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HomeMy WebLinkAboutBuilding Permit # 9/3/2015 it ,t%0RT#1 BUILDING PERMIT "t LED TOWN OF NORTH ANDOVER 0 10 APPLICATION FOR PLAN EXAMINATION - Date Received ATED 'Permit No - C 5 E4 Date Issued:.4 1 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER '77, 1,7aie- Print 100 Year Structure yes MAIO 0 PARCEL: -- ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential El New Building ne family El Addition El Two or more family 11 Industrial D Alteration No. of units: Ei Commercial El Repair, replacement El Assessory Bldg El Others: D Demolition El Other ............./!g/g' DESCRIPTION OF RK TO BE PERFORMED: Identification- Please Type,or Print Clearly OWNER: Name: qPhone:,;e- Address: 3 1<1,e 14 e Contractor NaPhone: i e�o r>-Pl Email: le a--0 0 4-' S- 6d Addres' : 14 ie-e--- Supervisor's Construction License: Exp. Date:_,-)' ..-- -1) -7 -, (�, 7 Home Improvement License: V " 62, , Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED ST BASED ON$925.00 PER S.F. Total Project Cost: $ c2l, .2, 35 FEE: $ Check No.: Receipt No. 41 'rantyfund NOTE: Persons contracting with unregistered contractors do not have access o i� SignatureofA ent/Owner Sia�nature of contractor t%®RTH Town of ndove ® 1 0 No. ., �o LAKE h y ver, ass, COCMIC Kl WICK ADRATED '9S' u '( BOARD OF HEALTH' Food/Kitchen PER IT T L � Septic System THIS CERTIFIES THAT ....... `l. L , P� BUILDING INSPECTOR .. ................ ..4.. ... �!! ................. .... .... ........ .. . .. .. .. e... ....... P g ��.I�A „ A / ... Foundation has permission to erect .......................... buildings on ....... . ....... 1/ ..... JL ... ..q .... Rough �•W4 �. tobe occupied as . ..... .... ... ............................................................................. Chimney provided that the person accepting this ermit 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 1M6 !. ELECTRICAL INSPECTOR UNLESS C®NSTRUC 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. ® T Town of Andover 0 No. C, (,�,"h ver, ass, O LAKE �• coc"Ic KE WICK °R IF `ATED P a .`g '9S U 'C BOARD OF HEALTH' Food/Kitchen PER. IT T LD Am Septic System THIS CERTIFIES THAT ........... G.................. ...6.. ... ...............a..................... .......... .................... BUILDING INSPECTOR has permission to erect r� Foundation .......................... buildings on ....... . ...... .. .. .. ..... .. / ....... .�.� �• Rough to be occupied as ..... ......... kaw............................................................................. Chimney provided that the person accepting this ermit 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 I 6 ELECTRICAL INSPECTOR UNLESS C STRU C 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. Davie's Home Improvements 617-968-6595 Construction Supervisors License 085049 Home Improvement Registration 138307 www.davie's-home-improvements.com Proposal prepared for: Bonnie and Lee Wilkinson Project address: 41 Bruin Hill Rd. North Andover Ma. New deck Description of work to be completed: Footings: Dia and r9our new concrete footings as required12" diameter 48" deep Dig and pour concrete landing pad for stairs Framing: All new pressure treated joists,posts, and stair stringers 6"x6" support posts 4"x4" railing posts bolted to framing Ledger board lagged to house All fasteners to be corrosion resistant Decking: Install customer supplied decking Railings: Install customer supplied rail system Lattice/Trim:. Install white pvc lattice to close in underside of deck on side facing street ProvidEyAnd install white pvc skirt and trim boards Pricing includes labor only Client to supply all materials All workmanship to comply with Ma. state building code, and guaranteed for a period of 1 year, starting at completion date Cost: $9,000 Perms: $2,250 at start: $2,250 after completion of framing $2,250 after installation of decking $2,250 after installation of railing Proposed start date: 9/14/15 Estimated completion date: 9/25/15 Homeowners signature: ] Date: Contractors signature: < �= f'` Date: .y� North Andover MIMAP 41 Bruin Hill August 24,2015 y�� Ilf y d ) Y y , �� � h1IllP� T✓/"/�i//r���G/'rl�/ ', l �,r " �l%��N�i �hI4 II , ''"�' ���r f�I i �� ��lY ��/J � /WI%/��a ✓/nr s uW 1 ll �1o4W�a-o,io2 � , lN,� �! ��°�49l�BFtllTN�rHI�L RCA�� 90 WTFdTER S"f / 104.a-0077 '�, r 0 MVPC Be Interstates Horizontal Datum;MA Stateplane Coordinate System,Datum NAD83, —I Meters Data Sources:The data for this map was produced by Memmack —SR 0011l Valley Planning Commission(MVPC)using data provided by the Town of Roads Of o q North Andover.Additional data provided by the Executive Office of two Easements 2 �4 �6 Environmental Affairs/MassGIS.The information depicted on this map is ParcelsF L for planning purposes only.It may not be adequate for legal boundary 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING # THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY t t " OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �sSACHUs�t 1"=50ft ' z , UHUIN HILL $ s /2 4m a - ROA OE 1 33 t ;,: Soo - -- NIA iC 4`1 fes_ ;fit- ;� � � ;. Y�a. � ✓.�' �l s 1 MDA # Al v 7A OT_ t ,41- r — s ' �t r,j v l IC oNOS' rid/ /° C , 7 0)9 0/Xe ry �6 di 'I � '� I�® t 4 �� ____� '� � I ��� i '� i I I i !, !d, i i I J I� '�� i .. C ■ m � I �� �,�' i I I I ;� � ^i pal i i __ __ _ --� ---�_ I �� 1� ® �i �) ':�I + IIS li — —_ I � I �-e� � 1 �'�'I .�_ I �'-----_ I "�®� i I ` F.: _ 'i UMM _ _ __ 1: o ' i l - _ i _ _ _ _ _ % r. C _ - _ f Vlots ow - y — ,-�,--�,;�-.�,--�,--.�"",;,?*"-.,: I A - . 2 !o ._ 4 y ' _{ __ .00ttmit,taattttco6 too BY.i A""A Y v . .R. 10010, - I X � -X,M--� ,.�,�7r";�,,,�,,�;�-.,,.�,�����,t��.:"�,.,. �. MW Kim WWWW"fNY r. _ } Miz I", cNot /. - MMEMA c ,{MMM r, c ON r v'.. - . -M:Qjj --.,�. _��..� .. M__ �I _ __,�—_ .� --�_ .... I 1 a°� "� `"" _: --�.w..��. ., I _..w�__ . .�..,�, �ww m._._..__._..� ...._._.. �.� The Commonwealth of Massachusetts Department of Industrial Accidents y 1 Congress Street,,Suite 100 Boston,MA 02119-2017 wwminass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ApplicautInformation Please Pra t L 'bl Natne (Business/Organization/Individual): m Address: r City/State/Zip: 4 Z174 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.n I am a employer with employees(full and/or part-time).* 7, M4ew construction 2.[j I am a solo proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.Fj I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. F1 Demolition 10 Fj 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 11.0 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 oil the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance) 6.0 We are a corporation and its officers have exercised their right of exemption per MGL C. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box tf l must also fill out the section below showing their workers'compensation policy information. t flomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 ani an employer that is providitig'rporkers'corupetisatdoti insurance for iiiy eutployees. Below is tile policy and job site information. Insurance Company Name: Policy#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 date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine tip 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 of the DIA for insurance coverage verification. I do thereby cerci y w Z r t e pai cul pet ies of perjury that the information provided above is true and correct. SignattrreK. x,. Date: Phone# 1 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - ASCIGI1 OP ID: BD CERTIFICATE OF LIABILITY INSURANCE DATE,MM/2014Y) 09/24/2014 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 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). PRODUCER CONTACT Supino Insurance Agency, Inc. Supino Insurance-Malden PHONE FAX 1012 Eastern Ave/Rt 60 (XC,No Ex):781-322-2800 A/c No): 781-321-2414 Malden,MA 02148 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Utica First 15326 INSURED Giuliano Asci INSURER B: 3 Lorenzo Rd INSURERC: Lawrence, MA 01843 INSURER D: INSURER E: INSURER F: 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 BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE OCCUR ART501984503 10/04/2014 10/04/2015 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 X Business Owners MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 RPOLICY❑ PEO LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ '.. Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F—] NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT' $. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 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 Giuliano ASCI ACCORDANCE WITH THE POLICY PROVISIONS. 