HomeMy WebLinkAboutBuilding Permit #372 - 101 CHRISTIAN WAY 11/6/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION Of NORTH 1
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Permit NO: T�
Date Received 0,0g� °
Date Issued: �' -d �'�s"^*e°
SACNU`�E
IMPORTANT: Applicant must complete all items on this page
LOCATION /Q/
Print
PROPERTY OWNELe y
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
❑ Addition ❑Two or more family ❑ Industrial
Alteration No. of units:
Repair, replacement ❑ Assessory Bldg ❑Commercial
Demolition
Moving(relocation) ❑Other ❑ Others:
E Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
fKl�C'�/P.�r CCC��✓f fT /�� •ivCPv�' /1�2iv /— /I e-sl G�S.H
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Identification Please Type or Print Clearly)
OWNER: Name: A-ew -? 17efA� Ie y Phone: '77,-9-Z&2-- 79,2
Address: W
CONTRACTOR Name:_ S lz'lVe'e7C2 i'TC /Q�, S' Phone
Address: 2 61 5'-F- Al AE2��,`���
Supervisor's Construction License: /-7 4 5��-?i!r Exp. Date: —/6-07
Home Improvement License: lladV72 Exp. Date:_
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER 81000.00 OF THE TOTAL ESTIMATED COST BASED ON 8125.00 PER S.F.
Total Project Cost :$ FEE:$ fJ -
'""�� 6 �
,
Check No.:�� yf Receipt No.: S—
Page Iof4
Locatio
No. Date
�ORTM TOWN OF NORTH ANDOVER
Of " O '•,�O
.�: • OL
F p
Certificate of Occupancy $
;�s'••° Eta' Building/Frame Permit Fee $ S
SgCMus
Foundation Permit Fee $ — —
Other Permit Fee $
TOTAL $
Check #
Building Inspector
TYPE OF SEWERAGE DISPOSAL Swimming Pools E.
� Tanning/Massage/Body Art
Public Sewer
Well
Tobacco Sales ❑ Food Packaging/Sales E
'!
Permanent Dumpster on Site
Private(septic tank, etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner� Signature of contractor -
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
L2
FIRE DEPARTMENT - Temp Dumpster on site
Fire Department signature/date
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
Building Setback (
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA—(For department use) `
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPPORM05
Crewed JNIC.Jan 2006
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
o 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
Addition Or Decks
❑ Building Permit Application
❑ 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)
❑ Mass check Energy Compliance Report (If Applicable)
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
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:INSPECTIONAL SERVICES DEPARTMEN'r:BPFORN105
Page 4 of 4
NORTH
Town of t itAndover
No. 3 Z -
= A dover, Mass.,T
coC MICMEWICK V
ADRATED PPS` �y
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
�
THIS CERTIFIES THAT.....k�.1/.f.l!�.....•.•••••14.stv% 6� BUILDING INSPECTOR
..................... ..;.......... ....................................... Foundation
has permission to erect.................................xletept0% ...... buildings on .D. .........CA-r-P. 0.. ' 09./1. Wim.. .... Rough
•to be occupied as.... ........A401.► ........ ,�......................... ....... Chimney
........ . . .. . . . . . .........
provided that the person accepting this permit shall in every respect conform to the terms of the application on fire in 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 of the Zoning or Building Regulations Voids this Permit. Rough
?r&too, PERMIT EXPIRES IN 6 NTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRU ST S Rough
........................ Service
.. . .. . .. .......................
LDIN CTOR
Final
Occupancy Permit Required W Ow4py Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
tThe Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
uv� www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
� V
Name(Business/Organization/Individual): ,A'!S/mil/,(i►z,- /IC'1 JZ7,Y&,n r
Address: 2 /*?,�. ,,, 5
City/State/Zip: 4b,/✓,n C, 117c Phone#: q 7,j-17�j— 3� 7 0
Are you an employer?Check the appropriate box: Type of project(required):
1.[jJ4 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. + 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ 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.] officers have exercised their 10.E] Electrical repairs or additions
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.] t employees. [No workers' 13.0 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 a new affidavit indicating such.
Contractors 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 Name: 7XCc yez.&/L S
Policy#or Self-ins. Lic. #: T Af/j -'7/ jam'/ k1_2 -3 - d� Expiration Date: 07--Z 7-
Job
-Job Site Address: /G/ C,4w r STr'a-+ hvr-v City/State/Zip: /V. .A'Q7vp/I /')G.
