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HomeMy WebLinkAboutREPAIR ROTTED TRIM WITH COMPOSITE, EXISTING DECK REPAIR BUILDING PERMIT ���o D 6�41 TOWN NORTH AV �°� PPLICATION FOR PLAN EXAMINATION _ Permit No# 6 / Date Received �RATEo Ppp`.i�9 �SSgCHUSro` Date Issued: YMPORTANT: Applicant must complete all items on this page 1n/,w/,, ri ri , r r r r r r /r. r / r / r i r / , / r r, r •rr ,, Machi Shop Village `y r` es � o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building e family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑/S�etic ell ❑ Flaodplam d Wetlands ❑ Watershed District t� DESCRIPTION OF WORK TO BE PERFORMED: r - 4 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor,Narne %,Phone T „ r r , r CA r //.✓ /// .i r rr /,r r.. ri r,/ o r ;. /,r �r r. r r. r r' r r r- r r ,,;� „r ✓ / r. J/r., / / ../. / // rrr // / r. , / / /f. /.., L r r//ii /r �r /� %/ r/ � ;% �%///..i//r/ /. / „/i//r/,✓� ,..rr �i� l �ri: ///�/� ail%/r�%r r ri../r ,l / r„-; 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: $ Check No.: d Receipt No.: " NOTE: Persons co ,acting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor i 10 __11S1 LEN GIBELY CONTRACTING CO., INC. Page No.__j_Of Pages 23R Winter Street PROPOSAL PEABODY, MASSACHUSETTS 01960 All home Improvement contractors and subcontractors (978)531-8234 Fax(978)531-9304 engaged In home Improvement contracting, unless www.lengibelycontracting.com specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered Submitted with the Commonwealth of Massachusetts. Inquiries To: V Z 0-jo �//Zox 0 5wijA about registration and status should be made to the r Director, Home Improvement Contract Registration, '74)V6:5 � y One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own /Uaconstruction related permits or deal with unregistered 12-T-6 ANOOL)IF& /V�6' Off 3 V�- contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. nia - � -M — DATE Y- 2 L/--IS- REGISTRATION NO. MA.REG.100811 J7NAME/NO.n - 3 - 141io�-_o JOB LOCATION :a 't 2_,z, - 16 hereby submit speliffications and estimates for work to be performed and materials to be used: '42- t 6 de,11,7,e01 53�5 0-0 . ................................. k A4 A, 7t\l- OOS � 0o WORK SC D Contractor k before the third day following the signing of this Agreement,unless specified hotel%w C4uUac wl I I ok on or a hereby a A about a 11�w(ocr I W44,du�,used by circumstances beyond Contractor's control,the work will be completed y acknowledge and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall I.Cd-as—violations of I a Agreement. Hidden rot or conditions not seen at time of estimate that are required to be repaired In order to complete this contract,will be completed at$ % per man hour(IVSHOUR). WARRANTY The Contractor,wat ants that the work furnished hereunder shall be free from defects In material and workmanship for a part .1 w n,completion shall.comply ly with Contractor, the requirements of Agreement.In the event any defect In workmanship or materials,or damage caused by the Con "a or disc .,ad within 0110 year a lotion of any job,including clean up,the Contractor shall,at his own expense,forthwith remedy,repair,correct, aj— her comp cause to be remedied,repaired,or replaced, such damage or such defect In materials or workmanship.The foregoing warranties shall survive any Inspection performed In connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of q 3 2 0 .- dollars Payment to be made as follows: q o Remove all job trash. All guarantees on all products from manufacturer. %($—IV— —)upon signing Contract; Add permit cost if needed-we pull permit. upon completion of N tice: agreeme I I r hom Improvement contracting work shall require a) d n p nt(adv ce opo of more than one-third of the total contract pri or I total a nt f all as or payments which the contractor must upon completion of me I once, o order a r oth Ise obtain delivery of special order shall be made forawith upon mat I equl m nt, completion of work under this contract. Note:This proposal may be withdrawn by us if not accepted within days. it orrrr Z I afar Acceptance of Proposal I have read both sides of this document and acc jptr q(s,specifications and conditions stated.I understand I that upon signing,this proposal becomes a binding contract.You are authorized to d the specified. Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time pri r to n ght of the third business day after the I date of this transaction.Cancellation must be done In writ* g. DO NO SIGN THIS CONTRACT IF THE EAR NY BLANK SPACES. Data SignatureDo" —IMPORTANT INFORMATION ON BACK i.r The Commo,wealth of Mgsschusetts Department of Industrial Accidents Ogee of Investigadons I Congress street;suite 100 Boston,MA 02114-2017 . , ww>'umassgoy/din. .. Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/,lumbers Anplieant Information Flease Prmt Leti><bly Nate,(Business/Organization/Individual): - •.�.r x Ip,.� i_�( e� C.I. Address: . _2!y/State/Zi : 4r. Phone M C I Are you an employer?Check the appropriate box• 1.JZI am a employer with 4.' E] I am a general contractor and I e°f Project(required): employees(full and/or pad-time).* have hired the sub contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.. 7. 0 Remodeling ship and have'no employees These:sub-contractors have 8: M Demolition working for me in any capacity; employees and have workers' [No workers' comp. insurance comp.insurance. t 9• ❑Building addition required.] S. ® We are a corporation and"lis IO'M'Electrical repairs or additions 3.