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HomeMy WebLinkAboutBuilding Permit #323-15 - 25 COMMERCE WAY 9/30/2014 BUILDING PERMIT of"O RT b�tio 6 0 TOWN OF NORTH ANDOVER 02 Z. APPLICATION FOR PLAN EXAMINATIO 70 I � e Permit No#: Date Received -3U7�Qoq^TEo#M I c5 gSSACHUs�( Date Issued: a_ ORTANT:Applicant must complete all ' ems on this page 4. LOCATIONA Ccs r'►') (�'- t.,c,n��- rnt PROPERTY OWNER _ h'1G'lI_. a Print 100 Year StructureT ._ yesno MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Ind rial ❑Alteration No. of units: t0ommercial ❑ Repair, replacement ❑Assessory Bldg u,"O thers: f ❑ Demolition ❑ Other V444,ve-(abW+ �' 14 106(- ❑ Septic ❑Well ❑ Floodplain ❑Wetlands it Watershed District ❑Water/Sewer ,� DE CRIP I N OF WORK TO BE PERFORMED: :T M 5 CPO h / M0 kki cq�iw# J5 vdi it-rzeren 'A-t'v a v m be r 'F-i2yT, (vvvibt44 I entificat' n- P ease Ty a or rint Clearly OWNER: Name: rI vy?01) �- ��I Phone: Address: Contractor Name:. gVIS 6JJL07 e: - Address: W 2 QI�� ��- 5 �1111OVe r 041 dl�'V Or Supervisor's Construction License _ . __ - _ _ Exp. Date: (� _ Home Improvement License: __._.Ila- ARCH _ __ Exp. Date: IPhone: Address: Reg. No. FEE SCHEDULE:BULDING PgRMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ S� e od (f ISO FEE: $ Check No.: G�( � Receipt No.: �v NOTE: Persons contracting with unregistered contractors do not have access to the gu ty fund 7Signature of Agent/Owner _ Signature of contractor J Location No. - . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $� Other Permit Fee $ TOTAL $r Check# 2'0080 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/ 4assage/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'Departmentsignature/date . r 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 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 NORTH Town of s ndover No. � low � ._17 T - _ � � C0 O ver, Mass, 3o 261q LANE COC NIG Mt WICK � A�q�TEt) pP��.�S S V BOARD OF HEALTH Food/Kitchen PER T T D Septic System THIS CERTIFIES THAT f,.o......�`..................................................... BUILDING INSPECTOR Foundation ' has permission to erect .......................... buildings on ...,I .....CGoo A !!!!�........ .......... :"..... Rough to be occupied as ...a,h . . ...... ...... wR..... .WO M ....... Chimney provided that the person accepting this permit shall in evert 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 I '73 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST Rough Service ............... .... ...... ........................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. D.G. Contracting Inc. Additions,Kitchens,Baths,Decks, Home repairs,Excavation work Commercial fit ups*finished basements* Dumpsters* Man lift work *Tree pruning pavCd rJA6ZLGin PreSLAnt 428 Pleasant st. N Andover Ma.01845 Office 978 689 4797 - Fax 978 686 6337 - Call Cell 979 ats »as Ma. License # 001821 * Insured * Home improvement # 120199 Nbuildingfaol. com Amastan LLC ,j. Commerce way, North Andover ma Attention Kamal 617 899 4981 September 14, 2014 Move the kitchen sink and cabinets into the other room, drain the sink into the sewer ejector pump that is in the near by closet. Supply and install a stainless steel sink with a drain board on each side in the location of the kitchen cabinets. The drain system will be standard. Paint the wall where the old cabinets were. $12, 550.00 Supply and install new double doors in the existing opening, Paint the door frame and around the doors, stain the 2 new doors. $1,900.00 Payment is due at completion. ' I agree to the above work X � Date O 3n /� Z I i This price does not inc. any plans if needed or architectural fees if needed. The above prices do not inc. any work that is not listed and does not inc. Any work that the landlord or town may require over and above what is listed above .The Gari monweart.%offfaassaeh.useus ,.. Offlea bfhVestigafeons i 600 Washixagft Street ' Roston,HA 0. 111 WIMmusy.go-Idliz ' Qrc ex ' o tpe o�bquxa�.c�;. `taadt:J c erg f�a? ac o?