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Home My WebLink AboutBuilding Permit # 6/4/2015 BUILDING PERMIT �oRrH q" O��.r LED tb�•yO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received � pp�ATEp PPR` `5 �SSacHUS Date Issued: _ IMPORTANT:Applicant must complete all items on this page LOCATION l vytt'a(""m y "'-c Print PROPERTYOWNER Print 100 Year Structure yes b no" MAP PARCEL: A( ZONING DISTRICT:_ Historic District yes (nna� Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building I,One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial jKRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �Jrr QW rare/9�w k ',, , N DESCRIPTION OF WORK TO BE PERFORMED: /,�- ��>!-�, 2 ;grow w^�e' r.�.� �"' .i�7�-rP�� '��° rr� �`�°^�. ,�.' r,,� w�;iaa,°.',°;:•- .fid a� � �c.'�"',�') ,P,uly,,4 r x 64r#11-ellen of '% /e� i �t7a(, iAuya°`. o�Ad"°/ i✓ eaLra✓r r- c9c:a" r d� � Identification- Please Type or Print Clearly OWNER: Name: �" �= rrrr,r i��.d c �. . Phone: Address: � �• Contractor N me: Phone: Email: L Address: Supervisor's Construction License: 16Z 5 / Exp. Date: /,qf Home Improvement License: 1,592Exp. 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: $ '111, z 00, Ob FEE: $ r � Check No.: Receipt No.: NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund sL^,,;T l r /Iw/ iiK/ l /ii/"i✓lrr, // '/J� =11/1551/11 6al NORTH own of T E 1, , ndover 0 . 0% No. i '5 it - h ver, Mass, COCHICKCWICK �•4 AERATED ►P�,��(5 S U BOARD OF HEALTH PER I TT LD Food/Kitchen J / > Septic System THIS CERTIFIES THAT (. `�� . BUILDING INSPECTOR ............................ ................. ..... ... ......... .. Foundation has permission to erect ........................... buildings on � .....!..... ..Z ..... Rough to be occupied as ..... �Q:......9�„r;` e��.. ::^t..... ....�. ��.. ......:- .........................................c� e� 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTSRough 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. Contract between ALRO,LLC and Munson Property Management,LLC. 108 MOODY ST NORTH ANDOVER, MA 1. DEMO MATERIALS AS DISCUSSED 2. REMOVE ALL DEBRIS FROM SITE 3. REPLACE 12 WINDOWS 4. REPLACE 3 EXTERIOR DOORS 5. REPLACE 13 INTERIOR DOORS 6. REPAIR STAIRS TO BASEMENT 7. ADD CLOSETS AS DISCUSSED 8. INSTALL NEW CABINETS IN KITCHEN 9. REPAIR, PATCH AND PAINT WALLS 10. REPAIR/ REPLACE SLIDER 11. SUPPLY AND INSTALL NEW HEATING SYSTEM WITH A/C 12. REPAIR SAND AND POLY HARDWOOD FLOORS 13. REPAIR ROOF AND SIDING AS NEEDED 14. RENOVATE TWO BATHROOMS WITH NEW FIXTURES 15, UPGRADE ELECTRICAL 16. REPLACE RUGS AND TILE 17. RELACE FENCING 18. NOT INCLUDED: LANDSCAPING, FIXTURES,GRANITE OR POOL AREA 19. NOTE: PLUMBING, ELECT RICAL AND HVAC BY LICENSED CONTRACTORS JOB WILL START WITH ISSUANCE OF PERMIT BY TOWN AND BE COMPLETED IN TEN WEEKS TOTAL JOB COST$86,120.00 5/20/2015 JEFF MOLL/ALRO,LLC. MUNSON PROPERTY MANAGEMENT, LLC 1 q Vo 6 `1 by 7.12 (.i# el r The Commonwealth of Massachusetts Department of Industrial Accidents w I Congress Street,Suite 100 Boston,MA 02114-2017 ,�` www.mass.gov/dia /^ Sy'V Workers'Compensation Insurance Affidavit:Builders/ContractorslT♦lectricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. A licant Information Please Print Le ibl Name(Business/Organization/individual): Address: City/State/Zip: a Phone#: Areyou an ployer?Clreckthe appropriate box: Type of project(required): 1. am a employer with employees(Rill and/or part-time).* 7. F1New construction RIO 2 am a sole proprietor or partnership and have no employees working for me in 8. OKRemodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeovmer and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensationinsurance or are sole 11.F1 Electrical repairs or additions proprietors with no employees. 12.[1 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.Q Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showurg their workers'compensation policy information. 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 checkthis 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'contpensatiort insurance for•my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: V4 r-0)7 4 34 T Expiration Date: " - p Job Site Address: 14" inOVOY .5 City/State/Zi Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 enalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a and/or one-year imprisonment,as well as civil p day against the violator.A copy of this statement may be fol warded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certiMZ— Phone#: asand alties ofperjury that the information provided above is true and correct. Date: Signature: 447S' "•. 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#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY'Y) T. ' . 7IFICATE 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(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: JOSEPH PINTO INS AGCY PHONE FAX 142 PLEASANT ST (A1C,No,Ext): (A1C,No): E-MAIL MALDEN,MA 02148 ADDRESS: 27BSY INSURER(S)AFFORDING COVERAGE i NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA ACTION SIDING AND REMODELING INC INSURER B: INSURER C: INSURER D: 3 PINEWOOD RD INSURER E: PEABODY,MA 01960 INSURER F.- COVERAGES :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 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. '., INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (Y"DmYYYY) (MM�DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE D OCCUR. REMISES(Ea occurrence) ED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ ENERAL AGGREGATE $ POLICY [:3 PROJECT❑LOG 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 LIAROCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XweSTATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-2E072226-15 03/10/2015 03/10/2016 LIMITS ANY PROPERITORMARTNEWEXECUTIVE WA OFFICER'MEMBER EXCLUDED? E.L.EACH ACCIDENT $ 100,000 _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERA noNSILOCATIONS!VEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED i IN ACCORDANCE WITH THE POLICY PROVISIONS. j AUTHORIZED REPRESENT VE ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD 1988.2010 ACORD CORPORATION. All rights reserved_ 3 CJ1ze triallv�rao-�zule�lffia �'/l�rc�uacfrt�elfa fl#�iceofF.onsu�trr�s��s& ess �ioa IMPRDIIEMEi!�-T GQirF�"tt�GTUR on. .� 1'39367 Tye: , ai3oR 4116 DBA ACTION SIDEING ARTHUR CARSONE 3 PINEWOOD RL?. PMADUUT-,WA'0"1960' Uuderseeretary r� - Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS404M1 `,r I I,, ARTHUR R CAR$b 3 PINEWOOD ROAMM PEABODY MA 6964 Expiration Commissioner 12/11/2013