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HomeMy WebLinkAboutBuilding Permit #314-15 - 65 BEAR HILL ROAD 9/26/2014 TOWN OF NORTH ANDOVER , APPLICATION FOR PLAN EXAMINATION 1VL - w " � - b Permit NO: l Date Received 7 q�A�TIO nom` Date Issued: 9SS^cHus�� /IMPORTANT: Wicant must complete all items on this page LOCATION (o S Ae,,9fiLllil tC( P 'nt PROPERTY OWNER—,/–Irli/Iy/VZ-tf Print MAP NO: PARCEL: 'o ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial IAIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain Wetlands ❑ Watershed District ater/Sewer A 61d Identification Please Type or Print Clearly) OWNER: Name: .L i1✓q ,�U.-i�er�-- Phone: Address: s' r CONTRACTOR Name: -Phone: Y'_D//5' 0\16 L/ CIYAJ Address: Supervisor's Construction Lice se: S _ Exp. Date: d 3_/6 Home Improvement License: �S Exp. Date: 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: $ 906v . FEE: $ Check No.: --;,o Receipt No.: v 79-4 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor as t NORTH r z BUILDING PERMIT r 0-t Fo 16�ti TOWN OF NORTH ANDOVER O APPLICATION FOR PLAN EXAMINATION h T Permit No#: Date Received gs0ArEO ISO ��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential i ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Address: Supervisor's Construction License: . Exp. Date: Home Improvement License: Exp. Date.- ARCH ITECT/ENGI NEER ate.- 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature Location //J ••f,/ No. Date TOWN OF NORTH ANDOVER • 64A, Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ; Check# � 200 / 1 Building Inspector a .•= s I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan '❑ Stamped Plans ❑ i TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools 11 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ i 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments t 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 _ �y t COMMENTS �- i 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 an - p d G min.$100 $1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email LDate Time Contact Name Doc.Building Permit Revised 2014 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses La 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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 a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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:Building Permit Revised 2014 t � r �� �� `JJJ Renov 9-29-1 K'eyfl am 65 Bear Hill Rd 3:37pr North Andover,MA I of Beam4.605 rBeamE@ne 4.6.1.0 aterials Database 1476 �y S I/ r ` IAember Data )escription:Beam A Member Type: Beam Application: Floor o replace attic brg wall Top Lateral Bracing: Continuous Bottom Lateral Bracing: None Standard Load: Moisture Condition: Dry Building Code: IBC/IRC _ive Load: 30 PLF Deflection Criteria: L/360 live, L/240 total )ead Load: 12 PLF Deck Connection: Nailed Member Weight: 10.8 PLF Filename: 31 Aubumdal 3ther Loads Fype Trib. Other Dead Description) Side Begin End Width Start End Start End Categor teplacement Uniform(PLF) Top 0' 0.00" 13' 1.00" 420 168 Liv valk up attic load 14'trib @ 30112 IT 13 1 O Q 13 1 O 3earings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF#3/Stud 2x or 4x End-Grain(650psi) N/A 1.500" 3961# -- '. 13' 1.000" Wall SPF#1f#2 2x or 4x End-Grain(1150psi) N/A 1.500" 3961# -- Maximum Load Case Reactions Ised for applying point loads(or line loads)to carrying members Live Dead 2778# 11839 2778# 1183# )esign spans 13' 2.750" Product: MASTER PLANK 2900Fb 1.75x9.25 3 ply PASSES DESIGN CHECKS Connect members with 2 rows of 0.131 x 3.5"nails at 12.0"oc NOTE:Nails must be applied from both sides Minimum 1.50"bearing required at bearing#1 Minimum 1.50"bearing required at bearing#2 Design assumes continuous lateral bracing along the top chord. Design assumes no lateral bracing along the bottom chord. 