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Home My WebLink AboutBuilding Permit # 7/25/2016 BUILDING PERMIT ORTft. TOWN OF NORTH ANDOVER 00 APPLICATION FOR PLAN EXAMINATION Permit Nod`: Date Received ATE D Date issued: L I items on this page L41 LRaAxNT:� LOCATION UTint el;� PROPERTY OWNER PCint- 100 Year Structure yes MAP PARCEL: ZONING DISTRICT:---Historic District yes Machine Shop Village y no TYPE OF IMPROVEMENT— PROPOSED USE Residential Non- Residential El New Building 0 One family 0 Addition 10Fuvo or more family [I Industrial [I Alteration No. of units: [I Commercial .::�epa�it�je_placemet t�- o Assessory Bldg El Others: [I Demolition [i Other 111 19 1� DESCRIPTIO) RKI TO BE P ,,�RFORMED .......... Identification Please Type or Print Clearly OWNER: Name: �x Phone: N Address: Contractor Name:�,�:_;,W) i I R hone: 7S —?q'( -2,KL�Y) Email. t Address._ -5- Supervisor's Construction License:S/l/7/me"ISr2a1f6Lq_",(o0 Exp, Date: (,)q Home Improvement License.- Exp. Date: 17S'._37e�� 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: $ 1'2 FEE: $ Check No.: Receipt No.: NOTE: ' Persons contracting with unregistered contractors do not have access t ae guaranty fund hatdito-of-Agin ttOmnei Sicjna1qrea_�Qf_qmA..' T%O R H Town of Andover LAKh q ver', Mass T O E COC��C.. r 1' �.q '4ATFD S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .............. '.(V.!F'r�, BUILDING INSPECTOR .. `.. �. ........ .................. has permission to erect .......................... buildings on ... ,.�.... ,�.��.,. ., ..................... Foundation . � �� Rough to be occupied as , .. ...1 r„ ►�1, .as ...d !.j!+., .............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of theilication Fini a 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 C®�A �+ �+ A �p Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TI® Rough Service .. .... .......... .. Final BulLD1NG SPECT GAS INSPECTOR g uilding Rough ccu,puncy 'erua�t Re aired to Occupy B__ 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. 6 C/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 617-8161369 The undersigned proposes to furnish all material and necessary equipment and perform all labor necessary to complete the following work; Exterior ❖ Replace 4 existing windows ❖ Install exterior siding All the above work is to be completed in a substantial and workman like manner for the sum Of one hundred thirty thousand dollars ($13,000) to be paid at the actual cost of labor. A first payment of ($ 7,000). A second payment of($6,000) 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 agree 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. !� Z Client G a for ate Q SYL£o 16'MQ Town of North .Andover *�o Machine Shop Village Neighborhood Conservation District Conurlission `�4qqYEp`PA`y�y 1600 Osgood Street North Andover, MA 01845 Cu Certificate to Alter Date: Contact Name&Address: -31 -1 t-37"KDOCLA ZQ 14 Project Address: Project Description (attach additional pages,if needed): v �' W C�. d6OW IA)(1-h I c fuY c.h ay) to L�- LIj ' s" f',)� c 1-e nn ti I n -e x-,t '5 ti CJ vvo 6d : Commission Vote: Voted—q.to�to grant/deny Certificate to Alter on.� [,l. Comments (attach additional pages,if needed): f Signed: Machine Shop Village Neighborhood Conservation District Commission MSV NCDC Page 1 The Commonwealth of.Massachus'etisy f Department of''Industrial Accidents f I congress Street,Suite 100 .Boston,MA 02114-2017 www mass.gov/dia ,y. Worl(ets'compensation.insurance Affidavit:Builders/Contractors[Ei lectricians/Plumbers. TO BE 1<I[.ED WITH TIIE P+'RIMTTMG A.UTHORITX" A licant Information Please Print' 5 Le "bl NaMo(Business/Organizatlou/Cndividual): K �_, _.. Address: 'J Gity/State/Zip _ _ � � Phaae - Areyou an employer?checkt&apl ropriate box: Type of project(required): 1 I am a employer with _t employees(full and/or part-time).' l" Ll Now construction 2.L]I am a solo proprietor or partnership and have no employees Working for me in 8• ®Remo delirig any capacity.[No workers'comp,insurance required.] I F—I I am a homeowner doing all work myself.[go workers'comp..hrsuranee required,]t 9. �]Demolition 10E]Building addition 4.E[I 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 sole 11.[:]Electrical repairs or.additions 1 11 proprietors with no omployees. 12;[(k'pumbizxg repail•s or additions 5.n I am,a general contractor and I have hired the sub-contractors listed on the attached sheet, 13• ppf repair's These sub-contractors-iave ei'ployees and have weIrkers'comp.insurance.$ 6.©We are a conporat;on pnd ifs pfficers•have exercised their right of exemption per MGI,c. 14T]Other 152,§1(4),and wo have no,employees.[N9 workers'comp.insurance required.] *Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information. l Homeowner's who si,b"'if affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such. tCantractors that check this box must m ltapJ1ed an additional sheet showing the nae of the sub-contractors and state whether or pot,those entities have employees, If the sub-c6rl6ic6s Have employees,&Y,must provide their worke'rs'comp.policy number, Xam an emloyea t1zcct is pravzciircgivar^kecs'camperesation ir�sut^ancefor my employees.'Below- is thepolley andjob site aca at^matca�c. Insurance Company Name.�,�� L)C" .f Policy#or Self-his.Lie. Expiration Dato. __ • Job Site Address: _-- _ City/State/Zip: Attach a copy of the workers' compepsatlon policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 1.52,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year u . •isonment,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 iol^ 'or.A,copy f this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver`-cat' 11. X da lieteby y under t a ns andpena ofperjr.ary that the inJbnnatiacapt at�zded ove is t^ue and care ect. Signature: _w._... _-. _ 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 _. __Issuing Authority(circle one): i 1.Board of Realtlx 2.Building Department 3.City/Town Clerk 4.1lectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _.._ _. __ _ Phone#: 978-685-0310 Silverio Ins. 11:54:11 a.m, 06-16--2016 212 ACC> CERTIFICATE 4F LIABILITY INSURANCE °A' '�`°°'"�"' 06/1612018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS IPPON 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 CONTACT NAME; Johanna Gutierrez Silverio Insurance Agency PH° (978)685-0209 A c o; 978)685.0310 10 S.Broadway AE LSS; inf,:Csilverioinsurance.com INSURE S AFFORDING COVERAGE NAIL i Lawrence MA 01543 INSURERA: WESTERN WORLD INSURANCE INSURED INSURER 6: LIBERTY MUTUAL FIRE CARLOS CASTANAZA DBA CA Construction INSLrRElRC; CA CONSTRUCTION INSURER D: 317 So.Broadway-Suite 154 INSUJRERE: LAWRENCE MA 01843 tNSIXRERF: 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. E TYPE OF INSURANCE POLICY NUMBER PMI CY YY MILDDm LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAtMS•MADE0 OCCUR PREMISES Eaoccurrence $ 100,000 MED EXP(Any one person) S 5,000 A NPP8326275 05118/2016 051/8/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 . � POLICY JEC7PRO- F—]LOC PRODUCTS-COMPlOPAGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COM NED SINGLE LI T $ Ea accident ANY AUTO BODILY INJURY(Per person} $ AU AUTOS!EC SCHEDULED IL€D BOINLY INJURY(Per aKddem) $ HIRED AUTOS NON-OWNED !'R A r1AGE PINTOS Per ac itlent � UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESSUAB CLAIMS,MAOE AGGREGATE $ DED I I RETENTION$ $ WORKEtRSCOMPENSATIONPER TH- AND EMPLOYERS'LIABILrrY Y(N STATUTE ER B CCACMMEM ECCLUD)ED?�CUTfVE �NIA EL,EAC1-i ACCIDENT $ 1r3U00E1 (Mandatory In NHt VUC2-315-365147-036 02f24l201 B 02/24/2017 El.DISEASE,EA EMPLOYE $ 100000 It yes,dascribe under DESCRIPTION OF OPERATIONS bel. I I E.L.DISEASE-POLICY LIWT I s 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEFICLES(ACORD 101,Additlonal Remarks Schedule,maybe 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 DARE THEREOF, NOTICE WILL BE DELIVERED IN City of North andover ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood street AUTHORIZED REPRESENTATIVE North Andover,NIA 01545 071988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD nJ14rr:rcud,rrdelli Office of Consumer Affairs 8c Sus dess Regulatio n Massachusetts -Department of Public Safety HOME IMPROVEMENT CONTRACTOR Registration 176376 Type: Board of Building Regulations and Standard; j Expiration 417121)18 Individual C011str€sction Sirliervisor Lice nse; CS-096289 ESMIRNA ENCARNAGION ESMIRNA ENCARNACX ESMIRNA ENCARNACION 136 BUTLER ST 136 BUTLER STREET :e �_- y s`."— LAWRENCE MM 0184fq, low LAWRENCE,MA 01811 Undersecretary rs ,A ✓..�..� �' Expiration Commissioner 1011312016