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HomeMy WebLinkAboutBuilding Permit #592-2016 - 128 MILL ROAD 11/13/2015 {IORTH BUILDING PERMIT OF�tt�c TOWN OF NORTH ANDOVER o - APPLICATION FOR PLAN EXAMINATION JiNd Permit No#: — �f°/ Date Received SSACHU`+� Date Issued: 1,2 M RTANT Applicant must complete all items on this page b LOCATION Pont PROPERTY OWNER- �-�-r __. y� Print 100 Year Structure yes no. MAP PARCEA1 _ ZONING DISTRICT _ Historic District yes no Machine Shop Village yes no . . TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building Ane family ❑Addition ❑Two or more family ❑.Lndustrial ❑Alteration No. of units: ❑ Commercial ❑ Re air, replacement ElAssessory Bldg ElOthers: D-ffemolition ❑ Other CSeptic CNelh ElFloodplain Wetlantls ❑ Watershed,District Water/Sewer D SCRIPTION OF WORK TO BE PERFORMED: �-@1 l4�r fey �C /4Ing Z�e%A% /ICs o 2 Identification- Please Type or Print Clearly c OWNER: Name: 1.�+c I Ian 3�o ,.a C k 14, Phone: 9Z&-Z-5 7--6 C(7.6 Address: / ( � Contractor Name �-� V�'�Crti x 1, _ Phone. b Email; w . ✓n �'.�... -� Address: L Supervisor's Construction License o b 3 Exp. Date: . Homme Improvement License._-_-__� '`�' 3 7 _w Exp, Date.: - - --- - _ . - ARCHITECT/ENGINEER Zd 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: $ S� 904.00 FEE: $ 1�`J Check No.: Receipt No.: C;2-1`e NOTE: Personsg with un a . tered contractors do not have access to the guafrf777 u gnafureof Ag nt/ x _ Sign ture of contractor. _ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses /Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales . Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS r t HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located fDEPAR_TMENT T,ernpiDump,; ter��on 3noiosgooreet - - �- -- - s� site y, llhbc�tb'di,atl.12.4MMain,,St�eet 'Fire Department signature/dafe; ONIMENj _ i I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use � p ) ❑ Notified for pickup Call Email Date Time Contact Name I Doc.Building Permit Revised 2014 Location < .1 6 ' /i J1 / d p No. . 5911,7— 02a/ Date 1113115 • - TOWN OF NORTH AN , OVER ' Certificate of Occupancy �$ C j Building/Frame Permit Fee $ 9� y Foundation Permit Fee $ -77 °P Other Permit Fee $ TOTAL $ Check# 296 S Building Inspector i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 115,902 .00 m $ - $ 190.82 Plumbing Fee $ 23.85 Gas Fee 100 comm. $1 100.0.0 Electrical Fee $ 23.85 Total fees collected $ 338.53 128 Mill Road 592-2016 on 11/13/2015 Basement Remodel r 7NORTh W. I a . , 0 vA)-- t,6 i� h ver, Mass �� T O LANE COC NIC NlWKK � A�RgTeiD / .�5 S V BOARD OF HEALTH Food/Kitchen PERMIT T LD� 1 AA Septic System THIS CERTIFIES THAT .........�l ,�. .�.l.F'➢t..... c6i,�i',�... BUILDING INSPECTOR t.O /............................................ . .. Foundation has permission to erect ..... .............. buildings on .....k� K-01\ It'-mck. p 1.�� �� r� ChRough t0be occupied as ............................ ................................................................ 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 6y N ELECTRICAL INSPECTOR UNLESS. CONSTRUC A T Rough Service .............. ....... . ................. ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. s v z � e i i I 1 JropOtJ (7Y (�l SeOkG Dwar � s p' vQc l� � r )9 4 , 2-M Construction Billerica, MA Tel: 617-839-2032 THIS AGREEMENT, made as of Nov 10, 2015 Between the Owner: Stella Chistyakov And the Contractor: Paul Vercellini Billerica, Ma 01821 (617) 839-2032 Home Improvement License#: 138378 Mass. Builder's License#: CS 083641 For the project: 128 Mill Rd North Andover ARTICLE 1. CONTRACT DOCUMENTS The contract documents consist of this agreement, construction documents, specifications, and allowances and all change orders or modifications issued and agreed to by both parties. All the documents noted above shall be provided to Contractor from Owner ARTICLE 2. SCOPE OF WORK 2.1 