41lowable Stress Design Actual - Allowable Capacity Location Loading 'ositive Moment 13100.# 19565.# 66% 6.54' Total Load D+L ihear 3499.# 103604 33% -0.06' Total Load D+L L Deflection 0.6270" 0.6615" 0253 6.54' Total Load D+L _L Deflection 0.4398" 0.4410" U361 6.54' Total Load L ;ontrol: LL Deflection DOLS: Live=100% Snow--115% Roof=125% Wind=160% Design assumes a repetitive member use increase in bending stress: 4% All product names are trademarks of their respective owners D Webster Copyright(C)2013 by Simpson Strong-Tie Company Inc.ALL RIGHTS RESERVED. Hood DistributionA Ayer,MA rising is defined aswhen the member,floorloist,beam orgirde[shown on this drawing meetsapplicable design criteria for Loads,Loading Conditions,and Spanslisted on this sheet.The y dgn must be reviewed by a qualified designer or design professional asrequired for approval.Thisdesign assumespmduct installation according to the manufacturer's specifications Milton,VT NORTH Town of t E 1, ndover - h h ver, Mass, �I COC NICNtWICN pDR�TED S lJ BOARD OF HEALTH Food/Kitchen PERM I T L D Septic System r THIS CERTIFIES THAT 1d�.1!�.�.�r.......... .....!^. � , ,,,,,,,, ,,,,,,,,,, BUILDING INSPECTOR ............ ....... .. ................ r �`...` Foundation has permission to erect .......................... buildings on .�jlJ a................... ....................................... - e^/`r Rough tobe occupied as ......... t.R....{A.�Q. ...................................... ........................................... 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 r®�, PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR I • UNLESS CONSTRUCT N S RTS 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. Rightfax C3-2 5/23/2014 8;37;03 AM PAGE 2/002 Fax Server DATE IMM/DD/YYYYI CERTIFICATE OF LIABILITY INSURANCE T. TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY ORAEGATIVELY 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: DANIEL OROURKE INS AGCY PHONE FAX 429 HIGH ST (A/C,No,Ext): (A/C,No): E-MAIL MEDFORD,MA 02155 ADDRESS: 7857W INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITYCOMPANY OFAMERICA DONOVAN,JOSEPH DBA JOSEPH DONOVAN CONSTRUCTION INSURER B: INSURER C; INSURER D: 43 ACROPOLIS RD INSURER E: LOWELL,MA 01854 INSURER F: 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,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO SUB I POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYVY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE [J OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ ENERALAGGREGATE $ POLICY PROJECT LOC PRODUCTS'-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB4890P83A-13 10/21/2013 10/21/2014 X LIMITS ANY PROPERITOR/P /EXECIJTIVE A E,L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/ I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500m0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AF-FECTTNG WORKERS COMP COVERAGE. TRB WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR DONOVAN,JOSEPH. CERTIFICATE HOLDER CANCELLATION LINA HUNTER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 65 BEARHILL RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT/} NORTH ANDOVER,MA 01845 g j, ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. � 'he�ox�2 xtax2 eaZi o, '1V1'r ae e , , Offlee ee offAvesfigafions . 600 Kashin onStleet .804ON,.tom 02111 mpip.mssgo-PIM Wo r kex,q'Coxntpewatio) .bsuvance Affidavit: ,Az�ant Worca7aa�oz� W. 'Name,(Brasiness(Orgauiaafion&&idiza): J p 2_ �On/0 U fY.c/ c NS> Address: 1/3 i Cx�yt�tafef�'�: .how-��( d�t.�— • Pbon��: 9 7�—�U��Sal S . . .Arf) ,x an employer?Check- fl o appxopxiatebox: Type of project(yegmlred): e Io exwith 4, El S am.a genexal contractox and I €. Nuff c6nstxuction T am a xn �--- . �. y 'e the soh-contractors em to eesandtor axe Vie): 7�aveb�x d � � � � listed onthe attached sheet°� 7• []Remodeling axf�.ex- o ze x or r2.