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HomeMy WebLinkAboutBuilding Permit #717-2011 - 133 MAIN STREET 4/26/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,1 Permit NO: 7 Date Received Date Issued: 711 EVOORTANT:Applicant must complete all items on this page LOCATION V�G iv C;q - Print PROPERTY OWNER C7a e7 rint MP NO; t)0 PARCEL: o ° ZONING DISTRICT:C4�( Historic District yes no Machine Shop Village yes no &2 1003� � 0 -Oc � � ' ec3od•0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑Industrial v-Alleration No. of units: I I=mmercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other �p S ptica i0lWellt�.�, -1fi, - � � FD�Filoodplauit `glWetlandsl f � ;❑�yUatershed�District .� -' t OYY ater�L7e�er` ix.__._ _ DESCRIPTION OF WORK TO BE PERFORMED: V" 9�q�� a(_y d tti►9 q, C a�fega � Identification Please Type or Print Clearly) OWNER: Name: y-t ( �5 Phond: ��i. Address: 1057 1`er?/1Y_ Ulf ��ezo � PhQ/>,F JY� > >y CONTRACTOR Name: one: Address: Vn s t � 11 n dd44-- n4 Q Supervisor's Construction License: C 5 fExp. Date: Home Improvement License: °-U 1 Exp. Date: l ARCHITECT/ENGINEER 7 Phone: / f/ Address: - d q $ g I n 5 (,'✓ 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: $ 6906,CX1 FEE: $ Check No.: Receipt No.: R-//D f/ NOTE: Persons contracting with unregistered contractors Flo not have access to the guaranty fund ractor.� - ,t,_7 7 , __ dam! ./��r1 --•-- -- - - � I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ E WERAGE DISPOSAL ❑ SwimmingPools TanningWassageBody Art ❑❑ Tobacco Sales ❑ FoodPackaging/Salesc tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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 384 Osgood Street FIRE DEPARTMENT - Tem Dum ster on site es no Temp p Y Located at 124 Main Street Fire Department signature/date COMMENTS 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.$10041000 fine NOTES and DATA-- For department use U Notified for pickup - Date Doc:.Bi lding Permit Revised 2008 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 i ❑ 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 o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cro Sprinkler Plan And ssection/Elevation Plan Of Proposed Work With p 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 i 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording ist be submitted with the building application I Doc: Doc.Building Permit Revised 2008mi Location ?3 /A I)Gt No. 7I '7 0/1 Date .7 6 // MORIN TOWN OF NORTH ANDOVER O � 9 Certificate of Occupancy $ 9 Bui(din /Frame Permit Fee $ s,+cMuse Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check # t 24 i Building Inspector C.G. Contracting Inc. Additions, Kitchens, Baths , Decks , Home repairs ,Excavation work Commercial fit ups* finished basements* Dumpsters paved c,uLezLQVL T>YesWevut 428 Pleasant st. N Andover Ma.01845 Office 978 689 4797 Home 978 683 0397 Fax 978 686 6337 Cell 978 815 7745 Ma. License # 001821 * Insured * Home improvement # 120199 Dgbuilding@aol.com James Lappas 133 Main st N Andover Renovate the stairway and front entrance per GSD plans . Estimated cost $26, 000. 00 I authorize David Gulezian to do the above work. X Date LT U 100 1410 - 0 � I TOWN OF NORTH ANDOVER Construction Control Affidavit I Project Number: Architect's Project Number: 1102014 Project Title: Proposed entrances, exterior landing &stair reconfiguration Project Location: 133 Main St, North Andover Name of Building: 133 Main St Nature of Project: Reconfiguring existing entrances, exterior landing and interior stair In accordance with Section 107.6.2.1 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith Registration No. 8688 being a Registered Professional Engineef/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural )OOIX Structural Mechanical Fire Protection Electrical Other(specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF e EDITION OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 107.6.2.2 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in Chapter 17. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the construction documents and this code. I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPA CY. �tigED ARC/ Signature and Stamp (no facsimile) Mfr P.s yro. No.ffi88 NORTH ANDOVER, ARA. f0 SU CRIBED AND SWORN TO BEFORE ME THIS �AY OF 2011 MY-COMMISSION EXPIRES L NOTARY PUBLIC PATRICIA E.SIFFERLEN s NOTARY PUBLIC COWkIORWEALTH OF MASSACHUSETTS MY Comm.ENftS Nov.3.2017 n `r� a Yft.S�13�CtK['QxW'�'6 •..P ;h SI� t + y 7t Al 1 hq D Vi TT r 1 - •� ={ft 7 .� of ".` `- 'pis � � H * - a y N AN06VER-MAifT E s _ tc P-UAP"M&W COMMAC OR cpirati Ft2Di l T2WZ24 . a /0N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IL!U € 600 Washington Street ;!€ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): Address: q�_ Y �1�ge a q City/State/Zip: . !M a ��$ Phone#: Q 7 l 5 A=am employer?Check the appropriate box: Type of project(required): 1. employer with V 4. ❑ I am a general contractor and I 6. []New construction . employees(full and/or part-time).* have hired the sub-contractors �-� 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. EF emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.F1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Insurance information.Cmpany Name: V t u�( a Policy#or Self-ins. Lie.#: �� � a Expiration Date: / Job Site Address: -3 3 WW0- City/State/Zip: !Y Ir kw dl � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Sedtion 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fortn of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance.coverage verification. I do hereby certify uncle tl pains and penalties of perjury that the information provided above is true and correct.' Signature- Date: Phone#: q Official use only. Do not write in this area,to be completed by city or town officiab 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#: 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 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"every 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-contractor(s)name(s),addresses)and phone numbers)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 confinnation 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 pen-nit 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 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 pen-nit/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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston}MA 021,11 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www..mass.gov/dia �."moi ram,(! DATE(MMIDDfYYYY) CERTIFICATE 4F LIABILITY INSURANCE OP{D NEt�fA 04/04/11 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 WANED,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 Macdonald S Pangione Insurance NAM : P.O. Box 428 Arc Nc UUC,No): 1.04 Main Street ADDRESS: North Andover MA 01845 cusTOMERIDs: DGCON-1 Phone:978-688-6921 Fax:978-688-5350 INSURER(S)AFWRDINGCOVERAGE NAIC# INSURED INSURER A: Travelers Prop a Casualty CL 25674 D G ContractinInc 428 Pleasant Sir INSURER 6: Safety Insurance Company 39454 North Andover MA 01845 INSURER C: National Ubion Fire Ins Co Of 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 UA Ut1UHM1W A X COMMERCIAL GENERALuABILITY I-68 0-1553818-1-ACJ-10 05/17/1.0 05/17/11 PREMISES(Eaocwrneace) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $1 r 000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 X POLICY I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per acciderrt) $ B X SCHEDULED AUTOS 3116538 07/12/10 07/12/11 PROPERTYDAMAGE B X HIRED AUTOS (Peraaidenq $ B X NON-OWNED AUTOS $ $ UMBRELLA LIAR HOCrUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION WC009874107 03/31/11 03/31/12 X - - AND EMPLOYERS'LIABILITYTORY LIMITSER ANY PROPRIETORIPARTNER/D0ECUTWEn E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? u IIA (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ 1,ODO,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below CERTIFICATE HOLDER 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. Town of North Andover Attn: Building Dept AUTHORIZED REPRESENTATIVE 1600 Osgood Street North Andover MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD