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HomeMy WebLinkAboutBuilding Permit # 8/25/2015 ®� %40RTh q BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION - Permit NO: 1, I— k Date Received y �9SSACHUS���y Date Issued: � IMPORTANT: Applicant must complete all items on this page LOCATION Pri PROPERTY OWNER" Print MAP NO: PARCEL-DU` ZONING DISTRICT: Historic Districtyes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial P°Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 1 , ❑Well ❑ Floodplain ❑Wetlands 11 Watershed District ❑Water/Sewer O C' La A)AI UL ` �/� 1 ) '/Ut L bl' J "m "'A Llk'- N) �'�Jltkb P S "'T4 L=o CA Iden ' i a iron 1lease ype or-Pria Clea y) OWNER: Name: -A l�, 1 �� !��� Phone 7 - � I(A Address: CONTRACTOR Name"' Phone:: Address: Ile 1 � . Supervisor's Construction License: �� Exp. e: Home,Improvement License: Exp. da#e: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ OJ-b � Check No.: d Receipt No.: NOTE: Persons contractin with unregistered contractors do not have access to uaranty fund Signature of Agent/Owner Signature of contractor �® e ukL rip ®F�1 01wn Ouf ? . .� a :..�,, 111duvel 0 �+ h ver Mass, 'Q cocH�cNew�cx 1• A°RNTE® S' u BOARD OF HEALTH Food/Kitchen PERM Septic System THIS CERTIFIES THAT AJ. ,, BUILDING INSPECTOR . ......... .. . . Foundation has permission to erect .......................... buildings on ..... ..... ... .. .............. Rough tobe occupied ... .. ... ...... ... .... ...... ... .. ..... ....... . ......... . ..........E............. Chimney provided that the person accepting thi permit shall every respec conform to the terms o 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 N H ELECTRICAL INSPECTOR UNLESS CONSTRUCST TS Rough Service ............ ..... .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buiddin Rouen Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall T® Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. E i' Sweepnman,Inc. Proposal 108 Main Street 8/812015 Building H North Reading, MA 01864 Phone: (978)664-6642 E-mail:sweepnman@yahoo.com Service Information Billing Information Daniel DelGaudio Daniel DelGaudio 326 Foster St 326 Foster St North Andover,MA 01845-2210 North Andover, MA 01845-2210 Contact:Daniel DelGaudio Phone: (617)224-2774 E-mail:dan.delgaudio@gmail.com Job Mame DelGaudio, Daniel - 07/2412015 Job Type PO# Invoice# Scheduled Start End 08/08/2015 11:00 AM 1:00 PM Item Description Quantity Rate Amount LINER:PELLET INSTALLATION OF PELLET LINER:stainless steel with 1.00 $1,220.0000 $1,220.00 LINER all stainless steel-components, LINER:OIL LINER Installation of Oil Flue Liner including all components 1.00 $2,385.0000 $2,385.00 necessary at termination and breaching to connect existing vent connector. Permit Permit Fee for pellet stove in 1 A0 $250.0000 $250.00 CAP:MF SS CAP INSTALLATION OF MULTI FLUE STAINLESS STEEL 1.00 $475.0000 $475.00 CHIMNEY CAP TO COVER ENTIRE CHIMNEY CAP:MF SS.CAP INSTALLATION OF MULTI FLUE STAINLESS STEEL 1.00 - $450.0000 .$450.00 CHIMNEY CAP TO COVER ENTIRE CHIMNEY - - WATERPROOF/ APPLICATION OF "CHIMNEY SAVER" WATER 1.00 $425.0000 $425.00 CHIMNEY SAVER REPELLANT TO ENTIRE EXTERIOR CHIMNEY Left side chimney WATERPROOF/. APPLICATION OF "CHIMNEY SAVER° WATER 1.00._ $375.0000 $375.00 CHIMNEY SAVER REPELLANT TO ENTIRE EXTERIOR CHIMNEY Right side chimney-: MISC. SERVICES Left side chimney: Application of stucco to base of the 1.00 $235.0000 $235.00 chimney where needed at cinderblock. Total Due: $5,815.00 System Info Home Heating System Chimney Info Chimney Cap " Job Notes and Instructions: 5"x 30'corrugated SS Liner kit$2,3135.00 4"x 20'corrugated liner kit SS$1,220.00 with pellet stove installation. Permit$250 Two stainless steel multi-Flue chimney caps 450+475 17 x 29 and 17 x 35 Parge base of left side chimney exterior where needed. Application of waterproofing to left side chimney 425 Application of waterproofing to right side chimney 375 DelGaudio, Daniel - 07/24/2015 Proposal(continued) Ali pricing and proposed work is based on visual inspection. If other conditions are discovered upon commencement of work,it may increase the scope of work and if additional work is mutually agreed upon,may increase the price. All material is guaranteed to be as specified. All work is to be completed in a substantial workman like manner according to specifications submitted,per standard practices. i Signature: x .,. --� DelGaudio, Daniel - 07124/2015 Proposal(continued) Images: j�:t; : � ..int 3���• ::«:,,.,I, { a. ;«• ,««{ �{t�. '•I':'�I�'I,.iif�i,�i�a:•'I.� Ilii ! :.��� 8/8115, 10:37 AM 818115, 10:38 AM 818/15, 10:38 AM T c , il6 x'r• 8/8115,10.38 AM 8/8115,10:38 AM � � Sweepnman, Proposal 8/8/2015 |OBMain Street Building North Reading, MA 01864 - Phone: (978) GG4-G642 E-mail:swenpnnmmn@8yahoo.nnnn Service Information B||Uim0 Information Daniel DalGaudio Daniel Oo|Gaudio O2GFoster Gt 32GFoster St North Andover, |NAO1845-221B North Andover,kH/\ 01G45-221D Contact: Daniel Om|{Saudio Phone: (617)` ' � E-mail: dmn.do|gaudioC@gmmiioomn � � Job Name Oe|Gaudio' Daniel - 07/24/2015 Job Type ���# �� Um�m� # Scheduled Start End | ' 08/08/2015 11:00 AM 1:00 PM � Nem Description Quantity Rate Amount L|NER:PELLET INSTALLATION C)FPELLET LINER: stainless steel with 1.00 $1'220.0000 $1,220.00 LINER all stainless steel components. L|NER:C>|LUNER Installation ofOil Flue Liner including all components 1.00 $2.385.0000 $2.385.00 necessary ottermination and breaching toconnect existing vent connector. Permit Permit Fee for pellet stove installation 1.00 $250.0000 $250.00 CAP:K8FSSCAP INSTALLATION OF MULTI FLUE STAINLESS STEEL 1.00 $475.0000 $475.00 CHIMNEY CAP TOCOVER ENTIRE CHIMNEY CAP:MFS8CAP INSTALLATION [)FMULTI FLUE STAINLESS STEEL 1.00 $450.0000 $450.00 CHIMNEY CAP TO COVER ENTIRE CHIMNEY WATERPROOF/ APPLICATION [>F "CHIMNEY SAVER" WATER 1.00 $425.0000 $425.00 CHIMNEY SAVER REPELLANT T0ENTIRE EXTERIOR CHIMNEY Left side chimney VV/g-ERPR[)[>F7 APPLICATION [)F "CHIMNEY SAVER" WATER 1.00 $375.0000 $375.00 CHIMNEY SAVER REPELLANT TDENTIRE EXTERIOR CHIMNEY Right side chimney: PN|GC. SERV|CES Left side chimney: Application ofstucco tobase mfthe 1.00 $236.0000 $235.00 chimney where needed sdcinderblock. Total Due: $5,815.00 System Info Home Heating System Chimney Info Chimney Cap Job Notes and Instructions: 5' x3O'corrugated GSLiner kit$o.385.On 4"x2O'corrugated liner kit OS*1,220.0nwith pellet stove installation. Permit$250 Two stainless steel multi-Flue chimney caps 45V+475 17x2aand 17xa5 Pu,Qebase ofleft side chimney exterior where needed. Application ufwaterproofing toleft side chimney 4o5 Application nfwaterproofing toright side chimney 375 DelGaudio,Daniel - 07/24/2015 Proposal (continued) All pricing and proposed work is based on visual inspection. If other conditions are