HomeMy WebLinkAboutBuilding Permit # 12/9/2015 NORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER 3
APPLICATION FOR PLAN EXAMINATION
Permit ND# 'v Date Received
J— q HOSE<
Date issued:
Ii4PORTANT Applicant must complete all items oB flus page
\\�\o
On
MAP�-' �pARGELyVZONINGDISTRICTV��Histo��Distti�ct���`y`e� Vrto ,, r
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building ❑One family
❑Addition ❑Two or more family ❑Industrial
❑Alteration No of units ❑C mercial
❑Repair,replacement r]Assessory Bldg Others
Demolition ❑Others��
�p:Septic ❑WeII� yD F\�odplai� ❑Wetlands \ vA W�e sVA� lct
.�DW�tedSewec .;� Avg A\A�y A .� e�..��.,
DESCRIPTION OF WORK TO BE PERFORMED.I [
�' �,L `� � ;•✓l}— \mss` S\[� �` C r\Yi�.i.�
Id-ficatioD,Please Type or Print Clearly OWNER: Name:l r I' -1 Phone
Addre A�
�Conttactor
Email y y A AAVA VAVy\yAA\v w
Address
Supervisors-�C�sf ur ctto�Li�n°seA \��V A yAV�ExpyDate�V� '��V���
`� Ex Date
H,omeImprovementLlcepse {t,�U.:ea„
ARCHITECT/ENGINEER Phone:
Address: Reg.No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$ �—.—r-, FEE:$ ---�S'
Check No.: t- 1 C) Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarhantyfund
Signature of Agent/Owner f)\ __ture of contractor
Fl done ns o.""Z,Mc�zaz;z,a eneW a ea ropoo'oi Membarol
Owens Corn ng Preferred Cantmctpr-12826 H Hee#168661 Ne
OSHA 30 Hour Construction Safety Tranng MACSL#104)28
f yr; EPA Lead Sete Certfed
_e
go3c>n®rad Contracting,LLC
51 S Bri lmaq#2214 Salem,NH 03079 (603)890.9084 ) 10 Stevens Street,Y141 Andover,MA 01810
rrEero �_ _ GN •(978)475-0095
f n C21� (ilk iS'
flower beds.
S m Qpoky Protean t home with trips to cath g opens.Respect and protect shrubber
P s f o fng material down to the bare rest deer Iflaeect the roof decx for structural def ate
Detemman,the condition t he underlying Plywood or boards and repair and replace as necessary*.
trp et miefidge for Proper 1 U pacing On either el of rid
t II heavy gauge j,; _ 5 ax-mem exhaust vent)t .Cut in
if necessary.
Ir t -_ - 7 —'Q--- (cion) r3 M -
7 ' ---ti"t=icevvt-sh eld to meet ho f tspecificationsdrp ti t roof Eaves.
valleys,around fl kyfghts h-coney bases-oo`benetraE p s - t (t o 6`pet from.of edge,3 feet centered in
In t I s — n at all sdewall t2 ns tons).
In all new
IesheavYgauge —breathab!(r f)de k pro' on remainder of the roc'deck,I In II y, d 1p edge at roof rakes.
notah Cr iL
-
starter strip at to.,eavesa,
In tall wfl shing tom et rra of ct r d �a la I �t�y,�,��kc
sP t s(,.e. ewalls chimneys",lights and roofpenetration,',,,,,,,T t )�, LS
In Iia (feet)of 6-4 <, L.." `�*
Hand na-to p p r f ,e ridge vent at roof ridge to allow maximum ve,laE on ��,
g
Inst (feat) - -/", ""b,
Th y �------d'to tiv h' and ridge cap.Hand Hai;to ensure Proper fastening,
ghl lean d d pose f II roofing deb On
Property,Ulacnetically sweep property for nails.
Nota.:JTzoj1. LfL- �f^
acv e �� �Er 0,
5os,if s%c ,--
141,
Edmunds General Commotinwill:
9 n
Obtain II necessary o t - let d
Perform k N. ,out
complete th s Pipe
ct. �� -
m F urn h efficiently Pbl :h ut f' -9 9ual ty
d -t II II e sarY t to co pie theproject,=Provide a thorough clean up and op all degenerated3 {
d g project.
