HomeMy WebLinkAboutBuilding Permit #544-13 - 72 WINDSOR LANE 1/29/201301/23/2013 06: 43PM 9782081871 MCARPENMRSERVICES PAGE 01/01
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of 4�ti,av e AND
BUILDING PERMIT_ �.•..9f. - ��
TOWN OF NORTH ANDOVER 0-
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
9 °Rwtm
Date Issued: I - ;-h -_(.
F PE OF IMPROVEMENT I PROPOSED USE
Non -
El New Building 0 One family
❑ Addition p Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
0 Repair, replacement 0 Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
,_-: • lain .::::V1le#latids'':°. : a:::aNater l strict
o Septto . u Well.::. odp
ed ,Di
n;1/Nater/S.ewer :..:
)(0-0 rx
x..-11 ►Y"_
Identificatioo Please Type or Print Clearly)
W r''UI G
"I
ARCHITECT/ENGINEER Phone:
Address- -- _-- _ Reg. No_
FEE SCHEDULE: SULDING PERMM $1100 PER 54000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $_ ��Q� FEE: $ �..3
Check No.: aa, Receipt No.:
NOTE: Pers -contracting with unregistered contractors do not have access to -the guaranty fund
Signat.ure.1of Agent/dwher ' . im ture of contractor.
7n1Z_ni-77 IQ -A7 Q7R7nR1R74 Pana 114
Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
t
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
PLANNING & DEVELOPMENT
COMMENTS
DATE APPROVED
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
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 Towo Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster onsite yes no
Located at'IN.Main Street
Fire Department-signature/date ° A ,
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 - Date
i
E
Doe.Building Permit Revised 2010
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 2012
Location :2 /IV/ a f0 /I- Arl,
No. v Date/' -015 .3
• ' TOWN OF NORTH ANDOVER
rviPR rn 0
�. Certificate of Occupancy $
• Building/Frame Permit Fee $�`
- Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
26126 Bui ding Inspector
Enter construction cost for fee cal -
North Andover Fee-Cakulaflon
Construction Cost
$ 31620.0-0
m
$ -
$
43.44
Plumbing Fee
$
5.43
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
5.43
Total fees collected
$
154.30
72 Windsor Lane
544-13 on 2/1/13
Remove 7' non bearing wall between
Kitchen and DR, relocate wiring as needed
Build knee wall in place of exisitn wall
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Giovannucci Brothers, Inc.
CUSTOM CARPENTRY 8& REMODELING SERVICES
59 Atlantic Avenue
Marblehead, MA 01945
P: 781-639-4400 — F: 781-639-4401
Massachusetts Construction Supervisor License #082453
Home Improvement Contractor License #141448
PROPOSAL
PROPOSAL SUBMITTED TO: DATE PROPOSAL
Matt Capenter
ADDRESS HOME PHONE
72 Windsor lane
CITY, STATE &ZIP WORKPHONE
North Andover MA 01845
WORK TO BE PERFORMEDAT. MOBILE PHONE
ARCHTFECT/DESIGNER DATE OF PLANS PHONE
ADDRESS FAX
Giovannucci Brothers, Inc.
CUSTOM CARPENTRY & REMODELING SERVICES
PROJECT START DATE: to be discussed
PROJECT DESCRIPTION
Remove wall between kitchen and living room. Build knee wall as discussed for a new
breakfast bar. Patch plaster as needed on ceiling and walls as close as possible. Install
new crown molding around kitchenette ceiling matching crown in living room.
Patch in base board and trim work where needed.
Electrical by others
Plumbing by others
Painting by others
Trash removal by matt carpenter
Giovannucci Brothers, Inc.
CUSTOM CARPENTRY & REMODELING SERVICES
WF PROPOSE. TO FT IR:NISH-MATERIAL AND LA -BOR, COMT7.ETE INACCORDANCF, TVIT77ABOVE SPECIFI(Z?1770NSFOR TIS SUM OF.-
Three
F.
Three thousand six hundred dollars
53)620.00
PArMENTISTO LAIADEASFOLLOWS:
Amount Dace Total
500.00 deposit writh signed proposal c, d' . C '` 2 500.00
1,000.00 start date 1,500.00
1,500.00
1500.00
2,120.00 upon completion of project 3,620.00
3,620.00
3,620.00
Please Afake all Checks Payable w Brian Gimannucci
f'IL9f\TCF CHARGI',4FTER 30 D 4YS ON UNPAID BALANCE, IIj2% PER MONTHOR 18% ANNUAL PERCENTAGE RATE.
ALL AdATERLAL LS G(L4R41NTTF.ED TO BF. AS SPF.CII7ED. ALL WORK TO BF.' COJWLi.TED IN A WORKMANLIAT 114ANNER ACCORDING TO
STANDARD PRACTICES A D TO STA77; BUILI)T.NG CODF.,S. =L\'Y ALnRAT7O OR D1,Y7A770N FROA4 ABOVL SPF.CIFI(A77ONS IlT7rOLMI(;
F,XTRA COSTS WILL BF EXC,'UTFD OL\ZY UPON iVRIT T -N" ORDERS:, AND WILL. BFC004E AND F1T73A COTITR CHARGI, OVERAND ABOVE. 773E
F,ST711•IATF. ALL AGREFA4ENTS CONTNNGf'iNT UPON AC'CIDE4TS OR DFLA Y.S BF.�YOA?D 0 U CONTROL. OWNF,R TO CARRY FIRE AND ANY
0THF,R ATF.CF.,.S'.L4RYP12OPERT T Ii\7,SURANCE.