� l +Zec re c x l' iex id; nytc Kj/,-a-7wm �O v �nr�r� 4170 Name(Busiz3.2sdargamzationft(HY1 �}•^ `1 . Aye you an employer?Cheak the appr'opxzatelOox'. Type of project(re%u' eco): �. p y . d z,=a general confxactor and E4-1-m- a exn to er'wifh 4 �� 6. f]New cbnsfrrzction emplayeeg( a�c�(oxpax�dime}T ha�venedtlio mb-contractors emoc elfin +2.Q I ani a sole ropxietor or Patin er �s fec�on the attached she Bt.� �. �' These sul�contraetaxs have S. �l�emolifzon shi and`havena.em loyees , p p woxk�ag fome in anycapaczt Y workers�comp.korauce. 9. Buffftaddiion cam ." auce S. We axe a corporaEion and its 'ca e airs ox additions ' o wor�exs � M '10. Electxz lr � � c' e th " � p officers ave exex zs cl. ezr �x h xeq*ad.� 7 b` e irs or additions omeowner doin�allwoxk light oxexempiionparM um zngx pa s.El my L[goworkexs°comp. c.��2}§l��},andwebavel.o 12.pRao.�xepaixs insuxanc re ed. employees.PTO Workers, 13.E]Otlier '� comp.insurance recinixerl.� �Auyapplicauttdiat checksbox�Z�usialso�Ilonifheseefion.bel6wshowingtfteirwozkers'compensafio�policynfozmafton. , i i omeev�ners wha sahm t tbis afEidayitmdxcatang iey to doing ailworkandthenhira outside contractors must suhm t amw afixdapitindleaffig W-A xContracforsthacclzeekthisbo musfaffached ladditionalsheetshOwmgtfienamen thesuh.-cou[raeforsandthei workers'Comp.policyinfomiation. Ir�rnaFtexn �oy4Ntricispavicli�2gr � er }cornpe�aationinsrc�ar�eefbx��yernproyees; erowieatieyt�ndaii�`e ire,fp;rmution. h. mance CoxnpanpName;. r �`ox el' ins. Mr l�xc. 7 �/ L7 7 Expir�tionDate: �7 Rollcy 0 - d ess`; (C)to V^,5e CityfState/ %p: �M o, Vola Bite.A dr Attaeh a copy oMewoxkexs'coznpensatioaa�olzeyaeolaxatioupage(showI g-Mepoltcy'utmaiaeXmd exPkatzo)x date)- C. c'oxz o 1V1G1,G. can.leadto the iin. oOlan.of eximinal enaXfzes of a �co exa e as xe 'e�.undex;�e tz 2 .�. p failure to secure GOYMBO. �' L' Og W ORIS ORDER.and afmo ear xm. xzsozvnent as well.as civil enal�tes in she zoxn?of a�'�' I, Ime to$1500,00 andlor one y p x p flfup to$250,00 a day against Ar,WDZator. Bo advised that a copy of 619 sfateiaent may'be£oxwax'ded to the Oface ox" 7nvestigatdons of the))fA fox inmxance coverage wx tfion. -T do riereby migy pniter Aeipair�g ler2aldeg of per, ay Mial tree i�t,�a�vation�rovzded above%�z`�z�e and co��ec�, awe, Date: gilt•m 'hone# �/ C/ > Offieial uga oily. Do riot write in trail area,to be coMletecl ry city or lagm off"eia" +City or To n: BOrxaztlLidense# Dming.A-atlxoxity PCle une}: 1.Board okffealth.I BuRdzng)Department I CztylTowza Clerk 4•FllectxzcalInspector S.Blurabingxnspactor fi.Other - Information and Instructions - Massachusetts General Laws chapter l52 xeVkes all.employers to provide workers'Compensation fox Moir employees. Pursuanttothisstatute,ane��,ployeeisdefinedas",.,everypersoxtzrithesezvzceofanotherunder any contracto hire,, egress ox•implied,oral.orwxiftex�." Aa era fqq 4 defined as"an individual, axtnexs . � hip,association,cox�poxation or otherlegal entity,ox'anytwo oxnzoxe Oftbe oxegoingengagedinajointenterprise,and incZaftthe'legal xepxesentatzyesofwdeeeasedeptplQ�eWO �fte zed eiver ox tt�astee of au individual partnership,association or ofherlegal entity,employing employees. 31owevex the omerofadwan ghousehavingnotmoxethmfkeeapartmentsaudwhoxesidesfexeiiz,oxfheoccupanto f7�e dweliing h ouse of another who employs persons to do maintenance,construction orxepak wo*on such.dwelling house OT onthe,grouads orbuilding appuzLenanithexefa shallnot because ofsuch employmeutbe deemedto bean employaz:" MOL chapter 152,§25C(o-)also states that"every state or Ideal jhensing agency shall withhold the issuance ox renewal of a Reense or permit to opexate a business or to comtrIxet huMings bl the commonwealth for any applicant vvho leas ztot pxodrtced•acceptable evidence o coxnplzanee wztSr the insurance coverage rec�ni ed:' Additionally;MGL chapter 152,§25C(7)stafea Voltherfhe commonwealth nor any ofifs political subdivisions sha11 enferinfo any contraciforiheperforma�ce ofpnblicwoxl�until aacepfable evidence of compliance with the insurance xacluiremenfs ofthis chapferhavebeertpresenfedfafhecoufractingauthority.,, .t�pplicants . . �'leas��out the workers'comp ensaiion affidavit completely,by checlang the boxes that apply to got7x situation and,is necessary,supplysub-confractox(s)names},a dresses and lionennmbex(s�aXangwith