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HomeMy WebLinkAboutBuilding Permit # 10/2/2015 t%ORTH BUILDING PERMIT 'LED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#A Date Received Date Issued: S C US IMPORTANT: Applicant must complete all items on this page Y IIJ�G18111" r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family El Addition 11 Two or more family El Industrial 11 Alteration No. of units: 11 Commercial 11 Repair, replacement El Assessory Bldg El Others: El Demolition El Other z '04ir,AON /01/ N/ e #-79)MVIRI, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: 0110111 YEMEN i vwneni/ oll 0/1 �� 11 u , r /,�/>V�x, ��Da��! ,, '�l /,,,J a y� ���% MIR ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. A Total Project Cost: $ 6- c) FEE: $ Check No.: 42A Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty, und A I Signature "f"Agent/Owner 7- gn --p- — fn/� IAORTH Town of 2 ,�.,:...1, Andover ® / - T , LAHQ ♦ er, ss, COCHIC HQWICK 1• BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ... ., .. . BUILDING INSPECTOR .. ... .. ...... ....... ` �iIR has5-a'04-.0 ermission to erect ftal .p .......................... buildings on ..: ........... .. ...... ........ ........... .,, Foundation. ,,qq Rough .1.to be occupied as .... .. . . .v. . .. ..................................................................... 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 I THS ELECTRICAL INSPECTOR UNLESS TI Rough Service .................... ...... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR ccu2ancy Permit Required to Occupy BuzldinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. CIRCLE G, LLC Construction Management Specialists 59 Bonanno Court Methuen, Mass. 01844 978-876-5263 June 30, 2014 Isaac & Erin Willard 2001 Salem Street North Andover, Mass. 01 845 Quote: #15886 Install 2 new windows. Windows will be installed on each side of the fireplace. (Brand of windows will be Paradigm) • Remove siding and outside sheathing. • Remove insulation, save and reinstall. • Frame new windows from the outside of structure. • Install 2 new construction windows with built in J-channel. • Trim the inside of window to match existing trim. • Reinstall sheathing and siding to original state. • Install flashing on top of new windows. Note: Circle G LLC, is fully licensed and insured. Circle G will warranty the work for one year. Total Cost for work completed.• $4,600.00 Stephen Giordano .Ell ,y The Commonwealth of Massachusetts Department ofIndustrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib NaMe (Business/Organizationadividua 1): oz. -e,, t,4. Address: City/State/Zip: o,v4- Phone Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am.a employer with employees(full and/or part-time).* 7. E]New construction 2.E]-faui a solo proprietor or partnership and have no employees working for me in 8. [I­Mnodeling any capacity.[No workers'comp.insurance r'equired.] 9. Demolition 3.F-1 I am a homeowner doing all work myself.[No workers'comp,insurance required.] 10 F]Building addition 4.❑1 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 117 El Electrical repairs or additions proprietors with no employees. 12.[J Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13. Roof repairs Thesb sib-contractors Have employees and have workers'comp.insuranco.t 6.F1 We are a corporation and its officers have exercised their right ofexemptionper MGL c. 14.❑Other 152,§1(4),and we have noemployees.[No workers'comp.insurance required.] *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-cimiraci6rs have employees,lhcy must provide their workers'comp.policy number.' 1 am an employer that is providing workers'compensation insurance for'my employees.' Below is the policy andjob 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 o. 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 of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties ofpeijiny that the information Provided above is true and correct. Sign Date: Phone#: 11/' Z 2 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#: ,--1 © DATE(MMIDDIYYYY) ���o CCE�'TI MCS � J E ©F C�� -` C���flTl M UUR N E '1 5/7/15 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEP.TIRCATE HOLDEN 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 BET WEEN THE ISSUING INSURER(S), AU1 I;OP.iZED REPRESENTATIVE OR PRODUCER,AND THE CEIii IFICATE 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 endorsemerlf(s). PP.OIFJCER CONTACT NANT Trud-v Lawler Armand P. hiichaud Insurance AgPHCNQ (978) 685-25x9 FAX (878) -794-0822 105 Haverhill Street E-MAIL ADDRESS:hiiethuen, 1x0L 01844 INSURER(S)AFFORDING COVERAGE NAIC r INSURERA c Concord Group INSURERB: Circle G T'hC INSURER C- 1 Stephen Giordano INsuRERD I 59 Donanno Court INSURER E: Methuen, MA 01844 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 AEOVE FOR THE POLICY PERIOD INDICATED. NOTM-THSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEhf T 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 ANDCONDITIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR IEFFhDD1EXP TYPEOFINSURANCE NSPVAfD POUCYNUIMER MSUBRI MIDWYIMU1 -1 LIPDTS A GENERALLIABILITY I y 20004335 2/25/15 2/25/16 EACHOCCUPRENCE Is 000 000 Ii 5Ah'4GET0 RENTEDI S 50,000. 50,000__ i COMMERCIAL GEhERALLIABiUTY 2B-11-1 E$/ada orci rren., CLAIMS,l4ADE z OCCUR WED EXP(Arty one pasm) �S 5 OOO —I PERSONgL&ADV INJURY S 1,000,000 GE14ERALAGGREGATE 1S 2,000,000 GEITLAGGREGATELIMITAPPUESPER PRODUCTS-COMP/OPAGG S 2,000,000 POLICY PCT F-1 LCC I I S j AUTONo81LEUASIUTY ( COM3INEDSINGLELIMIT caaccid?rn I S EODILY INJURY(Per psrson) I S ANY AU i0 ALLOWIED SCHEDULED BODILYINJURY(Per eccldenl)I S AUTOS AUTOS OWNEDI PROPERi Y DAMAGE S HIREDAUTOS _AUTOS eraccidenl UMBRELLA LIAR OCCUR f f EACH OCCURRENCE is I EXCESS LIAB AGGREGATE S l CLAIFr1S-PAD: DFD RETFJNTION S 1 I S WORKERS COMPENSATION ( ! I WC T.Ry'I. I IOTR-I AND Eh1PLQYERS'LIABILITY E.L. CHACgrrNr S YIN r i I _I_i AFROPRIEiORWARTNER>CXECU7IVE I NY OFFICER/MEMEER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S I`tixesdrsaibeunder EL.DISEASE-POLIC'fL1hM1n 5 1 OLSAPTION OF OPERATIONS below 1 I j i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renarlis Schedule,ITmore space is regrdred) '.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE .DELIVERED IN ACCORDANCEWITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE I Trudy lawler ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0322 E-Mail: trudylacrler@m�chaudinsurance.cos p4l.-ra�uve«�l _ ceotCcns irerAfturs Tt►i ►a� R,�i�ac/zrr�e/C rem►stration valid fnx u.d►vidnl use only �. ;v 0�;,�f�1C► wore the ez , tr+ �: $ para ►ot►antef fo►znd return ta'. . r^€ pr armi!i ►Ype; OY"ce cf Consurnrr f_Zi ►►-E r uaine�s eg►ifa ion �n^'IVi(dGcl- OMppJ CJIORU/ r r^sJhL WAY s -RHiLL,r,�A o?ssz Unders«rctary r a► Not valid wit, out.signatur � Massachusetts Department of Public Safety 1 9, Board of Building Regulations and Standards License; CS-076638 '" Construction Supervisor LAWRENCE F GIORDANO.II 897 BROADWAY , HAVERHILL MA,,01832 4 I � CA— Expiration: Commissioner 09/16/2017