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Home My WebLink AboutBuilding Permit #363 - 15 COLUMBIA ROAD 10/25/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: �` T- 1 I IMPORTANT:Applicant must complete all items on this page LOCATION S /& a I Print PROPERTY OWNER "114 Li Unit# Print MAP NO: — PARCEL: ZONING DISTRICT: Historic District yes Ono Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building U_Gn'e family ❑Addition ❑Two or more family ❑ Industrial �eration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r �I ptic �tiWelh D Floodplain Wetlaridst � Watershe ® dDistnctr - DESCRIPTION OF WO TO BE PERFORMED: (Identification Please Type or Print Clearly) ° OWNER: Name: I Phone: / / r Address: CONTRACTOR Name• / )if'l r/i 1 Phone: 2F7-1214 f✓' ��/ Address: �� I /l Supervisor's Construction License: Exp. Date: �Z"12 Home Improvement License: Exp. Date: 2,0 ARCHITECT/ENGINEER /VA Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 02 06 Q. 6/ ' _FEE: $ �i Check No.: Receipt No.: �j -S 3 NOTE: Persons contracting with unregistered contractors do not have acces o he guaranty fund nature of Agent/Owner , F. z Signature of,contracto Location 6 eel-e, J/ /!� No. Date A' y E r a° TOWN OF NORTH ANDOVER is 3? •. O S A i` Certificate of Occupancy $ s'ale. Building/Frame Permit Fee $ S ` Foundation Permit Fee $ 3: Other Permit Fee $ l'- TOTAL $ Check # 24753 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans,, TYPE OF SEWERAGE DISPOSAL vY 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature t 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 - Temp Dumpster on site yes no 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 o Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks o . Building pp Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ® Engineering Affidavits for Engineered products (VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Doc: Doc.Building Permit Revised 2008mi NORTI-p , Town of And No. �D� -_ �v � �` I� �a.� • �� 0^ o , '� lover, Mass, ^� Q -- LAKE �, COC HICHEWICK 7�S0RATED A �C� BOARD OF HEALTH V Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..............�. 14.W4M.M.0 ., 3.......... .. .... .. ... . . ....................... ................................ Foundation ,� ... _. has permission to erect........................................ buildings on ...........�. .. ........ �.�.. . ��.. ............ hy Rough to be occupied as.......�r11--&-� t.:. .............. . ................................................ ...................... C imn eprovided that the person accepting s permit shall in every respect conform to the terms of the application on file in Final 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 S ELECTRICAL INSPECTOR . - UNLESS CO3W* NSTRUCTI S TS Rough .................. ............................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE S1 D E Smoke Det. 1012412011 15:41 M P.0011001 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MNADW"M 10/24/2011 PRODUCER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED David Di arto immERA: Merchants Mutual Insurance Co. 19 Guild Road INeuRERe. Safety Indemnity 33618 Saugus. MA 01906 INSURER C- Merchants insurance Group INSURER D: INSURER E: COVERAGES 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.AGOREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER MONEM, LIMITS 09MMLLIARUW ROP9092479 03/18/2011 03/18/2012 EACH OCCURRENCE S 1 000 00 DAMAW X COMMERCIAL GENERAL LIABILITY PREMISE aoalrrenw E 500,0001 CLAIMS MADE X❑OCCUR MED EXP(AM ors pawn) 5 15,0001 A PERSONAL AAOVINJURY I Include GENERAL AGGREGATE 6 2.000.00 OEN'LAGGREOATELIMIT APPLIES PER. PRODUCTS-COMPICPAGO S Z 000 00 POLICY PE O.CT F1 LOC AUTTMOB ELABLITY 2700401 11/10/2010 11/10/2011 COMBINED ISINGLE LIMIT = ALL OWNED AUTOS BODILY INJURY X SCIEOULEDAUTOB (Pwpemn) : 100,000 B X HIRED AUros BODILY IIV,AIRY I X NONO&INED AUTOS ° "") 300,000 PROPERTY DAMAGE S (P'B ditnQ 100 00 OARAOF UAefinv AUTO ONLY.EA ACCIDENT 9 ANY AUTO OTHER THAN EA ACC 6 AUTO ONLY: AcG e EXCEd61UMBRILLA LIABILRY EACH OCCURRENCE 6 OCCUR F-�CLAMS MADE AOGREOATE e i DEDUCTIBLE $ RETENTION 6 3 WORRERS COMPENSATION WCA9096S33 04/15/2011 04/1572012 T RruMrrs AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNERIEXECUTIV�; EL EACH ACCIDENT IS 100,0001 C OFFICERIMEMBER EXCLUDED? L J {Mendetery 9i NH) E.L.DISEASE•EA EMPLOY s 100,00 fill cleto�eunax sa PROVISIONSbebw &L.DISEASE POLICY LIMIT I 6 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VOUCLES I EXCLUSIONS ADDED We ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DISCRIBBO POLICIES BE CANCELLED BEFORE THE EXPIIATION DATE THRIMP,TNfi ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W TSN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SD SHALL Attn: Building Department atMENOOBLIDAMNORLIABILITY OFANY KIND UPON THE INSURER,IT$AOfiNTSOR 1600 Osgood Street RIPMENTAIWES. North Andover, MA 01845 [A.