HomeMy WebLinkAboutBuilding Permit # 9/23/2015 �ORrN
BUILDING a� 010 , ��
TOWN OF NORTHVR
APPLICATION FOR PLAN EXAMINATION
Date Received �� <„rs�:_,
Permit N�° Received----__------- so
Date
I . PORTA T A pltcant must coiyaplete all rtcrras ori this pale
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TYPE OF IMPROVECVIFN r PROPOSED I�
Residential ._._ _ Non- Residential
i,I New Building Kone family
❑ Addition ❑ Two or more family ❑ Industrial
[:I Alteration
_ _No. of units: 1-1.�...�,�. CI Comme
rcial
Repair, replacement Assessory Bldg 1-i Others:
_—_
Demolition El Other
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Location
OWNER: Name: � � a
p q
... a No. gym .. Dates I
Address > �
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ANDOVER
,/�/i l Certificate of Occupancy $
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Building/Frame Permit Fee $
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Foundation Permit Fee $
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Other Permit Fee $
ARCH ITEC°/ NC INEER,,---!! � TOTAL $
Address:
FESCHEDULE:S2d.�t7l9UC�F��R Check# ���
Total Project Cost: $ J
Check NO.' _ �,. Building Inspector
NOTE: persons coritraclitig m)4
� 22 _... .._—.._._,U
tkORTH
dover
_t , own of
.:� 0
® 3006
% LAKE h Verb ass,
COC KICa WICK
A04+rED P4iL�.`5
S U
BOARD OF HEALTH
Food/Kitchen
PE �R =M= IT T D Septic System
l BUILDING INSPECTOR
THIS CERTIFIES THAT ............. .... ..�. . ............ .l•T i'r/�' N��
............. Foundation
has permission to erect .......................... buildings on ....... ......... ................ .....®®....... .
Rough
1�
to be occupied as ...e.... %4.%A4.......k , dino ......vs!!!.......m. .. . _ 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
IT EXPIRES IN 6 MONTHAELECTRICAL INSPECTOR
® UNLESS CONSTRUCT ARough
Service
...................... ...................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Prop,PECIFICgjS
Sweet Contracting Corp. dba AND ESTIMATE
Billy Sweet Chimney wee
PROPOSAL SUBMITTED TO: DATE:
Susan Letourneau 9/11/11
STREET - _ PHONE
536 Forrest St 978-687-0442
MA CSL:#106967 CITY,STATE,ZIP CODE PHONE
MAHIC:#125338
P.O.Box 287 North Andover, MA 01M 978-807-7323
Swampscott,MA 01907
78L593.2333 or EMAIL
800.248,4900
781,595.1140 fax smiet536@gmall.com
• Pull a building permit with the town of Andover.
• install a properly sized stainless steel chimney liner for the woodstove,with proper terminations
at the top of the chimney and proper connection to the woodstove vent pipe and proper tee at
the bottom.This will include a new damper on the vent pipe also.
® Cut down the flue tiles so they are flush with the crown of the chimney.
® TOTAL(includes scaffolding, labor, materials,waste removal and cleanup):$3,300.00
The installation of a new stainless steel chimney liner comes with a lifetime warranty as long as Billy Sweet
Chimney Sweep inspects and sweeps the chimney annually. Hilly Sweet Chimney Sweep guarantees all labor
and installations for one year. If we come back each year to do a sweep and inspection of the chimney, the
material warranty,and the company guarantee stays-intact. Take advantage of our annual 20%Spring Discount --for inspecting and sweeping your chimneys during the months of February and March. The first annual sweep
and inspection is free..
The National Fire Protection Association, the Chimney Safety institute of America, the U.S. Consumer Product
Safety Commission, the U.S. Environmental Protection Association and the American Lung Association
recommend annual inspections of your heating system chimneys, flues and fireplaces.
