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Home My WebLink AboutMiscellaneous - 59 SUMMER STREET 7/31/2015 BUILDING 1LIN NIT 2.0� %a,OR.T, ,i =ue° 6 4, TOWN OF NORTH ANDOVER =6 APPLICATION FOR PLAN EXAMINATION IDn a q' Permit NO: Date Received 'ts�40pare° �SSAC14US�� Date Issued: - I ORTANT:Applicant must complete all items on this page LOCATION %, r ,:PRC7PERTY OWNER tY i� Pri MAP NO PARCEL ZONING JDfSTRICT I FORTH Town of ve rNo. Hal 201P `AE h ," ver, Mass, CoCNIC KEW/CK AOA?ATED I"P`'�,c� S 17 BOARD OF HEALTH Food/Kitchen PER IT T Septic System THIS CERTIFIES THAT ........... A.Z.d r7b A................................................................................. BUILDING INSPECTOR Foundation has permission to erect . ..................... buildings on .... .. ...... �. .... ..................... Rough to be occupied as ...... .11-t .. I�/.1.......... ��. ....AM.......................................................... 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 UNLESS CO STRC S S Rough 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. 6-14-2015 Valerie Kozdras Cow Shed Repairs Segmented Item Description Pricing Remove all tractors, boxes and debris from Cow shed--clean interior of cow shed; sister in ceiling rafters as required where suspect from winter snow and ice. remove all debris from site. $1,900 Keep structure same as it is. Repair any suspect interior rafters by sistering in new ones;wall studs same-, the intent is to reinforce anything that may have become damaged by big ice dams. create enough roof support and straighten the roofline that was damaged by ice dams. $8,800 Project Total: $10,700 Approved by. Valerie Kozdras Red Tail-Steve McCullough Payment Schedule: Upon Approval-- $1,500 Upon Start of Project—Demo and Start Restructuring $3,500 Upon Start Painting inside $2,900 Upon Substantial Completion: $1,800 Completion of Project: $1,000 Start Date is expected to be late July 2015 and will be completed no later than early September 2015 7 7o e ",t LI C_� �*_ OqV3 � / The Commonwealth of Massa chusetts Department of IndustrialAecidents 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name (Business/Organizatlon)Tndividual): Address: v" vs, 2_u City/State/Zip: C - Phone#: 7 2' . Ar ean employer?Checlt the appropriate box: Type of project(3equired): 1 a employerwith employees(full and/or part time).* '7, co 0 2. m a sole proprietor or pa ership and have no employees working for me in 8,< Remodenrig any capacity.[No workers'comp.insurance required.] - 9. Demo i ion 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 F1 Building addition 4.❑I am a homeowner and will.be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions prop'rietors with no employees. 12.0 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.insruance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] r; *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T 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 check this 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,%ey must provide their workers'comp.policy number. X am an employer that is prdviding worakers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name; Policy#or Self-ins.Lia#: Y. & Expiration Date:j i c Job Site Address: T ` 1 ?� city/State/zip: Attach a copy of the workers' compexisation po icy 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 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage X verification.do hereby certify un derthepains .....�..n�.a..ltles ofpejYuiy that the in ormationpreovided�above bovextrarn, correc. Signature: Dat . w Phone#: �. Official use only. Do not write in this area,to be completed by city or town offzcial.. 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 4: - MLxtiSTE WARUS0 AC CERTIFICATE OF LIABILITY INSURANCE o6/3a12fl f �g 'i�iSAaAMA'fTERt�H�R�!!A'�LOEI�YAl1Df��'t� iTPt3�1T1E - . .�•�H D01=S NO[pPp�tA'iNELY OR NEtip'iIYELYAwA�E�ORAI.TERTl�t�OVERAt�E -.7MATEOF�DOESWTCOMM MEACOM MAGTBEInfI3 mim G8� �MMVEORPRODUGER,A[Si7iEt�i�[E[�1D�. - fSlifMIED, � 13�p�glties)� �or� U ate fsrm wo con"Ons afew Potion,�P�mayan A oafl�is o f'u doss adt fo the a ttoldet�Re�to�snch ems?- - _ y8 _$38.5028 New England Ner'itage InsUrmwe Agency GroW, InC. 33-5 !lain Street S'fORet!taG, MA 021$0 w t warxsiw: V90A.a _a aage i l 14788 n 25658 McCTrllorrgh, Steve _ us r3: . Tra DBA: Red Tait construction mac- 733 Tunw ike St- 110 t 142 TPA P: North Andover, MA 01.845 - E' SIF_ COY CERTWICASE Sfiet` 12 23 REY 1 TH[ ISTOtEi� -M7 iWN�S0FII�MUiANCELwrM5bOWHAVEBFF�1 ZiDTE�SYSUR� -WISH i 7"OCHE fl1 WAiH7.NOiWiiMAND ANYii�TBtUlOR OFAN4YCOAi ?AL"l ORt3�I .DIX -@AILT (EtTff�7EUAYSE�ORMAYP811AK7M� RD®8YU19POISES[3I 12 F7(CIUSt 15A[1t) OFSUCHPOLKXMLMMSH(3YVl�fafAAY,YAVEII�t aim WN um S t�R 77PEOFW�AME � FOUCY i7 03 Zt115 7tfi /2016 '�GOMWALUAMMY X ( 11LUA8UFY s 5,Od- �t t �v ) cid OCCURanws�aanr $ I,000, - A X Addtl Insd with i 2,000; written c+nfitact _ca+�oPAs� 2,000 - e,t�Y aes Atm - - - go�atru�sxttiiQesvers�) $ �owt� M AUTM Q 18MMAUTM- -ppm UAB S ow T�it31i1QFtS 5Kt1B0607N76-4- 9#qq/zoos 94/09/2016 ranrnseTs ez woTa� _ ANDY Yin EL-EACHACCObW S 5091 B- ANY y NTw = ate ► 5 50Q, pmnab9 500.000 - jVqgCLM V&ad,AC0W18LA "ect to the terM, conditions, endorsenents and exclusiba-on the-policy_ ificate Hider is listed as an aMtiGMA insured wM Witten-Ott C�CATE Ii�ER CANCELLATION FA*X 47.1.965.5313 ninoAw�ra AeTT„E. sEcnTns� i�nnT paudi Valerie Kozdras < 59 Summer St North Andover,MA.01845 Wnuass Kell e�- AC0RD-2512M" �.ACORD-ime and Logo ate aegis m s ofACORo