—UT"WORMWREPRESENTATIVE eter Sennott/LA ACORD 28(2008101) ®1968.2009 ACCIRD CORPORATION, All rights reserved. The ACORD name and logo are registered mark*of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /�I/ 1��o7�t7 Address: City/State/Zip: J i4-i,�,�l � _ Phone#: Are y9ldn,employer?Check the appropriate box: Type of project(required): 1. am a employer with�_ 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. t 7. odeling 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 required.] officers have exercised their 10.❑Electrical repairs or additions 3. ❑ I 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.] I employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit 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 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 information. Insurance Company Name: e Policy#or Self-ins.Lic.#: �� 9(J �� Expiration Date::�� Job Site Address: roF��r,�� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 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 form 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 erti undeP sins and penalties of perjury that the information provided above 7tr2andcorrect. Si nature: Date: vL Phone#: 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#: N'tassachusetts- Department of public Safety Board of Building Regulations and Standards Construction Supervisor License Lice'lse: CS 67710 Restricted to: 00 . I DAVID M DIBERTO 19 GUILD RD i SAUGUS, MA 01906 - 1 Commissioner. Expiration: 2/5/2012 i � Tr#: 15997 Ufficc of o sumer i�rrs&Bifsiness egu'x HONE IMP,•ROVEMENT CONTRACTOR RedisYrpition: -136789 Type: w Extl&Aion: ;.OL 6%2012 Individual D DIBERTO ;r. f r _ 0 u DAVID DIBERTO 19 GUILD RD. ._T. SAUGUS,MA 01906 Undersecretary '' Propoal Page No: of Pages FenCommercial David & Son Design s 9 Guild Road &Insured Saugus,MA 01906 /�� Cell:781-405-4964 AMW'&J, & (./� Z Fax:781-231-2133 / "� 2�tg�ce Sfiiacem" I TED TO PHONESTREET 0DATE ¢ IJOB NAME / Li e fHER AN P CODE JOB LOCATION &,fA AML M CDATE OF PLANS JOB PHONE5.SUBMIT SPECIFlCATIONS AND ESTIMATES FOR: Ellen Zeglaskis - Kitchen Renovation 9/27/2011 Scope of work: Demo: Entire kitchen area to be stripped to rough framing, walls ceiling and floor. All debris to be disposed of into onsite dumpster. Framing: Per new design one of the existing windows to be removed and framed in. The built in hutch in dining area tol be removed and filled in. An oval pass through from kitchen to dining area to be framed. Basement: Lally columns to be installed at new footings. Two additional footings to be added at main beam with lally columns. Flooring:;Fir flooring supplied and installed in kitchen and pantry. Insulation: Exterior walls to be insulated per code.' Board&Plaster: 1/2"blueboard and skim coat plaster on walls and ceiling. (smooth finish) Cabinet Install: The installation of cabinets,moldings, and hardware per plans included. Trim around windows and doors along with baseboard trim included. If any interior doors to be replaced, each at a cost of$400.00. Total cost- $18,000.00 WC 3Pt0p0!9Q hereby to fumish material and labor-complete in accordance with above specifications,for the sum of: Payment to be made as follows: dollars($ ,� "ddu—). An material is guaranteed to be as specified.All work to be completed in a workmanlike mariner according to standard practices.Any alteration or deviation from above specifica• Authorized tions invoking extra costs will be executed only upon written orders.and will become an Signature extra charge over and above the estimate.An agreements contingent upon strikes,accidents mote'Thisproposal ma be or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. - Y Our workers are fully covered by Workmen's Compensation Insurance_ withdrawn by us if not accepted within days. Ra9ture of J)ropool—The above prices. specifications 1�7 and conditions are satisfactory and are hereby accepted. You are authorized XS lure to do the work as specified.Payment wil!be made as outlined abmre. Date of Acceptance: _ Signature