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HomeMy WebLinkAboutBuilding Permit #756-13 - 13 LACONIA CIRCLE 5/13/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: � Date Received r Date Issued: IMPORTANT: Applicant must complete all items on this page , LOCATION PROPERTY OWNER DAM Es Print 1�L t4 D t=ilt- O(P,6Print 100 Year Old Structure yes MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family 0 Industrial ❑Alteration No. of units: 0 Commercial CTjtepair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other ❑ Septic 0 Well 0 Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) p 7 Ob � J OWNER: Name: 'Y,4M e� 1 E& �� �' Phone:/ Address: CONTRACTOR Name: Phone: Address: Gd wid Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date:- ARCH ITECT/ENG I NEER ate: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: $ U FEE: $ OL Check No.: /a 7 Receipt No.: S.� NOTE: Persons contracting with unregistered co tracto s do not have access to the guaranty fund ,Signature of Agent/Owner V Signature of contractor Plans Submitted ❑ 71ans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments !dater & Sewer Connection/Signature& Date Driveway Permit DPW Tovvo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTME--Nt -'Temp Dumpster on site yes no Located at 124 Mair Street Fire Departinerit 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 U Notified for pickup - Date I Doc.Building Permit Revised 2010 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 app.al 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: Doc.Building permit Revised 2012 Location A L J n l ei— L. Date i • - TOWN OF NORTH ANDOVE9 • . Certificate of Occupancy $ Building/Frame Permit Fee $1441, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1 26384 i ding Inspector J Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 16,000.00 m $ - $ 192.00 Plumbing Fee $ 24.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 24.00 Total fees collected $ 340.00 13 Laconia Circle 756-13 on 5/13/13 Kitchen Remodel CX The Commonwealth ofVlassachusetis Department of IndustritclAccidents Office of Investigations 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): 4!L rl P e 4,14 J Address: )3 ),/1-C Pen A C/2 j— City/State/Zip: rlo a 1H AW9 oy!-- 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.El am a sole proprietor or partner- 7. emodeling listed on the attached sheet.$ ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, E]Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.Pq I am a homeowner doing all work right of exemption per MGL 11.E]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' ME]Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. I 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.Lie.#: 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 requiredunder 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 thepain ndpenaId ofperjury that the information provided above is true and correct. Simature: Date: Phone#• g 79 — &�&— ��ls 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 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-contractors)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 Coxr Monwoalth of Massachusetts Department of l dustrial Accidents Office.ofIuvestigations 600 Washington Street Boston,MA,021 It Tel,#617-7274900 ext 406 or I-877,MASSAFB Revised 5-26-05 Fax#617-727-7749 www-mass,govfdia TOWN OF NORTH ANDOVER °TIL OFFICE OF BUILDING DEPARTMENT AL at', ,P^ :1600 Osgood Street Building 20, Smote 2-36 uus1405 t9 North Andover, Massachusetts 01845 Gerald A.Brown Inspector ofBu.ildings Telephone(978)E88-9545 H111"EMNER1I9ENSE EXEMPTION Fax (978)688-9542 BUIDINNG PERMIT APPLICATION Please print DATE:_ jmj,-;LV13 JOB LOCATION: 13 4 ACD rn,/I NumberC f Street Address Map/Lot . IJOMEOWNER_SA M S �k�X171:2 ,r Name. ' / / — ,� Home Phone 1 tnA- jjrQrjPhone PRESENT MAILING ADDRESS /_ ANIJOvric— Cif�Tow S+w+w. Zip Code The current exemption for"homeowners" was to allow such homeovimers to engage an i7i&ivid