMATION ON BACK �►
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
License:CS-094763
1,Is
THOMAS K DO&BINS.
19 Cedar HdWrive
Danvers MA—,01923 I
Expiration
Commissioner 05/1412014
'6 11M)Ilfllaocal�ll
Office of Consumer Affairs&Business Regulation
License or registration valid for inclividul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
iry4Vegistration: 100811 Type: Office of Consumer Affairs and Business Regulation
- ,expiration: 6/23/2014 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 valkid;;' 7utiggInature