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Home My WebLink AboutBuilding Permit #203-2017 - 57 AUTRAN AVENUE 8/26/2016 A, BUILDING REMITo� Na°Ty u� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " Permit No#:G� Z01 Date Received d Z� �q°�RAT'D "�c5 SgNCHUSE Date Issued:®� IMPORTANT: Applicant must complete all items on this page LOCATION A AVUM ,AV Print PROPERTY OWNER o ca n Cmos Al w&a Print 100 Year Structure yesDno MAP PARCEL:ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial t Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Ye )q a\/ UI hn YWv^ ihAVI MliAA Gv d AOUV-3 I'nS:)Aki InUF e" 10IA4-a1( c,:,.u� Y6Vlr`0v-t A1,18 rnrtA S iv\ l!i�!Anffl (AAd I1VIVIa V_mw,rYQ WALE R .I✓ Ca 1(6JQ)�Ce SO ht o4u;,- S�Ao 6W SfAgAvuhk n� kdUSR r_TIr bA's tsynen+ ,�61r5rFJqa�(. IA nhWj, Identification- Pleape Type or Print Clearly OWNER: Name: Qay\ 1yncjhae �t*� Phone: %S-7- Address: 5� Contractor Name: k601Phone: ' LIU -%�-0 Z Email: c c, Address: ZG J c,�c-y' C LawPC_nC e O1I?L1 1 C S- 1 Oo12�9 1 Supervisor's Construction License: OS s C14 �b"�2 Exp. Date: I--i 3- 26 /9 Home Improvement License- Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THjETOTAL ESTIMATED COST BASED ON$125.00 PER S.F. " Total Project Cost: $ �- FEE: $ Check No.: Receipt No.: 7 NOTE: Persons contracting with unregistered contractors do not have access t guaranty fund — �� Location Naz 3 Date 66 0,4 • - TOWN OF NORTH ANDOVER, Certificate of Occupancy $ Building/Frame Permit Fee $ 6f�Q Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector l 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature_ f COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit i DPW Town Engineer: Signature: ; FIRE DEP Located 384 Osgood Street _ ARaTMENiTi ;TempDumpsterFon;siteyes� Located�jaf,�124iIVlainlStreet Fiir'40epartment�signature/datef COMMENTS_ 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 ❑ Notified for pickup Call Email ( Date Time Contact Name Doc.Building Pennit 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, 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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 it Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 55,050.00 m $ - $ 660.60 Plumbing Fee $ 82.58 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 82.58 Total fees collected $ 925.75 57 Autran Avenue 203-2017 on 8/26/2016 repair living room etc NORT11 '9 Town of f _� s ndover O " 0 No. �o h y ver, Mass,L Ko OB ;W COCHIC Hlwic" ��• p�A?A ED PQM��y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..'% .&.910.4n...�..�.L.�./�0��.. ...... BUILDING INSPECTOR ......................... has permission to erect .......................... buildings on ......�� ..... Foundation ..... . ..... Rough to be occupied as ( .. ... . ... .. . ... .. ... Chimney provided that the person accepting this permit shat in every espect conform to the terms of a 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 CONST ION S T Rough Service .. ... ...... .................. ....... .... ...... Final BUILDING IN CTO 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. MIGUELIN CONTRACTING INC. 289-291 ESSEX STREET, LAWRENCE MA 01840 978-794-1182 Cell 978-420-8052• Fax 978-327-5599 *ROOFING*SIDING*REMODELATIONS*BOILER *LEAD PAINT REMOVAL*ASBESTOS REMOVAL CONTRACTOR LICENSE#175629 MAXIMO GUERRERO CS-089346 DELEADER CONTRACTOR#DC001924 FREE ESTIMATE-FULLY INSURED E-MAIL: miguelincontract(a)aol.com PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME: Jean Carlos Almonte 57 Autran Ave. Phone: 857-234-8050 North Andover Ma 01845 DATE: August 19, 2016 We hereby submit specifications and estimates for SCOPE OF WORK: Repair The house Walls ceiling living room, floors: new floors, Install insulation, blue board, plaster and finish All floors, bathrooms and cabinets. Knock down two walls in the kitchen and living room. Staircase and front door. Install a new siding on the front. Basement. Staircase down to the basement. Break the walls andP ut sheetrock in the basement. Put five windows in the basement. Put a new ceiling in the basement. Bathroom Install new toilet, new sink, new bathtub and walls. Roof: Install new roof. Ladder in back area. Doors front and back. Put the interior doors. Retouch the walls. Walls: Install insulation, blue board, plaster, and finish. JOB TOTAL: $55,050.00 The propose hereby to furnish materials and perform the complete labor according with above specifications, for the sum of: Payment to b made as follows $25,025.00 is require to star work. Balance upon complexion $25,025.00 NOTE: MAKE CHECK PAYABLE TO LUIS MIGUEL TEJEDA/MIGUELIN CONTRACTING INC. All material is guaranteed to be as specified, all work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by workmen's Compensation Insurance. Thank you for your business and look forward to our relationship. Authorizedj� C 8/19/16 Signature Date I Luis MijWl Jejeda HIC Jean Carlos Aimonte ACCEPTANCE OF PROPOSAL the above prices, specifications and conditions are satisfactory and are hereby accepted. You ar authorized to do the work as specified. Payment will be made as outlined above. s Signature:`� fj Date of acceptance: / i f A f Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CS-109251 Construction Supervisor JOSSERY DIAZ T NORTH STREET HAVERHILL MA 01830.. jZU; CA—-- Expiration: commissioner 01/1312019 r . The Commonwealth ofMass�chusetts z . h Department ofWustrialAccidents �.; :•, _ d 1 Congress Street,Suite 100 J Boston,MA 02114-2017 • 'l^`.•':'SYiGY www.mass.govldia . Workers,Compensation Insurance Affidavit:BuUciers/Contractors/EIeetriciamIPlumbers. TO IM FILED WITH TBE PERARTTII`TG AUTHORITY. A heantl'nformation Please Print Lei=ibly Name(Eosiness/Orgamzation/Indmdual): N 6 �►� Address:_ 2 q S� City/State/Zip: Lawenc& Phone Areyou an employer?Checktiieappropriate box: Type of project )Veq�odred): 1.r-1 I am a employervdth employees(fit and/orpart time).* 7.• []New coAstrartion 2.E]I am a sole propdetor or partnership and have no employees working for me in 8. Memo deag any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3 Q I am a homeowner doing all work myself[No workers'comp.dmurance required.]t 10 []Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors wiflino employees. 12, Plumbing repairs or additions 5. I am agenerd contractor and I have hired the sub-contractors listed ou the attached sheet. 13.'[]Roof rep airs These sub-contraator;Aave employees and have workers'Comp.innmance� ' 14.❑Other 6.0 We are a corporation antis officers have exerdsedtheirright of'exemption perMGL c. 152,§1(4),andwehaven0.employees.[Noworkers'comp.i ancerequired.] -• *.Anyapplicantthatchecicsbex#1 must a lsofdloutthesectionbelowsho &gtheirworkers'compensationpolicyinformation. S Homeowners-who submitt�is affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ?Contractors_that checkthis box must-attaghed an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-contractors nave employees,tliey must proside then workers'comp.policy number. I ain an employer that isp�ovidingworkers'compensation insurance for my employees.'Beloit/is thepoliey acid job site infoi7nation. Tnsurance Company rame--,AftM4 ey I rten Yk Policy#or Self-ins.1i C'.#: )_ - &IJ A IA 3"1 S ExpirationDate: Job Site Address: u"n AygF City/State/Zip: W Iny19r Attach.a copy of the WO kers' compep4atlon policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required underMGL 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 flue 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 DTA for insurance coverage verification. I do hereby certify u r e pains and penalties ofperjzrry that the information provided above is true and correct. Si ature: Phone#: Official use only. Do not-write in this area,to be completed by city or town official City or Town: PermiULicense# Issuing Authority(circle one): i 1.Board of Healtla 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 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 bf 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 enferprise,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"every state or to cal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the comm ompalth for any applicant who lias riot produced acceptable evidence of compliance-with the insurance coverage required." Additionally,MGL,chapter 152,§25C(7)states`2l'either 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 ofthis 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 numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'other than the members or partners,are not required to cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. B e advised that this affidavit may be submitted to the Department of•Industrial Accidents for confirmation of insurance coverage. Also b e suxe to sign and date the affidavit. The afftda-vit should be returned to the city or town that the application fox the permit or license is being requested,not the Department of industrial Accidents. Should you have any questions regarding the law ox if you'are required to obtain a workers' compensation policy,please call the Department•at the number listed below. Self-insure_d 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 areference 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"rob 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 (Le.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-MA.SSAFE Fax#617.727-7749 Revised 02-23-15 www.mass.gov/dia _ - Office of Consumer Affairs and Business Regulation r*d 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175629 x! Type: Corporation jr' Expiration: 5/24/2017 Tr# 266019 MIGUELIN CONTRACTING INC. u, LUIS TEJEDA 291 ESSEX STREET LAWRENCE, MA 01840 A Update Address and return card.Mark reason for change. SCA I r, 2OM-05m E] Address [] Renewal 7 Employment Lost Card l� i a�rrrrearrcura�/l o�C-'/l�r�tarec/rr�eLlJ Office of Consumer Affairs&Business Regulation .License or registration valid for individul use only i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 175629 Type: Office of Consumer Affairs and Business Regulation Expiration 5/24/2017 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 MIGUELIN CONTRACTING INC t LUIS TEJEDA .+ #kyr 291 ESSEX STREET 5, ' LAWRENCE,MA 01840 Undersecretary j Not id wit t signature i /24/2016 12:57PM FAX 5087556412 THOMAS WOODS INSURANCE Q0001/0001 MIGUCON-01 LBIGELOVI CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"W) THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.HIS 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 pollCy(ies)must be endorsed. If SUBROGATION IS WAIVED,Subject to the terms and conditions of the policy,certain policies may require an endorsement. A statoment on this certificate does not confer rights to the certificate holder In Ileu of such"endorSemon s. PRODUCER N RMI 20 J.Woods Insurance Agency Inc. 20 Park Ave PMONI508 755-5944 Worcester,MA 01805 MaIL c N 508 755-6412 � -Info oodsinsurance.com INSURERS AFFORDING COVERAGE NAIL d INSURED INSURIHRA;MaXURI Indemnl co INSURER 2;Miscellaneous Migualln Contracting Inc INSURERC: 289-291 Essex St INSURER 0: Lawrence,MA 01940 INSURER 19; COVERAGE$ INSURIIR F; 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. TR PH OP INSURANCL� 'irO u X COMMERCIAL CEN POUCY NUMBER MM! !Yy MM/DD/Yyyy LIMITS BRAL LIABILITY CLAIMS-MADE a OCCUR BDG3005358-03 EACH OCCURRENCE S 11000,000 03/25/2016 03/25/2017 P 8ES cru Occup n 3 100,000 MED EXP An one anion 3 1,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L ACGREOATE LIMIT APPLIES PER: POLICY❑jEC ❑LOC GENERALAGGRECAT[ S 2,000,000 OTH'R' PRODUCTS-COMP/OP ACG S 2,000,000 AUTOMOBILE UADJUTY 3 MEIN IN(:L LIMIT 3 ANY AUTO I n ALL OWNED SCHEDULED BODILY INJURY(Per person) s AuTOS OS AUTOS NON OWNED BOOILYINJURY(PergeCldanl) $ AUTOS HIRED AUTOS AU'ros t2T9�� S 1 M UMBRELLA LIAe $ OCCUR EXCESS LIAR EACH OCCURRENCE y CLAIMS-MADE s _DE D RETENTION S ACGREGATE WORKERS COMPENSATION 3 AND EMPLOYERS'UABIUTY 0 - ANY PROPRICTOR/PARTNER/EXECUTIVE Y/N TA T OFFICER/MEM6tR ExCWDED7 N/A (Mande,ory In NH) E,L.EACH ACCIDENT S II yes doacrIbe under E.L.DISEASE-EA EMPLOYEE. 3 DFS RIPTION F P RATI N Blow B General LiabilityCPL105090 E.L.DISEASE•POLICY LIMIT a 413/25/2016 03/25/2017 POLLUTION LIAB 1,000,000 04CRIPTION Or OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Rom■rlp Schedula,may be anachod If more apace le raqulrod) POLLUTION LIABILITY INCLUDES LEAD 8,ASBESTOS REMOVAL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE' CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andovor,MA 01845 .. AUTHORIZED REPRESENTATIVE ! ACORD 25 2014/01 m 1988-2014 ACORD CORPORATION. All rights reserved. ( ) The ACORD name and logo are registered marks of ACORD