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 certify and a aims a en ies of perjury that the information provided above is true and correct
Si nature: Date:
Phone#: ?..2Ja
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#:
a
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia
NOTICE z NOTICE
TO a TO
EMPLOYEES A` EMPLOYEES
�o� IoW
p�M Sv�v
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As bg�,da�sachtta General Law, Chapter 152, Sections 21, 22&30, this will give you notice that
I we} ha>�e p[ovided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
ONF- TOWER SQUARE
HARTFORD, CT 06183
ADDRESS OF INSURANCE COMPANY
(IEUB-7191W24-3-06) 07-27-06 TO 07-27-07
POLICY NUMBER EFFECTIVE DATES
HUB INTERNATIONAL LLC 299 BALLARDVALE STREET
WILMINGTON MA 01 887
NAME OF INSURANCE AGENT ADDRESS PHONE#
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o� DESIGNING KITCHENS INC. 246 MAIN ST.
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NORTH READING
MA 01 864
a_ EMPLOYER ADDRESS
o=
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4= EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
N=
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
00000a W2ON= TO BE POSTED BY EMPLOYER
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All dimensions&size designations This is an original design and must hanly Scale:ma)amum Design: 06/13/06 pate : 08/03/06
given are subject to verification on not be released or copied unless
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed. Designer
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Designing Kitchens Inc. CONTRACT All home improvement contractors and
9 9 subcontractors engaged in home improvement
246 Main Street contracting, unless specifically exempt from
No. Reading, MA. 01864 registration by Provisions of Chapter 142A of the
TEL(978) 276-3230 Date: 8/3/06 general laws, must be registered with the
Commonwealth of Massachusetts. Inquiries about
FAX(978)276-3240 registration and status should be made to the
Director, Home Improvement Contract
Registration, One Ashburton Place, Room 1301,
Boston,MA.02108. 617 727-8598.
Submitted to: Job Name& Location:
MR. & MRS. HANLEY SAME
101 CHRISTIAN WAY RDAf �yNORTH ANDOVER, MA 01845
978-682-7926
We hereby submit specifications and estimates for work to be performed and materials to be used:
PLEASE SEE ATTACHED ADDENDUM
PAYMENT SCHEDULE
$5,000.00 DUE TO SIGN CONTRACT $3,580.00 COMPLETION OF KITCHEN
$5,000.00 TO ORDER CABINETS
$5,000.00 DUE TO START JOB
$5,788.00 DUE UPON COMPLETION OF ROUGH ELECTRICAL
$20,000.00 UPON CABINET DELIVERY
$5,000.00 UPON GRANITE RESERVED
$5,000.00 UPON GRANITE INSTALLATION
$5,000.00 UPON COMPLETION OF FLOOR INSTALLATION
$3,600.00 COMPLETION OF POWDER ROOM
WORK SCHEDULE
Contractor will not begin the work or order the materials befptathe third day following the signing of this Agreement, unless specified
here in writing. Contractor will begin the worts on or aboutr4� {date). Barring delay caused by circumstances beyond Contractor's
control, the work will be completed byi° (date). The Owner hereby acknowledges and agrees that the scheduling dates are
approximate and that such delays that are noi'�voidable by the Contractor shall not be considered as violations of this Agreement.
WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of one
year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or
materials, or damage caused by the Contractor, his subcontractors,employees or agents, is discovered within one year after completion
of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, correct, replace, or cause to be remedied,
repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection
performed in connection with the agreed-upon work.
WE PROPOSE hereby to furnish material and labor-complete in accordance with these specifications, for the sum of: $62,968.00
Payable as follows: SEE ABOVE (SEE PAGE 4 FOR ADD ONS TO CONTACT DATED 06/28)
NOTICE: No agreement for home improvement contracting work shall Authorized License#048236
require a down payment(advance deposit)of more than one-third of Signature Registration
the total contract price or the total amount of all deposits or payments #110479
which the contractor must make, in advance, in order and/or Note:This proposal may be withdrawn by us if not accepted
otherwise obtain delivery of special order materials and equipment, within 3 days.
whichever amount is greater.
