HomeMy WebLinkAboutBuilding Permit #362-14 - 276 MASSACHUSETTS AVENUE 10/17/2013 o��No or 6 qN w BUILDING PERMIT TOWN OF NORTH ANDOVER °" '' APPLICATION FOR PLAN :EXAMINATION Permit NO !i' Date Received... Date Issued �9SSgeHus���y. IlVIPORY ANT: A l"cant must'c'om,lete:all items on this a e p w ��, � ��� Y „�, ih�e`7�r `+ • �, - # �a ail s 4a art 'PO LQ�CAThII"Y rya, ({ � aalr a i! s. r •r'.� oda - r 4 s`� Pr rft y'a lmir: d {F{R+OPERTY 01I`NER �n a n k ..- P•rllR vy r t - r. .r ' t� t.�>k :p '? EMAP N�O�« tirP,ARCLr -ZONIrNG D�LSTRICT �� Hist®nc D�sfnc$� uk pie , �no � •G , ' � 3a s,�.. a 4.'a 1,�� a�� R �« biz �`'''+ S��¢ 4�f '"�1 w- � a � �..• �'v ! ay r �• :s r � A rte• a"}" ��,.: � "`>, d Machine�SI�o VIIIe e'� esr �nq , TYPE OF`LMPROVEMENT PROPOSED U:SE :' Residential Non- Residential O'New-Building ci Oho family ❑Two or more farnil , ❑ Industrial; ❑ Addition Y ❑ Alteration No. of units.: O:Commercial plRepair., replacement ❑ As'sessory Bldg ❑ "Others: - ❑ Demolition ❑ Other 2,•, + n.,aG �y 'S r#,t a t �"+ rk r.<„ - r ae; B95. irk into ❑;Septic. �aV\1ell�q� t n FIQod�lain CWetlands ry Watershed#C?islnt �g„ o 4p�Water/,�e�o ,r.:�a_� +;:�..x +. „�� ��. .,� .,. s>ro x • � �3 :A /yRcJ on , ~Fe Identification- Pleas6lype Or'Print Clearly)• OWNER: Name: 1 D�� [ar Phone:-Ci 7 2S &e7 -70 Addrid ess 3 f� r `. F.r;y. ,'- �. t '� ilfN "v'�ifti {d sr c�G a PllOne u �rs 7t CO1NTR°AC<T®:R N}arae '� w � s p1 : ��` 9x�. . t.-Ax+4'+l�,�[ s ^^%r•�' +fry @ �f$ "A�#' +� .�.• .,�. - k: ,�,, • � '+w �.. y�.. ��. "�"�" ��� ���� \/ �.s�+�a� Y ��`��� � •� �!•it � � 4 � �, z�,`���•.yx u,��,�€r91 �moi'' { a i �s 9x y -a ,+ s a��, .r ^�''��'�'s i �� tM✓ ��'"'� paid' � .: r # xk� ;• *"� t '�*' aF. n-, r,�,• '''�` a r-.. e '+ �t'- +P #"'� ;< Exp Date w Hdmel" proveTent icense ,4� _ §>!�"ti�`sf st #$•rd. �i�j�'t, �`. � i�°ur^ �` 1�` ''�.si:�'�'�.'2W`.'r�.-� �.e. L. ,x-_F«�.k 'a f ,ll��s'�- r� #�,'�A��rSl�n�'.'�3;1'a�lA'��'xY�;�a; ARCHITECT/ENGINEER'. Phone:: Address, Reg No.. FEE SCHEDULE..BOLDING.PERMIT-$12:00 PER.$1000 00 OF THE TOTAL_ESTIMATED.COSTBASED.ON$,125:00 PER:&F. Total Project Cost: $ � FEE ,$ CheQk.No.: Rece pt No the- ariiol �und tered contractors:do no't y f NOTE: rersons ontractans with unre�is. . , t y? amr e! tF..int fn. acto , �Si'g�o�;a�ttu ��of�,gent/O�wn,�r�� µ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 3 Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION] Print PROPERTY OWNER-- Print i w0 ear Old structure yes no MAP NO: n. __._ (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 ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands. ❑ Watershed`District El Water/$ewer DESCRIPTION OF WORK TO BE PERFORMED: s Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: -CONTRACTOR Name: _ Phone: Address: Supervisor's Construction License: _ __-_ _ _ Exp, Date: Home,Improyeme.nt License: ______ .w Exp. Date: 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 Nc�.! Receipt No.: NOTA: Persons contracting with unregistered contractors do not have access to the guaranty fund I ..P Signature,of Agent/ weer-. - Sig ature,of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The following is---a list of the required.forms to be filled out for-the appropriate.permit to be obtained. Roofir�g, Siding, Interior Rehabilitation Permits a ' Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Floor/Crossection/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 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 a 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 Li 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 apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 . i l r a Plans Submitted ❑ Plans Waived ❑ -Certified Plot Plan ❑ Stamped Plans❑ �a i f TYPE-OP-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 DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature COMMENTS c HEALT11111 Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: :Comments WaWr & Sewer Connection/Signature& Date Driveway Permit JDPW,. 'ow;2 Engineer: Signature: Located 384 Osgood Street FIRE D�PARTIl f NT - Temp Dumpster on site yes no � Located'at 124.Mair, Street -Y -Fire Departure"it signature/date' ; COMMENTS k 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 - Date I Doe.Building Permit Revised 2010 I Location Mw Age,, No. 2 ( Date{ 3 e - TOWN OF NORTH ANDOVER Certificate of Occupancy $ rt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f' ATFD X TOTAL $ Check# II 27006 Building Inspector OORTH Town Of 2 o LAK! h , ver, Mass, I'D ��. A- COC NICNl W#Cu 7d A°RATEED) ►'4�,��5 lS U BOARD OF HEALTH Food/Kitchen PER*MIT T LD,( Septic System THIS CERTIFIES THAT ..........dam�]. Oi;4a.................................................................................... BUILDING INSPECTOR has permission to erect ....... buildings on ...Q-.: .Y,�. ................... .....yyu ..5......� ................... Foundation Rough to be occupied as ........... j.: I!1.a... ...... Tx.. ,e ..�..........�..`.1'�4�......�t�.��.,.rr......... Chimney provided that the person ccepting 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 CONSTRUCTION SX S 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. SEE REVERSE SIDE E The Commonwealth of Massachusetts print Form Department of Industrial Accidents Office of Investigations -x I Congress Street, Suite 100 d Boston,MA 02114-2017 t�.n. Nj-T1 N.. • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e, Qni .6 ,2 -q,C�I Address: S -05e.ryoy- Ci /State/Zi w'v � e tY p ��t e�Cu ►^'►A f' � Phone 7 2)p Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 E] New construction 2.Mi am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. F-1 Demolition working for me in any capacity. employees and have workers' insurance.$ 9. E] Building addition comp.[No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its 10.❑ 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 12.0 Roof repairs insurance required.] 1' c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *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. .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. I I'the sub-contractors have employees,they must provide their workers'comp.policy number. I am tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in formation. Insurance Company Name: Policy #or Self-ins. Lic. #: Expiration Date: .lob 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 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 penalties ofperjury that the information provided above is true and correct. f Si>nature: 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#: I of r � area JOB PROP'OSAL 65 Reservoir St, Lawrence, MA 01841 Phone 978 8040894 DATE: OCTOBER 17, 2013 ; s TO: FOR.;. Deb Lord 276 Massachusetts Ave: 276 Massachusetts Ave. N. Andover, MA 01845 N. Andover, Massachusetts 0184:5 - DESCRIPTION - AIWOUNT This proposal is for the,following work-at.the above addres's The work will consist .of removal. of entire old stairs, stringers, railings and kick plate below the door. f • Rebuild the landing and install 2,granite treads and stone risers., Repaace kick.pfate below door with Azec board. • Install new vinyl railings. • Price includes removal of old, stairs. Please make a//checks out:to JEFF,66 ; RDI $5,750" 00' We require a 1/3-down,as deposit, 1J3,at halfway, 1/3 upon A//pricing iio/sides completion. Thank for your business. materia/& /abor. Owners Signature:, . Jeff Gerardi: {{ V d2G�j09YU/7GCYILU/P.CY�/�O�P�/J�fG�GiBLyq Office of Consumer Affairs&'Business Regulation Aj ME`IMP,ROVEMENT CONTRACTOR = egistrafion 157875 Type: ! expiration: 11/8/20.15 Individual JEFFREY D.GERARDI`. s s__ JEFFREY GERARD 65 RESERVOIR ST LAWRENCE,MA 01841 Undersecretary 9 Massachusetts -Department of Public Safety Board of Building Regulations and Standards ( !)IINtructu,u Supra i��ra License: CS-094657 ' JEFFREY D GERADI Y 65 Reservoir Street. 'a Lawrence MA 01$41 { I � Expiration Commissioner 09/12/2015 I JEFFGER-01 (CRUZ ACORO' DATE(MM/DDIYYYY) `., CERTIFICATE OF LIABILITY INSURANCE _ 10/17/2013 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). PRODUCER CONTACT NAME: ICfUZ@aaaSne.COm Lawrence AAA Branch PHONE` FAX 155 Parker Street A/c,No,�:(978)681-9200 (978)681-9226 Lawrence,MA 01843 E-MAIL v—--"� ADDRESS:_ INSURER(S)AFFORDING COVERAGE NAIC 8_- T — — INSURER A:Travelers Casualty and Surety of America 119046 - INSURED INSURER B: Jeffrey Gerardi INSURER C: 65 RBservior St. INSURER D: Lawrence,MA 01841 — — —" -— —— INSURER E: I 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 j 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 AD L UBR POLICY EFF POLICY EXP I - -- LTR TYPE OF INSURANCE ISR WVD POLICY NUMBER _ N -- (MM/DD/YYYYI__(MM/DDS ___ LIMITS GENERAL LIABILITY — 1 EACH OCCURRENCE $ 500,000 DAMA E T EN� — A X COMMERCIAL GENERAL LIABILITY 68070454945 1/28/2013 1/28/2014 PREMISES(Ea occurrence)$ CLAIMS-MADE L—_I OCCUR MED EXP(Any one person) $ 5,0001 PERSONAL&ADV INJURY $ 500,000! —_ GENERAL AGGREGATE $ 1,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG_ $ 1,000,0001 POLICY F7, PRO- JECT — LOC -- ----- ---- $ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ) I BODILY INJURY Per accident $ }— NON-OWNED PROPERTY_DAMAGE_( ! HIRED AUTOS _ AUTOS (PER ACCIDENT) 1$ Is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE, AGGREGATE $ I --._ - ------------- - DED RETENTION$ $_ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N I TORY LIMITS ER L.--_._— ANY PROPRIETOR/PARTNER/EXECUTIVE I OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ _ J (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE! $ j If yes,describe under �� DESCRIPTION OF OPERATIONS below ! E.L.DISEASE-POLICY LIMIT $L DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) l I _ _ I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEB LORD and CLAIRE OBRIEN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 276 MASSACHUSSETTS AVE ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD