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HomeMy WebLinkAboutBuilding Permit #376-15 - 211 CANDLESTICK ROAD 10/20/2014 pORTH BUILDING PERMIT oF�1�Eo 6�ti0 TOWN OF NORTH ANDOVER ,oma ry '_ . -^ .`° o� APPLICATION FOR PLAN EXAMINATION `' ' '0 Permit No#: Date Received �SSgcHus�� I Date Issued: IMPORTANT:Applicant must complete all items on this page ,LOCATION _ - Pnnt PROPERTY OWNER_ . -- _ _ Pnnt, RAdoYearStructure, yes no ` MAF ____r-____iPARCE,L:. _ s ZONING'DISTRICT; -__ Historitbiijtrct yes mo - 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 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - - p`Septic []1Nell ❑-Floodplain . -]Wetlands ? Watershed District i DESCRIPTION OF WORK TO BE PERFORMED: i i Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: ContractorWarne _ rP. ho he i l Supervisor s Construction;License . . _ y _;EXp. fHome`Improvement;<License:._- r F I ARCHITECT/ENGINEER 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: $ FEE: $ Check No.: Receipt No.: NOTE: ' Persons contracting with unregistered contractors do not have access to the guaranty fund i BUILDING PERMIT 3���t.`��. °•ego TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received Aq cxKwiwK.��' Date Issued: a �9SSACHUS I P TANT: Applicant must complete all items on this page LOCATION 2_k 0 Ar � �•�� Q �tor_PROPERTY OWNER J_C)\`,� -�� 'tX: FPAri Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes (no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition C Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement C Assessory Bldg ❑ Others: '❑ Demolition E, Other ❑ Septic E. Well , Floodplain Wetlands L] Watershed District ❑Water/Sewer r � �e �C �� k a &:L an Identification Please Type or Print Clearly) OWNER: Name: Q �p � A)CMk)L Phone: c'1q-)-2,G'�s- 2.,162S Address: b CONTRACTOR Name: �Cel�l-�1 Phone: +0 b- Qc� 1=n C Address: od CWrnmk Sle-, 22MZ _hfAR_,V1WOtS 1,5 Supervisor's Construction Licen : Exp. Date: Home Improvement License: Exp. Date: 2� ARCHITECT/ENGINEER 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: $ is' ©C� FEE: $ Check No.: Receipt No.: NOTE: Person co ra ting with unregistered contractors do not havecc ss a gua fund Signature of Agent/Owner Signature of contract I I Locatio No. _l Date b / f • TOWN OF NORTH ANDQV- ER Certificate of Occupancyv $ Building/Frame Permit Fee Foundation Permit Permit Fee Other Permit Fee $� TOTAL $� Check' ' Building Inspector i r, Plans S�brnitfed ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Swimming Pools El Public Sewer ❑ Tanning/Massage/Body Art E] ; Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ , I 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_ 1 COMMENTS i i CONSERVATION Reviewed on Siqnature I' COMMENTS HEALTH Reviewed on Signature 0 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 Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street ',FIRE'' : _ n�site } es FIRE DEPARTMENT = TemplDumpster o y, �LOCated at,124{Mai,-`Street i 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) I i i ❑ Notified for pickup Call Email 3 Date Time Contact Name Doc.Building Permit 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 o Building Permit Application I o Workers Com Affidavit Comp ffldavit i o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ' o Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/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 ' iTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit j New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o 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 a Engineering Affidavits for Engineered products 'E: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit 311 cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals t the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy androof of recordin st be submitted with the building application p g Doc:Building Permit Revised 2014 NORTH own of ° No. h C, ver, Mass, cocH�cMew�cw meq• �ips R�TE� �QP'�•`y U BOARD OF HEALTH - Food/Kitchen PERR IT LD Septic System THIS CERTIFIES THAT , ......... ........... BUILDING INSPECTOR �yrd�... . .� Foundation has permission to ere ......................... buil s4eC A.'...... ............ ..... g .............. • 4 Rou h to be occupied as ... ....... .... y ... ..... ... ....... ...... imne provided that the person ac epting this permits all in veryrespect conform to the t s of the applic tion 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 MONTH ELECTRICAL INSPECTOR re UNLESS CONSTRUCTION S Rough Service ..................... ...............so Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz 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. V![C ((10497//Yfa92f.UC6ll�ll O�Vl�(.CGIJC,C�[lJCGId �.+�� � ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 'Registration: 168672 Type: 10 Park Plaza-Suite 5170 Expiration: 3/24/2015 Supplement Card Boston,MA 02116 EDA CONSTRUCTION INC. EVANGELOS LIARS 27 WATER ST SUITE 116 WAKEFIELD,MA 01880 Z Undersecretary N id with signature I � j Massachusetts -Department of Public Safety - �ll Board of Building Regulations and Standards Conctructio n Supen•isor License: CS-084795 EVANGELOSLWIS --- 12 STONE STRElI`I ° - DANVERS MA (F19 23 -`. 