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Home My WebLink AboutBuilding Permit #516 - 110 BLUE RIDGE ROAD 1/22/2006 TOWN OF NORTH ANDOVER r►ORTIy gtio APPLICATION FOR PLAN EXAMINATION �b • a OL O � Permit NO: Date Received Date Issued: 9SSACHU`�� IMPORTANT: Applicant must complete all items on this page LOCATION_ PC t U ems£. Print PROPERTY OWNER �S S f�tl 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: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED +� Identification Please Type or Print Clearly) OWNER: Name: gwss stew ."s Phone. 9Y� `15`1 ' og06 Address: ilo 03LI-k e )-1-L ' C�o3 Z 6 s '70s'i? CONTRACTOR Name: E=lli O k-NL ws W ov o\ Wc�cke/-\s Phone: 36-Z 6 y�J?O Address: '1 71 s L4,14 F,-4 USC 4 f)f k "-xs v-. , U 4 Supervisor's Construction License: s� 7 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ `1 y 17 d' FEES Check No.: /141-fI Receipt No.: Page I of 4 Location/w No. 5! Date �09 NpRT1y TOWN OF NORTH ANDOVER f 9 ' Certificate of Occupancy $ ��b'••° '<�' Building/Frame Permit Fee $ �3 ss�CH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # x947 � Building`lnspector TYPE OF SEWERAGE DISPOSAL Swimming Pools 1111Tanning/Massage/Body Art ❑ g Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ ❑ 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 guarantyfund Signature of A ent/Owner � � Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F1 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 Drivewav Permit Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided - F 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 ❑ 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 DF.PARTMENT:BPFORM05 Page 4 of 4 011 PROPOSAL Eric DuBois, Owner Phone: (603) 362-6480 Date: 11/30/06 NOVA KITCHENS LLC. Fax: (603) 362-8449 Revised 12/19/06 GENERAL CONTRACTING Cell: (508) 265-7058 7 Island Pond Road Atkinson, NH 03811-2129 Massachusetts Construction Proposal Submitted to: License#052746 Russ & Marie Stephens Home Improvement 110 Blue Ridge Ln. License# 115786 North Andover, Ma. 978-794-0406 cell 508-633-6009 We hereby submit this proposal for the following: Kitchen. Job prep and demolition: Prep job with zip wall plastic barriers to control dust. Remove and dispose of all existing cabinets, counters. Remove and dispose of all sheet rock on backsplash. General carpentry/window and door installation. Supply and install (1) French door unit. Cost$800.00 is included in total. Plumbing: Install customer supplied sink, dishwasher, icemaker. Install customer sinks and faucets in three bathrooms. Electrical: Allowance of$2500.00 for all electrical. Any unused allowances will be credited back to customer. Add additional outlets to kitchen counter area. Supply and install 5 inch recessed lights, halogen under cab lights. Install customer supplied pendant lights. All lights will be on dimmer switches. Lighting and switching plan to be discussed with customers. Install customer supplied cook top and micro/oven. H.V.A.C: Supply and install duct work and appropriate wall cap for range hood. nn: Ins la i / u to a Plaster: Install blue board and plaster for backsplash area and ceiling patches. Wood flooring: n/a Tile installation: Install customer supplied the and grout on backsplash area. Cabinetry installation: Install customer supplied cabinets, mouldings, end panels and hardware. Install customer supplied cabinets in three bathrooms. Counter tops: existing granite counter tops will be removed and reinstalled on new cabinets. Please be advised: There is no guarantee existing granite counter tops can be removed from existing cabinets in one piece. Cost :$1500.00 is included in total. ;�Q ,f Painting: Int. and ext. painting is not included at this time. Job debris: Contractor to provide dumpster for all job site debris. Supply all job permits as required. Total $17,777.00 All Material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner. Drop cloths to be used in all traffic areas. Job area to be kept as neat and clean as possible at all times. Job to be completed in a timely manner. Payments to be made as follows. $9000.00 Deposit payable upon acceptance of proposal. $7,000.00 to be paid at start of job, $9777.00 balance, due in full, upon job completion. Respectfully submitted by: Eric DuBois Any alteration or deviation from above specifications involving extra costs will be executed only upon written order and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. The clients may cancel this contract at any time prior to midnight the third business day after the date on this Contract. ii Signature Date I �L ZZi �� Signature //O G'L tee-�*��c -'C . 