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HomeMy WebLinkAboutBuilding Permit #529-11 - 10 MAIN STREET 1/7/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Ir Permit NO: Z Date Received - S -t2o I I i Date �- Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 10 OCL�h S+ . _ Print PROPERTY OWNER o ( 6 d ev,0.cs Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop VillageC-V-m no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other + �LJ � �- �-- .. �-� 9!���r.-rj a :w D Septic ❑e Well _ �,�, p, MPW�etlands ❑;Watershed District y f®WR ater7Sewer _ r h � DESCRIPTION OF WORK TO BE PERFORMED: tcil K o of e, Q mac, boo r- i v s{-4(1 ©q.'lc--&oo(f r►.Gw .I Identification Please Type or Print CIearly) OWNER: Name: S& ® Phone: cI Address: CONTRACTOR Name: do t61---Q( IS. lAoev'e_, So(A"a V". Phone: 128-,3 9?-Sd Address: of Supervisor's Construction License: 1 0 3 a ? a )3xp. Date: 16Z13 la o/s Home Improvement License: 'ii 44 ? Exp. Date: I b 16-.6 t a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$72.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 5 I ,C5 FEE: $ - �- �f q Check No.: l��' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fun _ �.. ._.. ._ Signature.of=Agent/Owner Signature'ofcontractor 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 ❑ Flo or/Crossection/Elevatio n Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered.-.products NOTE: All dumpster permits require sign off frorri 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 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit a all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals ,at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording . Lust be submitted with the building application Doc: Doc-Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 1 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ' Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS bt'F i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wates' & Sewer onnection/Sianature 8 Date Drivewa rLPermit DPW'town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 MGL Chapter 166 section 21A—F and G min.$10041000 fine NOTES and DATA— For department use N cc- v UA) �1 i i a El Notified for pickup - Date ? Doc:.Building Permit Revised 2008 7 t Location/(/ No. Date NORTq TOWN OF NORTH ANDOVER F � w A �D Certificate of Occupancy $ s�cMus to Building/Frame Permit Fee $ C Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ° Check # 23845 Building Inspector NORTH Town O 6An- over 0 ,Yw.ro I over, Mass. �- ,p ORATED BOARD OF HEALTH Food/Kitchen .PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ......' r...•. q.A.q ��.�.....-5.......................................^..............................,.......... Foundation has permission to erect......................................... buildings on ..... ....JT ................. Rough 1 C� V� "�� R.. lei. Chimney s to be occupied as.................................................... ..........P.l�il............... �....... d ��00...... . . . . .. . . . . . . . provided that the person accepting this permit shall in eve res ect conform to the terms of thea lication on file in P P P 9 P nl p PP Final 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 oFthe Zoning or Building Regulations Voids this Permit. Rough Final PERMITPERMITEXPIRES IN 6 MONTHS nal UNLESS CONSTRUC STARTS ELECTRICAL INSPECTOR Rough ................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to OccUpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove ; Final No. Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner'FIRE DEPAtTMEN ' ' Street No. IFSEE REVER smoke Det. "-�JD x'11 j 0© � a cam' s ,�, - ,6 � •. . d j COON 0U-6 .SL j $ T `�GCi ' 1 r`?•n G r��-a�,� t,a 0,� j 00 4� o V "bpi a `l Al r r r i ,r�a �m.. �-0 Co f' f,� CN. f Cb f77 ,mom Q r co a eb nT O �• Y p" III i 01/05/2011 13:19 9786831381 READER INS PAGE 01 . jy 1C >..... ORS , .:'�: � :�.�'S,ISI ..�I�:•... Y,':� � \ •t «./.: ::h l I r., PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER)OF INFORMATIC'j ONLY AND NOREADER INSURANCE AGENCY 1-NC. HOLDER. THIS CONFERS CERT FICATE TGHTS HE NOTOAMEND, EXTiNIDACc 690 Haverhill St, ALTER THE COVERAGE AFFORDED BY THE POLICIES SELO'1 Lawrence, IVIA 0 12.4 1. COMPANIES AFFORDING COVERAGE Tel 973 663-56C!''' COMPANY -���•a:��_.��..� A U S Liabilitv Comnanv IN$UR€D COMPANY T''ordell ''s Home Solutions e . Granite State Insurance Comma-.-- 9 Park Avenue COMPANY 'Methuen, MA 01844 C COMPANY i D iaa)>!)>:�:.� : mo. r:33">: iSii%: :,.k.as•:)o-: i:•.)'.,•i.::.y,.;i,,ar:;:::::::,.;;�o:o!•i:<e•:::r..;:,.;, �yr,yrimrr:<•i .... �"+n:rr•sif;<;:;:>•):«..::<..:::;;;).+.i<�:: ' �y� '.,�:.:a•:>... <):::,;:,:vsr. :>��,3a.::)':>::.>a:<!:++er4t.,n ,,,,,,.��,� ;ar. .3.,$):.. +��r^: n;:�xaxtri?i V/ .h .......)n... ........hr i � ..iii i.r. ..:...<....... ..n i.ii i i �r;i���iiii?i'i,'?i ..•. .rirr�r ..,.,,.... .. .. Si Fri i S. .... ...h..4...T i ...,.... . 3.).<...n'}. If..)., .:....,..i..m.V i ..3.a.a.:.,..i...,.t,.i,..:'�...::.ii 4i 1.i ,.::.i6,a S:.o.0:.Y...::.•:Y�.,. �.�....�?.1:�:l:t:;:ti::+... •:::s,.�::::.::�.i...:;.i::::.�.::::.•::25:•:):'+.r.N,1::!•F.y+wV,:::<a..i�)>,<o),.h::r1.:,.�.nVV..<.::�.::::,.:,.:.e..c:,..:,iyy!I,MN:,.:,.M.�y.,,xu.E............,.o.<v:.�,V,h�y.. THI.IS TO CERTIFY THAT THE POL!CIk3 OK INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A60VE FOR 7HE POLICY FEFIC� INDICATED.NOTWITHSTANDING ANY RECUIP,EMIENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI, CERTIFICATE MAY EE ISSUED OR MAY PERTAIN,THE INSURANCE A==pRDED BY THE POLICIES DESCFiIBED HEREIN IS SUBJECT TO AL''-THE TE=MS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ----- Co TYPE OF INSURANCE POLICY NUMBER POLICY=FFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDNY) DATE(MMIOnNY) GENERAL UABILITY GENERAL AGGREGATE -n n r ,�n n A COMME. CAL GENERAL_IABILI i? PRCCUCTS-CCNIP OP AGO 'a� 0 n onn`•:':!'i CLAIMS MACE OCCURP"SCNAL&ADV INJURY S-3. �_(�r)r: CL1166414 10/1Q/16 10/18 ___- _ CWNEP'S d CONT P.ACTOR'S PROT EACH CCCURRENC2 s 'M Q (1 =!R.DAMAGE(Ary one iimi 5 50 10/ MMD wXR Amv erre Bersvi 5 5 AUTOMOBILS LIABILITY 5 ANY AUTC ALL OWN=C'AUTOS =CCILY INJURY SC�-EWULSD AUTCS I �IP.E7aU-05 30^IL`!'.Nr:URY NCN•CWN AUTOS I-af 2.81.en7) —' PRC?F=7'�DANIA55 I GARAGE LIABILITY AL' C ONLY-CA ACGICENT 3 '%NY AUTC GTHER-FAN AUTO CNLY: i — WAC-ACGOSNT SxC_?SS LIABILITY _,LCH CCCUPPENCE i UMBRE:.LA FORM AQGFE-IA C CTHE.9 TFAN U`I===L;.A rCFMXy — WORKBRS COMPENSATION AND EMPLOYERS'LIABILITY- B t'?C00n0770433 3/4/10 3 4 11 "- cHACWIDE>1T s E?5CP91�'CR' / / _ 715EASE-IWCYLIMIT INCL -- , P?RT'NERSiEXECUTIV.= ELDISEASc-Ear+AP�OYEE 5 =''C_ERS AF_E_ ExCL OTHER�w .. DESCRIPTION OF OPERATIONS/LOCATIONSNEMICL!S/SPECIAL ITEMS This certificate is subject to policy terms and conditions Carnentrv. painting Wallpaper n � ,:•:i,i�;i,r;rrii:•r'h„,.i�,.•;.+y.,:i,i, ,),,h•r'ir:m)<.<t:ri >.)...., ...: ..lin .S. .3..<:t:•::3�, ,.i., r,h.. ,.F.. }yT�� rr .r T�! ,:?f:i�vIi1:KG'I s,�+�m ri'�F?