theircertWcate(s)of insurance; LimitedUability Companies(LLC)orUm&dLiA*Partnerships{L P)v fL,no employees otherthmtbe members orpartners,axenotregakedto canyworkexs'compemationinsnxance. LaxILLCorUp dosshavo employees,a olicyisxecluired. De advisedthatibl�afdavitxmybo Mbmittedto thel7epar6nent of Industrial Accidents fox confiimation of insurance coverage. .Alsa be snxe to sign,and date the aMdavz. The afiidavitshould be retuxnedto the c V or townfheM6 applicationfox thepexmzt orlioenseisbeingrecpxeAed,xaottbe]74atiment of IndusfralAccidents. Shouldyouhave anycuestionsxegaxdingthelaw oxi yonar'exec�nixedtaobfaina attmet' comp ensaizon policy,please call the Iyepaxbnent at the nt�mbex listed below. Self insured companies should enter�dieir seli~insutance license nnm�6ex on the appropriate line. � . Katy or Tom OMelals �'Xeasebesuxathaftltea"r"�tdavifiscompXeieanclpxinfectlegibZyi I'heDepaztmenthaspxovzdedaspaceatthebofLonz oz the arlavif fox you to 0 out in the event the Ogee of Investigaflons has to contact yorxxegaxding the aplxcanf. 1?'leasebesnxefaz"rliirt'iltepemaifllzcensenumbex�vhicbwitlbe used asaxeiexencenumber, Zvaddition,auapplzcant ihatxnustsubmifrnultiplepexmzf/Ilcex eapplicationskaR.ygivenyeax, lead only submit one affidavitindicatfngcurrent palzcyinzonnaiion(il�necessaxy�and under'%b Mo Address"the applicant shouldwxite t`alllocationsin (city ox tovvt)-":A:copy oARo afftdavitthathas been offfciallysfainped oxmarked bytrto city or townMaybepro-tided to the applicant as prflo at a valid afC"tdavit is an file ar luxe p ezmits or cen ses, Anew afff davitmust ba Mqd out eadA year where,ahome,owner orcitizenxsobtawngWbusinessorcommercial yenture (z,e.a dog license orpe t to burn leaves etu)said person,rs NOT mquirod to complete this a£fldavit, The Office of Investigations would Bice to thank you in advance fox your cooperation.and should you have any gtzestrons, " please do nothesifate to give w a call. The Deputmoet.saddress,telephoneandfaxnumbex. Moe OxImstigAvou 40 Waft..gto�a• xe OP ID:SCDO CERTIFICATE OF LIABILITY INSURANCE DATE(M 09/225/15/1YYY) 4 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(les)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). CONTACT PRODUCER Phone:978-688-6921 NAME: Hannah Courtemanche,AAI,CISS Macdonald&Pangione InsuranceFax:978-688-5350 PHONE 978-688-6921 FAX No; 978-688-5350 P.O.BOX 428 AIC No Ext 104 Main Street E-MAIL m hannah ms.net North Andover,MA 01845 ADDRESS:hannah@mpins.net DGCON-1 Donald Schemack CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED D G Contracting,Inc ID 646648 INSURER A:Travelers Prop&Casualty CL 25674 428 Pleasant St INSURER B:Safety Insurance Company 39454 North Andover,MA 01845 INSURER C:ChartlS INSURER D: INSURER E: INSURER F: 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. 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 TYPE OF INSURANCE POLICY NUMBER MM DIDY EFF POLICY EXP LTR /YYYY MMDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY 1-680-1553R18-1-ACJ-12 05/17/14 05/17/15 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE FKOCCUR MED EXP(Any one person) $ 5,00 PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICYX PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULEDAUTOS 3116538 07/12/14 07/12/15 PROPERTY DAMAGE $ X HIREDAUTOS (Per accident) X NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A CUP-0090153321 05117114 05117115 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X TNRY LIMITS OER AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N C009874107 03/31/14 03/31/15 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 7- DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Massachusetts Port Authority is added as additional insured for this project CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Massachusetts Port Authority THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. One Harborside Drive,Ste 209S East Boston,MA 02128 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD tori txiAeLt-Sbf133tiC�i�sL=t kt� trG,�La Suer'4�r� ! c »se 01821 DAVID PP GULEZ694 428 PLiASANT STS r.w N ANDOVER Mak 0l$4j �Fa r:�omrrafs�iart�-r 10/,02/2015 r i i.