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Home My WebLink AboutBuilding Permit # 3/28/2016 BUILDING PERMIT %AORT� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No##: y Date Received Date Issued: `71 N r•" )[liilP R I Al°d I:Applicant must complete all items on this page v LOCATION a Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: y ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other t i,,��Rfts;�'v"fn'Nj�'�� ni!� TO BE PERFORMED: ��. DESCRIPTI N OF�1�IORKm � �. r Identitication- Please Type or print Clearly OWNER: Name; .. t �` i - Phone: ° .. . Address: -. 7fl Contractor.. ame: J, a, 69J 1,'T(`0V1 � Phone: Email 6 io a" c6 r Address: I, Supervisor's Construction License: ° Exp. Date: Home Improvement License: Exp. Date: 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. .� X3 Total Project Cost: $ FEE' _�q�Check No.: Receipt No.: NOTE: .Persons contracting with unregistered contractors d'o n t have access to the guaranty fund a i. of ./iii �rGa., ,r�, ..,.rill . i <,., r "� ,,:. /l r w ° n raCff�CG� �/9 ——--_--------_-- Plans Submitted-E Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OFSEWS RAGE Dff0_ SAL Public Sewer ❑ Tanning/Massage/Body Art F1 Swilming Pools 11 Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent D-w-upster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature. COMMENTS �. CONSERVATION Reviewed on Signature COMMENTS (A�CL CA, HEALTH Reviewed on ';,k_/10 16 Signature h] COMMENTS_- jtn - , ) Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street all Fgl NOR,E=---' Q E. 41111111,13M11.1111........... 11N 1X11271//)1?1'F"1q� 1h9 154 L 4,68-ate iaflo 0/0", f "'Y AID FORTH own am' --i - E. ... �� nclover No. bol- 2.01 Z ' h ver, Mass, O LAKE COCNICNEwICK �®A�RATEoA4 'j5 7S U '� BOARD OF HEALTH P �� R� m T L D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR Foundation has permission to erect.......................... buildings on.......... ...... ........ .... ......... ...... . .s............ v � Rough to be occupied as ... ... . . .. . . ................................pp;......... Chimney provided that the person accepting this permit shall in very respect con So to the terms of thea lication 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 UNLESSRough 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. D.G. Contracting Inc. Decks ,Excavation work Commercial fit ups* Dumpsters` Man lift work°Fres pruning Sport court Installations t3ovid C'ttte,LnvP,esideVt 428 l'leasoat st. N Andover ldn.01815 Ca 1 I Cell sre e1 s 17es Na. License 9 001821 * insured * How improvement r 120199 Dgbuilding@aol.com Jeff 121 Farnam st N Andover 6037854598 mi.tch94989gmail. com_ March 10, 2016 Quote up dated March 22, 2016 Install white railings like you saw at Westford park. Theates will noL be an (,riw , match to the railings. Add for white railings $ 2, 340. 00 Bring in a licensed electrician to install a Panasonic fan IighL combo uniI. in iti .k :1 one light in the bathroom, Remove the sheetrock in the tub are of the bathroom, replace with new sheeLrock. and paint the affected areas. Supply and install a 400 series Anderson patio door. Install concrete deck footings 4 feet below grade. Build a deck 18 x 20 feet + - using pressure treated framing and 2 sets of stil ir. a gates. The decking will be composite decking and the railings will be pressui,e ire,ited. Labor, sales tax, permits, inspections and materials. $17,800- 00 Thank you David I auth y e David to do the above work X—m X Print -3 Date_I) MIO Y)A LAAW Al (r 621-D AD IP 1 , d I'U qp w Ale � ?,r lb"dc �(i q oFFibe6rc,,,,, 1 9 16 jo Op bra ol e io w Pry �� -P 9c: � North Andover MIMAP December 31,2015 d � N pa n� a MVPC no Mlaratalaa Hatrol li Detwn.MA Sw"Umra Cawduuaa Syatmh,Datum HADB9, _.SR WIl Dm Sawa:TNdM(wMmapwasprodvwdbYM&nim M. koala ,q� VMlay PWvft Ccmmlall(MVI )ll data proMad by the Tw of yaatb r• 'M Nodh And9 r,AddAvrnal dela pm'rk9ed by the E.