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Home My WebLink AboutBuilding Permit #467 - 410 GREAT POND ROAD 1/23/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit 140: Y 6 7 Date Received Date Issued: ll'alQj IMPORTANT: Applicant must complete all items on this page "IM-011fild milk. A h 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 Uad �Zersle�src !2 i2 'J4 �� `I`v- 'a�'`'e.v..}' DESCRIPTION OF WORK TO BE PREFORMED: to %T%.-% N s%>> o N s ( 4- Ni GFb Ca F 1w %S Ut 9 A-5 ✓ -04 03 1 Identification Please Type or Print Clearly) S OWNER: Name: (o f j1 i u *y Sc"y Phone: Cod 3 Z * 7 Orlrimcc- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ to CV -0 FEE: Check No.: 'i9 Rz,� Receipt No.: W flO NOTE: Persons contractinpr with unrepristered contractors do not have access to the Quaranty fund 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 .0 Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Mass check ,Energy Compliance Report Of 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: INSPECTIONAL SERVICES DEPARTMENTMITORM07 Revised 2.2007 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 MGL Chapter 166 section 21A —F and G min.$100-$1000 fine NUTES and DATA - (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 No S 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Located at 384 Osgood Street Location No. el6 Date A116 a TOWN OF NORTH ANDOVER Certificate of Occupancy $ ITS ttn Building/Frame Permit Fee $ •�� J�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2?% 209Zoe 46 Building Inspector 01/23/2008 15:50 16173877753 MESSINGER 1N5UKAI'f r - DATE (MWOD/YYYY1 ACORD CERTIFICATE OF LIABILITY INSURANCE 1D i 01 24 oe PRODUCERTHi3 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ME832NGER INSURANCE AGENCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 475 BROADWAY BVERETT MA 02149 NAIL # Phones 617-387-2700 Fax1617-387-7753 INSURERS AFFORDING COVERAGE _._ ., ,. _ INSURER A' SABBTY INSURANCE CO. INSURER B: American Int 1 droup ._. _.. DICENZO EROS CONSTRUCTION CORP INSURER C: FRANC DICENZO P 0 HOX 160 INSURER D: __ _......... ...... KEDPORD NA 02155 INSIIRF,RE; COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THF, POLICY PERIOD INDICATED. NOTWITHSTANDING WITH RFSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN. THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ...-... LTRWWL TYPE OF INSURANCE POLICY NUWKR DATE MMI LINQTS EACH OCCURRENCE 5 1 GENERAL UABIU7Y A X COMMERCIAL GENERALI.IABtLITY DP00002711 07/26/07 07/26/08 PREMISES(Caawmntc)_„!'10000 CLAIMS MADE f� OCCUR MED ERP (Any one person) $5000 '— PERSONAL A ADV INJURY $ 1000000 -” GENERAL AGGREGATE S 10 0 0 0 0 0 G_EN'L AGGREGATE APPLIES PER: PRODUCTS - COMPIOP AGG S 1O O D 00 0 pLRNUIT POLICY JGCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 (EfnccWenp ANY AUTO " BODILY INJURY ALL OWNED AUTOS $ A X SCHEDULED AUTOS 1703001 07/26/07 07/26/08 (Per _.._ BODILY INJURY T X HIRED AUTOS x, NON-OWNEDAUTOS (Pr..neddenl) PROPERTY DAMAGE S (Per acUaenl) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT S OTHER THAN EA ACC ANY AUTO ! _ AUTO ONLY; AGO S tzXCESSRIMBRELLALIABLITY EACHOCCURRENCQ $1000000 A ?7L OCCUR L CLAIMSMAOE 0000000264 07/26/07 07/26/08 AGGREGATE 91000000 T DEDUCTIBLE S X RETENTION $10000 $ WORKERS COMPBISATION AND TORY LM -5L S ER $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC8949549 07/30/07 07/30/08 E.L. EACH ACCIDENT s 100000 _ OFFfCERIMEMSER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 10 00 0 0 a Oewlbc�ntlaf :p GIIALPROVIVONSbelm -... —._ .. E.L. DISEASE -POLICY LIMIT $ 500000 OTHER A SAFETY INSURANCE SP00002711 07/26/07 07/26/08 BQUIPMSNT 87,500 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS JOBSITE: 410 GREAT POND ROAD, NORTH ANDOVER, NA TOWN or AuDOVER QRRRI 1600 OSGOOD STREET NORTH ANDOVER MA 01845 25 TOWNAND I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE 158MG INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR .. � _ .._ _ .. r y. _ _ _ ._ _ .. _ .. _ _ .. _ ._ .. Y � ... � ._F _ } - .. _ � _ .... _ .. _ .. .. _ ._ � � .. ..�_ �_ t � - _ .. .. - � > .. � � ..-- s � � - � -- - '--� --�-. � _ _.�_ .� ...- --'. -- � -. .._ .