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Home My WebLink AboutBuilding Permit #266 - 189 HIGH STREET 10/10/2007 i BUILDING PERMIT of "°DTH qti 2 bb�t�• .,,...,6 T6 TOWN OF NORTH ANDOVER O c - APPLICATION FOR PLAN EXAMINATION x Permit W Date Received Date Issued�r v IMPORTANT:Applicant must complete all items on this page T 4 A^Pis .aE k —i'4 LOCATION 5�v �. , ,. z. r c a w flnt PR0PERTY 1 VNER s , Pnf1t ' - ." -•- '`"3` t rMX1P N0: PARCEL` Z"O11NG D�S2CT - x °` 3 - k y I�stonc District ' yes no ., 39 .Machine Sage des �o . . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family; Addition Two or more family Industrial Alteration V/ No. of units: Commercial Repair, replacement I/ Assessory Bldg Others: Demolition Other Septac �IVetl >tzt Floodlaiain "AV etlands� � atersted Oistr�ct DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: onl4kj Phone: J'27 07TS' Address: 91 6 so q CONTRACTOR'-lame �. Phone: w Address w t is � _� i t 3 C `' 1 :,W,b t �$�' } SupeTvisor's ConstrUbfidn � . z _ �„ _ Horne lmprovement:L�cense. r Exp Date. :' M ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2– 000 — FEE: $ ?)0 Check No.: f 9,f Receipt No.: Od&--4 NOTE: Persons contracting with unregistered contractors do not have access to the gu an fund Signature of I�gent/Owner = signature ofxcontracto / rvM 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses `'❑ Workers Comp Affidavit b 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 k must be submitted with the building application 9 A� k. Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer i 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 D EJECTED DATE APPROVED CONSERVATIO COMMENTS �� Ny tULS DATE REJECTED DATE APPROVED HEALTH COMMENTS F: Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments T Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit Located at 384 Osgood Street FIREDEPARTtVIENT Terni Durnpster,on10_alte ye`s rior Located at 14(�am 5reet . Fare D:epartr>"tent-s�gnatnre�date r 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 2007 sT` . Location /0 No Date e� �aRTN TOWN OF NORTH ANDOVER ' 0 AL a Certificate of Occupancy $ s„CHUs<�' Building/Frame Permit Fee $ �6, Foundation Permit Fee $ Other Permit Fee $ -~~TOTAL $ Check #M 2061' 3 Building Inspector �.IORT►y _ 0 0Andover No. LAK o11- dover, Mass., la • • COCMICMEW11 K V �d ADRATE D P 5 7`s BOARD OF HEALTH Food/Kitchen PERMIT D Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT... .a �........��rr. l..Q. .x..... ...................................................................................... Foundation has permission to erect........................................ buil 'ngs on .. .. 114...........A.-IfA.....!!S. ...T Rough to be occupied as....; ev d.f.g.i.or...... .. .ei.../.a..wt j..................................... Chimney that the person accepting this permit shall in Ae respect conform to the terms of the application on file in provided p p g p ry P PP 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 300 — PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ST TS ELECTRICAL INSPECTOR Rough ....................... Service BUILDING INS Final Occupancy Permit Required to Ocmpy 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information CoPlease Print Legibly Name (Business/Organization/Individual): )(J. l Q CID 1) CLiu r Address: 31 k P u_.)I s City/State/Zip: SLL2AA 6 3 CO Phone #: y 3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with �7 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. E] Remodeling 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.] t employees. [No workers' 13.0:1/Other � �tJ 60-IMcomp. insurance required.] *Any applicant that checks box#1 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. :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: Policy#or Self-ins. Lic.#:� fpV 5(��p _ Expiration Date: Z Job Site Address: M z4z&(:, bJt 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 her by rt'y :t7stdpe alt' of rjury that the information provided above is true and correct Si natur . Date: 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#: 10/01/2007 10:32 FAA. 19787779L8U (:AaS1llY Aaauc W--jVV1 ACORD,� CERTIFICATE +OF LIABILITY INSURANCE ioliizoo' PRODUCER (781)598-4300 FAX: (781).599-1530 THIS;CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cassidy Associates Insurance en ONLY; AND CONFERS NO RIGHTS UPON THE CERTIFICATE y Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 232 Humphrey Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Swampscott MA 01907 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA COMMerOO Insurance D'Alelio Construction INSURER B:Travelers 31 LEWIS RD INSURER'c:Colony Insurance INSURER D:AIG INSURANCE SWAMPSCOTT NA 01907-2326 INSURERE: THE POLICIES OF INSURANCE LISTED BELOW HAVE SEE14 ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00'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. A RFG LIMITSSHOWN MAY HAVE REP.4 REDUCED BY PAID CLAIMS, 'NSR AIDO'L'Lm Imsmin TYPE OF INSURANCE POLICY NUMBER POLICY MMMMDIYY DEFFECTIVE ATE(MCY MPIDp YY) LIMITS GENERAL LIABILITY EACH QQCURRqNCF $ 1,000,000 X COMMERCIAL GENERAL 6s.o-7aa6C24A 04/01/107 09/01/08 PRANE 'MAGETORENTEDnce 300,000 71 CLAIMS MADE a OCCUR MGD EXP(Any ane emon $ 5,000 PERSONA $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: MP/OPAGG $ 2,000,000 X POLICY 7 P LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Es accident) 11000,000 A ALLOWNEDAUTOS 306024 5/11/2007 5/11/2008 BODILY INJURY X SCHEDULED AUTOS (Pef person) $ X HIREDAUTOS BODILY INJURY It X NON-OWNED AUTOS (Par nuidanl) PROPERTYDAMAGE u (Per accMunt) GARAGE LIABILITY AUTO ONLY•EAACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S C EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 11000,000 x OCCUR D cLAIMS MADE UM142767 11/03/06 11/03/07 AG12REfl T' S 1,000,000 s DEDUCTIBLE $ X RFrENTION 1110400 / S D WORKERS COMPENSATION AND =6875062 06/12/2007 06/12/2008 g TATWSj DTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under SPECIAL PROVISIONS belmv I EASE•POLICY LIMIT $ 500,000 OTHER i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED 6Y ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (781)598-1833 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF NORTH ANDOVER EXPIRATION DATE THEREOF, THE ISSUING INSURER VVILL ENDEAVOR TO MAIL BUILDING DEPARTMENT 30 •'DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 1600 OSGOOD STREET FA0.URE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE NORTH ANDOVER, MA 01845 nURER,ITS AGENTS OR REPRESES. NTATIVE HORIZED APPRES XA VE 1 N ACORD z5(2001108) CIACORD CORPORATION 1988 INS025(oloa).cae Pa9a 1 oft One Ashburton Place - Room .1.301 Boston, Massachusetts 021-,08 ome Immoveme ntractor Registration Registration 114720 D'ALELIO CONSTRUCTION CO. anon I.b1f Corporation Expiration 101:1:9/2007 ARTHUR D'ALELIO P. O. BOX 435 SWAMPSCOTT, MA 01907 --- — - — w _- Update Address and return ealyd.Mark reason for change. s oPs_-c.a.l_. soM oaioa��o�2�s ..1 Address F] Renewal ❑ EnfPlb ment Lost Card _ gHOME IMPROVEMENT CONTRACTOR License or re istration:.valid Regifor iudividul.use only before he expiration date. Tf found refurn to st 114720 Board of Building Regulations and Standards Expki�fila 10/19/2007 One Ashburton PlaceRm 1301 to Corporation Boston,: Ma.021'0$ D'ALELIO CON � I NRTHUR D'AL _ r a; 1 31 LEWIS RD SWAMPSCOTT,Ma y — -..•.. Administrator of vaii without si n PIDOPOSAL 1786 D'Alello Construudon Co., Inc. Page 1 of 2 P.O. Box 435 Swampscott, MA 01907 i 781-598-1843 Ph. 781-598-1833 FAX qq TO: Mr. John Lesofsky PHONE 9/769 /2007 189 High St JOB NAME/LOCATION 89 High St North Andover, MA 01845 North Andover, MA 01845 JOB NUMBER JOB PHONE We hereby submit specifications and estimates for. II,> _____ _ -- -- -•� - - - - - Vie- .ems'. •�.n._to I . Thankou for the o ortuntyY -to bid `t-his y pP P - replace your existing stone foundation with a new Concrete/Concrete CMU block foundation Scope of work: Demo/Excavation (Note: D'Alelio construction Co. will pursue a repair foundation permit for this project. If additional permits are required, additional charges may occur. ) 1. Excavate and Demo existing stone foundation, (3 walls)Area= 80 linear feet long and 7 feet high, dispose of material. Excavation area will be approx. 4 feet outside existing stone foundation. 2. Excavate and remove existing interior material to establish concrete floor sub-grade (3- 4" below existing concrete floor grade 3. Excavate for new concrete footing 12" below finish floor height. 4. Supply and install interior french drain system using 4" SDS drainage pipe around new foundation interior. 