***b*09.02 of Em k;mt w+lai AlfandMaaa@t9.The lAfa m ll dmpkted on Wo map h parmla 3" tw pamarro w+mea+a a��i tl may rva bo pde+wela wr 4aga1 m++trday M dogrobwarrvWW"IllwInUdion.THE TOWN OF NORTH ANDOVER MANES NO WARRANTIES,TIES,EXPRESSED Oft IMPLIED,CONCERNINO THE ACCURACY,COMPLETENESS,REUASIUTY,OR SUITA131UTY 6$ # OF THESE DATA,THE TOWN Ok NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF +y,M al �* THIS INFORMATION The Commonwealth of Massachusetts Department ofIndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name (Btisiness/OrganizatiorVfndividtial):_ 6 (boq ra ,54 i'r q ":T 1/7 Address: 0-Z, Pv trf eq gg City/State/Zip: '6- Phone#: 17F 7/ 5 Areyouanemployer? heckthTeappropriate box: Type of project(required): 1,0,.m a employer with , Lemployees(full and/or part -time).* 7. QNew construction 2.Q I am a sole proprietor or partnership and have no employees working for mein 8. ®remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]f 4. 1 I am a homeowner and will be hiring contractors to conduct all work on my property. 1will 10 F1 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 0.Q Plumbing repairs or additions 5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6Q We are a corporation and its officers have exercised their right of'exemption per MGL G. 14.FJ Other 152,§1(4),and we have no,,employees.[No workers'comp.insurance required.] *Any applicant that checks box##1 must also fill out tho section below showing their workers'compensation policy information. t Homeowners who submit this affidavit fidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, fContractors 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 have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers I compensation insurance for'my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie. ' 70 Expiration Date: A� �T, (21 1-1 ( Job Site Address: 1-6� �U M < t 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. I do hereby certify urzde zepains andpenalfles ofpeijuiy that the information provided above is true and correct Signature: ry Date: Phone 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:GOGL AC DATE(MM/DD/YYYY) CERTIFICATE LIABILITY INSURANCE03/24/2016 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 Phone:978-688-6921 NAME: Hannah Courtemanche,AAI,CISR Macdonald&Pangione Insurance Fax:978-688-5350 PHONE 978-688-6921 ac No 104 Main Street A/c No Ext: 978-688-5350 North Andover,MA 01845 E-MAIL m hannah ins.net Donald Schemack ADDRESS:hannah@mpins.net DGCON-1 CUSTOMER ID#:_ INSURER(S)AFFORDING COVERAGE NAIC# INSURED D G Contracting,Inc ID 646648 INSURER A:Travelers Prop&Casualty CL 25674 428 Pleasant St INSURER B:Safety Insurance Company 39454 North Andover, MA 01845 INSURER c:National Liability&Fire Ins INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 DDL BR POLICY EFF POLICY EXP LTR 1 D POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 680-1553R18 05/17/2015 05/1712016 DAMA T RENTED 300 00 PREMISES Ea occu rence $ CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PE j X LOC $ AUTOMOBILE LIABILITY COM BINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS 3116538 07/12/2015 07/12/2016 PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNEDAUTOS $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A CUP-0090153321 05/17/2015 05/17/2016 DEDUCTIBLE $ RETENTION $ $ '.. WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A V9WC704542 03/31/2016 03/31/2017 E.L.EACH ACCIDENT $ 1,000,0001 OFFICERIMEMBER EXCLUDED' (Mandatory In NH) E.L.DISEASE-EA EMPLOYEO $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 13000,00 '.. A Property 680-1553R18 05/17/2015 05/17/2016�Lsd/Rent 20,000 Equip DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is req Ared BARK{AN MANAGEMENT COMPANY, INC. AND THE OWNERSHIP ENTITIES OF THEIR OD OR MANAGED PROPERTIES are additional insured as required per written agreement in reference to General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barkan Management Company Inc. HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 p ynC. ACCORDANCE WITH THE POLICY PROVISIONS. c/o Compliance Depot P O Box 115006 AUTHORIZED REPRESENTATIVE Carrollton,TX 75011 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i �': of ConsumerATfu►rUusiness.R fld(E IfVIPROVEMENT'CONTRACTUR e14trafiiott20199 Type: � paxatjQn 1,111/ t31 lnojj t dual DAVID tJLEZI?N DA),b GULI=ZIAN 428 PLEASANT ST Q NbRT0,"'A OVER,MA 01845 I3 irler`s�ci�fary Massachusetts Department of Public Safety "Board of Building Regulations and Standards License: CS-001821 Construction Supervisor DAVID P GULEZIAN 428 PLEASANT S7 NORTH ANDOVER MA18� �t4sa lJl_ Expiration: Commissioner 10/02/2017