ACCEPTANCE OF PROPOSAL-I have read both sides of this document and accept the prices, specifications and
conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the
work as specified. Payment will be made as outlined above.
You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction.Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
'
Signature Date 111!I0�
Signature Date
✓ ti
All home improvement contractors and subcontractors
Designing Kitchens, Inc. ADDENDUM engaged in home improvement contracting, unless
246 Main Street specifically exempt from registration by Provisions of
No. Reading, MA. 01864 Chapter 142A of the general laws, must be registered
TEL(978)276-3230 Date: 6/28/06 with the Commonwealth of Massachusetts. Inquiries
FAX(978)276-3240 about registration and status should be made to the
Director, Home Improvement Contract Registration,
One Ashburton Place, Room 1301, Boston, MA.
02108. 61 727-8598.
Submitted to: Job Name&Location:
MR. & MRS. HANLEY SAME
101 CHRISTIAN WAY PAGE 1
NORTH ANDOVER, MA 01845
We hereby submit specifications and estimates for work to be performed and materials to be used:
KITCHEN REMODEL-
CABINETS - CANDLELIGHT(PLYWOOD CONSTRUCTION)
DOORS- (,�C.Ypo�. �
DRAWER HEAD- tgdeas �a�y�,,�T 9Rc�� Q�-Ses (,Qa,�PoeT Sc�vu�e) S 6 est,
WOOD-CHERRY
FINISH- eU.12r6's,V
WALL HEIGHT-33"
SOFFIT-3/4"SOLID STOCK
CROWN-31/2"WITH DENTAL INSET
TOE KICK-MATCHING WOOD
*Glass to be picked, not yet quoted, glass price to be added to total contract
*WOOD SPECIES, FINISH AND DOOR STYLE MAY CHANGE PRICE UP OR DOWN
*QUOTED PER PLAN 03/06 SEE PLAN FOR CABINET DETAILS AND SPECS
1.PROVIDE ALL NECESSARY PERMITS.
2.REMOVE EXISTING SINK, FAUCET AND DISHWASHER. CAP WATER LINES.
&REMOVE EXISTING COUNTERS AND KITCHEN CABINETS.
4.REMOVE KITCHEN FLOOR TO SUB-FLOOR.
&REMOVE EXISTING CLOSET LEFT OF EXISTING FRIDGE.
6.13OARD AND PLASTER WALLS AND CEILING AREAS AS NEEDED WHERE CLOSET WALLS WERE REMOVED.
7,SUPPLY AND INSTALL NEW CANDLELIGHT CABINETS PER PLAN 3-06
&SUPPLY AND INSTALL 1 1/4 GRANITE COUNTER TOPS. MID PRICE GRANITE QUOTED, $4,800.00 ALLOWANCE)
9.INSTALL OWNER SUPPLIED TILE BACKSPLASH.
ACCEPTANCE OF PROPOSAL - I have read both sides of this document and accept the prices, specifications and
conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the
work as specified. Payment will be made as outlined above.
You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction.Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Date W Q� Signature
Date
r
Designing Kitchens Inc. ADDENDUM All home improvement contractors and subcontractors
9 9 engaged in home improvement contracting, unless
246 Main Street specifically exempt from registration by Provisions of
No. Reading, MA. 01864 Chapter 142A of the general laws, must be registered
TEL(978)276-3230 Date: 6/28/06 with the Commonwealth of Massachusetts. Inquiries
978 276-3240 about registration and status should be made to the
FAX
( ) Director, Home Improvement Contract Registration,
One Ashburton Place, Room 1301, Boston, MA.
02108. 61 727-8598.
Submitted to: Job Name& Location:
MR. & MRS. HANLEY SAME
101 CHRISTIAN WAY PAGE 2
NORTH ANDOVER, MA 01845
978-682-7926
We hereby submit specifications and estimates for work to be performed and materials to be used:
10.SUPPLY AND INSTALL 1/2 TILE BACKER BOARD, INSTALL OWNER SUPPLIED TILE.
11.INSTALL NEW DOOR,WINDOW AND BASE TRIM IN KITCHEN AND POWDER ROOM. DOOR JAMB AND DOOR WILL
REMAIN.
12.STAIN NEW DOOR, WINDOW AND BASE TRIM. STAIN TO MATCH EXISTING AS CLOSE AS POSSIBLE.
