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Home My WebLink AboutBuilding Permit #Exception - 21 HIGH STREET 5/1/2018 BUILDING PERMIT N ' O��%A1-'D 1/6 qHO TOWN OF NORTH ANDOVER �2 hf `-'1 tb APPLICATION FOR PLAN EXAMINATION Date Received pq<ecc+e.. Permit No#: °R�ren iV Ssgc►+usE Date Issued: 1 ORTANT:Applicant must complete all items on this page LOCATION `L'� 14`�,tc `mob •�� J d �►`'G�rW �� ,/�L e6- Print PROPERTY OWNER 1 - f "Hijj i U-- - rr,w, Print 100 Year Structure a no MAP PARCEL: U ZONING DISTRICT:_ Historic District no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial >ZRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D"Septic ❑1Nell ❑ Flootlplain 01Netlantls; ❑ Watershed ®astnct - ESCRIPTION OF WORK TO BE PEFO1wRrMED: ri--1�V` �, � • 1 1I`c Ii�r .ShflJS Q � �b �,� o ��r- ,S Identification- Please Type or Print Clearly OWNER: Name:e- J),4ui O Phone: Address: SJ 1 n5 0 J IV cf �e o° `' pL,e Contractor Name ��' R l' Phone: b A 6-7 7 13 Email: VZ�aVIA . s t2._ Address: j i Supervisor's Construction License: b 3 Exp. Date: q ,Lb 1-7 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 1 " • Phone: Address: Reg. No, FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. - Total Project Cost: $ OF S0 FEE: $ Check No.: J Z7T o Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund __ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑ Well E 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_ OMMENTS -F6 N 15 u,11W 1 hS d k (A kK(A i CONSERVATION Reviewed on Signature COMMENT JV 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 a-.-,DPW Town Engineer: Signature: Located 384 Osgood Street E RE DERIAM- MEN F4-T�ernp Dumpsfer�on site; y�es�, ;t: ��' '�� iLo ateda1�24Maint�eet, .,Fire Departments gr>iature//date _ 1114 `ail 11 4 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) i i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits 4. Building Permit Application ,6 Workers Comp Affidavit ,,: Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4, Copy of Contract Floor Plan Or Proposed Interior Work 4. 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) 4, 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 IECC 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 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 I CONCRETEC� rnh' , (I \•1 GRAVEL r Lkr - - / — — — — — —W— — — — / / + �(vAc ' • , r i L // / // \ COOLING / TOWERo / / f CONCRETE/ S /( j j / AIC / CO- 'G / ( WOOD / r / LOADING SL CONCRETE/ / I DOCK („ j / BIT. CONC. F \® ® / PAVEMENT �BL BL / • \ FEEL E GL /BL / BUILDING 11 1t ?• CL 6' DIA. INTAKE PIPE j 3.85' DIA. INTAKE PIPES >- / I 1 / / / / 4" OUTFALL t / / 1=51.61 1=78.4 ' / r r ///I ✓/ � ' W BL G.M. _ BL WOOD — — , -DECK -•r A21- --�____� Al2�. A22 ��- — `A20 9,2-- / CP ,� f e `3 X91 /W `D ` ,u fU/A23// APPROX. EDGE I I I\I A18� BIT. CONC.4 PARKING LOT `\ I I F- n OF WATER 6" OYTFALL / ! SL SL / i I FLOOD ZONE �;�`� �• BL �- LINE = ELEV. 90 11' FEMA ZONE X r i I FEMA ZONE AE .�\`\\ A17 \ i Ll �� j 'I _ �.C� �c�s -'~' �~r', 1� - � cf►� c1 -r� �s - bvi � •�-�� `�\\\\ � � � ,� JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 Proposal Date: 3/20/2016 Proposal#: 210 Project: Bill To: Erik Giangregorio ERS<pond Entryway, N.Andover,Mass 01845 ............ Description Est.Hours/Qty. Rate Total �.,. :. ., Plans and Permits 350.00 350.00 Demo steps and brick side walls, remove fram site, 2 3,200.00 3,200.00 'dumpeters figured Construct 8ft x 8ft square deck using PT framing 5,300.00 5,300.00 lumber,standard building grade trex decking and White, PVC railings, ,picket style.with 6 steps. Footings to be 4 ft below grade. No landscaping included in quote.M&L Demo; If no footings needed ,deduct$650.00 _ 0.00 0:00 Thank you for the opportunity to bid this work. Total $8,850.00 1 MassNachusetts Department of public Safety = R Mations and Standards Board of Building e9 R` License, CS-066334 Construction Supervisor KIERAN T WHEIAN� 31 RICHMOND S _ WEYMOUTH MA 021 f rs r,( f Expiration'.. 0912612017 Commissioner JKCON-1 OP ID:CD rDATE(MMIDDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 05106/2016 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 endorsoment(s). IPRODUCER CONT-ACT DeSanctis Insurance Agcy,Inc. M�E;__. -................................................. PHOE 100 Unicorn Park Drive AAICN,Np,,gxtJ. ................ ............ ...... ...... tac.......... ................ :Woburn,MA 01801 E-MAIL ........................ ................. ............................................ INSURER(S),AFFPRDING COVERAGE NAIL.................. INSURER A:Star Insurance Company...................................................... ........................... ............. ........... ........................ ..........012...--.......... 245 NsuRED JK Contracting,LLC, INSURER B!Selective Insurance Company ------------ 19259 4 High Street Suite 108 .......... North Andover,MA 01846 INSURER C:............ ................. ................ ............................... INSURER D: .............. ............ .................. ,INSURER k: --.................... ....................... ......................... ............... INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 'HIS13 To I CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTV41THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO,%/VHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCI USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID Ct.AINIS, ............. �4,9k` - ............... �ObU5USFC ' - -PbLICY 6(0- i NSID WVD. POLICYNUMBER_- L.TR TYPE OF INSURANCE WDDfYYYY) (MMIDDIYYYYI i LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ............. $ 1,000,000 AIVAG-E-ITZ-REENTEb 7 CLAIMIS-MADE x 1 OCCuR 1S2205113 02110/2016 1:02/1012017 D ......................... PREM Ea cccui e.i $ 100,000 MED EXP Any one person) ........... ................................ .......................... 10,000 ........................... ...............---................. P ...... .... ............ ...................... ERSONAL&ADV:NJURY S 1,000,000 ........................... ............... .............I.............. GFW1.AGGREGATE LIMIT APPLIES ............. PER: GENERAL A .G.....G.....REGATE ..........3...,..0. 00,000 X JECTLUC . .. PRODU-SOMPIOP AGG $ 3,000,000 ............. ........................ .............. O-HER. $ AUTOMOBILE LIABILITYCOMBINED SiNGLE UfOiT ...................... ANY AUTO 8O0!LY:NJURY!Pei per6ori' ; ............. . ALL OWNED SCHEDUi-ED ............................. ........... O AUTOS ALIT BO. OS ILY iNN (Per @06den!) NON-OWNED PRt7PE tlY UAMI+G.. ... ...... . ......................... HJRED AUTCS AUTOS ............................. ................ UMBRELLA LAB OCCUR .......... EACH OCCURRENCE ..................... ......................... ... EXCESS LIAO C.L.A.I .S.-MAD E i AGGREGATE .......... .. i DED RETENTION$ iW WORKERS COMPENSATION PER i AND EMPLOYERSLIABILITY yeh X -4. ---................... ER :A A,'O PROPRIE:!'OR/PARTNER;EXEILITII,/E WC0853742 02/171201610211712017 1 E.L.EACH ACCIDENT OFPCEWMEMBER FX(,-UDE N/Al $ 1-010,00.0 ....... ... ;Mandatory in NH) MA E.L.D;:SEASE-EA ENIPLOYEE!S 100 i if yes,clPscrit)e under '00 .......... ................. L ON OF OPERATIONS below........................ E.1 DISEASE POKY LIMI I $ 500,000 ............. DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 'Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION RCGLL-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RCG LLC ACCORDANCE WITH THE POLICY PROVISIONS, 17 lvaloo St.,Suite 100 Somerville,MA 02143 AUTHORIZER R ENTATIVE QD 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts ,- Department oflndus *1Accidents Office oflnvesiigations 600(Washington Street Boston,MA.02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElePetriiccimfPtumbe 1 Anulicant Information Name(Business/O wftation/fndividual)• ,`� '�e•J� n n� I l� !r L l� L Address: �ti5 t i� g R i c-H City/State/Zip• N - 14 rs 4�v t 0 018�rlPhone Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with _____ 4• ❑ I am a general contractor and I 6, [1New construction employees(full and/or part-time).* have hired the sub-contractors 7. iRemodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ship and'have no employees These sub-contractors have 8. ❑Demolition_ working for me in.any capacity. workers'gyp•insurance• 9. ❑Building addition [No workers'comp.insurance 5. ❑We are a corporation and its 10.[]Electrical repairs or additions required.] Of have exercised their t of exemption per MGL Plumbing repairs or additions 3.El am a homeowner doing all.work � emP P myself.[No workers'comp. c.152,§1(4),and we have no 12,❑Roof rep9m insurance required.]f employees.[No workers' 13.❑Other comp.insurance required.] !Any applicant that checks box4l mustabo fill outthe sectionbelow showiagtheirworkers'compensationpoIicy infonnatioht t Homeowners who submit this affidavit indicating they she doing all work and then hire outside eontnutors must submit a new affidavit indicating sucb- " tContractors that checkthis box must attac3hed an addhh w� onal sheet sho the name ofthe sub-contractors and their workers'comppolicy infonnation I am an employer that i sproviOng workers'compensation insurance for my employees Below is the pollcy and Job site Information. Insurance Company Name:. CS jj( .+J 1 NJ d K OW Le �} c,'7�, fy Policy#or Self-ins.Lie. Z' Expiration Date: i-1 ! •`7 �J J Job Site Addressy4 p�a • �" • Arm 6. City/State/Zip: M!� Attach a copy P of the workers'compensation declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of fine up to$1,500.00 and/or onr-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 maybe forwarded to the Office of investigations of the DIA for insurance coverage verification. Ido hereby certo under the pains andpenaltles ofperpjy that the information provided above Ls true 'correct. Simature. Date: 'hone# e�Al 7= 0 Oficial use only. Do not write it this area,to be conpleted by city or town official City or Town: PermitUcease# Lssuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5.Pltunbing Inspector 6.Other - Phone#: Contact Person: u S- i XJ � Ilk c ,i VIA U o o U(L -,41- CIO 141 C-1 v" (4- yi - Q f� - C) Com_ r � r f