63 OP7 Y-- 79'�'— -0 (16igns Am CO o 978-388-1229 www.dpkitchens.com 31M WR123 ¢� l Po 3.,, BDR1236-0 CBD3636 DM U n � d � o � i�— 0 Proposed kitchen m (cabinet replacement) Stephens residence Oct.30,2006 e n C4 OD m 3 � o m C OD M BD3038-0 43M I UDROj90 UDL33900V j -AMI 190 W3036 W3618x2A DL247—DDL153 2668 YV BOL1532 X!i-0 x210 �.O — R15361 W2415 M15M LIVING AREA 687 sq ft U4/U0/&UVQ aU VO;-)O raA 4�,..,,. ACOCCCDATE IMMIDDffVYY K CERTIFICATE OF LIABILITY INSURANCE 04/06/2 061 PRODUCER (603)898-6320 FAX (603)898-8269 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Foy insurance Group - Salem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 130 Main St - Suite 1Q3 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 6ELOW, Salem, NH 03079 'Terri Truhn INSURERS AFFORDING COVERAGE NAIC# msuREO Nova Kitchens, LLC INSURERA: Concord General Mutual Ins Co 20672 7 Island Pond Road INSURFR n Atkinson, NH 03811 INSURER C -- — - — INSUHI_H U INSURER C. COVERAGES THE POLICIES OF INSURANCE LIS,rEO BELOW HAVE DCCN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTI ICR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POUC(ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEkMS•EXCLUSIONS AND CONDITIONS OF SUCI I POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' TYPE of INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMRS GENERAL LIABILITY E880015-8 04/01/2006 04/01/2007 IACHOCCURRENCE $ 1,000,00 X COM Mr RCIAL GENE RAI.LIARII ITV DAMAGE To RCN I'I':!J E 50,000 PUMISkSJkaDCWWU -- I CLAIMS MADE I OCCUR MED EXP(Any ono parson) 5 51000 A PERSONAL&ADV INJURY S 1'.000.,.000 - - GENERAL AGGREGATE S 2,000,000 GI:NT AGGREGATE LIMB'APPI WS Ork IIHOuUC IS-COmwOH AGG 5 Z,000,000 POLICY HaCTo. WC -----. JE AUTOmO81LE UABILI'IY C844790-3 04/01/2006 04/01/2007 COMOINED SINGLF LIMrr S (Ca acaidunt) ANY AUTO ---^- -_-^ 1,000,00 ALI.OWN Eu AUTOS BODILY INJURY (Per pmon) E X SCHtllULtO AU 1 U5 X I IIRCD AUTOS BODILY INJURY X NON-OWNED AUTOS real awmb,.q b PROPERTY DAMAGF 5 111ar mcnumnl) CARACE LIABILITY AUTO ONLY CA ACCIDENT S ANY AU 10 OTHFR THAN BA ACC 5 AUTO ONLY' ACR 5 EXCESSIUMBRELLA UABILITY EACH UCCURRENCE b OCCUR CLAIMS MADE AGGREGATE. 5 _ _ b DEDUCTIBLE _ $_— ,.• -. RETENTION S S WORKERS COMPENSAYiON AND wC.LIMIT EK TURY.LIMII'li EJ{ ......-----...---•--. EMPLOYERS'LIABILITY k 1.TACH gCGIOfN'I b ANY PROPRICTORIPARTNERICACCUTIVE OFFICGRIMCMBER FXCLU0RD9 E.L.DISEASE-EA EMPLOYEE S h so,ftserlDe undo SPECIAL PROVISIONS buluw C.L.DISEASE•POLICY LIM)T S OTHER Tom' DESCRIPTION OF OPERATIONS I LOCATIONS I VE HICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPFC1 4 PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEPORE THE EXPIRATION DATE RHkREOF,THE ISSUING INSURER WILL£NDEAVOR YO mA1L 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town Of North Andover, Mass. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 27 Charles Street OF ANY KIND TN RER,ITS AGENTS OR REPRF-SFNTATW5. North Andover, MA 01845 AUTHORIYEO P AYIVE ACORD 25(2001108) CACORD CORPOUY1014 1888 1 I x -. ,• �� ,_ � \ � \�� ? 1� �� 1/ /� !� U • Complete Kitchen �1YTC' NS & Bath Installation tV • Home Offices General Contracting • Additions Eric Dubois Office: 603-362-6480 President Fax: 603-362-8449 Fully Insured 7Island Pond Road MA Construdon Lic#052746 MA Home Improvement Lit#115786 Atkinson, NH 03811 - —- - - ✓fie �ommzo�zwea�i o�✓�aaaac�Zuaelta .. . BOARD OF BUILDING REGULATIONS � License: CONSTRUCTION SUPERVISOR Number: CS 052746 rv. Birthdate: 02/04/1965 Expires: 02/04/2007 Tr.no: 7944.0 Restricted: 00 ERIC F DUBOIS 7 ISLAND POND RD G" ATKINSON, NH 03811 Commissioner SIX ��11-e alJt J7z49tUeQ�� z/t f1.u.uurluaem Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 115786 Expiration: 4/13/2008 Type: DBA ERIC DUBOIS/NOVA KITCHENS ERIC DUBOIS 7 ISLAND POND RDS ATKINSON,NH 03811 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations d 600 Washington Street Boston, MA 02111 ^M 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual): '►-i/t 0_�4 w s Address: City/State/Zip: Af k,!-\s-^,\ WH Phone W Ll L{ g 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 1 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors � listed on the attached sheet. $ �� [j Remodeling 2 �! I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for mem any capacity. workers' comp. insurance. 9. ❑ 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.] f 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 an:doing all work and then hire outside contractors must submit a new 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 an: 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: Attacb 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 coverag�_verification. I do hereby certify under the s andpenalties of perjury that the information provided above is true and correct- Signature: orrectSi ature: � —' Date: - Phone#: 3 6 2 �i L( `1 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#: 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 legalentity, 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. Re 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 pe rnut/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 Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia NORTH T e Town of No. - �` ti dower, Mass., o - LA I� COCKICMEWICK V ADRA7ED PPS` '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT....... ...C .SS....... .. ! 1............................................................................................. Foundation has permission to erect............................. ......... buildings on .... .. ?......... J../.� ..... c�.... ............... Rough C to be occupied as.....�`T.!.Y ....�......-.. ... � lPth... 'I �a''w ✓...'. ......................................... ............... himney provided that the person accepting thi ermit shall in every respect co m 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 493- PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUS TS 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.