HomeMy WebLinkAboutBuilding Permit #1288-2016 - 100 ELM STREET 6/9/2016 i
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BUILDING PERMIT Q��,iLE
�I{ ' I OWN OF NORTH ANDOVER o� rye'`- wpb
PLICATION FOR PLAN EXAMINATION ,-
Permit No#: — 201 Date Received A_ "
7,4 A°RATED
SSACH►15fc
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION U 0 1 ty\ C-r
Print
PROPERTY NER 1 ��e1 �' � QG%k-c-%A
Print 100 Year Structure yes
MAP PARCEL:ZONING DISTRICT: Historic District es no
Machine Shop Village e no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition $ Two or more family ❑ Industrial
`Alteration No. of units: 2 ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
Demolition _ ❑ Other _ _
C fl Septic: ❑1NeII Y. FloodplanWetla.nds � ❑atershed�®stns
x.
J 1`WaterlSewer`
..
DESCRIPTION OF WORK TO BE PERFORMED: Q �' �EB�M �
'Nsm 's, Qi Yl,\ 0 fl C C- 5 0VA L C-5�k\
pow �Lx,-C1\N3*-� ywQ �KT C*k -t-7-uzo%i—S Pim�p ( uk�k. e�
Identific tion- Please Type or Print Clearly Y��N
OWNER: Name: ,nvc io X i-TI,f rAa-y c-,4 Phone: 6 ►�--
Address 'aJ f ,P I �.j._ rC3 f ou �`
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t'sq(tom c-m
Contractor Name:K,%,,�ylkq� kl� NGtiiovJ Phone: k,`7--�'�2 —63-`S—
Email: V-,-k\5
Address: Sta 6e !�® �'. 040\1n%-% A
Supervisor's Construction License: 0 16 h 3 3 Ci- Exp. Date: cl 2b /C7 .
Home Improvement License: 2 Exp. Date: / J
ARCHITECT/ENGINEER n ( 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: $ t Z Z� �0 FEE: *I��Z�
�
Check No.: aAq®� Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Location L "a '
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No. �' �` { 1 Date
• • TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ �.
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
�t Building Insp cct r- f
i
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL s
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumnmg Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on q (Co Signature
0/0
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
r,
PI«nning Board Decision: Comments
e
-`Onservation Decision: Comments
Water& Sewer Connection/signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
— "t 'ate.*r... _ a •1'; . (. .++a.— ..-
�FIRE DEPAR
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ARTMEfVTfTern Dum sesrp p t r on site ,yes � "off4.0(ated at124 Mam Strey#
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Fire Departmentsignature/dates
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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
Electricale t
Ins c or Yes No
p
DANGER ZONE LITERATURE: lies No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
f
Q Notified for pickup Call Email
Date Time Contact Name
Doc.Suilding Permit Revised 2014
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4. 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/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 Departmentartmentprior 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
2012 IECC Energy code
4, 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
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
11 24,,326:.00 m
$ - $ 1,491.91
Plumbing Fee $ 186.49
Gas Fee 100 comm.
Electrical Fee $ 186.49
Total fees collected $ 1,964.89
100 Elm Street
1288-2016 on 6/6/2016
Selective Interior Remodel
NORTIy
Town of �� _ L ndover
lag% — T h ver, Mass Vl r-j
o CNEWI[.t 1.
COC MIC MI �
'ls,9s RA"rEO PPa�.(5
U BOARD OF HEALTH
Food/Kitchen
PER IT T LD Septic System
Q ` �� er: ,
THIS CERTIFIES THAT ......A. ...............1� BUILDING INSPECTOR
has permission to erect ...................... buildings on . ..C'A m... Foundation
.... .... .................................
. ......r�.G/C�:.Y..t.!:�.1......�N.L�:!�� I Rough
to be occupied as ....... dr� ............................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application 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 CONSTCTIO T -Rough
Service
........ .......... .......... ....... ..... ....................... Final
UILD NG INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinjq 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.
