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HomeMy WebLinkAboutBuilding Permit # 7/1/2015_ ........ ........_. _ BUILDING PERMIT ®F " IDORT M �,� TOWN OF NORTH ANDOVER e!�Pl- 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received o a� ��ssAlCHUS���y . Date Issued: IMPORTANT:Applicant must complete all items on this page t� 1�� TV��tNV I .a"--s`u- J 4 u 3` 1-{ a, s,.:...�.K,.^'•-is [^ •�.� WE r ai t � JJ + � moi-`; d y, y -t�- i�,r et � �,.t'T• �7 ^�ar� u �•�.. a `tp e y .ra -2. .'�, `{. �N u. l`.� N,1 'R, .r ),�Y ,a + t. rr.� .3; e-•'y'F'�,3a1=` h t it .,.r,;,+l -� 5 .r .�1 1 :..JE� :r� t^'1;}wi o-�1.i<� ,n>vY- �,d'�ta�.�t51y. �..i+'y,*✓� ��., I y}t'1%''��f;Y,'_+4}f\ �'� �-J'�,�?�2•-r3f. ¢-r +a: c ir.Y �� s x-.. s-: J �"��`� r n, �.�...�.n7�J;.5r +_nig J x�J��'?'��� Jc,s i s .I"3i•�J'x J ';aPf11I1#�,_.s�. a'!�r h'.d �-.Fs i� •��' .�-..E. -Z' v- ts.r.� i.� ��..r t �_ J _ s ., �" a ;4�` t.' -.r`'.-.��.. 1.!�N�'•'�i .t.re`urSa�lE�tz t�� !- r<�7�.'+ t--r �-; j y�'-`'r -4 {ti rS''�, r s*"t' r�'� J;'a �''����Vai�- - 'fr;C%.n")=rP'�tfi?! "G •kl "3}i�` �, 11�79LL 11 e i 'v S'.t. �,xC`�5 I �aFi r "= �1'rI�,G-�c,�'�r�l'x T�tx �5�s,..�r fi�liM����`�tit' �� �ku1"7`Er,�; ,�K 'm'•iC.�ti?:.,� t ,��'+ ',�. yr7trl.:�s'r,'ry., rt}x sn,r"1'„f 4 ,,f^a4 ��r,-r5. s.. tiJ,rt.� s5 r ,�� 'e _r •� �'��-.�•+ .cj]yxJ_.,?mt21S r y�-r,�1-c;a "� t'a ''r f �i.-.. J 1 _ � t'.S 4 a' i ,_i�•, _ Nr,<`�F';�;,•IIr=,b ur't1J:'?.y'.'`.5�,y.:9t'M-'4 •srv�::r' C�rt7�s���{J+'",:��?! � `tr 'J rr� '�i �i ._.�. ..iu.�. 'L fir-. G."s 1 ;, �, -,.-.�n'-f. "=:• � 1....;w.'��{,..,1_.��?',',�-r'��``,,a..; .Jiry.lt?{s'�l"l"aa r`t. Ski�,�� -m ,�` fG �G r�ti�� f�QTr ,,... ."'�+ . .��,u,.Z �., . 7- _..- .y.•t_.... . . ...�. -�';r....{4,a.0„''� _.... ,.. :. -y,, �'�la,ge�! 7��'�iG � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building VOne family Addition Two or more.family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other �� `�r1 Y. i x� y��.s....3' ti�r:�',t3%��'�,.� y-� �-,-'fix' '3�y ,Y�.,{.y •"rt'��.'=: �:;N?=';'S• �e� r),r.^...S=S`G`-,a4 s5i ..f:,..,:1G�a��,"•;.= n•-^r'�.���.�.��YYx��, �.�Q '... 3 1 K�'.� s���Jlt7�1��� .�c�. S�.:v141+�J � •� ,r>,.'J rc-'S��� �'' ,r�"�.yy e z 'es,.,s- �� '-ye�FC�" �:.�ls�.�r�•yl,€ 4-4"��['��2 �sY�.�`��+F,st���' r -�IS�Y•y�.r c- r G�d�,F-sem a���}�,.a ���i�J��� �I�IL����7�.�i�c +.., Y�^"4."�f/��/,� i�- 7.5 -�>�',j;s e_yy'. s �.y'"t'�.S tF.fi-O-� l�r,�„�. �".a. +_�5.��C.`�.�y °�i"i�'.- ,y�. >f iii j�_�4i.. �.�'='�'b��6, � �'�•i-;Y�Y x a^��E�?�,,--yt ,s[rL�¢J��t#�-��. '.�'`•3'Y+VKaGI'Y�r�n�;£�111rL1,f �' r1 St(`4�r-�:1-CJs-.`-�.y��.'„��._ ;pr,:��=cj��Fi:. ,`�'"�1tL..1�},cr`yt-,.::. ter-, -JAL .•.r-r9z' �'+ �� ��4e� .,� PSr h.•�+..'�a A .r"... s-?...r_..} .,�i.:_s•.;'�,:n,L'�;�a.`1,JS..fF`x..���jk b Y yh "-Jt` "t-�+;'7 DESCRIPTION OF WORK TO BE PREFORMED: M-� � t ! entifii tion Please T or P nt Cleanly) OWNER: Name: . ( Phone: Address I (-,e 0 /.t-u} Lie �`.�����f��,r,.�+��ar)"`2$ L- k='-f yj, + Y�J.,-,,, L e , r' r-E• i ,x r �{ L,� - r tom.+.�w2L' �r ¢'f �' .�1e F$-.�+aT.F' .r' tca+ .u.r'fir ,s- `..11• -J r' h' ,-.ry-i la.>� Jr 5 f{ s J- ..CT.r.. f S.7�aNL'..yFx'2 CJs{ ,.