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HomeMy WebLinkAboutBuilding Permit #556-2017 - 676 OSGOOD STREET 11/22/2016 BUILDING PERMIT RT a�4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ', '' ~ Permit No#: -,;�0 f 7 Date Received _I.I - �� R01 �.9 0 ATED PFp�.( • / �SACHUS�� Date Issued: " `fid' - !}dib LWPORTANT:Applicant must complete all items on this page 77 t, P&Q)PER�TY � _ YearStruc ure kyes ,_, zno MAP'` .Vim° PARCELZ®N NG DISTRICT � Hstonc ®istnctln�` y >` - ''i � yt=.�9-;s .�;a„a ,`�,�•,y `. .=�'°s.�f 2S r '_ i�. :� �"� aChl�•nefSho V lage''�'�� es ,no . •:+•ecr�lt' "�e...••+G_rk,+�w.l�+.'Tr'ei L`w.l�'.`2 M.v" 3t."s..:<ie.,.W,. ..+: ,�..wwr_�-�w.,.��•a, <:ks�-. ._�e,,,?�, y,t,:�1. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building O'One family ❑Addition ❑Two or more family ❑ Industrial [9-Alteration No. of units: ❑ Commercial R'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic. 0 Wellµ ❑Floodplain D Wetlands 0•�Water5lied Distract e �, « f•'- 4 ♦ tr, ❑.Water/Sewerxt�n Y5X>rT �l � S�K. DESCRIPTION OF WORK TO BE PERFORMED: 4 Identification- Please Type or Print Clearly' OWNER: Name: L-eo Te-scd , W9 rJ Phone: 97Y `3?7--7323 Address: 676 0s9-ya y' ,� wContractor' Nafne r`T (T,wo Phone: j")-,?33,766 $D - t. N/?wu� Address i�� .e a �r- t. `SupervisorsConstructionLicense8 �044 G Z * xpDate llB ' "= t 6: -r+yr^��'€ t..:n.�r .� =r� r:<;+-r•"`�,',.`? '"'"•,�"'i's" r,`'. 3 wj' ',l`%'I-. 'S..,.v 'r `. �; xi 111�I :, � #'uA t<. �+"� yx "i p �s� j i{•r .,,. � �+�� MHome�Improvement+License /74�GZ . .�" } �� �`-Ex Datet � � �7 .,+ntN..ma. .ns`, �. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. .Total Project Cost: $ /8. ��• o b FEE: $ /d �" ! Check No.: Receipt No,. 1 .3-5 NOTE: Pe s co tracting with unregistered contractors do not have:access to the guaranty fund Signature of. g_nt/Owner' Signature of contractor' 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit j ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 j ❑ 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 40TE: 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 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ 'IYPE`OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ ! Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I a Planning Board Decision: Comments I Conservation Decision: Comments t 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 r limension 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.$10041000 fine NOTES and DATA— (For department use) I` ❑ Not for pickup Call Email at Time Contact Name _ ----- — DocHailding Permit Revised 2014 Location to 0 S r 1 No. q f-7 Date ! • • TOWN OF NORTH ANDOVER a � Certificate of Occupancy $ >� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# r i 123 3 Building Inspector~ i Enter construction cost for fee cal- North Andover Fee Cakulaflon Construction Cost $ 18,500.00 m $ - $ 222.00 Plumbing Fee $ 27.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 27.75 Total fees collected $ 377.50 676 Osgood 556-2017 on 11/22/2016 renovate kitchen � NORTH Town of A 0 0 h � ver, Mass, 11 - 7� • � ®� cocNic«e w�c« �1' U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT . .Ok ....P'..N.0.......... .. ...Le V.... .rj. .. .. ... BUILDING INSPECTOR _ Foundation has permission to erect .......................... buildings on ....47. .........0'.S.. .............. . 10 _ pM Rough to be occupied as ...... ..�R�L. ....... ..14C.ke. ............................................... 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 CONSTRUCTI TAR Rough //���� ............................ Service .......... ........Wl�..................... Final BUILDING INSPECTOR 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. Robert Pino 26 Wave Way Winthrop, Mass. 02152 Leo& Tiffany Jesudian 676 Osgood St. North Andover,Mass. 11/20/16 We propose the following renovations to kitchen: 1.Frame and shim walls as per plans. 2.Insulate outer walls. 3.Install rough electrical as per plans. 4.Install replacement windows. (supplied by owner) 5.Sheetrock and plaster walls and ceiling. 6.Install new cabinets as per plans. (supplied by owner) 7.Trim doors and windows. 8.Install new pre-fmished flooring. (supplied by owner) 9.Paint walls and ceiling with color of choice. 10.Counters and plumbing will be installed by others. I Unstall all finish electrical as per plans. 12.Rubbish will be disposed of in existing dumpster on site. Cost for all work listed above will be: $18,500.00 Deposit of$5,000.00 2nd payment after framing and is complete $3,000.00 3rd after sheetrock and plaster$3,000.00 4th after flooring is installed$3,000.00 5th after cabinets and trim$3,000.00 Balance due upon completion ert ino PO Pino Construction I I 3" 71' 9"° m ! C l72T73 ,eF 971D 2F+1�.E4F7 :R6 C{�4-(C: C E2i „ �� e D) N Al —•— ._..�� 'E p: �tTD ZFYT 8UT =?± � ,'� c 334" 38:' Customer has provided meaOurements and agrees .� 5' ,�- to design 9 •� 90 Fi t L'Jea76 Be 59= s` 6' 5' 190" -,.De Commonwealth Of.Massachusetts _ ;• .