❑ T oxo a s61 pxto px p . These sutx-eontxaetorshave 8. �Demolition ees ship and.7�avexza employ . world g forme in any oapaczty. woxlcerscomp.insuxauce• g, Building addition [No worIgge comp.insurance 5, ❑ e axe a corporation and its JQ.r]Electxicalxepairs ox additions xecuixed. offlcexshave exercised.their light of exemption�ex MOL 11,. (PIumbingxepaixs ox additions 3.El S am.a homeowner doing alt work � myseL. Ioworlcexs'comp. c.152,§1(4)a andwakwano -i2•Q�.00fxe�airs iusuranc�xe ed. i employees.ENO workers' —,- ©thex comp.insuxancexegfted.] AWapplzcanfthatchecksbmifuiusEalso Tlouithese�fionbel6wshowingtheirworkers'compensationpolicyinforsnafiOR- �iomea�vners-t3*ho suhmiftbis affidayitmdxcatingittey�'re doing a11.�rorT�andfhenb?re outside conizaafors mus�snhmf anent afCxdayif indica5ng such, ?Con-raefoxsMe,ChCAfhis box must attached aa'ddi6onsl sheeEshowk9thomme of the s4-eojifraefom andthekworkers'comp.policy fi fbnna&n. x agz an ern�Toy�N�iirazs��avir�ir�g l�o�keP�'eornpe�z�atxor�insr�Par�ce formy MT10yeeg. Belau Whevaliey amajob site Lnsuxance Cornpany�l'azrte; f�Y��(��-S - e=-ins. yic.#: C� 5��90 P 3� ExpirationDate: /o -a l /� a 'a �oz S I�. jCitylStatetip: ti� /�N Iola fife.t�.ddzes�: CPS ' Affaeh,a copy Gfi;'tWwoXkeX5'compensatlowpoltcycleclarafloupage(showing-Me poTzcyMaher and eUkatzolx date). `ailt�x ,to securo covexage as xequixecl.undor Section 25A ofMOf,o.152 call leadto the impositian of eximinalVenalfles of a .trite-�to$1,5Q O•DD and/ozone-year.hnpz'.isopmettt,.as welt.as civilpenaltzes nz the tom.ofd�TOg�ORT£ORDER.olid a fu�.e ofuw to$250.00 a day ago stthe-Violator. Ba advisedthat a copy oftT�sfatem.entmaybe foxwartdedto the 01'£xce-,of Investigations o�the DfA.fox insnxauce coverage vexitioatzon. x4,0 Hereby 0eYt�p4ariderAie'iair 1 �J272CIXlLe�O��leP�U�yt�ZCl frZexP1 OPYlIILtLD7Z jJPflVZfL�2G t111OvE7 1L[e[LFZI COPd2C afore• 7 Date: Phone# 9'7�•'loaf--�/� ojffeiaZ z,Se arrly, Do not write in this area,to die corgleted by city or tom offteiaf. +GRY or Town: RerznztlT�,icense# fm&g.AuthorRy(circle orte): Z.$aara of 7 ealtlx?.13nxScu)lglDepartmerz,13.Cibyi9Coym Clem 4.Electrical xit5p€°tor �.�°luzcbizig�rispecto �.011ier Information and Instructions .* Mas1a1;b4seffs General Laws chapter 152 requires all empLoyexs fo xovide Rroxlzers'co P p mpensation fox tl!eiem Lo ees, ursuant to this ad,ora ov yWL ou!j is defined as G0-e'Vex,�person ii.ii b service of auother under any coriiraot o bixey • e�presg orim�Lzed,oral orwxit�en." An er lgye is defined as"anixtdividual,parinexship,assoolattox,corporation oX otherlegal entity,or any-Wo oxMOxe' ofthe toxegoinj engaged in,a joht ente rise andinolu � 9 dmg11eZega7xepxesezttativesofa-deceasedem.Zo ex.ox'the xedeiver oh�•usfee o.an zndivcdua�pazfnersbip,association ox Other legal entity,employing employee..�ov,�everiha olmorofadwaaghouselhavingnotxuore,thanfhreeapartmenfsandwhoxesides exein,ortheoceupau�oftke dweltirog ls.ouse of anther who employs persons to do]maintenance,construction oxrepair wo*ort sack,dwelling house or onthegxouuds orbuilding appuetenamtherefo sb.aLlnot because of such employMentbe deemedta be an exrrployer:" MGL chapter 152,§25C(6)also states that"every state or local yeenslo agency , gshall Wilk hold the or renewal of a licettse ox perrmit to op este a business or to cousixud hadfugs in the coxnmmonwealth for any appl Mat who flag not pro duced.acceptabfe evidence of cobmpliaxtce,with.the insurance coverage required:' Additionally;IVICxL chaptex 152,§25C(7)states"ZtTe enter into any contractfor thepexfoxznauce of itheany ofrthe Commonwealth ROT rts political,subd&Isrom publicwoxl�unMaGcepfable evidence of compliance With f7ieinswm-ce xequftements of this chapfexhave b eenpxesenterl to the Ggntxac&g authoxify." .ci.A�ucanEg 'Leash fi11 out the woxkexg'comp eusaffon affidavit compLefely,by Gb eckimg fLie boxes that apply fo your sitaa on and,if iiecessaxy,supply sub-confractar(s)name(s),addregs(es)aud�hoxrenumber(s)alongwiththezr certi�cafe(s)of insurance, L�mifedLiabMVCompanles(LLC)orLWtedLiabi& panne rshi �'-- s p withmo ern. axzembers ox axtuers are p �'Z' ) pXoyees otherthatafhe p , gcuredtocan workem,compenmti-oni=s mGe. Si anLLCorLLP doushave employees,apolicy isxecpxirecl. lie advised thaf m afdavitmaybe mbmittedto theDe Acoident for confirmation of insurance coverapar6nent of industrial ge. Alga be sure to si and date the 2ff Ire afudavitshould. bexetumedtathe ciiyartown thattheapplicationfoxthepexmitorJlcenseisbeing recluested,gtheDuartmentof 7mdustraLAcGidenis. Shouldyouhaveany guesdongxegaxdingthe law Orziyo-uaraxequitedtoebtauta*orkexs' corn-PonsaflolNORGy,p7easecall tkeDepartment atfkenumberhtedbelow. Self-zusuterlcompauiessboutdentertkexr sak insurance license nun�t er on the appropriate line. City or',l!'owxt O.Mcials �'Xeasebe sure thaf'cbe azizrlavit is compXeie auclpxzntecl legibly. I'heDepartmenfbas provzcled a space attke�ottorz oftkea�davitfoxyouto�Flouf�.theeventtheOf�ceoS�,vestigafzoughasfocortaGcyouxegardiugtkeap�liGanf; - Please be-sure fe z�Fl inthe pemsitJLicense number tvhYGb vfill be used as a reference number, In addition,an appLtcant tkatniusf submitntulfipLe pexmitllicex e applica ons irz any givenycar,nerd only submit one afgdavitinc&afing cmr nt p oRGy inz"oxxmaflon(i,,necessary)and under .Tela Me Address"the applicant skouldwxite"all Locations iii (city or towia):'A copy otTie a; davLtthathag been oaciallysfaimped oxmarledbythe oify or fovrxtmaybepxovtded to fke applxGanfaspzoofthatavalidaffrtdavat•YsonlefoxIx L%ftepermifsorlicenses. ney� davitxnustbefi]Ledoufeack year:Wb.exe a.7roane owl�.ex orciti.�enis obfainingaLicense oxpemiitnotrelafedto auybusiness ox com7n,erciaZ venture (i.e.a clog license o4ermit to butt leaves etc)Saul p exson its X-CMequhad fo complete this affidavit. TRO Office dfXnvmggafxons would like to thw*you iat advance for your ccopexation and should yo a have any gizest[ons, - please do not hesifafo to give us a call. TheDepattm•enf S address,telephone aixdfa�number. CQaxaw�ax oX1�? a 'huP 600 WasWhgQxee � Q2 03111 Revised 5 26-05 a � �1 1' �7k t trlrrltfie�nr-Yttlt r !�l moi;.%[rfir�;r✓/. �t' e Massachusetts-Department of Public Safety y i Office of Consumer Affairs&Rosiness Pegulation �/� ,{ + p�(y0V NT CO7g{y.��agyy Board of Building Regulat ons and Startdz.,ds F4 ---. 'y7VYwd ia411'S'r.§18 )o� [Yi tr�f�tf]'tACTOR . t_ ,?eg 15:0.9 Ty¢e; Expiration: 5/15/2015 D'EIA License: C"-;)2,-a04 JOE DONOVAN CONSTRUC'T11ON JOSEPH r 7C:2Fat0vt-': i 43 x CRCP€1LIS rZD JOSEPH DONOVAN LOWELL rAA ON54 43 ACROPOUS RD. :_.--- LOWELL.MA 01854 �# Undersecretary ' Cwnmuss.oner d35J?0/ w'u i License or registration valid for individul use only before the expiration date. If found return to: Unrestricted-Buildings of any use group which Office of Consumer Affairs and Business Regulation contain less than 35,000 cubic feet(991M )of 10 Park Plaza-Suite 5170 enclosed space. Boston,MA 02116 f Failure to possess a current edition of the Massachusetts Not valid without signature State Building Code is cause for revocation of this license. ` For OPS Licensing information visit: www.Mass.Gov/DPS i i r Rightfax N2-1. 