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Home My WebLink AboutBuilding Permit #818 - 20 NUTMEG LANE 6/11/2007Permit NO: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �el�ke Date Received I IMPORTANT: Applicant must complete all items on this Daize I £?CATION:.. . Print int ..& MAP NO: .� F'AIEL:_ Z2 ZONING DISTRIGT:�/?_Histaric District r yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building pV One family Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other y; Septic ❑ Well Water/Sewer ❑ Floodplain ❑ Wetlands ❑ Watersed Dista( " n DESCRIPTION OF WORK TO BE PREFORMED: ox 6ce S L iJ & ,W zd- -Y Identification Please Type or Print Clearly) OWNER: Name: rz4- ,,c Ab,.;s Phone: Address: CONTRACTOR Nat e: a ` Superviso s Construction Licenser Exp. Date: / 2;2 pq Nome Improvement License - i'"l...S U -7—v Exp. Date: lfJ ? 1AP ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $ 2.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1`49 FEE: $ Check No.: o Receipt No.:v NOTE: i, Signature�kd7ryl in awnegistered contractors do not have access to the guarantyfund ,Signature of contractor Plans Submitted W Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer JK 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 PLANNING & DEVELOPMENT ❑ COMMENTS DATE APPROVED 11 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH COMMENTS i u Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: DATE REJECTED ■❑ Comments Conservation Decision: Comments DATE APPROVED Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes MicA�at 124Wain Street ' Fire" Department siignatureldate 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 servic p requires approval of Electrical Inspector Yes o 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.Building Permit Revised 2007 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location J4w, x� jg�%' Date // V/' No. MaRTM TOWN OF NORTH ANDOVER F 41 FEW 9 Certificate of Occupancy $ a •O�Alne��. cHusE<'�'' Building/Frame Permit Fee $ d Foundation Permit Fee $ ti Other Permit Fee $ TOTAL $ Check #�� Building Inspector B v CO) O CD 'v Z O CD O CD 0 II� Oq ZO V J n O cn I RR —H N Oa.5r m CO)�O ._ny-rn �n••a. m ` CD o CO) m m m a *gyp �o = t m O H A ir• O O N cm. o_ m m H a CD O O m CD 01 y CLcr W- a CD 0 �. m m N CA O CO N 'O mo �a _ •a o � e 1 O m �y m : Fm i o CD Im m _ Im m �+ a� n� � !RJ_ .. o C2 ??, re C � O aGa Cr1 "oM 7 w aCa CO2 d CM) 'v CD az O H �.�y CL n� m m CL y m �� m c v o.� CD o (X Y/ CL Q p m CD CA CCD O cD m C CSD y. aov y to CD I B v CO) O CD 'v Z O CD O CD 0 II� Oq ZO V J n O cn I RR —H N Oa.5r m CO)�O ._ny-rn �n••a. m ` CD o CO) m m m a *gyp �o = t m O H A ir• O O N cm. o_ m m H a CD O O m CD 01 y CLcr W- a CD 0 �. m m N CA O CO N 'O mo �a _ •a o � e 1 O m �y m : Fm i o CD Im m _ Im m �+ a� n� � !RJ_ .. o p ??, O oda :'- O aGa Cr1 "oM 7 w aCa w G �.�y Ly ^ O p O 1 s a 0 c CD 9 Board of Building Regulations and Standards License or registration valid for indis idul use on[% HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Y, y Registration: 152820 One Ashburton Place Rm 1301 Expiration: 10/3/2008 Boston. lila.02108 Type: individual BLAINE SCR:BNER BLA,NE SCRIBNER 385 SUTTON ST NORTH ANDOVER, MA 01845 Deput% 1,dministrator \ot valid without signature BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 063513 Birthdate: 121181953 ��Jjj'j Expiros: 12/1&"2007 Tr. no: 11651 Restricted: CO BLAINE A SCRIBNER 385 SUTTON ST C' N ANDOVER, MA 01645 Commissioner TRAVELERS CLASSIFICATION LOCATION 001 01 ( CONT' D ) CARPENTRY -DWELLINGS -THREE STORIES OR LESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY QUOTE PROFILE POLICY NUMBER: (GKUB-5482C72-7-07 ) PREMIUM BASIS ESTIMATED TOTAL ANNUAL CODE REMUNERATION 5651 IF ANY RATES ESTIMATED PER $100 OF ANNUAL REMUNERATION PREMIUM 9.03 ------------------------------------------------------------------------------------ 1.00% EMPL. LIAB. INCREASED LIMITS(9807) $ 10 ADD FOR INCREASED LIMITS MINIMUM (9848) 40 .950 MERIT RATING MODIFICATION (9885) 52 TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 991 EXPENSE CONSTANT(0900) 284 0.0300 FOREIGN TERRORISM / TRIA (9740) 3 4.19% MA WC SPECIAL FUND AND TRUST FUND 40 TOTAL ESTIMATED PREMIUM 1318 DEPOSIT AMOUNT DUE 1318 DATE OF ISSUE: 05-18-07 WC ST ASSIGN: MA SCHEDULE NO: 2 OF LAST TRAVELERS INSURER: THE TRAVELERS INDEMNITY COMPANY INSURED'S NAME: BAILEY CUSTOM HOMES LLC WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY QUOTE PROFILE POLICY NUMBER: (GKUB-5482C72-7-07 ) 11347—MA RATE BUREAU ID: 143087 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNU'AL PER $100 OF ANNUAL CODE REMUNERATION REMUNERATION PREMIUM 5545 IF ANY 47.57 5645 11000 9.03 DATE OF ISSUE: 