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HomeMy WebLinkAboutBuilding Permit # 6/29/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1�-IC5 Date Received Date Issued: W�74 IMPORTANT:Applicant must complete all items on this page ?4/,'2 q LOCATION /........... t A, 0 PROPERTY OWNER , yes 'i 0 Pant; ..... 1 00"'Y66/f Old Struidf ,PARCb;1-' "La"", "I", ", yes,:1 no ,�P NO' 'HiStbri6`b";`f` ZONING DISTRICT It"T.'� z*/,/�/ 'IlSTIC Village ;;yes,; ' 'no ,', TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -4eDne family El Addition El Two or more family El Industrial ,L?Alteration No. of units: D Commercial El Repair, replacement El Assessory Bldg D Others: El Demolition El Other D Septic OWell, ElfP lood lain,:,�� -[],Wetlands D Watershed'District , EJWaf&[8e'Wer DESCRIPTION OF WORK TO BE PERFORMED: It 7) Identification Please Type or Print Clearly) OWNER: Name: C 1-1 ��L.q VL- Phone: C1 I 3e ;R 01,-1 Address: �0,z_ev-)V_ -G, one.- 'Ph ­ 'CONTRACTOR, Name:, , 'Address, . E Date / Sub'ervi8or s, C onstructiOn'License: 'c Xp "J Ex" 6tb:;­, 6'm-6 lmprov'ement'License' ': Norrie I I �, p, D 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. S Total Project Cost: $ 6 , - — FEE: $ I Itu n e�, Check No.: Receipt No.: 226cl NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan El Stamped Plans El 4 FORTH Town of ndover 0 No. — 15t _ * nQ� LAK& h ver, ass, �1 COc"Ic"t WICK 4•`" ,q�°'aaT�® BOARD OF HEALTH LD Food/Kitchen PERt. T.0—15*&0. Septic System -z* BUILDING INSPECTOR THISCERTIFIES THAT ......... ....... ........Y..............13. ............................ .................11 1C ........�....,.......... • ' Foundation has permission to erect .. buildings . . ...... .... • E• ..................... ... Rough to be occupied as . ................ ... .. .. .. . . .................................................... cnimn y e provided that the person accepting this permit shall in every respe onform 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES ELECTRICAL INSPECTOR ARough UNLESS CONSTRUCTIO' Service .................... .... .. ................................................. Final BUILDING INSPECTOR GAS INSPECTOR ccupancV Permit Required to Occupy Bu Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr all a Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Page No _/ of I Pages LEN GIBELY CONTRACTING CO., INC. n 23R Winter Street 2 6 4"7,9, , ,F R ,, ,+ r PEABODY, MASSACHUSETTS 01960 All home ImprovemenYconi ractors and aubaon#raptors (978)531-8234 FaX(978)531-9304 engaged In home improvement contracting,.unless ibet contraating.com specifically exempt from,registration by Provisions of wvrwaen 8 y Chapter 142A of the'Onstral'14wa, must be registered wlth,the,CommomNgslth a1F swfea hl!4e,(ar l qulrlas SubmittTo: tor,`Homs� � _ - about regl,stration and is, I slffoi�id bs mwldn,ta,the DirecImpr9fif nt og irao�Fleglstrallon, Place,PoOm'I34i;8datort;MA Q21O One Ashburton n .� (817)�7278t398 rownsrs`�riFie ieecuretheir`"ovvn construction related permits".or deal wlth unregiatered � pcontractors will be excluded from the Quaranty Fund Provision of MGL c.142A n e AnaNNor H�1i,PJ ,,� �✓ktF.a„ rnd�lo�a Jfi'l 1.�r..:C«a ,r... J[7A'ra ,,,, , �n 1 MA RFr0,K ,00811 - r� /S J / Q^� ZIOaNA�o.��(l iCJ7 i1 a , '.49a LQCATioN,,, estimates for work to be performed and materials to be used: — - illcationsandesti ��-- wen��s�h� I_,� .Q._ — - r, + „F �,F o-A r �� F-* .'^^t�'^d r rf rr 5d r 't - ='( - r Vic- �/- 71 '77 11 -�-- aAA � _ D 71 1 � L �r Conlr 1yW ba a vMrk ar order the materials balers the third day fpilowing the signing of Ihls Agreement,unless specified herein writ) Co Iyb�TiiP.Ow work on or aoknow edges and a rasa t' (data).Barring delay caused by clroumstanCea beyond Conlraotor's control,the work will or completed bon viol^l o 9 hal the scheduling dales are approximate end that such delays chat era not avoidable by the ototracfor she o be considered r violhour(I of Inls Agreement ba �_5�,�.