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HomeMy WebLinkAboutBuilding Permit # 2/10/2016 BUILDING %AOR PERMIT o�-cTye-Tuvo ,q 6 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATIONCIA Permit N Permit p�o#.�j. ® }(� Date ReceivedPp"^`5 7 ATED I �SSACHU`��� Date Issued: I l7tp IMPORTANT:Applicant must complete all items on this page LOCATION , Pnnt PROPERTY OWNER 1/►d1 k/<a t� Print 100 Year Structure yes no MAP / PARCEL: D� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑A eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r z, ,, . err'7 f f �f r in= ❑^lNetlaitls , „ r. r , Watershed District ,F ® Se tt ❑Well ❑ Flood la ,. r, r;, r ;r P.rr mY s�/..,;wr,✓ s! rr r.. a.. .a ru;fi,:N. N", f9r :�}:.r�r -:� /✓" �. �,c1 n ra .,...kid t, ,�: � d �.:.f' 5.. „a � t r 1 ,� Ir r .r ✓.rt: r//�i`u ;r���, 3. :� d (k, ,e�x :�,rr '<'?!; r,• .,."'i;.N"'.h ....d '�!` arrfia9>ss�.u:+a:�if r.- ? �17'�, ��r( �a ,ar ,',t�fvz` !_6"r�; .^v...�, a-T.,."y tG�. i�/f.: �✓' ,. ,.n.-;- �../1! U � ✓ �� r rrria� a.�i� � :r � s�,L r r t.:✓ ..r I r �/ s � r .lf r....��t r } ®�Watet•,����E�11/eC�:�,r,�rru�,.clr'%.'��fi�'�a.��„ _�,r�,rr ?>✓�rfs:r �',�✓.c�.�,' ,�< ar, :�, ,�P,rt�F ,ria �,li r., �rr,. � r.� ,r', >%, a„c DESCRI�OFWORK TO PE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: eTPhone: Address: ` Contractor Name:_t �I Phone: Email: Address: 9m m c Supervisor's Construction License: Exp. Date: a Q Home Improvement License: - Exp. Date: 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: $ G FEE: Check No.: 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do o ha v acc s to the guaranty fund I If - — r KITCHEN INSTALLATION ESTIMATE WORKSHEET - USA Stare: Scrwca Prorlticr: '. 2685 R.J.MIOAtruction Customer. Oste: Tim True, 617-834-1265 11/25/2015 Category Breakdown Dema and Haul Away $3,127.00 Electrical W1635r00 Plumbing $2,730.00 Hardwood Flooring $1,800.00 Drywall/Repair $1,010.00 Cabinetry/Appliances $2,452.00 Additional Charges/Permits $730.00 Totaltt Customer Signature: (� /.'L�i't.Z� .i: :/l, Date: Associate Signature: �;Z, ):Z•� •t. — Date: 1 GC Signature: Data: Z•d 9990LLZ9L6 u0span pjuyoiy d9g:80 9 b ZO Qat -rt m :T 103" N Tim&Jennie True` oa 55" 24" 781.956.7424-Tim I aP24" 617.834.1265-Jenn co CROWN MOLDL9G information HSEE Molding Detail for Profile Placement Under SOFFIT.: Ctt`24301, l CY{ 2130P OGPB;Ogee Pilaster used to build crown to ceiling: 1, ! w SITE::52 Clarendon$t LCM8;Large CrossmMolding tobefacenwuntedonOGP8 (11 ,.i36RiVD SSS3633 w Nortb Andover,MA i ;a and placed up against soffit bottom M f' 'UF3SB30 BllTI STO OF rn m .� CeilingHtisht:9;-3/4' '.. I_ soifitBottom:87 134-" 54. I Top.Uigunent:E (underso w vE^ 4'_ fiomeOepot6L•Lurements en 41" 87"— 0" o, 1Q" Ctliinginth(momEi.S' I _ ' II Daor$t}ie:DeiRapThertnotail Doo:Coos.:FuIFC-day.Rxcssi W21301,W21301, T89 TDS ' _ t Box Cort,Standudifi-NDF etsomt3rs'Fumitmeply+mot i l Pulls:32 9911 Eoa Fuil I N lapprot-thets}autafthelutc - O N Al K) i "I lutebeen adsfsedotthees: Oraade:i.acdu*.ed-indti s+Jleanrattmedirectlytoscb � ( dateandtime. Ceiling in this mom?4.75! . i .. /,/-N 'lhnraL^obnadsiseddut k N nudeforbll'Fm;ec Itis the: +� i do hi,90 d ysHm eceip: cOi I` Y(L--. wry N Apo t�HYmisn;;damaa N co tapiacemen; 'v E Ir 26851EtiH'i TRUE } k co i.C16.centered51'off the leftcttiLhas;d4osaL tel- 2D:v?4ctntend23�alEtie rightctl m co O N r 3.Dnirsjrea tnesinkgwIntothe0oor; '. 1.5ta�c30'gas.ireesGndin;carttered5G.75'ofithedghn+v3.� If 5.Hoad30'teasautslde. I 6,Fddge30:rs31dx67 -- � 7.Ceilingrmdife:ertrtc3hts.kitchea3i.5'.Dinrtin9=�s' -�` i INSTALLATION NOTES are located on the! . •. 4SEE Molding Deta4 for Profile Placemet 59�. 39 9.. 157 i DETAIL STARTS HERE FAX PURCHASE ORDERS Date: 01/09/2016 Page: 2 FROM: THE HOME DEPOT FAX: (978) 946-6417 STORE 2685: METHUEN PHONE: (978) 989-9025 xt. 420 72 PLEASANT VALLEY ST METHUEN, MA 01844 this number to invoice The Home Depot) P.O. Nbr 85459053======= For customer: TRUE TIM=-===== 0000-282-627 KITCHEN POINT-NAT FROM MEASURE: 239969MOI MEASURE PO#: 85458290 INSTALLATION SITE: Jennie True PHONE: (617) 834-1265 Ext. 52 CLARENDON ST NORTH ANDOVER, MA 01845 TRIP CHARGE: X0100 CUSTOMER NAME: TIM TRUE PHONE: (617) 834-1265 WORK Ext ORDER: 239750 REF #: 02 No merchandise selected. MERCHANDISE WILL ARRIVE AT SITE VIA THE FOLLOWING: KITCHEN POINT-NAT CUSTOM WORK: 01 PO #1 OF 7; DEMO AND HAUL AWAY PER INSTALL WORKSHEET 1/08 Quantity: 1.00 UM: MR Price Ea. : $3,127.00 Extension: $3,127.00 SPECIAL INSTRUCTIONS: PO #1 of 7; Demo and Haul Away per Install Worksheet 1/08 INSTALLATION LABOR SUB-TOTAL: $3, 127.00 CREDIT FOR MEASUREMENT: -$99.00 INSTALLATION LABOR TOTAL: $3,028.00 9-d 999OLLZ8L6 uosipsu, paeyoi�j d00:60 9l ZO qac i DETAIL STARTS HERE FAX PURCHASE ORDERS Date: 01/09/201.6 Page: 2 FROM: THE HOME DEPOT FAX: (978) 946-6417 STORE 2685: METHUEN PHONE: (978) 989-9025 xt. 420 72 PLEASANT VALLEY ST METHUEN, MA 01844 ____---====_(Use this number to invoice The Home Depot) P.O. Nbr 85459054======= For customer: TRUE TIM------= 0000-282-627 KITCHEN POINT-NAT INSTALLATION SITE: Jennie True PHONE: (617) 834-1265 Ext. 52 CLARENDON ST NORTH ANDOVER, MA 01845 TRIP CHARGE: $0.00 CUSTOMER NAME: TIM TRUE PHONE: (617) 834-1265 WORK Ext ORDER: 239750 REF #: 03 No merchandise selected. MERCHANDISE WILL ARRIVE AT SITE VIA THE FOLLOWING: KITCHEN POINT--NAT CUSTOM WORK: Ol PO #2 OF 7; ELECTRICAL PER INSTALL WORKSHEET 1/08 Quantity: 1.00 UM: MR Price Ea. : $2,635.00 Extension: $2,635.00 SPECIAL INSTRUCTIONS; PO #2 of 7; ELECTRICAL per Install Worksheet 1/08 INSTALLATION LABOR SUB-TOTAL: $2,635.00 INSTALLATION LABOR TOTAL: $2,635.00 g-d 5890LLZ8L6 uosipeW pjeyoi�j dL9:80 9 L ZO qe3 :J41L'eiL�. g/IL. aGd Ace afi�r�SPLm V4 Q -e O,�havesfig V 600 washw>�H, pec fni� zsg sy ,Y � {�1? Ir�L MeeA�n �n�o �flecti!idansIPRnrmb zG 1`l�=;�c(3usiness(OrgznizA�ior,/6�ndividual): �E�`� rS/ �7' �E"' �'"� Au Lwess: q®R 6 a 5-4�"'U �! Ci a;dst l te/Zllp: 1�1J5t1 P ®1,57 s, Filone Are yuu 2a empisyer?Check the appropriate tea: Type of project(required): I.❑ I am a employer with j 4. °'` I am a general contractor and I 6. ❑ .amu construction employees(f0and/mF zlart✓tine).* have hilted Fite sub-c©niractors 7. remodeling 2.❑ 1 am a sole proprietor or partner- listed oil the attached sheet.4 ship and have no employees These stab-contwtors have g. ❑Demolition working for Isle in aay capacity. workers'comp,inswar-tce. g. ❑Building additior, "No workers' eorup.intro 2raaee D. ❑ Gee are a corporation and its El pal officers have exercised heir I0❑ �_ccrrical repairs or additions required. ;1. Plumbing repairs or additions ❑ 1 am a homeovmer doing:LII wort rine of exemption per j GL ❑ g P [No workers' 'romp. . I52,§I(4),and we ha,e no 12.❑I{ _spars insmTaace reg7iir .]7 employees. FNo worker I3• er com=p.insurance required. 4� ny.applicant:hat checks box#I must also fill out the section below showing their wormers'compensation policy inf rmation. T I3omeowam who submit this affidavit indicating 11M nae doing all work and then hire outside eontmetom must submit a new affidavit indicating such. �Co-ruactors that ca—T.-this box must attached an s.didaual sire-showing the risme of the sub-connacmxs and weir worker'comp.Policy infbanation. i€grenaaeeyt-F my employe �e atw v� e o andjob tie ,fa'3�SiF'3K.CZZf�QF'�. `� zasumnce Company Mame: Micy#or Self-ins-Lic.