E PROPOSE hereby to fumish materials and labor--complete in accordance With above specifications,for the sum of:
* ** * Three thousand three hundred and 00/100*"'****��*T*�� Dollars ($) 3,300.00
FAYMEPl'i TO!dE MADE AS FOLLOWS
1/3 deposit in advance ($1,100.00), 1/3 payment at the start: of work ($1,100.00), balance due when
the work is complete ($1,100.00).
Advanm arts are non-refundable in C se of canct�Uaiion b customer.
- _g5z -
M mdsW is guaranteed to be as speAed.All w LA is to be completed In a substanVal wo,lvnan,
Me manner according to speocations sutxnitted,pes standard pn cbces.Any aeration or Authorized
de don Irom aboyaspecfiodons involving tetra mstsVRI bo executed o0 upon written ads,
and vA home extra charge over and above the estimate.All agreements contingent 11W signature
strikes,accidents or delays beyond our control. Owner tory fire,tomada and r rxc5&ary Ndte:Tltls ptopa � ��
in�nce, be
tmithdian by u8' ®t ace �titttf Pays.
ACCEPTANCE OF PROPOSAL' The above prig, ptira s and
cwd'6wm are satisfactory and are harzby ac d. You are strthcu W in do the r�txk as Slgnetltt :
specified. Payment will be made as outlined above.
�i�natUPt?: .�
Date of Acceptance: 14
c:\Docs\Custome,r Reports 2015\1-m.\Utourneau 536 Forrest St Proposal 150901.doex
The Comt oniveaafth ofMassachusotts
gpartfs emt of rrti�st°Irl rcdr���rrts
Office of InvaO�'( Ufions
' $ I corky"H'e'ss' `trees" ,,511i e 100
. 0stonf AIA 02114-20J7
' 1brkers' Compensation Insurarive Affidavit, t���c�e��1�: �>a�������•�1 �����i��� s/ ��xrta6ers
Ap fleant Informaf€on .�. _ Please Print Ltg bly
Name (Business/Orgenizatiorlt'ndii,idLal):�
�Are you aner°nplaytr� �lracl� lt3«tpprrrpri�lrrrx: �
r ype of prose ct(required):
1. f ern a errtplcr ser;vitrt t� I azrt a be n_r,}i c,orittt�ctor and I � �
s( irlt -- --'.' 6.rt�_ r
ew consti-actionI« c mied he �rztctaedlorpa� tier%). wrsoyeeern
listed or the alux'J bed�tteo€. 7. I�emodelina
2.(� �aiit a soft;proprietor or i,rsi"tttci'. �-�
Aip and nave ric,employer Thne Sub contractors?1av 8. Demolition
err pip eFes.stn rwwc;��o,&rs'
o,�rsrkiri farm; it any capacity. 9, [j Building addition
[No workers' crs:np, insurance, ctarnp lawranm,'
a. 7 Wovea coniutatioti and its trical repairs or additions
regt7lxed,l -_3
3. 166 a homeowner doing all work off cors have t .xci:cd their I IQ Plumbing repairs or additions
tnMlf, [No workers' camp. right of exe,roption leer 141G1., I ?.��]Roof repair's
insurance require4.1 c. IS2,§1(4),iwd,ve have no f
cr rployoes. [NO,workers' a3.0 ether
cornpl insurance rucla ed.] _.J
"Any tippficarttthat ch c}s box:1 trnu;t'itsa tilt auc he';tirtion blow their it work,zs compvts.ation Policy inrom ation.
t Hnrncowr w who submit this sfi1davit irdicadng t _y<W0 dohag n11'u'otk and?heli hire Ot.tside con!ra,ciarg i>as;s auhrhic t now a 0ldavit indicating such,
tContmctors drat check this box must attrfched nn additiornd sheet sho c i tg tha mrot%of the and stag whether or ziot those entities have
employees.I If the sub-contractor have employevs,they must f.nvide thei +?irr4cr;'es�tt7 raficy ftxtrtbrt.
