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Home My WebLink AboutBuilding Permit #384 - 18 MORRIS STREET 12/9/2008 BUILDING PERMIT NORTF� o�tT1�D. TOWN OF NORTH ANDOVER 3� bt '`- ,_h..'a ° APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received 'PqD V SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION WMIZ4Z-0 Print PROPERTY OWNER Print MAP NO, PARCEL: ZONING DISTRICT: Historic District yes 'no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One fad Addition wo or more family Industrial Alteration No. of units: Commercial ;epai:t placement Assessory Bldg Others: emolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: CL��N�, �LU� �l rS�l,��D L/S �(a✓rSfiF ��rr-� �� l�yi.76uay�.+T'�T Identification Please Type or Print Clearly) OWNER: Name: \,4 /V nA IV -VA-K gn Phone: 978-397---2!I O t., Address: le /KOXV-5 o tzry 170 (c2 M4 'CONTRACTOR Name: %moi C�(�� ✓�f�5 Phone: q7 S -a>o*—7,E8 S Address: ( -Supervisor's Construction License: 4C � Exp. Date: -T -Home Improvement License: f 49 69-9$ Exp. Date: 74� ARCHITECT/ENGINEER A4/L(ZS Phone: Address: L`6 ��i�o� 4�1� �� Reg. No. -33 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS D ON$125.00 PER S.F. Total Project Cost: $ 'z;Q®C? FEE: $ Check No.: Receipt No.: `1 NOTE: Persons contracting with unregistered contractors do not have access to t un �gnature of Agent/Owner Signature of contractor J ` i 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature. COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Siqnature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpste.r on site yes no Located at 124 Main Street Fire Department-signatureldlate 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 2008 •i 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/Crossection/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) r ❑ 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 Application E Revised 2.2008 { Location/1s No. Date �O�TM TOWN OF NORTH ANDOVER O'�•�•• ,•X10 • Certificate of Occupancy $ Building/Frame Permit Fee $ off_ r Foundation Permit Fee $ Other Permit Fee $ *' TOTAL $ Check A �T ,L. 2 , 745 Building Inspector NORTH ' To' '" Of Andover No. o jLdover, Mass., 1294I. d O COCMICHEWICK OF V ORATED 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System WC1%.4"W � BUILDING INSPECTOR THIS CERTIFIES THAT........... ................ ......................... ..............:......................................................................................... Foundation _ tion buildings rtr 1.+............. ` has permission to erect..................... gs on .....L ..............�.:4.......... �. ..................... Rough to be occupied as............. .. ....... A1/ 1RT:......,.5.�.�.� Chimney . ........................................................ provided that the person accepting this 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 MONTHS UNLESS CONST T TS ELECTRICAL INSPECTOR 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 SIDE Smoke Det: s The Commonwealth of Massachusetts K i >^Y fl Department of Industrial Accidents t�#d '; Office ofInvesfigatins o 600 Washington Street ' Boston , MA 02111 '- WWW.mass.gov/dia Workers' Compensation Insurance.A€fidavit: guilders/Can tractors/Electricians/Plum A licant Information hers Please Prinf Legibly Name (Business/Organization/Individual): Address: l 6 Vioa-D LA*4D City/State/Zip: L&L110 lr'l t e-9 Phone#:- 176 - e)o -7.18$ Are you an employer?Check the appropriate box: 1. I an a employer with 4. ❑ I am a a Ty;[] of project(required): general contractor and I 2.❑ employees(frill and/or part-time).* have hired the sub-contractors 6. New construction I am a sole proprietor or partner- Iisted on the attached sheet 1 7• ❑ RemodeIing. ship and have no employees These sul>-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑ Building addition 3. required.] officers have exercised,their 10 ❑ Electrical repairs or additions ❑ I an 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.] t employees. [No workers' COMP. insurance required-] 13•XOthei-AAS-C-t-AEUT ftyt #f *Any appiicant,that checks box#1.must also fill out the section below showing their workers'compensation policy information. t nr. omcowners wlte submit.Phis a-111davtt indicating utei'ale uilif e' :or.at- thon hiry outside conirac tors must submit a new amdav lContractors that ehcck this box must attached an additional sheet showing the name. f he su• ii indica^ng s ch. o.t ,.b coruactots and their workers`comp.polio,information. I am an employer that is providing workers'compensation insurance for mJ'employees, Below as the oft informationp cy and job site Insurance Company Name: CO/vii N(F P-rA-L �S,UJ4-L Policy 9 or Self-.ins. Lic.