8/26/2014 12 :49:47 PM PAGE 2/002 Fax Server '? <s DATE(MM/DD/YYYYI CERTIFICATE OF LIABILITY INSURANCE T. IIFICATE 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 O RODUCER 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: DANIEL OROURKE INS AGCY PHONE FAX 429 HIGH ST (A/C,No,Ext): (A/C,No): E-MAIL MEDFORD,MA 02155 ADDRESS: 7857W INSURER(S)AFFORDING COVERAGE NAIC Jt INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA DONOVAN,JOSEPH DBA JOSEPH DONOVAN CONSTRUCTION INSURER B: INSURER C: INSURER D: 43 ACROPOLIS RD INSURER E: LOWELL,MA 01854 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSRADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCEL R POLICY NUMBER (WAODIYYYV) (MM\DDWYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) EO EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY $ ENERALAGGREGATE $ POLICY PROJECT Q LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR 'CLAIMSWADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X i we srnruroRv OTHER EMPLOYER'S LIABILITY YM UB-4890P83A-13 10/21/2013 10/21/2014 LIMITS ANY PROCER/E MBER/EXCLUDR/EXECUTIYE 7 N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 II yes,deeaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR DONOVAN.JOSEPH. CERTIFICATE HOLDER CANCELLATION ALLEN JEFFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 12 STUBTOE LANE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENT/, SUDBURY,MA 01776 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. / , ® DATE(MMIDDIYYYY) A�D CERTIFICATE OF LIABILITY INSURANCE 8/25/14 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 endorsemengs). PRODUCER CONTACT NAME: Mart: Daniel N. O'Rourke Insurance PHONE FAX WC,N. (781) 396-8244 1 IAJC.No: (781) 391-2975 429 High Street E-MAIL ADDRESS: sales@ORourkeInsurance.net Medford, MA 02155 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Commerce INSURED INSURER B:Citation JOE DONOVAN CONSTRUCTION INSURER C: 43 ACROPOLIS RD INSURER D: LOWELL, MA 01854-1301 INSURER E: INSURER F: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IM WVD POLICY NUMBER MM/DDIYYYY MMIDDdYYYY LIMITS A GENERAL LIABILITY BCDZZQ 8/9/14 8/9/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED -NIEMIBES/Ea'occurcencel $ 100,000 CLAIMS-MADE FIOOCUR MED EXP("ore person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPP LIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PR(o LOC $ B AUTOMOBILE LIABILITY B13XWKJ 11/28/13 11/28/14 EOMB 'd nll GLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ 100,000 ALLOWNED SCHEDULED BODILYINJURY(Peraccident) $ 300 000 AUTOS AUTOS r NON-OWNED PROPERTY DAMAGE HIREDAUTOS _ AUTOS Paraccident $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N!A (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ If yyes describe under DESI;RIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ALLEN JEFTS ACCORDANCE WITH THE POLICY PROVISIONS. 12 STUBTOE LANE SUDBURY, MA - AUTHORIZED REPRESENTATIVE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: � p i � S f/ I� t i V 1 ' �Oj IV pm _....._.___._- ____...._......._.._.___....... . II � s f r y { 9 j f i { iI { I i R e e 4 I I "• t I f I a .Joe uonovan construction uo. Proposal f 43 Acropolis Rd. Lowell, MA 01854 Number: E103 Date: September 21, 2014 Bill To: Lina Hunter 65 Bearhill Rd. No.Andover, MA Date Description Amount September 21, 2014 Remodel Master Bedroom closets Provide Permit, licenses ad insurance certificates Remove existing carpet Demo closet walls back to small office area Relocate AC chases Remove and relocate existing electrial outlets and switches etc Frame new walls to create walk in closets to back sloped ceiling Hang,tape and sand drywall, patch eilings Paint all new work and any patched ceilings where needed Build and install closet organizers(provided by owner) Add ventilated shelving where needed, Install new hardwood flooring in place of carpet Remove all debris from jobsite i Page:2 Joe Donovan Construction Co. Proposal 43 Acropolis Rd. Lowell, MA 01854 Number: E103 Date: September 21,2014 Bill To: Lina Hunter 65 Bearhill Rd. No.Andover,MA Date Description Amount TOTAL 9,000.00 PAYMENT SCHEDULE DEPOSIT-$2,000.00 After inspections-$2,000.00 After drywall-$2,000.00 Upon Completion-$3,000.00 Total $9,000.00