BRIAN GTOVANNUCCI or ERICA GIOVANNTUCCI DATE
ACCEPTANCE OF PROPOSAL
THI,.ABOI7i PRICFS, SPF.CIIICATIOVS AND CONDn7ONSART SA77.SF.4CTORYAND ARI IIt.'RF,I3YAC(;F.P7TD. C.7OIANT UCCI BROTHI.RS, INC
I,SAUTHORIZFD TO DO THF. WORKAS .SPFCIFITD. PAY_MFNT TT7LL B'AIADF, AS OUTS, NNT.DABOFT.
:ITJRE DATE
SIG "ATURE DATE
THIS PROP05,4L .bL4Y BE TI7THI)RAI4riV IF NOT ACCEPTF,D A7THIN 30.DAYS.
l`CQTIMPATC t%C 11AQ11 1'fV 1AIC110AKWIC
AC20REF Vvl� t �$ 1VA `. V$ L.$/"1u$i..$ I 1/�V�I$�AI�V[
DATE(MM1DDMYYY)
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
01/2412013
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Blackstone Insurance
P.O. Box 3144
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Worcester, MA 01613
E (
LIMITS
INSURERS AFFORDING COVERAGE NA1C
INSURED
INSURER A: Guard Insurance
GiovannucCi Brothers Inc.
INSURER B:
59 Atlantic Avenue
Marblehead, MA 01945
INSURER C;
INSURER D;
INSURER E:
.J COMMERCIAL GENERAL LIABILITY
❑ CLAIMS MADE ✓Z OCCUR
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, 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.
INSH . LTR
JUUrLI
NSRD
TYPE OF INSURANCE
POLICY NUMBER
DA D
E (
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE S 1,000,OOD
A
.J COMMERCIAL GENERAL LIABILITY
❑ CLAIMS MADE ✓Z OCCUR
GIBP301979
02/20/2012
02/20/2013
D E T ENTED 50,000
PREMISES Ea o0corence) $
MED EXP (Any one person) S 5,600
PERSONAL & ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER-
PRODUCTS - COMPIOP AGG $ 2.000,000
POLICY M PROJECT LOC
AUTOMOBILE LIA89JTY
ANY AUTO
COMBINED SINGLE LIMB .S
(Ea awdeMI
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per person)
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY $
(Per acddee+I)
PROPERTYDAMAGE $
(Per aocideni)
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT $
_. __.
OTHER THAN EA ACC S
T
ANY AUTO
AUTO ONLY: _AGG $
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE $
AGGREGATE S
S
$
DEDUCTIBLE
:S
RETENTION. _-_$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
7 TORY LIMITS ER
El
E.L. EACH ACCIDENT S 100,000
A
ANY PROPRIETORIPARTNEWEXECUTfVE
GIWC324907 �'i
04/03/2012
04/03/2013
OFFICERIMEMBER EXCLUDED?
Ifyes,descrioaunder
SPECIAL PROVISIONS below
EL DISEASE -EA EMPLOYEE $ 100,000
E.L. DISEASE - POLICY LIMIT S 500,000
OTHER
OFSCHIP"ON01`0 LHATIONS I LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BYEN N5
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
(2001108)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR .
AUTHORIZED REPRESENTATIVE
1 "lassachusetts - Der;ar-me- Dubuc Safety
�--% Boaro or Building=ec,,anory a:,, StanoarGs
Cun.truaiun Suprr�i• �r t &
License: CSFA-082453
BRIAN R GIOVANNUCCI i
59 ATLANTIC AVE.
Marblehead MA 01945
Commissioner 03/28/2014
` Office of Consumer Affairs andusiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 141448
Type: Partnership
Expiration: 4/22/2014 Tr# 221486
GIOVANNUCCI BROTHERS
BRIAN GIOVANNUCCI
59 ATLANTIC AVENUE
MARBLEHEAD, MA 01945 - -
Update Address and return card. Mark reason for change.
—_ Address _- Renewal —_ Employment Lost Card
DPS -CAI Co SOM-04 04•Gl OI216
only
d
l
��� 1` License or registration valid for indiviuuse onfice o Consumer Affairs srness egu anon g Y
Of
_- - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
" Registration: 141448 Type: Office of Consumer Affairs and Business Regulation
Expiration: 4/22/2014 Partnership
10 Park Plaza - Suite 5170
Boston, MA 02116
GTO ANNUCCIBROTHERS
BRIAN GIOVANNUCCI
59 ATLANTIC AVENUE g
MARBLEHEAD, MA 01945 Undersecretary y� No . 'hid witlr6at 'signature
'Print Form
The Commonwealth of Massachusetts
-- Department of Industrial Accidents
Office of Investigations
1�1 s
I Congress Street, Suite 100
Boston, MA 02114-2017
P� www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: 59 ATLANTIC AVENUE
GIOVANNUCCI BROTHERS, INC.
City/State/Zip: MARBLEHEAD, MA 01945 Phone #: 781-639-4400
Are you an employer? Check the appropriate box:
1. ❑✓ I am a employer with "�
4. ❑ I am a general contractor and I
employees (full and/or part-time).
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.$
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, §1(4), and we have no
employees. [No workers'
insurance
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
1.3. ❑ Other
"Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
f Homeowners who submit this 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, 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:
GUARD INSURANCE GROUP
Policy # or Self -ins. Lie. #,:' r GIWC324907 ,, rr A �Expiration Date: 4/3/2013
Job Site Address: 72 UVZ <�b5o� L.km�r N' n�b0City�Sta�teZ" Ah 0 1104 e)
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 undet the pains and penalties of perjury that the information provided above is true and correct
781-639-4400
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
Contact Person:
Phone #: