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HomeMy WebLinkAboutBuilding Permit #260-2017 - 133 MAIN STREET 8/13/2016 L_ NORTH, BUILDING PERMIT °�<t`Eo L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION z _ Permit No#: Date Received �SSAC"Lls�C Date Issued:tv Ile IMPORTANT: Applicant must complete all items on this page LOCATION '� � P ,y a 5 PROPERTY OWNER Y100 Year Structuricte yes no Print istrict no MAP PARCEL: ZONING DISTRICT:�T___ MachinHistorice Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑Addition El Two or more family [I Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg El Others: _,_ . �_ Ely: Demolition _ . . v p,Fl otlpla nR Wetl` I Watershed'Dist(jj [IOt er D Septi, ❑V_,11e,111 ands Ell\NateXlSetiex I� ( DE CRIT T IQi n F WORK TO BE PERFORMED: v V v� 5 Identification Phone: cation- Please Type or Print Clearly OWNER: Name: I m (q r R f, hot Address: F r ame: Id G I � Phone: vr�l aS Oel&2 - Ex Date: ��r's Construction License: �J p'provement License: d f 7 Exp. Date: p ARCHITECT/ENGINEER n D Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 70 D. Gn FEE: $ ,, C> �- Check No.: Receipt No.: NOTE: Persons contracting with u gisteredcontracto— �,n rsdo not have access to the ayanty fund — - - -- -------- ------ -- - , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning 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 WEALTH Reviewed on S iq nature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& ®ate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE,DEPARTMENT - Temp Dumpster on site ;yes.. Located of 124 Main Street - t ---^_-- FireDepartrient 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: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.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. 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 OTE: 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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 roof of recording that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and p g must be submitted with the building application Doc:Building Permit Revised 2014 4 a � fz Loi;ation No. U �) Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $' -7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r f / Check# � �f Building Inspector 1 � NORTF� q Town of 2 t b ndover No. hm I L h ver, Mass, 0 A- COMIC MIWKM 7a A0RAATED 0'Pa��,�5 lS U BOARD OF HEALTH Food/Kitchen P -ERMIT _T D Septic System THIS CERTIFIES THAT . . V .. .. ..... .. .. .... BUILDING INSPECTOR `` ........ .............. Foundation has permission to erect .....:.................... buildin son .....1��......... �.�. ..... .... Rough tobe occupied as .......�.. ........S� ... A..... .......................................................................... Chimney provided that the person acceptin this permit shall in 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 CONST CTI T Rough Service .. . .. .... .... ............... Final B ING I SPECTOR GAS INSPECTOR Occupancy Permit Required 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. D.G. Contracting Inc. Decks ,Excavation work Commercial fit ups"Dumpsters ' Man lift work 'Tree pruning Sport court Installations mlvw CLdtzLQA President 428 Pleasant st. N Andover Ma.O1845 Office 978 689 4797 - Fax 978 686 6337 - Call Cell 978 815 7745 Ma. License # 001821 * Insured * Home improvement # 120199 Dgbuilding@aol. com Jim Lappas 133 Main st N andover Alpine realty September 12, 2016 Install vinyl siding over existing siding and 3/8 fan fold. Estimated price $22, 700. 00 X Date / OP ID:GOGL CERTIFICATE OF LIABILITY INSURANCE DATE08/24/201 1� 08/24/2016 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). CONTA T PRODUCER Phone:978-688-6921 NAME: Hannah Courtemanche,AAI,CISR Macdonald&Pangione Insurance Fax:978-688-5350 PHONE 978-688-6921 AX No:978-688-5350 104 Main Street Arc No Ext North Andover,MA 01845 E-MAIL ss:hannah@mpins.net Donald Schemack PRODUCER CUSTOMER ID#:DGCON-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED D G Contracting,Inc ID 646648 INSURER A:Travelers Prop&Casualty CL 25674 428 Pleasant St INSURER B:Safety Insurance Company 39454 North Andover,MA 01845 INSURER C:National Liability&Fire Ins 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 ADDL SUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MWD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AGE ToRENTED A X COMMERCIAL GENERAL LIABILITY 680-15531118 0511712016 05/17/2017 pRMMISEs Ea occurrence $ 300,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS 3116538 0711212016 07112/2017 PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,00 A CUP-0090153321 05/1712016 05117/2017 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVEYF NIA V9=704542 03131/2016 03/31/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 A Property 680-15531118 05/17/2016 05/17/2017 LsdlRent 20,00 1. Equip DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Fax: 978-688-9542 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Common-vea th of Mass ch efts X Congress Street,SuUe 100 Boston,.A 021142017 ` Workers'CompensatiouInsurance Affidavit:Builders/Contractors/EIeefadczanslPXumbexs. TO 33E FnKD VTH TSF PERILCCT MG AUTHORITY'. A� Reant Wormation Please Prat Fe�ily Name(Business/osganiza-tion/Tndivzdual): �- Address: �- I I`P �ityl tate/zip: , Jqd d d r IW C,(�S�5� Phone Areyou an employer? meet&appr kopriate box: Type of project )Vsq=ed): 1- am a employervlit$ employees(hill and/or parttime).* iime). 7. []New coraction 2.0 I am a sole propdefor or partnership andbave no employees working forme in 8. Remo deag any capaoity.INo workers'comp.insumnce required.] 9, El Demolition 3❑I am a homeownardoing all workmyself IND workers'comp.�nstrance required]' 10 []Building addition <1IamabomeowneiandvMbahiring coniractors.a conduct all workonmyproperty Iwill mum Electricalrepairs airs ox.addltioxls ensure fha;all contractors either have wodcers'compensatien iee or are sole x E propriefms�,zfhrzoemployees. I2--[(Plumbingxepairsoxadditions 5.QIamageneralooptraatorandIhavehiredfhesub-contactorslistedonthea;.taehedsheet. I3_0 Rooffrepairs 1Desesbb-coutracbrsliaveemployeesaadhaveworkers'oomp_;,,"e.; 14.[TOther 6.E]We are a corporatim and its oftieers.have oxereised-the r right of exemption perMGL c. - 152,§1(4},andv�eha�ena.employees.jNoworkers'eo�»p.iusr¢anceraq�ed-] :Any apphcaotthat I must also jlru out the section below showingtheirworkers'Compensation pohicy inrnrm9'Fron. T Homeowners w"ho so iiRlak 4fldaeiaE icLmgthey are doing all work and then hire outside contractors mast submit a neyy davit fildicafing such_ ?Contractors hat checkthis bow must 4ached an.additional sheet showing the name of the snb contractors and smote whether oznotthose entiies have employees.Ifthe sub-carairacfors liave employees,&Ymast pravidefiheu works'comp.policy number. I airs era e Oyer tri rrt isTio-picttngjvorkers'compensation insuran for r acy eryTlayee,.'Beloiu is thepoZiey acid jog sate Tt T Insurance Company Name: J- n S /q� (i(f(�' C - 2 E�piration3Yate: Po1icy4 or Self-ins.ZiG4: 1 7d 1 Yob Site Address: �a�'( � /�j 1 City/State/zip: Attach a copy ofthe�Vorkers, compensatjoupolicy doclarationpage(showing thepolicynumb er and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a tine up to$1,500.00 and/or one-year liuprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a esti ations of the DIA for insurance the Ofztce oflnv day against the-violator-A,copy of this statement maybe forwarded to �h g coverage veritication- Ido hereby ceYtify uIlder thep andpenaltzes of pefj�zry tlzaithe info: taiionp ovirXed above as rue c �t�ec Signature: Date: Phone of• daZ use only. JIo not-wrHe zn this area,to be cornpleted by czty or town off�czaZ Cry or Town: Perxnit/License 0 IssUb1gAatb.oritg(circle one): i 1.Board of Health.2.JBuiMi-agDepartment 3.C!Wown Clerk 4.Electrical bspector 5.Plumbiuglnspector 6.Otber Phone Cow act Person: #r: Information and Instructions Massachusetts General Laws chapter 3.52 requires all employers to provide workers'compensation for their employees. T f•s•i Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract bf hire, express or implied,oral or written." An employer is defined as"an individual,partnexsl ip,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enf6rprise,and including the legal representatives of a deceased employer,or the receiver-or trustee of a u 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 b e deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the ismanee or renewal of a license or permit to operate a business or to construct buildings in the commonwealth,for any applicant-who lias not produced acceptable evidence of compliance-with the mmrance 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 fdl•out-the workers' compensation affidavit completely,by checkingtha boxes that apply to your situation and,if necessary,supply sub'contractox(s)name(s),address(es)andphonenumbers)along with theircertiftcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees*other than the members orpartners,are notxequiredto carryworkers'compensationinsurance. If an LLC or LLP doeshave employees,a policy is required. Be advised that this affidavit may be submitted to the Depa tment of Jltdustrial Accidents foi-confrmation ofinsurance 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 I-udustrial Accidents. Should you have any questions regarding the law or if you'are xeggired to obtain a wbrkers' compensation policy,please call the Department at the number listed below. Self-ifis 6d.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 areference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current poll6y information(if necessary)and under"lob 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 maybe 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 not related to any business or commercial venture (i.e.a dog Ecorse or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Deparbnent 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 CIRIVSR'S yaar@ d� ^, r NONE" , °� .� S 7401'650 �-. 10- ;a -t12195g I5 Rai 5 a 428 PLEASANT w � N ANDOVER,M 01845.2920 •h - i fay/ ,` 6:D009-11 Af3RevOf-15.appy -.,,OffxeC of ConsumcrAffairs c Business Regulado4 ME IMPROVEMENT CONTRAMR ��t'" istratian: 12fl I99 Type: {�expiration: 11/112017 t�ciivdttal DAVID GULEZIAN I DAVID GULEZIAN 428 PLEASANT ST NORTH ANDOVER MA 01845 C ttdersecretary 1 :,:ari#s1J,J itS Qltp«.1+Ulm.ntof PuWtcsdf-hY . 3 of Building Rcguiatit}ns and Standards-.-. ,cense: CS-001821 Co z *ruction Supervisor DAVID P GULEZIAN 428 PLEASANT ST NORTH ANDOVER MA 01845 . , Expiration. Commissioner . 1fl/02/2037