3 Lorenzo Rd Lawrence, MA 01843 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. AWC-400-7024258-2014A PRIOR NO, AWC-400 7024258-2013A' ITEM 1. The Insured: Giuliano Asci DBA: Mailing address: 3 Lorenzo Road FEIN:"-"'9748 Lawrence, MA 01843 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from 05/29/2014 to 05/29/2015_ 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of j Annual Remuneration Remuneration Premium INTRA 316704 INTER SEE CLASS CODE SCHEDU E i Minimum Premium $500 Total Estimated Annual Premium $500 GOV ! GOV Deposit Premium $500 STATE :CLASS MA ! 5403 MA Assessment Chg. $.00 x 3.4000% $ This policy, including all endorsements,is hereby countersigned by { YL�� 04/11/2014 Authorized Signature Date Service Office: Supino Insurance Agency Inc 54 Third Avenue 1012 Eastern Avenue Burlington MA 01803 Malden,MA 02148 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with Its permission. A.I.M. Mutual Insurance Company Insured: 7024258 Producer: 03125-001-001 Giuliano Asci Supino Insurance Agency Inc 3 Lorenzo Road 1012 Eastern Avenue Lawrence, MA 01843 Malden, MA 02148 Insured FEIN: "'9748 Issue Date: 04/11/2014 Policy Number: AWC-400-7024258-2014A Endorsement Effective Date: 05/29/2014 Policy Period: 05/29/2014 -05/29/2015 Endorsement Number: LOCATION SCHEDULE Insured Unit:001 Workplace:001 Business Type:Sole Proprietor Business Type: Giuliano Asci 3 Lorenzo Rd Lawrence, MA 01843 TAX ID: 012549748 Business Type: Business Type: Business Type: Business Type: Business Type: Business Type: Business Type: Business Type: Business Type: Business Type: Insured (11/11)LocalionSch A.I.M. Mutual Insurance Company Insured: 7024258 Producer: 03125-001-001 Giuliano Asci Supino Insurance Agency Inc 3 Lorenzo Road 1012 Eastern Avenue Lawrence, MA 01843 Malden, MA 02148 Insured FEIN: 012549748 Issue Date: 04/11/2014 Policy Number: AWC-400-7024258-2014A Endorsement Effective Date: 05/29/2014 Policy Period: 05/29/2014- 05/29/2015 Endorsement Number: INSTALLMENT SCHEDULE Policy Unit No: 001 Units Billed to this Unit:1 Policy Unit Name: Giuliano Asci Billing Plan: Annual Installment/ DIA Total Amount Due Date Billed Endorsement No. Assessment Annual Payment $0 $500 05/29/2014 Insured InstallmentSch(04/11) A.I.M. Mutual Insurance Company Insured: 7024258 Producer: 03125-001-001 Giuliano Asci Supino Insurance Agency Inc 3 Lorenzo Road 1012 Eastern Avenue Lawrence, MA 01843 Malden, MA 02148 Insured FEIN: "-"'9748 Issue Date: 04/11/2014 Policy Number: AWC-400-7024258-2014A Endorsement Effective Date: 05/29/2014 Policy Period: 05/29/2014 -05/29/2015 Endorsement Number: DIVIDEND CLASSIFICATION ENDORSEMENT As required by Section 80 of Chapter 175 of the General Laws of Massachusetts, notice is hereby given that the risk insured by this policy is classified for the purpose of fixing and determining the percentage of dividend or expiration return of premium to be paid on expiring or cancelled policies in the classification(s) hereafter designated by an "X" below: X.. 1. Workers Compensation except such policies subject to the Company's Retrospective Rating Plans, Loss Ratio, Safety Group, Retention, Large Risk Deductible, or those policies assigned by The Massachusetts Workers Compensation Assigned Risk Pool or those policies placed by brokers within the scope of the Company's Brokerage Agreement. 2. Workers Compensation Policies subject to Retrospective Rating Plans. 3. Workers Compensation Policies subject to Loss Ratio Plans. 1 4. Workers Compensation Policies subject to Safety Group Plans. l 5. Workers Compensation Policies subject to Retention Plans. L_ 6. Workers Compensation Policies subject to Large Risk Deductible Plans. F 7. Workers Compensation Policies subject to (1) above placed by brokers within the scope of the Company's Brokerage Agreement. F 8. Workers Compensation Policies subject to Hospitality Loss Ratio Plan. 9. (Reserved for Future Use) 10. (Reserved for Future Use) Nothing herein contained shall waive,alter,or extend any condition or provision of the policy other than as above stated. Countersigned by -��" ``��� � Insured AIM-1A(07/11) Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperNisor License: CS-085049rm JAMES G DAVIER 25 CHIPMAN AVE Melrose MA 021'TG Expiration Commissioner 09/12J2016 A Office of Consumer Affairs&Business Regulation lr� lWOME IMPROVEMENT CONTRACTOR Type: �r=� _t�egistration: 138307 DBA `,Expiration: 3/1912017 DAVIE'S HOME IMPROVEMENTS JAMES DAVIE 25 CHIPMAN AVE. -- MELROSE,MA 02176 Undersecretary E 4E