#: C' 6) J Expiration Date: Job Site Address: 2-15 ^.itylState/Zig: A-t; ch a spy of the workers'compeagadon policy declaration page(showing the p®Ucy HumbeF a>ad eX&'a€ion ds4e}. Faiiure to secure coverage as required under Section 25A of MGL c. 152 can lead torte imposition of criminal penalties of a Line up to$1,500.00 and/or one-,mar imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine OT up to$250.00 a day agate tine wolator. Be advised that a copy of this stab meet may be forwarded to the Gfflce of Lnvestigations of the DLA for insurance coverage verification. 1 deZe: 8 e a.€ad�o.;�perY d2@9 tae drawn Baa Prov €tie and cwreet Si-na Date - r hone#: o Quid use only. Do aroB ewrke in Mb alb to be campk9ed by city of torus q xiaL Ciiy or Town: PeemiVLieense## Issuing Aunt%ority(circle one): L Board of Health 2.Building Department 3.Cil;Nown Oerk 4.EIL--cleat InspeCtor 5.Plumbing lAspeetor 6.Otlneir Phone#: Contact Per'soan• Y �y =G�W4'iI2015 YYY) A�,10 CERTIFICATE OF LIABILITY INSURANCE 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(les)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). CONTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER a o Ezi: Arc No 3560 LENOX ROAD,SUITE 2400 E MAIL ADDRESS: ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE NAIC 9 100492-HomeD-GAW-1516 INSURER A Steadfast Insurance Company 26387 INSURED DEPOT AT-HOME INC.-HOME SERVICES INSURER C: amP INSURER B:Zurich American Insurance Co 16535 DBA THE HOME DEPO THD AT-HOME SNew Hshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685-09 REVISION NUMBEPU7 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. INSDDL SUBR POLICY EFF POLICY EXP LIMITS LTRTYPE OF INSURANCEINSR WVD POLICY NUMBER M1DD MMIDDNYYY A GENERAL LIABILITY GLO4887714-05 0310112015 03101/2016 EACH OCCURRENCE $ 9,0001000 X ow COMMERCIAL GENERAL LIABILITY PREM SES Ea occurrence $ 1'�' CLAIMS-MADE M OCCUR LIMITS OF POLICY XS Mm EXP{Any one person) $ EXCLUDED T7— OF SIR$1 M PER OCC PERSONAL&ADV INJURY $ 9'000.0 GENERAL AGGREGATE $ 9,00.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,00.000 X POLICY JE 6 LOC $ B AUTOMOBILE LIABILITY BAP 293886312 03/01/2015 03101/1016 CEoa aBI ED SINGLE LIMIT nt) 3 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccldent s UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED I I RETENTIONS $ C WORKERS COMPENSATION WC017731493(AOS) 03/01/2015 0310IM16 X WC srATu- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS E C ANY PROPRIETORIPARTNEME)(ECUI NE Y 1 N WC017731495(AK,KY,NH,NJ,YT) 03!01/2015 03101/2016 E.L.EACH ACCIDENT $ 1'�'� D (Mandatory In ER EXCLUDED? N r A WCOIT731494 FL 03/01/2015 0310112016 ,000.000 (Mandatory In NH) ( � E.L.DISEASE-EA EMPLOYE $ It yes,describe under Coniinued on Additional Pae ,000.000 DESCRIPTION OF OPERATIONS below B E.L.EDISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,R mon:space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Muldtegee ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD =J x- Office of Consumer Affalrs'and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improti`ement Contractor Registration THD AT HOME SERVICES, INC. RICHARD FALLONEf� ` 2690 CUMBERLAND PARKWAY SUITE 3r` ATLANTA, GA 303 Lpd3_eddre an—d rc?t] C3iti_-mark fe3�0u'or: 3II :- _ �ddr� Empio, ent _ Logic Card s,t-os Jul 28 15 09:40a Richard Madison 9782770685 p.1 Massachusetts Department of Public Safety - Board of Building Regulations and Standards License_GS-030000 Oonsi:action 5nuervacr RICHARD)MADISON `�-.• " ' 3 MADISON AVE GROVELAND MA 01834 - t jZCK CA— Expiration: Commissioner 07/2V2017 — ==Office or Consumer Affairs&BbsinessRegulation 1��kOME IMPROVEMENT CONTRACTOR ff� Iegistration: 118508 - Type: 'Expiration:- 312912617 DBA R.J_CONSTRUCTION RICHARD MADISON- 3 MAD1§0N AvE ADISON3MADISONAVE GROVELAND,MA 01834 Undersecretary