Edmunds General C t-acting LLC agrees to commence work on/ t G
d described work will be completed'n aboutHCl':
days.
Product U r 1
pgrade 7:
Product Upgrade 2:
claC N Ply sere fully covered by workmen's Compen t
ll tlrb'rty It'frthr agreed that this contract may he assgnetl by the PCntractor and also
m tth bl'gafons moofair,bind and apply to the the rs successors or esiatae
UP Plet ftheabova�ork all untlere gnetl agree to ex uteantltlel'ver to fh plies.
th t t th'rjoni note'n aeoortlancewth his(thei)abo bl'gfn Etlmuntls 0enerel Cao[raCling LLGguaralrtses elll orkmansh'
req t tl by tractor.Upon refusal[o tlC so contractor may t t pt declare
me ti m }p h th �.�y pPerrormetl for
l)_ 9 d�tf nntlefl tldt� hllbeaP.dbim w II gt Srs?�t €''-s
t tl tl p tl th[h II b 9th[e s a d Gond tions p tl g'��y f t i tl i IX factory enhanced vaarranty
o"r th nhactand/Cra yl' neonnecton herer✓th. _ �rorkmanah'p defect Gov 9e and iR years of
enc ehra�r e hrough {,`,y�__�.
g _the dtlla Icast of
pip ea s99 cry
�� e1o�s�c ed„oealre=.
Edrn npd Crilarc
Cont t P
.ab r P w agr t f -h t BIr
(
af th the b p ' to t5
it ler($"e`c- "
cM
peyna-zTerns,:
b
Atlp tf----2�mut ldl/3 of hha rotirrot,s
it,.upmn start ofwok.This
h b5isd demo las,a yo aourm7m.
o completed to the s iod,11on or all p rt es. en wwk AUthorizetl S g tore ,'
A finance charge of 1.5%Par - '� al conrrec g LLc
Past due amoun5 over 30 daysonth(18%per year)will bs ohsrged on
Note:This propOsaLm�y ba.1ml.mlby us if not accepted w thin
days.
. 'teyTair,I,jure LnpegBl They,
lit facteryand are Hereby ac a Pecfcat'ons and DO NOT SIGN THIS CONTRACT IF THE
e wak p fed Pe Ft Y euthor1zd tc d0 �� EANY BLANK SPACES.
ymenl wil be made --I above.
Date ofi acceptance: f Authorial Signature: �_
I'F /
' Authorzetl Signature .y
� ORTfy
Town of
.,-,.t, , Andover
® ® M
s h ver,Mass,
�qs g1T[O�PRR�J
U PERMIT TOI BOARD OF HEALTH
L DFood/Kitchen
Septic SY.—
THIS CERTIFIES THAT............... BUILDING INSPECTOR
.
has permission to erect :A....................buildings on... V .....&6,,*....jo fuL
nondatmn
Rough
to be occupied as................. • ..... Ch-ooy
............. .. ... ..............................................................................
provided that the person accepting this permit stall 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.
..............: MONTHS e,lee
ELECTRICAL INSPECTOR
..A Rogh UNLESS CONSTRUCTI ..................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises—Do Not Remove HnI
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No,
Smoke Dei.
4heCommonwealth ofMassachusefts
Department oflndustriaZAccidems
_ = 1 Congress Street,Suite 100
Boston,MA 02144--2017 ,
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/E}eeteicians/PInmbers.
TOBFFrz xn RTIHTIdc'PERNIITT7NGAUTIIORITY.
A lbeautlnformation Please Print Levibl
Name(sn.=mesaioxgaxdzaticalVidnap: 6V1
Addxess: U 30 72.LLI SC �v� ly�1 Mo7'l
CitylState/Zip: Phone#: G c)—L) -IC5 T7
Areyon an employer?ch ktlieappiopriateb= ',,. Typoofpraject(retjab d):
S.QZem aemployerwitti_emp�oyees(bill and/orpact-time).+ 7.0 Now conattvctias
2.QIam asole proprietor orparmemh[p andfiaveno employees'working inrmein
S.QRemodsling
any capacity,llvovmrkrns comp.ivsumv re4vked.] 9.❑Demolition
4.[�Iamahomeowner doing allwork myselfc[No woxlmrs'comp.iusmancaxequixed.lt 10 O 13u3ldingaddition
4.Q Ism ahomeowner evdwillbebidng covtmctomto ceuductall work on my Preyeriy.Iwill 11.0 Hiectrical repairs or additions
efhat all covhsetoxs eitherhavo workers=eompecssanuiasmencs or ora axle
pmprietom with,m employees. ', 12.�]Plumbingrepairs or additions
5.QIam ageneralcovEactor andFhaVebnedthesob-coillmctorslistedoaflra at+achedsbeet 13.0 zepaira
These aim-conhacforsltave empioyeesaadbaveworkus-er.insmmce.t 14. Other
6.0 We aze acorporatioa and its giSFem have exercisedtheirrigM oftxemptionperMGL c,
152,§1(4),and—havenn.Fmployees.[No workers'comp.msmance required.]
eAny applicmtdrat checks liar#I muY'a9so fill outmesectionbelow showing themwoxkers'wmpensationpolicy information.
t Homeowners who sitimit iisis affidavit ind3cat'v�g dray oxo doing all work®dthen him outside conhnerors must submit a new affidavit indicating such
?Comra'ctors drat efieck flilg box mus{'ztached an additional sheet sig tiv name ohne subcontractors end state whether m not those entities have
employees.I£the sub-canhac'Iors have emploYazs,3lieY mustpravide the¢workeis'comp.policy number.
Sam an employer thatisprovu&ngworkere'compensationi usur¢rzceformy ployees.Beiow is thepolicy andiandfe
i.1—ad— , { ��
Insurance Company Name: 1--
Policy#or Self ins.Lrc.#. [n/L Z 3 `?�7G/�
sob Site Address: / =yl c,vl til �/' � -Y—eiL3statoMP::: X/f}r �cr!<tl t
Attach a copy ofthe workers'coroppastionpokcy�,,Ematron page(showingthe policy number and expiration date).
Failure to secure coverage as required uaderMGL o.152,§25A is a oiiminal vWrtionpxmisbable by afire up to$1,500.00
and/or one-year imprisonment,as well as civrl penalties is the€erm of a STOP WORK ORDER and a fine ofnp to$250.00 a
dayaoainsttlraviolator.Acapy£tbis srtemeat maybe forwarded to the Office oflavestigxtions ofthe DIA forinaurame,
eoverageverifi tic.
Ido h—hy c t=ep ns andperlfiss afpe1jsxry that the inform d"Imovided above is true d corracc
Si star.
Date: Z 17 /
Phone#: �� 7
Officialese andy Do atwritein this area,to be completed bycityortownoffzosaZ
City-T— !. PermitZLicense#
Issuing Authority(circle
1.BoardofHealth 2.BuildingDepartment 3.City/Toavn Clerk 4,Flectricalluspector S.Plumbing lnspecfor
6=Other '....
Contact Person: Phone#:
FromA,—Boudreau F-D:S.—lnsru— Paget of Dale:12/91201509.03 AM Hag—of3
EDMUN-1 OP ID:NB
acoFzo
CERTIFICATE OF LIABILITY INSURANCE DATEIMNIDD"
12/09/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE OO ES 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 INSURERNN,AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holtler is-ADDITIONAL INSURED,the pOlicy(ies)must be endorsetl.If SUBROGATION IS WAIVED,subject to
the terms antl conditions of the policy,cerlafn policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsemenl(s).
Plamight N_E
JamesA Santo
224 Met.Insurance-Salem ----
224 Mam Slrset Suite 3C '.. P"c°NN Ex<:603-890-6439 603 890 6521 _
Salem,NH 03079 n� ss:Jam ie santoinsurance.com --
James A Santo
RCR{sl arrDRwNw cDrERncE
RA:St Paul Sur lus lines Ins Co
U 1 Edmunds General I,. e-Liberty Mutual Insurance Co
Contracting,LLC I..
PO Box 2214 '..
Salem,NH 03079 '..
