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Home My WebLink AboutBuilding Permit # 4/8/2015 r10RTy I BUILDING PERMIT pF�t�eo ,610 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION i a Permit NO: _ Date Received Date Issued: � IMPORTANT: Applicant must complete all items on this page 01,k "LOCATION r �'? ri PROPERTY OWNER P�inf MAP NO PARCEL: ZONING aISTRICT: Historic District yes: "Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑61iffation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other o Septic ❑Well ❑ Floodplain �Wetlands Watershed District El Water/Sewer -� n Identification Please Type or Print Clearly) d� OWNER: Name: ,� Phone: Address: CONTRACTOR Ra ,"rne. �` Phone; Address: Supervisor's Construction license: Exp.` Date: Home Improvement,License ' 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: $ FEE: $ 033 - Check No.: 0, I Receipt No.: �Z--' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owngr Signature of contractor ' NORTH -Town ofS E ndover ® �„K. h ver, Mass, -Apo862515 0 coc 1-11,11, .c �1 ADRATED S U BOARD OF HEALTH VERT T Food/Kitchen Septic System . THIS CERTIFIES THAT �;,,, LD,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR .......... .... e. .... . ........ .... .. . . ... .. ..... . . Foundation .......... buildings on .. 1... has permission to erect ................ g .�..... . �� .... .............. Rough tobe occupied as ...... .. .......... 1.. ... ......... ..................................................................... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTI TARTS Rough Service ...... . ..�,flr�rr ......................,....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. Proposal HIC#136779 TVVC)MEY w ,,.& „,LEG a. Ire �.� �,�..M� �. �� . �� -a„•m � � � �,,.� � �” ��,• "Couldn't your home use a little TLC?" Specializing in Residential Additions 87 Belmont Street • North Andover, MA 01845 P: 978-685-7447 o F: 978--�685-7446 NAME OF OWNER & �� C- /�/ �+✓ ADRESS OF JOB- 30 / /' 4CE/G`61- &^ , /�IAV I ' TEL. Cl &.- D Z ! �p DATE: f �'/— 2-0 5— We hereby submit estimates for: ��j�! /�✓ j` f% f/ f A'Vis r Cr f7 r, ,,,,1-/CVs'/ �/ /V&- SN'` '' /`�'' C%'-��;!�-=h X S ir1✓�- C✓'� ��7 a+�,s7.1 d We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: y,,e-c. e-/C:. dollars($ Payment to be made as follows © � f7 J t f © c)a d 6,0. r ti'."! J a C)11 e_ ✓ P%u�`. t./ G 11 C.-6) 1 �L �✓1 a Authorized Signature NOTE:This proposal may be withdrawn by us if not accepted with in_days Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature [__Ieof Acceptance: l��"�•�.�� Signature The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations . 600 Washington Street Boston,MA 02111 wwminass.gov/dia Workers? Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: X21 m✓� fi City/State/Zip: �� y r 1�- AZA Phone tit: Are y n an employer? Check the-appropriate box: Type of project(required): 1. I am a employer ith 4. ❑ I am a general contractor and I w 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet ?. ❑ Remodeling ship and have no employees These sub-contractors have 8- ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y P tY- -9. F� Building addition [No workers'.comp.insurance 5. ❑ Wc'are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions. 3.❑ I am a homeowner doing all work .❑right of exemption per MGL 11Plumbing repairs or additions myself. [No workers' comp=- c. 152, §1(4), and we have no 12T] Pdofrepairs ` insurance required.] t employees. [No workers' 13Other c� 6 COMP. insurance required.] — `'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information_ I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractom that check this box must attached an additional sheet showing the name ofthe subcontractors and their workers'camp.policy information. I a7n ars employer that is providing x>oakers'eontpensatiotz insurance for my enzployees. Below is the-policy and job.site information. Insurance Company Name: FIZAVCL Policy#or Self-ins.Lic. U Il'► 1 t / u' / ��•- Expiration Date: ILL— Job Site Address: �� City/StatdZip Attach a copy of the workers' compen on 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 filie violator Be advised that a copy of this statement may be for'tvarded to the Office of Investigations"of the DIA.-for insurance cover-�g verification. I do hereby cerci u ider the pains and penalties of perjury that the information provided above is true and correct Signature: Date: / '/ Phone#: l / 71 Official use only. Do not write in this area, to be completed by city or town official, City or Town: PermitlLicense Issuing Authority(circle one): I_Board of Health 2.Building Department 3. City/Town Clerk 4_Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone##: RightFax C3-1 1/13/2015 5 :44 :51 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T- tIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: DOHERTY INS AGENCY INC PHONE FFAC)PO BOX 1985 (A/C,No,Ext): ,Noy: 21 ELM S'T'REET E-MAIL ANDOVER,MA 01810 ADDRESS: 22YMX INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA TWOMEY&LEGARE CONTRACTING INC INSURER B: INSURER C: INSURER D: PO BOX 366 INSURER E: NORTH ANDOVER,MA 01845 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 PAD CLAIMS. NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DDIYYYY) (MIADDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) P� ED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ ENERALAGGREGATE $ POLICY a PROJECT❑LOC RODUCTS-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 LIA11 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION ANDY WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-029OM994-14 09/18/2014 09/18/2015 LIMITS ANY PROPERITOWPARTNEWEXECUTIVE Y N/A E.L.EACH ACCIDENT OFFICERWEMBER EXCLUDED? $ 500,000 ',... (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST. BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT,94 VE NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Client#:13298 7WOMEY6 ACORD- CERTIFICATE OF LIABILITY INSURANCEDATE(M WVYY) PRODUCER 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURED Twomey& Legare Contracting,Inc. INSURER A: Arbella Protection Ins Company PO Box 366 INSURER B:INSURER C: North Andover,MA 01845 INSURER D: 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. LTR NSR TYPE OF INSURANCE POUGY NUMBER Pp LICY EFFECTIVE POLICY MM LIMITS A GENERAL LIABILITY 8500043255 06122/14 06/22/15 EACHOCCURRENCE S1,0001000 NCOM MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $5.000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2.000.000 GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOP AGO s2,000,000 JECT X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accidenp $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Porpenson) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraccidenp GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S $ ''...,. WORKERS COMPENSATION AND 1!1C STATU• DTH- EMPLOYERS'LIABILnY FRMIT I ANY PROPRIETORIPARTNEIBEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?es.dosen'be under II E.L.DISEASE•EA EMPLOYEE $ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS Covering operations usual to Twomey&Legare Contracting,Inc... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WELL ENDEAVOR TO NAIL 10_ DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR NTA VE i ACORD 26(2001ro8)1 of 2 #S31415/M30577 DML 0 AC CORPORATION 1988 %�r° arwynr rrrarnf/�r� (�iti.,rrr✓raJv//: '' Office of Consumer Affairs&Business Regulation t� HOME IMPROVEMENT CONTRACTOR l, —,Iegistration: 136779 Type: Expiration: 8/26/2016 Partnership TWOMEY+LEGARE CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST. N.ANDOVER,MA 01845 Undersecretary CS-067560 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER MA 0184.5 i 10/25/2015 fd 7 IT' t kI ,ET1',c CS-055108 DOUGLAS J LEGARE 79 GARY AVE HAVERHILL MA 01830 09/0212016 I