The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #394-2017 - 23 CONCORD STREET 10/13/2016 Rw�c��n�>=D 4, + IWO 4, ut BUILDING PERMIT NoRTt♦ o�Zt LEu ibq~� TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION * _ U11MPermit No#: Date Received SyR,TEoSUDate Issued: TANT: Applicant must complete all items on this page LOCATION _Z73 _ CpA�CL Print PROPERTY OWNER V /Mpi6k Print 100 Year Structure Ve&snMAP PARCEL: ZONING DISTRICT-: Historic District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential )(New Building ❑ One family ❑Addition XTwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OPLL kt c- a- brc,k r Identi kation- Please Type or Print Clearly OWNER: Name: — la MDT-aInc,iPhone: Address: q3 (00rk\q r M.{. Ot(j�44 Contractor ame: A—A-, .Phone: Email GuIr Address: Supervisor's Construction License: (�� /� 3 Exp. Date: C�"'Q Z�l Home Improvement License: 0 Exp. Date: -7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON 925.00 PER S.F. Total Project Cost: $ 1 � , tj(,� � FEE: $ 49 t� Check No.: J ��l �� I Receipt No.: 3 I of o NOTE: Persons contracting with unregistered contractors do not have access to thhe uaranty f d Signature of Agent/Owner Signature of contractor Location 2 3 r'Q roc ari +1 % No. -3 i'� ` . / 7 - Date /� + - W • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ 1 ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 -- is _�. �`1`. r � Check#",, '! % r Building Inspector 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 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 DEPARTMENT -Temp Dumpster 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.$1oo-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doe.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 ❑ 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/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 F NORTH Town of dAndover p :. - 0 51 +jb o h ver, Mass, A10 I I COCNIC«.WICK • �.9 q°R^rEo �•Pa,��(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...... .........4 rE: . .. ..... ...• ............. ..................... ......... BUILDING INSPECTOR ........ Foundation has permission to er t .......................... buildings on .. .. .. ... ...... .... ...... .. Rough to be occupied as . / .. i. . r !!/ .. �It` .................................................... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TIO Rough Service .. ..... ........ .... ........ Final BUILDI INSP CTOR 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. ESTIMATE Elba n morency � 23 concord st norte andover R North Andover, Ma 01845 M&N Construction Enterprise Inc. Estimate # 000072 525 Essex St. Unit 1107 Date 09/29/2016 Lawrence, Ma 01841 Business /Tax# License #CS-108367 Phone: (978) 397-9803 Email: penafranklin@yahoo.com Fax: (978) 258-8311 Description Total Wall repair $0.00 Reinforce beans and replace damage wood Replace damage plywood in the same area New porch on the left hand side $10,500.00 -restore a porch with Pretreated wood.42 inch high rails with column 4 feet below grade. -all debris will be pick up and clean. -labor guarantee is 6 years. -job cost labor and material is$10,500 with a down payment of 4,000 and rest upon completion Subtotal $10,500.00 Total $10,500.00 'Franklin Pena Elba n morency Page 1 of 1 Sales: 800.448.3636 Phone: 804.271.2363 NEXT GENERATION Fax: 804.743.7779 LET'S GET IT DONE STORMWATER MANAGEMENT SOLUTIONS acfenvironmental.com Site Development and Retrofit . Low Impact Development . Green Infrastructure FOCALPOINT(high flow biofiltration) - R-TANK(modular subsurface storage) - PAVE DRAIN(paving,drainage,storage) - FABCO(decentralized treatment) 1 j I I i ; • I I I , , i i I ' i • ; i I I a _ I 1 I I I i I 1 ' tilt I • : I i _ I I ' I I i I I I I I +►+ j i 1 i I 7 : • i , , I I i I 1 ' : • � 1 { I e I j � : I i _ i 1 ' tI I -- -- -- — ' _ _ I v+ i — .i • I , 1 ---------I-- I , i : ACgF I - ;- - - e I ; A1%CtW1FrSales: 800.448.3636 Phone: 804.271.2363 NEXT GENERATION Fax: 804.743.7779 LET'S GET IT DONE STORMWATER MANAGEMENT SOLUTIONS acfenvironmental.com Site Development and Retrofit . Low Impact Development . Green Infrastructure FOCAL POINT(high flow biofiltration) - R-TANK(modular subsurface storage) - PAVE DRAIN(paving,drainage,storage) - FABCO(decentralized treatment) I I � I ' ! �- I -- --�-- i I I ' ; I I ! - — o The Commonwealth of Massachusetts { Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 �< www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNRTT'NG AUTHORITY. •Please Print L . 