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HomeMy WebLinkAboutBuilding Permit #671-16 - 503 BOSTON STREET 11/30/2016Sd,qWJVF0 11- 3 -/S- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#-- L Date Received Date Issued: YTqPOP,TANT: Applicant must complete all items on this page Pint CR—JR, —@) P �OR k1%,1,S_R�&_--FR'S tTkY/ (KW,-,CNfft MrPA R HE- &a 2 -IT—LR AL 0 ZED TYPE OF IMPROVEMENT PROPOSED USE Contra or Na�6. Wk-Pho ResicJential Non- Residential 0 New Building 0 Addition El 61teration One family 0 Two or more family No. of units: 11 Industrial El Commercial Wf:,Iepair, replacement El Demolition 0 Assessory Bldg 0 Other [I Others: S. �p�,!_i WR• .1 r V,V� '18 W,-�'6t1'a69s,:4,A, -1 0 am ntpi @ M—Tae �.g M -B DESCRIPTPN OF WORK _/TO2P RERFORIVIED: Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: im "N Contra or Na�6. Wk-Pho A. W'_ r 0' Ad rens: �fflr-e--K-tv&sq�Dates, rs �on t �r 06 0 S/ '�7r Home & -5. T 5) v e n t Lice g7e�', INV =om nJ rt =e Me -- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT,'VZOO PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED OM$125,00PER S.F. Total Project Cost: $ FEE: $ Check No.: —Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the &arantyfund -7-- 7 ----- -- ---iriatUrbofWdenllOWhersicnatdrb Of, -OM Location .67\3 �yrir'1 J%r No. ( Date 4t� Che/4r 2 j 7 Building Inspector Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ F WERAGE DISPOSAL ❑ Tanning/Massage/Body Ari ❑ Swimming Pools ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U PORK PLANNING & DEVELOPMENT Reviewed On Signature, COMMENTS CONSERVATION Reviewed on Signature COMMENTS Y HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Water & Sewer Connection/Si�nafiure � Date Driveway Permit DPW Town Engineer: Signature: Locateq ;Jd4 Usgood Street FIREDEPAR�TMEIVT Tempt®umpster on site yes �,: ;r�nort .,�• ti Lo$atecl atg12.4jMainStreetw = , `r t r _ •J z "'h FireDepar`tmentasigna�ture/date`. ,"�� ,,;; _ _�� :� �� _y 1\.. ., e t _•?':S ti • _- _ .,ryc.r��sytti�y....a - e s Ns'= COMMENTS CI11�(1Si��,l 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Peimit Revised 2014 The followings is a list of the required forms to he filled out for the appropriate permit to he 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 DTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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 )TE: 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 )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit n all cases if a ,variance or special permit was required the Town Clerics office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording dust be submitted with the building application Doe: Building ]Permit Revised 2014 w 0 a E : � ., 3 :r "Z 0 �u W 0 r PO j�� o �Q SNL jQ*/ J Q LL O m O .t \ -0 LL E a0+ N U Ln 0 W Z ZZ J m C O + "6 c LL .i to a+ ai C U LL 0 OoC LL H Z m J a of LL o d IA Z :Q.7 J LL! L toCU d' U (n LL 0 u LU a Z Q (7 L w LL Z { JJ Q Lu LL w L►. N m O Z N +� N O N L. C O O r O O as Q r Ie: O O E a .�+ O d d O G0 L = cn O <„i L .r+ y v c � J i m ' � c o :.__ 0 C cn —�� CD 0 4 - Ego a� oz - y c o v c c~ L .4+ m yOa •L� H O O a O Q L L LC 'a ~ � �.vm N W_ O 70— O O a: 'y.d M N C 0- tO 0.0 0 W E V V Q O -a CO)M O d .> = 0 to 0 F— @-- Q. 0 0 E a LA U) 2 co m O 0) O N as t O Z O Q J O W L r - 0 Z co L) Z N L) W cn a Z w0 1--o U) W LLI -j a Z VI U :a c� J m V O 7MW L.: CLN C W W s O O o C. CL � Q C Cc M J -0 O (1) Z CLN a M Y N CONSTRUCTION ENTERPRICE INC � 525 ESSEXST UNIT 1107 LAWRENCE MA 01841 TEL;978-397-9803 FAX;978-258-8311 ROOFING,SIDING,DRYWALL AND MORE. PROPOSAL Submitted to: LINDAi� vt 503 BOS ON ST. NORTH ANDOVER MA 01841 Job description new roof We propose to furnish all labor and materials to complete the following: -STRIP AND INSTALL 14 SQ. OF SHINGLES. -INSTALL DRIPEGE ALL AROUND THE HOUSE -INSTALL ICE AND WATERSHIELD THE FIRST 3 FEET FROM EDGE BOTTON THE REST COVER UP WITH TAPE PAPER -REMOVE ALL DEBRIS,AREA WILL BE CLEANUP -LABOR IS GARANTEED FOR 6 YEARS,ROOF MATERIALS ARE GARANTEED FOR 30YEARS. -LABOR and material TOTAL COST $ 5,400 We propose to complete all work in accordance with above specifications for the sum of: ($5,400 WITH A DOWN PAYMENT OF $2,400. All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to specifications submitted, per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. If either party commences legal action to enforce its rights pursuant to this agreement, the prevailing party in said legal action shall be entitled to recover its reasonable attorney's fees and costs of litigation relating to said legal action, as determined by a court of competent junsdictio . Authorized Signature: / r�'� '� Date: Z�? V ACCEPTANCE OF PROPOSAL The above prices specificati ns and -conditions are satisfactory and are hereby accepted. 