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Home My WebLink AboutBuilding Permit # 7/22/2015 V%01?TH BUILDING PERMIT oF�t�Eo �6�wo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h Permit No#: Date Received ��SSACHU`''��5 Date Issued: IMPORTANT: Applicant must complete all items on this page ��, LOCATION � rint PROPERTY OWNER Print 100 Year Structure yes no MAP 2 PARCEL: _ a ZONING DISTRICT: Historic District yes L Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Ubne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial PAepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic i1`Well r ❑ Floodplain x ❑UVetlands r r ❑ Watershed District �',+.,,'�.��Pi'r/SPiwelt. � r� 7J; ..,� � t'�r•,.,,,?, ,,�'.��'`�.,.,l <", i�r ,,;�rl, � r?r r� .f ,.�rrr 1YH.t r� r. ,w 1-' DESCRIPTION OF WORK TO BE PERFORMED:�e�>6eQ, �oc,,r � 0-S0 , t �✓l�s� ��,Oi�� `�' �� :-»��+�w— f k ncy.,v.9•�+-(C �c9�� c� r� � .�i�-c c.J n.,�—°� °��—�-- OVI Identification- Please Type or Print Clearly OWNER: Name: 6046- 0--le-0 Phone: c1 73 lj 7.5 -5 771 Address: L Contractor Name c��to. ��, ' Phone: Email C, Address: qfa , v Supervisor's Construction License: C5-0 Exp. Date: ,,3 Home Improvement License: / J 6V Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED 90ST BASED ON$125.00 PER S.F. Total Project Cost: -� FEE: o G Check No.: Q Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1 — — - i _ __ _ r-11111117,911 A" OORTH ur own of 2 E. :..'..,. ® ®. . - _ �. K770' C' LAKE h ver, ass, A_ COCHIC"VWICK �1 7�ADRATED p �Cl S U BOARD OF HEALTH PERMIT T L �D Food/Kitchen Septic System THIS CERTIFIES THAT .................... ...�.�!�!!�!^. .' ...,.......................................................... BUILDING INSPECTOR Foundation has permission to erect.......................... buildings on ..... .......... w•••••••• Rough P. Chimney . to be occupied as ....6.4 Dapt-e%..... ..�ai1'�.... 4............... ...... ... . ..�!• .. ,� provided that the person accepting this permit shall in every respect conform to the terms of the pplication 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 EXPIRESI 6 MONT S ELECTRICAL INSPECTOR LESS S CTI TAR Rough Service ............. ...... ..... ....... .. . ................................... 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. CONSTRUCTION 34 BIRCH ROAD ANDOVER MA 01810 978.835.5194 GREG.ZALANSKAS@COMCAST.NET QUOTE#j 24 Order# _ Date 7/20/2015 QUOTE SUBMITTED TO: WORK TO BE PERFORMED AT: Name Gemmell Name SAME Address 390 Winter Street Address .City-state North Andover MA Planned Date Phone small Job Description: Replace front entry door Doors being installed Before August 1st Cost of door$585,00/labor$550.001 disposal$30.00/trim$125.00/reinstall existing storm door$50.00=$1340.00 The front door will be a Therma Tru fiberglass system with 4 lights,reuse existing storm if possible. Replace garage door with a 20 minute fire door. Cost of door$588.00/labor $550.001 disposal$30.00/trim$80.00=$1248 work completed 6115 repairs to house,new weather stripping on 2 doors,new weather stripping an garage door,repair cements floor in garage door,repair ceiling in garage stain block water stains in garage,fix basement window,secure railing on basement railing, Materials and labor$645.00 Permit$90.00 All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of. $3,323.00 PLEASE MAKE CHECK OUT TO ZALANSKAS CONSTRUCTION with payments to be as follows Due at completion$3323.00 Submitted by: GREGORY ZALANSKAS OF ZALANSKAS CONSTRUCTION Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the workacified above. Payments will be made as outlined above. Accepted by: L)j-m Im Please note: T proposal may be withdra n by us if not accepted within 30 days a1�/s The Commonwealth of Massachusetts Department of IndustrialAccidents tea. . a 1 Congress Street,Suite 100 Boston,MA 02114-2017 -` www.mass.gov/dna sy, Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetrieians/Plumbers. TO BE FILED WITH THE PERA UTTING AUTHORITY- Applicant UTHORITY.A licant Information ,r Please Print Legib Name (Business/Organization/Indi-vidual): \ ' fn Address: ) d A r rc—.) City/State/Zip: kV\Ol d/ f (f Phone#: �3 5-S? 9 'J Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am.a employer with employees(full and/or part-time).' 7. ❑New construction 2.[Uflam a sole proprietor or partnership and have no employees working for me in $, [9-Remodelirig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition 4.F1I 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.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.) i 14.Eglbther 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. T -- 152,§1(4),and we have na employees.[No workers'comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submif this affidavit indicating they are doing all work and then hire outside contractors must s4bmit 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-contractors have employees,lliey must provide their workeis'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: fob 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 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 DIA for insurance coverage verification. I do Hereby certify under•the pains andpenalties ofpeijuiy that the information provided above is true and correct. Si nature: rr 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.Other Contact Person: Phone#: Client#:10322 ZALANSK S ON T AC®R®- CERTIFICATE OF LIABILITY INSURANCE DATE(MMtODIYYYn orn1no15 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC N INSURED Zalanskas Construction INSURER A: Arbeila Protection Ins Company INSURER B: GregoryZalanskas (OBA) INSURER C: 34 Birch Road Andover,MA 01810 INSURER D INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY nEOUIREMENT,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, SR kDall TYPEOFINSURANCE POUCYNUMBER PO CY FECTIVE -OOUCY EXPIRATION LIMITS — A GENERAL LIABILA Y 6500022056 06/15/15 06/15/16 EACH OCCURRENCE S1 00O 000 X GDMMERGALGENERAL LIABILITY DALUIGETORENTAE'Onmt $100,000 CLAIMS MADE Ir(OCCUR MEOEXP(Arty ono porson) S5000 PERSONAL SADV INJURY $1!000.000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO s2,000,000 X POLICY M PR4 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Eo acddent) ALL OWNEO AUTOS BODILY INJURY S SCHEDULED AUTOS (Pot Potson) HIRED AUTOS BODILY INJURY S NOWOWNEO AUTOS (Pot mcidon0 PROPERTY DAMAGE $ (Pot accidont) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTOONLY: AGG S EXCESSIUMBRELLALIABILITY EACHOCCURRENCE S OCCUR F-1CLAIMS MADE AGGREGATE IS S DEDUCTIBLE S AETENTION S S WORKERS COMPENSATION AND WCSTATU• DTH- EMPLOYERS'LIABILITY � ANY PAOPRIETOPJPARTNERIEXECUTNE.L.EACH ACCIDENT $ E '.. OFFICEROMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S IIypt'C,d."'P"De under SPEGAL PROVISIONS Golow E.L.DISEASE•POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS Job:Gemmell Covering operations usual to Zalanskas Construction... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OE CANCELLED DEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SD SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR IJASILJTV OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUMOA') SENTATIVE ACORD 25(2001f08)1 of 2 NS32351/M32350 ML 0 ACORD CORPORATION 1988 ----------------- Office of consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type: wX9P istration: 126875 iration: 8!312416 Individuall GREGORY J.ZALANSKAS GREGORY ZALANSKAS 34 BIRCH RD ANDOVER,MA 01810 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-072201 GREGORY J ZAIMS 34 BIRCH RD Andover MA 018'10 Expiration Commissioner 03/18/2016