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HomeMy WebLinkAboutBuilding Permit #366 - 11 RICHARDSON AVENUE 10/27/2006 TOWN OF NORTH ANDOVER NORTIy APPLICATION FOR PLAN EXAMINATION o�tt�•o bq�o Permit NO: Date Received /0 ACHU Date Issued: / ��®�! �9SSS�t�� IMPORTANT: Applicant must complete all items on this page LOCATION D a 0,0 UE Print PROPERTY OWNER Print MAP NO.:3_PARCEL: / 5 ZONING DISTRICT: - 7 TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ane family ❑Addition ❑Two or more family ❑ Industrial Y Alteration No. of units: ❑ Repair,replacement ❑Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED 7CEN6 Lm--r -' E 171 hl L-" A2 Identification Please Type or Print Clearly) OWNER: Name: .4 6U iL Ll/��'h,S Phone:7Q/- Address: /e D s 6 N CONTRACTOR Name:--R 0 G� k Tse q.1)E L Phone:&U 3-.993-��Y7 Address: IP 8 L&'E S%- -151114--e M ,tJ H 0 .30-2 .9 Supervisor's Construction License: 0 n o o Q,3 Exp. Date: -� /136 Z Home Improvement License: / 7 Exp. Date: 0 69 S/ 60 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost S p° °—` FEE:$ Y 302- -r Check No.: O a' Receipt No.: �� 7 Page 1 of 4 i TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art L] Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to proj ect NOTE: Persons contracting 0ith un egister contractors do not have access to the guara fund s Signature of Agent/Owner Signature of contrac Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ #ampned 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 FIRE DEPARTMENT - Temp Dumpster on site yes no 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(ft.) 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 Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.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 adding Pgrin it-Action -kers Comp Aff Y I.C. And/Or C.S.L. Licenses Copy of Cont oor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) o Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) o 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 DEPARTMENT:BPFORM05 Page 4 of 4 Location// 1,7 No. Date 0 aG NaRTM TOWN OF NORTH ANDOVER 1 ~ 9 + ; ; Certificate of Occupancy $ a Building/Frame Permit Fee $ 3� sACNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 420n?---7- 19737 "� 1 97 37 Building Inspector NORTIy Town of t _...... ...._ Andover .... No. LA K E dower, Mass.. COCMIC MEwICK y^ �A0RATEO '9S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......1���� .......1W. 6 1 ..... ............ ......................................................................... Foundation has permission to erect................. ..................... buildings on./t. ev 40W.a.a......0*4........... Rough • to be occupied as ........... .......... Chimney Ch' e provided that the personccepting this permit shall in every respect 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 f?7, woop PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST S Rough Service BUILDIN 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. IF SEE REVERSE SIDE Smoke Det. i a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02.111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lepibly Name (Business/Organization/Individual): ? 6 /C ( de u CC- 196 /L 614) G d Address: L4,(%C S City/State/Zip: S fi- v3a7 L E tw A/H • hone #: 0 3 —eZ 3— Cl cKI> Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 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 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 11.0 Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also till 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 roust 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. /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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby Gerd rnder the pains and penalties of perjury that the information provided above is true and correct. Si,nature: Date: Phone#: 3 Official use only. Do not write in this area,to be completed by city or town offrcial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Roger Trudel Building & Remodeling 88 Lake Street SALEM, NEW HAMPSHIRE 03079 (603) 893-6947 i'9 - L f e. 000093 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION N, ANDauei2 yl� A 5414 ARCHITECT DATE OF PLANS JOB PHONE Ile 11rapast hereby to furnish material and labor— complete in accordance with specifications below, for the sum of: � cu «P.a�ymmeen be made as follows: dollars ($ 110 3.55 l All material is guaranteed to be as specified.All work to be completed in a workmanlike �--� manner according to standard practices.Any alteration or deviation from specifications be- Authorized low involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,acct- No his proposal may be dents or delays beyond our control.Owner to carry fire,tornado and other necessary Insurance.Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within / fill' days. We hereby submit specifications and estimates for: ........ Q. ...... ................ �1 - crt ... 4-- .. .......... .... ... ... . . . ....... .. ,-� ......... ,�. . . .. . ....... ...... .. .. .. ..... .. ... .. ... ... . . ..... ... . 16 4. y_ C -e `z w _t ACQW CERTIFICATE OF LIABILITY INSURANCE D /27IDDIYY TM 100/27/2006 6 PRODUCER (603)898-6500 FAX (603)870-9444 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C & G Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 288 North Broadway HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem, NH 03079 Patricia Blais INSURERS AFFORDING COVERAGE NAIC# INSURED Trudel Building & Remodeling INSURERA: Peerless Insurance Company 88 Lake Street INSURER B: Salem, NH 03079 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IINNTSR DD'R NRRrTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMIDDIYY) DATE(mminniYY) LIMITS GENERAL LIABILITY CCP9444969 10/18/2006 10/18/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 ESTFa nr }rrnne) CLAIMS MADE O OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROECT LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- Ca EMPLOYERS'LIABILITY Y_LIM I FIR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATJVES. N Andover, MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACO D CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) --- 90... . . --...... --- - -------50".. — Build false wall behind Refrig to ceiling 12"behind range wall Wood Hood to be mounted 30"off deck critical finish dimension Blower unit installed by others I .. ' ! 2RW3614 ! F630FF6Z 2W2730 ' 1 i 2W2730 i ---- CH'RH3030- J L l�- 2B30RT B18R �— -----' No deco end S:.:..:..:..:..-::::::::::.:::-_:::,-�:::::. ...:...:.::::::::_.:,.__::.', UB1484R i BAC R 12 Refrig space 36"x 70" This wall mu t bef27"deep F1.579 I cut to fit CO ! I 2SRB36 Tilt out tray � `"" I II! 1 — MB24 No deco end 0 No de end I� DB15 24.DISHW � ; '!i {II Ili O Q oy a „✓ it C4 I� -Er wc.:r. III 1 o'I Ir ' ' N O=, This cabfull height door to receivfp- n:; TCORB.RO TCORB.RO TCORB.RO I I.. ro Computor hard drive U U �. aN ro -- — x Q - — — -- X(� ea�O I I:_....—_____--.___._____.—.102" x Oe — d _ .._ No deco 4nd rc.�lC a✓ 82,-� 1A.16G ae I ( N b lV &ff 14/it1 G 1"filler at Wall&' 1"'- filler on base by UB3624 I I Irr­ All dimensions-size designations given are 20 This is an original design and must not be Designed: 9/25/2006 subject to verification on job site and TECHNOLOGIES released or copied unless applicable fee has Printed: 9/29/2006 adjustment to fit job conditions. been paid or job order placed. Williams, Jim-Lisa Kitchen 2 All Drawing#: l - - - -. 0 LJ , t i I., �. I I 1 G7 Q I I i! � I; I6 I�' Ir. 'i.; i I �i,. <<<<<<<<<<<<<,I<<<,<LLCL<<I d Note: This drawing is an artistic 20 Designed: 9/25/2 interpretation of the general appearance of TECHPOIOGIES Printed: 9/29/20( the design. It is not meant to be an exact rendition. Williams,Jim_Lisa Kitchen 2 Williams,Jim_Lisa Kitchen 2 Drawing "i : I ' I ® -, CZ] is r �I i Note: This drawing is an artistic20 Designed: 9/25/200 interpretation of the general appearance of TECHNOLOGIES .� Printed: 9/29/2006 the design. It is not meant to be an exact rendition. Williams, Jim-Lisa Kitchen 2 Williams, Jim-Lisa Kitchen 2 Drawing#: L l i w� �-C1 -" -- U , ly I i 1 I II I Y. J � I L I i - Note: This drawing is an artistic 2U Designed: 9/25/20( interpretation of the general appearance of TECHNOLOGIES Printed: 9/29/2006 the design. It is not meant to be an exact rendition. Williams,Jim_Lisa Kitchen 2 I Williams,Jim_Lisa Kitchen 2 Drawing#: - - - - -- - - I+ 3 I,I i I I Note: This drawing is an artistic 20 Designed: 9/25/20 interpretation of the general appearance of TECHNOLOG E; Printed: 9/29/2006 the design. It is not meant to be an exact rendition. Williams, Jim_Lisa Kitchen 2 Williams, Jim_Lisa Kitchen 2 jDrawing# i —� ✓lie �anrmconurea ./��oadEuaek2 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000093 Birthdate:07/30/1952 1 ; Expires:'07/30/2007 Tr.do' 170.0 Restricted:-.00 ROGER P TRUDEL 88 LAKE ST SALEM, NH 03079 Commissioner l GJ�e-�. ....o�o�.�iamacr4ua� HOME IMPROVEMENT CONTRACTOR Registration 117389 Type - INDIVIDUAL Expiration . 09/28/08 ROGER TRUDEL (X� ZV FOR C. TRUDEL ADMINISTRATOR 88 LAKE ST SALEM NH 03079 i