❑ I am a homeowner doing.all work officers liave'exercised their 11. Plumbin myself. g repairs or additions y No workers comp. right of'exemption per MGL 12. insurance t. c. 152 f(4),and we have no Roof repairs . employees No workers r 13.[x]Other comp.'msurarlce'requued.] *Any applicant that checks box rel must also fill out the section below showing thea workerscompgnsapon policy information. Homeowners who submit this affidavit indicking they.are doing all work and then hire outside contractors must subinit a new affidavit indicating such, tContractors that cheek this box must attached an additional AM showing the name of the sub-contractors and state whether or not those entities have en►ployces. If the sub-contractors have employees,they must-provide their workers'comp.policy number: lam an employer teat is providing workers'compensatlon Insurance for my emplo information. yees. Below IS the policy andja8 site Insurance Co:iinpany Naine:� "r'V A L .L�v e A Policy#'or Self-ins. Uc.#: VW C -i Q 0- 60 b1I Ex p iiatidn Dater 1 Job Site Address City/State/Zip , •,. a ,page,( g.. policy number and ex iratit. Attach a copy of the workers' compensation policy declaration shown the otic Failure to secure coverage as.regwred under,Sec on 25A of vlG) c. 152,can 1, to.the P . on date). fine up to$1,500.00 and/or one- impositian ofcrinli*penalties of a Y imprisgnmpat, 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 oftbel)M,for insurance eovoratge:verification. Ido hereby certify ander,thepa(ns and penalptes.of perjury that the infgrmadon:provided gboYe.is true and correct Si Date -„ IS Phone 31 ,. Official use only. Do not write in this area,to be completed by eiO or town official. City or Town: Permit/Licerige# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityg6w'n Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M i ACOREr. CERTIFICATE OF LIABILITY INSURANCE 'YYY) as PRODUCER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Len Gi bel y Contracting Co. , Inc. INSURERA: First Mercury Insurance Co 23R Winter Street INSURERB: Safety Indemnity 33618___ Peabody, MA 01960 INSURER C: 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. TITSR 05TC POLICYEFFFCTIVE POLICY EXPIRATION LTR �NSR E TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDrYYYY) DATE(MMIDOff" LIMITS GENERAL LIABILITY MA-CGL-0000051263-01 01/29/2015 01/29/2016 EACH OCCURRENCE $ -1,000,000 A AGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS MADE r_v__1 OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYJERC0j El LOC AUTOMOBILE LIABILITY 6221693 COM 02 01/29/2015 01/29/2016 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY B SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F ]CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER '__ ANY PROPRIETOR/PARTNER/EXECUTIVEM E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under --SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Proof of insurances. 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 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1Robert Sennott/RP ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved.. The ACORD name and logo are registered marks of ACORD 0 C ERTIFICATE OF LIA ILI`fY INSURANC DATE(MMIDD,�YY) 08/01/2014 THIS CERTIFICATE 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 an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01634-001 VHANJAECT ICM Np Edward F Sennott Insurance Ao.Ext: A1C.No.; 16 South Main Street Topsfield,MA 01983 ���L Ess: INSURERISI AFFORDING COVERAGE INSURERA; A.I.M.Mutual Insurance Company 26158 INSURED Len Oibely Contracting Company Inc INSURER B: 23 Winter Street Rear — Peabody,MA 01960.6941 D INSURER E: 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 yBEY�pPAID pCLAIMS. ILTR TYPE OF INSURANCE I Slt _pOLICY,NUMBER tAM1DD/YYY MMND/Yl'YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY 7 GKM—AO—ETORENTE—D — $ PREMISES(Ea CLAIMS-MADE r OCCUR MED EXP(Anyone person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 3EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG $ --]POLICY O- OC Ef_'_'[ . AUTOMOBILE LIABILITY COMBINED SI G E LIMIT $ e ANY AUTO (FA gocid , ALL OWNED SCHEDULED BODILY INJURY(Per person) $ — --- AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OVMED PROPERTY DAMAGE "- AUTOS (Pei oc e t $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $� EXCESS UAB CLAIMS MADE AGGREGATE �. $ W_ogKDEEpD �p NETTpENNTIONN$ � yyC S7 �� S AfJyDpEMpP{LOY�ERpS��LIABI�QTY YIN X TORYLIMITS OER A OEFIC�RI' IMBfftrPRIaFR/FJ(ECUTIVENIA VWC-100-6010979-2014A 8/3/2014 8/312015 E.L. AGHAGCIDEM $ 600000.00 C DED7 — ----------.....__.—. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000.00 WVI'MON Or OrPERATIONS below E.L.DISEASE•POLICY LIMIT $ 600,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety �J Board of Building Regulations and Standards Construction Supvl-Nisar License: CS-094763 THOMAS R. 1)0Bj3I1V .� T r w , Expiration Commissioner 06/14/2016 C://t8 t(JIYIIl�Nlly�4lG�!{�/L U�C��IJJ!!L'✓LIWF��tI ': 'Mee of Consumer Affairs&Business Regulatiou License or registration valid for individul,use only OME IMPROVFMNT CONTRACTOR before the expiration date, If found return to: ` Office of Consumer Affairs and Business Regulation Registratl Type: 10 Park Plaza-Suite 5170 Expirll� Supplement Card Boston,MA 02116 LEN GIBELY CONS . L{v',INC. r '. .' THOMAS DOBBINGQ. 23 R WINTER STy PEABODY,MA 01860 Uadersecretary lyot valid without signature