COVERAGES CERTIFICATE NUM BER: 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. N OIW HE STAN DING 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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
AR X c .. ARILT1'00o'00
otos mnoE ao cI.R WS264625I,,, 11M 1/2015 11/11/2016 �_H A - 50,00
�:a lnny ono Persil 5,00
1,000,00
R. 2,000,000
IR
O Ec. c 2,ODO,DD
TE
Al----Sul
RylP6L111T
B
11-�11NI 111—TY IAIAIE
E-11 UAI
11"
11T IN
Xo
B RRF Luo
=DP l,nv YO N WC531S-6p2821-015 04/03/2015 04/03/2016 = - 500,00
µienealie yEMe�R EXC 3ANH _ 500,00
EI-A1EA1E III 1Y LIMIT 500,000
FS IaeoRDlm,aeamooni.Rem.rx:s�n:awgmy auameartmo,a:oa«:reavreal
Dave Edmunds is excluded from work comp coverage
CERTIFICATE HOLDER CANCELLATION
EXPIRATIONT--ULDANYOFTHEA OVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE NOTICE WILL BE DELIVERED IN
Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS
120 Main Street
North Andover,MA 01 B45 I, a .-F-FPRESENTa
'..
81988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
From:Nlml.Boudreau FaxID:Banto lnsnaance Page 3 of Date:12/9201509:03 AM 1,XjEC 1C
4C CERTIFICATE OF LIABILITY INSURANCE DA silo/zols
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:Ifthe certificate holder is an ADDITIONAL INSURED,the policy(ie11must be endorsed,If SUBROGATION IS WAIVED,subject to
the terms and conditions ofth.policy,certain policies may require an endorsement.A.
an this certificate does not confer rights to the
Certificate holder in lieu of such andorsement(EL
oouCER PLANRIGHT INSURANCE&FINANCIAL LLC SAN T�CT
224 MAIN STREET STE 3C I..
SALEM,NH 03079
aREss. RERIsI AFroaOwa c.vERA.E
A: NAIC.
LM lnance Cor oration 33600
su
"%UNDS GENERAL CONTRACTING LLC
P O BOX 2214
SALEM NH 03079
COVERAGES CERTIFICATE NUMBER:26473324 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.
s;`EEELA-11 N
GEN L <RIE LMIT os N
..ILEDABID a l
A Yl— 5DU11—By
of
A WC1-31S-36B152-025 1112612015 1/26/2016 ✓.R -
ANnEMMILOYiRSE 500000
CE__BF,&T o�xFcunv vO N
lanaEaetory U rvrvl 500000
io stzleltnon
a1 o PeRAL-S e— EL 11111Y LIIIT500000
SCRIPnoN 11.1ERATI.N1/LOCAnONSIVEHICLE3 IA11RD 111,Aaaltlonal -—j
Workers compensation insurance cove2ge applies mly to the workers compensafion laws of the state of MA
This certlfcate cancels antl supersedes all previously issued certificates,only as they relate iC workers compensation coverage.
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER,MA sxNOTICE
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BBFORB
120 MAIN STREET THE EXPIRATION DATE THEREOF, WILL BE DELIVERED IN
NORTH ANDOVER MA 01$4$ ACCORDANCE WITH THE POLICY PROVISIONS.
} 1
AUTHOwzEO BEPREs.rvTAnvE
LM Insurance Corporation ff!I,I�JC
0e 1988-2014ACORD CORPORATION.All rights res.Toed.
ACORD 25(2014101) The ACORD nam'',.and logo are registered marks of ACORD
aenr�3 I -sews I -.e e I aeS�n zs h-I s,�,cross c o wu Ie I s ee_or.
L98£o HN'OV31SdWVH
08 OdodHSV 9L
SONNW03 OIAVO
011 0tld1N00-ltld9N30 SiW03
olleaodio0 9LOZILZl9' 1 Id 3 -.
:atlAl - L9999L. :u 7 4
8010Vd1N001N3W3A0ddW`o us
au ww I
uo lealdx3
YD
s=�
FLO£O HNW31VS
4LZZ%08 O'd
SONnwaa OOIAVU
to uo i
AJadng yona;suo0
OZL706B0:asuaall
spaepuelS pue suolleln0ay 0ulpl!nH yo pieog
R;a;eS o,Ignd)o 4uaw1eda4 s7yasnyoesseW -
i