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HomeMy WebLinkAboutBuilding Permit #462 - 156 PALOMINO DRIVE 12/9/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION LS� ?,41 A P6 w O -b�- Print PROPERTY OWNER f L k A nyA y� Unit# Print MAP NO:h2&,,_PARCEL:11'9- ZONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure yes no 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 L® Sep is 0 loodplain ®W,�,e lands ' ,, - '® Watershed Bis_ fflffaip:V, er DESCRIPTION OF WORK TO BE PERFORMED: (Identification Pleas�pe or Print Clearly) OWNER: Name: yv �� �'`�.J Phone: Address: l ��o �/� �� t, i'Ve '�l/ 4 CONTRACTOR Name: IC =J L.,, /ZvSe A • zinc Phone: S7 B-S'5-7—c,24 Z; Address: v Supervisor's Construction License: Z Y / Exp. Date: 6 6 Lo/Z Home Improvement License: Z S �/ Ir' Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ G Z- o FEE: $ 5131 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ac ces o Oe guaran and --- :. 60,s gnaAent/Ocaner., egnatuoLVdntraw.uc: ' 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 o 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 Li 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 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: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ' I Public Sewer ❑. Tanning/Massage/Body 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 I 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 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location Gt %v,,4 4 r. No. � Date &ORTPI TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ �'' _ s�cNusE 9 Foundation Permit Pee $ � Other Permit Fee $ TOTAL $ Check # 24875 Building Inspector 407 Turnpike Street .Andover Kenneth M. LaRose - ' North Andover, Ma 01845 President Builders, Inc. Tel: 978-557-0212 Fax: 978-557-0213 www.andoverequitybuilders.com 11/28/2011 Dro and Lynn Kanayan 156 Palamino Dr. North Andover, NLA, 01845 Basement proposal Andover Equity Builders Inc. will provide a building permit from the town of No. Andover. • AEB will dispose of all waste materials. • AEB will frame walls to floor plan that was supplied by owner. • AEB will install a plaster soffit around the center HVAC duct chase. • AEB will box in two lally columns to a square shape. • Electrical allowance of$4200 for wall outlets and 13 recessed ceiling lights. • Plumbing allowance of$1200.00 is for the utility sink in the storage area. • The ceiling to be suspended with a plain white inset panel. • Supply and install (1) Andersen French wood hinged patio door. 5'-0" x 6'-8" Supply and install (5) masonite paneled doors in the new basement. • Supply and install Y2" blueboard and apply plaster skim coat on framed walls. • All plastered surfaces will be primed and painted two coats of latex paint allowance of $1800.00 • Supply and install wood 4-1/4" ogee base board around wall perimeter. • Basement stairs to have four open treads with newel post and balusters. • AEB will build shelves in closet area Allowance of$1275.00 • Total material and labor for the above tasks $ 44,612.70 Flooring or carpet is not included in this proposal Any required sprinkler work orsprinkler heads or trim not included. . If this proposal is accepted please sign one copy and send a deposit check in the amount of$4500.00. A payment of$4500.00 is due when the framing is started. A payment of$7000.00 is due when the electrical is started. A payment of $8,000.00 is due when the blue board is delivered. A payment of $8000.00 is due when the basement is plastering is complete. A payment of $4000.00 when the wood trim is started. A payment of$6000.00 is due when the painting is started. The balance of$2,612.70 is due upon completion. Signed Date II /moo /2011 ** Federal Law provides you with the right to cancel this transaction, if you so desire, without any penalty or obligation, at any time before midnight of the third business day from the date you sign this contract. Any down payment or other consideration you may have tendered on entering this transaction must be Y Y 9 refunded to you in the event you cancel. If you desire to cancel this transaction, you may do so by filling out the following form and mailing it to Andover Equity Builders, Inc., 607 Turnpike Street, No. Andover, MA 01845 Date:--J--J- I/ , wish to rescind my contract with Andover Equity Builders for the Proposal # . I wish a refund of $ for the deposit made be sent to: Signature '� � p., fie Ua7z7no7uuecz�x a�.�,aaaa:c�u�aelt6 , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR i Registration. '°126392 Expiration` 5/2512.012 Tr# 294649 Type Priyate Corporation ANDOVER EQUITY B.fJILD�RS INC KEN LAR OSE 53 PORTER ANDOVER, MA 0181:0„`.' Undersecretary q Massachct,rc t:, .partinvi-I t t'1't�a lic Safi [� M '. Bo::dA n.' clarions and Standards orttructtnn :Sttpetviacr License License: CS 12411 KENNETH M LAROSE r 53 PORTER RD ANDOVER, MA 01.P10 p Expiration: 6/16/2012 ('unuuissiuu��' Tr#: 30034 i N0RTH 0 o over 0 ., No.4 _ o , dover, Mass., T Q LAKE I� COCHICHEWICK 7�S RATED PP�,`�5 -PERMIT T U BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... 'h sw ... h 4 ............................................... Foundation has permission to erect..........:.. ...................... buildings o .......trig.......P41A.M..°4.1�!.0........... ..�...I. Rough to be occupied as ...