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HomeMy WebLinkAboutBuilding Permit #788 - 71 LACONIA CIRCLE 6/1/2007k. Permit NO: � K— BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received `* �9 c«w�c�ewa• . 1e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building K One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,9 Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Wel! "„ `. DC7 Floodplain i Wetlartds - ❑ Watershed District Water/Seger. DESCRIPTION OF WORK TO Please Type or Print Clearly) OWNER: Name: Address: i k L -o n<j2)n k' o. ED: z3q ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �,n00 FEE: $ FS'A .06 Check No.: M Receipt No.:`��� NOTE: Persons contracting w th nregiste d contr ctors do not have access to the guaranty fund Signature of Agent/Qwne Signature. of c©ntractorov� k 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMM�.NTS u DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT'- Temp'umpster;on cite" yes Located at 124 Main Street:. � � � �° :� Fire Departt'nent signature/dale s. M 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine No NOTES and DATA — For department use ❑ Notified for pickup - Date .......... _....... .............................................................................................................................................................................................................................................................................. .............................. ............................ ................ .......................................................... ............................... . Doc.Building Permit Revised 2007 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location i CO At o- " No. - Date V i I NORTH TOWN OF NORTH ANDOVER �y 9 Certificate of Occupancy $ ..::_:.. 6 s' MUFee $ S t� Building/Frame Permit Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20Jv Building Inspector May 31, 2007 PATTY HART 71 LANCONIA CIR NORTH ANDOVER, MA 01845 - RE: Certificate of Workers Compensation Insurance Insured: GLENN BATTISTELLI DBA GLENN BATTISTELLI PAINTING CO PO BOX 496 BEVERLY, MA 01915 Policy Number: WC2-31S-455968-047 Effective: 5111/2007 afforded under Workers Compensation Law of the Bodily Injury By Accident: $100,000 Each Accident Bodily Injury by Disease: $ 100,000 Each Person Bodily Injury by Disease: $ 500,000 Policy Limits Liberty Mutual Group P.O. Box 7202 Portsmouth, NH 03802-7202 Telephone (800)653-7893 Fax (603)-431-5693 Expiration: 5 /11/2008 MA Sole Proprietor/Partner Coverage Election: The workers' compensation policy does not provide coverage fon GLENN BATI"ISTELLI As of this date, the above -referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions, and is not altered by any requirement, term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date, Liberty Mutual will endeavor to notify you of such cancellation e.Al 0—wi ';iL AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those companies. cc: Insured:- GLENN nsured:GLENN BA=STE= DBA GLENN BATTISTELLI PAINTING CO PO BOX 496 BEVERLY, MA 01915 C 121 /7rY1'T Producer of Record: STERLING INSURANCE AGENCY INC P O BOX 493 BEVERLY, MA 01915 • W H c W y m W CLC.) �•� = 50 �m oC ' c �Q a �► 93 v O Z c t■,� O O m mID o C 16.- y C CL*" v12 w cn U W w° no' v U w � a ao' w W a o°G w wo' w w G rA 6 A o cn W H c W y m W CLC.) �•� = 50 �m oC ' c �Q c �► 93 v O Z c t■,� O O m mID o C 16.- y C CL*" .G '' Z A c CJ C.3 WO CD CL .Q C • o -S a � Avco a4m ' o y E a d O O d 91 Qo y 1. S CoRi `TAC, ** cm m c 1p O z h �O 3 N co m � � m CO2 LLJW F- ac CLW V CO) E Ir Ma Z zoo h c ZC co m cc m O Cm c �C N m Z 0 Z 0 M 0 W P-4 l Go I., T M/l." C 0 v W 0 N N 19 W W W N H c W y m :o CLC.) �•� = o oC ' c �Q EL 93 v O Z K c o 0 CL m mID o CL*" .G '' Z A c E WO CD CL 0 • o -S a � w Z a4m E Ir Ma Z zoo h c ZC co m cc m O Cm c �C N m Z 0 Z 0 M 0 W P-4 l Go I., T M/l." C 0 v W 0 N N 19 W W W N = iC o ui uig egu ati ns an tan ar s One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement: -P-, actor Registration Repistration: 104352 Type: DBA Expiration: 7/13/2008 GLENN BATTISTELLI CONSTRU`I0N �. Glenn Battistelli �Y,, PO BOX 496 --_ __...__._ ...__ ....... Beverly, MA 01915 Update Address and return card. Mark reason for change. Address E Renewal f] Employment Lost Card DPS•CA1 0 SOM•05106-PC8490 Board.orBml ingeg�,/,.d taadard HOME IMPROVEMENT CONTRACTOR Registraon 104352 Exp ra' on • /2008 License or registration valid for individul use only before the expiration date. 'If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ms. 02108 GLENN BATTISTE�L ST T,,JON Glenn Battistelli F,`f 11 BROADWAY R� -VIM ..�G. Not valid without signature reverly, MA 01815 ""� Deputy Administrator �Y � •i�Z�u1�� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgadons 600 Washington Street Boston, MA 02111 l Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers u deontrac s/C �licant Information tors/Electricians/Plumbers Name (Business/organization/Individual): Address: City/State/Zip: d yew\ Phone #:�►��2�7 � �- Are you an employer? Ch k h — . ec t e appropriate box: VfQ. I am a employer with 4. ❑ I am a general contractor 2. ❑employees (full and/or part-time).