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Home My WebLink AboutBuilding Permit #771-15 - 130 MIDDLESEX STREET 4/8/2015 `Q f pORTFI q O`�t�eo 6• �O _ BUILDING PERMIT F?<0.,:.• �p c Cl � j TOWN OF NORTH ANDOVER / APPLICATION FOR PLAN EXAMINATION - _ h n O O Permit NO: Date Received ED > Date Issued: b IMPORTANT:&11�e Aplicant must cor items on this a e LOCATION / ® 12 rint PROPERTY OWNER G4/ 11.. Pnnt MAP NO:OkPARCEL b ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [] Septic IJ Well ❑ Floodplain I I Wetlands Watershed District C I Water/Sewer Identification /P-lease Type or Print Clearly) —� OWNER: Name: �G,CI✓`' � �. Phone: xc7 'S��"` d Address: CONTRACTOR Name Phone: , -' 7yV7 Address: jy/`� � ? X/, a 4 9, Supervisor's Construction License: `7�-� �.SK Exp. Date: C� Home Improvement License: � Exp. Date: S5 eu.^le 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: $ FEE: $ 3 a- Check No.: Receipt No.: "2-tw2-1 NOTE: Persons contracting with unregistered contractors do not have access to the uaranty and Signature of Agent/Owner Si nature of contractor ' Plans Submitted ❑ Plans Waived ❑ Certified_ Plot Plan ❑ Stamped Plans ❑ i TYPE'-F SEWERAGE DISPOSAL I hiblic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ I 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS { CONSERVATION Reviewed on Sianature 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 Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR N-,-T- - Temp pumpster on site yes_ - _ no Locatedi at 124 Main Street - Fire Department Dimension Number of Stories: Total square feet of floor area, based on Exterordimensions. 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.s1oo-s1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date _T Time Contact Name Doc.Building Pennit Revised 2014 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 o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 o Mass check Energy Compliance Report a 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:Building Permit Revised 2014 Location No. ( Date . - TOWN OF NORTH ANDOVER 0 o Certificate of Occupancy $ Building/Frame Permit Fee $��a Foundation Permit Fee � Other Permit Fee $ TOTAL $ Check#� Buildi g Inspector � NORTy � Town of S E ndover IVLb h ver, Mass 26 O A- COC"IcneWIC« 7,as RATED U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THATPERMIT �w!. ...........a*!0t ................ BUILDING INSPECTOR ..... ...... . 1.36...01 ..... �of. Foundation has permission to erect .....%..................... b �Idin son . . • Rough 4cr to be occupied as .. .�. 11.... .. . ....L1�..�,�.`. �. ...�I1� .............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applica toftV Final on file in 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST RTS Rough Service ........ ....'....... ................... .... . .. . ,.w, . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. TWOMEY & LEGARE CONTRACTING INC . "Couidn't your home use a little TLC?" Specializing in residential additions 87 Belmont Street, North Andover, MA 01845 HIC#136779 North Andover - 987.685.7447 Facsimile- 978.685.7446 EXHIBIT B Proposal/Specification Homeowner: Contractor: Twomey&Legare Contracting, Inc Dawn Casale 87 Belmont St. 130 Middlesex St. North Andover, Ma. 01844 North Andover, Ma. 978-609-2856 The following is a description of work as discussed. Renovation of Kitchen 1. Remove existing cabinets and dispose of. 2. Install a couple of the old cabinets into the laundry room. 3. Relocate power for range. 4. Correct any other electrical issues. 5. Relocate water lines,and drain line for sink. 6. Complete insulation. 7. Complete all dry wall,and plaster.] 8. Install new cabinets,and tops. 9. Counter tops to be laminate post form tops. 10. This price includes 6 feet of cabinets,and counter tops outside. 11. Reuse existing sink,and faucet. 12. Venting for range hood to be self venting. Use old range hood. 13. Blend paint as close as possible 14. Contractor to obtain all building permits,&inspections. 15. Contractor to dispose of all debris. 16. E floor to remain. Si Date �r Allowance Page Cabinets & Tops ------------------- $23,725.00 Plumbing ---------------------------- $1,200.00 Electrical ---------------------------- $800.00 Job Total & Payment schedule Job Total $10,960.00 Balance 1 St signing of contract $33,500.00 $7,460.00 2"d Completion of plumbing $31000.00 $41460.00 electrical roughs. 3'd Completion of install of cabinets. $2,500.00 $15960.00 4th Substantial completion of $1,960.00 project and final sign off. Sign Date 72" W3015WCM W1830R DC243 { f SB30WCM T9F B ............. _----- o fw ti W � 0 3 W i 5 �J The Commonwealth of Massachusetts Department of Industrial Accidents J Office of Investigations . 600 Washington Street Boston, MA 02111 www.fnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly - Name (Business/Organization/Individual): �7(� `' Address: -7 City/State/Zip: IV #JVV v,16/z- Phone #: Arry an employer? Checkthe-appropriate box: Type of project(required}: m a employer with �� 4. ElI am a general contractor and I 6. F-1 New construction employees (full aud/orpart-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition Working for me in.any capacity. workers' comp.insurance. 9. F-1 Building addition [No workers'.comp. insurance 5. ElWe'are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a hdmeowner doing aL1 work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp=- c. 152, §1(4), and we have no 12.❑ Roofrepairs insurance required.] t 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 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 fvorkers'compensation:insurance for my employees. Below is the.policy and job-site information. yy Insurance Company Name: 7/Z,'ve-L&—A-i Policy#or Self-ins.Lic. Expiration Date: Job Site Address: 10 d ��' �r City/StatelZip;� �y(/`�/`�IJX 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*tbe violafor-.-Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA-for ins LCC cove4g verification. I do hen•eby certif�rdz andpe7zalties of perjury that the infon•mationr pn•ovide d abov�eeiis true and correct: Si- ature: Dated or Phone Oficial 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): I-Board of Health 2.Building Department 3. City/Town Clerk 4_Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: RightFax C3-1 1/13/2015 5 :44 :51 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T. 'TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: DOHERTY INS AGENCY INC PHONE FAX PO BOX 1985 (AIC,No,Ext): (A/C,No): 21 ELM STREET E-MAIL ANDOVER,MA 01810 ADDRESS: 22YMX INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA TWOMEY&LEGARE CONTRACTING INC INSURER B: INSURER C: INSURER D: PO BOX 366 INSURER E: NORTH ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS IS TO CERTIFY THAT 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 PERTAN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (AWDO%YYYY) (MNhDDWYYY) LIMITS GENERAL LIABILITY FACH OCCURRENCE $ H�COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE Ej OCCUR. PREMISES(Ea occurrence) — ED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ ENERALAGGREGATE $ POLICY a PROJECT a LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR [71 OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XIWC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-029OM994-14 09/18/2014 09/18/2015 LIMITS ANY PROPERITORIR/EXECUTIVE OFFICEFLRdEMBER EXCLUDED? =NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD 5T. BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT/! VE NORTH ANDOVER,MA 01845 -r - , ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. I Client#•13298 TWOMEY6 ACORDnr CERTIFICATE OF LIABILITY INSURANCE ;,A,u2Q1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER 1, Arbella Protection Ins Company Twomey&Legare Contracting,Inc. PO Box 368 INSURER s. North Andover,MA 01845 INSURER C: INSURER D_ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTEO 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. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE O CY PIRATION TE IMUMIZIM LIMITS A GENERAL LIABILITY 8SOOM255 06/22/14 06/22/15 EACH OCCURRENCE S j.000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100 OOO CLAIMS MADE 51OCCUR MED EXP(Any aro person) $5.000 PERSONAL A ADV INJURY $1.000.000 GENERAL AGGREGATE SZ 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOP AGG S2 000 OOO X POLICY PCT RO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea actidenI) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per persm) HIRED AUTOS BODILY INJURY § NON-OWNED AUTOS (Per acrideni) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION S S WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPMETORrPARTNEWEXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? II yes describe under E.L.DISEASE•EA EMPLOYEE S SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENOORSEMENT l SPECIAL PROVISIONS Covering operations usual to Twomey&Legare Contracting,Inc... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF.THE ISSUING INSURER WALL ENDEAVOR TO MAR In DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO 00 SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPA NTA E ACORD 25(2001/08)1 of 2 #S3141SIM30577 DML 0 AC CORPORATION 1988 Xe Office of Consumer Affairs&Business Regulation iROME IMPROVEMENT CONTRACTOR l� registration: 136779 Type: Z;. =Expiration: 8/26/2016 Partnership TWOMEY+LEGARE CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST. N.ANDOVER,MA 01845 Undersecretan C'un%tructinn Supt-rio1w CS-067560 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER MA 018 i5 Jam~ 10/25/2015 x`11 (onstructior, Sui)rrii%11F Z - CS-055108 DOUGLAS J LEGARE 79 GARY AVE - HAVERHILL MA 01830 - 0910212016