'bl A .•licaut Information Name(Business/Orgaiiization/Individual): o Address: 6! � g�� 6-T tate/Zi �7t G� 9// Phone City/S p: fx... . Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. jkjNeVd6nstr6eti0n 2.�(l am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.(No workers'comp.insurance required.] 9. ElDemolition 3.Q 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 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole bin repairs or additions proprietors with no employees. 12,E]Pum, g p 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•.0 Ro6f repairs These sub-contractors have employees and have workerscomp.insurance.* 14.Q Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 worker's'compensation insurance for my employees. Below is the policy and)oh site information. Insurance Company Name: Expiration Date' Policy#or Self-ins.Lie.#:. 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 certl&under tli a' s and penal i f perjury that the information provided aboveistrue and correct. Date: —/ 3 e` Signature: 1 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 Phone#: Contact Person: Information and Instrnctions 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 hire, 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 enferpri'se,and including the legal representatives of a deceased employer,or the receivet'or trustee 6f 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 b6 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=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 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' compensatioii policy,please call the Department at the number listed below. Self-insured companies should enter their self✓insurauce 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-MASSAFE Fax#61.7-727-7749 Revised 02-23-15 www.mass-gov/dia AC oRo® CERTIFICATE OF LIABILITY INSURANCE 7(MMIDD 10/12/16 ' 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 endorsement(s). PRODUCER ACT NAME: Kate Lawler, Armand P. Michaud Insurance Ag PHONE FAX 105 Haverhill Street (Atc.E-MAIL ' (978 685-2549 Nei: (978) 794-0622 Methuen, MA 01844 ADDRESS: katelawler@michaudinsurance.com INSURERS)AFFORDING COVERAGE NAIC# _ INSURERA:Essex Insurance INSURED INSURER B:Safety Insurance Co M&N Construction Enterprise In INSURERC: Juana Vasquez INSURER D: 525 Essex St. PMB 1107 INSURER E: Lawrence, MA 01841 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M/DD/Y MMMD/YYYY LIMITS A GENERALLUIBILITY 3DY6888 4/2/16 4/2/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIALGENE RAL LIABILITY 3 occurrence)DAMAGE TO RENTED $ 50,000 CLAIM-MADE OCCUR MED EXP(Ary onepersm) $ 1 000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPUES PER PRODUCTS-CDMP/OPAGG $ 1,000,000 X POLICY PRO- LOC $ JECT B AUTOMOBILE LIABILITY 6232950 3/31/16 3/31/17 COMBMd.' IN LELIMR $ ANYAUTO BODILY INJURY(Per person) $ ALL O WNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS OPERTY HIREDAUTOS _AUT SWNED PR r..d rnDAMAGE $ 100,000 UMBRELLA LIAR E OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? N/A (Mandalory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requi red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Suite 2043 North Andover, MA 01845 AUTHORIZED REPRESENTAWE Kate Lawler ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail: katelawler@michaudinsurance.com r 10 Palk Plaza z►wvl e • o'y C�1'�lset�s 02116 ^�4 Boston, Massa Fes: Home improvement Contractor Re �istrat�on �$ Registr ` .�� [d '•1assachuset•s . _, p ul. iriment �t � EXPI Board of B ' ''� ` �it ' 9�n�( Sulatl n, Q s s A 'a Standards r � ,r C , !'1�.:Ili n 1 p A p q uh��r� .•,r T�1"1 LIf'1. PEt`► -�cen:.• - -108367 �1 _.� .-.-�• FRAMCIN PENA FRANKLIN PENA 35 ySTREET APT .1 35 MAY ST Lawrence MA 01341 ,�. LAWRENCE, MA 01841 "�• /� r Com,nissionmr `xPlration pt3ate 06/08/2018 tr ,,,�,� •,•, ... Adds. SCA 1 0 2091-off 11 r°//r ` rr/irair+Nlr/r'N{f/lrr' frrl3r�r•!►rt.1rtr/J "' office of Consumer Affairs & Business Regulation License or registxNattot IMPROVEMENT cONTRACTOR before the expiration IMPROVEMENT d .. . OtTice of Consumer % r , Regimtratlon: 181101 Type. .'. lration: 2/28!2017 Individual lQ Park Plaza Suite 5 Boston, MA 02116 FRANKLIN A. PENA FRANKLIN PENN 135 MAY ST LAWRENCE, MA 01841 Undersecretary I iot varld