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Home My WebLink AboutMiscellaneous - 1216 SALEM STREET 4/30/2018 1216 SALEM STREET 210/106.A-0182-0000.0 i Location �� S 2 xe(/u S No. /7 Date MORTM TOWN OF NORTH ANDOVER O? • • Op Y • • s ; + Certificate of Occupancy $ / J Caus�< Building/Frame Permit Fee $ i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # da f 16140 v/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,, OR DEM/O�LISH AjOp�NE OR TWO FAMILY DWELLING J, ..... _: S_ SO�`..QiLIiffi.,sys..sr>✓ xe-U4 3`""4` .? h SS BUILDING PERMIT NUMBER. DATE ISSUED.C ic _ SIGNATURE: a—I Building Commissioner/I for of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dimrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided 1.7 Water Supply M.G.I-C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(P nt) Address for Service �" O 4AI ignature Telephone w� 2.2 Owner of Record: Name Print Address for Service: O — - — - —. . m Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v AAo�-s;"Ae p Company Name L l g q Ljo 1� � Registration Number rM re Expiration Date Si nature Telephone �!/ SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......X No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t��1!%1 '01 ,VAak `t NL S�l V SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be x y s OFFICIAL USE ONLY ,' Completed by permit applicant :Ykk •-tr• .. ._.: 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 4rIA90 617 ;as Owner/Authorized Agent of subject property Hereby aue to act on My behalf matters r tiv thorized by this building permit application. I,e(An Sij'nature of weer Date l SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A 9,ent Date `t NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TRABERS 1 s 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIA EY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ACORDCERTIFICATE OF LIABILITY INSURANCE ! DAT TM. JAN 2903 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION R B KIMBALL INSURANCE AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 1390 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HAVERHILL MA 01831 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE: 978-374-6365 FAX_978-374-7769- -Agency Lic#:MA 1003120 INSURERS AFFORDING COVERAGE _ NAIC# INSURED — INSURER A: ZURICH INSURANCE GROUP JURGEL,DAVID AND TULLEY,DONALD !INSURER B: TRAVER_LERS INSURANCE �- 9 64TH STREET C INSURER G: NEWBURYPORT MA 01950-4219 INSURER D: I'I �INSURER E: COVERAGES 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. IN LTR TYPE OF INSURANCE j POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION l LIMITS DATE DATE NIMMO GENERAL LIABILITY SCP 39995726 ) MAR 15 02 MAR 15 03 EACH OCCURRENCE_ $ 500,000 X COMMERCIAL GENERAL LIABILITYjDAMAGE TO RENTED is 300000� CLAIMS MADE I XOCCUR MED.EXP(Any One Person) $ 10,000 A PERSONAL&A INJURY 1$ 500,000 --... GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000 XPOLICY I I for IAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _..... ' ANY AUTO (Ea accident) ---- ; ALL OWNED AUTOS ! ;'BODILY INJURY SCHEDULED AUTOS (Per person) I$ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) j PROPERTY DAMAGE $ i GARAGE LIABILITY ONLY----EA ACCIDENT 1$ ANY AUTO I -- ----�.._............._ — -....__ (I 'OTHER THAN EA ACC $ AUTO ONLY: AGG is I EXCESS t UMBERELLA LIABILITY i EACH OCCURRENCE is OCCUR i CLAIMS MADE AGGREGATE $ I DEDUCTIBLE $ _. RETENTION $ -- ---- - .. WORKERS COMPENSATION AND i VX STATL- EMPLOYERS'LIABILCOMPENSATION 6KU8-859X370-A-02 , MAR 27 02 i MAR 27 03 X Y RSI OTHER E.L.EACH ACCIDENT i6000 B ANYPROPRIETOR/PARTNER/E7CEWTIVE ( I ._._—_.,..._..—... —... ..._-......,._._.. ' ill oFFlcEwmAMSER EXCLUDED? ! 1 E.L.DISEASE-EA EMPLOYEE $ 1 00,00O j if Yes,describe under SPECIAL PROVISIONS below j E.L.DISEASE-POLICY LIMIT I$ 500,000 I OTHER: I1 i DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES/EXCLUSIONS ADDED ENDORSEMENT/SPECIAL PROVISIONS VINYL SIDING,REPLACEMENT WINDOWS,TRIM.METAL COVERAGE AND GENERAL CONSTRUCTION SERVICES INVOLVED IN RESIDENTIAL CONSTRUCTION. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: — CANCELLATION CARL GUSTENHOVEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1216 SALEM STREET EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT NORTH ANDOVER,MA 01845 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,IT,S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: CARL GUSTENHOVEN ACORD 25(2001/08) Certificate# 312 Malcolm D. Kimball Jr. 6595 � � � , ✓� �_�«� ��\/ . �. & # \ \ | Board k Ai�m ��u Aw and ya.Ards \ \ HOMEIMOIR6VEMENTCONTRACTOR ! | \ G� 0t } � : 7 � . ,. ! a= .:«, y i 7mLk 410ƒD / . . DYokALp L 7 9,64TH ST. , ! - . ��y�. . . NE/BURY FZT,¥+$s50 — . . - �A 4AMr North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A.. The debris will be disposed of in: kE� WAM) SQ7 (27 CCRC0WAJ M,4 (Location of Facility) Signature of P it A cant b Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I P.O.BOX 5776 SALISBURY,MA,01952 VINYLSIDING&REPLACEMENT WINDOWS PHONE/FAX 978.465-0456 H.I.C.Reg.#119440 CONTRACT Date: 1/15/03 Worked to be performed by: ADDSIDE EIN#043493661 Partners:Don Tully, 194 Lafayette Rd,Salisbury,MA 01952 David Jurgel,9 64th St.,NewburypoM MA 01950 Work to be performed: As outlined in attached Proposal#0421 Payments: As outlined in attached Proposal#0421 Work to begin within 15 days from acceptance of proposal. Work to be substantially completed 45 days from start date. Contractor is registered,inquiries should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place Room 1301,Boston MA 02108 Tel.(617 727-8598) Home Owners Rights: Three day cancellation under MGL c 93 s 48,c 140D s 10,c 255D s 14 Warranties 780 CMR R6 and MGL c 142A Liens or security interest on property as consequence of contract:N/A Other matters:N/A Other provisions:Homeowner will be responsible for electrical work and permit if needed. Permission to act as the homeowners agent to obtain necessary permits:YES "The contractor and the homeowner hereby mutually agree in advance that in the event that the con- tractor has a dispute concerning this contract, the contractor may submit such dispute to a private ar- bitration serviwhich has been approved by the Office of Consumer Affairs and Business Regulation and the cons er shall be r ed t ch arbitration as provided in MGL c I42A. Owner: Contractor: X� NOTICE: The signatures of thy' wales ab v apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution eo even where this section is not signed separately by the parties." DO NOT SI S CON. RE ARE ANY BLANK SPACES Owner: Contractor: Date: !j 7� fADDSIDE PROPOSAL VINYLSIDING&REPLACEMENT WINDOWS PROPOSAL NO.0421 P.O.BOX 5776 SHEET NO. 1 SALISBURY,PAA.01952 W.REG.M 119440 PHONE/FAX 978-465-0456 DATE: 1/13/03 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME:KIM&CARL GusTENHoVEN ADDREss: 1216 SALEM ST. ADDRESS: 1216 SALEM ST. CrrY,STATE: NORTH ANDOVER MA 01845 CITY,STATE: NORTH ANDOVER MA 01845 We hereby PTpose to furnish the materials and perform the labor necessary for the completion of: Vinyl Siding w/house wrap(approx.30 sq.) Vinyl Soffit Aluminum Wrap on trim-windows,doors,Pada&soffit Shutters-11 sets 20 ft Foam Backed Comers(fluted or plain) Repair rotted sills&trim(does not include structural damage if any) Strip existing siding R remove(#1,500.00) All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: Fourteen Thousand Seven Hundred Sixty Dollars ($ 14,760.00) with payments to be as follows: Deposit of$4,920.00 Halfway payment of$4,920.00 Final payment:$4,920.00 Respectfully submitted , Per Note-This proposal may be withdrawn by us if no acce 'thin days Any alterations or deviation from above specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby a p YoV o o the work as specified.Payments will be made as outlined above. _ 1 SIGNATURE l DATE Cl ` SIGNATURE Town ofdover Lclover, Mass. oP COCMICMEWICK > �d AORATED PC S G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .d.I�.I........... ..V :�4... ' ......................... .O..V.. ................................................ Foundation p �i...1......... g 10140......:5*l.W w►.........$ {' has permission to erect...V.�.� ., buildings on ...... .. .... ................... Rough to be occupied as......S.1. 1.�V V„I Vr! r �. Chimney Co.............r...... ............................................ y provided that the person accepting f permit shall in every respect conform the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws,relating to the Inspe on, saw and Construction of Buildings in the Town of North Andover. I r� A / 1g � O � PLUMBING INSPECTOR s VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final .UNLESS CONSTRUCTIQN A D T ELECTRICAL INSPECTOR A ( Ao� Rough .................................................................... .................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 0 Street No. b SEE REVERSE SIDE Smoke Det.