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HomeMy WebLinkAboutBuilding Permit #1322-2016 - 69 WATER STREET 6/21/2016 �j 41 O®RTH BUILDING PERMIT oF��,�D ,bgtio TOWN OF NORTH ANDOVER b APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received a,� RgDR'17ED .(5 > SSACFEUS�� Date Issued: 0 i� IMPORTANT: Applicant must complete all items on this page LOCATION' 14 2a 124 5� " &rb7u P p— _ Print PROPERTY OWNER )ol-�afon_cv_a Print 100 Year Structureyes no MAP _PARCEL 12— ZONING DISTRICT: Historic District no Machine Shop Village (y5) 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: li ❑ Demolition ❑ Other O Septic 01Nell Floodplain ❑Wetlands ❑' Watershed?GDistrict, Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: i , C�1veAQOokcc& 01.6 4 e` 1 r,7\`n6 Ce da �C Identification- Please Type r Print Clear y OWNER: Name:�r t�Y\ Phone: Address: Contractor Name: 2/f1A) c��nct.cton Phone: �'-fZ��q/-7� � Email: Address: t� Supervisor's Construction License:-(12!? Exp. Date: /d//31Z6 v Home Improvement License: 1`ZS3 7,j�2 Exp. Date: / r 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: $ 01p_06n FEE: $ I/ Tt`zl_ Check No.: � 2J® Receipt No.: 2 tq ,�. 2 NOTE: Persons contracting with unregistered contractors do not have acces to a guars ety fund ,v..ps i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanuing/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 - D FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH1 Reviewed on Signature COMMENTS ` Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes o Punning Board Decision: Comments 1 Conservation Decision: Comments Nates'& Sewer Connection/Signature & Date Driveway Permit DPW Town]Engineer: Signature: k- Located_ 3sgoo - I E D,EPAR�TfVII N Tem Daum: 84 Osgood d Street qi ated at+1 4 ain StMU, � , � � 4 � , PK �i� `�"� 4 I�ia� ©e artment segnataare/ �--, s r , z ,z 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 I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department apse) I i i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 durnpster 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 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 4- 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) 4, Copy of Contract 2012 IECC Energy code 4, 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 Locationtitl 6 ' } �� � Dated n !� No. • t • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building%Frame Permit Fee $ �� - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check It -� E 3 0 e Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 96,000.00 m $ - $ 1,152.00 Plumbing Fee $ 144.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 144.00 Total fees collected $ 1,540.00 69 Water Street 1322-2016 on 6/21/2016 two family remodel NORTH own o ndover - :�r h ver, Mass16 Tume, D O CLAK A. CO[NIC«tw�C« V ADRArED 1'PP��(2 S U BOARD OF HEALTH T T L D PERq1 Food/Kitchen Septic System THIS CERTIFIES THAT ,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ......... . .... .. .. has permission to erectAj g Foundation � �if.f►[ .�. �� vll. . Rough y to be occupied as ... ... .. ....... . . ... . . . .; .... .... . . . ... Chimney provided that the person accepting this permit shall in eve respect conform to the terms of the application p p p g p every p pp � 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. I*; � PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR N Rough Service ... .. ...... . ...... .... Final B DING SPECTOR 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. Construction 317 south Broadway Street Lawrence MA, 01843 Fax: 978-683-4017 Cell: 978-242-2707 Caconstruction01 @hotmail.com Jonathan Zapata 69 Water Street North Andover, MA 01845 617-816-1369 The undersigned proposes to furnish all material and necessary equipment and perform all labor necessary to complete the following work; Interior ❖ Install sheetrock on ceiling and walls on both apartments ❖ Renovate each bathroom of each apartment (2bath) ❖ Renovate both apartment kitchens ❖ Update the electrical circuit panel (2 apartment) ❖ Install% hardwood flooring in living room and 3 bedrooms (2 apartment) ❖ Install ceramic flooring in both apartment kitchen and bathroom All the above work is to be completed in a substantial and workman like manner for the sum ninety-six thousand dollars ($96,000)to be paid at the actual cost of labor. A first payment of($ 55,000). A second payment of($25,000) and a third payment of($16,000) at completion of the project.Any alteration of derivation from the plans and specifications will be executed only upon writing orders by the owner and will be added to/or deducted for the sum quoted in this contract. All additional agreements must be in writing The contractor agrees to carry the Workman's Compensation and Public Liability Insurance and they are to pay all taxes on material and labor, furnished under this contract as required by Federal Law and the Laws of the State in which this work is performed. Estimates are based on plans provided. If client would like any changes made to the plans, the client must discuss this with the contractor and provide written documentation stating the changes. There will be a new estimate done. Both the contractor and the client must sign upon agreement. Plan price will vary according to changes. Price may also change due to unforeseen-obstacles. In other words, if the contractor has to do extra work for things that are not visible,the client is the one to pay for this. The client will be informed of any unforeseen obstacles. Respectfully summited by Construction Supervisor Acceptance You are hereby authorized to furnished all materials, equipment and labor required to complete the work described in the above proposal, for which the undersigned agreed to pay the amount stated in the proposal and according to the terms thereof. A/, Client Contr ate W � - 1 ' i Ae Commonwealth of Massachusetts z .Departm.ent oflndnstria-lAceldents 1 t egress Street,Suite 100 'F Boston,MA 02114-2017 www.rnass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ApplieantInformailon Please Print Le 'bl Name(Business/Organiaation&dividual): .Address: City/State/Zip Phone#: 0i en A.reyou an employer?Checktlie appropriate box: Type of project(required): I.Vain a employer withemployees(full and/or part-time).* 7. F1 New eonistmction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. [AZemo deling any capacity.[No workers'comp.insurance required] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4-F]I am a homeowner and will be hiring contractors to conduct all work on my property. l will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[(Electrical repairs or additions proprietors with no employees. ' 12-❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.[ oof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MU c. 14. Other 152,§1(4),and we have nQ employees.[No workers'comp.insurance required.] r *Any applicant that checks box 41 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. tContractors 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. Ifthe-sub-contractors flava employees,they must provide their workers'comp.policy number.'.: fa'man employer that is pr ovidiiag world rs'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: ^{ -- Policy#or Self-ins.Lic.#: w c 2� wi —v3 to Expiration Date: fob Site Address: q "I ]a S, � City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(late). Failure to secure coverage as required under MGL 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 fine ofup to$250.00 a day against thA violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage ve anon X do hereby ce i under aepains - penalties ofpetjury Haat the information provided ab ve is trice and correct. signafore: Date: / 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.Othek Contact Person: Phone#: Information and Instructions Massachusetts General Laws ci x 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 of lure, 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 trustde 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 b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who lias not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)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 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 carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Depattment 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' compensations policy,please call the Department at the number listed below. Self-insured companies should'enter-their self-insurance],.cense 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"lob 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 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 021.14-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 e 2-23-15 www.mass. ov/dia Revis d 0 g 978-685-0310 Silverio Ins. 11:54:11 a.m. 06-16-2016 2/2 aco& CERTIFICATE OF LIABILITY INSURANCE DATE"MIDUNT"' 06/16/2016 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(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 NAME: Johanna Gutierrez Silverio Insurance Agency PHOS pa. (978)685-0209 No: 978)885-0310 10 S.Broadway App sg: info�silverioina►rance.com INSURER(S)AFFORDING COVERAGE NAIC 0 Lawrence MA 01843 INSUtERA: WESTERN WORLD INSURANCE INSURE INSURER B: LIBERTY MUTUAL FIRE CARLOS CASTANAZA DBA CA Construction R49URERC. CA CONSTRUCTION INSURERD: 317 So.Broadway-Supe 154 INSLRERE: LAWRENCE MA 01843 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. L TYPE OF INSURANCE POLICY F POLICY EXP POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCURPREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A NPP8326275 05/18/2016 05/18/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POUCY❑JECO'-T_ F�LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY CUM&N U 1FGLE LI T $ Ea a ciden _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMSMAOE AGGREGATE $ DELI I I RETENTION$ $ WORKERS COMPENSATION PER 0 - AND EMPLOYERS'LIABILITY YINANY STATUTE Ek B OFRCERIMEMBER EXCLUDE CLMVE F NIA WC2-31 S-365147-036 02124/2016 02124/2017 E.L.EACH ACCIDENT $ 100000 (Mandatory In NH) E.L.DISE E-EAEMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATION I LOCATIONS I VEHICLES(ACORD 101,Addldoral Remarks Schedule,maybe attached K more space Is required) Additional:Insured is added automatically as long as there is a written agreement requesting to be added CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of North andover ACCORDANCE WITH THE POLICY PROVISION& 1600 Osgood street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I i r-31.`fovravronaroea C�a Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR bass clause s De Type: � »ara en lic Safetlf Registration 178376 c3td 0;SaHMP,, Rv t iaf 0n* a Individual and �rax �s Expiration 4/7/2018 Si€phi 4 Auj- ` ='cense: CS496289 ESMIRNA ENCARNASCIONe X ESMIRNA ENCARjgACI0AI ESMIRNA ENCARNAG It�Ni;4 136 BUTLER ST.' P � �F a' - _ LAWRENCE 136 BUTLER STREET '� -- MA 01&11, LAWRENCE,MA 01841 Undersecretary Ex��t r Cassa�rss©sc•r 10/18/2016