<<''sia�::• 1��' it t� - +�-HOirDEf�<=; r;�;;:a;>•� ............yye•;y,::<,f. M<';:II;r<`,,,,,r,+�+•3 i�, ,;:<,ir�r+:ri:: i:;•..';'i:t��h:):):.,�:;:..:.a•:iii i�>::.��><, � <so::.,, i .a,.::<:::,a<.o::,,:°)a.<..:.::,:.,,...:,.r rl ,rias.i•:,.l S::Z•:a�V,. �� �r .).;. .3.<....):ac::,.i)J.::::v,.r'fi;ri .. ...:. •. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MA:L Inspectional Services --L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE L27. 1600 Osgood S t BUT I AILunE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIA611-171 No Andover i Ma 01845 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEN T'ax. 978 688 9542 PCm - :<.333<3.>::3l:a.:...:..,.....,.+•,.....r. .. ......:::.<.. ACOF}D,25�` '1,95 ..,£'i•i.:'.)::.:;):'..:..:,:,,,:::.., 1r„r a'.,.;)t>:::.)::.;;:.):,)::�<.:.::�::,:r::r.,x•;••r:•;:...:,..... �............iM1,;���. , The Commonwealth of Massachusetts Department of Industrial.flccidents Office of Xnvestigations 600 Washington,Street Boston,MA 02111 UqV Www.mass gov1dia Workers' Compensation Insurance Affidavit: Biiilders/Contractors/JElectriciansfPlumbers Applicant Information c� Please Print Legibly NaMO(B.usiness/Organization/Individual): Address: Pyr tp-- yx , , City/State/Zip: o t,�L(zf Phone#: 01 Tr-3 9 7-S-1, 12.Are you an employer?Check the appropriate box: Type ofprojeet(required): AI am a employer with 4. ❑ I am a general contractor and I 6 E]New construction employees(full and/or part-time).* have hired the sub-contractors ElI am a sole proprietor or partner- listed on the attached sheets 1• E]Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing-repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.❑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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Namo: G r o-w;*-e— Policy#or Self-ins.Lie.#: LOC, O 0 d 0 7 7 0 4',3,� Expiration Date: J y / I rob Site Address: to Mn ,,,,%1 fi O o r f6 int tc ,u M A- 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 fne up to$1,500.00 and/or one-year imprisonment,.as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert under the pains ndpen It. s ofperjury that the information provided above is true and correct. Si ature• Date: Phone#: 8 . 9 ^2 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# -Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical In5.Plumbing Inspector 6.Other Contact Person: Phone#: Wordell's Home Solutions LLC Estimate 9 Park Ave - - Methuen, MA 01844 Date Estimate# ' (978)-397-5248 Lic.#144467 12/22/2010 1371 Name/Address Cynthia Arsenault 22 Wharf Lane , Haverhill, MA 01830 Office @ 10 Main St. N. And. r Due Date' 12/22/2010 Item Description Qty UM Total Labor(2) Move existing 6' of wall and base cabinets into adjacent lunch area along side existing 1 2,400.00 cabinet and sink. Install a new pre-fab counter top across the base of all units. Remove existing door on front office to back office wall along stair well;Close up old doorway opening with sheetrock on both sides. Construct a partition wall in front office area, see plans for details and location. Install a new 36"6 pnl door matching existing decor at location designated on plans. Patch and plaster all walls as required for painting. Seal off un-used plumbing in wall of waiting room. Replace any damaged;ceiling tiles as required. Construct or assemble any required shelving/storage, (pricing not included). Paint all interior area's using the color scheme selected by client. Labor ADDED ITEMS: Install a new lockable matching door knob to storage room door. Have TBD 0.00 lock changed to be keyed like office entrance doors. Paint bathroom wood work white. Change bulbs in hallway entrance to remove yellow glow, (not to bright). Attach new mailbox once received and location verified. Materials 6 pnl. 36"x80" hollow core door, sheetrock, 2x4x8 kd, countertop, paint and any other estimated 801.00 purchased materials Permit Costs Construction Permit Costs (plumbing/electrical extra if required) estimated 125.00 Miscellaneous Miscellaneous Installation Materials for above mentioned materials. 40.00 Disposal Costs Disposal Costs for Project 150.00 Sub work Subcontracting Charges (plumbing/electrical if required) TBD 0.00 Phone# E-mail Web Site Total (978)-397-5248 les@wordellshomesolutions.com wordellshomesolutions.com Home Owner Sig: ch Page 1 Contractors Sig; w Wordell's Home Solutions LLC Estimate 9 Park Ave Methuen, MA 01844 Date Estimate# (978)-397-5248 Lic.#144467 12/22/2010 1371 Name/Address Cynthia Arsenault 22 Wharf Lane Haverhill, MA 01830 Office @ 10 Main St. N.And. Due Date 12/22/2010 Item Description Qty UM Total NOTE: Project should complete in no more than seven days. All material costs will be actual costs verifiable by receipts if requested. Please see terms and conditions to determine the required payment plan. Items or changes not listed would be in addition or subtraction from the original quote.A signed copy of this quote will be required at the start of project and can either be mailed or handed over before the start of the project. Cost does not include labor or materials for any shelves or storage space that will require more detail. ADDITIONAL NOTE:All work shall be completed by 01/15/2011 barring no unforeseen delays. Terms and Conditions 1) Scope of Work; Contractor agrees to furnish all labor, services, materials, installation, supplies, insurance, equipment, tools and other facilities required for prompt and efficient execution of the work described herein in a professional and workmanlike manner 2) Quote Amount; Client agrees to pay Contractor for the strict performance of his work, the sum as indicated above subject to additions and deductions for changes in the scope of work as may be subsequently agreed upon. 3) Payment Schedule; Client agrees to pay Contractor in progress payments as follows: Phone# E-mail Web Site Total (978)-397-5248 les@wordellshomesolutions.com wordellshomesolutions.com Home Owner Sig: Page 2 Contractors Sig; 7 Wordell's Home Solutions LLC Estimate 9 Park Ave Methuen, MA 01844 F Date Estimate# (978)-397-5248 Lic.#144467 12/22/2010 1371 Name/Address Cynthia Arsenault 22 Wharf Lane Haverhill, MA 01830 Office @ 10 Main St. N. And. Due Date 12/22/2010 Item Description Qty UM Total Payment#1 $1000.00 Upon Signing Contract and accepting terms Final Payment#2 Full Balance of Invoice within one week of 100% completion and all inspections. 4) Work Schedule; Contractor shall complete the work as required by agreement with the client. Contractor is agreed to be no more than 7 days late to start or finish per agreed schedule. Work schedule may be amended based on additional work inclusions and deductions and by agreement between client and Contractor. Not subject to delays caused by other contractors or their agents. The parties hereto have executed this Agreement for themselves, their heirs, executors, successors, administrators, and assignees on the day and year written below. Phone# E-mail Web Site Total $3,516.00 (978)-397-5248 les@wordellshomesolutions.com wordellshomesolutions.com Home Owner Sig: Page 3 Contractors Sig;