ram an jrnplo'yer that isproviding wotrkers'compensation iB4,01v is the policy asci jab vite
information. /,
Insnrancd Company Name:
Polk #or Self-ins. Lie.it: .? ; 1% '' i e
y - _. _..��..®w� ..:;riirt�.tun i}ste: ,�(.. .�,�__
f
Job Site ddress:_5 r('
aie _S :ity.Statei'.r . o ove
Attach a Copy of the workers' compensation pojity declaration page(?hew.sang the poll[:y nu_lber a"d expiration date).
railu e to,secure coverage as required tin&r Sectttot;?5A of��IC'xI c. 15-2 can lead to the imposition of criminal pennities of
hire up to 1,500.00 and/or one-year irnprisom-nu rt, as s�•e11+is civil licualt=f s in the form cif--�JCrP WORK ORDER and a fine
of up to 50,00 a flay against the violator. Be advised thm a ropy o€';:leis staieimem may be fat warded to the Office of
fayestigat ons of the DIA for iarsurancc coirerage verific,noir.
.Ido hereby certify ranger thepraina rand p,.irt-Alfie; ofp ti -p that h,'w itfartttalion tete,vided above k true atat✓s rorrect.
Cfficfxr Use Only. '00 not write bt Mis:aref--;e'°b ?
1
4
City od &Ywww Per S0$ f t 12t C
Issulud Authority(circle ow):
1,Board of Health 2.Building rtepartmmit 3.CitylTo t,Clerk 4 111 ctricarl J.rrspec+r>r• s,p'lctrrsbing�r�specfpr
6.Other
Coutact
AC CERTIFICATE F LIABILITY INSURANCE DA09/22/2015 YY)
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 Thomas A St.Jean
Thomas St Jean Insurance PHONE 978-531-8053 FAX 978.531-8653
484 Lowell St AIC No Ext): (AIC,No):
E-MAIL
Suite 1-C ADDRESS:
Peabody,MA 01960 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: ATLANTIC CASUALTY INS CO 42846
INSURED Sweet Contracting Corp dba Billy Sweet Chimney Sae INSURER B: CHARTER OAK FIRE INSURANCE CO 25615
P O Box 287 INSURER C: NAUTILUS INSURANCE COMPANY 17370
Swampscott,MA01907
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 ADDL SUPOLICY EFF POLICY EXP
ER LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DDIYYYY
A COMMERCIAL GENERAL LIABILITY MPOO20000500177 04/12/2015 /12/2016 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 50,000
CLAIMS-MADE 12 OCCUR PREMISES Fa occurrence $
MED EXP(Any one person) $ 5,000
PERSONAL&ADV IRIURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY PRO DOC PRODUCTS-COMP/OP AGG $
1,000,000
JECT
OTHER:
B AUTOMOBILE LIABILITY BA7167M153 11/30/2014 11/30/2015 CEa ccident
OMBINED SINGLE LIMIT $ 1,000,000
a
BODILY INJURY(Per person) $
ANY AUTO
ALL OWNED / SCHEDULED BODILY INJURY(Per accident) $
/ AUTOS �// DOWNED OS PROPERTY DAMAGE $
�/ HIRED AUTOS V AUTOS Per accident)
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTT+
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORIPARTNEMEXECUTIVE f l N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? u
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
C CPL201151010--POLLUTION 04/1212015 0411212016
DESCRIPTION OF OPERATIONS I 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
Susan Letourneau THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
536 Forrest Street ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover,MA 01845
AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
�' CERTIFICATE LIABILITY INSURANCE DATE(MM/DDIYYYY,
09/22/2015
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
i certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME7 Thomas St Jean
NE
THOMAS ST JEAN INSURANCE AH1 No,Elt): (978)531-so53 (A]C,Ne);
E-MAIL ) � )
ADDRESS: tstacan st'eaninsurance.com
484 Lowell St. Ste 1-C INSURERS AFFORDING COVER AGE NAIC#
PEABODY MA 01960 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035
INSURED INSURER B;
SWEET CONTRACTING CORP INSURER C:
I DBA BILLY SWEET CHIMNEY SWEEP INSURER D:
PO BOX 287 INSURER E
SWAMPSCOTT MA 01907 INSURER F _
COVERAGES CERTIFICATE NUMBER: 1501 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 GFF POLICY EXP
_LTR TYPE OF INSURANCE � POLICY NUMBER �(Mk1/D�/YYYY)('P9MrDDlYYYY _LIMITS ^`
COMMERCIAL GENERAL LIABILITY-- EACH OCCURRENCE $
F– I DAMAGE TO RENTED
CLAIMS-MADE a OCCUR ( LPREMISESA Ea occurrence $
MEQ D EXP(Any one person) $
N/A PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _
POLICY❑JE 0 �,LOC PRODUCTS-COMP/OP AGG $ _
OTHER: $ _
AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
rALL OWNED SCHEDULED N/A BODILY INJURY(Par accident$
AUTOS F AUTOS —
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS APoraccidenl
_l !T $
UMBRELLA LIAB OCCUR Y ( EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE N/A ( AGGREGATE $
I DED RETENTION$
WORKERS COMPENSATION PETATIJTF R �— OTRH-
AND EMPLOYERS'LIABILITY S
ANYPROPRIETOR/PARTNER/EX.ECUTIVE Y/Pl I E.L.EACH ACCIDENT _i $ 500,000
A
OFF ICER/MEMBER EXCLUDED? NIA N/A NIA l�C231S351551035 05/07/2()15 1 06/0//2016`--. _
(Mandatory In NH) F,L DISEASE-EA EMPLOYEE $ 500,_000
If yes,describe under j
( ! L.DISEASE-POLICY LIMIT $ 500,000
i DESCRIPTION OF OPERATIONS below � _—_ _
i N/A
!DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space iS required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in forceon the date that this Qertificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/lwd/workers-conipensation!investigations/.
CERTIFICATE HOLDER _ CANCELLATION
1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Susan LetOurneau ACCORDANCE WITH THE POLICY PROVISIONS.
.536 Forrest StreetAUTH "'�" —
ORIZED r:k'PRESENTAn'IVE
North Andover MA 01845
Daniel M.Crq(viey,CPCU,Vice President—Residual Market—WCRIBMA
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD nama and loqo are registered marks of AGOR.L
Massachusetts Department of Public Safety = ~
Board of Building Regulations and Standards
1�CER1IFiED
License: CS-089583W EE
Construction Supervisor
WILLIAM F Valid Thru SWEET ����
PO BOX 287 � �
45 NEW OCEAN,5T
SWAMPSCOTT MA 0 2016'
Expiration:
Commissioner 04/26/2016
Billy Sweet Chimney Sweep.
Boston, MA
a e
Office of Consumer Affairs and Business Regulation
l' 10 Park.Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 125388
Type: DESA
Expiration: 11/24/2015 Tr# 245475
BILLY SWEET CHIMNEY SWEEP
WILLIAM SWEET
PO BOX 287
SWAMPSCOTT, MA 01907
Update Address and return card.Mark reason for change.
ss t 2orn�s>>
Address '.` Renewal Employment Lost Card
OMee orComuaner,ctiairs Ra,ihtpss Pet;sala?ian I is Fuse or;c8istratinn v alsd for inativddaa%use only
ME IMPROVEMENT Ct5NTPACTOR before ahs iix9irticion drmte. if found return to:
gistration: 125338 Type: O ice of Cori tuner Affairs and Business regulation
iratlon: 11124/2015 OBA 10 Pnrlc Ply xa Suit;.51'70
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BILLY SWEET CHIMNEY SWEEP
WILLIAM SWEET
45 NEW OCEAN STREET
SWAMPSCOTT,MA 01€1D7tl _.___...
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