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HomeMy WebLinkAboutBuilding Permit # 11/2/2015 .......... i I BUILDING P t,®RTS IT a�RxOR Q- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ _n- Permit Permit No : Date Received �SSACHUS Date Issued: ELL V - I TANT: Applicant must complete all items on this page /l Wl N i aarari�u ro �^ ��r^wx�wf umr r p m r�sm wrrw i u�ia�i�iru (l ' 1 � ",�. � �' ,1, � I ��� ��/ lr✓JJI uv,dr+ ' 1,�/, 1 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 I„,, ,, r . ,,, f r y r , , y � irr /, r rr r,1 rrt / rWIr rN/�, r 0, /f/!!/r / f OJ 11 ( // ...t...e.��,, 1 i NEW mmo i r n r,o/islrl G./ci WN 1 1/ ,.1/(, r 1. / /„ /r Y, ,rryl a/i/lJfllf;.09r �✓ ,1 rJ 1/!!!G 1J/ i ,/il // ///,! ///!!il/,d rr///,, Il (Il ! / 1i j t, / / // // il le, � �/ g/f f ! DESC IPTION OF WORK TO BE PERFORMED: �. �' �� ���s�t � �.:�,�� '�"� � � m'r�_5�;lcr 1 '' �n'c"s �✓� ��r-�'r�`�C CZra,x^� .:� /,�i°6 �r�r, Identification- Please Typg or Pr nt Clearly Address: ////I�/�i/iu- �� 'v' .If ir>I��� ,1 ra, r J�;✓ l ,�r, Ire orr� J ;� o f r, f Err/! � � r �, � rf� ,j1 u ,P y T! r� 1��� 1,., ,,���11 (fir!) ✓r r" �,r r � i , i r r in'A'd� ' i0C"n��ii�uu�l QmaliwR���r, �hdwx!���1� iti ihSvmerr�SMn�ivx�Aruri`pif�rir�l�rr�l6r��r�l l�� �r� r/1f1( °r r I f,n,l7rd� � �fj„E ,,„frfuil,�oDOi�urmtireai$i,,_;. i i r 1 b �r.'� 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. a Total Project Cost: $ <, FEE: $, Check No.: 30 Receipt No.: �. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund d tkORTH _t own of nuover Cd 6144-0 i - 2 ® LAKE 1 ver/ �.5s' COC NIC NE w.c. RATED U BOARD OF HEALTH PE �m1op 1no%r- Food/Kitchen M IT 'MIT L Septic System ......... THIS CERTIFIES THAT ....... .. „ ,,,,,,,,,,� BUILDING INSPECTOR .................... has permission to ere Foundation p ......................... buildings on ...... .. ........ .�.. . ... .. .. ... ....... Rough to be occupied as ... ...... ..... ..........!!'�"'........ .. ........ ....................... chimney provided that the pe on 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 MONTHSELECTRICAL INSPECTOR UNLESS A Rough Service ................. ....... ........ ..... ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupj7 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. NORTH SHORE BUILDING SERVICES LLC 1 Westward Circle North Reading, MA 01864 1-800-564-4016 Licensed: CS-060149, HIC-165538, RRP Lead Certified PROPOSAL September 25, 2015 *Revised October 18,2015 per Arnica Mutual Insurance Company's Report Steven Diamond 940 Johnson Street North Andover, MA 01845 Email: sdia eapaoE.rom We hereby submit specifications and estimate for: Finished Basement SCOPE OF WORK • Check exiting framing and interior partitions. • Frame in opening on stairs. r me u . • Insulate to Massachusetts code. • Install fire rated insulation in furnace room. • Install%2"blue board on walls and skim coat plaster; smooth finish. • Install existing doors,trim and baseboard. • Install new doors,trim and baseboard where needed. • Apply two finish coats of paint on ceilings,walls,trim baseboard and doors. • Install existing toilet,washer and dryer. • Install existing baseboard heat covers. • Install laminate flooring on floor($3.50 per sq.ft. allowance for material). • Contractor to obtain all necessary permits. • Contractor to dispose of all debris. BATHROOM • Repair water damaged sheetrock. • Skim coat to match existing finish. • Apply two coats of paint on ceiling and walls. We hereby propose all materials and labor—complete in accordance with the above specifications,for the sum of: $ 21,290.00 Twenty One Thousand Two Hundred NinetV Dollars Payment to be made as follows: 1. 1/3 upon acceptance of proposal. 2. 1/3 at midpoint. 3. 1/3 upon job completion. Acceptance of proposal—The above prices, specifications, and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of acceptance: -7 �5 (Customer's Signature) ontractor's Signature) All work is 100%guaranteed for one year on all craftsmanship.All other warrantees are through the manufacturer.All warrantees will be null and void if job is not paid in full. Thank you for letting us serve you! North Shore Building Services LLC The Commonwealth of Massachusetts Department oflndustrialAccidents a I Congress Street,Suite 100 Boston,AIA 02114-2017 www mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAHTTING AUTHOPJTY- Applicant Information Please Print Lei4ibl Name(Business/Organization/Individual): �� �/l!J✓" �� /� - Address: City/State/Zip: O. � ��h� l+�dt' Phone#: � ® �2V-1 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am aemployerwith employees(full and/or part time).* 7. [❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $, Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition 4.F-1I 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.F1 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5� m I aa general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance) 6QWe are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 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 theirworkers'compensation policy information. i Homeowners who submit Wis 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-conirad6is have employees,ley must provide their workers'comp.policy number. X am an employer that is providing worlrers'compensation insurance for my employees.'Below is the policy and1ob site information. Insurance Company Name: Ce-1- Policy#or Self-ins,Lic.#: ,�� ��vt�� �C� �� Expiration Date: Job Site Address: _fti�7 ����� ..��"L-� City/State/zip:: 144,14 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$$250.00 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 certify under the ains and penalties ofperynry Haat the information provided above is true and correct. Si ature: ' Date: �� Phone# Official use only. Do notwrite 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##: v AC ®® ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/27/2015 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). PRODUCER CONTACT NAME: Nicole Orlanzo BYETTE INSURANCE AGENCY INC. aI _ ONE ,Ext): (678)851-6678 1 ac No: E-MAIL — ADDRESS: nicole@akfowlerins.com 200 Park St. _INSURER(S)AFFORDING COVERAGE NAIC# _ North Reading MA 01864 _ INSURERA: ACE AMERICAN INSURANCE CO 2_2_667 INSURED INSURER B: BARBAGALLO PETER DBA NORTH SHORE BUILDING SERVICES INSURERC: INSURER D: PO BOX 663 INSURER E: NORTH READING MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER: 8046 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 LTR SD WVD POLICYNUMBER MM/DD/YYYY MMIDONYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence $ MED EXP(Any one person) $ _ _ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT [—] LOC PRODUCTS-COMP/OP AGO $ '.. OTHER: $ --- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ '.. Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - - AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per_accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X SPERTATUTE EORH _ AND EMPLOYERS'LIABILITY Y/N — ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? I N/A NIA NIA 6S62UB2E30048515 07/02/2015 07/02/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under — — DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I $ 5001000 N/A DESCRIPTION OF OPERATIONS/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 force on the date that this certificate 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.inass.govAwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Crow)ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Co actor Registration Registration: 165538 Type: Corporation t Expiration: 3!1/2016 Tr# 248873 ' kEis C.J. & B CONSTRUCTION CORP PETER BARBAGALLO 1 WESTWARD CIRCLE - NO.READING, MA 01864 _ < } Update Address and return card.Mark reason for change. Address [:] Renewal Employment L] Lost Card SCA 1 0 20M-05111 �1LG WQ9)7A9Z04ZilJCQ�fJL O�� JQCLCfZIIQPif License or registration valid for indiviilul use only fiice of consumer Affairs&Business Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Type. Office of Consumer Affairs and Business Regulation gistration: iam,38 10 Park Plaza-Suite 5170 xpiration 3112018 ;_; Corporation Boston,MA 02116 C.J.&B CONSTRUCT O CORP PETER BARBAGALLZT 1 WESTWARD CIRCLE -:, NO.READING,MA 01864 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Consiruction Supervisor License: CS-060149 PETER J BARBAgAL ' 1 WESTWARD CIR 2 N READING MA7-Oi4 o_72.— — � �"�� Expiration Commissioner 10/31/2016