13.REPAIR CEILING WHERE THERE IS WATER DAMAGE.
14.INSTALL 2 COATS OF CEILING PAINT TO KITCHEN AND BATH CEILINGS.
15.INSTALL 2 COATS OF PAINT TO WALLS IN KITCHEN AND BATH, OWNER TO CHOOSE COLORS.
16.DISPOSE OF ALL BUILDING DEBRIS.
17.ELECTRICAL-
-SUPPLY AND INSTALL 12 RECESS LIGHTS, SWTCHING TO BE DECIDED AT TIME OF ROUGH WIRING. ADDITIONAL
RECESS WILL BE CHARGED AT$150.00 PER LIGHT INSTALLED.
-WIRE FOR TWO OVENS, ONE MICROWAVE, ONE DISHWASHER, ONE COOKTOP, ONE DISPOSAL AND ONE
FRIDGE.
-SUPPLY AND INSTALL ELECTRICAL OUTLETS NEEDED PER CODE
-WIRE FOR ONE PHONE JACK
-INSTALL ONE CABLE TV JACK
-PLACE AND CONNECT OWNER SUPPLIED APPLIANCES
-DUCT MICROWAVE TO OUTSIDE.
-RECESS LIGHTING WILL BE SUPPLIED BY DESIGNING KITCHENS, IF HANGING LIGHTS OR SURFACE MOUNTED
LIGHTS ARE USED, OWNER WILL SUPPLY AND EACH WILL BE COUNTED AS ONE RECESS PER HANGING LIGHT
ACCEPTANCE OF PROPOSAL- I have read both sides of this document and accept the prices, specifications and
conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the
work as specified. Payment will be made as outlined above.
You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction.Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Date b Signature Date_
MAll home improvement contractors and subcontractorsDesi
Designing Kitchens Inc. ADDENDU
engaged in home improvement contracting, unless
246 Main Street specifically exempt from registration by Provisions of
No. Reading, MA. 01864 Chapter 142A of the general laws, must be registered
TEL(978)276-3230 Date: 6/28/06 with the Commonwealth of Massachusetts. Inquiries
FAX978 276-3240 about registration and status should be made to the
( } Director, Home Improvement Contract Registration,
One Ashburton Place, Room 1301, Boston, MA.
02108. 617 727-8598.
Submitted to: Job Name& Location:
MR. & MRS. HANLEY SAME
101 CHRISTIAN WAY PAGE 3
NORTH ANDOVER, MA 01845
978-682-7926
We hereby submit specifications and estimates for work to be performed and materials to be used:
-ALL RECESS LIGHTS WILL BE CONNECTED TO DIMMERS
-INSTALL 4 UNDER COUNTER LIGHTS CONNECTED TO DIMMERS
18.PLUMBING-SUPPLY AND INSTALL ONE 18 GAUGE STAINLESS UNDERMOUNT SINK, SINGLE BOWL, $300.00
ALLOWANCE
-SUPPLY AND INSTALL ONE GROHE SINGLE POLE PULL OUT SPRAY FAUCET. $425.00 ALLOWANCE
-INSTALL OWNER SUPLIED DISHWASHER
-INSTALL ONE ICE MAKER LINE
TOTAL KITCHEN $51,537.00
any tile installed with borders or on a diagonal will be an additional charge
OPTION 1 -ADD ADDITIONAL FALSE DOORS OTHER THAN PLAN 3-06 ADD$200.00 PER ADDITIONAL DOOR
INSTALLED
POWDER ROOM
1.REMOVE EXISTING PLUMBING FIXTURES
2.REMOVE FLOOR TO SUB-FLOOR.
&SUPPLY AND INSTALL TWO RECESS LIGHTS OR INSTALL OWNER SUPPIED SURFACE MOUNTED LIGHTING.
4.RE-WORK LAV. DRAINS AND WATER LINE FOR PEDISTAL SINK.
&SUPPLY AND INSTALL ONE KOHLER MEMIORS TOILET AND ONE MEMIORS PEDISTAL SINK BOTH IN WHITE.
&SUPPLY AND INSTALL ONE LAV FAUCET,/$175.00 AL ANCE ON FAUCET
O wn CaC Sot l''a.•t �'i L /{d
7.SUPPLY AND INSTALL AB FLOORIN
ACCEPTANCE OF PROPOSAL - I have read both sides of this document and accept the prices, specifications and
conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the
work as specified. Payment will be made as outlined above.
You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction. Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Date a4 Signature Date_
Designing Kitchens Inc. ADDENDUM All home improvement contractors and subcontractors
engaged in home improvement contracting, unless
246 Main Street specifically exempt from registration by Provisions of
No. Reading, MA. 01864 Chapter 142A of the general laws, must be registered
TEL(978)276-3230 Date: 8/3/04 with the Commonwealth of Massachusetts. Inquiries
FAX(978)276-3240 about registration and status should be made to the
Director, Home Improvement Contract Registration,
One Ashburton Place, Room 1301, Boston, MA.
02108. 61 727-8598.
Submitted to: Job Name& Location:
MR. & MRS. HANLEY SAME
101 CHRISTIAN WAY PAGE 4
NORTH ANDOVER, MA 01845
978-682-7926
We hereby submit specifications and estimates for work to be performed and materials to be used:
8.SUPLY AND INSTALL NEW HEAT COVERS.
9.SUPPLY AND INSTALL ONE QT110 BATH FAN UNIT VENTED TO OUTSIDE.
10.INSTALL OWNER SUPPLIED MIRROR.
TOTAL POWDER ROOM $5,190.00
PLAN 3-06 ADD ON'S TO CONTRACT DATED 06/28/06
1.CANDLELIGHT PLYWOOD CONSTRUCTION-$4,000.00
2.PULL OUT BUTCHER BLOCK TOP DRAWER-$198.00
&OPEN CABINET END OF ISLAND-$855.00
4.ADD ONE FALSE DOOR ON WALL CABINET LEFT OF COOK TOP-$200.00
5.ADD CROWN OVER WINDOW- NO CHARGE
6.ADD 4 UNDER CABINET LIGHTS, 3 LEFT OF SINK AREA, ONE AT HUTCH AREA-$788.00
These prices are added onto contract dated 06/28/06
TOTAL-$6,241.00
— .1/V;52k.r-c- DO
ACCEPTANCE OF PROPOSAL - I have read both sides of this document and accept the prices, specifications and
conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the
work as specified. Payment will be made as outlined above.
You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction. Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Date (r Signature Date
NORTH
BUILDING PERMIT Aao
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION '' A
Permit NO: Date Received �ag0�A ED
S`TAC►1l1`��
Date Issued: ` a
IMPORTANT: Applicant must complete all items on this page
LOCATION_ r,rlk 0-7
Print
PROPERTY OWNER b;
Print
MAP Na. PARCEL: ZONING DITRICT:' Historic District -yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building Xone family
❑ Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
Repair, replacement Li Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
o-Septic El Well U Floodplain U Wetlands ❑ Watershed District
" 0 Water/Sdwer �
DESCRIPTION OF WORK TO BE PREFORMED:
Agee- /QOT.T GLcoP 6c+=i.cAt Galt-e- ye.nT, kftfjole�
Identification Please Type or Print Clearly)
OWNER: Name: A?P7lY fi Phone:
Address:
CONTRACTOR Name: �+ Phone: 2 ,- v '
Address: ! _
Supervisor's Construction License-: Exp. Date:
Home Improvement License.: Exp. Date
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: $ /'I� 9�2 7 00 FEE: $ /D
Check No.: . 7 ��� Receipt No.: -900')
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fu d
Signature of Agent/Qwner Signature of contractor
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
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
4
r�
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
Located at 384 Osgood Street
FIRE DEPARTMENT Temp Dempster ori site, yes no
Located at 124 Main Street
Fire Department signature/date G�'.,r.
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.$100-$1000 fine
NOTES and DATA— For department use
❑ Notified for pickup - Date
.......................................
................... .............................................................................................................................................................................................................................................................................................................................................................................................................................
:
Doc.Building Permit Revised 2007
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)
❑ Mass check Energy Compliance Report (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
❑ 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
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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
Location A/ C'�LF/� 1�''' k'� '
No. f�0 Date
�oRTM TOWN OF NORTH ANDOVER
F 9
Certificate of Occupancy $
��'�s'••°•
Mus E��'+ Building/Frame Permit Fee $
nc
Foundation Permit Fee $ .
Other Permit Fee $�
TOTAL $
Check # Ll
`T JJ
Building Inspector
NORTH
Town of
0
No.
