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HomeMy WebLinkAboutBuilding Permit # 10/21/2015 V%ORTFI 9 BUI L I N PERMIT �� yt::,,. :c TOWN OF NORTH ANDOVER`: 0 < . :.. ..,,: .. L APPLICATION FOR PLAN EXAMINATION * - Permit NO: � '� � Date Received Date Issued: sActau�`��R� IMPORTANT: Applicant must complete all items on this page LOCATION`, ` PpPTY CU�IN�R t Pant P Nq ? PRCE , ZONING DISTRICT Hlarld District yds no Mh�re Srp,'t1ille jrs ria` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential i New Building ❑ One family Addition ❑ Two or more family ❑ Industrial Alteration P ri f r llvu No. of units: _ _ C Commercial Repair, replacement r Assessory Bldg I I Others: Demolition ❑ Other r ep iiir > 1IV1� fl Flpadple� i i We[lr�ds , ullterkid ©� tr�ct Q�Nter/ ewer, A Identification Please Type or Print Clearly) OWNER: Name: 1 w AA Aoil C ST10A) Phone: sD Address: Addr"esF S�apqru>ImrEpp , r H rn I t# t r rtt � nse Am,p aT M l# ARCHITECT/ENGINEER r Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ so Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accessto the gu anty fund Sid nture of AgentlOwrer " ignatiare of cantracta 11 F ,AORT H v e r own of ndu 0 . 3 `; 1 s LAKE h ver, Mass, I t COCMICMIWICK y1. A°RAreo S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT �. BUILDING INSPECTOR . Foundation has permission to erect .......................... buildings on .... .. ... .......... .... ..�............................ Rough to be occupied as ......... .........:....... .............. ....° ..... L .................................................. 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 MONTHS ELECTRICAL INSPECTOR 0 UNLESS CONSTRUCTIO T TS 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. 160CT2015 Glenn S. Preston 190 Pine St. Danvers, MA 01923 (781)760-9646 PROPOSAL SUBMITTED TO: JOB LOCATION: Mr. Tim Armstrong Same 444 Salem St. North Andover, MA 01845 (978)289-3473 —PROPOSAL- We hereby submit specifications for the following pellet stove installation @ said location: -To install insert pellet stove in existing fireplace on floor# 1. -To completely line chimney from top to bottom. -Chimney will be capped. We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: One thousand, sixtyfive dollars ($1,065-). Payment schedule for the above price as follows: Payment to be made in cash immediately upon completion of installation. Respectively submitted with great gratitude, Glenn S. Preston Licensed builder& home improvement specialist i' Acceptance of proposal: ,` (Ho eowner) (C tractor) Date: lc' / /2015 Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the proposed estimate. All agreements are contingent upon accidents,and delays beyond our control such as acts of God, weather,terrorism,state of emergency,and unforeseen existing circumstances which exist on said structure. 160CT2015 Glenn S. Preston 190 Pine St. Danvers, MA 01923 (781)760-9646 PROPOSAL SUBMITTED TO: JOB LOCATION: Mr. Tim Armstrong Same 444 Salem St. North Andover, MA 01845 (978)289-3473 -PROPOSAL- We hereby submit specifications for the following pellet stove installation @ said location: -To install insert pellet stove in existing fireplace on floor# 1. -To completely line chimney from top to bottom. -Chimney will be capped. We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: One thousand, sixty five dollars ($1,065-). Payment schedule for the above price as follows: Payment to be made in cash immediately upon completion of installation. Respectively submitted with great gratitude, Glenn S. Preston -- Licensed builder& home improvement specialist Acceptance of proposal: X - = a g X (Homeowner) (C etor) i Date: (0 / /2015 / -Any alteration or deviation fro m,the"above specifications involving extra costs will be executed only upon-written order,and -will"become an extra charge over and above the proposed estimate. All agreements are contingent upon accidents,and delays beyond our control such as acts of God, weather,terrorism,state of emergency,and unforeseen existing circumstances which exist on said structure. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Business/Organization Na e: 7`0 < C�NS'7 .PJ c' �N /c� � '✓ Address: N -ST - City/State/Zip: Dc) N hone#: L -; � O Are youjan employer?Check the a propriate box: Business Type(required): I-01 am a employer with employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8• E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, n with no employees. [No workers' comp. insurance req.] 12 Other C 01J'1rctCtl>4 '' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I azn an employer that is providizz workers'(c_ompensa ion insurance for zny employees. Below is the policy information. Insurance Company Name: yrc C "\ M f/-i C�t- Insurer's Address: 2 `f 2 L1,7 ff40n•tua't- City/State/Zip: /2 r (0 tJ d 3 2 / Policy#or Self-ins. Lic.# 0j(3 ���S��2,^ ® � - �� Expiration Date: /d 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. I do hereby certify, under the pains and penalties of perjuzy that the information provided above is true and correct. Signature: s Date: tq C �� r Phone#: cq-� t :?-(c) ` 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia DATE(MM/DDNYYY) a ®® CERTIFICATE OF LIABILITY INSURANCE 10/16/2015 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). IRODUCER CONTACT NAME: Neal Hutchins AX Archer Insurance PHCo N Ext: (978)922-4600 PA/c N0; (978)922-9276 271 CABOT ST E-MAIL ADDRESS:neal@archerinsuranceinc.com INSURERS AFFORDING COVERAGE NAIC# 3EVERLY MA 01915 INSURER A:MASS. WORKERS COMP. NSURED INSURERS: Glenn Preston INSURERC: L90 Pine St. INSURER D: INSURER E: )anvers MA 01923 INSURER F; 3OVERAGES CERTIFICATE NUMBER:CL15101600523 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. 4SR ADDL SUBR POLICY EFF POLICY EXP LIMITS JR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ MAMAGETENTED A CLAIMS-MADE 1:1OCCUR PREMISES a occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY El PRO-JECT LOC PRODUCTS-COMP/OP AGG $ 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 eOaccident) DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION R STATUTE ETH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? 6ZZUB 2X50925 6 15 10/9/2015 10/9/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 )ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) r v-e( cc, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIM ARMSTRONG THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 444 SALEM STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Neal Hutchins/ALEXA ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS026(201401) A� CERTIFICATE OF LIABILITY INSURANCE ��(MM o�6'15 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 CERTIR ATE 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 NAME: Lindmark Insurance Agency, Inc PHONE FAx 607 North Ave E-MAIL ' (781) 2455-0100 No; 1781) 246-5553 Door 12 ADDRESS: Jake@LindmarkInsuranceAgency.com Wakefield, MA 01880 INSURE R(SI AFFORDING COVERAGE NAIC H — ' —_-__ _..................._ I NSURER A:NORTHLAND INSURANCE INSURED INSURER B; GLEN PRESTON INSURERC: DBA PRESTON CONTRACT INSURER D: 190 PINE ST INSURER E: DANVERS, MA 01923 1 INSURER F; COVERAGES CERTIFICATE NUM ER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE JSTED 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 -- -- - -- AWL SUER -- --. — - - POGCY EFF POUCI EXP — ---- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBERMMIDD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY WS19 647 10/21/14 10/21/15 EACH OCCURRENCE $ 1,000,000 MtSr COMMERCIAL GENERAL PRE S JE,DAMAGE To RENTED coocurren $ 5O 000 CLAIMS-MADE D OCCUR MED EXP(Ary one person) $ 5,000 _ PERSONAL&ADVINJURY $_100Q_000 'GENERAL AGGREGATE $ 1i00010Q0_ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY Esaacccident ED SINGLE L IT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWFED SCHEDULED AUTOS AUTOS ! BODILY INJURY(Per accident) $ NON-OWNED I PROPERTY DAMAGE $ HIREDAUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ EXCESSIAB _ CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN EEL ANY PROPRIETOR/PARTNERlEXECUTNE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLLDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II ea describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1(1,Additional Reim rks Schedule,if more space is-qui red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TIM ARMSTRONG ACCORDANCE WITH THE-POLICY PROVISIONS. 44 SALEM STREET NORTH ANDOVER, MA 01845 AU7HORIZE4 REPRESENTATNE ©1988-2010 ACORP gORPORATION. 