1 _ _ Signature Date of Acceptance 77 —/-51 A� oP CERTIFICATE OF LIABILITY INSURANCE DATE( ) TYPE OF INSURANCE 11/30/15 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(ies) 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 endorsement(s). PRODUCER CONTACT Armand P. Michaud Insurance Ag NAME: PHONE 105 Haverhill Street 978) 685-2549 AIX No: (978) 794-0822 E-MAIL Methuen, MA 01844 ADDRESS: INSURE S AFFORDING COVERAGE NAIC # INSURERA:Essex Insurance Co. MED EXP (Any one person) $ 1,000 INSURED INSURER B : M&N Construction Enterprise In INSURER C: Juana Vasquez 525 Essex St. PMB 1107 INSURER D: Lawrence, MA 01841 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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 AML SUBRPOLICY POLICY NUMBER EFF MMIDDIY POLICY EXP MMIDDIYYYY LIMITS A GENERALLIABILITY Trudy Lawler 3DY6888 4/2/15 4/2/16 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE I—XI OCCUR DAMAGE TO RENTED $ 50,000 Sr MED EXP (Any one person) $ 1,000 PERSONAL &ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMITAPP LIES PER PRODUCTS - COMP/OPAGG $ 1,000,000 17 POLICYF_] ECT PRO LOC $ AUTOMOBILE LIABILITY EOaBIINEDtSINGLELIMIT $ BODILY INJURY (Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICE RIME MBER EXCLUDED? N I A / E.L. EACH ACG DE NT $ E.L. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OFOPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Rerrarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The AC ORD name and logo are registered marks of ACO RD Phone: (978) 685-2549 Fax: (978) 794-0822 E -Mail: trudylawler@michaudinsurance.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Trudy Lawler © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The AC ORD name and logo are registered marks of ACO RD Phone: (978) 685-2549 Fax: (978) 794-0822 E -Mail: trudylawler@michaudinsurance.com w . % AC40RV CERTIFICATE OF LIABILITY INSURANCE `� ATE(MM/DDIYYYY) r11/30/2015 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 endorsement(s). PRODUCER CONTACT NAME: Trudy Lawler MICHAUD INSURANCE AGENCY PHONE , (978)685-2549 a No: DAILD michaudinsurance.com ADDRESS: trudylawler@michaudinsurance.com ARE INSURERS AFFORDING COVERAGE NAIC If 105 HAVERHILL ST. INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 METHUEN MA 01844 INSURED INSURER B: M & N CONSTRUCTION ENTERPRISE INC INSURERC: INSURER D: GE TO RENTED PREMDAMAGE Ea occurrence $ 525 ESSEX ST PMB 1107 INSURER E: LAWRENCE MA 01844 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 14884 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ GE TO RENTED PREMDAMAGE Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ N/A GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT F LOC HOTHER: GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY Per accident $ ( ) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per $ accident UMBRELLA LIAB [��OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE N/A AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 I N/A (Mandatory In NH) If yes, describe under N/A N/A 7PJUB2E82404715 04/01/2015 04/01/2016 SPER R X1 TATUTE ORH E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below N/A _F DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street AUTHORIZED REPRESENTATIVE No. Andover MA 01845 CI Daniel M. Cr y, CPCU, Vice President — Residual Market — WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts : Department of IndustrialAccidents f �a 1 Congress Street, Suite 100 =- Boston, MA. 02114-2017 �www mass.gov/dia sy Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: City/State/Zi 444r! Are you an employer? Check the appropriate box: 1.Q I am a employer with employees (full and/or part-time).* 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] IF] I am a homeowner doing all work myself- [No workers' comp. insurance required.] t 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 ❑ Building addition 11. FJ Electrical repairs or additions 12. [] Plumbing repairs or additions 13. MRoof repairs VU 14.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who subuiit Us affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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,'ttiey must provide their workers' comp. policy number. I am an employer that is piovidiing workers' compensation insurance for my employees. • .Below is the policy and job site information. Insurance Company Name: �'+%`' ' IC��'`����svd�� Policy # or Self -ins, Lic.i5 Expiration Date: O//— Job Site Address: �1? s City/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 MGL c. 152, §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 $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c rtif nder the ins and penalties perjury that the information provided above is true an correct. ADJ... `/% D� Tata• / /' �O _/!5 Official use only. Do not write in this area, to be completed by city or town officiall. City or Town: Permit/License # Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: r C is W e a Tj r Cl) Nr coN 0 N G "a N T > � 'a N K e - CD Z o W Z <t Q- w :a d n" F W. ZZCOU vy<W Z Z:E d< to XC)<( U- i:_ - J ; -0 9 Q c ❑ Q o w 2 Z E U Z 2 LL C .o" m a Tj r 1 .. bo Qi Q �) W Uf ,� Cl) Nr coN 0 N G "a N T > � 'a N K e - CD Z o W Z <t Q- w :a d n" F W. ZZCOU vy<W Z Z:E d< to XC)<( U- i:_ - J ; -0 9 Q c ❑ Q o w 2 Z E U Z 2 LL 03 O bo W -bo • •-� r, N O tYi i.., �V co ^� N - cd N N CC$ c V rn O V3 O O � v O Cl) Nr coN 0 N G "a N T > � 'a N K e - CD Z o W Z <t Q- w :a d n" F W. ZZCOU vy<W Z Z:E d< to XC)<( U- i:_ - J ; -0 9 Q c ❑ Q o w 2 Z E U Z 2 LL