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HomeMy WebLinkAboutBuilding Permit # 10/28/2015 ORTpl BUILDING PERMIT TOWN OF NORTH ANDOVER ► APPLICATION FOR PLAN EXAMINAT Permit NO: Date Received— Date Issued-, SC H 1 0 items on this /, ��u � ///, r/ , /i /, / 11 /�,�/r TYPE OF IMPROVEMENT PROPOSED USE Residential Non® Residential ❑ New Building )<One family 11 Addition 11 Two or more family El Industrial El Alteration No. of units: 11 Commercial XRepair, replacement 11 Assessory Bldg 1-1 Others: El Demolition 11 Other 'Tk Li, 140) r4fk) W i KtmJS Identification Please Type or Print Clearly) OWNER: Name: Address:.. I hXTER-G( '14 AviQNCv- WA 0 1 b /, ., ;, ,/�//r /�>% //., r,,,,, r r,„ /r/f ,r /rr�/,%%>,, r�,ar /b ,ri!r/ r .1�/ rr 11 / r r/ I� / r/ J ARCHITECT/ENGINEER 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: o C) L", FEE: $® Check No.: I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc s to the guarantyfiind NORTH Town of t Endover ® 7 No. 11L— t - h ver, Mass., coc«ic«ewicK �1' Al TE S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ............ x_ -� �Q j prr� BUILDING INSPECTOR ....................................................... . ... ..c�- -...................... Foundation 1:// [10 has permission to erect .......................... buildings on ... ..... t!x.co ...... ........ Rough to be occupied as ....... ........ .{'��Y.D........ ....................®........ 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION A T 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. RICHARD A. FIORENZA 287 CHICKERING ROAD [FORTH ANDOVER,MA 01845 978 7fi4 4388 August 25,2015 Felix&Susan Layne 46 Wintergreen Drive North Andover,MA 01845 RE: SCREEN PORCH CONTRACT i Demolition of all existing screens and interior only of existing half walls f F/I framing for installation of(7)new openings and a beam over the new slider ® Installation of(4)5'x 4'window sliders,(2)4'x 4'window sliders and(1)12'x 6'8"slider '.. ® F/I interior and exteriortrim for new slider and windows '... a Removal and disposal of all trash and debris ® New Paint interior and exterior of new trim for sliders(Color determined by Homeowners) '.. All Materials and Labor(excluding(6)window units and(1)slider) 7,785 ® Removal,repair and re-installation of(3)sets of existing sliders correctly 0 Labor only '... 750 0 F/I Bat insulation to walls and ceiling 0 All Materials and Labor 1,800 ® F/I Closed Cell Spray Insulation under floor and install pressure treated plywood to cover B All Materials and Labor 3,500 s F/I wonder board to floor and installation of new the and grout 0 All Materials and Labor(excluding new file and grout) 2,550 0 Total Contract Amount: $16,385 The Commonwealth of Massachusetts Department of IndustrialAceidents B I Congress Street,Suite 100 Boston,MA 02114-2017 wwmmoss.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/PIumbers. TO BE TILED WITH THE PERAUTTING AUTHORITY. Applicant Information Q Please Print Le ibl Name (Business/Organization/Individual): Address: ,U1 i'� �1kb City/State/Zip:t4 ty!Dw IM 61b fS Phone#: C17 b qb+ T 3� Are you an employer?Check the appropriate box: Type of project(required): LQ I am a employer with employees(Rill and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 10 Building addition 4,F]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.❑Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof re airs These sub-contractors have employees and have workers'comp.insurance.# p 6.Q We area corporation and its officers have exercised their right of'exemption per MGL c. 14.%Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employe/•that isproviding ivorlcers'compensation insurance for my employees. Beloiv is thepolicy and job site information. �+ j Insurance Company Name: S C�'t A�r� t Policy#or Self-ins.Lic.#: L /���r P j pirationDate:5zl(-, — Job Site Address: /keV"C �7 �e�nd� +,{/tn�lG 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 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. Ido hereby cert fy ttllde r•the airy�t an penalties of pei jwy that the information provided above is true and correct. Sin titre: t/1 Date: Phone#: — eyr Official use only. Do not write in this area,to be completed by city or totvrt 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#: t%oRTH Town of ndover O . .. h ver, ass o t„KE ' I CoCNICNl MACK ►.P��t J BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT ............E ..( / (� --I-- Q J ►°�''-� ►/ F BUILDING INSPECTOR .... ............................................ „ ...... .... . // Foundation has permission to erect.......................... buildings on ... �4N61CirP"S....... .. .......... AdA .�. Rough to be occupied as ....... ...... p. 0W .... ........ a .. 6 rz,k_ -........ 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 LESS CONSTRUCTION,7 T 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. 10/26/2015 11:14:05 AM PST (GMT-8) FROM: 100005-TO: 19786889542 Page: 2 of 2 DATE(MM/DD/YYYY) ,ac®Iz®® CERTIFICATE OF LIABILITY INSURANCE 10/26/2015 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 certificate holder in lieu of such endorsement(s). CONTACT PRODUCER TL SOUTHMAYD INSURANCE AGENCY LLC NAME: 668 MAIN ST PHONE FAX WILMINGTON, MA01887 E-MAILo Ext: Arc No: ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC t/ INSURERA: Liberty Mutual Fire Insurance 23035 INSURED INSURERS RICHARD FIORENZA 287 CHICKERING ROAD INSURERC: N ANDOVER MA 01845 INSURERD INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 27051563 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS-MADE 1-1OCCUR PREMISES Ea oNTEcur ence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑LOC PRODUCTS-COMPIOP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS ILIA B HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION WC2-31 S-381419-015 4/15/2015 4/15/2016 STATUTEETH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN N E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 '.. If yes,describe under 500000 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) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR RICHARD FIORENZA This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF N.ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST N. ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE I411) Liberty Mutual Fire Insurance f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 27051563 1-381419 15-16 WC Kaztik WaLi 10/26/2015 2:11:40 FM (EDT) Page 1 of 1 ` y Massachusetts -Department of Pubh( `:safety Board of Building Regulations and Standard Construction Supers icor. License: CS-067249 r-<. RICHARD A FI N_ 287 Chickering Rdad r� North Andover MA 0f8t Expiration commissioner 05/20/2016 %ln B n m I OWCe of Consumer Affairs&BusynCss Regulnttan S MEW PROVEMENT CONTRAflR jYPe egistration: 126,1,25 Individual )piratiog q12 72016 RICHARD At4THONY FICRENZA RICHARD,FIORE,NZA ��w, CAC At*lDdVER�t�A 01845 ;<3�tle�s�ct`xiary� �.