810
dower, Mass.
i >
ISO COCHICHEWICK
7�ADRATED
`s BOARD OF HEALTH
Food/Kitchen
T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...............
...4.01.4.
. ... ... .. ............................� ................ ................................ Foundation
has permission to erect... buildings on ..�d,/...........C.l�i.. '.l.l �...... ..... . ...... Rough
2 to be occupied as........... ............. . ..........moo: A....... /.. ...... �. ........................... Chimney
provided that the person accepting this permit shall in every, spect conform to the terms of the application on file in 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 of the Zoning or Building Regulations Voids this Permit. Rough
Final
5g- PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIOTS 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 FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
t Boston, MA 02111
s. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual): SjG/�/O
Address: 21-16
City/State/Zip: �f/, e 4 Phone #:
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,N1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
officers have exercised their 10.❑ Electrical repairs or additions
required.]
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.] t employees. [No workers'
comp. insurance required.] 13.❑ Other
*Any applicant that checks box#]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 a new affidavit indicating such.
+Contractors 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 Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job 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 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 certify unde• e ains and p ies of rjury that the information provided above is true and correct.
Si nature: Date:
Phone#: �7�— �Q —
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#:
DESIGNING KITCHENS, INC.
DESIGNING KITCHENS,INC. Estimate
978-276-3230
246 MAIN STREET 00ESit�lAfi °,
NO.READING,MA 01864 04/13/2007 1010
i
srbadman@yahoo.com (� [
JADORESS.
Hanley,Mr.&Mrs.
101 Christian Way j
North Andover,MA 01845 i
I i4c ivitjT AMourd.
i
•FRONT ENTRANCE 2,330.00
LREPLACE TOP RAILINGS AND BALISTER WITH ALL CEDAR RAILS,2 X 4'S AND BALISTERS. j
CEDAR IS GREAT FOR NOT ROTTING.
2.REMOVE FRONT AND SIDE FACE BOARDS AND REPLACE WITH KOMAR KOMAR IS A MAN
MADE PRODUCT THAT LOOKS LIKE PINE BOARDS BUT IS MADE OUT OF PVC. IT NEVER ROTS. i
i
3.REPLACE CROWN MOULDINGS WITH PRDv1ED PINE CROWN.
4.REPLACE DENTAL DECO BLOCK WITH NEW BLOCKS MADE OUT OF KOMAFL
5.REMOVE OUTER PINE THAT WRAPS THE TWO FRONT SUPPORT COLUMNS AND REPLACE
j WOTH KOMAR.
&EXISTING RUBBER ROOF,CORNER POST ON TOP AND CEILING BELOW ALL LOOK GOOD AND
I WILL REMAIN.
{ TREMOVE ATTIC VENT ON NORTH END OF HOUSE.FRAME OPENING AND REPLACE WITH NEW
CEDAR CLAP BOARD.
•OPTION 1 -REPLACE FRONT ENTRANCE DOOR UNIT WITH NEW THERMATRUE FIBER CLASSIC I 0.00
DOOR UNIT.INSTALL NEW DOOR TRIM INTERIOR AND EXTERIOR TO MATCH EXISTING.
MODEL-FIBER CLASSIC-PAGE 49 j
DOOR-FC 40-PAGE 49
SIDE LITES-FC18SL-PAGE 68
INSTALLED ADD$2,497.00 TO TOTAL j
I
i
I
THANK YOU FOR THE OPPORTUNITY TO QUOTE THIS FOR YOU! SUBTOTAL, $2,330.00!
TAX(5%)l s $0.00
TQAL330 �
Accepted By: /% Accepted Date: �/ ��
Board of Building Regulations and Standards
lugHOME IMPROVEMENT CONTRACTOR
Registration: 110479
Expiration: j0120/2008
Type: Private Corporation
DESIGNING KITCHENS INC
RAYMOND BADMAN
au^a p
246 MAIN ST. ,
N. READING, MA 01864 Deputy Admini'
License: CONSTRUCTION SUPERVISOR
Number: CS 048236
Birthdate-,b8/16/1,956
Expires gel 6120W Tr.no: 4541.0
Restik
RAYMOND C BAbM
246 MAIN ST
�-
NO READING, MA t}1$6.4��"a � �—
'� Commissioner