13 i ell 954""' Expiration Commissioner 05/13/2015 I I 1 The Commonwealth of Massachusetts Print Form�. Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): GAOL, ncn Address: t�` U.YY11M 11/�C OVVK City/State/Zip: Phone#: W1,11 q006_ 1(04(a Are you an employer?Check the app priate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I YP P J employees(full and/or pa -time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.+ required.] 5. ❑ We are a corporation and its 10.EJ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.5Q Roof repairs insurance required.] t c. 152, §1(4),and we have no 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. 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 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.Lic.#:(r) 1�13�3°j - Expiration Date: Job Site Address:7_,� W, U-,:�klC4 - City/State/Zip:V_�) 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 certify under the pains and a ties ofperjury that the information provided above is true and correct. Signature:f (- - - --- Date: _ X67'�' N Phone#: (D n— `'1 ' 1 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#: i 2014-09-18 15:24 isoprt75 9788800021 >> P 2/2 SSZR135A LOWE S HOME CENTERS, INC. DMS 1094 � PAGE: 2 DATE: 09/18/14 153 ANDOVER STREET ORDERED FOR: DONAHUE, ROBERT DANVERS MA(978)646-9099 ADDRESS: 211 CANDLESTICK RD NORTH ANDOVER MA 01845 PHONE: (978)258-2826 VENDOR NAME: EDA CONSTRUCTION INC CONTACT: ADDRESS: PHONE: (781)451-7801 WAKEFIELD MA 01880 FAX: (978)998-4861 PROJECT: 359996497 ROOF LOWES P0: 143323981 LOWES INVOICE: 0 ASSOCIATE: PETER GAYESKI EST DELIVERY: 09/14/12\000 AR NUMBER: QTY ITEM ITEM DESCRIPTION BIN VEND PART# COST EXT COST ----------------------------------------------------- 1 322256 LABOR TO INSTALL ROOF LMBR BASIC LABOR 4,125.00 4,125.00 1 322256 EXTRA LABOR FOR DUMPSTER LMBR BASCI LABOR 500.00 500.00 FREIGHT $0.00 TOTAL $4,625.00 I I 2014-09-18 15:23 isoprt75 9788800021 >> P 1/2 PurdMe Order No. Lo WE WORK ORDERA3 2S) OWE OrlghW Date: DATE CREATED L01N£S REPRESENTATIVE CREATING WORK ORDER DATE INALLER CONTACTED STORE# p- —� (\ ®G"I /cyu�sr.� M HoME#y: CU �j ST.■ N. + AODAESS���VfANI./I,��r,/�� !r✓I A COST_CELL#: �' ORICaINAI.INST �S vLKSTA 6zip ASSIGNED WST DESCRIPi10N OF CUSTOMER ISSUE(1'O BE COMPLETED BY PRODUCRoN oFRCE): 0. u./ AS Dom t N TYPE(CMCLEONE)' ON OFFICE USE ONLY: (NC) lnsUlation.Not Complete CUP-)Defective Product Approving g - li (FM In-Warranty Repair 0-1U) Or�rty Dames �---- (OW) Out-of-Warranty Repair (CS)Customer Sawn Billinglid DESCIPIMM OF ADDITIONAL MATERIALS AND LABOR TO BE PROMO®(To BE COLM.nM BY INSTALLER): 1) 2) 3) The above work and/or mateftts to be completed represent the work ed to$atisfy the original Corrtract referermed above.Customer initials. Additional labor Approving Manager Billin Code Customer and Installer to sign below upon COMPIetiorDf all items on Work Order POD-90166 INSTALLER/DATE Cusr-/DATE A CORD CERTIFICATE OF LIABILITY INSURANCE 4 2222/ 14 � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON RfIRCATE 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(iea)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement onthls certificate does not confer rights fA the certificate holder In lieu of such en lorsemen gh PRODUCER CONTACT Cocoa Insurance Associates Inc aikiltc-- -- ,vaetinsurancehere.com Carmen Cocoa dba Water Street Insurance Age24 S FAx . (781) 246-3926 27 Water Street Wakefield, MA 01880 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Commerce Insurance INSURED Eda Construction Inc INSURERB:Essex Insurance 100 Cummings Center INSURER C:Travelers Ste 226 ► R D: Beverly, MA 01915 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE A L POUCY NUMBER IDDIYYYY UMTS ME B GENERALIJABIIJTY X 3DS5526 1/11/14 1/11/15 EACH OCCURRENCE $ 1 O OOO X COMMERCIAL GENERAL LIABILITY DAMAGETORENTED CLAIMS-MADE 7x ampmncel $ 50,000 OOCUR MED EXP oneperson) $ 1.000 PERSONAL&ADVINJURY S 1,000,0()o GENERALAGGREGATE S 2 GEN'LAGGREGATELIMTAPPUESPER PRODUCES-ODMPIOP AGG S 1,000,00 O X POLICY WT LOC S ! A AUTOMOBILE LIABILITY X BBLQ47 4/6/14 4/6/15L L IMT- X ANYAUTO rfING $ 300,000 ALLOWNED SCHEDULED BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Per aceldent) S HIRED AUTOS NON-OWNED AUTOS PROPEDd% IAMAGE $ S UMBRELLA UAB OCCUR EXCESS UAB CLAIMS-MADEEACH OCCURRENCE $ AGGREGATE _ D R I N C AANNDEMPPLL.OYEPS LUMUTY 6HUB5B94898-A-14 4/25/14 4/25/15 YINX ST.A 0TH- OF�WRMEIMBER CLUDEDED?�� 7 N U A EL.EACHACOCENr 5 100,000 (Mandatory In NH) Mdescribe under E.L.01$EASE-EA EMPLOYEE 100,000 IPTIO OFOPERATI NSbelo E.L.DISEASE•POLICY LIMIT 500,000 T-7 -CESCRtMON OF_OPERATIONS U LOC►TiONS UVE)I(�.ES (Attach ACORD 101,Add clonal Remarks SehkbJk,Ummespace kngrhaM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W AOCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE Carmen Cocoa 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: