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HomeMy WebLinkAboutBuilding Permit #737-13 - 57 Peters Street 5/1/2018 ttORTH q -7 BUILDING PERMIT t' e_` �bo'"'6'6M0 TOWN OF NORTH ANDOVER I a APPLICATION FOR PLAN EXAMINATION 1 b Permit NO: Date Received I A6gATlD ,PP 'l' Date Issued: 9SSacHus�� IMPORTANT:A -ticant must complete all items on this page LOCATION — �Print PROPERTY OWNER' 1 `�� nno jPrint MAP NO: W- PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building = One family D Addition =Two or more family _ Industrial Alteration No. of units: _ Commercial Repair, replacement - Assessory Bldg - Others: Demolition - Other Septic ❑Well = Floodplain ❑Wetlands = Watershed District Water/Sewer w S,-L AA OVA A C2yO 4 Identification Please Type or Print Clearly) -7`6- �ZS09L OWNER: Name: �� L �c%��'�" 1 Phone i Address: CONTRACTOR Name: 9.7%- %�S4:-96 36(w-u-) /�.c.►'Cotv�J G . SJVNTaS Address: Supervisor's Construction License: Exp. Date: G � �l0 4 - i O � Home Improvement License: �ii i Exp. Date: 11 _ ( 0 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: $ (!�>1 ©® FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ac� e�antyfu Signature of Agent/Owner Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page L®CATIONi ! ..._.�. P.- PRO_ PERTY OWNERS :: -- — `- - f x Pnnt 1.O.O�Yearf ld4Structurei yes: no MAP�NO' PARCEL_ A ZONING�DISTRICyT t H storip istrid-V ye_s no - }. V ei y `nb MachineShop .illages ; •L 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: ❑ Demolition ❑ Other ❑ SeEptic ?O�Welll N `Floodplaina ®Wetlands =a_❑ 1Natershed District ❑a1%Vater/SewerY _ _ -, .F. -� Y �' i n1 �. DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONRACT® Nam ,R _ m ho Tne ' e P }Address _ -- _ _ - — - Supervisor{sConstru`cfioniLlcense: Horne�Im rovementyLicense : Date #v. f . _ .- ,pw _ _.. _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature t/Owner w .f__rSig7aturenofcontractor� :� ' r';. t � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Star ped-r'lans ❑ a_ 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY 1 INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i CONSERVATION _ _ Reviewed o_n_ Signature COMMENTS HEALTH Reviewed on Signature r COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Osgood Street FIRE'DEPARTMENT` -Temp Dumpster on site yes no Located at 124 Mair Street Fire Departiier�t=signatureldate' COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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 ® Notified for pickup - Date Doc.Building Permit Revised 2010 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) L3 Mass check Ener Compliance Re Energy p port (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 j ❑ 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 j ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: 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 apu:.al 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: Doc.Bui?ding Permit Revised 2012 Location / e o S 7- ' ��✓/^� No. Date t - . - TOWN OF NORTH ANDOVER o, Certificate of Occupancy $ Building/Frame Permit Fee $ E a'= Foundation Permit Fee $ Other Permit Fee $ TOTAL $ l' Check# —S9-e lF: 26359 uilding Inspector l Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 16,893.00 m $ - $ 202.72 Plumbing Fee $ 25.34 .Gas Fee 100 comm. $ 100.00 Electrical Fee $ 25.34 Total fees collected $ 353.40 47 Peters Street 737-13 on 5/6/2013 repair from water damage ttORTH Town of 0 . . - 0% No. % ksogorh ver, Mass, Gt o2a 13 coc"Ic Nl W.c. y1' �,9 p�RATED �Pa�.(5 S u BOARD OF HEALTH Food/Kitchen PER..MIT T LD Septic System THIS CERTIFIES THAT I5 ..ULf'-AV44 0&-s BUILDING INSPECTOR ......................: .................................................................................. s � L C�w Foundation. has permission to erect .......................... buildings on ... .1......e !e 5..... 17C.e PJ... ................ • Rough to be occupied as ..........' ....Vtn (!.S r......... 4-c.. Du Y��L4:.. ..a:'. .:f� KS Chimney .... ......... ' ...�.. .'......... .. provided that the person accthis permit shall in every respect conform to`!he terms of th 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 CONSTRU . S 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. SEE REVERSE SIDE Logus Construction, Inc. 25 Linda Rd—Andover—MA—01810 Phone—978 475 9565 Cell—978 886 9636 Fax—978 475 956 Email—tmctnntnc(@P,mai) rnm Proposal : 0313 28 Jan 2013 Proposal/Specification for:1s`United Methodist Church(Douglas Bacchi) Address Job Site:57 Peters St—N.Andover—Ma 01850 Phone:978—475 0901 978 390 2743(cell) Work to be done: Level 400 —Room#400: (area :400sf.) Repair stain from water damage, apply(stain block Kills), two coats of paint ceiling and walls Price for labor and materials:----------------------------$1,314.00 -Room#401: (area:400sf). Remove and dispose vinyl thefloor, installfiberglass insulation R30 or R38 over ceiling, install blue-board on ceiling, apply plaster veneer on blue-board, apply one coat of prime and two coats of white ceiling paint on ceiling,prepare subfloor(refastening) were necessary, apply one coat of sealant over subfloor, skim coat of cement to smooth the subfloor and install new vinyl tile floor and vinyl base-board(821f). Price for labor and materials:-----------------------------$5,074.00 Rom#402: (area:400sf). Remove and dispose remaining vinyl floor tile, apply(Prime Kilz) were necessary and.finish with two coats of white ceiling paint, repair walls and apply two coats of paint,prepare subfloor(refastening) were necessary, apply one coat of sealant over subfloor, apply skim coat of cement to smooth the subfloor, install new vinyl the floor and install vinyl base board(821f) Price for labor and materials---------------------------$2,904.00 -Corridor Across room#402.: Remove and dispose existing carpet(+/-275sf); install new carpet, install 1001f of vinyl base-board and paint walls Price of labor and materials:------------------------------$2,116.00 Level 200 Archive room:Re-connect ducks for A.C., install 72sf of drop-ceiling(size 2'x4'), install 36 If of vinyl base-board and paint walls -Bath-room :Install 72sf of drop-ceiling(size 2'x4'), install bathroom fan,paint walls and install 36 if of vinyl base-board. -Custodian room:paint walls and install36lf of base-board -Corridor.Install entire drop-ceiling (+/-370sf), 115 if of vinyl base-board and paint walls Price for labor and materials:---------------------------$2.659.00 Levet 100 i -Corridor and bookcase areas.Install 80 If of base-board and paint aUs Price of labor and materials:----------------------------$97'6.00 -Holes on walls:patch all holes that was made for inspections. , Price for labor and materials.-----------------------:$220.00 Electrical work on level 400. Remove and replace 9 fluorescent light fixture on the ceiling Price for labor and materials----------------------$1,630.00 t Total price for the work --$16,893.00 i Notes:All fire sprinkler head covers included. Permit fee not included (Votes: All materials will be supplied by the contractor All materials are guaranteed as specified. Any alteration or deviation from above specification involving extra cost will be executed only upon written orders and viill become an extra charge over and above the estimate. We propose—Hereby to furnish labor and materials in accordance with the above specification for the sum of$ 16,893.00: (then thousand,eight hundred and thirty six dollars) Form of Payment: $6,893.00(when start the work) $ 10,000.00(when the work is completed) Date of Acceptance Authorized Signature Acceptance of proposal—The ove rice is s p p p p specified and conditions are satisfactory are hereby accepted. You are authori d o work as specified. Payment will be made a outlined above. f �ogus Construction, Incorp ation Date From: 11/16/2012 14:58 #059- P.001/001 A�SDP CERTIFICATE OF LIABILITY INSURANCE C`TE`� 11/16/2012 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: N the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,.certain policies may require an endorsement A statement on this ce"Niiwte does not confer rights to the certificate holder In Iieu of such endomemen ). PRODUCER CTTATIANA SALES GLOBAL HELP CENTER INC PHONE 19 MILL ST 2ND FLOOR 978)275-0997 FAx (978)275-0589 LOWELL MA 01852 .GHCLOWEI.L@YAHOO.COM INSURERsI AFFORDING COVERAGE NA�f INSURED INSURER NAUTILUS INSUINSURANCE INsvRwt s: TRAVELERS ADELSON PEREIRA INSURERC: DBA:.A C PEREIRA CONSTRUCTION 101 CONCORD ST 2R tD LOWELL NA 01852 018UREREs I URER F COVERAGES CERTIFICATE NUMBER: REVISION NUAABER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW.HAVE BEEN ISSUE!}TO THE IAISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT}FlCATE 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. TrCPE-OF INSURANCE D WV131 POLICY NUMBER EBF am GENERALLU181UTY LIMITS EAC"OCMMUNM 1,000,000 GENE`RAt�ltk8ftt7Y P_tjF ems IES onanenoe S 50.000 'yam A—. OCCUR -97536 09/12/2012 09/12/2013 MM � �Pa� s 50 - - PERSONAL A Apq(INJIJRY S1,0 GENERAtAGGREGATE S 21000.000 GEMLAGGRECIATELIMITAPPLIESPOt- PRODUCTS.COMPVOPAGG S i OODr000 X POLICY PRO i LOC $ AUTOMOBILE LIABILITY ELI Mr �stiL ANY NF BOOLY Nam(Per P�n1 S ALL OVYNEO SCHEDULED AUTOS AUTOS BODILYNAM der Wil") S HIREDAUTOS AUTOS � PROPe D S E UMBRELLA LiAB rOCCUR EACH OCCURRENCE S EXCESS LAB I d CLAIMS-MAOE AGATE S D OI IIZETENIOKS YYORIG RS COMPENSATNIN $ AND EMPLOYERS'LIABB.RY AN OTH YIN ANY PROPRIETORIPARTNEReXFCUTIVE g OFEXCLUDED? IIYNIA B7276-1-i2 10/24/2010/ 4/201 $ 100.. 000 yyooss,dasvibe uMier E-L DISEASE.EA EMPLOYE S 100 000 DESCRIPTION OF OPERATIONiw bev E L.OIWM-POLICY LMIT S 500,000 DESCRIPTIONOFOPWATIONSILOCATIONStVMGCLES(AUnhACORDIDI,AdMaWRonadnSdodWP,Ntm apw*jsregwnA SIDING % CERTIFICATE HOLDER CANCELLATION LOGUS 2/2 CONSTRUCTION 25 LINDA RD S HOULDTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ANDOVER MA 01810 N DATE THEREOF, NOTICE LAI LL BE DELPI6tED IN THE POLICY PROVISION& TIVE AM /j,% J 1 i " i r 'p Office.o oasumer airs' sores „ egu as on License or registration valid for indivitlul use only before the expiration date. f found return to: HOME IMPROVEMENT CONTRACTORType:, Office of Consumer Affairs and Business Regulation Registration 140671 Expiration 111/0/2013 Individual 1k0 Park Plaza-Suite 5170 Boston;MA 08116 A 10 C.SANTOS W77 ANTONIO SANTOS �. Al COLONIAL ANDOVER IA 01810 `� ;-` Undersecretary Not valid without gnature '`yam _ •. `'l.._, .A .. 66£61, :#Ji iauosatuui,,. ' £l0Z/£t/9 0LeLo VW `83A0®Nd ON VGNI-I SZ SOlNVS OOINOINV b0698 SO :asuaai� - asuaafi 1 JoS}na@dnS uo+zonilsuoo i�.11!1)ur.7S hur. suoilrinj1�aH 41puepirn8 to h.►r()H tatF'S z�irrttd.io lu ilty lY(i7n -�laJ�n4i11:5�r.;1 I i 4 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name (Business/Organization/Individual): r� '� ti-0 G ' ': cZ' J Address: '2-C�5 L L 1J Dom- tit L — ID ( e ( CD City/State/Zip: Phone#: �� -7 �5 9 C:�7 Are you an employer? Check the appropriat�Vam Type of project(required): 1.El am a employer with 4. a general contractor and i employees(full and/or part-time). have hired the sub-contractors 6. E)New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have shipand have no employees 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 131:1 Other comp.insurance required.] *Any applicant that checks box#1 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 anew 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,they must provide their workers'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.Lic.#: +� \�j" Cj�j �,1�� 11-1Z Expiration Date: l012-LV 13 A Job Site Address: 1 �i✓TC—CLS 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci ,under thepains and pepallieslofpeilury that the information provided above is true and correct i Signature, _Date: D 5 M= /` Phone#: 7 b - -7 7 S S �l 7S & 9 6 3 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