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HomeMy WebLinkAboutBuilding Permit # 5/17/2016 w OOR T&i BUILDING PERMIT R"rD TOWN OF NORTH ANDOVER pp "' APPLICATION FOR PLAN EXAMINAT[O'N.. Permit No#: Date Received_ ���arep Pep` Date Issued:._ , �— IMPORTANT: Applicant must complete all item§:on thf§,page LOCATION � " PROPERTY OWNER .. o� °n " � e �� Print _. 100 YearStructure yes no MAP PARCEL: ZONING DISTRICT:--Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial [I Alteration No. of units: [I Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ­777Leer ' ' % Waters ed,Distnct ds „ , ,. s // , ,'r. �/;�/ "tan .,..,. ❑,.. ,Flood la� / i.,, ,,, W II ,/ � r Se ti p "/;❑�WaT�r�S�WeI"'i/i '/ /ii//Iiii�/���////�///�/ril flr'��1J//� %�%�„ !,!�„ .�G,,,., v,, 1,�, ,,,�,.,-„i.,, TESCRIPTION'OF WORK TO DE PERFORMED:�w�:,w� � �°�.". �� �� G C y Identification�P ease Type or Print Clearly OWNER: Name: �_.f Phone: a x w.m. � Address: Contractor Name: 4 Phone: Email. z i a 4 .. Address""" ) / � �� 4�.n Supervisor's Construction License: C.S � ;y µ., Home Improvement License: G E><p:.,Dates:,. ARCHITECT/ENGINEER .. .... Phone: Address: Reg .No. FEE SCHEDULE:BULDING PERMIT.$92,00 PER$1000.00 OF THE TOTAL ESTIMATED COSEMASEWOM$125.00 PER S.F. Total Project G® t: $ °. FEE: $ Check No.: Receipt .zcce� NOTE: Persons contracting with unregistered contractors do not ha sf,�the guarantyfund _ rmiC t%®RTH ipT,own of Andoverl ® 0 ® 12o 3- vi ol� T C° LAKH ver, ass, r.1 2A 11 1Q COCHICHl WICK �• Q ammIT T LD� U BOARD OF HEALTH Food/Kitchen P E WOW a Septic System THIS CERTIFIES THAT ............. BUILDING INSPECTOR ............. .,. .. ...... .... ....................................... .... ...... ......... uwal . ........ Foundation has permission to erect .......................... buildings on ........ ......... .. .... ....... .. ..... . 901 Rough tobe occupied as ........I ........ ......4.4,;......... .. ..... ........ .... .. ... ..... ................................. 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 STARTS Rough Service ...............:..... . ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ZALANS"S CONSTRUCTION 34 BIRCH ROAD ANDOVER MA 01810 978-835-5194 QUOTE# 3 Order# Date 1/25/2016 QUOTE SUBMITTED TO: WORK TO BE PERFORMED AT: Name Ed ewood Retirement aft Rick McCloskey) Name Storage Bam Address 575 Os ood Street Address City-State North Andover Planned Date Phone email i nicclosl<ey(cbedgewoododre.com Job Description: Remove 8 window sashes from top of Barn and install 8 New fixed Vinyl extended half round unit,White,grills between the glass,The grill between the glass will match the existing design.The new windows will be Harvey Industries. All debris will be removed from site.$50.00 permits$175.00 Product cost$$704.00 x 8 units=$5632.00 Installation and materials$1100.00 Windows take roughly 4 weeks from order date. Painting not included. Due to the inconsistency of the openings,I will order 1 window as a markup.Then order the other 7. All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: $6,957.00 PLEASE MAKE CHECK OUT TO ZALANSKAS CONSTRUCTION with payments to be as follows $5200.00 deposit to order $ 1365.00 due at completion Submitted by: GREGORY ZALANSKAS OF ZALANSKAS CONSTRUCTION Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work specified above. Payments will be made as outlined above. f Accepted by: �. � q �3 Please note: This proposal may be withdrawn/by us if not acq6pted within 30 days Manufacturing � ��s ACKNOWLEDGEMENT A-A HARVEY 4111! Mr. BUILDING PRODUCTS Harvey Industries.Inc. 1400 Main Street,Waltham,MA 02451-1689 (781)899-3500 harveybp.com Salem 413 Raymond Road SALEM.NH 03079-9283 Phone:(603)893-1611 Fax:(603)893-8196 BILL TO: SHIP TO: ZALANSKAS CONSTRUCTION ZALANSKAS CONSTRUCTION MIIng111RU11111111 34 BIRCH ROAD 34 BIRCH ROAD ANDOVER,MA 01810-0000 ANDOVER MA 01810-0000 Ph o e: 978-409-1773 Fax: 9783730736 Phone: 978-409-1773 Fax: (978)373-0736 QUOTE NRR CUST NBR CUSTOMER P DATE CREATE DATE ORDERED ORDER TYPE 3909863 1036881 -0 11!20/2015 Quote Not Ordered Cash ORDERED BY STATUS SHIP VIA DELIVERY AREA None Whse Pickup SALEM WAREHOUSE CLERK JOB NAME COUPON cajl -Cory Jolicoeur None LINE# DESCRIPTION QTY 10000-1 Vinyl Shapes Extended Half Round,Unit Size 36.5 x 60.5,RO 37 x 61,._ 1 EXTENDED LEADTIME Frame Short Side=42.25,Frame Radius=18.25 Window Label=None _ _ Overall Glass Thickness=7/8"Insulated,Double Glazed,Low E,Argon Filled, k_ DSB,Custom Annealed IG=Yes,IG MFG=CL - Unit 1:U-Factor=0.28,SHGC=0.3 1,VT=0.57,NFRC CPD Number=HII M —f — 30 00177 00002,Replacement r Unit 1 Glass:NFRC CPD Number=HH M 30 00177 00002 Energy Star — Base Color=White Contour In-Glass,Colonial,Match Frame,3 W4H Overall Rough Opening Width=37,Overall Rough Opening Height=61 Room Location: None Assigned "Note:Delivery charges may apply and are not included on this quote. This quotation is based on our interpretation of the information provided. All quantities,sizes,extensions,grand totals,and specifications should be verified by the contractor prior to his/her bidding or ordering of materials. Harvey Industries,Inc.,is responsible only for the items as quoted above. Any changes or addendums will be subject to a requote. We propose to supply the materials as described above,subject to the terms and conditions as required by our credit department. The prices are guaranteed for 90 days from the date of quotation unless otherwise noted. Delivery charges may apply and are not reflected on this quote.We appreciate the opportunity to quote this job. If you have any questions,please call your local warehouse. CUSTOMER SIGNATURE DATE **IMPORTANT NOTE Please be aware the Energy Star requirements are changing for the Northern zone on January 1,2016. Orders placed after 12/31/15 will be subject to additional costs to meet hese new Energy Star guidelines,If applicable. Last Update:11/20/2015 8:41 AM Page 1 Of 1 Printed:11/25/2015 1024 AM The Commonwealth o,f Massachusetts Department ofIndlustrialAceidents " X Congress Street, Suite 100 1r1 f i w Boston,AM 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/L'E lee'tricians/Plumbers. TO BE, I+ILTD WITH TING PERMITTING AUTHORITY. Applicant Information Please Print Leo Y Name(Business/Organization/Iridividual): �� � ,� a .Address: a , City/State/Zip: .- .u ... a Z� .'hone#: Are you an employer?Checktlio appiopriate box; Type of project(xecluir'ed): .L lama employer with ". , employees(full and/or part-time).* 7. El New construction 2. l 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.❑l am a homeowner doing all work myself.[No workers'comp..insurance required.]t 1.0 E]Building addition 4.❑l am a homeowner and will be hiring contractors to conduct all work on my property. l will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.[1 Plumbing repairs or additions 5. l am a general contractor anal l have hired the sub-contractors listed on the attached sheet. ❑ t 13.[]Roof repairs These siib-contractors have employees and have workers'comp.insurance. ialeAl 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other t t tY G 152,§1(4),and we have na.,empl6"yees.[No workers'comp.insurance requited.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who subunit 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 sub-contractors and state whether or not those entities have employees. if the sub-cori`tractors fiavo employees,they must prcvrrl^their wo;kcrs'comp.policy n7amber.' X am an employer that is provldlhg rvorkr rs'compensation insurancefor my employees.'Below is thepolicy and job site information. r f� hisurance Company Name: A, (k, ., _i Policy#or Self-ins,Lic.##: L &l s ' t Expiration Date: 1� Job Site Address: ...�. City/State/Zip: lU e) j- tt. tri" Attach a copy of the workers'coxnpepi ation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 1.52,§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 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 offuvestigations of the DIA for insurance coverage verification. X do Hereby certify under .. rth�e�.p�az s..a. nl1�eraltes ofrJ r that the providedabove is true r correct Stnure: 4 Date. z . Phone#: s�rwr 7 Official use only. Do not write in this area,to be completed by city or totvrz 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#: ® C TIFI T LI ILITY I URAN DATE(MIwDD/YYYY) Ilti� F 05/16/2016 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 pollcy(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 endorsements. PRODUCER NAME: Diane LeBlanc DOHERTY INSURANCE AGENCY INC PHONE t)i (978)475-0260 ADDRESS: dieblan dohertinsurance.com P.0 BOX 1985 INSURERS AFFORDING COVERAGE NAIC 0 ANDOVER MA 01810 INSURER A: ATLANTIC CHARTER INS CO 44326_ INSURED INSURER 8: GREGORY ZALANSKAS INSURER C. ZALANSKAS CONSTRUCTION INSURER D: 34 BIRCH ROAD INSURER E: ANDOVER MA 01810 INSURER F: v COVERAGES CERTIFICATE NUMBER: 53280 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. INBR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLtCYNUMBER M OD M LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE r OCCUR PREMISES Ea occurrence) S MED EXP(Any one person) $ -- N/A PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY a PRO• CT D JELOC PRODUCTS•COMPIOP AGO S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accldenl ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED ; NIA BODILY INJURY Wer accident) $ AUTOS AUTOS ( NON-OWNED PROPERTY DAMAGEHIRED AUTOS AUTOS Per accident $ b UMBRELL.ALIASOCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS MADE i N/A AGGREGATE S DEO I I RETENT;ONS �/ y WORKERS COMPENSATION /� STATUTE DI AND EMPLOYERS'LIABILITY Y I N A OFF CANYPEMMEMB R XCLUDED�ECUTIVE FP—UA] NIA NIA WCV01254000 10/02/2015 10/D212016 E L.EACH ACCIDENT S 500,000 (Mandatory In NH) E L.DISEASE-EA EMPLOYEE S 500,000 qos,describe under E.L.DISEASE•POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additlonal Remarks Schedule•may be attached It mora 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.mass.goviWdiworkers-componsaflon/investigationst. 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 Edgewood Retirement Community ACCORDANCE WITH THE POLICY PROVISIONS. 575 Osgood Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 �"" (�(J Daniel M.Croey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Client#: 10322 ZALANSKASCONST "' CERTIFICATE ' ' ' DATE(MMIDDIYYYY) 5/16/2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01810 INSURERS AFFORDING COVERAGE MAIC# INSURED INSURER A Arbella Protection Ins Company Zalanskas Construction INSURER B: Gregory Zalanskas (DBA) 34 Birch Road INSURER C: Andover,MA 01810 INSURER 0: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFTIEMMr Y E POLICY EXPIRATIION LIMITS A GENERAL LIABILITY 8500022056 06/15/15 06/15/16 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY OAMAOE TO RENTED $100,000 CLAIMS MADE �OCCUR MED EXP(Any one person) $5,000 PERSONAL b ADV INJURY $1.00 000 GENERAL AGGREGATE s2,000,000 GEN L AGGREGATE LIMITAPPLIES PER PRODUCTS•COMROP AGG $2 000 000 X POLICY PR01 LOC AUTOMOBILE LIABILITY ANY AUTO (EO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per parson) HIRED AUTOS BODILY INJURY $ NON•OWNEO AUTOS (Per amdent) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY' AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S _ OCCUR F�CLAIMS MADE AGGREGATE S __ 5 DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION AND WC STAT.U-1 DTH• EMPLOYERS'LIABILITY ER ANY PROPRIETOR PARTNERIEXECUTIVE E.L EACH ACCIDENT S OFFICEMMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI S II yes,describe undor SPECIAL PROVISIONS below E.L,DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Covering operations usual to Zalanskas Construction... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Edgewood Retirement Community DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I_ DAYS WRITTEN 575 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRE TATI ACORD 25(2001/08)1 of 2 #S33584/M32350 DML © CORD CORPORATION 1 888 Massar,tiusetts Department of P.,ibhc Safety Board of Buiidintq RCaaBations and Standards I is ense CS-072201 ronstru t¢arra Supervisor r tt� GREGORY J ZALANSKAS 34 BIRCH RD //� Aft ANDOVER MA 01810 A„ aua a xto i°aatiasr"rv: er ��`'°" er 03/18/2018 .Office of Consumer Affairs(&Business Regulatiau�c�/l3 License or registration valid for individul use only -- ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 126875 Type: Office of Consumer Affairs and Business Regulation xpiration: 8/3/2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 GREGORY J.ZALANSKAS GREGORY ZALANSKAS 34 BIRCH RD ANDOVER, MA 01810 �Vali Undersecretary ithout signature 4