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Home My WebLink AboutBuilding Permit # 6/10/2016 OORTH BUILDING PERMIT "r ID,6'a6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 0 Permit No#: Date Received ArED A Date Issued: j— I POR�TANT�.: Appip�licant7myst complete all items on this page LOCATION Pnn� PROPERTY 0 N E R XA\3 �Y3 Print 100 Year Structure yes no MAP ARCEL:_Kbb' ONING DISTRICT: Historic District no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 11 Addition 11 Two or more family D Industrial 11 Alteration No. of units: [I Commercial El Repair, replacement 11 Assessory Bldg [I Others: 214bemolition El Other 1 ❑°�UV'ate'rshed District -vu/ I", 'iv,a OPTION OF WORK TO BE�PERFOR LMED:5 r I Al j �Jt. ,V"T C5 Identification- Please Type or Print Clearly Y'\ Phone: OWNER: Name. Acldress�K,J T15' A—\J Vc:*s VYW--- Contractor Name: Phone: Email: Address: Supervisor's Construction License: e— Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER T Phone: Address: Reg. No. FE�r� EDUL �QI NG PERMIT,$12.00 PER1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER$.F. Totalect Cos : FEE: $ Check No.: 2J+q Receipt No.: NOTE: Persons contracting with unregistered Contractors do not have access to the guaranty fund' i1( �_'_ ____ __,,__,..---'.1 2� 11 ntr ct m4 7 Plans Submitted ❑ Flans Waived ❑ Certified Plot Man ❑ Stamped Flans F F SEWERAGE DISPOSAL ewer °� Tanning/Massage/Body Art ❑ Swimming Pools ❑❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Diunpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY _ INTERDEPARTMENTAL SIGN OFF - U FORD PLANNING & DEVELOPMENT Reviewed On � � .g � �' W 11 -. � �.�� k ,�� Si nature .�' � � COMMENTS CONSERVATION Reviewed on ( � C � ( Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS "m Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/S�raat�are� Dato Driveway Permit ]DPW Town]Engineer: Signature: Located 384 Osgood Street FIDE �ART4 - Temp Dumpster on sits yes no — Fireat 124 Main Street Five Department signatu, re/date COMMENTS 1 IA®R Town ofi_ I 2 ndover \A ® _ ver, ass qj Lkok C% 7 7 O La C 1 COC NtMWIC m( A°RarE® � U BOARD OF HEALTH Food/Kitchen PER M LD Septic System THIS CERTIFIES THAT et® BUILDING INSPECTOR ............. .. .. ........ ...... ......................... .................................................... has permission to erect .. g ..................... Foundation ...................... buildings on ..1.0.0.................. :...................... ® Rough to be occupied as ...... ...... . ......lit... .... . N. .... . .. . .... .. . .... .. ... chimney provided that the person accepting this it shall ery 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 Rough Service .... .. . .............. Final BUILD G I PEC TOR GAS INSPECTOR Occupancy Permit Required to Occupy By Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr Dry Wall To Be Done FIRE DEPARTMENT Until S ece and Approvedthe Building Inspector. Burner Street No. Smoke Det. X Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 6/10/2016 Proposal#: 203-19 Project: Bill To: David Streinbergh 100 Elm St, N.Andover, Mass 01845 Description Est.Hours/Qty. Rate Total Demolish garage [provide dumpster set on site for 3,600.00 3,600.00 removal of debris] Supervision 360.00 360.00 Insurance 40.00 40.00 Total $4,000.00 NORTH pY into a�ti0 Town of forth Andover Machine Shop Village Neighborhood Conservation District Commission o. 1600 Osgood Street North Andover, MA 018 t5 4SSC uS� Certificate t0 Alter Date: March 24 20 6 Contact Name&Address: Seth Zeren RCG LLC. 17 Ivaloo St Suite 100 Somerville MA. 02143 Project Address:100 Elm Street Project Description (attach additional gages,if needed): /Demolition of the shed structure on the"roperty ret IA, tA,c2 Commission Vote: Voted S' to 0 to grant/deny Certificate to Alter on Comments (attach additional gages,if needed): vel, Side vG/� "Z`1z' 2 c� 3- �tF�Zctj6 Machine Shap illage NeighboAood Conservation District Commission Page 1 MSV NCDC The Commonwealth of Massachusetts Department of1ndush*1Accidents Office of Invesfigations 600 Washington Street Boston,MA 021.11 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Piumbers Applicant Information Please Print Leg b�iy Name(Business/orgauization4ndividual): ,+ c 17 ft&L1 1 N Z, Address: r,is 10 14 D a V 18 1 City/State/Zip: N - A 0 0 4V s+- i RVI 01 6lPhone if Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 7. J&Remodeling 2.