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Home My WebLink AboutBuilding Permit # 10/29/2015 `AORT01 4� Leo � BUILDING PERMIT + R 6 T NORTH V '�4° ®°� ® APPLICATION FOR PLAN EXAMINATION ' Date Received ryRA��A /eay Kermit iVo#: r TEDcwus�� Date Issued: M .U�14 IMPORTANT: Applicant must complete ete ar�Items� on Y this page( pp � , � �� .,'o � � r � r �p � p• �, �,,,a h ,r' �h�il llll� /� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other k, F111,11 - DESCRIPTION ,.%i!//fJ DESCRIPTION OF WORK TO BE PERFORMED: k 0 /-/vAt to 4 Va , !11 Identification- Please Type or Print Clearly OWNER: Name:, tl Phone: ? °- % Address: / ` ttsn y G ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project Cost: $ FEE: $ �1b 01�— Check No.: Receipt No.: 1 ed contractors do not have access to the guar anty fund NOTE: Persons cont�actuz with n eggs er r �i"ii rr/T it✓ry / /I/i,'% �/i y/ i�l / /� /r ' � g une f�i�d tra w^.rtor /� /i07/""""/`1 ria n Town of ndover 0 ?, h ver, Mass, 1' ",6 Njc«ewjcxy A0RATED r'PA�,�S S BOARD OF HEALTH ID PERM- IT T L Food/Kitchen Septic System THIS CERTIFIES THAT .... ....... . f �RIS �S BUILDING INSPECTOR .. .. Foundation has permission to erect ........ ................. buildings on .3..h....... .... .. ...................... �. M. A Rough tobe occupied as ........... .... ........ ........ ... ... . .. .........:.............................................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service ............ ..... ... .. .... ...ING.. INSPE .................... Final BUILDCTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. Joesph Banko 11 ocean Terrace Salem,Ma 01970 Date Proposal# Phone# 978-855-1696 massbaybuilders@juno.com 10/17/2013 291 Name/Address Project Terms Terms Description Total Airy alterations or deviationsfrom above specifications involving extra costs will be exectited only upon written orderand will become an extra charge over and above the originalproposal.Persons other than Joe Banko,employees and authorized agents of Joe Banko.are eapressh forbidden on any ladders,scaffolding or use of any tools owned or operated b}Joe Banko or authorizeddger:ts ofJoe Banko.Joe Banko shall be entitled to charge a one and one half percent(1.5%) monthly finance charge for all invoices on which W i inen_t is hot received within(30)days. The customer agrees to pay all cost of collection,inluding but not hoited to reasonable attorney's fees in regards to any and'dl[past due amounts. *Quote pricing valid for 45'days, **1'tll special drder materials are nonrefundable Please do not hesitate tocontact us with any questions or concerns $0.00 Total Re.Vectfuily submitted by:Joe Banko Cla.Stoll erSipature/Date a The Commonwealth of Massachusetts Department oflndustrialAccidents X Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/ludividual): '5 a S pw Address: I G 2 (�,,C a f62 14 1K cle City/State/Zip: Phone#• _C � Are you an employer?Check the appiopriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2&1 am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions pro'p'rietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.F1 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#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. $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-contractors fiave employ ees,'tliey must provide their workers'comp.policy number. lain an employer that is providing worriers'compensation insurance for my employees.'Below is the 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 up to$1,500.00 and/or one-year imprisomnent,as well as civil penalties in the form of a STOP WORD 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 certify under t pains andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: Phone#' a 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.CitylTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NOTICE OF ASSIGNIVIENT EMPLOYER: COMBO I.D. STATUS OF EMPLOYER Joseph J Banko 00026997 Individual 11 Ocean Terrace Salem,Ma 01970 The Waiver of Our Right to Coverage under this assignment Recover from Others Endorsement applies to Massachusetts Is available on Pool policies. operations only.For coverage Contact your agent for details. outside of Massachusetts,contact the appropriate Pool or Plan for the state AGENT David E Zeller Insurance Agency Inc INSURANCE COMPANY: OR David E Zeller American Zurich Insurance Company PRODUCER: 370 Lynnway Jonathan Schamberg Lynn,Ma 01901 P O Box 3556 Orlando, FL 32802-3556 (800)453-9843 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION ----------------------------------------------------------------------- --------- ------------------------ --------- ---------------------- CARPENTRY-DETACHED ONE OR TWO FAMILY DWELLINGS 5645 $0 8.06 $0 CARPENTRY-DWELLINGS—THREE