Loading...
HomeMy WebLinkAboutBuilding Permit #571 - 122 LANCASTER ROAD 3/1/2007 BUILDING PERMIT Ot NORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ; Permit NO: Date Received ?, �'� ,•� .�g ,s�/ICHU`�Et Date Issued: S / 0 IMPORTANT: Applicant must complete all items on this page LOCATION122 . LAt�1 CAS i E2pND Print PROPERTY OWNER Print: MAP NO: `f `PARCEL: :ZONING DISTRICT:- HISTORIC DISTRICT yes no 1 - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ),One family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other . Public l Sewer"' .1Water ❑ Floo lam aWetlands' ❑ Watershed,DistrictDESCRa IPTION bF ORK TO^BE PREFORMED: Identification Please Type or Print Clearly) ` OWNER: Name: K,A•R�1 # ?4-)S .'RT Phoneb-7b) C-Z6'2-?63 I Address: l LP44C NG i r=Z RW--D -- K=o T)4 W1DU1JF-R- MA" a LC61-419 CONTRACTOR Name. :i oD3� N� C.k� Phone t �— Address. Supervisor's Constructron Licens. Exp Date: Home,Improvement License: j 3 80 Exp, Date:4 - �- ARCH ITECT/ENGINEER 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: $ 2—Ono GG FEE: $ 2r—lS'---,%Check No.: Z rj Receipt No.:-?02Z NOTE: Persons contracting with u (registered n actors do not have access to the guaranty fund Signature of Agent/Owner i r 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 ❑ ❑ I COMMENTS DATE REJECTED DATE APPROVED HEALTH El- El COMMENTS . . , .. .. . . TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑. . . . , �.,_,--: .. . • ' ' � - . .. , Tanning/Massage/Body Art' ❑ : {S.wimming`Pools• ❑ . , „ Well ❑' Tobacco Sales ❑ n• °Food Packaging/Sales ❑ Private(septic tank,etc. - ❑' Permanent Dumpster on Site ❑ 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 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.$100-$1000 fine :NOTES and DATA— For department use ❑ Notified for pickup - Date ...................................._......................................................................................----............................................................................ 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 u Building Permit Application o Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) u Engineering Affidavits for Engineered products New Construction (Single and Two Family) u Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract Li Mass check Energy Compliance Report L3 Engineering Affidavits for Engineered products 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 NORTH Town Of : 4Andover 0 No. - �`y 0i dover, Mass., T O '- LA E COCMICKEWICK V ADRATED P? �y BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... ... .��./''f.... ..... . .`.. .....-............................................................ Foundation has permission to erect. ................................... buildings on .... . ��...417-*-Kkr57�e� .............. Rough Xe. Chimney to be occupied as..... 1 ..... .. 'r.. `i..%�-�. .!�r! ,,/,�.� � ,.51......... provided that the person accepting this permit shall in every real conform t6the 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 thb-Permit. Rough Final PERMIT EXPIRES IN 6S ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TS Rough .... . ... ... ........ .......... . ...................................... Service BUELDING INSPECTOR Final Occupancy Permit Required to Omtpy 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 Massachuseus Department of Industrial Accidents Office of Investigations UT 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_rCXDD RU ,,—r•MLy-� LI-L. Address: 1011N W F_G; Mk—X1_1 ST. City/State/Zip: R`Z9 Zip.L MA, oto Phone 9S)QS) 5ba PLC-J42_ Are you an employer?Check the appropriate box: Type of project(required):, 1.V I am a employer with 6 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.# 9• Building addition required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[1 Other comp.insurance required.] *My 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Amr_R mG� i�\r_xw.k-T 10W1A_ GROUP Policy#or Self-ins.Li c.M WC_ 1-16-'_7(c:;�--7S S Expiration Date: Job Site Address: Z.Z. City/State/Zip: NOR`T*A / tJOV 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 Ido hereby certify under the ains and s of perjury that the information provided above is true and correct Si afore \\ / Date: �'� �—07 Phone#: �ff 7�) — Offlclal use only. Do not write in this area,to be completed by city or town offlcial. 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 oin engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the f the foreJ o foregoing 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 Ad P Y 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-contiactor(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 _. . Fax#617=727=7749-- Revised 11-22-06 www.mass.gov/dia ACORD DATE(MM/DD/YYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 02/27/2007 PRODUCER Phone: 978-346-8761 Fax: 978-346-9620 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION JOURNEAY INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 WEST MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MERRIMAC MA 01860 ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insurance Co 14788 TODD MICHEL CONSTRUCTION,LLC INSURER B: American International Group C/O TODD MICHEL 109 WEST MAIN STREET INSURER C: MERRIMAC MA 01860 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. INSR ADD'LTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS LTR INSR DATE MM/DD DATE MWDDNY GENERAL LIABILITY MSB92418 04/01/06 04/01/07 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 PREMISES(Ea occurence) CLAIMS MADE FX OCCUR MED.EXP(Anyone 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 JPEROCT LOC 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 F]CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC176-76-75 02/25/07 02/25/08 TORVTLIM7s77 OTHER EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNER/EXECUTNE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN HALL EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO NORTH ANDOVER,MA. DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: Derek Journeay ACORD 25(2001/08) Certificate# 1448 ©ACORD CORPORATION 1988 .: lie&irmtamaeaaa v/,A aaac%uaelld Board of Building Regulations and Standards Construction Supervisor License . ` Licb-nse: CS 69490 Btrihda#e 1:2/29/1965 P-11 9912129%2008 Tr# 8116 fi ssh Iltit:=00' TODD R MICHEL;::: 109 WEST MAIN ST MERRIMAC,MA.01860 Commissioner 00-35,000 cf enclosed space 1A-Masonry only 1G-11 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. TODD MICHEL CONSTRUCTION, LLC 109 WEST MAIN STREET MERRIMAC, MA 01860 (978) 346-0464 CS LICENSE#069490 HIC LICENSE # 138046 PROPOSAL - SUBMITTED TO: Karen and Robert Barnett DATE: December 23, 2006 ADDRESS: 122 Lancaster Road GOOD UNTIL: 60 Days North Andover, MA 01845 START DATE: TBD PRONE: (978) 686-2763 END DATE: TBD Thank you for allowing us to quote your project. We propose to furnish all material and perform all labor necessary to complete the following: PROJECT DESCRIPTION: Materials and labor for the demolition and reconstruction of the basement remodel as per plans and specifications by Todd Michel Construction, LLC. SPECIFICATIONS: DEMOLITION:Selective demo for the completion of project as outlined per plans Any hazardous materials uncovered during demolition may require testing to determine the necessity of removal by licensed professionals and will require additional fees not included in this contract. FRAMING: PARTITION FRAMING: 2 X 4 @ 16 OC with treated sills INSULATION: Fiberglass R-19 in all exterior walls ELECTRICAL: General electrical from existing panel new recessed ' ht fixtures(6"IC rated,incandescent cans) --New-smoke—and-00 detectors in renovated area as per code,connected to existing building system Supply and install wiring for wine cooler and refrigerator, dedicated outlet for microwave Supply wiring/switching fosconce light s fixtures supplied by Owner) Install electrical outlets as requu by code Supply GFI outlets at bathroom and kitchen area as required by code Supply and install a fan/light in bathroom with vent to exterior Supply wiring/switching for light at closet One phone and one TV.jack Electrical permit is included in overall estimate cost PLUMBING: Plumbing provided by Homeowner's plumber r ✓' J 5T ell'' t� HEATING: Re-work HVAC. supplies and returns as needed DRYWALL: Provide and install V? moisture resistant drywall ware applicable (taped and finished) Repair drywall as necessary SUSPENDED CEILING: Armstrong 934 revealed edge ceiling tile with 15/16 exposed tie system INTERIOR PAINTING: Supply material to prune all new and repaired drywall Supply and apply latex paint to ceilings/soffits(to be smooth finished and painted as specified) Supply and apply latex paint to all walls(Customer to select type and color) Supply and apply paint at all new interior doors and trim(Customer to select colors) (Note: Maximum of two wall colors and one trim color selections in this quote) INTERIOR TRIM: Interior doors to be 6-panel with 3" Marblehead casing Install 5 '/4" primed speed base throughout new addition and 3" Marblehead primed casing at windows with sill Crown molding and chair rail in study and playroom • Interior stairs to be 3/4 oak treads, pine risers with oak rail#6010, Painted Balusters#501 oak Newel post#C4042 open to study CABINETRY: Supply and install new kitchen base and wall cabinets with all required fillers, end panels, crown moldings, and countertops, etc. Cabinets to be Kraftmaid or like quality; layout to be determined ---2-_,,Su ly �nmstall TV and bookcase cabinetry as per plan upp y I stavanity in bathroom as per pl4 an Total Cabinetry and Countertop allow an -000. - KITCHEN APPLIANCES:Not included in this contract FLOORING: Supply and install laminate and tile flooring, Allowance $4,500.00 OTHER SERVICES: PLANS AND SPECIFICATIONS BUILDING PERMIT APPLICABLE INSURANCES REMOVAL OF DEBRIS PRICE: Todd Michel Construction,LLC, agrees to do all work as described above for a total price of $42,940.00 (Forty Two Thousand,Nine Hundred Forty and 00/100 Dollars). Payments to be made as follows: $ 15,000.00 When demolition& framing has started $ 10,000.00 When rough electrical is installed $ 10,000.00 When drywall is installed and finishes are started $ 5,000.00 When finishes are substantially completed $ 2,500.00 When job is completed pending punch list $ 440.00 Punch List payment Contractor's signature: Date: ('?—'2'-S, - 200(�—, 2 ACCEPTANCE OF PROPOSAL Timely decisions and selection of any products and fixtures that are the responsibility of the Homeowner must be provided in a timeframe reasonable to the progression of the job. Todd Michel Construction, LLC will work with the Homeowners to provide the highest quality products within the schedule and budget of the project,but is not responsible for job delays caused by Homeowners' failure to provide specific instructions,products,or product selections. To the extent permitted by law, if the Homeowners are in default due to failure to pay according to the Disbursement Schedule,the Homeowners are responsible for any collection costs, attorneys' fees, court costs, and all other expenses of enforcing the rights of Todd Michel Construction, LLC under this agreement. The above price, specifications, and conditions satisfactory and are hereby accepted. Todd Michel Construction,LLC, iso o ' d�e rk as` cc' ed. Payment will be made as stated above. Z11 . Owner's sigDate: OWNER'SBENEFITS: The owner may have 3- day cancellation rights under one or more of Mass. Gen. Law Chap. 93, Sec. 48; Chap.140 D, Sec. 10;and Chap. 255D, Sec. 14. The owner is entitled to certain rights and benefits under Mass. Gen. Law Chap. 142A. 3 Location No. / Date / �a^TM TOWN OF NORTH ANDOVER 3? i • OL , + Certificate of Occupancy $ Building/Frame Permit Fee $ /7 s+CHus Foundation Permit Fee $ , Other Permit Fee $ TOTAL $ Check # O 200 ) 13' T Building Inspector