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HomeMy WebLinkAboutBuilding Permit #572-2017 - 129 WEYLAND CIRCLE 11/28/2016 BUILDING PERMIT NORTy TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION permit No#• �7 �� Date Received(' ��` ZED " "oDRATED�PPy�c � L, �SSacHUS G Date Issued: / " d-E MORTANT:Applicant must complete all items on this page ITR, t , , P.,� C _- PR®PERTYOWNER ky 1 —` �� Pnn I�10Yea Structure: w- ryes ono* w Hisfonc®i'stncf> ,IMAP��PARCEL�-;.��� -Ir T_ � _ ._ • : tyeSa ,. r» 5, -,�.., 1.. ,."�dT'�.�'_...-a•x,,.K.w.�..r.x.� -1-.. - al-• .�.st x.a.0-„ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r9...r- it+rs - t ^7 -{F• .. teal. z „,:-. '"'1.,.. yt^s.:.+ ., .. 0 Septic" ❑swell ;� } 'EDFloodpla_m ❑WetlandsWatershetl District .F ❑_ ,Wateff-S r; at .� �: .:, .:. _ x r st n :,,� .. •- DE CRIP TION OF WORK TO BE PERFORMED: 0 Identification- Please Type or Print Clearly OWNER: Name: tot , a rA Vjtyye4^ Phone: 115 Address: r . CYC t1 .. r •} ,`5, ♦ +� Contr ctor Name,, i�44�1 �� Phone; , , 111/// � , ,� ,_ .* • - �_ .•� �.r � � . ; ; }4 u a41"'"r A+i"F '-:++-�T�Css"..rt*""d��' ��1` ` .w a�� �.., cA + ?Adtlress: ''. t' (�: � ►r.1. _ .1,1 / �'� 1`'.�qQ � .4 // 11L_ � "!",F: '.i��� J�`r,... 'yjsi/p��.�.y4���.�.• .! -E"' y' �4 I ." Z .. ..,r,', `' `� ! ,�'�.• .a :4" `.`r/),y(/�/!J O+l���., rrj ` C. ! -r �•.: _Supervi s Construct�on3# icense 1 Horne Improvement Licensdi;;i_ ate i ARCHITECT/ENGINEER '1 Phone: i Address: Reg. No.. � FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ,9 , H5 0 FEE: $ Check No.: Receipt No.,- NOTE: o,-NOTE: Persons contracting witli unregistered contractors do not have:access to the g r nd l Signature of Agent/Owner Signature of contractor, -t Plans Submitted ❑ Plans Waived 01 Certified Plot Plan ❑ Stamped Plans ❑ 'nw OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent 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 HEALTH Reviewed on Signature E i COMMENTS I e Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street i FIRE DEPARTMENT - Temp Dumpster on site yes no LocateOt 124.Main Street Fire Department signature/date ,, a tr _ . COMMENT limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: f: ELECTRICAL: Movement of Meter location, mast or service drop.requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doe.Building Permit Revised 2014 _. . Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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) o 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 VOTE: 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 L I Doc:Building Permit Revised 2014 Location I d No. 7 O �Ut Date t 1- y d 7, (v • - TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# l/ (,/ Building`Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 4,450.00 m $ - $ 53.40 Plumbing Fee $ 6.68 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 6.68 Total fees collected $ 166.75 129 We land Circle 572-2017 on 11/28/2016 basement finish NORTIr E f Town of ndover O - to o h ver, Mass, A_•Q COCNICKIWICK y1. 7a ORATED J`P�`�,�5 7S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT ................ . .......... ..... .. �.................. .... �.. ........ ....�. » • •. Y.L MO0• ��� Foundation has permission to erect buildings on .... . ..... ••••••••• ••••••.......................... Rough to be occupied as /'"o..ow.4............AoxovX04... ................................. 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 STARTS Rough ••. Service .............. ........ ......................... ... BUILDI.NG INSPECTOR Final GAS INSPECTOR Occupancy Permit Reguired 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. 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. ( c • Pad out low wall5and end wall as required to insulate.,�g n a�, l` �cAlw`' ►`�u-rC�9�v�c-}�t `'I 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.4��"L r nr WI, J • 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 1 have read and understood,and I agree to,all the terms and conditions contained above. A� V Dat Michael Dio ati MD Design Build Date Owner Date wne ' The Commonwealth of Massachusetts Department of IndastrialAecidents M I Congress Street,StUte 100 "' v :mm= d Boston,MA 02114--2017 F 4� www mass.govldia .p r�Ty sty Via kers' Conapensationhsurance Afl?tdavit:Builders/Conn.TaB+ctors/.lectricia)as]Plumbers. TO BE F1LED WITH THE PERMUTING AUTHOR#'. P.Iease Print Le 'bl A •']icantXnformation ' Name(Business/Orgavization/lndividual): I Address: b � Ci /StatefZi : 1.G� W� � 'y Phone#: Axeyou an employer?G�ecktlio approprlafebox: Type of project()reCluixed); em 1 ees full andlor part isme). 7. El N6W'collstl'udt[ou I.F]I am aemployerwith P(l prietor or partnership and have no employees WO11 ng for me in 2. 1 am a sole proPncto 8. Remo deliij g any capacity. rOrP comp.insurance required.] 9. ❑Demolition 31-11 am ahomeowner doing all work myself.[No Workers'comp.insurancerequire d.]r 10❑Building addition ¢,❑I am a homeowner and willbe hiring contractors to conduci all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole Plumbin repairs or additions proprietorswithn0employees. ��L I g 5.❑I am a general contractorand Ihave hiredthesub-contractors listed on the attached sheet. 13%0 Ko6f repairs These sub-contractors hav6 employees and have workers'comp.insurance•i 14. Other 6.❑We gre a corporafiod and its,offices have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required-] hcantthat checks box#1 must also fill out the section below showingtheirworkers'compensationpolicy information:' aPP sub-contractors ?Homeowners who rh..sub •ibis affidavit mdncatmg they ate doing all work andthen hire outside contractors must submit a new affidavit indicating sur tContractos that check this box must attached an additional sh r dde their wename of the orkers comp.policy number.�d state whether or, (hose entities have employees. If the sub-contractors have employees,they must p I am an employer t1W 1, p ovidingwor�kers'compensation insur�ancefor•my empZoyees. .Below is tliepolky andJoh site information. 7xisurance Company Name: ExpirationDate' Policy#or Self-ins.Lie.#:. City/State/Zip- Job Site Address: Attach a copy of the workers' coanpensation policy declaration page(showing the policy nis a umber and expiration date). by a fbib up to$11,500-00 Failure to secure coverage as requited under enaltses inMGL o. ,the form of a STOP WORK ORDER and of p to $250.00 a and/or one-year imprisonment,as well p day against the violator.A copy oftbis statement may be forwarded to the Of6.ee of fnvestigations of the DIA for insurance coverage verification. pdo Ziereby certify and th ai andpenalties ofperjury that the information provided above is to ue and correct. .• �/!/� �, Date: l Sinature: Y Official use only. Do not write in this area,to he completed by City or'town official Permit/License# City orTown: Issuing Authority(circle one): 1.Board of Health 2.Building Departanent 3.City/Town Clerk 4.Electrical fuspector 5.Plumbing Tnspector b.Other Phone#: Contact Person: Information 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 receiv6for trastde of an individual,partnership,association or other legal entity,employing empl6yees..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 b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or to cal 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 applicantwlio has not produced-acceptable evidence of compliance with the insurance coverage requiired." 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 certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to catty 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 con_frmatiou 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 IndustrialAccidents. should you have any questions regarding the law or if you are required to obtain a workers' compensatioxi policy,please call the Department at the number listed below. self-insured companies should enter their self insurance license number on the appropriate 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 permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit nat related to any business or commercial ventuxe (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-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia DIODA-1 OP ID: BC CERTIFICATE OF LIABILITY INSURANCE FDATE(M3/20 11/03120 6 16 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(ies) 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 NAME: Foster Sullivan Insurance LLC 163 Main St. AIC,N Ext:978-686-2266 aC No): 978-686-6410 North Andover, ns rance ADDRESS:certificates@fostersuilivaninsurancegroup.com Foster Sullivan Insurance LLC INSURERS AFFORDING COVERAGE NAIC II INSURER A:Merchants Mutual Ins.Co. 2332.9 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 &DDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD Ma POLICY NUMBERMMIDD MM/DD LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS MADE OCCUR 11/01/2016 11/01/2017 DAMAGE TO RENTE9_ PREMISES Ea occurrence $ X Business Owners MED EXP(Any one person) $ 15,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY❑JET LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acc dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE Perac $ AUTOS ddenl UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) I 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 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety i Board of Building Regulations and Standards License: CS-092360 Construction Supervisor MICHAEL PAUL DIODATI,JR. 16 PLUMMER ROAD LAWRENCE MA 01843 Expiration: Commissioner 01/19/2018 j Office of Consumer Affairs and usiness Regulation a _ r` 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home improvement Contractor Registration Registration: 180802 E - - Type: Individual ;(g Expiration: 1[7/2017 Tr# 261778 MICHAEL P. DIODATI JR. MICHAEL DIODATI 16 PLUMMER RD LAWRENCE, MA 01843 ;' � _� - Update Address and return card.Mark reason for change. - E] Address [:] 'Renewal ❑ Employment Lost Card DPS-CA1 0 5010-04/04-13101216 z Consumer &i o�ness Regulation License or registration valid for individul use only Office of Consumer Affairs&BUsioess Regulation g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TAELMI Registration: 180802 Type: Office of Consumer Affairs and Business Regulation Expiration: 1/712017 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 P. DIODATI JR._: MICHAEL DIODATi, 16 PLUMMER RD LAWRENCE,MA 01843 �- Undersecretary Not valid without signature