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HomeMy WebLinkAboutBuilding Permit #288-13 - 444 WINTER STREET 10/11/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: _ a Date Received Date Issued: IMPORTANT:A licant must complete all items on this page LOCATION L.1. LJ '-S Print PROPERTY OWNER EL.L..p.� crS c-� LL 'c94�ttis�,4z Unit# + Print MAP NO: I e4 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no 100 year-old structure ye no TYPE OF IMPROVEMENT PROPOSED USE I Residential Non- Residential ❑ New Building t6�-0ne family ❑Addition ❑Two or more family ❑ Industrial cn,A+teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: p ❑ Demolition ❑ Ot-her-- Lill9 D - . ' e f a DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: phone: 017a 4.98 `3 ) t� Address: 'L4 L-k L4 CONTRACTOR Name: L,.o..- �t(� L,cl C^-.,, 7- Phone: 9 S 31 a Address: _�-- 3 (Z.- !✓.ti-rJ`T�� Supervisor's Construction License: l Exp. Date: —i I Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON"$925.00 PER S.F. Total Project Cost: $ d 0 © � FEE: $_ Check No.: Receipt No.. ?6T11 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sgnature�of Agent/Ownerr' Sig natureoflcontr-.act_, m_^� r I 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 Siqnature 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 I a Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i Total land area, sq. ft.: M 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 I NOTES and DATA— For department use i I I I II ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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: Doc.Building Permit Revised 2008mi Location No. d b / Date 1 !I Y • TOWN OF NORTH ANDOVER • '- Certificate of Occupancy $ a � 1 Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# t 2- i 25811 Building Inspector 1P The C'ommonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 M www.n:ass.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?Checkthe appropriate box: Type of project(required): 1.® I am a employer with 12 4. Q I am a general contractor and I employees(full and/or part-time).* have hired the sub-!contractors6.�❑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 g, Q Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp, insurance comp. insurance.$ required.]' 5• ❑ We are a corporation and its 101:1 Electrical repairs or additions . 3.❑ I am a homeowner doing all work" officers have exercised their 11.❑Plumbing repairs or additions ' myself. No workerscomp. right of exemption per MGL Y [ P 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' . 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors 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 ' 08/03/2013 Policy#or Self-ins. Lic. #: 6010979012012 Expiration Date. Job Site Address: City/State/Zip: 'IV, q�y Wig_ M 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. I do hereby certify under the pains and penalties of perjury that the information.provided above is true and correct Signature: t Date: 2..9— (2 Phone#: 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. f Contact Person: Phone#: NORTH own of 2 aAndover No. t ,� � h ver, Mass, COC NICNl WICK S ►1 BOARD OF HEALTH Food/Kitchen PERMI D` /r Septic System THIS CERTIFIES THAT �11KV ...To...J.. `/�SQ'. ............................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...17.�.LCCa�..10..r?!;l..�'r �.............................. Rough to be occupied as J.'.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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ...................... Service .............G..... .W-. ................ Final ILDING 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. t SEE REVERSE SIDE JAN-24-2012 14:35 Sennott Insurance 978 887 2404 F.01 ....... ... — —• - - •- - -- -- — — - --- ---- 01/24/2012 PRODUCER 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 CERTIF=ICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 4S1 Topsfield, MA 01983 _ INSURERS AFFORDING COVERAGE I NAIL n INSURED Len Gibely Contracting Co., Inc. IN8URERA Catlin Specialty Insurance CO _ 23R Winter Street INSURER 9, T~— 119038 Peabody, MA 01960 INSURER C: INSURER INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANOING 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 TERMB,EXCLUSIONS AND CONDI(IONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRN130 SRC TYPE OF INSURANCE �• POLICY NUMBER POLICYIEFFICTIVE POLICY EXPIRATION DATE 1MMfODtTYYYj DATE MM/DO/YYYY UMITS GENERALUABILTIY 3700301015 01/29/2012 01/29/2013 EACH OCCURRENCE a _11000,0_0_ X COMMERCIAL GENERAL LIABILITY OAMAHO1 Ea RENTED CLAIMS MADE T OCCUR ME EXP(Any ww penw) S 5 100 A PERSONAL&AOV INJURY $ 1,000,000 GENERAL AGGREGATE & 2,000,000 GEN%AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AUG $ 2 000 00 PRO• - ... _... .�...—L._ .S_�_ POLICY JECi LOC AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT 1 9 ANY AUTO (Ed aalderl) I ALL OWNED AUTOS BODILY INJURY I X SCHEOULEO AUTOS (Pw pamn) S X HIRED AUTO$ 50DILY INJURY X NON-OWNED AUTOS (Per aoeld&U) S -_ F ROPERTY DAMAGE S ------- (Par accident) GARAOE LLABIUTY AUTO ONLY•EA ACCIOENT 3 �` ANY AUTO —'-`----- " EA ACC i OTHER THAN I AUTO ONLY: AGG S4 EXCESS/UMBRELLA LIAGIUTY EACH OCCURRENCE b — OCCUR U CLAIMS MODE AGGREGATE DEDUCTIBLE _..,.._ ' .I N .._$ �......... WORKERS COMPENSATION ,. .. AND EMPLOYERS-LIABILITY TIMI ORY LTS ER _ ANY PROPRIETOWPARTNER/EXECUTIVE Ta '-- C OFFICER/MEMSER EXCLUDED? E.L.EACH ACCIDENT M $ IMaAddofy In NH) E.L DISEASE-EA EMPLOYEE I If Yea.doWN under 6GECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT II OTHER JJ� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDEO BT ENDORSEMENT/SPECIAL PROVISIONS — VIDENCE OF 2012 RENEWAL COVERAGES. I CERTIFICATE HOLDER CANCELLATION v�� SHOULD ANY OF THE ADOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIHaTtON 1 DATE THEREOF,THE 188UINO INSURER WILL ENDEAVOR TO MAIL 10 GAYS WRO-I 0, NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO$HALL IMPOSE NO OBLIGATION OR LIAMUTY OF ANY KIND UPON THE INSURER,ITS AOEN T9 OR REPRESENTATIVES. AUT IORLZEO REPRESENTATIVE Sennott Ins. Agency ACORD 25(2006101) 01988-2009 ACORD CORPORATION. All right$reoervad. The ACORD name and 1000 are registered marks of ACORD ` CERTIFICATE OF LIABILITY INSURANCE T'AT)`07/24i20121 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRUATIVELY OR NEGATIVELY AKWD, EXTZND OR ALTER THE COVERAQE APItORDtD BY THE POLICIES R&LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE I35VING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, L*lPORTANT: If thecertificate holder IS an ADDITIONAL INSURED, the polleyties) must be endoreed. I£ 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 j confer rights to the certificate holder in lieu of eueh endoroement(a). i PRODUCER - CONTACT .---__—_—_—_ Edward F Sennott Insurance HMCo PHONE FAxi Agency Inc — a^MAIL 16 South Main Street Topsfield, MA 01983- QPTQaa IDI. Imsum[)(f) AFFORDING COVIRAGs _I INsuREAA: A.S.M. Mutual Insurance Co 337;,5 -� ILen Gibely Contracting Company Inc 1NSURIA 8; 23 Winter Street Rear INIDPEA G: -- Peabody, MA 01960-5941 INSUA[A D: COVERAGES CER'CIFICATE NUMBER: REVISION NUMBER: 'CHIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. I j NOTWITHSTANDING ANY REQUIREMENT, TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR HAY YE T1,1N, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SVCS POLICIES. L1bf I'IS 5'.i0kt; NAY HAVE BIEN REDUCED BY PAID CLAIMS. POLICY EFT POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBERDWmirrm n„/�/rm) i GENERAL LIABILITY EACH DccuAANLB S � Oi Y}7[R>;.IA:.4:V�i:.L LL"b=ll rY DAMAGE 70 R6 NTID I '------ PRW(IICf(ea.oeeurrenxl ❑ MID IYP (Any on. Person) 6 PIRSOMI,4 ADV INJDRy S f RM7".ii=Pf?A.9S I.I If-^APPI•R!1 Rk: , OIHIRAI,AGORCGATE i PRODUCfi -GOhy/OP Alii S —____. AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT `^--��'---- lea ACCAdent) BODILY INJURY (PGF prrfon) S ❑".:i l:lY:'.f"1 AI�'Y: BODILY INJU0.Y(pm♦rridtnrl ❑:if RLL TL":iA PRO➢[RtY °AHAGL j (per�oOl dentl S L�:DiRRf'.'