STORIES OR LESS 5651 $0 8.06 $0 ROOFING-ALL KINDS EXCEPT FLAT 5551 $156,000 41.56 $66,056.36 EMPLOYERS LIABILITY 100/100/500 9845 STANDARD PREMIUM $0 LOSS CONSTANT 0032 $150 EXPENSE CONSTANT 0900 $259 TERRORISM CHARGE 9740 $0 RISK MINIMUM PREMIUM 0990 $500 TOTAL ESTIMATED PREMIUM $65,742.60 DIA ASSESS.5.75% $0 -------------------- TOTAL EST. PREMIUM PLUS ASSESSMENT $65,742.60 INSTALLMENT BASIS:ANNUAL DEPOSIT PREMIUM: $3,500.00 THIS IS NOT A BILL COMMENTS COVERAGE EFFECTIVE 12:01 AM ON 10/08/15 CARRIER NOTE:The Bureau reviewed the classifications and descriptions provided with the application and determined that a change to the classes provided on the application was warranted. DATE OF NOTICE:10/19/15 PREPARED BY: Joanne Shea EXT 530 The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street•Boston,MA 02110 (617)439-9030• FAX(617)439-6055 9 WWW.WCRIBMA.ORG NOTICE OF ASSIGNMENT LETTER ID: ** VOLUNTARY DIRECT ASSIGNMENT * 4473573 The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street•Boston,MA 02110 (617)439-9030• FAX(617)439-6055•WWW.WCRIBMA.ORG Feb. 24. 2015 '0 .0151 `1 ?1j. 931 P. Iii IIASSAYB-01 SLARSEN a DATE(nIM, DYYYY) ! CERTIFICATE OF LIABILITY INSURANCE 21zar�ole THIS ERTIFICATE IS iSSUE;D ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOCS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NDT 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). PRODUCER Llcense#100109+5 CONTA Commercial Insurance.NET PIZCNE -- ---—-- FAX --- --------.-- 2420 Springer Drive FA�0604�CESS-.�c�ertsO-commercial,insurance.net No F11.(877)907-526'7 ----------- No 2420 Sib-63617 - Suite 100 Norman,OES 73069 - — ----- '---- ----- IrISURER(S)AFFORDNG COVERAGE MAIC Y ---------------------------- ,NSURERA:United Specialty insurance Cesmpany ------12537 ENSURER B_ 1tO Mas Say builders Ocean Ter MSURERD --— ----- ------ --------�-------- 11 O c n 01970 F------ ----------- -- NSURE __ _ _ _ I iNSUIRER F: COVERAGES _ _ CEF2TIF'ICATE NUME16E : __.___ REVISION NUMBER: THIS IS TO CFRTIFY THAT T_HG POLICIES OF INSURANCE LISTED EELOWHAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD- PdDICATED. NOTV\IITHS?AND;NO ANY P.E;DUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT'ro WHICH THIS CERTIFICATE MAY BE iSS!ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TEP.M5. EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNIiA- - --------- i S - - - --"'-FISLTC4'eFF--ls'Oi:ICYE LTR —---TYPE OF INSURAISCE------- INS 13 i wvo POLICY NUVEER --- MMiDDYYYY) (MMIDDq-yYY1 LI14I7S A X C-0M-MERCIAL GENERAL LIABILITY i I — --- - ---1 -, -- I _ _ EACH V�,_Jt-REPd--=_ t$ 1,tOL3,00 F- X ocn- I IS(122059101P4 02123i209S 02/231201ti F ) " - r F'�T ------ CLAIMSMADE E1 I PREPASESiFaosur nc l S 50,000 MED E-P(Ani o9B perso) e ---- 5,000 -�--- --- ----- PERP,-,;,A.L8 ACI1N,,LIRY — 1,0_00,000 GENLAGGREGATEUMITAPPUESFIER GENE{ALAGG�EGATE $ 2,000,000 ., -r-------i X I POLI-Y I— JE(.T L j LCC I rR JGVP10=.4GG F -f----- —----- ------ C iMENED •iVG_EI mrr LAUUTOMOBILELIABILIT( - I t o.ldontf—_ I ANY AUTr I � SOCILYINJJP ,Por person) —o --___-- ',. ---- - ----' c 1 SCI-iECJi.=p I i ---------_------ Ai._U1�,N C t AvTU:' �� A;JTOS I BOCkL1'INJ_IFY'iF'Zr eccLTe•iti $ F;;FEC:\iJTVS I,—I AU�',,c ; I =a eccla�rc. ------ ---�-- LJMBPRO LA LIARi-- ---- I r�L�t�-: 1 I E a�H OG'!�RRErJC� R EXCESS LIARr 1 fS 1:DE I I ;GRFG:9Tc I$ --^-- - i----r— —I--~--_—.-1 f— —.—__—_--- .--._—_.— DED I 1 T PUE,1TOIJ -- WORNE S COhiF ENSATION F_ I S A.TLUE AND F.AMLOYERS'LIABILITY YIN, I I '- -'J E ANY PROPRiETOR/PARTNEFJE:,.-VJT\'E --�) E L FAC-i.ACCIPFNT --f$ JrrIC .4Jh1FMB�RP<CLDu0' [ NtAI I ---- l -----� (Mandatory in NH) -JI El CaSfASE-F`Er,1 LO'YEE -tSCRI=T f I`LPs,desc•ibe❑ uer ---------�----- OPI OF OFERA?I�I:_:salon I i E.L CdiEABE.RC C;'Ur I71$ f DESCRIPTION OF OPERAT10NS1 LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,mey be attached Y more space Is required) Please call 877-007-5267 to confirm coverage is still active. L CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE 1 Insureds Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN kCCORDANCE WITH THE POLICY PROVISIONS. AtJ7HOR(Zl:-D REPRESRJTATIVE 01988.2014 ACOR D CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD l rn /1e Cpaa�r��zoazcaca�� tacccll d' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 176831 Type: Office of Consumer Affairs and.Business Regulation Expiration: 10/1/2017 Individual 10 Park Plaza-Suite 5170 JOSEPH J. BANKO Boston,MA 02116- . i JOSEPH BANKO 11 OCEAN TERRACE SALEM, MA 01970 =-- Undersecretary of vali wi t gna re � Massachusetts - Department of Public Safety 1 Board of BuildingRegulations gulations and Standards CunitrnCiion�ilperi'isor License: CS-070671 JOSEPH J BANKQ` 11 OCEAN TER/op Salem MA 01970 Commissioner Expiration 01/06/2017