� Department of lndustrialAccidents X Cong-cess Feet,Suite 100 Boston,MA 02114-2017 www mass.gov/dza pPa kers'Compensatiouhsurance,AffidavitsBtdldexs/CSA a Os y. zczans/k'lnznbexs. TO BE TURD WITH TEE P� please Print Le 'bl A �Rcant Information Name(Business/Orgmjzation/IrodMdual): Address: 2 tj A✓W p 4 City/State/Zip: r►� 54. 02/57 Phone#: hox: Type of project 0V quireci); Ase you an empioyer?CI eck the appropriate - '7• ❑N Q e�v consixaction 1. I am a employer with employees(full-and/or part 2.damasole proprietor OrPlrn shpiandhavenoemployees-Wor1ffigforme,in $. eIIlodeXiiig any capacity.[1`Iow1111ers'comp.insurance required] 9. ❑Demolition In I am,homeowner doing all work myself(go worke,,,comp.insurance required.] 10❑Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill 11.[]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no enpioyees. 12,❑Plumbing repairs or additions 5.❑I am a general contractor and l have biredthe sub-contractors listed on the attached sheet 13•,❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.L]Other 6.❑We are a corporation and its ofFicers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.jNo workers'comp.insurance required] *.Any-applicantthat cheoks bbac#1 must also fin outthe seetionbelow showing their workers'compensation policy information: Homeowners who submit•tbvg affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this boic crust attached an additional sheet showing thea workers'comp.p°h� ber.�d state whether or not(hose enes have employees. If the sub contractors have employees,they must prom X am an employer that is pr oviding-workeps'compensation inszsrance for my ernpZoyees. .13elow is tliepolicy andjoh site information. Insurance Company Name: ' ExpvrationDate: policy#or Self-ins.Lie.#:. City/State/Zip: lob Site Address: icy declarationpage(showzagthepolicpnumb er and expiration date). Attach a copy of the Workers' coampensationpo Failure to secure coverage as required under MGL G.152,§25A is a criminal violation punishable by a five up to$1,500.00 of the DTA fo and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDF t and a fine o£up to $250.00 a day against the violator.A copy Oftbiss Vaal statement may be forwarded to the Office of Iavestig-,tions r insurance coverage-verification. l do herehy certi under the airs andpenalties ofperjary that the information provided above s true and correct .- Date: //2 Z Si atme: Phone#: 6 —8 Official rise only. Do notwrite in"1118 area,"o be coar�pleted by city or to7vn offzciar City or Town- YexmiiE/License# issuingA.uthoxity(circle one): 1.Board of Health. 2,.Building Department 3.CRY)TOVn Clerk 4.EIectrieal Inspector 5.plumbing Inspector 6.Other j phone#: Contact Person: ,4co c� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWYM) 5/15/15 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: It 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 CONTACT Robert M. DeGregorio Insurance PHONE rAx 34 Woodside Avenue noNss. (617) 846-3313 N ; 1617) 846-3317 Winthrop, MA 02152 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Evanston Ins. Co INSURED I NSUREt B: Pino Construction IIISURERC: Robert Pino INSURERD: 26 wave Way Ave INSURER E: Winthrop, MA 02152 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. NOTiMTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE RUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND_CONDITIONS_OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR --- TYPE OF INSURANCE ------AOD �INSR M POLICY NUMBER _ PMS YYYYV T p tMMA)OrtYYYI LIMITS A GENERAL LIABILITY 3EG4171 8/1/16 8/1/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENEFALLIABILITY DAMNGE TO RENTED $ 50,000 CLAIMS-MADE EIOCCUR MED DIP(Ary one person) $ 1 000 PERSONAL&ADV INJURY S 1 OOO OOO GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATELIMIT APPLIES PER PRODUCTS-OOMPlOPAGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT-- Fza accidarl $ ANYAU10 BODILY INJURY(Per person) $ AU OVVPED „ SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) _AUTOSNON-OPROPERTY DAM4GE $ ^ HIRED AUTOS era ',dent $ UMBRELLA LIAR OOCUR — EACH OCCURRENCE $ EfCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIE10RIPARTNERIEXECUTIVE $ OFFICERIMEMBEREXCLUDED? NIA E.L.EACH ACCIDENT (Nlandabry In NH) EL.DISEASE-EA EMPLOYE If describeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMrr $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addidonal Rerrerks Schedule,ifmore space le regdred) General Carpentry I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. III A'7 RE PRE"TATaVE i Pe th ©1968-2010ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registetIladmarlts of ACORD Phone: Fax: E-Mail: �i I Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-044462 Construction Supervisor � ROBERT PINO 26 WAVE WAY AVENGE WINTHROP.MA 02152 ¢1 Expiration: Commissioner 05/31/2018 n��e�ayn-»ea��rac�x���-a�'G/�iusar�«delt u Office of Consumer'Affairs&Business Regulation: OME IMPROVEMENT CONTRACTOR egistration. 174662 Type: Expiration:.- -1141201-7-1Individual ROBERT PINO a :ROBERT PING: K 26 WAVE WAY AVE WINTHROP,MA 02152 Undersecretary