* 1 am a sole proprietor or and I have hired the sub -contractors partner- ship and have no employees listed on the attached sheet. I These sub -contractors have working for me in any capacity. [No workers' COMA i p insurance workers' comp. insurance. 5. ❑ We are a corporation 3. ❑required.] I am a homeowner doing all work and its officers have exercised their myself. [No workers' comp, insurance right of exemptioti per MGL c. 152, , 10), and we have requiredj t no employees. [No workers' coin Type of project (required): 6. ❑ New construction 7• ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs P• insurance required.] I 17-1 13 L Other 'Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy mformadon. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their wn&p-, ng such. - -••- »•• —•N.uyer ansa rs providing workers' compensation in information. surance for my employees.Below is the policy and job site \ 1 Insurance Company Name: Policy # or Self -ins. Lie. #: WC2 `_ ut-ro► hTC 0 ,� Expiration Date: S - X\ ?�L1X\_ Job Site Address:_3� Attach a copy of the workers' compensation policy declaration Page (showing the Po ict number and ex it Failure to secure coverage as required under Section 25A of MGL a 152canlead to the imposition of criminal p ation date). fine up to $1,500.00 and/or one-year imprisonment, as well as civil nal penalties of a of up to $250.00 a day against the violator. Be advised that a copy of this state ent may be forwarded to of a STOP Wo the he O E oan f d a fine Investigations of the DIA for insurance coverage verification rd- ,... _`- _ ••-• - —,,,,jy wnaer m"a'n's enalties of perjury that theinformationprovided above is tare and correctature- r , In _ — '1(� Official use only. Do not write in this area, to be completed by city or town o/Jicia% City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical rnannn►.._ ...____. 6. Other _ Contact Person: Phone #: ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE/DO 05/3131/2007007 PRODUCER (978) 922-6600 Sterling Insurance Agency, Inc. g g cy. 306 Cabot Street P.O. Box 493 Beverl , MA 01915- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Glenn Battistelli Painting Battistelli Painting Co. P 0 BOX 754 ,Beverly MA 01915— INSURER A: Commerce Insurance Co. COM INSURER B: INSURER C: INSURER D: INSURER E: r+nvoo a nec 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'INSR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY TEYMM DD/YYE ( ) POLICY ( MP D/YY)N LIMITS A GENERAL LIABILITY WV1751 02/26/2007 02/26/2008 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 50 000 PREMISES Ea occurrence X COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR MED EXP An one person)$ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PD POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO / COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Workers Compensation certificate being sent under a separate cover. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Patty Hart FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 71 Lanconia Circle JNSURER,JTS N E TIVES. UTHO RE No. Andover MA - ACORD 25 (2001/08) © ACORD CORPORATION 1988 *ne INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327 Page 1 of 2 GLENN BATTISTELLI PAINTING -ROOFING -SIDING -CARPENTRY -VINYL REPLACEMENT WINDOWS KITCHENS -BATHROOMS -PORCHES -DORMERS -ADDITIONS P.O. BOX 496 BEVERLY, MASSACHUSETTS 01915 (97DIRECT LINE ( 922-6338 978) 9 9 8956 FAX (978) 921-9202 CELL (617) 962-1235 ESTABLISHED 1974 GLENN BATTISTELLI CO.y hereby agrees to perform the following services for: Al a,C 1 zx at ? >J ' Home Phone:- -, Business Phone � G Sealer applied to all vent pipes and chimneys All Flashing will be inspected. Roofing Nails will be inches. Grounds will be cleaned of all roofing materials. All workmen are covered with Public Liability and Workmen's Compensation. All work will be continuous and will be performed in a workman like manner. Chalk lines will be used to line-up the shingles. Roofing Shingles are self Sealing. While installing the new roof, we will protect your home and plantings from debris. Roofing Shingles to be delivered Install new fiberglass paper to roof boards when stripping of shingles is required. All shingles will be secured with four nails. State and local building codes, along with manufacturers specifications will be adhered to at all times. Color of Roof to be e23 %> z All work is priced as specific. The possible occurrence of rotted roof boards or poor flashing will warrant an additional cost of The homeowner is responsible for covering their" articles within the attic. Work is to be commenced on Payment is to be delivered Apply inch aluminum drip edge to thefollowingareas: Year Workrnanship Guarantee.Year Material Guarantee Roofing shingles to be �� :i 1 A/ %�i�' 4"" !a f..0 � / 7..- l �(%�f' •mss'^' � / i a60 Agreed by Homeowner Agreed by Contractor 'Ref. Page Date 3 Day Cancellation Notice Required