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Home My WebLink AboutBuilding Permit #333-14 - 192 STONECLEAVE ROAD 5/1/2018 i. i �10RT1{ y' BUILDING PERMIT TO1#N OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION PermitNO: Date Received 9 °AA ` rap Date Issued: 9SSAC14US�� ^IMPORTANT:Applicant must complete all items on this page LOCATION I 9,+�` T-0 fVGL Print PROPERTY OWNER �� Ob b fl t' <- Print MAP NO: Pull—PARCEL: ZONING DISTRICT. Historic District. yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9'6ne family ❑Addition ❑Two or more family ❑ Industrial VIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer �- _ q L�,L CIA L ty I�-�VJ G=y-&K H L4- AND4!1%evtM r LAI t-4/001,) rfAll ff fo Identification Please Type or Print Clearly) OWNER: Name: I A- Phone: t4b Address: CONTRACTOR Name: Phone: rVaZoL6 Address: &<A�nm 0a, 06" /,-"e Supervisor's Construction License: 6o G Exp. Date: r Home Improvement License: aJ� Exp. Date: _ _t 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: $ i 0 FEE: $ p0 Check No.: Receipt No.: �26 5�O NOTE: Persons contracting with unregistered contractors do not have access Mtog rant nd Signature of Agent/Owner Signature of contractor TOMN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATilO-N _— - - PROPERTY, OWNER —�a 0 d.t�ucture es no;, - - Print T00 Ye_ y, MAP NQ: PARCEL" _ ZONING117FSTRICTHlstorrc Dlstrfct :yes €n:o+ _ Machine SfiVop Village yes, 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 _ Septic ❑Well. Floodplain Wetlands �' _❑ 1Natershed.Distrlcta DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR"'Name _ hone n T f Supervtso 'sl:Constructlon ' Home Improvement ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Sig;iature,of contractor'.,: 1]i- Ce.lhrrmil-Fnrl F-11 Dinno 1AIn4rnrl n (`nrFifiorl DIM DInn I—I Ctomnorl Plane n Plans Submitted❑ PlansWaived-11 Certified Plot Plan ❑ Stamped Plans ❑ TYPE OYSEWERAGEUSPOSAL Public Sewer ❑ Tanning/MassageModyArt ❑. . ..Swimming Pools ❑ Well ❑ . Tobacco.Sales El 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 I !Nater & Sewer Connection/Signature& Date Driveway Permit DPW Tow Engineer: Signature: Located 384 Osgood Street FIRE OEPARTIVIE lT =-Temp Dumpster on site yes no Located-at 124 Main Street Fire'Departiner it sigri�tu're/date ICU 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 M-F and G min.$100-$1000.fin.e NOTES and DATA— (For department use EJ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foh3wing is a-list of the r_equired.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 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 casi s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui!ding Permit Revised 2012 4 Location No. -��/ Date o TOWN OF NORTH ANDOVER S fED, . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r'kar xt TOTAL $ 9 r Check# 26970 Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 253750.00 m $ - $ 309.00 Plumbing Fee $ 38.63 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 38.63 Total fees collected $ 486.25 192 Stonedeave Road 333-14 on 10/8/13 Kitchen Remodel NORTFj Town o t . - No. - �AHe h , ver, Mass, CO[H.GHlw.CK J�A�OATED 01 S U BOARD OF HEALTH PERMIT T. LD Food/Kitchen / Septic System ` �d� BUILDING INSPECTOR THIS CERTIFIES THAT ....... ®... .....�.......:...`. � �' e/YL_C/C�vE Foundation haspermission to erect .......................... buildings on ............................................................................. Rough to be occupied as �C` l"G�� ' ' ' " G�� ...... Chimney ................................ ............................................... 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 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 STARTS Rough Service ......... .... .. ..... ............................................ 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. SEE REVERSE SIDE Oct 3 2013 10:44 P. 01 c�® CE . . RTIFICATE OF LIABILITY INSURANCE FDATE0 (M�D11„ Y► HIS CERTIFICATE 1S 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), AUTHORIZtD REPRESENTATIVE OR PRODUCER,AND THE-CERTIFICATE HOLDER. IMPORTANT: If the certificate holder,is an ADDITIONAL INSURED, thepOIICY(ies)mggt b . e endorsed. If SUBKOGA'TION IS WAIVED,subject t0' •the terms and:conditions of the policy,certain policies may require an endorsement. A statemelit on this certificate does not confer.rights to the certificate holder in Ileu'of such endorsement' . PRODUCER CONE IKathleen Miller. CISR, CPIW , NSURANCE 30LUTIONS CORPORATION PNONE 60 Weatville Rd (603)382-4600 1'Ax ,(603)382-2034 ' E.MAI AD kmillare isci—insurance.cion -Plaistow NH 03865 INSURERS AFFORDING COVERAGE INSURER A:peerl6S& NAIC dl INSURED, 4 198 Peter T.Max2ola dba Lorenxd Construction INffiuRERe: 2 Richard Dr INSURER c: INSURER D DetNFi 03038 INSURER E INSURER F: COVERAGES CERTIFICATE NU BER:CL1310313 M 409' THIS IS TO CERTIFY THAT THE POLICIES'OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORREVISION NUM13M 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL AM LTR' TYPE OF INSURANCE POLICY NUMB R POUCY'EFF r0_ucyExp GENERAL LIABILITY M/D LIMITS' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500-'000 PR E A . COCCUR 50,000 AIM$-MADE /e/2ola MED EXP_(8M22Lpqr..L S 5 000 PERSONAL 4AOV INJURY $ 500,000 GENFRALAGGREGATE $ 11,000,000 GEWL AGGREGATE LIMIT APPLIES PER X ;POLICY PRO. LOC PRODUCTS-COMPIOP AGG $ 1,000,000. /1UTOMOBILE LIABILITY $ C ED SINGLE Ea aoci p; ANY AUTO 300 000 ALL OWNED X .SCHEDULED 520926 BODILY INJURY(Per person) $ AUTOS AUTOS /31/2013 / /31 201a NON-OWNED BODILYINJURY(Per eWdent) $ MIRED AUTOS AUTOS PROPERTY DAMAGE $ -Lbf accident UMBRELLA LIABUmna,rmdniotorleicombined $ 300,10-00 OCCUR EXCESS LIAR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE g ' DED RETENTION; WORKERS C0MeMATION $ 'AND'EMPLOY•ERS,LIAVILITY• WC ATU- I I OTH- ANY PROPRIETORIPARTNERIQ(ECUTIVE YIN OFFICERIMEMBER EXCLUDED? ' N 1 A E.L.EACH ACCIDENT $ (Mandatory In NH) Ifn descdbe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below EL D18EASE-POLICY LIMIT .S DESCRJPT16N OF OPERATIONS I LOCATIONS[VEHICLES (Attach ACORD 101,Additional Remarks Schedule;Dmoiro apace Is regylred) Jobsi:te: ' Jobe & Patricia Broderick, 192 Stonecleav@ Rd, No Andover MR 01895 CEKtIFICATE'HOLDER CANCELLATION ' (97.8) 686-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICJES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town .of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. : 1600 Osgood St -'No. Andover; MA 01845-1048 AUTHORIZED REPRESENTATIVE Keith Maglia/KRM m. ACO'R17.:26(2010/05) ®1988-2010'AC.ORb'CORPOR-ATION. All rights reserved.. INS025(aoloo5).0i The ACORD name-and.logo are..registered marks of ACORD The Commonwealth ofMassachusetts - Depa>rtment of IndustY aMccidents M1 - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/ilia 'workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers Applicant Information /p Please Print Legibly Name(Business/Organization/Individual): ' (10 fLlS''V 2U Address:_ 9 Iz-\C Ma-6 0 it, City/State/Zip:- N14 0)0% Phone#: 7?/ ,? Are you an employer?Check the appropriate bog: Type.of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction 1 p ployces(full and/orpart-time)z have hiredthe 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 S. ❑Demolition working for me in any capacity. workers'comp.insurance. g• F1 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'camp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 11d Other 'Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. T Homeowners who submit this affidavit indicating they 9re doing all work and then hire outside contractors must submit anew affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'camp.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 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 ofthis statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cer i n he pai s dpenalties ofperjury that the information providefd above is true and correct, - Si afore: Date: d — 3 Phone#: 2 3 6 Official use only. Do not write in this area,to he 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.PIumbing 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 numbers)along with their certificates)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 maybe submitted to the Department of Industrial Accidents for confirmation of-insurance coverage, AIso 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 andprinted legibly: The Department leas 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 pennit/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. Anew 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 bum 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 Gommonwoalt�ofAlasso'cah-:setts - JDep.afteztt ofzadustdal.A,ccideats �f�iee of Intve�ti�a�io.�zs 600 Waskiixtgta-.Street Boston,MA,021 It TQJ,#617-727-4900 e:.Kt406 or 1-877:WSA,FF Revised 5-26-05 FaY,4 617-727-7749 p LORENZO CONSTRUCTION ` ' r From Minor Repairs to Major Renovations Construction Supervisor Lic.No.076063 Peter Mazzola, General Contractor Home Improvement Lic.No.130248 978-771-3646 (MA) Customer:John and Patricia Broderick Location: 192 Stonecleave Rd. North Andover, Ma. Kitchen Renovation • General Contracting: All work to be done as per discussion with home owner and according to supplied plan Full gut of kitchen down to sub floor and suds Reframing and installation of new Jeld Wen French door with Anderson 4000 series full view storm door to match existing (supplied by Lorenzo Construction) Reframing to bump out approximately 6"and installing new 400 series Anderson double casement window (supplied by Lorenzo Construction) Insulate exterior walls to code Blue board and plaster all walls and ceiling Install all cabinets and trim (supplied by homeowner) Install all finish trim inside and out to match existing as close as possible Reinstall all appliances Supply all necessary permits Remove all construction debris from premises • Plumbing Pull permit Disconnect all plumbing prior to gutting kitchen Upgrade plumbing to code where needed Convert base board heat to toe kick heater to accommodate new layout Install all plumbing fixtures and appliances supplied by homeowner (sink, faucet, dishwasher, and fridge) • Electric Pull permit Upgrade all electric to code Supply and install six recess lights and fo.ur halogen under cabinet lights to accommodate floor plan Any other light fixtures shall be supplied by homeowner and wired and installed by electrician (i.e. wall sconces, pendant light, or ceiling light) Wire for new toe kick heater t • Hardwood installation Install 2 %"red oak throughout kitchen and into front foyer. Match existing as close as possible Sand and finish with one coat sealer and two coats poly • Plaster Apply skim coat of veneer plaster to all walls and ceilings • Paint Paint all walls, trim, and ceiling in kitchen using Benjamin Moore colors TBD Paint all exterior where needed to match existing as close as possible using Benjamin Moore exterior paint (Paint supplied by painter) a 6 z iX ' Deposit of$5000.00 upon starting job 4 payments of$5000.00 shall be distributed throughout the iob at the request of the Contractor Final payment of$750.00 upon completion of iob Total $25,750.00 The above estimate is provided following initial review/consultation.Unless otherwise specified,a non-refundable deposit of$500.00 is required upon signing of contract,and will be applied toward the balance of the account. Unpaid accounts over 30 days are subject to a $100.00 monthly charge.Any checks rturned for insuffici nds are subject to a$50.00 fee. The client's signature below certifies understanding and agreement of the atements of thisAkument. Customer's Signature 1 Date: Contractor's Signature Date: Payment Schedule Date Amount Signature Office o onsumer airs mess egu ahon HOME IMPROVEMENT CONTRACTOR Registration: x130248 Type: Expiration: 2!_712014 DBA Lor zo Construction t 1 Peter Mazzola 2 Richard Drive Derry,NH 03038 a Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen'isor License: CS-076063 PETER T MAZZOA ,. 2 RICHARD DR; °e-) DERRY NH 030A c >I oA�` Expiration Commissioner 05/21/2015 O 09 Ll Note: This drawing is an artistic 20 2OE7 Designed: 8/7/2013 interpretation of the general TECHNOLOGIES Printed: 8/9/2013 appearance of the design. It is not meant to be an exact rendition. Broderick 5 Kitchen All. Drawing#: 1