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Home My WebLink AboutBuilding Permit # 7/26/2016 �ORTF3 BUILDING PERMIT TOWN OF NORTH ANDOVER Q - APPLICATION FOR PLAN EXAMINATION � 4A c ewicx�h� Permit too#: � Date Received - SACi-IVSD Date Issued: Il!'.IP RTANT: Applicant mull complete all items on this page : LOCATION 4, Print PROPERTY OWNER - Print 100 Year structure yes too. MAP PARCEL: />�ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial teration No. of units- ❑ Commercial epair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se is ell Ffoodp ain Wet ands 17e shed ®i `tric 11Vater-��_.e _._ DESCRIPTION OF WORK TO BE ERFORMED: 4 NpRTIy owe. of A o �h ver, Mass, J-1 COCHIC"MWICK 4 �9S ATE 1) +kPa,�(`� U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect g Foundation .....,... ...... buildings .��., Ak .. .... ��...�,�........ Q&ftjp.t. . .. .. ..... . Rough to be occupied as .... Chimney • i• 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 he In pection,Alteration and Construction of Buildings in the Town of North Andover. Z PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit, Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST04 ..T- IO S Rough Service .. ....... ,... Final BUILD] SPEC R 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. Daniel Construction Company Mark Emero 56 Gordis St.Wakefield, Ma. Proposal John and Sue Percival Stagecoach Rd. No. Andover Scope of work: remodel basement Contractor will: • pull permit • demo basement as needed • frame all walls, doorways, closets and half hath • install electric to code including 24 recessed cans • install plumbing for half bath • move wash sink to other side of wall • install plumbing for bar sink • insulate to code • blueboard and plaster all walls and ceilings • install exterior door into basement area • install interior doors and locksets • install deadbolt and lockset on exterior door • do minor HVAC if needed • the and grout bathroom floor • homeowner to supply tile and grout as well as plumbing and electrical fixtures • install baseboard and door trim as needed • homeowner to supply flooring,carpet on floor and stairs,as well as painter • dispose of all job related debris 1 Total cost of Labor and Supplies..............................................................................$34,000.00 Payment schedule......$9,000 to start..........$5,000 after electric inspection........$5,000 after bldg. inspection.........$5,000 after plaster..........$5,000 after tile and trim......$5,000 upon completion .f -v v,n i CIO t C�2, s vn { r ry l- 1 � T1e Commonwealth ofMlglsff chuseds z Department ofi"ndustrial,4eadents " X Congress street,,Suite 100 $oston,MA 02114-2017 www.mass.govIdia Workers,Comp ensat-ioaInsurance Afdav:it:Builders/Contractors/EIQG#icians/121ia�mbers. TO BE FILED)AMI TEE PERNIZTTINC AUT'COMTY' A Please IicantIn�formation print Le 'b1 . f Name(. usiness/orgarizaixoau&dividual): c _ Address: � C� City/ date/Z ^W�,,, �c. /� 0 �-Ty Phone#: `� �1 �7 -Fr` Are you an employer?Check&app` Type of project(Te' 0d): ' ;aic box: I.[]I am a employerwith. :., employees(full and/or part-time).* 'l. Q NeW coasixuatioil 2.F. am's.sole proprietor or partnership and have no employees vVorlc€ng for me in 8. �rrlo deiirig any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3-[]X am a homeowner doingall workmyselt[No workers'comp..hrstwmoo required.]t 10 0 Suilcling addition 4.1]X am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation.insurance or are sola 1. Electrical repairs oradditions pr6piletors-Withna einployegs, 12:Q Plumbing repairs or additions 5.❑I arq a general contractor and I have hired thq sub-contractors listed an the attached sheet. 13.'0 Roof repairs Thesb s6b-contractor'.++6 employees andhaveworkers'comp.instirance. 14. Othar 6.[]We are a corporatiqu pd#q a�,9ers have exerciscd their right+£•exemption per M(3L c. (� I52,§1(4),and we have r}q.eMployees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also"fill outtha section below showing their workers'compensation policy information. t Iiomeowne€s,who sfai iitttus afAdavit iadicatingthey are doing all work andthen hire outside eonfractors must s4hinit anew a£�davitindicating such. tContractors that ohedzthi box must•Rttacled an additional sheet showing the name of the sub-contractors and state whether or not those entities kava employees. if the sub-cori�Cadors have emplayem, tisy must provide their workers'comp.policy number. Iain an employer t1l at is providingtivorkersI compensation insurance for my employees.'Below is th9policy acid job site in'fofmmtion. Insuranco Company Name: Policy#or Soif ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of thewolrkers'cbmpepgation policy declaration page(showingthe policy)]urxmber and/expiration date). Failure to secure coverage as required under MGL o. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonfnent,as well as civil.penalties in tiro 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. 1-do hereby certify undep Mepains and aloes ofperjury that the information provided above is true and correct. signstore: a., Date: Phone# " Offacial use only. Do not-write in this area,to be completed by city or town offrciat City or Tom: Permlt/License# Issuing Authority(circle one): i 1..Board.ofEealth 2.Building Department 3.City/To"Clerk 4.Electrical Inspector 5.Numbing Inspector b.Other Contact Person: Phone#. 2016/07/2610:00:40 2 /2 ACERTIFICATE OF LIABILITY INSURANCE 7/26/2016"'' 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(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 endorsement(s). PRODUCER co ACT Select Department NAME: ecp Eastern Insurance Group LLC arcc°N�o Ext: (800}333-7234 �c66807 FAX No:(781)585-8244 233 West Central St aooAll selectwork@easterninsurance.cotm INSURER(S)AFFORDING COVERAGE NAtC A Natick MA, 01760 INsuRERA:Har1e sville Worcester Ins Co 26182 INSURED INSURER B: Mark T Entero INSURER C 56 Cordis Street INSURERD: INSURER E: Wakefield MA 01880 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 CERT 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 MAYHAVE BEEN REDUCED ��BY PAID CLAIMS. I S TYPE OF tNSURANCE POl.IC1YEM POLIO EXP LIMITS LTR NS D POLICY NUMBER MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMACE ° 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea flcwrrence $ i A CLAIMS-MADE Fx_] OCCUR SPPOGO00039892V /27/2016 /27/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY PRO- EJ LOC $ AUTOMOBILE LIABILITYO aBINEDcident SINGLE LIMIT(Ea 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SPP00000039892V /27/2016 /27/2017 BODILY INJURY(Per accldent) $ AUT' AUTOS X }11RE€3 AUTOS X NON-OWI4ED PROPERTYPDAMAGE $ AUTOS UMBRELLAL€AB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIA131LITY YIN TORY I IWTS 11 ANY PROPRiFTORIPARTNERIEXECUTIVENIA E.L.EACH ACCOENT $ ER CFFTCIMEMBER EXCLUDED? (Mandatory In NHI E.L.DISEASE-EA EMPLOYEE $ DMes.yyes,describ a under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Add€tonal Remarks Schedule,If more space Is required) Residential. Carpenter CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE BLDG 20, STE 2035 NORTH ANDOVER, MA 01845 r John Koegel./KH3 ~-- ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS02519nlon i m Tho ArnRn names and Inno arses rnrihclararl markfi of AC(]Rn Massachusetts Department of Public Safety - Board of Bu Regulations and Standards i CS-dfi733A License: ervisor Construction Sup MARK T EMERO 66 CORDIS STR>=ET WAKEFtEt-D MA 01880 Expiration: „M Vim~ 111(1812017 ' commissioner --- C;/�� >rn�rr�rtarrcaerrl(�o/C,/1%�nJ:rrrc�rr3e — Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration 122114 Type: i Expiration 7f23LZ018 Individual MARK EME;RO = - MARK EMERO 56 CORDIS STREET WAKEFIELD,MA M80 Undcrsecrctaiy 3 i s a I g� I