.a ';Al ❑ (?'f'10. EACH oCCUARENCB S --T`_`---- OE.CL.•;i CL4LA3 WdL AGGRIGA7C S — ---- �cenr..Ileu i ---` _._.__-..._.. la'ILM.v';R 9 i WORKER$ COMPENSATION ® ctAry -------'----"— EMPLOYEES LIABILITY orR- Ton ia= a[ AND [:IB i'F.C•PR:3C^R•'?AAI:7835i 1.4. 1"K AGCIDIPT i 50Q;00j Fx^1 6010979012012 08/03/2012 08/03/2013 B.L. Dff@AIC -POLICY LIMIT i 500,000 � _. .�_�._.. I.L. OIf[Ai[ - [A tPLOr[[ S 5QQ.00D I , I1 L CERTIBICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIU.' Evidence Of Insurance EXPIRATION DATE THEREOF, NOTICE HILL BE DELIVERED IN ACCORDANCE WITH TIL. POLICY PROVISIONS, AUTNORI I[O NtPRLiCYT�TiVC�.✓'� �{///j ,(\/�]l�) ~ - `� LEN GIBELYCONTRACTING Ca., INC. 2920 'Page No. Pages of PROPOSAL 23R 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.lengibelycontracting.com specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered Submitted9 T with the Commonwealth of Massachusetts. Inquiries To:-��� e �.-_V O 6.50-a—_1 about registration and status should be made to the Director,Home Improvement Contract Registration, 441q Zd, L" 's- One Ashburton Place,Room 1301,Boston, MA 02108 -F-L- ii�� (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered -.<vi J�C�Q /-'(-✓7- _:[.5.---..--- contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. P NEDAT REGISTRATION NO. Z3� MA.REG.100811 NO. JOB LOCATION We herellyjUbmit speciri tions and estimates for work to be performed and materials to be used: r 1 I t'—I -#3, s dro,� 6A-/-te 4 0Ai V - _ _ L(2�__1760evg ,02-0, 0j^K ---- ��� >-_3_ _� rr Construction relat d er _ /9eh iu(4-01- A-Y-0-4; -CIC. WORK SCH Co." ill t begin rk or order the materials before the third da following the signing of is Agreement,unless specified herein wrltln rect will begin the work on or (dale).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by ate).The Owner hereby ackn I e 0 t the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be st ered as tions of this Agreement. WAR NTY The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of Q 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 s n rectors,employees or agents,is dlsGovered 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 Pro pose hereby to furnish materialnd labo�,/m lett in cordance with above specifications,for the sum of: p y �1p J� p dollars($ ). Payment to be made as follows: $ n signing-Contract; ocK 4'I 7-4A�g.e ( ) Po — —pd/� 'Name of Centr6ctoIstren�(\�/--��(��� g V, ($ )upon completion of Street Address �4 %is )upon completion oft/ ___on._.__.__. city/state Phe ($ )shall be made forewith upon com ledon of work under this contract. — -- — p Pho Federal No. Notice: No agreement for home improvement contracting work shall require wn Na t Salesman - payment(advance deposit)of more than one-third of the total contract a 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, th ignaturs whichever amount is 0 er star.. . Note:This proposal ma awn by us if not accepted within days. Acceptance of Proposal i have read both sides of 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 of the third business day after the date of this transaction.Cancellation must be done in writing. DO T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. /I �� L� Signature ice— Date SignaNre Date �• IMPOR NT INFORMATION ON BACK P*- Massachusetts - Department of Public Safety Board of Building Regulations and Standards ( ui�trurtiun Sulmr;i� r License: CS-094763 THOMAS IL DtDYBINS, 19 Cedar HUbrive Danvers MA-01923 . of Expiration Commissioner 05/14/2014 �.. Office of Consumer At'fairs& Business Regulation License or registration valid for individul use only a= — OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i. . registration: 100811 Type: Office of Consumer Affairs and Business Regulation ? txpiration: 6/23/2014 Private Corporatior, 10 Park Plaza-Suite 5170 y>' Boston,MA 02116 LEN GIBELY CONTRACTING CO., INC. Brian Dobbins 23 R WINTER ST. _�r ` PEABODY, MA 01960 -- Undersecretary Not valid W' ut ignature i