05-18-07 WC ST ASSIGN: MA SCHEDULE NO: 1 OF MORE 000569 993 CLASSIFICATION LOCATION 001 01 FEIN 043550830 ENTITY CD 001 BAILEY CUSTOM HOMES LLC 385 SUTTON ST. NORTH ANDOVER, MA 01845 ROOFING NOC & YARD EMPLOYEES, DRIVERS CARPENTRY—DETACHED ONE— OR TWO FAMILY DWELLINGS m 0 0 0 0 d� d� 0 m r 0 0 m WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY QUOTE PROFILE POLICY NUMBER: (GKUB-5482C72-7-07 ) 11347—MA RATE BUREAU ID: 143087 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNU'AL PER $100 OF ANNUAL CODE REMUNERATION REMUNERATION PREMIUM 5545 IF ANY 47.57 5645 11000 9.03 DATE OF ISSUE: 05-18-07 WC ST ASSIGN: MA SCHEDULE NO: 1 OF MORE 000569 993 BAILEY CUSTOM HOMES LLC P.O. Box 973 Middleton, MA 01949 Phone: (978) 683-9468 Fax: (978) 683-9468 bailey22_2001@yahoo.com April 30, 2007 Budget for Robbin's project at 20 Nutmeg Rd., No. Andover Ma. Basement: 1. Permit.............................................................................? 2. Framing material ....................................................$1700 3. Framing labor .........................................................$1500 4. Insulation of new walls............................................$1000 5. Electrical work ........................................................$4000 6. Floors ( carpet ,and the in bath ) ..............................$2300 @ 7. Doors, stair parts, base & window moulding ..........$2500 8. Labor to install above...............................................$1200 9. Paint........................................................................$2500 10. Shelves, and misc......................................................$600 11. Plaster......................................................................$4400 12. Trash disposal, cleanup and misc. labor......................$600 13. Move columns.............................................................$600 14. Add 2 windows to knee wall........................................$1000 15. Plumb for lit bath ........................................................$3700 16. Install suspended ceiling.............................................$2100 @ 17. Install heat off existing system.....................................$2000 Total.......................................................................... $31700 20% fee......................................................................$6340 Total......................................................................... $38,040 Estimate for constructing stairway from garage to basement ..... $2000 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: :4.s-_& mt2 si-: City/State/Zip:��(/_ ,n dazes.� '%4-- _ Phone #: Q 7 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. [,X I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. ❑ required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I 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 workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: '?tom t/ eze2 C Policy # or Self -ins. Lic. #: Ir 116 — 2./_7 -- 7-- o? Expiration Date: 7�/ Job Site Address: %('Z -m P 1�2 City/State/Zip:��/,�,1��z 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. Ido hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Siynature: Date: 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 #: BAILEY CUSTOM HOMES LLC P.O. Box 973 Middleton, MA 01949 Phone: (978) 683-9468 Fax: (978) 683-9468 bailey22_2001@yahoo.com April 30, 2007 Budget for Robbin's project at 20 Nutmeg Rd., No. Andover Ma. Mud room: 1. Permit.............................................................................? 2. Framing material ......................................................$600 3. Framing labor...........................................................$500 4. Insulation of new walls..............................................$200 5. Electrical work ..........................................................$800 6. Floors (approt 120 sq. ft. tile at $7.00) ....................$840 7. Door, base moulding and stairs material...................$500 8. Labor to install above.................................................$500 9. Paint..........................................................................$300 10. Shelves, seats and misc..............................................$300 11. Plaster........................................................................$600 12. Trash disposal, cleanup and misc. labor .......................$300 Total........................................................................... $5440 20% fee......................................................................$1088 Total............................................................................$6128