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HomeMy WebLinkAboutBuilding Permit #075-2017 - 69 WATER STREET 7/25/2016 � NORT{� q BUILDING PERMIT Q SLED 16 y6:tt. k.:q •y � TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION '- ` '-7 y Permit No#: ` Date Received �qs RATED,pP��� gACHUSfc Date Issued: I L2-:d L ORTANT:Applicant ust complete all items on this page LOCATION Tint PROPERTY OWNER ' ' , ) Print loo Year Structure yesno MAP `-�1 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village zly no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition � o or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ., epair, replacement- ❑Assessory Bldg ❑ Others: - ❑ Demolition ❑ Other �,.�» Sep�i `�t�U1le "�, ;�' y�`� ® Floodplain ® etlands =� '� ® �Wa-ers►ed ®istr.ct �r��a= - _ DESCRIPTI OF WORK TO BEP RFORMED: Identification- Please Type or Print Clearly OWNER: Name: ��(�, yi � � � �� Phone: Address: Contractor Name: ;c3n1Ii hone: 7 �q Email: l' © C Address: C3 Supervisor's Construction License:&/-rt I/eta Fg/d rnaCto� Exp. Date: Horne Improvement License: Exp. Date: 1-755 37 ., ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1'7-3, , 04Z)o12e FEE: $ Z Check No.: ` \ Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access t e guaranty fund _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Public YPE OF SEWERAGE DISPOSAL t. Sewer Tanning/MassageBody Art ❑ Swimming Pools ❑ell ❑ Tobacco Sales ❑ Food Packaging/Salesivate(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on_ Signature COMMENTS W WEALTH Reviewed ori Signature COMMENTS j Zoning,Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes T Planning Board Decision: Comments _ I Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street f FIRE DEPARTMENT' �Temb Dumpster onisite Locatetl at 12.4 Mam Street � � �•"�?'°`�- ae i r Fyi',r�e Departmentsignatur�e/datis e COMMENTS , . r ,,� �� " "; 4 mss• 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 j MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) - i` - I I k ® Notified for pickup Call Email G Date Time Contact Name Doc.Building Permit Revised 2014 k 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 6 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 q OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit { Addition Or Decks -fi 4- Building Permit Application 46 Certified Surveyed Plot Plan 46 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 Comp p Affidavit of Building Plans One To Be Returned to Include Sprinkler Plan And Two Sets g ( ) Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC 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 Location ' r—v_- No. 4 f Date 2 S� ' p • - TOWN OF NORTH ANDOVER � FT-:s y°3 °,•�� Certificate of Occupancy $ ___-- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# �f 30651 Building Inspector NORT-H oven of � � Andover O - 0 No. 2 -1 h ver, MassTd44 5 Ml WICK S U BOARD OF HEALTH Food/Kitchen PERMIT T LD� 11 Septic System THIS CERTIFIES THAT ....... :4T t4 .. INSPECTOR ........ .......................................... 0 5iW has permission to erect buildings onWFoundation Rough to be occupied as .. . ....... .... " . .............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the lication 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 TION Rough Service . .. .. . . .. .... .......... ........... . Fina BUILDING SPECT 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 617-8161369 The undersigned proposes to furnish all material and necessary equipment and perform all labor necessary to complete the following work; Exterior ❖ Replace 4 existing windows ❖ Install exterior siding All the above work is to be completed in a substantial and workman like manner for the sum Of one hundred thirty thousand dollars ($13,000 to be paid at the actual cost of labor. A first payment of ($ 7,000). A second payment of($6,000) 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 agree to carry the Workman's Compensation and Public Liability Insurance and they are to a all taxes on material and labor, furnished under this contract as required Federal pay qu ed by ede al 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. _ 71Z,Z, 410 Client a for ate i N°RT7{ 2°¢ttlEO 16 q�° g °A Town of North Andover o Machine Shop Village Neighborhood Conservation District Commission 94 QRATF�w'PP,�•(y 1600 Osgood Street North Andover, MA 01845 SSACHuse, Certificate to Alter Date: Contact Name&Address: C (� w5��c.4--►t y-) -31 -1 - Project Address: Q Project Description (attach additional pages,if needed): I c OW, I c) � t�c�C tor Y—)..-�rll a-H.Lw'S k- � L/J(Y) 017 ( m� 1--e mry-) Ct i v) -( KA -5 h riq Commission Vote: Voted to j to grant/deny Certificate to Alter on Comments (attach additional pages,if needed): Signed: C 7 Lr Machine Shop Village Neighborhood Conservation District Commission MSV NCDC Page 1 : The Commonwealth of Massachusetts z. .. F Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA.02114-2017 www mass.govIdia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE VMED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legribl Name(Business/Organization&dividual): ] Address: Co City/State/Zip 9 Phone Areyou an employer?Checkthe appropriaie box: Type of project(required): ,10 I am a employer with employees(full and/or part time).- 7. []New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] ❑Demolition I Q 1 am a homeowner doing all work myself_[No workers'comp.insurance required.]t 10�Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12;h Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.❑Other 6.Q We are a corporation pnd ifip officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no•employees.[No workers'comp.insurance required.] 7. '`Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T 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. If the sub-c'i6d6rs tave employees,ley'must provide their workers'comp.policy number.' Iain an employer that ispioviding workers I compensation insurance for my employees.'Beloit/is thepolicy acid job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year 9n1sonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against thq,?fio1Vtor.A copy this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver' ca i n. I do herebyt'y sande sans and pen ofperjury that the information provided ove is true and correct. aigpilore: Date: 2 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#: Information and. Instructions Massachusetts General Laws chapter 1.52 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 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 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 checkingthe'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. lie advised that this affidavit maybe submitted to the Department of Industrial Accidents for confi-rmation 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-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"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 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-MASSAFE Fax#617•-727-7749 Revised 02-23-15 www.mass.gov/dia 978-685-0310 Siiverio Ins. 11:54:11 a.m. 06-16-2016 212 ACo[ ' CERTIFICATE OF LIABILITY INSURANCE ` 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 CONTACT NAME- Johanna Gutierrez Silverio Insurance Agency PHONE (978)685-0209 F o; (978)685.0310 10 S.Broadway sq- info@siivedoinsurance.com INSURERS)AFFORDING COVERAGE NAIC 9 Lawrence MA 01843 INSURERA: WESTERN WORLD INSURANCE INSURED INSURERS: LIBERTY MUTUAL FIRE CARLOS CASTANAZA DBA CA Construction INSURE?C CA CONSTRUCTION INSURERD: 317 So.Broadway-Suite 154 INsuRERE: 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 INSURANCEWVD INSO POLICY NUMBERPOLICY POLICY EXP LIMBS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES a occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A NPP8326275 06/18/2016 05/18/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 P,ERCOT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COM NEU NG LIMIT $ Ea a ciden) ANY AUTO BODILY INJURY(Per person) $ ALL 01NNEp SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPER DAMAGE AUTOS Per acc nil $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSUAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNR/E7EGUiIVE B OFFlCERlMEM6ER INCLUDED? FN]NIA WC2-31S-365147-036 02124/2016 02/24/2017 EL.EACHACCIDENT $ 100000 (Mandatary In NH) E.L.DISEASE•EA EMPLOY' $ 100000 Ifyyes,de cbeTI'ONOF OPERATIONS below under RI E.L.DISEASE-POLICY LIMIT $ 500000 DESC DESCRIPTION OF OPERATIONS?LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If 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 PROVISIONS. 1600 Osgood street AUTH OR¢EDREMSENTATIve North Andover,MA 01845 m 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORO z a, �va�c�eLt Office of Consumer Affairs&Bus ness Regulation � I' �I _. HOME IMPROVEMENT CONTRACTOR Type: Massachusetts -Department of Public Safety 1 (. Registration 178376 Board of Building Regulations and Standards on "4/712D18 Individual ExpiratiConstractOn Supentisor 1License; CS-096289 ;x, h ESMIRNAENCARNACION{ ESMIRNA ENC ARNACIO,�T _ r. ESMIRNA ENCARNACION ; 136 BUTLER ST: A LAWRENCE MA 01841 i 136 BUTLER STREET ,' LAWRENCE,MA 01841 Undersecretary j __._._._ — —�• Expiration Commissioner 10/13/2016