#:_ Expiration Date; Ze- O .lob Site Address: �� /S/1 n e e iS S-r- NSA 0+845 City/State/Zip: N0�A N D O v F-F- Attach atopy 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 tine of up to 5250.00 a day against the violator. Be advised that a copy of thi Investigations of the DIA for insurance coverage verification. s statement may be forwarded to the Office of I do hereby ce u e airs and pe f perluri'Thai the information Provided P above is true and correct Sienature: Date Z Q8 8 Phone#, 78 v s,e7it-7sa8 7.ficialnly. Do not. write in thisarea to becompleted b,city or town official : Permit/Licertseority(circle one): ) 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone it E 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 ofhire, express or implied,oral or written." An employer is defined as`pan individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and inciudi-no,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 he deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state o r 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 o•f 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 compl-etely,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 submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the.affidavit. Theaffidavitshould 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 lata, or if you are required to obtain a workers' compensation policy,please call the Department at the nu.FnbJhs+wd below. Self insu cd companies should enter their self-insurance license number on the appropriate line. City or Town Officials Piease 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 pennit/license number which will be used as a reference slumber. in addition,an applicant that must submit multiple permitnicense 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 vaiid affidavit is on file for future permits or Iicenses. 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 burnleaves 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 shodid you have any questions, please do not hesitate to give us a call. 1 The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 'Faching•ton Street Boston, MA 02111 Tel. 4 617-727-4400 ext 406 or 1-877-MASSAFE Revised 5-2645 Fax f 617-727-7749 VAW'.mass.bov/dia 12/05/2008 10:51 6176660037 AMAZONIA INSURANCE PAGE 01/01 Aa.9n CERTIFICATE OF LIABILITY INSURANCEDATE(MMMOfTY"r) PRODUCVR 1215108 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ANAZON�a Insurance Agency Inc. ONLY AND CONFERS NO RHWS UPON THE CBWTIFICATE 66 Dov- Street HOLDER TNS CERTIFICATE DOES NOT AMEND, EXTEND OR Somervj lle, NA 02143 ALTER THE COVERAGE AFMRDED BY THE POLICIES BELOW. rasueeD INSUIiM AFFORDING COVERAGE NAS 8 INSURER A: SCott 1W IN:ORPORATED adAle IneuranCe CO 118 INSURER 3DLAW T Continental caeuail~ Co IPO S Y LAWRzK:E, MA 01841 INSURER C: INSURER 0: ' COVERAGIINSURER 'S THE POLIOES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NO1WI11iSTANDING ANY REQ IIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY WI ISSUED OR MAY PERI AIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES,'AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -1. POLICY POUCYEFFECTNE POLICY EXPIRATION LIMITS 01 JIERPLLIABI TTY eaCNoxuRRENCE x 300�Q00 A x COMMERCIAL GENERAL LIABILITY CLS1445704 12/28/07 12/28/08 DAMA(FT-pZ E $ 50,000 CIANASMADE OCCUR -affillAmM®EXP(ArVQwpmm) $ 5,000 PER§pNALRAQVNJuRY $ 300,000 GENEMLAGGRMATE _ b 600 000 GINlAGGREGATEUMITAPPLIESPER: PR000CT3-COMPpPA(•Li $ 600a000 POLICY LOC AL TOMOBILE LIABILITY ANYAUTO CPNBNEDSNG-ELIMR(Es accidwt) b ALLOWNED AUTOS — A(`MEDUlEQA1JTOS BODILYNJURY - S (Rifperson) HIRED AUTOS — NONONMEOAUTOS EOOILYNJURY S (Rreca�rru} FROPERTYOAMAGECJ S (R►acct Arlt} :AGEUABn11Y A}70OnLY•EAA000BrT f OTHE R IH AN EA AOC b AU700N.Y: AGG S EX'EbiNMBRELLALWBILIIY EACHOCCURReNCE x (OCCUR CLAIMS MADE AGI3IIN,ATE 8 S DED(JCTIBLE " x RETENTION $ s WORKEISCOMPEN9Al*mmD WCSTATU• OT - 8 EMPLOYIRBLIABILJT'Y