••�° r irour(MAN F#4t1R)., Hkklen rot orcondiUone rwtaaen at Uma b1 estimate that are raquite<f fo be repaired kr ardar W Complete this canvas win completed at$���"c/ �� WARRANTY The contractor warrants that the work lurniehed hereunder shall be iree from defects in material and workmanship for a period of following completion and shall comPwithin N with the re AF an,.of thl.Agm men(,In Iha wovant any,datect fn Workmanship ar rnaterlels,or damage caused by the Gonlraotor,.hla subcontractors'am la aee or d enls,le discoveredlaced, one year after completion o1ihCiuding'clean up,the conirac(4r shal6 at hla own expenes,forthwith remedy,repair,correct,replace,or cause to ba remedied,repaired,or replaced, such damage grsuobyfefeot Ip metpdH 1 gflVgr an nip.Ths fpregoing warrengea shall surive any inepeation performed in connection with Igeragreed upon work p r sum 7,77 We Propose hereby to`furnl$h material and labor,—completeln oporda pa with above speollloa(Ions,for t rte of r 'r! � � �{wlry l trri', � Ia � t,,� 4,Fro, 4x„�o,{ u0 rCli Qara —)r' Payment to be made as follows %' Remove a ) � ll ob bash, _ All guarantees on all products from manufacturer _% ,3 )oPan slgning C�ontraah Add permit post if needed-we pull permit.` r , t nl .t , -i, ($,,b4 $k� )upon completion of h Notice: No agreement for home ImProvemanl coniraating work shall require a �, down payment(advance deposit)of more than one-third of the total contract /,($ )upon completion of price or the total amount of all deposits or payments which the contractor must make,In advance,to order and/or otherwise obi delivery of special order shall be made lorawith upon materials and a ui ent'YtbLgtl@1t&fes %($ )completion of work under this contrast l ;f tro Note:This proposal ma qp vritipr�v�P nate pte(f wflhin r.,, r,., days, ✓-i,r yga,, ignalure J I„fW P ',r tr v ,, „L ACceptanc8,,,of:P opQBal ,I have read both sides of this document and accept this prices`,"apec0lcatI i and conditions slated t understand that upon slgnlr)o�;thtsProA9r tF,h fi "ss a b(nding contract,^You are authorized to do the work as specified Payment will be made as outlined above.: You,the BttXet,troy„ an0fIr thla#ran,sction at any time prior to midnight of the third busi es day after,the date of thls,transactiofl{Cancellation must be done In writing , rr pO NO SIGNTRI CONTRACT IFTNf q, l#RE ANY BEAN PACEP," kr , Q4 v A fd ( K; ( �a "N' ,', t pate, Signature p11 ais Signature IMPORTANT INFORMATION ON BACK 01► Thi Cda�mor�w�alt�raf Mgss°�r�,�u.,,�et�s: Department of hdustriarl Accidents O,f ee of Inve-stlgadons r C64iistre'e4 sulci 1'00 Boston,MA 02114-2017 www.mussgoy/dux, Workers'Compensation Insurance,Affidavit: Builders/Contractors/ElectriciansMIumbers Applicant Information Tlease Print Iseaibly Name,(ButinesslOrganization/Individual): :cr a.'i&A,L`�'"t,+�� o Address: . F ..W .j-r �e rtv S City/state/Zip. : ca.. Phone 3 $ :3 Are you an emiployer7'.Check the"appropriato box: 4. I am a general ofiroject(required) I.[Z I am a y "er*ith cad.'' g neral contractor and i erri 10'�ees full and/or part-bine).* kava hired the sols=contractors 6 .a 1`Tew construction . 2.❑ I am a sole proprietor or partner- listed oh the attached sheet, 7. []Remodeling!, ,ship aiiid have'no employees These:sub'-conttactors$.have. g: =D Demolition working for me in any capacity: employees and have workers' r, jNo Wgrkers' comp,insurance comp.insurance.= 9• ❑Building addition required] S We area cotporation and.its I0[:]Electrical repairs or additions 3.❑ I atn,a homeovvxter doing all work ., officers latve eicercieed their 1`1 []1'lumbuig repairs or additions myself [NQ wor ers' comp. nglrt of`exemption Icer fi%IGL instuance refigured.]t�, c 15�,X1(4),add we have no 1r� oofrepuirs employees [No 3.E Other com Insurance'requuei.] *Any ePPhcantthct checks bgx#1 p,$4 al$o fill out the seghon bgiow shgWin#their wgrkers'ccirnp��rsatign policy Ilnformation. t Homeowners whb submit this affidavit indica ey: doing i3ng th are do all Work and then litre outside contractors must submit s new affidavit mdicatmg such. t ' '* hed an additional sheet sho Contraatois that cSeck this liox must attaC .Y,. r employees U the sub-contractors have em to ees,the must. rovide then workers com li number have wing the name of the sub-contractors and state whether or not those entities I am an employer that Is providing workerscompensation Insurance for my emplo information. yees. Below Is the pollny wird Job site �� .. Insurance CI'A 4,.': L�c i� � d Ay Policy#'or golf-ins. tic, #. "( W� ,.1 6 0 6 d I 0 T'7!4 h piration Job Site Address ® � r V(., Ci ;/State Attach a ._d"� copy of the . rkprs'.compeusatIon policy declaratlaq page(showip the policy pumber and expiration_dptc). Failure to secure