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HomeMy WebLinkAboutBuilding Permit # 6/21/2016 gaORTH BUILDING PERMIT ®�ggLED ,g��o `�++ fib'.,,, .:,:+.• 96 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION _ 4RA Permit No#: j 1 Date Received �'�ss"7EDPS10;�aS CHU Date Issued: ® � IMPORT'ANT: Applicant must complete all items on this page LOCATION >,:J -F C kl 5 4JA 4ii114 da(')e Print PROPERTY OWNER C Print 100 Year Structure yes no MAP Oil PARCEL: 1 ZONING DISTRICT:_ Historic District no Machine Shop Village s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition kilrwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial O/Kepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic% ©UVelly< ❑ Floodplain Wetlands ❑ Watershed Distrrct ❑1Nater%Sewer: - ,. DESCRIPTION OF WORK TO BE PERFORMED: O a m 0- Vt - 4Y\@ i IJCI Ce�CAiC Identification- Please'Type pr Print Clear(y OWNER: Name: ��� `Z�°� Phone Address: Contractor Name: Phone: 2 S4 221.-7 Email Address: Supervisor's Construction License: toqkg Exp. Date: � /f Home Improvement License: 1-7 J '?L 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. Total Project Cost: $ 'x6 FEE: $ Check No.: t �1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not liccve lacces tot e guara ty fund k IAORTFHI it own ol" Annover ® TtAC' Ver' aSS' ou O� COC LAKE MIC lWICK S U BOARD OF HEALTH Air in PEK IT T %j LD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .' ..................... . ... . ..... Foundation has permission to erect.......................... buildings on .. . . Rough to be occupied as ... ... .. fmz ... . 0.J. .1. .... .. ... ... ............. ...®........ 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. 1 54� PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS Rough Service ... ... Final B DINGISPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. A Construction 317 south Broadway Street Lawrence MA, 01843 Fax: 978-683-4017 Cell: 978-242-2707 Caconstruction0l@hotmail.com ...................... Jonathan Zapata 69 Water Street North Andover, MA 01845 617-816-1369 The undersigned proposes to furnish all material and necessary equipment and perform all labor necessary to complete the following work; Interior 4+ Install sheetrock on ceiling and walls on both apartments ❖ Renovate each bathroom of each apartment (2bath) Renovate both apartment kitchens • Update the electrical circuit panel (2 apartment) Install % hardwood flooring in living room and 3 bedrooms (2 apartment) 4++ Install ceramic flooring in both apartment kitchen and bathroom All the above work is to be completed in a substantial and workman like manner for the sum nine -six thousand dollars ($96,000)to be paid at the actual cost of labor. A first payment of ($ 55,000). A second payment of($25,000) and a third payment of($16,000) at completion of the project. Any alteration of derivation from the plans and specifications will be executed only upon writing orders by the owner and will be added to/or deducted for the sum quoted in this contract. All additional agreements must be in writing The contractor agrees to carry the Workman's Compensation and Public Liability Insurance and they are to pay all taxes on material and labor, furnished under this contract as required by Federal Law and the Laws of the State in which this work is performed. Estimates are based on plans provided. If client would like any changes made to the plans, the client must discuss this with the contractor and provide written documentation stating the changes. There will be a new estimate done. Both the contractor and the client must sign upon agreement. Plan price will vary according to changes. Price may also change due to unforeseen -obstacles. In other words, if the contractor has to do extra work for things that are not visible, the client is the one to pay for this. The client will be informed of any unforeseen obstacles. Respectfully summited by Construction Supervisor Acceptance You are hereby authorized to furnished all materials, equipment and labor required to complete the work described in the above proposal, for which the undersigned agreed to pay the amount stated in the proposal and according to the terms thereof, Client Contrktorr7 biate � N * IIIIIIIIIII I /, � � � The Commonwealth ofMass�ehusetts Q. f Depaz%°tment of Industria-Meeidents _ - X t- egress Street,Suite 100 .Loston MA 0.2x1 -2017 ^ • ,s�;V°t www mass goh/dza Workers'Compensation Insurance Affidavit:Builders/Contractors/Electrieians/I'lumbers. TO BE FILE_ D WITH THE PEWYnTTING AU'THOPJTY. Applicant Information Please Print Legib Name(Business/Organization&dividual): Address: city/State/Zip Phone,#: Are you an employer?Crecktfie appropriate box: Type of project(required): 1. m a employer with 2 employees(full and/or part-time).* J, EINew construction 2f]1 am a sole proprietor or partnership and have no employees working forme in S. [Alemo delirig any capacity.[No workers'comp.insurance required] 3.F1 S am a homeowner doing all work myself[No workers'comp..insurance required]t 9 Demolition 10 F1 Building addition 4.[]lam a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[, Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.[ oof repairs These sub-contractors have employees and have workers'comp.insurance.T 6.Q We are a corporation and ifs officers have exercised their right of exemption per MGL e. 14.0 Other 152,§1(4),and we have na employees.[No workers'comp.insurance required.] r:- *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submif#his 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. 1f the sub-contractors have employees;aliey must provide their workers'comp.policy numbEr. f air'an employer that is providing workers'compensation insurance for my employees.' Below is the policy andjob site information. Insurance Company Name: ( v c Policy#or Self-ins,Lic.#: �A� �. ?� l S ®�io`7 1 1 -f7 3 to Expiration Date: Job Site Address: City/State/Zip: 0 "&o Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under MGL e. 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 forms of a STOP WORD ORDER and a fine of up to$250.00 a day against th.R violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve- atlon. Y do hereby cer i under zepains a penalties ofperjury Haat the informadonprovided ab ve is 7,,e and eollrect. Signature: 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 978-685-0310 Silverio Ins. 11:54:11 a.m. 06-16-2016 2/2 .4C'b,Ro CERTIFICATE OF LIABILITY INSURANCE YY) DATE(Mmimm lllt� 06/16/2016 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 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). PRODUCER CONTACT NAME: Johanna Gutierrez Silverio Insurance Agency HONE (978)685-0209 Fac N,,): (978)685-0310 10 S.Broadway ADDRESS: info@silvedoinsurance.com INSLRER(S)AFFORDING COVERAGE NAIC 1 Lawrence MA 01843 INSURERA: WESTERN WORLD INSURANCE INSURED INSURER B: LIBERTY MUTUAL FIRE CARLOS CASTANAZA DBA CA Construction INSURER C: CA CONSTRUCTION INSURERD; 317 So.Broadway-Suite 154 INSURER E: LAWRENCE MA 01843 1 INSURERF: 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 IMiICH 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, 11wTYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER DDfYYYY MIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 CLAIMSMADE FIOCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A NPP8326275 05/18/2016 05/18/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 X POLICY❑PRO JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMEINED iNf,LEII T $ Ea acnden ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OM-IED SCHEAUTOS BODILY BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIABOCCUR EACH OCCURRE14CE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEG I I RETENTION$ $ WORKERS COMPENSATION SSTATiJTE ER AND EMPLOYERS'UABILITY ANY PROPRIETORPARTNER/E>ECUTIVE YIN E.L.EACH ACCIDENT $ 100000 B OFRCERJMEM6ER EXCLUDED! FN NIA WC2-31S-365147-036 02/24/2016 02/24/2017 — (Mandatory In NH) E.L DISEASE-EA EMPLOY $ 100000 If yyes,describe under DESCRIPTION OF OPERATIONS beloq E L DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Additional Insured is added automatically as long as there is a written agreement requesting to be added CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of North andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ~ epo�u�zaa�zruerz`l� r & Office of Consumer Affairs CONTRACTOR Reg ladon HOME IMPROVEMENT TYPOd5it #3 s. 0"' ;.tss7l¢€a s<. Qfr Registration 178376 a 3 V , +f Expiratioama n 417./2018 Individual a 9a, Cdr;„:� aas�39�t,; ESMIRNA ENCARNASGION CS-096289 C4 J.1: ESMIRNA ENCARIVACZ4N ESMIRNA ENCARNA, 10Nt;f 136 BUTLER ST "+ < '°” —M- LAWRENCE MA�01841 136 BUTLER STREET _ , - LAWRENCE,MA 01841'1- Undersecretary 10/1312016