- - .. .. _ � .. _ _ ,_� _ .. _ _ .. ._ _ r __ � _ _ �_ _ _ ._ January 9, 2008 Young Park and Jinah Seo 410 Great Pond Road North Andover, MA 01845-2019 RE: Basement Finishing Project. 410 Great Pond Road, North Andover, MA As per your request, we hereby submit specifications and estimates for the following items of work: 1. The work area consists of the basement area as shown at our site meeting of December 29, 2007; 2. Provide 2 X 4 stud walls from exit door to garage on left hand side of existing basement toward existing stairs returning past existing stairs to existing stud wall at rear of house so as to provide an unfinished basement area; 3. Provide and install one bi-fold door to access drain pipe clean-out; 4. Provide and install two three foot doors on either side of existing stairs; 5. Provide new studs and door to existing stair opening to act as closet; 6. Provide studs and louvered bi-fold doors to enclose existing boiler to allow adequate room for ventilation; 7. Provide and install appropriate size insulation to all exterior walls; 8. Provide and install vapor barrier on warm side of walls; 9. Provide and install 1/2 inch sheetrock with three coats of joint compound to all sheetrock joints and screws; 10. Provide and install base trim and casings to all doors and windows in work area; 11. Prime and paint all trim and sheetrock. We hereby propose to furnish all labor and material to complete the above project for the sum of $10,000.00. Please note the above contract does not include any mechanical or electrical work that may be required. Payment terms to be agreed upon. Sincerely, Michael F. DiCen Accepted by: AMERICAN INTERNATIONAL AMERICAN INTERNATIONAL COMPANIES GROUP, INC. Specialty Workers Compensation Group Invoice number: 030000025268 INVOICE For billing inquiries call: (800) 645-2259 Email SWCSupporttct AIG.com Billing Date: 12/31/2007 CUSTOMER NUMBER 1001827076 Page 1 of 1 Billed to: 1001827076 Producer. P0069194 i 00495 DICENZOI BROS CONSTRUCTION CORP PO BOX 168 ,TPA INSURANCE AGENCY, INC. 10 NEW ENGLAND BUS CTR DR MEDFORD, MA 02155-0002 ANDOVER, MA 01810-1096 1IINIII111111.J1. hill 1.I.11is3111111111111ifWIN 1i gills III II . �. . d4MOUNTBIEL-ED ON THIS INVOICE r x s INSTLMT WC 6870575 1,398.00 30.00 8,268.00 12/30/2007 1,398.00! +� 01/30/2008 1,398.00 1 AMOUNT DUE Please pay either the amounts in (E) or (1) Balance (G) must be received by due date shown or immediately if past due, or your policy will be subject to cancellation. i r 1,398.00] I 1,398.00 Account summary through TOTAL POLICY PREMIUM 16,098.00 TOTAL PAYMENT RECEIVED TO DATE 7,970.00 TOTAL REFUNDS 0.00 FEES BILLED TO DATE 140.00 CURRENT BALANCE 8,268 00 i� ---------------- -- —•-•- • -- • ..•�... vwrvn ocL-v" WWII h T VIJK PAYMENT '*` DO NOT SEND A PHOTOCOPY 30000025268 1001827076 WC 6870575 2,796.00 LJ CHECK HERE IF YOUR ADDRESS HAS CHANGED AND COMPLETE FORM ON REVERSE SIDE CHECK HERE IF YOUR POLICY IS FINANCED AND ADVISE US IMMEDIATELY SEND PAYMENT TO: SEND CORRESPONDENCE TO: BILLED TO: American International Companies AMERICAN INTERNATIONAL COMPANIES DICENZO BROS CONSTRUCTION CORP 22427 Network Place i Specialty Workers Compensation Group PO BOX 16 168 Chicago, IL 60673-1224 PO Box 409 MEDFO MA 02155-0000 Parsippany, NJ 07054-0409 INSUREDS COPY 013 00000000030000025268 01302008 0 00000000279600 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ` Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrici Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provideworkers' 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 enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of 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 be deemed to be an employer." MGL chapter 152, §25C(6) also states that "ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpergte-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, §25CM 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 maybe 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' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone -and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston, MA 02111 Tel. # 617-727-4000 ext.406 or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-.22-06 www.mas&gov/dia \ . 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