The Contractor agrees to build the above mentioned addition and or install fixtures attached there to in N Andover, Massachusetts according to, contract documents that were submitted to building dept, and permit issued on these documents only. All work must conform to local and state building codes. ARTICLE 3 . TIME OF COMPLETION The projected completion due is approximately ( 4 weeks) from the first day of construction. NOTE: Change orders and/or unusual weather might delay or otherwise effect the completion date. ARTICLE 4. ALLOWANCES: 4.1 Home owner has$ 1,000.00 allowance for 2 exterior doors DESCRIPTION OF WORK 5.1 .All work performed by 2M Construction and or any contractor hired by 2M Construction is to be done to Massachusetts state building code. 2M Construction is responsible for all building materials needed to complete project, and all paying of sub contractors hired by 2M Construction only. All trash removal as well. 5.2 BUILDING SCOPE INCLUDES : Supply and install 2 exterior doors, door to garage to be fire rated per building code. Install ceiling medallion supplied by homeowner. GYM AREA SCOPE: Demo existing shelving in proposed gym area. Frame new walls to create gym space, Insulate wall on foundation side of proposed gym area. Supply and install all building and finish materials needed to create proposed gym. Blue board & plaster walls in this area, ceiling to be a drop ceiling, will try to match what's in existing basement area as discussed. Frame for walk in closet, size roughly 7'x7'. NOTE : Any custom built in shelving will be a additional cost to homeowner as this was added after agreed proposal price. Supply and install rubber ( gym rated)flooring in gym area color TBD.Trim out window by basement exterior door. Supply labor & materials for paint for all proposed work mentioned above, paint to be Bengamin Moore Regal Select 5.3 ELECTRICAL INCLUDES: N/A 5.4 PLUMBING INCLUDES: N/A 5.5 HVAC INCLUDES: N/A 5.6 INSULATION TO CODE: Exterior foundation wall only 5.7 Blue board Plastering: Walls&soffit areas to be smooth, closets to be textured finish 5.8 PAINT: To be Bengamin Moore ( Regal Select) 1 coat of primer and 2 coats of finish on walls &trim NOTE: Any colors that may take more than 2 coats of finish will be added cost to contract price. HOMEOWNERS RESPONSIBILITY Paying of any contractors not hired by 2M Construction Selecting of exterior doors style/door handles Paint colors ARTICLE6. PAYMENT SCHEDULE PAYMENT ONE $ 5,000.00 upon signing of contract and project beginning PAYMENT TWO$ 2,500.00 after rough inspection is completed by building inspector PAYMENT THREE $ 3,500.00 after blue board & plaster is complete PAYMENT FOUR$ 3500.00 when gym flooring and finish work begins PAYMENT FIVE $ 1,400.00 after final inspection is completed by building inspector NOTE: ADDED COST TO ORIGINAL AGREED PRICE FOR ADDED SPACE WITH WALK IN CLOSET $ 550.00 ARTICLE7.THE CONTRACT PRICE 7.1 The contract price of the project is $15,900.00 subject to approve change orders Please note: Any changes the homeowner decides on before or during project may result in a change of the total cost and change the finish date ARTICLE 8. MERGER CLAUSE The agreement represents the entire agreement of both parties and supersedes any prior or oral or written agreement. All changes must be writing and agreed upon before work can be performed. Owner �f Paul Vercelli ni(2-M Construction) Owner 11/13/2015 09:56 FAX 7813959454 Bates Insurance R0002/0002 DATE(MM1DE'YYYY) `' '° CERTIFICATE OF LIABILITY INSURANCE 11/13/15 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 NAME: Bates Insurance Agency Inc. PHONE FAX 92 High Street, Suite el (A&N ' (781) 396-4985 NO: (7e1) 395-9454 Medford, MA 02155 ADDRESS: Joan batesins.coin INSURERS)AFFORDING COVERAGE NAIC q INSURER A:Preferred Mutual Insurance Com INSURED INSURER B 2M Construction INSURERC: Paul Vercellini INSURER D 4 Berry Street INSURER E: Billerica, MA 01821 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 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. -- - -- .....r..------- -.. INSR AODL SUB R POLICY EFF POLIf.Y EXP ...... ........ . LTR TYPEOFINSURANCE POLICY NUMBER MlDDIY MINIDDYYYY UNITS p, GENERAL LIABILITY BOP0100718249 7/5/15 7/5/16 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE lx�OCCUR RED EXP(Any ore person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY D PRO- LOC $ AUTOMOBILE UABIUTY COMBINED IN LELIMIT a accident $ ANYAU10 BODILY INJURY(Per person) $ ALLOWWD SCHEDULED BODILY INJURY(Per accidenl) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eraocident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ OED RETENTIONS $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? —` -'— (Mandamry in NH) E.L.DISEASE-EA EMPLOYEE $ Nyes,tlescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHI CLES (Aftech ACORD 101,Adclitional Rernarks Schedule,ff more space is requi red) 128 Mill Road, North Andover CERTIFICATE HOLDER -CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department North Andover, MA AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: The Commonwealth of Massachusetts F Department oflndustrial Aceidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 "` www mass.gov/dia sy' Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Ledb Name(Business/Organization/Individual): e Address: G �f City/State/zip:�� C ✓1 C c, At 1 Phone# Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with • employees(full and/or part-time).* 7. 0 Ne nstruction 2.� am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 []Building addition 4.❑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 proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1'mu.st also fill out the section below showing their workers'compensation policy information Homeowners who subriiif'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such #Contractors 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. a Insurance Company Name: t ��/11c) �LA Ue-e, Policy#or Self-ins.Lie.#: �? D 1 s X 60 _ Expiration Date: o Job Site Address: ,�� Y)-1 i ( I 'ed City/State/Zip: v V> CXIa Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 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. I do hereby ce-rLML under theains nd pe alties of perjury that the information provided above is true and correct. Si ature: )aADate: 1 D ' ' Phone#: f ,?r 2 �� 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: s Informati®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of Hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C 6)also states that ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out the workers compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate ro riate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia d Business Regulatio . Office of Co 10 Park Plaza and 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 138378 Type-. DBA Tr# 264640 -= Expiration: 3/28/201,7 2M CONSTRUCTION -------------- f------- - - PAUL VERCELLI 4 BERRY ST. 01821 ` ------ — BILLERICA, MA to meet "1 Lost Card Update Address and return cFaJr Emp ry reason for change. Address [-i Renewal SCA 1 •s 2OM-05/11 e�c///of'�r�JJ"� "�" License or registration valid for individul use only ��' Regulation a" ,, office of Consumer Affairs&Business Regulation before the expiration date. If found return to _d office of Consumer Affairs and Business Reg } SME IMPROVEMENT CONTRACTOR Type, Suite 138378 t0 Park Plaza-Suite 51.70 �t- %Expiration 3/.,I- - 7- DBA Boston,MA 02116 2M CONSTRUCTION 1 PAUL VERCELLI __ 4 BERRY ST. -`•'` " ` Not valid without signature BILLERICA,MA 01821 - Undersecretary 9602/LO/LL ,aauuolsslwEuoo UCIjedIdX� ``%t,.ir 7:0 7 ? I'ro #, ��. �TZ8TO�VL1i V�I2Ia�'I'IIH �- HZA f'MVa spiepuejS pue suogej 6a�j 6uipllr:8 jC pmoI3 AlaleS o!Ignd;o juautjaedaCI - sjjasntyaesseln