aLrLiIuHTS ANYPROIRIETO"ARtNERlE71ECUTNE 0531141608 4/24/08 4/24/09 EL.EACNACGoeNT $ 500,000 OFFICEP.MEMBER EXClLtOED? dyes tleGSl/0vunder EL.DIMAM-CA EMPLOfEE $ SO0,000 SPECIAL. IONShelow 9:1 DIWASE-POUCY LMIT S 500 000 OTNER DESCRIPTION C f OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDIb BY EMDOR9EMENT l SPECIAL PROY19tO m JOS LOC)TION: 18 MORRIS ST, NORTH ANDOVER CEI:TIFICAI E MOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPRATIQN TOWN 010 NOR'T'H MMOVF,R DATE THEREOF,THE tSSUING(NSVM WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN INSPECTIONAL SSRVIC88 DSp NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT.BUT FALURE TO DO$O SHALL FAS: 978-688-9542 IMPOSE NO 08410MM OR LIABILITY OFIND UPON THE INSURER,ITS AGENTS OR 1600 OSGOOD ST a EPRESENTA111IM, NORTH ANDOVER, MA 01845 AUTMORIMDREPUSENTAIWE ANAZONIA INSURAN ACORD 25(::001l08I TION 1988 h£099h 01/0£/90' 30N3SMVI i 5i£Z-1h8i0 VW 1S QNtliQOOM 91 S213A3Q d S03?1dW i 013SN30I-1 SII-Il S3nSSl a33NIJNA31'�F/t1� dObd/J3a sj--L3snvi-ovsSv''N =10 -lado!ss!muloO 14910 VIN '3ON3NMV-1—�� 1SaNVldOOM 91 S.81AAQ V SOObVW P � is 00 uoi;ola;ssl� 1509 #Jl 600Z/5Z/O1 _ P94--d- 0961JG Z/01 :a;epNla!8 990Lb SO sua�!� 0sua31-1 ios!Atadng uogoni;suoo 3ut �!nf{;o p:mof1 i p. /1i6 C/JOIJ7I72°/2I.!/P�LLf7 d�✓< CCdC6 Board of Building Regulatio'ns and Standards HOME IMPROVEMENT CONTRACTOR Registration: 106698 Expiration -7/24/2010 Tr# 278164 Type Private Corporation j , MDJ INC. j Marcos Devers 61 WOOD LAND STREET ,�GZ LAWRENCE, MA 018'41' Administrator MDJ Inc. ........ Marcos A. Devers,P.E.-President•16 Woodland Street.-Lawrence,MA 01841 •Tel.978-804-7588•Fax 978-685-5691 Date : 11/16/08 Home Improvement Contract Parties: Contractor: MDJ Incorporated, Federal I. D. # 04 3089043 with Address: 16 Woodland Street in Lawrence Massachusetts 0 184 1. MDJ Inc. representative: Marcos Devers Construction Supervision License#: 047056 Home Improvement Contractor License#: 106698 Registered professional Engineer License#: 33848. Owner: Wanda Navarro. Address: 18 Morris Street,North Andover, MA 01845 Job Site: 18 Morris Street,North Andover, MA 01845 Use: single family dwelling Construction Type: wood-framed Structure. Work is scheduled to start on 12/08/08 and to be completed before or by 12/12/08. Description of the work: To lower ground slab and footings approximately 1 % feet to enlarge floor to ceiling clearance to at least T-8"within a 200 sq. ft. room. Works also include finish walls and ceiling surfaces within and around the room. Total Amount to be paid for the work to be performed under the contract is: $6,824.85 Time schedule of payments: One third 33 1/3 % of the total p y ( ) contract price: $2,274.95 at the beginning of the job. A 2°a third (33 1/3 %) of the total contract price: $2,274.95 after 2/3 of'ob progress has been attained andr a rd o J p g ress geed upon by the parties 3 (33 1/3 /o) of the total contract price: $2,274.95 after the job is completed to the satisfaction of all parties. All Home Improvement Contractors and subcontractors shall be registered and any inquiries about a Contractor or subcontractor relating to a registration should be directed to: Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston MA 02108 Tel: (617) 727-3200 ext. 25239 1 H Homeowners have three-day cancellation rights under MGL c 93 s 48; MGL c 140D s 10 or MGL c2551) s14 as may be applicable. Under this contract Homeowners have all warranties to owner's rights under the provisions of 780 CMR R6 and MGL c 142A Owners shall be informed of any and all necessary construction-related permits. It shall be the obligation of the contractor to obtain such permits as the owner's agent. Owners who secure that secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The contractor and the homeowner hereby mutually agree to the execution of this contract. Owner: Date:_l a D$,�' coptr4c�Rr: Date: / Z o o� MDJ Incorporated represented by arcos Devers 2 ARBITRATION: "The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall e g b required to submit to such arbitration as provided in MGL c142A. Owner: Date: k Contractor: Date: (Z O 7 /010 MDJ Incorporated rep-resented y arc evers NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner my initiate alternative dispute resolution even where this section is not signed by the parties. 3