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HomeMy WebLinkAboutBuilding Permit #702-15 - 419 ANDOVER STREET 3/5/2015BUILDING PERMIT TOWN OF NORTH ANDOVER' <1-0-L APPLICATION FOR PLAN EXAMINATION:` Permit No#: U \ / Date Received:.: , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: R16emolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands Q Watershed bistrict. ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: e�- Identification - Please Type or Print Clearly OWNER: Name:QMbW LLC D64- 5pn4-zm o-PLow-e(/ Phone: US KS'f - ?5'77 Address: �1' Ui c1tri , �- � 0 ll 1,4 Contractor Name: t/,Cwr Oar -14/ - Phone:. J� Address: 5l/ 40g2!;�.^-37 c5/ Gdcr� �l Supervisor's Construction License: O -S- 104 q76 Exp. Date: I(,. Home Improvement License: 73.75Y -,-,.-,Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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.:, $ � Check No.: Receipt. -No:` NOTE: Persons contracting with unregistered contractors do. not ]iave._access o t e gugrg4y_� re Location 411 No.l b2-15 Check #( Iq 28544 Date �1 Is TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee 1U %�— Foundation Permit Fee $ . Other Permit Fee $ TOTAL Building Inspector 11 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYpF.oF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature. COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS �K Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Com Comme C 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 o 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/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 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: Building Permit Revised 2014 a� 0 c 0 EEO AAMNL CA I = Q C c��4 M ¢ �NOO �P v L J i � O a a �m N m _ i. d > cc p n =v:cn0a t t O E c c R cn=o O Lo- 0 - a��CD � m lm� O c c a = K O = as Q. N r u) O V m d W -0— O O 4 - LU I-- T .tiN LD g u) C O Q t O w v 5 O W i 0 O O C.i Q � N N Q u� O O — 0 2 w O Cl O L- r.L CL �a a � J O Z CL O O cr- w �• v O •� L �a s o E n 1-0 i N J O d J � � O 2 O C�� L CD oC Z Q uj O W d OW a cWc G S of of Z Vf ZCL U Lu Q Z D z Z Z V u.l m Q W 0 m DW LL v d J LV L ate+ O �+ N = Y N r'Ja a) N O Z C L L U O Q _ � O C LL LL co N = Q C c��4 M ¢ �NOO �P v L J i � O a a �m N m _ i. d > cc p n =v:cn0a t t O E c c R cn=o O Lo- 0 - a��CD � m lm� O c c a = K O = as Q. N r u) O V m d W -0— O O 4 - LU I-- T .tiN LD g u) C O Q t O w v 5 O W i 0 O O C.i Q � N N Q u� O O — 0 2 w O Cl O L- r.L CL �a a � J O Z CL O O �• v O •� L �a s o E n i N O d J � � 2 C�� L CD O = = Q C c��4 M ¢ �NOO �P v L J i � O a a �m N m _ i. d > cc p n =v:cn0a t t O E c c R cn=o O Lo- 0 - a��CD � m lm� O c c a = K O = as Q. N r u) O V m d W -0— O O 4 - LU I-- T .tiN LD g u) C O Q t O w v 5 O W i 0 O O C.i Q � N N Q u� O O — 0 2 w O Cl O L- r.L CL �a a � J O Z CL . SERVPRO of Lowell Fire & Water. 0—up 6 Reneraibn' SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978)454-7577 tax. id # 27-3673699 Client: Ethan Allen (2) Property: 419 Andover St. N. Andover, MA 01845 Operator: VGRANDE Estimator: Vinny Grande Company: Servpro of Lowell Business: 9 W Adams St #3 Lowell, MA 01851 Type of Estimate: Weight of Ice & Snow Date Entered: 3/5/2015 Price List: MAEM8X MAR15 Labor Efficiency: Restoration/Service/Remodel Estimate: 2015-02-03-1506-3-2 Date Assigned: Home: (978) 685-3546 Business: (978) 454-7577 E-mail: vgrande@servprooflowell. com SERVPRO of Lowell fire 8 Wobr - CInwO 8 Renow�on• SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978)454-7577 tax. id # 27-3673699 2015-02-03-1506-3-2 Main Level Room 1 Height: 8' DESCRIPTION QTY 45. Tear out wet non -salvageable carpet, cut & bag for disp. 350.69 SF 46. Tear out wet carpet pad and bag for disposal 350.69 SF 47. Tear out wet drywall, cleanup, bag for disposal 306.67 SF reflects 2 layers of wall 48. Tear out wet drywall, cleanup, bag for disposal 87.67 SF 49. Tear out and bag wet insulation 241.01 SF Room 2 Height: 8' DESCRIPTION QTY 56. Tear out wet non -salvageable carpet, cut & bag for disp. 251.39 SF 57. Tear out wet carpet pad and bag for disposal 251.39 SF 58. Tear out wet drywall, cleanup, bag for disposal 254.00 SF reflects 2 layers of wall 60. Tear out and bag wet insulation 127.00 SF Room 3 Height: 8' DESCRIPTION QTY 66. Tear out wet non -salvageable carpet, cut & bag for disp. 172.20 SF 67. Tear out wet carpet pad and bag for disposal 172.20 SF 68. Tear out wet drywall, cleanup, bag for disposal 212.00 SF reflects 2 layers of wall 70. Tear out and bag wet insulation 106.00 SF Room 4 Height: 8' DESCRIPTION QTY 78. Tear out wet drywall, cleanup, bag for disposal 217.33 SF reflects 2 layers of wall 80. Tear out and bag wet insulation 108.67 SF 2015-02-03-1506-3-2 3/5/2015 Page: 2 . SERVPRO of Lowell fire 6 W... a—, B P—.1iio " SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 Room 5 DESCRIPTION Height: 8' QTY 86. Tear out wet non -salvageable carpet, cut & bag for disp. 367.03 SF 87. Tear out wet carpet pad and bag for disposal 367.03 SF 88. Tear out wet drywall, cleanup, bag for disposal 315.33 SF reflects 2 layers of wall 90. Tear out and bag wet insulation 157.67 SF Room 6 DESCRIPTION Height: 8' QTY 96. Tear out wet non -salvageable carpet, cut & bag for disp. 222.48 SF 97. Tear out wet carpet pad and bag for disposal 222.48 SF 98. Tear out wet drywall, cleanup, bag for disposal 238.67 SF reflects 2 layers of wall 99. Tear out wet drywall, cleanup, bag for disposal 55.62 SF 100. Tear out and bag wet insulation 174.95 SF Room 7 Height: 8' DESCRIPTION QTY 106. Tear out wet non -salvageable carpet, cut & bag for disp. 467.50 SF 107. Tear out wet carpet pad and bag for disposal 467.50 SF 108. Tear out wet drywall, cleanup, bag for disposal 364.67 SF reflects 2 layers of wall 109. Tear out wet drywall, cleanup, bag for disposal 116.88 SF 110. Tear out and bag wet insulation 299.21 SF Grand Total 4,185.01 Vinny Grande 2015-02-03-1506-3-2 3/5/2015 Page:3 . SERVPRO of Lowell Fre 6 W— - O—p B ResioMion" SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 Grand Total Areas: 3,817.33 SF Walls 2,013.54 SF Floor 0.00 SF Long Wall 2,013.54 Floor Area 2,725.50 Exterior Wall Area 0.00 Surface Area 0.00 Total Ridge Length 2,013.54 SF Ceiling 223.73 SY Flooring 0.00 SF Short Wall 2,144.21 Total Area 302.83 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length 5,830.88 SF Walls and Ceiling 477.17 LF Floor Perimeter 477.17 LF Ceil. Perimeter 3,817.33 Interior Wall Area 0.00 Total Perimeter Length 2015-02-03-1506-3-2 3/5/2015 Page:4 a cit � = o � I M V1 E O O 04 i `f r' ja6 The,Commonwealth of Massachusetts Business Certificate ?—#— z0oomDate In conformity with the Provision of Chapter one hundred and ten Section flue of the General Laws, as amended, the undersigned hereby deelare(s) that a bus cc ceder the go SERVPRO OF L014LL ° is conducted at 9 WEST ADAMS ST 01851 Lowell, 978- 454-7577 by the following nutnedperson(s) !or Co �e rp.,fult name. Name/Corp. GRABRO LLC Signa .