5. Supply and install new Zoellar sump pump and pit (3 feet by 3 feet by 3 feet deep) hard piped to the exterior. Scope of work: Foundation/slab installation 1. Supply and install new 10"-12" concrete footing (not to exceed 80 feet) for 3 walls 2. Supply and install new 10" concrete foundation 4 feet high and reinforced with rebar into new footings and into existing concrete walls. 3. Supply and install new 10" concrete block foundation on top of concrete for a complete reinforced foundation (All concrete block cells are filled with cement) 4. Waterproof exterior foundation walls and asphalt foundation coating 5. Backfill using on-site materials compacted 6. Supply and install new 3-4" interior concrete floor to match existing (Dimensions 25 feet e Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: � I Cont'd dollars($ Cont d ) Pay ent to e made as follows: 1 ,4&,-er-'d0 upon contract acceptance,$ 00 Upon removal of existing foundation,$4,000.00 upon pouring of f000ting,$10,000.00 Upon pouring of wall, $ 1,200.00 Final . , All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accep within 10 d S. Acceptance of Proposal— The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work Signature as specified;Payment will be made as outlined above. Signat re Date of Acceptance: ._...._..___.___.._...._..__................... PRINTED IN U.S.A. B i PROPOSAL 1785 D'Aielio construction Co., Inc. Page 2 of 2 P.O. Box 435 Swampscott, MA 01907 781-598.1843 Ph. 781-598-1833 FAX TO: Mr. John Lesofsky PHONE 9/09/2007 189 High St JOB NAME/LOCATION 89 High St North Andover, MA 01845 orth Andover, MA 01845 JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: ****Exclusions to contract: No temporary shoring o—fi me; work, no Plumbing, no landscaping no Engineering and no Ledgework. Approximate project duration: 4-6 weeks, weather permitting. We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: 25,200.00 Twenty Five Thousand Two Hundred and. 0/100 Dollars dollars($ ) Payment to be made as follows: $6,000.00 upon contract acceptance,$4,000.00' Upon removal of existing foundation,$4,000.00 upon pouring of f000ting,$10,000.00 Upon pouring of wall, $ 1,200.00 Final All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications Authorized j involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within 10 days. Acceptance Of Proposal— The above prices,specifications and accepted.conditions are satisfactory and are herebyted.You are authorized to do the work Signature p as specified.Payment will be made as outlined above. Signature Date of Acceptance: PRINTED IN U.S.A. B k ' t x PaOF`:Bl�llr�►1�((3'�RECa(1l./�7"�OIV� t'�cer�se: C�pN TRij-TfO►YIPEV15R u${rth�sf'e�0�62/1.$38 ` $Siftic _ ARTFiUa T f:o►nmissioner a --- - j j • • amu'- '' '• Qu'�' SURANCE COMPANY OF THE STATE OF :PENNSYLVANIA 75190-0000 WC 687-50-62 ------- ----------- --------------------------- 13889 013-82-o6o7-01 . • PENNSYLVANIA ,M I I w0res 0910 . . [oil D'ALEL I 0 CONSTRUCTION CO Member Companies of LEWIS ROAD KAmeripan International Group AMPSCOTT, MA 0}907-0000 EXECUTIVE 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990616 PMC INS AGENCY INC. WORKERS COMPENSATION AND EMPLOYERS 50--CABOT STREET LIABILITY POLICY INFORMATION PAGE PO BOX rL920179 NEE.DHAM MA. 024 2-0002 _ INSURED IS I PREVIOUS POLICY NUMBER CORPORATION REWRITE\ 006875o62 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC 06.10. ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the Insured's mailing address :F I ROM 06/12/07 TO 06/12/08 ITEM3 A. Workers Compensation Insurance:.Part One of the policy applies to the Wor kers. Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI :MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SO TN TX UT VA VT WI ITEM41 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Remuneration Premium Code Number 5700 OF Re= ❑X Annual ❑3 Year muneration 0 Annual ❑3 Year INFORMATION PAGE - WC SEE EXTENSION OF INFO 7754 TAXES'/ASSESSMENTS/SURCHARGES $6p,4 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $284 MA MINIMUM PREMIUM $5500 MA TOTAL ESTIMATED PREMIUM `' ^ $14,752 If indicated below, interim adjustments of premium shall be made: 11 Semi-Annually 11 Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORMNUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 04/36 o'j PAR91PPANY 82 Issue Date Issuing-Office Authorized RepresentbLtive WC 00 00 Ot 39967 IN10I 10CnIQ r1nDV