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Home My WebLink AboutBuilding Permit #188-12 - 148 MAIN STREET 9/6/2011 TOWN OF NORTH ANDOVER , APPLICATION FOR PLAN EXAMINATION Permit R10: — />�_ Date Received n Date lssued: 1LMCPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER �A/fS print MAP NO: P ARCED ZONING DISTRICT: Historic District yes OU0 3q Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Ad '#ion [I Two or more family 11 Industrial fetation No. of units: 11Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition -- ---- ❑Other - cu;cr_.r: —,'"�.�' •Z•t' c�.�"_=Yahc..fi.-'�i'+T�^'i'. �SJ'='Fi�_�--�;risrf..'t='r: .: - �-c-.. :mss-=-•..��yY � i i;;�®:Septic �p �.f(7�3d'ater/Suer �`t•_:� '_ �L� ..�. .�t'-- _} -- _._._..;y _. � _>_'� �.�,: _ _ J �_ ,.s- .�t,{'t `; tt - DES Cc 11 s ION OF WORK TO EE PERI O BL: (Identification Please Type or Print Clearly) OWNER: Name Phone: i Address: x CONTRACTOR Name: Phone: ��(J-1�' 17P Address: Supervisor's Construction License: _57 _ Exp. Date: 9 Home Improvement License: �� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.-B ULDJNG PER :$12-00 P R$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ 16G .-I - _ Check No.: f 7dReceipt No.: oZ ) y ' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund -------------_ :;G•:-- - _..,:— — _ -::�'s - eri�/0t'wner:_ �o9a - —_ -_ •-: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ TanningMassage/BodyArt ❑ 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 Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS y Zoning Board of Appeals:Variance, Petition No: Zoning Decision/recelptsubmitted yes Planning Board'Decision: Comments Conservation Decision: Comments Water & Sevier Connection nature&Date Driveway Permit DPW Town Engineer: Signature: Located 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, rust 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 Doc:.Buiiding Permit Revised 2008mi i 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 ❑ !JVorkers Comb 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 DOTE; 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 Cont-raci ❑ Floor/Crossectlon/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 COTE: All dumpster permits require sign oft 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 Doe: Doc.Building Permit Revised 2008mi Location No. A� Date NORTh TOWN OF NORTH ANDOVER 3? �. • O Certificate of Occupancy $ Ar— Building/Frame Permit Fee $ CH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # j 7d 24547 Building Inspector NORTH omm o over , 0 No. 4. dover, Mass.t_ AKE , ISO COCMICEWICK 7�ADRATED P? C2 qS BOARD OF HEALTH i Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...............I..v!!'L v ��`< ......................... ............................................... ......................................... Foundation ...... .........r..I T has permission to erect........................................ buildings on ..... ... .. ..... �.�.......l11V.I ......L�..�0Rough to be occupied as Cf-WINVal.......� .... Chimney . . . . . .. . . . ..................................................................................................... provided that the person accepting 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- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR S CONSTRUC" S TS Rough g ................. ..... .. h.................................................................... 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 S i D E j Smoke Det. TPM CONSTRUCTION LLC 20 WHEELER AVE SALEM,NH 03079 (603)898-0864 PROPOSAL SUBMITTED TO: PHONE:(97a)-973-6753 Tom Vines 148 Main ST Vinesboston@aol.com PAGE: l OF 2 N Andover Ma Date: July 30, 2011 Target Start Date Seat 5,2011 We hereby submit specifications and estimates for: New Kitchen Remodel Demolition Work • Remove / dispose of existing kitchen cabinets • Remove 10' section of drywall soffit between kitchen and living room New Construction • Install new kitchen cabinets / finish trim/kitchen hardware pr drawing Labor allowance • Install 4'x6'8" door to laundry room • Install 700sq.ft. Hardwood flooring Labor only. if existing concrete floor needs to be leveled additional coast will be add Plumbing Allowance $750.00 • Install finish - kitchen faucet/kitchen sink drain/ Install existing toe kick heater/garbage disposal / Y2 bath vanity sink/ faucet/toilet Electrical allowances $675.00 • Install 4- 5" Recess light units • Change out fixture to decor in kitchen area Homeowner to supply— kitchen cabinets / plumbing fixtures/Hardwood Flooring � 1 TPM CONSTRUCTION LLC 20 WHEELER AVE SALEM,NH 03079 (603)898-0864 **TPM CONSTRUCTION WILL DISPOSE OF ALL CONSTRUCTION DEBRIS IN AN OFFSITE DUMPSTER** Permit coast to be added to contract price after permits are nulled We propose hereby to furnish material and labor complete in accordance with above specifications for the sum of: Five thousand Eiaht Hundred Fifteen Dollars $5815.00 Payment to be made as follows; At Start of Job:$2,907.50 Job Half Done:XOO Upon ComD19kh$2.907.50 All material is guaranteed to be as specified. All work to be completed in a Authori d workmanlike manner according standard practices. Any alteration or deviation from Signature