1 rights reserved. ACORD 25(2010/05) The AC ORD hame and logo are registered marks of ACORD - Phone: Fax: E-Mail: 10/'6/2015 SearchResults Search Results • , Select the licensee name below for more information. (If your search produced more than one page, you may select page numbers at the bottom of this screen.) • Select the Search for a Person or Search for a Facility button to perform a new search. • Select the Preview File button to view a sample of the fields included in a file you can download. • Select the Download File button to download a text file of your search results at no charge. • Select Public Information Request Form for a form to order a data file. 11 Search for a Person i Search fora Facility Preview File i Download File t , PRESTON JR WILLIAM -- (Null and CS-046697 Construction Supervisor Void HOLDEN MA 01520 Preston Alfred J � EM-005103 Elevator Mechanic_ _ _, ctive Petersham MA 01366_ Preston AnthonyJ _ HE-141017 Hoisting Engineer (Active gawam MA_01001 Preston Anthon J HE-141017 HE-213- Front end loader/backhoes :Active Aaawam MA 01001 Preston Anthon J ry HE 141017_ HE-4E-Catch Basin Cleaner Active gawam MA 01001 .__ m..__ - _ _ PRESTON ANTHONY L HE-081679 Hoisting Engineer _ _ --------Active New Bedford MA 02740 PRESTON ANTHONY L HE-081679 HE-1C-Telescoping booms w/o ctive New Bedford MA 02740 cables PRESTON ANTHONY L HE_-081679 HE-213- Front end loader/backhoes ctive__� New Bedford MA 02740—' PRESTON ARTHUR T HE-027788 Hoisting_Engineer_ - .T._._.__ _ _ ctive -�SOMERVILLE MA 02145 PRESTON ARTHUR T HE-027788 HE-2A- Excavators �- ctive _ SOMERVILLE MA 02145 PRESTON ARTHUR T HE-027788 �HE-1A- Derricks/ Lattice Cranes..A,ctiive SOMERVILLE MA 02145 PRESTON ARTHUR T_ HE-027788 HE-4A- Unlimited Specialty Series _ I Active SOMERVILLE MA 02145 PRESTON ARTHURT_ HE-027788 HE-3A-Air or electric powered chive —SOMERVILLE MA 0_2145 PRESTON CHARLES E HE-031895 Hoisting Engineer _ _ Expired Mvakka City FL 34251 HE- PRESTON CHARLES E HE-031895 cranes BB-Telescoping Boom w%cables Expired Myakka City FL 34251 cran __ PRESTON CHARLES E HE-031895 - HE-2A_- Excavators �4 ~_ — Expired Mra_k_ka City FL34251 PRESTON, CHARLES E HE-031895 ^ HE-4A- Unlimited SpecialtSerie------ CHRISTOPHER Expired _Mvakka City FL 34251 . PRESTON CSFA- Construction Supervisor 1__&__2 Active LAKEVILLE MA 02347 CHRISTOPHERR _ 057163 Family_...__...__. _ ctiv____v_.__. !` Null and PRESTON, ERIC ERIC EO-136814 Elevator Operator �' ARLINGTON MA 02476 _ _ I oid__�� PRESTON ET -162114 Fioistin ED ineer w m ----._.�._.__.___...___ ---_ - _ ._ _g 9 —w..._._._._._ w. Expired! New Bos NH 03070 N ETHAN D` HE-162114 HE-2A- Excavators w _ Exoired New Boston H-03070_ PRESTON GLENN CSSL- Construction Supervisor Specia ty Active i Danvers MA 01923 098758 _ � _ PRESTON GLENN CSS L- CSSL-DM - Demolition Active Danvers MA 01923 098758 PRESTON GLENN CSSL- CSSL-SF - Solid Fuel Burning Active Danvers MA 01923 098758 Device L PRESTON GLENN CSSL- CSSL-WS-Windows andSiding Danvers MA 01923 098758 _ P TON GLENN CSSL- CSSL-RF - Roofing _ tive Danvers MA 01923 PRESTON JAMES R III HE-155074 Hoisting Engineer est S ringfiel ___ Void 89 PRESTON JAMES R III HE-155074 HE-3A-Air or electric powered Null and West Springfield MA oid 01089 PRESTON JOHN T CS-080676- Construction Supervisor Ex ired w SWANSEAmM_A_ 02777 -tt PRESTON KEITH 1N HE-052551 µHoistin�Engineer _,_�___�_- �_ ctive_______Granby MA_01033 ~-W _._ ______�____ _... _ PRESTON KEITH W CS-064521 Constru_ction_S_upervisor Active Granby MA 01033 . _ PRESTON KEITH W —_HE-052551 _ HE-2A- Excavators �- _ Active Granb MA 01033 PRESTON, KOREY Ewell CS-097937 Construction Supervisor _ Expired LoMA 01852 ._____..__.._.h.___A__..�__ '_ est Yarmouth M http://elicense.chs.state.ma.us/Verification/SearchResults.aspx 1/2 C`%�B�(�'OOI/J9109GCl1BCCG�lL Q!".��`''"fIJJCIC!?CIJG'�fJ ; '\ Office of Consumer Affairs&Bu lsiness Regulation ! MOME IMPROVEMENT CONTRACTOR 2egistratton 136827 Type: �Expiration:- 9i4/2kkf8 Individual GLENN PRESTON GLENN PRESTON >� 1 190 PINE-Sf: ; DANVERS,M4:;01923 Underve*eta'ry a, Massachusetts -Department of Public Safety Board of Building Regulations and Standards + Construction Supervisor Specialty License: CSSL-098758 GLENN PRESTOI! 180 OCEAN AVEME I Salem MA 01970= J � Expiration Commissioner 10/05/2015 E ����� � � reo k.AJ Pet 1"Y C SSC. 1 r e W P 5!+•� j� �� ��� �J�is cP if r �'� C ( Cc C//( et C( U<r 4GG'di Coi i'' r �i AW co-,Ce 0