HomeMy WebLinkAboutBuilding Permit # 11/22/2016 OORTl1
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION r
Permit No##:. . (0 `+ 17 Date Received
Q�RATeo r..PR .(
SSS4C14us�
Date Issued: " - d 4,01
IMPORTANT:Applicant must complete all items on this page
LOCATION ��
Pant
PROPERTY OWN1=R % f
PontYear Structure yes no,
MAP - PARCEL :.: ZONING DISTRICT Historic Distract yes ::.no
Machine 5ho Villa e es no
P..
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building O'One family
❑Addition ❑Two or more family ❑ Industrial
RAlteration No. of units: ❑ Commercial
ZRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
0 Septic p Well ❑ Floodplain 0 Wetlands 0 Watershed District
0 Wat_eriSo-wer
DESCRIPTION OF WORK TO BE PERFORMED:
N v k,r � �X �:•- � s ray,- ,�/ .� -
Identification-,Please Type or Print Clearly'
OWNER: Name: Leo T&-suJ ,,qYJ Phone: 97 `v�97- 7323
Address: G 76 OsG'ao� or � a�c,�
Contractor Name- ►,•o Phone: i 7 -,?3 3 -46 94. .
Address: Z( .��ve [,J tlys►�►� rc�
J
Supervisorrs CoristructionDate. ...
Horne Improvement License 17-1.6 6 Z Exp. Date : / �� �.. j
ARCH ITECTIENGINEER 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.
.notal Project Cost: $ /S, tea. 0 FEE: $ �-
Check No.: Receipt No.: l 43�-
NOTE: Pe s co tracting with unregistered contractors do not have.access to the guaranty fund
r
Signature of 9 nt/)wner Sionature of contractor
�ORT11
own of tAndover
Q ., `y ` go
sh ver, Mass, - ®�
cocHicIc"[w.cR
Al
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT .. k !.. Lev....at*.S. f..�. BUILDING INSPECTOR
has permission to erect .......................... buildings on ....(9676........0 S lff. .Q.......S. Foundation
.
.Y Rough
4vQv..* i
to be occupied as ........aa. ° ........k ..
C....... . ............................................. 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 COSTRUCTI TAR Rough
AP....... .................................... .............. Service
Final
BUILDING INSPECTOR
GASINSPECTOR
Occupancy Permit.lie uired to Occupy Buildin 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.
Robeart Pino
26 Wave Way
Winthrop, Mass. 42152
Leo & Tiffany Jesudian
676 Osgood St.
North Andover,Mass. 11/20/16
We propose the following renovations to kitchen:
I.li rame and shim walls as per plans.
2.Insulate outer walls.
3.Install rough electrical as per plans.
4.Install replacement windows. (supplied by owner)
5.Sheetrock and plaster walls and ceiling.
6.Install new cabinets as per plans. (supplied by owner)
7.Trim doors and windows.
Unstall new pre-finished flooring. (supplied by owner)
9.Paint walls and ceiling with color of choice.
10.Counters and plumbing will be installed by others.
11.Install all finish electrical as per plans.
12.Rubbish will be disposed of in existing dumpster on site.
Cost for all work listed above will be: $18,500.00
Deposit of$5,000.00
2nd payment after framing and is complete $3,000.00
3rd after sheetrock and plaster $3,000.00
4th after flooring is installed$3,000.00
5th after cabinets and trim$3,000.00
Balance due upon completion
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_ Department ofi"udustrzalAceldents
I Congress Street,,Snits 100
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Phone#' t � 8�3 " 4
City/state/zip:
,A.re you an exn]gloyex?GJ{ecl tTie aPpropriafe box:
'Pype of project( ec�ixed);
em loyess(full andlor pari tiwe}.� 7. �Ne'�'dai�sf:Ci7'otion
7.F1 Z am a employer with PemodeliYi
sola proprietor or partnership andhave no employees-vorlag forme in $
any capacity.tNDworkers'comp.insurance required] 9. ❑Deplolition
3•�Z am abonreovwnez doixsg all workmyse>£[inn workers'comp.insurance required.] 10❑Buil ding addition
4•Q)am ahomeoWner and twill.be hiring coatMrtors to conduct aU work on my prnperLy- X will
11.❑Electrical repaits Or additions
exustrrethat all.cantzacibrs either have-,turners'compensation insurance ar are sole Plumbirt re s or additions
,: �_dp . g pix
proprietors withno emppye63.
5.0 p an agenerd eontsactoz and x avehizedthe sub-contraotars listed onthe et
attached she .
13'.]�Roof.xe&itA
These sub-contractors lxave employees and have-Workers'comP.insurance.* l 4, other
❑We arc a Corp M6011 and ifs,off'cers have exercised their right otexeznption per lV€GL c.
s,
J 52,§i(4),and we have no employees.FTo workers'eomp,ifMMca required]
*Anyapphcantthatcheckshb #1 alsd:ioutthesectionbelowshowing�eirwoTkers'compez�satiorz-ORscyiufozmation, Such
aUvorkpd
Homeowners-rhols
submit•b amM Oft c ed di �sbeetshowingihen3meofthesub-coontractorosand.state-whethercrnotot-a2 semust submit a now affidavit en tts�,hava
tContractors that check this rnWide their workers'comp-policy number.
employees. 7i ttxa sub-conizactors have employees,they must P
lam an e Tjoyer that is.providingwarkers'compensation insurance for my errtployees. BeTaw is tliepolicy and j o site
information.
jnsuran.ce Company Name:
Expiration.Date•
Policy#or Self ins.LiG.#:
City/State/Zip:
rob Site Address: showh:lgthe policynumtber and expiration date).
Attach a cagy'of the waxlrers'coxupansationt policy declarationpa ge{
Failure to sect�e aoveraga as require -00
d and Gextalties in the form of
,riming
WORTS QRDEIZ Zalzd a�ofu�to $250.00 a
and/or one-yeaximprisonmont,as-well as
evil p
day against the violator,A.copy of this statement may bo fozvt+arded to the O�tca of Investigations of the DTA for insuxanae
coverage verification.
T'I-ixerI cerci under tlae airxs andpenalties ofperjury treat tree infoa catianprovided move s true ar�d cor ecz
Z
Si ature:
Phone#: g33—O 8 4
Official use only. Do nat-wrzte in Mis area,to he coripleted by city or town off elal.
Perini-Mcense#
City or Tovn-
)[s sulngA.uthoxity(circle one): ector
1-Board of Real& 2.BuildingDepartnzent 3.City1>Lo�n Clerk 4.ElectxicalTxrspectar 5.PZnm7oingInsp
6.Other
Phone#-
Contact Person:
CERTIFICATE OF LIABILITY INSURANCE CATE`M fi)nfY""ti
5/15/1a
THS CERTIFICATE 1S 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 T T
NAME:
Robert: M. DeGregorio Insurance PHONE 617) 846 3313 X No; (617) 846-3317
34 Woodside Avenue fA1CLL
s:
DaREs
Winthrop, MA 02152 AINSURERS)AFFORDING COVERAGE NAIC#
INSURER A:Evanston Ins. Co
INSURED R B
Gino Construction INSUREI Nsll RER&.
Robert Pino
INS{fRER a
26 wave Way Ave INSURER E:
Winthrop, MA 02152
INSURER F
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 TFE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADDL 9UBR POLCY El-f PMMUM)
J-- EXP _ --------LTR _ TYPE OF INSURANCE POLICY NUMBER MMIYYYY MMIDUM LIN3TS
A GENERALLIABILITY 3EG4171 8/1/16 8/1/17 EACH OCCURRENCE $ 1.1000,000
}F COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 501000
CLAIMS-MADE ❑OCCUR MED EXP(Any ore perscn) $ 3 000
PERSONAL&ADV INJURY $ 1 000 000
GENERAL AGGREGATE $ 2 000,000
GEN'LAGGREGATE LIMIT APPLIESPER PRODUCTS-COMPIOPAGG $ 1.000,000
POLICY PRO- LOG $
AUTOMOBILE LIABILITY N D ELI T
a accident $
ANYAUTO BODILY INJURY(Per peroon) $
ALLOWAUTOS NED SCHEDAUTOS BODILY BODILY INJURY(Per accident) $
HIRED AUTOS
NON-OWNED 7.0—r
ROrPERTI DAMAGE $
AUTOS eaaiet
$
UMBRELLALIAB OCCUR EACHOCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION WC STATU- 0TH-
IND EMPLOYERS'LIABILITY Y!N Y LWITS
ANY PROPRIETOWPARTNER/ExECUTIVE
IR
OFFICERMIEMBER EMUDEDY N/A E.L.EACH ACCIDENT
(Mandabry In NH) EL.DISEASE-EA EMPLOYEE $
fF es describeunder
D SU`RIPTf0N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additlonal Renarks Schedule,If more space Is required)
General, Carpentry
CERTIFICATE MOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
A 0 REPRE TATIVE
Peg `th
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registe d marks of ACORD
Phone: Fax: E-Mali:
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-044462
Construction Sijpervisor
ROBERT PINO
26 WAVE WAY AVENUE
WINTHROP MA €12162 M
Expiration:
Commissioner 05/31/2018
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Office of Consumer Affairs&Business Regulation
OMIT IMPROVEMENT CONTRACTOR
egistration: 174662 Type:
Expiration: 3/812017 . Individual
ROBERT PINO
;ROBERT PING
26 WAVE WAY AVE. '
'
WINTHROP,MA 02952 Undersecretary
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