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Home My WebLink AboutBuilding Permit #415-2016 - 2001 SALEM STREET 10/2/2015 NORTH BUILDING PERMIT J,�F q�rO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION t 70 VL Permit No#: !�") Date Received SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ( s� Print PROPERTY OWNER ((.til C?t f Print 100 Year Structure yes no MAP /Or PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or rant Clearly OWNER: Name: q c (A t ( cc � Phone: Address: UQ t SQ Contractor Name: Phone: 157 7 - ' 4 Email Address: Supervisor's Construction Licenser - (� ! Exp. Date:'` Home Improvement License: l 3 Exp. Date: /0. � __. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE,BOLDING PFtRMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Lf�C) FEE: $ Check No.: N224 Receipt No.: 1;_9+f9 NOTE: Persons contractink with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ignature of contracto 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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 DE_-PARTMENT - Temp pumpster -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 Call Email Date Time Contact Name Doc.Building Pennit 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 Li 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 ed 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/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 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 ❑ 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 Revised 2014 LocationNo. Date Date . - TOWN OF NORTH ANDOVER • Ea Certificate of Occupancy $ .` Building/Frame Permit Fee $ �""' Foundation Permit Fee $ Other Permit FeeAtt TOTAL $ Check# � 0 Building Inspector r � NORTH _ . wn o t _E ndover O ,. No. Zh ver, Mass C' �.-1 1 COC KICKl WICK p°RAT E U I,,? S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • THIS CERTIFIES THAT BUILDING INSPECTOR ... i .........�. . . 1 ............................ .. Foundation has permission to erect ..... buildings on ..,&40.-1. . Rough to be occupied as .... .. . ......... ..1.!!�.f�4.V�'v&.` ............. .................................... . Chimney provided that the person accepting this permit shall in every 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 M THS ELECTRICAL INSPECTOR C0 UNLESS CONSTRUCTIO ; Rough Service ...... ............................................... Final BUILDING INSPECTOR 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. CIRCLE G, LLC Construction Management Specialists 59 Bonanno Court Methuen, Mass. 01844 978-876-5263 June 30, 2014 Isaac & Erin Willard 2001 Salem Street North Andover, Mass. 01845 Quote: #15886 Install 2 new windows. Windows will be installed on each side of the fireplace. (Brand of windows will be Paradigm) • Remove siding and outside sheathing. • Remove insulation, save and reinstall. • Frame new windows from the outside of structure. • Install 2 new construction windows with built in J-channel. • Trim the inside of window to match existing trim. • Reinstall sheathing and siding to original state. • Install flashing on top of new windows. Note: Circle G LLC, is fully licensed and insured. Circle G will warranty the work for one year. Total Cost for work completed: $4,600.00 o Stephen Giordano �/ ,i The Commonwealth of Massachusetts z Department of IndustrialAccidents --- - s 1 Congress Street,Suite 100 Boston,MA 02114-2017 sV;vt www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leg-ibl Name(Business/Organization/Individual): Address: �71 �raGt, U,-!Lk City/State/Zip: yekv-�_V Phone#: l`?� '- 2C• S C 3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑c--I am a sole proprietor or partnership and have no employees working for me in 8. P-R0mo deling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a generacontractor and I hhid thb tctlisted on the attached sheet. have hired sub-contractors❑ l - 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other oyees.[No workers'comp.insurance required.] 