coverage as.requtred under,S.eotion 25A of�Q c. 152 cansl W.tll imposition o(ertmua}1 penglties ata fine up to$1,500.00 and/or one-icor it pnso anpn4 as weII.aq,civii.p t�altigs;in t1}e fotnx of a Sf0]'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 oftlte;,DJA for insurancorcoveraigewerification. Ido hereby certify#nder,the. p Jfp ! ►J' . . . pa andpen . er o that the i arn�atr ort:prQt!i d gcbdve:ls true,atid earreczr i Phone#; 0-1 1 "S, Official use only. Do not write in this area,to or town official City or Town: Permitfucense# Issuing Authority(circle one): 1.Board of Health 2.Building Dep'ari (tent 3.City/To'wu Clerk 4.Electrical 6.Other Inspector 5.Plumbing Inspector Contact Person: Phone#: aarE(MM/ODmrri ACC)O�r" CERTIFICATE OF LIABILITY INSURANCE 44,,,,,,,, - 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 pollcy(ies)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 bCOONJACT Edward F Sennott Insurance WSW.Ext): �c.No.: 16 South Main Street ADDRE Topsfield,MA 01983 ss: INSURER A,..A.I.M.Mutual Insurance Company 26168 INSURED Len Gibely Contracting Company Inc INSURER B: INSURER C 23 Winter Street Rear u Peabody,MA 01960.6941 --I!NSURER 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 B�Yp�PAIDpCLAIMS. . INK TYPE OF INSURANCE I POLICY NUMBER MMIDD YY M YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RED. $ '....... CLAIMS-MADE 0 OCCUR MED EXP(Any one person) $ '.. PERSONAL B ADV INJURY $ '.. GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ---]`-ICY ECL _ OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMITJEA accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOSNRVED PROPERTY DAMAGE $ r ac UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ '... WpRKKDppEppDgg���p_ REETTppETNTIIONNN$ $ AIVD EMPLOYERS�lIAB1�ITY X I TORY LIMITS I o !P ECIIIE N E.L.EACH ACCIDENT $ 600,000.00 A (Mand��PyInNH) ' N N/A VWC-100-6010979-2014A 8/3/2014 8/3/2016 — , �(ffMandrralItorylnNH) E.L.DISEASE-EA EMPLOYEE $ 544,004.44 DESt.:RI1�110ON O'WOPERATIONS be. E.L.DISEASE•POLICY LIMIT $ 600,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/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 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ACORQ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) Tri 1 01/30/2015 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 4S7 Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Len Gibely Contracting Co., Inc. INSURER A: 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. kDD* VF POLICY EXPIRATION LTR NSRN TYPE OF INSURANCE POLICY NUMBER DPAO W DATE(MWDDIYYYY) LIMITS GENERAL LIABILITY MA-CGL-0000051263-01 01/29/2015 01/29/2016 EACH OCCURRENCE $ -1,000,000 niENTm X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS MADE FX-1OCCUR MED EXP(Any one person) $ S'000 A PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ Z'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 J POLICY[ PER& LOC AUTOMOBILE LIABILITY 6221693 COM 02 01/29/2615 01/29/2016 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 CON ALL OWNED AUTOS 130DILY INJURY X SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS 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 $ 1 OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION 'TA-I11- LIMITS I jum AND EMPLOYERS'LIABILITY TORY ER ANY PROPRIETOR/PARTNER/EXECUTIVEYIN[:] E.L.EACH ACCIDENT I$ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ IfX.s,describe under d SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS �Iroof 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. bu AUTHORIZED REPRESENTATIVE Robert Sennott/RP ACORD 25(2009/01) @ 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ��.._Massachusetts .Department of Public Safety ^•� � Board of Building Regulations and Standards CMINIM001)Supuri'isur License: C"q788, THOMAS 4,DOB P Expiration Qommis*loner 05/1412015 y 4 , ....... ...... __. ...... &/zearlinearuc �CaJaue✓acpetla �,� Mice of Consumer Affairs&Business Regulation License or registration valid for individul..use only 0ME IMPROVNt NT CONTRACTOR before the expiration date, If found roturn to: Office of Consumer Affairs and Business Regulation Registratl ni ,; Type: 10 Park Plaza.Suite 5170 Expira Supplement Card Boston,MA 02116 ,- LEN GIBELY CON ;INC, ` THOMAS DOBBINS 23 R WINTER ST :``" lx' PEABODY, MA 01960 Vadersecreta �Not _. ry valid without signature } t