�.,.. Residence (Stftt zip) 9 WETS ADAMS., OWELL, MASS. 01851 Name/Corp. Signature Residence (a`ftvet, City, zip) Name/Corp. Signature Residence (Street; City, Zip) Name/Corp. Signature R.esi&nce (staff, (may, Zip) Purpose Of filing flus Business Cfttficate: ❑ New Business 0� �Rtmewal of an° �� ❑ Cheage in a business business certificate address ❑ Partial withdrawal ❑ Disconlinuance of a of an owner business A cert} flcate issued in accordance with this Section shalt be in force and effect for 4 years from the date of issue and shall be renewed each 4ears there ��� and shall Y thereafter so tong as such business shalt be lapse and be void unless so reneweat Middlesex S.S The Commonwealth of Massachusetts 23RD DECEMBER 4am—d On this day of 2ublic or Ci Clerk's designee, perso pep t3' through satisfactory evi of i Proved to me which were to be the P s whose name/s is/ e 'cument, and who swore or aflumod to me that the co of the document e ' and accurate to the best of his/her/their knowledge and °. ' A% A A n /1 n n " SHANNON t3OUVRA COMMission Notary ilia Carsys+enWr.id. �� i_____ _gym My Co�nmia:ion Expiraa /�d��� Dee�rnbar 16, X016 The 13L' s Certificate expires on �J�✓J , otariat or Ci Se ty al): CS -104M VINCICNTJGRAMi 117CLUFFcjtossvmiwsu SALEM MR WM 03MMIS r .TA _..OiilCe OTCAAfAmor fWBd3iAlBBadOA HOME IMPROVEMENT CONTRACTOR TRegbuWon: 173795 �' Explodon: 1111312016 I -I -C GMI LLC. SEjqVPRO OF LOWELL VINCENT GRANDE 9 W. ADAMS ST d3 LOWELL, MA 018$1 Underree"WY License or registration valid for Individui use only before the expiration date. If found returu to: Office of Consumer Affairs and Business RegulatAon 10 Park Plaza - Sane $170 $egg, A 02116 A� A Not v out signature GRABLLC-01 CONNIEI '`'`C -"K" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) TYPE OF INSURANCE 1/6/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES :NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen e . PRODUCER Elliot Whittier Insurance Services, LLC 75 Sylvan Street Suite 8202 Danvers, MA 01923 CONTACT NAME: Connie Parent PHONE PAX No.• (978) 977.4884 Ale.No): (978) 977.0860 EMAIL ADDRESS: cparen elllotwhittler.com INSURER ($) AFFORDING COVERAGE NAIC q INSURER A: Everest National Insurance 51GLOO6481.141 INSURED INSURERS: Pilgrim Insurance Company 0024 GraBro LLC DBA ServPro of Lowell INSURER C: Hanover Insurance Group 22292 INSURER 0: 9 West Adams St Unit 3 INSURER E : Lowell, MA 01861 INSURER F: %.%J V _r%,%x=Q cr.K i iFiCA L E NUMB R: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEIR POLICY NUMBER POLICY EFF D M/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR 51GLOO6481.141 11/07/2014 11/07/2015 EACH OCCURRENCE S 11000,00 PREMISES B(Ea occurrence) $ 60,00 _ MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY T jECT 7 LOC GENERAL AGGREGATE $ 2,000100 I PRODUCTS -COMP/OP AGG $ 11000100 $ OTHER: B AUTOMOBILE X LIABILITYCOMBINED ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS X NON-0WNED AUTOS PGC00001018501 11/17/2014 11/17/2015 SINLE LIMIT G Eaacd ern $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPER DAMAGE Peracddent $ $ UMBRELLA LIAROCCUR EXCESS UIAB CLAIMS -MADE i j EACH OCCURRENCE $ AGGREGATE $ DEO I I RETENTION $ I A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE5300007408-141 OFFICER/MEMBER EXCLUDED? Flffj (Mandatory in NH) If yes, describe under N r A 09/30/2014 09/30/2016 X STATUTE ER 1 E.L. EACH ACCIDENT $ 11000,00 E.L. OI EMPLOYE S 1,000,00 E.L. DISEASE - POLICY LIMIT I S 1,000,000 DESCRIPTION OF OPERATIONS belaw I C Bus. Pers. Property RHN980326603 12/20/2014 12/20/2016 $1000 ded. 29,71 C Contractor Equipment RHN980326503 12/20/2014 12/20/2016 w/RC $1000 ded. 146,61 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, AddMonal Remarks Schedule, may be attached if more space is required) ServPro Franchise CERTIFICATE HOLDER CANCELLATION ATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIMI REPR99ENTA7IVE iEvidonce of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD