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HomeMy WebLinkAboutBuilding Permit # 8/17/2015 t%ORT#1 BUILDING PERMIT of 4,, TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NoJ Date Received ox SSACHUSE Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION It, Ail ctue 2 re,w (rzl,c, Print J PROPERTY OWNER 4- r Print 100 Year Structure yes 0 MAP PARCE ZONING DISTRICT: Historic District yes no 0 Machine Shop Village yes no - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building �"C7ne family El Addition El Two or more family El Industrial 11 Alteration No. of units: 11 Commercial repair, replacement [I Assessory Bldg 11 Others: El Demolition 11 Other gvv MR/0 arfds �Vrgmrllv Fgogin, lei ®r, 101 1, dibi"11OW611 @ ME W LIOil urs W Itern .......... DESCRIPTION OF WORK TO BE PERFORMED: IV Identification- Please Type or Print Clearly OWNER: Name: C f,eq Phone: ,4 Address: Z—() e,L)e- 6? . .....-L6 4 Z Contractor Name: 4,) L,,4 Phone: Email: Address: Supervisor's Construction License: '2 7 Exp. Date: e) Home Improvement License: Exp. Date:. 2V ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:B ULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS BSD ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the r and .......... q /11y- tkORT H Town of Andover ® • !t• _ LAK9 h ver, Mass, 1� «.ICC 2WICX y� S � BOARD OF HEALTH IJERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ...... i. �.. .. ® BUILDING INSPECTOR .......... .. ....................... ............................. .�.................... Foundation has permission to erect .......................... buildings on ..p.. . ........ ..... 6 ( .......��. Rough tobe occupied as .... ..... .. .4�.1.. .......... :. ...•...............................................I.............. 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 ® PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S A TSRough 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 ntil Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. John Maksou Home Improvement Contractor Registration 176051 Construction Supervisor License CS-093545 Fully Insured ( 781) 258-1211 Aricia Makkinje 121 Weyland Circle North Andover, MA (978) 500-5773 Dear Mrs. Makkinje, The following is a contract for your deck installation. Your new deck will be approximately 25'x 16' 1. Remove entire existing deck 2. Remove and eliminate stair case. 3. Install new joist 2x10 at 12f and center 4. Support post are to be 6x6 5.All material for framing are to be purchased by me. (joist, joist hangers, nails, posts, concrete, and sona tubes) 6. Deck face, railing, sleeves and azec to be purchased by you. 7.All debris to be taken to the dump by me. ** Material and Labor Cost: $ 11,730 If you have any questions or concerns please feel free to ask. Any changes from the above agreed is subject to price increase. Thank you for your business. ohn Maksou Date Aricia Makkinje / Dat The Commonwealth of Massachusetts zDepartment oflndustrial.Accidents 1 Congress Street,Suite 100 =` Boston,MA 02114-2017 www anass,got�/dza 4y. Workers'Compensation Insurance Affidavit:Builders/Contractors/Elgctrlcians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 4 h 4 Please Print Le 'bl Na111e(Stxsiness/0rganization/Tndavidual): �.,� " - .A.ddl.eSs. µ City/StatelZi - ' Phone#: ' Are you an employer?Checktlio appropriate box: Type of project(1'eguired): 1.F1 am a employer with employees(full and/or part-time).* 7. ❑New construction 2•Q I am a sole proprietor or partnership and have no employees working for me in 8. F]Remodeling any capacity.[No workers'comp.insurance required] 9. El Demolition 3.,E]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 []Building addition 4.E]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 proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13. Roof repairs These sub-contractors have employees and have Workers'comp.insurance.l 6.0 We area corporation and its officers have exercised their right of exemption per MGI.,c. 14.0 Other 152,§1(4),and we have nq,employees.[No workers'comp.insurance required.] *.Any applicant that checks box 41 must also fill out the section below showingtheir workers'compensation policy information. i Homeowners who submif 1�is Adavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-c.'.6c6s fiave employees,%ey must providetheir workers'comp.policy number.' I am an employer that ispidvidingworkers'compensation insuranceformy employees.'Below is thepolicy andjob site information. Insurance Company Name: Policy#k or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration(fate). 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 form of a STOP WORK 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 ofthe DTA for insurance coverage verification. X do her' by rtiunder: liaep i s dpena1des ofperjury that the inforination provided above is true and correct. r Si afar ' , Date: Phone 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DD/YYYY) ACORDM CERTIFICATE OF LIABILITY INSURANCE 7 6/15/2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mathias Insurance Agency, IncNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE y nc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 200 Sutton Street, Suite 160 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 978-688-5531 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Safety Insurance Com an John Maksou INSURER B: 24 Weisner Parkway INSURER C: Methuen, MA 01844 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 I 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. INSRDD'L -' POLICY EFFECTIVE POLICYEXPIRATION LIMITS LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDP(Y)- DATE MM/DDNr GENERAL LIABILITY EACH OCCURRENCE $ 500 ,000 DAMAGE"'REN-1 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oCcurence $ CLAIMSMADE Fx—] OCCUR I MED EXP(Any one person) $ --1-0-1 00 Q i A CP 00001096 04/27/15 04/27/16 PERSONAL&ADV INJURY $ 500 ,000 GENERAL AGGREGATE $ 1 ,000 ,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1 ,000,000 X POLICY JECT LOC _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Peraccident) $ PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ '..... ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CICLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ W TATU- T - WORKERSCOMPENSATIONAND TORY LIMITS ER FMPLOYFRS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETURIPARTNERlEXECUTIVE '. OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ _ Ifyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSFMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Methuen DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 41 Pleasant Street —IMPOSE NO OB 6ATTII,ON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Methuen, MA 01844REPRE �A i ,// _ n Ho E ES ATv ACORD25(2001/08) ` ©ACORD CORPORATION 1988 o-- C�/ae y,a7za,acaec/�/a�C/��c�aac/zuaef/i License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Type: office of Consumer Affairs and Business Regulation _= o egistration: 17605110 Park Plaza-Suite 5170 xpiration: - 7/8/2017 .; Individual /,. Boston,MA 02116 JOHN MAKSOU JOHN. MAKSOU 24 WEISNER PKWY MEHUEN,MA 01844 - Undersecretary Not valid without signa ure Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-093545 Construction Supervisor JOHN M MAKSOU-� 24 WEISNER PKWY METHUEN MA 09844 !P= 1�-/►�^^^ v�-- Expiration: Commissioner 06/20/2017 lot f Iq � I Zvi PIA �c r c Ar s