152,§1(4),and we have no,empl *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,'they must provide their workers'comp.policy number. 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.Lie.#: Expiration Date: Job Site Address: 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: ��--''�— << Date: In -�7-—/__C 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#: 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 fore, 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),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 be submitted to the Department of Industrial Accidents for confirmation 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 permit 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 permit/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 permits 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 0 DATE(PfM10MYYYY) Q CERTI CATE OF LOABOLOTY INSURANCE 5/7/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER T1-IIS 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), Aull'OR)ZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ils)must be endorsed. If SUBROGATION IS WAIVED,Subject to the terms and conditions of the policy,certain policies nlay require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsenenf(s). PRODUCER NA ERCT Trudy Lawler Armand P. Michaud Insurance ACJ PHONE (978} 685-25x9 FAX Ne: (978) 794_-0822 jm-105 Haverhill Street ADDRESS: Methuen, MA 01844 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Concord Group INSURED - -- 114SURERB: Circle G LLC INSURERC: Stephen Giordano INSURER D 59 Bonanno Court INSURER E: Methuen, MA 01844 114URERF- 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. No-RMTHSTANDING 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. 1NSR: ADD SUBR POLICY EFF POLICY L1MTS LTR TYPE OF INSURANCE INS,VNO POUCYNUNSER I l6VDDN Iihv+11001YYYY A GENERALLIABJUry Y 20004335 1 2/25/15 2/25/16 EACH OCCURRENCE ;s 1,000,000 DAMAGE TO RENTED n CaMMERCIALGENERALLIABIUTY i PR MI f'a rra:rrencel S 50 OOO CLAIMS MADE n OCCUR 1dED EXP(Arty ora?Pasco) j S 51000 -1 FERSOM4L8ADVIt RY l S 1,000,000 GENERALAGGREGATE I S 2,000,000 PRODUCTS I S r GGEEN'LAGGREGATELIMITAP(P�LIE;SPER I 2,OOO,OOO F-1 POLICY I I PR� I !LCC 1 COGfs31NED SINGLE LIMIT !S j AUTOMOBILEUABIUTY II caaccider: Is 1 y ANYP.UTD BODILY INJURY(Per parson) I S PLLOWi ttD SCHEDULED BODILY INJURY(Per mcidenl)(S AUTOS SCHED NON-OWNED DAMAGE S HIREDA(JTOS _AUTOS eraccidenl IS UMBRELLA LIAR OCCUR EACH OCCURRENCE 15 EXCESS UAB CLAIMS•PAADE AGGREGATE Is DED RETENTIONS I I S %ORKERS COMPENSATIONI i WC STATU- IOTH-1 AND EMPLOYERS'LIABILITY YIN t I av a cont:c FR jANY FROPRIETORRARTNERIEXECUTNE E.L_EACH ACCIDENT S _ OFFICER1t4EMSEREXCLUDED? NIA E.L.DISEASE-EA EMPLOYEEI S (Mandatory in NH) If xes.describe under OcSCR1PTION OF OPERATIONS belrnr 1 F1 DISEASE-POLICY L1Mrr S I 1 ASCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional RenarYs Schedule,irmore slsce is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE .DELIVERED IN ACCORDANCEWITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I Trudy lawler 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(209 0105) The AC O.RD name and logo are registered marks of ACORD Phone: (978) 685-2549 Far.: (978) 794_0822 E-Mail: trudylawler@michaudi.nsu=a ce.com -- Ccns;st rer A ff�tsr Ciu/.u<aaefu�el�u '`, . . Rcgu dcdo;, Uee :,e or rz titration valid for irdividui use ci iy Z4E Ih^,i t f 're r C before ttte Pxptra9lon natet found return to: aYpe; CYsaee 0f Consumer i�ft(}t5 �a f x i}siar �s E?.�guf t_ioa J Sw ✓lv i r"rld{t�t1a1.: t l r' ;I r, r s; Sir,te I:i iTyy A r - • y,'4 ' l3f Y'v)�� +l`A.041.7 +'-)AGI�;lAY' !ii•.\;"--RriiLL, PMA 01832 — Underaze.ct lry — ` Not valid witpout.sigrtature Massachusetts Department of Public Safety �J Board of Building Regulations and Standards License: CS-076638 Construction Supervisor LAWRENCE F GIOA;ANO,II 897 BROADWAY,' HAVERHILL MA;0183' S )Pili\1 1�/►LU CA-- Expiration: Commissioner 09/16/2017