{ .................. ! ! ��.......... r a chimney ..... ........................................................... ........... .. provided that the person accepting this permit shall in every respect conform to the terms o the ap lication 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. UNLESS CONSTRUCTI 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. Ol + ( t + I k-4 �f5 J41 VI ITA fit 8 /22/ 2011 x : 36 : 4/ NM dy30 VJ U21ud CERTIFICATE OF LIABILITY INSURANCE DATE 08/22/2011Y) THIS CERTIFICATE IS ISSUED As A HATTER OF INFORMATION ONLY AND CONFERS NO RIGHT6 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRHATIVELY OR NEGATIVELY AHEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TBE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES HOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AHD THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. it SUBROGATION 19 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer xights to the certificate holder in lieu of such endorsement(r). -iCdlioceRi _.._._____.�__.._ HUE International New England """'"' --PNDse - --.----__.__._�.7u LLC INC.Nr. bt): (A/t 299 Ballardvale Street Wilmington, MA MA 01887 cunana 1D/' _ __ _ nlsuPasE2lsl.Iwe■aDno covl0uar Puc s .. ..-_-_--__.___... _.. ...._ T_......__. ...... JirNSDAER A:Associated Oployers Insurance CotlRparly Andover Equity Builders Inc ^„!!Y!O„e- -- --. 607 Turnpike street INSUMR C: —-------- -------- ---_--. .--_..----- North Andover, MA 01845 IxsNan D: INSURER a: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: f THIS is To C=TIrY THAT THE PO=CKS or INSURANCE LISTED BELOW RATE BEEN Iss Ta AISUM XIM ABOVE TOR THE POL PERIOD Xffb=":C, NOTNITRSTANTEA DINO ANY REQVEMGvr, n 0R CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS COUILTL'ICATE HAY RN ISSUED 0E MAY PERTAIN, TIED IDSUNANCE ArrORDED BY THE POLICIES D=C&11=REREDI Is SUBJWT To ALL THE TERM, CxCLUSIONS An CONDITIONS or$VCR POLICIES. LxSITS SRo" MAY SAVE SEEN REDIAaD SY PAID CLADIS. TYe9 Or IPOLICY NUEIDP01ICY SR POLICY L�.S IISURANCE ER lamR/rTTTI cl/RTYrm! + GENERAL LIABILITY ____ _ DACM acc■mcl F_1CwIERCtAL SISMIAL!LN[Lm LAaace a REAtr■ -- -..-_-._ 1 PPn1ISCS IE•.rernitence)_ ...5 clmcAlm MAD: MOCCUP ❑ RD RIR IAny.•na peeranl I -PERSIUIIL i ALD Eurax I 1 UENCW.ALORDOAZt ! P ` UEN'L AOUSOIATC LIMIT APILIts SR, - DIOLICY EIPROCECT ML. PRODUCTS- GTO'/II AUL s k R -- AUTOxoa=LIABILITY — - — tOm RYE SIRStE LD[IT Ie.aeiLny Ri 7ANY AVID aAL4 04L1LC - DOILY ZiIVRx (Prr prom) p L.T. AnON — ❑ -I®ILY ILIURILULr■wi■ent) i ACEI OVL LC raoetR�rY cAwCDe" �A[PSE A■T09 ;ver mmq s I �Iw-ower .-Ce s �IOp RCLLA L[AF ❑ CCC DA [AOI aCCURReICE ❑[1Se59 LIAa CLA:lH lMDI + ALORCSATx I emvclzete � DRITIRTIO[ 1 II tDIT Lean'—� AUD SWLOYEES LI'ARILIT'Y THE PF.CPRIETDF./EARIN!;R3, D.L. FACS uclDen s 100,000 A EXCCUTIVE OFFICERS ARE 0 incl 0 exc: 500341101201107/19/2011 07/19/2012 t.L. DISCASE-POLICY LIMIT 500,000 C.L. DIM=-EA EMPLOYES s 100,000 c4mrgyt i DESCRIPIION Or UVIIATIINS Ia CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER ATTN: BRIAN LEATHE SBOInD ANY OA THE ABOVETumor, DEBUT=WILL RE CANCELLED ceou THE CRP7DATZON DATE Tf�REOP, NOTICE WILL BC DRLIVERCD>a AACORDARCN WI'1N i!E � 1600 OSGOOD STREET POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AurMlRxtcD RDcatsolraTlvt �-`Jam_ 2832 A��® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDKYYY)9/1/2011 THIS CERTIFICATE 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 pollcy(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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CUNIACI NAME: JOyce Dunlap Infantine Insurance PHONE 603-669-0704 FAC o:603-669-6831 P. 0. Box 5125 E-MAILAppgEss.Joyce@infantine.com INSURER(Sl AFFORDING COVERAGE NAIC p Manchester NH 03108 INSURERA:Union In_s_u_rance Co. 25844 INSURED INSURE R B: Andover Equity Builders, Inc. INSURERC: 607 Turnpike rat. INSURERD: INSURER E: N. Andover MA 01845 INSURE RF: COVERAGES CERTIFICATE NUMBER:2011/2012 Master 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, NOTVMTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMTH 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSIR AUUL�AJIJR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I SR VWD POLICY NUMBER .MM)DDIYYYY MM,DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 x COMMERCIAL GENERAL LIABILITY250 000 PREMISES1Ea ocrurrence $ , A CLAIMS-MADE D OCCUR CPA013298417 /1/2011 9/1/2012 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY X PRO I X I LOC $ AUTOMOBILE LIABILITY CO MSNe"D SING E LIMIT to accident $___ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRFNOF $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY yIN TORYLIMITS I I ER ANY PRO PRI ETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE E $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) All operations/activities usual to the insured's operations throughout the policy term CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Brian Leathe 1600 Osgood St. AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Paul Sullivan/BJM ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026(201005).01 The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 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): Address: City/State/Zip: Phone#: Areou an employer?Check theappropriate box: yType of project(required). 1. ❑ I am a employer with 4. ❑ I am a general contractor and I g ❑ employees(full and/or part-time). have hired the sub-contractors 6. New construction 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in 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 [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] * applicant that Anchecks box#1 must also fill yout 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 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: 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. I do hereby certyyunder the pains and penalties ofperjury that the information provided above is true and correct. Sienature: Date Phone#: 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#: