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HomeMy WebLinkAboutBuilding Permit # 11/28/2016 BUILDING PERMIT ` NoRry cs �,Lecs TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION �CCG1[t I�IQ .., Date Received . o, 1ogargnWaYf`• � acHuse � w. , Date [slued: ._ �. _.. I OJL�. . Applicant must complete all items on this page � 4 LOCATION "t Rl�C1PRTYwWNER % ' �' Pant 1 DO Year Structure , yes no MAP" PARCEL: ZONING DISTRIC�T:� _,.::..Historic Cistnct yes Machine Shop Village yes ^rlo TYPE F1MPROVEMENT PROPOSED USE Residential _ Non- Residential New Building One family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ E Septic ElWell El Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DE • GRIPTION OF WORD TO BE PERFORMED: k z e, - ease Type air Print Clearly Identification Please OVVNER: Name: ?OLS ` M �. � Phone: Address: 14 ' 51, - 45 2,1 µ Contractor Name: ., : f Phone.- Add ress: one:Address: It kA YI(Ntl,�„/ ” " (4, � M Supervisor's Construction License: Exp. Date: a Horne Irnproyement`License 1 Exp, Date ARCHITECT/ENGINEER Phone.- Address: hone:Address: Reg. NO. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F. FEE: $ Total Project Cost: $_ , Check No.: .._Receipt No,.: O E: Persons contracting with unregistered contractors do not have-access to t/ig rcr nd Signature of Agent/OWner Signature of cohtractor k �ORTIy 'Town ozAndover ® ...r•. W h ver, Mass, % : LAK. q_ cocKsc"tw.cK 1' p�Rwrep p,?p��,�r7 `S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 4BUILDING INSPECTOR THIS CERTIFIES THAT ti .�� .��. ��.�. .��� Foundation has permission to erect .......................... buildings on ..., .� ••••• Rough to be occupied as ............�'aR. �. ........... ."0 . ��... ............................................ 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTSRough Service .............. .......,.........,.................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancr Permit Regaired to Oceupy Puildin 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 Bet. and design build QUOTE 16 Plummer Road Lawrence, MA. 01843 mike@mddesignbuild.com DATE: NOVEMBER 21, 2016 TO; FOR. Bob and Zora Warren Basement finishes 129 Weyland Circle North Andover, MA.01845 ITEM DESCRIPTION AMOUNT 1 Basement finishes $4,450.00 • Site protection as required to isolate work area. • Pad out low walhland end wall as required to insulate. �• �i -l�ti.a �€���� 1+^S{`��` ��F- �f�" �` 0 2"rigid insulation • Supply and install 1/2"sheetrock where required. Tape and joint compound. • Supply and install paint-grade bench/cabinet,+/-72"long, 24"deep, 18"tall. Final design T.B.D. • Supply and install newel post,balusters and handrail @ stairs. • Install owner supplied stone/tile @ fireplace surround. • Supply and install paint-grade mantel @ fireplace with access to gas shut-off valve.J�:(.�N tai e/Let,C • Supply and install paint-grade baseboard trim to match existing. • Final site cleanup and removal of debris. • Carpet installation by others, • Electrical by others. • Painting by others. TOTAL $4,450.00 DEPOSIT $1,500.00 BALANCE DUE UPON COMPLETION $2,950.00 I have read and understood,and I agree to,all the terms and conditions contained above. 1_�41 t ap, Dat Michael Dio ati MD Design Build 7 iZ� ,A,__A ..)(.A � Date Owner Date lwne The Commonwealth of.Mass=11148eus F Department of Ind'tastrial Acezdent 1 Congress Street,,S`utte 100 �2Z4 2017 ,Boston,M w•ww massagavtd'ra •bi�M SYf ' Wcr�kers' Cnxnpensation Insurance�iida-vit;Builders/C��a'�O s��;�r�czansf�l�mbars. o-BE S?3LET)MUM i`S k'ER1VB k CSN Please Print —Le 'bl liealt Jnfoxno.aiaion. Namo(Fusinessl()xgm nation ddividual): 1 ' Ad&0,9s: ILA . LI aPhony Areyen an emliZoyax-?g4ecl 6e appropriate box: Type of project(Yequixed); ' e3n loyees(lull andlor parttime). 7. e 4Y`COfllStrlldizo� 1.❑I am acmployer with p Iamasolo proprietororpartnershipandhavenaemployeesWorkiugfoxmein $. ����l�ex�7ode�iiig any capacity.[Noworkers'comp.insurance required.] 4. k—1 I)b oiition 3.QIam,,homeawner doing allworkmyself [N"oworkers'comp.insurancerequired.] 10❑Building addition 4.0 I am ahomeuwner and will be hiring contractorsto conduci all work onbay propezty- 'will 11.x]Etectrka,l relpixs nt'p.dditi9ps ensure that all contm*fs either have workers'compensation insurance or are sols 1' g repairs DIC additions r. 72. proprietors�vitb-no employee's. 5.�I am a general cont?actns Cud.rave biredfha sub-contractors listed on the attached sheet 13.D Roof repairs Ihase sub-cont[acfors hays a?nPlaYees and hate workers'comp.insurance.$ 14.M Other S,❑We are a cozporation and its,oT'cers hays exezcissdtheix right oPt xsrgpfion per MGL c. -I we bare rfo employees.[No workers comp.insurance zerluired] atiom zAnyappbcantthatch6aMs b 4l d ansdi Yazd glaollvaorkandthenhireoutsideooni actopsmo subrw'tanewafhdavitindicatix�gsneb u Hoarreowners Who submit-this a,M•. is tContcaofars that clzeckthis box must attaclied'au.additional ahaetshnwmg the name of the snb-contractors and stafewhether oirgntfbose entities ave employees. '£thy sub contractors have employees,they must provide their workers'comp.pniiay number. Sttm an ernp�ayer treat rspraviding-vi compensactian insurancefor"V employees 8eloty is t iepa�iey aril ole site information. Tlasuxance Conapany�Tauze: Expiration.Datez l'aiioy#or Self ilS.Lic.#:. city/state/zip— Job Site Address: At-�aciZ a copy a£-Ehe�oxlrexs' compensatinxrpoTzcy declat'atio7zpage(sb.ow�gtb.epolicpnux�tbex and e�iratioxz da�Le)- FaiJ.t�'e to secure Coverage as regttixed order MCenalties in&o i4zm�of is a STOP WORD ORDS t�L o &u fie f up to $250.00 a and/or one~yeat'ixulprlsonnruent,as-we as cavil P day against ale,violator.A.copy oftbis statemoRt may be forwarded to trite Office of Illvestig4.tionsot the DJA faxIasurance covexage verification. do Hereby certify unci ' e info tla ai Mdpenal'ties ofperjUTY that thr�natio;t piovzcreri wave is aYr ue and correct Date: 1 i Si aryls: r 1']I0ne#: J ' Offzcittl rise only. Do not 01 to in this area,to be corrpreted by city or talon official p,erua t/License# City or Town: fs5uingA.ntltoxity(circle one), 1.Dnard of$ealtR 2-BuildingDepartrrxeaxt 3.CitylToVM Clem'. 4.Electricalimpmtox 5.1:'umbiotg'lnspector b.Other Phone#- Contact Person: DIODA-1 OP ID: BC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYI)11ro312n16 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 CONTACT Foster Sullivan Insurance foster Sullivan Insurance LLC AX 163 Main St. P(AIC.°NIJ Ext:978-686.2266 Fp N.,: 978-686-6410 North Andover,MA 01$45 EMAIL cartiflcates fostersullivaninsurance rou com Foster Sullivan Insurance LLC ADDRESS: G� g p- INSURER S AFFORDING COVERAGE NAIC A INSURERA:Merchants Mutual Ins. Co. 23329 INSURED Michael Diodati INSURER B 16 Plummer Road Lawrence, MA 01843 INSURER C.' INSURER D: INSURER E 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 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. INSR TYRE OF INSURANCE POLICY EFF POLICY EXP LIMEYS LTR 1 S NUMBER MMIDD MMIDO A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE D OCCUR 1110112016 11101/2017 PREMISES Ea occurrence)$ X Business Owners MED EXP(Any one person] $ 15,000 PERSONAL&ADV INJURY S 1,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- POLICY ❑ LOG PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBI EaacGNdent ED SINGLE LIMIT S ANY AUTO BODILY INJURY{Per parson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR :OGCUR EACH OCCURRENCE $ EXCESS LIAB AIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑NIA E.L,EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ yes, e under DE,L,DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION 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. 120 Main Street North Andover, MA 01815 AUTHORIZED REPRESENTATIVE f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts t epau"tment of Pubhc Safety Hoard of Budding Reigualations and Standards i.ocense, CS-072360 ("rtpY $6°ldr„`tion MICHAEL PAUL DIODATI,JR. „off 16 PLUMMER ROAD LAWRENCE MA 41843 G°P�f SofGr1r'P” 01/19/2018 E w � .. & , Aw4aa4wae& E n Office of Consumer Affairs andusiness Regulation 10 Park Plaza _ Suite 5170 ' Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 180802 Type: Individual Expiration: 1/7/2017 Tr# 261778 MICHAEL P. DICIDATI JR. MICHAEL D I C)DAT I 16 PLUMMER RD LAWRENCE, MA 01843 __.__ - --- Update Address and return card.Marie reason for change. ( � Address I—] Renewal Employment ._ Lost Card DPS-cna 0 50M-04/04-GIM216 w �� ��carre,�aarara.�rr✓r�«��� �r,�'..;l'�xTtatre�7r���s ... , Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only f HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 1$0802 Type: Office of Consumer Affairs and Business Regulation , 10 Park Plaza-Suite 5170 f , rr Expiration: 1/7/2017 Individual Boston,MA 02116 MI&A,EL P. DIODATI JR, MICHAEL DIODATI 16 PLUMMER RD �_— LAWRENCE,MA 01843 ..._..,... . __.-----__.._._.__._....... _ .__.w. ..__...__._..._ Undersecretary Not valid without signature