above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, N is pro may be withdrawn by us If not tornado and other necessary insurance. Our workers are fully covered by Workman's accepted within 10 days. Compensation Insurance. Acceptance of Proposal—The above price(s)specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature: work as specified. Payment will be made as outlined above. Any additions to the scope of work as outlined above after ac eptance of this proposal will be billable at $95.00/hour 2 men. / Signature: Date of Acceptance: / r { r . The Commonwealth of Massachusetts Department oflndustrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02I11 UT www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organizationlfndividual): A WnA Address: City/State/Zip: wd2l— Phone#: Je an employer?Check the appropriate box: Type of project(required): I am a employer with 4. ❑ I am a general contractor and I 6 ❑�Ncons�ction employees(full and/or part-time).* have hired the sub-contractors2.❑ I am a sole proprietor or partner- listed on the attached sheet.T 7. ng ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. o workers'comp. c.152, 1(4),and we have no y � P § 12.❑Roof repairs 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 anew 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. Iain 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: )APA, 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify and ai s and Penalties of erlury that the informationprovidedabove is true and correct. Signature: Date: Phone#: 9 FOther only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): I. Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: SEP-06-2011 TUE 01 :37 PM LAKESIDE INS, AGENCY FAX N0. 6034326076 P. 01/01 ACORQ, CERTIFICATE OF LIABILITY INSURANCE o 109/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPgN 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),AUT ORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcata holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed, 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 cotjfer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT NAME: Lakeside Insurance Agency, Inc. a/CPHONN E7ce: 603.432.3666 (AIC,No)FAX : Three Wall Street ADDRESS: Windham, NH 03087 INSURER(S)AFFORDING COVERAOE NAlca INSURFRA: Acadia Insurance 31325 INSURED Thomas McDermott INSURER e: Continental Western Ins. Co. DBA: TPH Construction INSURER C: 20 Wheeler Avenue INSURER 0: Salem, NH 03079 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2011 REVISION NUMBER: THIS IS TO CERTIFY-THKT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO ICY 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 DESCRIBE=D HEREIN IS SUBJECT TO ALL THS TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EXP LTR TYPE OF INSURANCE NSR WV0 POLICY NUMBER MMLDD MMIDD/YWY LIMITS GENERAL LIABILITY BOP032354311 1211112010 12111/2011 EAC1.1000URRENCE 1,000,01 -D'A 13ET�RE LIJ X COMMERCUIL GENERAL LIABILITY 100 OI PRENIISFS Ea occurrence 9I r _7 CLAIMS-MADF rk�OCCUR MED EXP(Any one person) $ 5,0( A PERSONAL S ADV INJURY $ 1,()00,OI GENERAL AGGREGATE $ 2,000,0( GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO IB 2,000,01 POLICY 7 PRO- LOC JECT AUTOMOBILE LIABILITY car .AE-9qcc dent ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS 90pILY INJURY(Por acnident) NONDAMAGE HIREDAUTOS AUTOS-OWNED e $ AUTer ccltlent 5 UMBRELLA LIAR OCCUR EACH OCCURRFNCF $ 4 EXCESS LIAR CLAIMS-MADE AGGREGATE S DEP RETENTION® $' WORKERS COMPENSATION WCA0323546111W1112010 12/11/2011 X AND EMPLOYERS'LIABILITY YIN ORY LIMITS ER ANY PROPRIETOR/PARTNFR/M-CUTIV. E.L.EACH ACCIDENT $ 100,01 B OFFICER/MFMPFREXCLUDED? NIA IMandatory In NHL E.L.DISEASE-EA EMPLOYEE $ :L00,01 If yea,describe under DESCRIPTION OF OPERATIONS below E,L DISEASE-POLICY LIMIT 1 $ 500,011 _F DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Atteeh ACORD 101,Additional Romans Schedule,11 more apace Ie requlred) Statutory coverage for MA s NH. Thomas McDermott has elected to be excluded from coverage.. CERTIFICATE HOLDER CANCELLATION FAX: 978.688.9542 SHOULD ANY OF THE ABOVE DESCRIBED ROLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,Nt TICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRPVISIONS. Building Department of N. Andover AUTHORIZED REPRESENTATIVE 16 Osgood 3t. , B1dg20 Ste 2-36 N dower, MA 03.845 Edwin Duvall/LBZ j ®1988-2010 ACORD CORPORATION. 411 rights reserve ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Find a Licensee Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Lookup The list is current as of Tuesday,September 06,2011. You can search/filter the licensee list by any of the criteria below. License I Businesses ii Individuals Select a License Type I Construction Supervisor Search by License Number 158632 Search Select a License Type I Select One Search by Business Name Search by Contact Last Name First Search by City Zip Code Search Select a License Type Construction Supervisor Search by Last Name First Search by City Zip Code Search ISearch Results LICENSE TYPE BUSINESS NAME CONTACT NAME LICENSE RESTRICTION ADDRESS STATUS Construction Supervisor1N/A 1 Mcdermott,Thomas P?58632 100 LSatem,NH 03079ICurrent http://db.state.ma.us/dps/iicenseeIist.asp 9/6/2011