�•x`�-4''�r,t WINE",INEt:,4,v - � r, .,! �5`r%=Thr-�'�"�T'' `°a""�,��.sG 5• ��..,,C”, / r7' _. .. .;f.. 1` L- -`, �T�����. t; -) s s- "f4,`Srsc.'r'vr' a':X Gin Noll, .):{,��,.," �"�!!��,r�"jJ�'�t�`',:.'`�1._T�ms; '��n",4�'�:�i z .� f�oll-,r„'�/ `�" r,',�,;F�,�y�71)�7z..._•,�C�r,i.`r':'�'���'3t °'���. ''.�il��".�.;:�'��,�:,,,t`'" '.�a..;.�.'„".�:.�,.�d ���s. }• � �.� IS d z � a'•v�a-+`'',.�, �,k' v I� r ..1! +' fiscy.�.. p-;Y•'rT rf..r;rTY`Ger..r t+..,.. +>' '4 S)f'Y;a.. 's: �.H�/`�.�..�hF�'S:.,, y e.ri�'+'�).�Sfl�.r5•,J��'Y�4�tl y,,}'G 3; ,w lie� 'lsx��. t ,s.r:Y��L'F".iA+b Sa,s 574 �a � ?` J'�. � �v''��'�, k�l�,"�rv',.4 n^.._�if"a�„'-��.��.af '4_ <`~5- may.• "1''. ��,r� ^�s1 t1t K .,i r':. �x""'ate`-1'Zz.-”-} L !1 tts,�,h..+4`s�1 t:rr: �5�=�'� M'6 '^[ �.x�r� - :ja5'4; �." b rte � Jti :U�- r �'i'.:�' �-7 �{•#{ rc' i I ra�Y r`F � ren E '"����1. �1 'r,;�:�t,•�1-�,,fi I�- -? Rµ7 t-�y�+�+'�to "'�,+ � � �� �y .,.� e tY �`I/k`J� n 15 r�r � s y �Ir 3i. - '.l .nJ'�:iY:TK.' TI tea. 4.�"x � � 1 "Ii�'�^' -4"•�'?=Cl{r•'-Vic: :4.L h #1rL': -,_�++rc¢,'"4`5^. -lt�Y'} i��.E,k',:r3 `•'Jv�iJ:,.�J•"'ql +;T. j :x /-c7y i ..„ttiq,�k S ..r ^lt.�' i'�'4�ii- Y r"L: •3" lmy: 'T'rf Y -21''t' l .:r *Y tuf)rv•". ,',�jl} :ti._4'�`yjl„!rrr.o-�tf:.,.t- rrFc f-.�.a-.5.._..,.,l,r-•a' ..mak �j` prc-,-a, �l.! ragw�Y •- Y Zvi a . �� ;^. �etir';Y4'3 Ji�uti'~5.3:8>�^_^]�i•"�'yT�,ll��'��v"F�'Y.v."a,'�ytfs'm' ¢tsar , `��;9._',;. �i`��Iu-r�r��.'•��s1�"•,M��;J ,.�}''x"Sr "—'aT�4.-�'Su`Z'�'�,.�-> n">#6��.�1�"a��_`" T 9�''•'-. ^� 6 J r r*'° L• '~ __ �� .,,rq";.;t�r.��N�><';Iu }7 h t}k I '�'' 9 t, -a., tF � r -k 1. {. �-J �y���� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ . e Check No.: Receipt No.: /' NOTE: Persons contracting with unregistered contractors do not have access to the or 11 Si ria- a flur�,, f A �-�-�,�-'-�'r�� v. �•- .� r , . ,� t%OR TH 'Town of Andover 0 No 014- .bt� � _ . ver, Mass, � I . � h a ,K! 1• COC NIG MI WICK X11,9 Q°Rgreo r ,CS `S UBOARD OF HEALTH Food/Kitchen IN ,7 ER I T �T Low Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .. ... �.... 11� ....... a... IG ......................................... . /,... . .� Foundation has permission to erect ........... buildings on ..... °/( ••• ............... Rough D.65.0..&S...` ..........................I.........to be occupied as . P (P) .................. Chimney provided that the person ac epting 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 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 IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO S Rough Service ................. ... ..............................................:...... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy RuildiRough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or all To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Owner's I 41, Job Addr( Diane DiBenedetto 978-686-3561 OR 123 French Farm Rd. nOtoned A North Andover, MA 91646 nd Opewayed ,we tiie rvxems)Cr1i me rfemiseInejltloilfld lu'low NtmLsy I"urlt' 'o I rista I I ConsJud and plaw(he iinprttvo rnenf,accoiding Nmc,h)I lmilvp smdifieaIons lee and crindifloini;o(t prem!',ts bMw(dl,'SGr I b Brand: (WINDOW)SPE4A0CATtIONS Quili Build e 100 LOW-E Metal PVC rotwiloside Roof Overhmig Aogon Screens G�ids T�rin TP Finish Color Ye,s N o Ye s No Yes No Yes No Yes No I(es No Yes No OBs No 1/3 Deposit$ l'i, iLratrfrfa2L G, 1/3 Start of Job$ [craw 9-a—T (;t acrd en 9/;3 6taapavrvc.ea 4,4gscarr Corripleflon$ "s IJ S' A Y— (S0NG)SPECINCATIONS Applyover body area of fKXISe, Type of .......... ............. ...... ....................... herns mt covered or irmtalled: Yes NO YPS NO lees No Strlijo off E xisfimg Skfing Vinyl Shutters noof ............ .. ...... Pitovide Containw and lernove all VI Mantels New(3uttels (jover i-asma&ecillfit Doo�&JIMUM (!utter off uy u" Fkded Post 51/�, Vinyl Fixillure Accessories it nqeded PVC'DIrn rrad!Vona�Post 71F ON START OF ALI,JOBS 410MEOWNERS MUST'REMOVE ALL PT"EMS FROM WALLS&SHELVES C'mistfuHon reated Verlifts:If the hunizovinair MA ins his awn permitr for Ow work desoNbv�under this agiroement,the honritowner is hele by advised that in the evenf of dispute,judgmenliand nanpaynienr Ist 1he owihactorffie hmviravynar wilt not be enfiffisd to make a daim to or cuifect from the guail fimd wsWblighed hy Chaii1er 142A,KG L .1 Yecir -"""a r"Kk "'I "oo", I��N 11l 1,"'j V 5�;�c J"J"A 10 i"' -c T m'jl'� ly I�6:Pj"A'TCM "�"3 41"N V wO 'rm' �',-o �A".!,��r6 j,jan,, H—L TOTAL$ Brcylokslyl V4 Siding WIndows Doolis Paymnotto 254 N,Broadway-Breckerlirk1ge M X4,1�bn s9ning Cont,=: — IT ✓ S&Iegn Nil 030 -4488 www.b rooksevvd.cor IS- rl of,�ob ,�So( C&j SIM" 1/3 _j 11alaRce upon r;qllnpebon "17 JII�l' t f d pi You'the Ri4yel"may mixet this rtansaefian M wily Urns ploy¢a midnIqM 0i the ffelid busIniess day affig tha abate ghhis kanuction,Ce'vilAHon umm be dono,in oflifiag.we wsarvo flip fi¢04 r.thpIck youl,updit f)0 NUT"SGA"N"rHIS CONTRACT W"HERE ARE ANY BLANK SPACES, IN WITNESS,M-t,CJF(AF of sioried thea narnes day of Sigric.d . . ............. ........... S Signed 4, The Commonwealth ofMassachusetts Department ofIndustriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 wwwmass.gov1d1a Workers, Compensation Insurance Affidavit:BuUders/ContractorsfFIectriciansfPlumbers Applicant Information Please Print Legibly Name(Businesslorgai�izationffndividual): P)f-606_,� Okofqskic-�"ovl C��, T Address: City/State/Zip: LIP (3 32;( Phone#: (00?,�q,_I-q''4U Are you an employer?Check the appropriate box: Type of project(required): 1.UJI am a employer with !J _ 4. D *1 am a general contractor and 1 6, D New construction employees(fall and/or part-timc).* have liked the sub-contractors 1/. [Remodeling2.El I am a solo proprietor or partner- listed on the attacheilsheet.T have no employees ship and' These sub-contractors have 8. n Demolition working* for me in any capacity. workers'comp.insurance. 9. n Building addition [No workers'comp.insurance 5. E] We are a corporation and its to.[]Electrical repairs or additions required.] officers have exercised their I LEI Plurnbing,repairs or additions 3.El I am a homeowner doing all work right of exemption per MGL myself.[No workers'comp. o.152,§1(4),and we have no 12.0 Roof repairs insurance required.)t employees.[No workers' 13.rl Other comp,insurance required.] J 'Any applicant that ched1csbox#1 mustalso fill outthe section below shoVifigtheir workers'compensation policyinformation. 