X Contracting LLC Proposal
31 Richmond Street
Weymouth, MA 02188
617-592-6775 (Kieran)
781-254-2862 (Judy) Proposal Date: 5/23/2016
Proposal#: 203-15
Project:
Bill To:
David Streinbergh
100 Elm St,
N.Andover,
Mass 01845
- �. . -,-
M
Descnption Est Hours/Qty. Rate tiv Total
.t.
(J K,h t-- — 1,660.00 1,660.00
Demo remove interior walls on 1 st and 2nd`=floors and, Y; b x;999-9 9'8fr
ceilin" ,Of 2 nd floor.kitchen td create,cathedral'ceiling.
b
Dumpster fees.[Figure 3dumpsters] 2,250.00 2,250.00
Doors&Trim, Includes 4-new entry:rated doors [Allow 3,200.00 ,r, 3,200.00
s
&00for entrydoors]
Doo rr_
Trim, Interior doors, Supply/Install 5,000 00 5,000.00
Plu nb'irig, Includes 3 new battiroorns, plumb 2 ' 18,OOQ 00 18,000.,00
Heating' ns&Cooling, bathrooms
g, ms and laundries 2,000 00 2,000.00
Electrical&Lighting, includes upgrade of panels...here 16,Q00.00', 16,00000
necessary
Insulation 5,000.00 5,000.00
..
Millwork&Trim ,.: 4,001:00 4,000.00:"
_ ,.
Cabinets &Vanities10,000.00 10,000.00
Painting . . u . x,... 1> 0 6, ,b0.00 =.-160
00.00
Floor Coverings . 13,01.010.9 013,000.00
Ceilings&Co`verings, Board and:;plaster- �, _ 10,000.00 10,006:60
Cleanup& Restoration1,000.00 1,000.00
Supervision �1 ,7fl5.00 11,705.00
Insurance 1,170.50 1,170.50
Total $129,985.50
The Commonwealth Qf Massachusetts
Department of.IndustrialAccidents
Office oflnvestigations
600 Washington Street
.Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Anulicant Information Please Print Legibly
Name(Business/Organizationlindividuai): �3 J� (48c
Address: Sz Prc 1 o I CrH -14 ND av�n - ►,�} 01 g �!'�
City/State/Zip: N - A o 4 Ov ate• 19 0 i 1 IPhone#: b 14-E 1'L
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with �_; _ 4• ❑ I am a general contractor and I 6. []New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet,:'
�• Remodeling
ship and'have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required,]
10•[]Electrical repairs or additions
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 wehave no 12.❑Roofrepairs
insurance reed,]t employees.[No workers' 13.0 Other
comp.insurance required.]
`Anya 'icantthat box#1 must also fillout the sectionbelowshowing their worersk 'compensation policyUrmation.
i Homeowners who submit this affidavit indicating they ke doing all work and hien hire outside contractors must submit anew-affidavit i adicat ng such.
tContractors that checkthis box must atffiched as additional sheet showing the name ofthe sub-contractors and their worlmrs'comp.policy iafomiation.
I am an employer that zr providing workers'compensation trrsurance for my employees Below zs the policy and job site
information. p
Insurance Company Name: �.l�}N f-;1 S NJ 0 Kpr► Lc IN C—
Policy#or Self-ms.Lie.M We' 0 g E 3 -7 L# Z""" _ _ Expiration Date:
r
Job Site Addressj l-o �!—tL aJ� City/State/Zip: N� ° J�
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or ones-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.
Ido hereby ceWry under Aepains andpenalties ofperjury that the information provided above is trure Correa
Si fore: Date: C
Phone#• a 6 Z ���
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/I,icense#
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#:
JKCON-1 OP ID:HIS
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TE(UMIDDIYYIM
ACo CERTIFICATE OF LIABILITY INSURANCE 712016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND
CONFERS�R RIGHTS VE�E AFFORRDEDID BY THE POLICIES
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERM AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER' subjed to
IMPORTANT: if the Z@Icab holder hi an ADDITIONAL INSURED,athe� )merneft A on this SUBROGATIONood. It dog ��9hffi t°we
the terms and conditions of the policy,certain Policies may req
uire certificate holder in lieu of such end s
PRODUCER gcy, PIfoNE
PHONI
DeSancds Insurance AIna NO
100 Unicom Parts Drive
Woburn,MA 01801 NAIC e
AFFORDBto covERAaE
INSURER A;Star Insurance Com 012245
INSURED JK Contrasting,LW- LNetAIER a:Selective insurance Com 19258
4 High Street Sults 108ROUFFRC:
North Andover,MA 01845 WSURER D:
Neumm E:
INUMM F:
COVERAGES
CERTIFlCATE 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
IX
CERTIFICATEIONS AND BEO ISSUED OF SUCH POLICIES.OR MAY PERTAIN,THE
INSURANCE
SHOWN MAY HAVE AFFORDED3Y THE REDUCED BY PAID CLAIMS'DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS,
LMRe
L TYPE OF 81MIRANCE POLICY NUMBER EACH OCCURRENCE
B X UASAIrY 021 o12018 0211012017 E s 100,
CLANG-MADE Q OCCUR 113 10,00
MED EV as �� S
PERSONAL a ADV INJURY
GENERAL AGGREGATE $ 3,000,00
GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AM S 3,000,00
X POLICY[:1 PJEP=O- F7 LOC $
OTHER i
AUTOMOBILE LIABILITY BODILY INJURY(Pa Pte) S
ANY ALTO BODILY INJURY(Per w:ddw:) $
O ED SCHEDULED O O
$
HIRED AUTOS AUTOS S
EACH OCCURRENCE
$
UMISRELLA UAe OCCUR AGGREGATE S
EXCESS LLAB.- M AUTA"WE S
DED RET8iTi0N i X A
VKNKMTIaN 100,00
AND pPL OYOW LIAeI RY YIN 00863742 0211712018 02117120/7 E.L EACH AwDENT :
A a"'E N"NIA E.L.DI -EA EMPLOYEE s 100,00
MA
(NIOWNINY11114111 E.L.DISEASE-POLICY LIMIT S +
K d ON L oPERATI blow
cEscRvrlDN OF OPERATIONS I LOCATIONS I VEHICLES 0cm 101,AddidonM Rwnmft edwduK my be dddwd M nan ywu M nquh�dl
Evidence of Coverage-
CANCELLATI
CERTIFI A HO ER TO WHOM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TO WHOM IT MAY CONCERN
TM/► INCE MYTH THE POLIS PROVISIONS- WILL BE DELIVERED IN
µITNOR�p REPRESErTATNE
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014101) The ACORD name and logo aro registered mart of ACORD
-------------
0/
' Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 171393
Type: Individual
Expiration: 3/15/2018 Tr# 288589
KIERAN WHELAN
KIERAN WHELAN
31 RICHMOND ST
WEYMOUTH, MA 02188
Update Address and return card.Mark reason for change
FlAddress n Renewal n Employment [] Lost C1
SCA 1 t'i 20M-05/11
License or registration valid for individual use only
:C—\ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to:
-!3HOME IMPROVEMENT CONTRACTORpace of Consumer Affairs and Business Regulation
Registration: . 171393 Tye' 10 Park Plaza-Suite'5170
.�y
Expiration: ..311512018 Individual Boston,MA 02116
KIERAN WHELAN
KIERAN WHELAN
31 RICHMOND ST
WEYMOUTH,MA 02188 Undersecretary ry Nof v
al
id witho
ut s
gn
ature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-066334
Construction Supervisor
KIERAN T WHELAN: r f
31 RICHMOND S
WEYMOUTH MA:02 -
Expiration:
Commissioner 09/2612017
North Andover MIMAP June 9, 2016
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Q MVPC Bo
Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
—I SR Meters Data Sources:The data for this map was produced by Merrimack
—
gORTI♦ Valley Planning Commission(MVPC)using data provided by the Town of
Roads Of u '9A, North Andover.Additional data provided by the Executive Office of
i r Easements ? aft r°�°�O Environmental Affairs/MassGIS.The information depicted on this map is
❑Parcels3' L for planning purposes only.It may not be adequate for legal boundary
O o definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
1111101*111WMAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
» THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
✓F s ^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
4 o9p .,... ,� • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
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