al forehire whoL;cd7oes not Possess a-ed license,_Tjgs to two units.or provided That the less anr1 r g"o acts as supervisor). State Du ilding (Code Section 108.3.5.7) owner DEFINITION OF HOMEOWNER Persons)who Qwns a parcel of land on which he/she resides or intends to reside,on which there is,oris intended to be,a one or two farm-tilt'structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibilityfor Applicable codes,by-laws,rules and regulationscompliances with the State Building Code and other. The undersigned"homeowner"certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements, HOMEOVINLRS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 FOnn Homeowners Exemption BOARD OF APPEALS 688.9541 CONSERVATION 688-9530 < HEALTH 688-9540 PLANNING 688-9535 NORTH ' c . . ve" ,* 0 No. r � in % h ver, Mass, COCMICKIWICK �'►• A°RATED ►Pa,�'�y S U BOARD OF HEALTH LD Food/Kitchen Septic System PERMIT BUILDING INSPECTOR �..�... THIS CERTIFIES THAT ..........................�.-e�'. ..�?..?.�.�S...fi.....A....�l�.�:4.R.:�.. �.,............ Foundation has permission to erect .......................... buildin s on ....... ........ s�t.4��?.� ..!..!!-�............................... Rough I ��............................................................ Chimney to be occupied as ..............�..�.T.."'....................�............. provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough Service .... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises — Do Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SE E REVERSE SIDE A American Cab'inet..C.aporation ' Village Mall 436 Broadway Methuen, MA 01844 CABINET ORDER FORM JORDER y1 TEL:978-687-682-5 FAX:978-687-6837 Site: SAME CUSTOMER: MIKE&JOANNE PRENDERGAST 13 LACONIA CIR. NO ANDOVER, MA 01845 KITCHEN: Cabinet: KRAFTMAID(GRANDVIEW MAPLE SQUARE 1/2'.'OVERLAY) Color: WILLOW ISLAND: ONXY $9,095 Construction: STANDARD Hardware: DOORS: N/A DRAWERS: N/A Countertop: n/o Detail: Ctop Collor: G1 MOULDING: S3S1 FOR RISER W/SCM8 SOFFIT CROWN TO CEILING TOTAL PRICE: $9,095.00 NOTES: 10%DISCOUNT -$909.50 INSTALLATION OF CABINETS BY CONTRACTOR DISCOUNTED TOTAL: $8,185.50 506/6 DEPOSIT WITH BALANCE DUE ON DELIVERY TAX: $511.59 AS BANK CHECK,CREDIT CARD OR CASH DELIVERY: $70.00 10%DISCOUNT FROM AMERICAN CABINET GRAND TOTAL: $8,767.09 (CABINETS ONLY) coupon DEPOSIT: $4,383.54 BALANCE: $4,383.55 1 I understand that by signing this order form, 1 will not be allowed to cancel or return all or part of this order. 1 also approve the design and agree to the styles and colors mentioned above. ?a t(� PfcUn Customer Signature: Date: y�3 do/ M 41 �f CUSTOMER: IO PARTS: MIKE&JOANNE PRENDERGAST SAMECOLOR:WILLOW 2-SM8(SCRIBE MOLDING) 13 LACONIA CIR NO ANDOVER,MA 2-WMTK(TOE KICK) KITCHEN COUNTERTOP STYLE:n/a 4-S3S1 (RISER FOR TOP MOLDING) KITCHEN CABINET STYLE:KRAFTMAID EDGE: 4-SCM8(SOFFIT CROWN TO CEILING) t (GRANDVIEW SQUARE 1/2"OVERLAY) 1-OGP8(BASEBOARD END OF RUNS) Jr COLOR:WILLOW COLOR: ISLAND: ISLAND COLOR:ONYX COLOR: ONYX KITCHEN HARDWARE:N/A CONSTRUCTION:STANDARD 1-SM8(SCRIBE MOLDING) 1-TUK(TOUCH UP KIT) INSTALLATION BY:CONTRACTOR 1-OSC(OUTSIDE COR MOLDING) 2-OGP(BASEBOARD) CEILING HEIGHT:90-1/2" 1-WMTK(TOE KICK) -209-2" 132 37' x' 83" 5" 31" 2" 522" T2" V 292" 32" r \ N1536L W301�fVP8 OUTT W3036BUTT WA2736R PREPED \ D15.3 DISH-IQ1 O FOR GLA SS NI GEIGIAS.30= TANDAR ;1 TE IOR �-----------B15L.2DXFW ------- -------------------------------------------------------------allo;. SB33BUTT.W a N EXTENDED STYLES C! w r r TRIMMED TO 1" N W 0 mi< v C o X: rn -ni v CO BPPS30 m o WBT18.2 B24BUTT.2DXF T? 41'" m Z " = WPL9634 CD D W o� v C N RD2430NH BRD2430NH.B1D2430NH.B cm L0 tM i o O �le d' ------------------------- r - ------------------ All dimensions_size designations This is an original design and must Designed: 3/6/2013 given are subject to verification on not be released or copied unless Printed: 4/3/2013 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. MIKE-JOANNE PRENDERGAST 13 LACONIA CIR NO All Drawing#: 11 No Scale.