1 0 I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit an w affidavit indicating such. tContractors that cheekthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 17in an employer that isprovialng workers'compensation lo .pensation insurancefor my employees. Below Is thepolicy andjob site information. Insurance Company Name% Vz, X c6"s Policy#orSelf-ins.Mo.0: c Expiration Date:. lob Site "INCA Address, \1 pity/State/Zip: ('A 1\1\Jm _,Y CD Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). failure to secure coverage asrequiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties Of a fine upto$1,500.00 and/or one-year imprisonment,aswell as civil.penalties in the form of a STOP-WORK ORDER and afine 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 of the DIA for insurance coverage verification, fdo hereby cer/10 raider t dpenaffles ofperjury that the information provNed above is true and correct. Sign re: Ait, Date! ( V Phone V: (0 Ofjtlelal use only. .Do not write in this area,to he completed official City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.33ullding Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6/29/2015 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(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). CONTPRODUCER NAME: Linda Bogdanowicz Insurance Solutions Corporation PHONE (603)382-4600 FAX (603)392-2034 AIC No 60 Westville Rd ED�Ress:lindab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURERA:Peerless Indemnity Insurance 18333 INSURED INSURER B: Brooks Construction Co. Of Lawrence Inc, DBA: INSURERC:EXeelsior Insurance 11045 254 N. Broadway INSURERD: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1552621745 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 PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMI DnW GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE FXI OCCUR CBP8945793 5/16/2015 /16/2016 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JECTPRO LOC $ AUTOMOBILE LIABILITY Ee aBINED SINGLE LIMIT .d.nt ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Medical payments $ UMBRELLA LIABHOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION ATU $ C WORKERS COMPENSATION WC SLIMIT OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE J1A E.L.EACH ACCIDENT $ 500 000 (Mandatory In H)EXCLUDED? C8836275 /16/2015 /16/2016 E.L.DISEASE-EA EMPLOYE $ 500,000 (Mandatory In NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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. Diane and Philip DiBenedetto 123 French Farm Rd AUTHORIZED REPRESENTATIVE N. Andover, MA 01845 Keith Maglia/CLS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INR095,gninnF�nt Thn Arnon nmmn*nrl Inn^nrn rnnl¢fnrnrl mt P-Lea^f Annizin %t.WWI erA.frm�P/A ��,✓'",'d't'e'l llrre"Ar rP11f:�(,I AfOce of Consumer Affairs&Business Regulition '','� �ME IMPROVEMENT CONTRACTOR � 2egistration: 101682 Type- Expiration: 6/2912016 Supplement r BROOKS CONST.CO., INC.OF LAW MARK DI PRIMA 2540 N. BROADWAY STE 110 SALEM, NH 03079 Undcrsccrctarry "JIaS S aC'4i, elfts- Board of Re�yuk,,,ttjo�js go cgSL-099730 MARK DIPRIMA - ISHAWKfib RrM SALEM NH 030-f9 2�t;C,n 0212012016