❑ I am a sole proprietor or partner listed on the attached sheet: ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g. D guilding addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12•[]RoofrepEd s insurance required.]t employees.[No workers' j comp.insurance required.] 13.❑Other !Any applicantthat checks box#1 must also fill outthe sectionbelow showingtheir workers'compensation policyinformation T Homeowners who submit this affidavit indicating they 6e doing all work and then hire outside contractors must submit a new affidavit indicating such. t0ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is provNing workers Compensation insurance for nV Employees Below is fhe policy and job site Inf03nZafIDfZ. Q Insurance Company Name: a•1 N c`1 a 6`1 d L C � �'�''�' M C' Policy#or Self"im.Lie.#: W e— d 419 3 -7 L#-- ExpirationDate: 1 l f -7 1 ' J v A 1't- �C-i . 1y , Rpl o c3 V o4— city/state/zip: M lob Site Address: C ' S Attach a copy of the workers'compensadonpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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 f ne ofup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. X do hereby cern under thepains andpenaMs ofperjury that the infonnationprovided above is true nd correct Si a e• Date• 4 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#: JKCON-1 OP ID:HS DAZE(MWDWfYYY) CERTIFICATE F LIABILITY INSURANCE 02/17/2016 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: R the certificate holder Is an ADDITIONAL INSURED,the policy(las)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorseme s. PRODUCER NAME: F DeWcds Insurance Agcy,Inc. PxoNE No 100 Unicom Park Drive Woburn,MA 01601 iw !!no AFFORDINGNAIC i INSURER A,St" 012245INSURED JK Contracting,LLC. MuRERa:Sei19259 4 High Street SUN@ 106 INSURERC: North Andover,MA 01545 INSURE D: COW INSURER E: OWN FM4MFFa 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- LTR NUMBER YID LMT ZG.ENL PE OF INSURANCE 1,000,00 L&oENERAL LwALrY EACH OCCURRENCE $ MS-MADE ®OCCUR 2205113 0211012016 02110!2017 an i 100, MED EXP one ardor i 10,00 PERSONAL d,AoV INJURY i 1,000,00 GENERAL AGGREGATE i 8,000,00 01 ATE LIMIT APPLIES PER $,000,00JCT ❑LOC PRODUCTS•COMP/OP AGG iS NGLEUMITi AUTOMOBII E LIABILITY sod•^ — BODILY INJURY(Par person) i ANY AU TO BODILY INJURY(Per seeidarm i ALL EU SCHEDULED NON-0WNED i AUTOS HIRED AUTOS AUTOS i EACH OCCURRENCE i UMBRELLAUAd OCCUR AGGREGATE i EXCESS LIAB CWM6 MADE i DED RETENTION i X AT WtORKERS COMPENSATION 100,00 AND EMPLOYERS'LIABILITY YIN C0863M 021IM016 02M 712017 E.L.EACH ACCIDENT i A ANY PROPRIETORIPARiMERIEXECUTNE ®NIA E.L.DISEASE.EA EMPLOYEE $ 100,00 OFFICERMEM ER EXCLUDED? MA (mandatory In E.L DISEASE-POLICY LIMIT i 500,0 under0 =OPERATION DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORID 101,Addtdorud Rwnwks BdwdduM,may be d4faelwd N mon 9 Is required) Evidence of COVGM9e- CERTIFICATE HOLDER CANCEL TI ON _------ ------ TO WHOMgNOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TO WHOM IT MAY CONCERN ACCORDANCE WITH THE POLICY PROVISIONS. AU"KWMD REPRESENTATIVE ®1968.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD @� Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor KIERAN T WHELAN 31 RICHMOND STR r ' WEYMOUTH MA 02 ' Expiration: f Commissioner 09126/2017 f r Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171393 Type: Corporation Expiration: 3/15/2018 Tr# 288589 X CONTRACTING LLC. KIERAN WHELAN 31 RICHMOND ST WEYMOUTH, MA 02188 Update Address and return card.Mark reason for change. SCA 1 Co 20M-05/11 E] Address Renewal Employment Lost Card i