discovered upon commencement of work, it may increase the scope of work and if additional work is mutually agreed upon,may increase the price. All material is guaranteed to be as specified. All work is to be completed in a substantial workman like manner according to specifications submitted, per standard practices. Signature: x ®elGaudio, Daniel - 07/24/2015 Proposal(continued) Images: 1 t/fi (`I i f�I II a Fr������1 j 8/8/15,10:37 AM 8/8/15, 10:38 AM 8/8/15, 10:38 AM l � rr k 4; �r f 8/8/15, 10:38 AM 8/8/15, 10:38 AM The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): —L C Address: City/State/Zip: Phone #: Are you an employer? Check the appropri a box: Type of project(required). 1.[ ,I am a employer with 4. ElI am a general contractor and 11 6 E]New construction have hired the sub-contractors employees (full and/or part-time).* 7. Remodeling listed on the attached sheet. 2.❑ I am a sole proprietor or partner- These sub-contractors have g. []Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑Building addition insurance.t [No workers' comp. insurance comp. 10.❑Electrical repairs or additions required.] 5. E] We are a corporation and its ❑ officers have exercised their 1 1. Plumbing repairs or additions 3.❑ I am a homeowner doing all work exemption tion er MGL myself. [No workers' comp. right p p 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.XOther employees. [No workers' comp. insurance required.] L *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: ,:�� 31 S •"�a�/ / Expiration Date: lg;� `� L� -� Job Site Address:�3 d� City/State/Zip: ( � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under tl e a' and penalties of perjury that the information provided above is true and correct. _ Date: Si ature: Phone#: J �z 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 8/12/2015 6:10:05 AM PST (GMT-8) FROM: 100005-TO: 19788875517 Page: 2. of 2 DATE(MWUI)/YYYY) A�?v CERTIFICATE OF LIABILITY INSURANCE F f3112l2015 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 tenns 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 D-JOHNSON INSURANCE AGENCY INC NAME: r 7 GROVE STREET STE#201 PHONE No E L_•�_.-�_ _ F(AIC,Xo _ _.-_..----- TOPSFIEi._D, MA 01983 fAIC.EMAIL ADDRESS: WSURERIS)AFFORUING COVE RAG E.. .,.._.._ _N .ICtI INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: SWEEPNMAN INC 27 LOWELL RD INSURERC: NORTH READING MA 01864 INSURERD: INSURER F: COVERAGES CERTIFICATE NUMBER: 26934393 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 SI TOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. —� INSR 1YNE OF INSURANCE ADD[SUER --�' � POLICY EFF NO[ICY EXP LIMITS [TR INSD tl POLICY NUMBER MMlDD/Y MMIDDNYYY COMMERCIAL GENERAL LIABILITY F.ACH OCCURRENCE $ CLAIMS-MADE Q OCCUR PREMISES E a $ MER EXP(Any one pomon) $ PERSONAL&ADV INJURY § _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE § _ POLICY PRO- LOC PRODUCTS-COMPIOP AGO JE CT $ OTHER: COMBINED AUTOMOBILE LIABILITY F accident)SINGLE $ ANY AUTO BODILY INJURY(Per person) $ ALi.OWNED SCHEDULED BODILY INJURY(Por accidem) $ AU AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Por accidP ntl UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION WC5.31S-3138139.014 12/18/2014 12/18/2015 ,/ 3T/Rjfi�1TE olli- AND EMPLOYERS'LIABILITY YIN FR ANY PROPRII:'r0IWPARTNrIM_XF.CUTIVE E.L.EACH ACCIDENT $ 100000 OFFICERIMGMBF11EXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $ 100000 Yes,descrfic under E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltioau)l Remarks Schedule,cony bo attached if more space la roqulrad) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and Supersedes all previously issued certificates, only as they relate to workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DANIEL DELGAUDIO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 326 FOSTER ST ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE ('� ) j I t/ vU LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 25934393 1-300139 14-15 wC yogasl).patil@LLI1acl:ycnutaal.cox, 0/12/2015 6:07:11 AM (PDT) Pagt 1 of L CERTIFICATE LIABILITY INSURANCE DA08/11/DD/YYYY> 'I/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(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). CONTACT iODUCER d1 NAME: DALE E.JOHNSON D-JOHNSON-NSON INSURANCE AGENCY, INCACNE E.t). 9713 887-8304 A!C No: 7S ��f-��'G7 DALE JOHNSON-AGENT ADM ess-DALE JOI-INSON@F RM-FAiV ILY.COM 7 GROVE STREET, SUITE 201 INSURERS AFFORDING COVERAGE NAIC# CO'PSFIELD, AVIA 01983-1862 INSURER A:MESA UNDERWRITERS SPECIAL TY SURED INSURER B:CERTAIN UND R.WRIT RS AT LLOYD'S, SWEEP MAN INC, INSURER C: 27 LOWELL ROAD INSURER D: NO. READING, IMA 01854 INSURER E: INSURER F: OVERAGES 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 BY PAID CLAIMS. -AD 5U8R POLICY EFF POLICY EXP p TYPE OF INSURANCE POLICYNUMBER MWDD/YYYY MM/DD/YYYY Lr�trrs A COMMERCIAL GENERAL LIABILITY MP0(104018000569 11/18/20141111€3/2015 $ 1,000,000 DAMAGETORENTED CLAIMS-MADE ® OCCUR PREMISES Ea occurrence $ ,i10 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 V POLICY PRO El LOG PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: AUTOMOBILE LIABILITY a aCOMBINED accident) BODILY LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION STAH TUTE EOR AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below crag-TRACTORS I ROFESSIONALL .IABILFFYAr�D SP0022�1 11/18/2014 11/1892015 $10,000 EACH CLACILAIM OLLIPROJT�10hh :IABILNAL .ue�¢�ILrow A POLLUTION LIAB9UrY �$iP.i,d�la£1 EACFP CLAIM 1"0.';IL.L.t.7T14,)Pd h.hAt�3�t.rIW ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) 311MN Y CLEAN IN /INSPFCTI N, MASONRY, APPLIANCE DISTRI13UTOR ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DANIEL O ACCORDANCE WITH THE POLICY PROVISIONS. 325 FOSTER ST. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE dl ©1988-2014 ACORD CORPORATION. All rights reserved. CORD 25(2014/01) The ACORD name and loao are reaistered marks of ACORD dam_, i Massachusetts -Department or Public Safety Board of Building Regulations and Sfanda r ds Cunsti action Sullcrti i5ur=iicci:iir� License: CSSL400886 DAVID A BANCReFT r 27 LOWELLRD.� North Reading MA 01864 �xpiracic^ Commissioner 03/09/2016 Commonwealth of Niassachuse s Department of Public S ' aret;; Oil BLU-lei Techniciiif] License: BU-026558 DAVID A BANCROFT ; 27 LOWELL RD, North Reading MA 01864 - Commissioner �-toiration: 03/09/2016 s&Business Regulation License License or registration valid for individul use only �;;.. Office of Consumer Affairs&Busmhss Regulation b iflME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation , 2egistration: 160389 YP ,.Expiration: 7/16/2016 Private Corporation. 10 Park Plaza-Suite 5170 Boston.MA 02116 SWEEPNMAN, INC. } DAVID BANCROFT 27 LOWELL RD. NO.READING,MA 01864 Undersecretary Not valid without signature