HomeMy WebLinkAboutBuilding Permit #332 - 204 SUTTON HILL ROAD 10/23/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all
items on this age
LOCATION V I lR I
Print
PROPERTY OWNER Ue cid
;��
�7� Print 100 Year Old Structure yes
MAP NO: PARCEL:M i�ZONING DISTRICT: Historic District yeC( no
o
rr Machine Shop Village ye
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Additi ❑Two or more family ❑ Industrial
eration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
E CRIPTION OF WORK TO BE PER,FORMED:
it
"Ac-e
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,Identification Please Type or Print Cle ly)
OWNER: Name: Phone:
Address: ao=j sc&nn
CONTRACTOR Name: J2&2-,6LA/I�e-S Phone:
Address: ez. E
Supervisor's Construction Licenser Exp. Date:
Home Improvement License: 32Z » Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
�� A l0� I.
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to t anty fund
Signature of Agent/Owner Signature of contracto
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 11 St d Plans ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
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
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 Os ood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at'124 Main Street
Fire Department signaturefdate
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
i
LJ Notified for pickup - Date
It
Doc.Building Permit Revised 2010
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
Li Building pp Permit Application
a Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
Li Building Permit Application
❑ Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o 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)
o 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
La Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
► o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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 subm'.tted with the building application
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Doc: Doc.Building Permit Revised 2012
Location
No.:�33Date'/�
• - TOWN OF NORTH ANDOVER
O
Certificate of Occupancy $ `
Building/Frame Permit Fee $�
� Foundation Permit Fee $
. r Other Permit Fee $
?4,
TOTAL $
Check
25865 Building Inspector
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 57,674.0,0 m
$ - $ 692.09
Plumbing Fee $ 86.51
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 86.51
Total fees collected $ 965.11
204 Sutton Hill Road
332-13 on 10/23/2012
New Kitchen Cabinets, Replace Slider with Door,
Replace Kitchen Window
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BOARD OF HEALTH
Food/Kitchen
PERMIT TG LD Septic System
THIS CERTIFIES THAT ....................IA!........... ...... ........ .�!r®........................ ... ...... ......... ....
BUILDING INSPECTOR
has permission to erect .......... ......... buildings on 0.. Foundation
Rough
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to be occupied as ........... ... 1.... ... ....... ..... ......�. ......�....�?�!d. ...: ..w.l.�lfiF.a. 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO ART Rough
Service
...................ks.... ............................................ 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.
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All dimensions_size designations20 This is an original design and must Designed:9/8/201.2
given are subject to verification TECH NOIOGIEStion on L�t ' not be released or CoP ied unless" Printed: 10/1312012.
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
J J Builders Krueger Residence APC Revised All Drawing#: 1
CONTRACT AGREEMENT
J & J Builders
www.*-*builders.com
300 Brickstone Square
Suite 201
Andover MA 01810
978-681-5368
Innovative Design & Construction—
MA Licence# CS 040305
DATE. October 18, 2012
William& Susan Krueger
204 Sutton Hill Road
North Andover MA 01845
978/682-9834
Wpkl934 ,gmail.com
1. Order and install Schrock brand all plywood constructed cabinets; style is to be
Huxley, with five piece drawer fronts. Wood is cherry and finish is Brierw6od.
No cabinet hardware is included in this contract.
2. Cabinet order will be from final revised plan from 10/13/2012 plan designed by
Darlene Benoit of Jackson Lumber. Plan approved by William& Susan Krueger.
3. Counter tops for new kitchen will be ordered and installed after all new cabinets
are installed and set in place. Cost for new countertops will be invoiced at time of
actual countertop order. Color, style and edges will be picked by homeowners.
4. This contract includes gutting out existing kitchen cabinets, all sheetrock behind
existing cabinets and kitchen ceiling in kitchen area only.
5. Install new header above kitchen doorway to allow for expanded floor plan.
6. Frame in and close off entrance to hallway behind existing kitchen cabinets.
7. Order one Andersen brand French Wood single swing door unit. FWH3168-
white/clear pine, high performance smart sun low-E4 glass.No grilles.
8. Frame in for new Andersen French wood single swing patio door in place of
existing 6' sliding door. Tie in new siding to match existing wood siding.
9. Order one Andersen brand casement window. CN235 (LR)white/clear pine,high
performance smart sun low-E4 glass.No grilles.
10. Frame in for new Andersen kitchen casement window. Size to be a CN235
installed above sink. Tie in new siding to match existing wood siding.
11. Wiring allowance for kitchen of$6.300 is included in this contract. Allowance
fill
includes 11 recessed light units in ceiling, under cabinet lighting, light above sink
and wiring above island area for pendent lights. Bring all current kitchen wiring
.Page 1 of 4
up to current building codes. Tie in wiring for new exhaust fan for stove and tie in
new toe kick heating units in kitchen,move hallway light switch.
12. Light fixtures above island are not included in the above wiring allowance.
13. Plumbing allowance of$2,000 is included in this contract. Allowance includes tie
in of new kitchen sink and faucets, water supply line for new refrigerator,tie in
gas piping for new stove top and order& install two additional toe kick heating
units for kitchen area. Remove and tie off existing heat in kitchen.
14. Plumbing sink& faucet allowance of$500 is included in this contract.
15. Install new R-21 insulation in all exterior walls in kitchen area only. Bring current
ceiling insulation up to R-38 level to meet all current building codes.
16. Install new 1/2" sheetrock for new kitchen ceiling and behind all new cabinets.
Tape, compound, sand smooth and prime all new sheetrock.
17. Compound hallway ceiling &family room ceiling to match new smooth kitchen
ceiling.
18. Install new kitchen cabinets as shown on final revised floor plan from 10/13/2012.
19. Remove existing oak parkay flooring from kitchen,family room off kitchen,
hallway at back of kitchen and on two landings at side door entrance. Sand and
refinish 14 treads at side door entrance. Treads will be stained to match new
cherry flooring as best as possible.
20. Order and install new 3/4"x 3 1/4" Tiger wood cherry flooring to match existing
bedroom hardwood floor as best as possible.
21. Paint new ceiling in kitchen,hallway ceiling &family room ceiling to match new
smooth kitchen ceiling.
22. Paint all new siding used to tie in around new kitchen door and window.
23. All paint used will be a Benjamin Moore brand paint. Color to match exterior as
best as possible. Ceiling paint will be a flat white color.
24. J&J Builders will remove all construction debris form job site via on-site
dumpster.
25. J&J Builders will be in compliance with all state and local building codes.
26. Total cost including all outlined allowances and kitchen cabinets $57,674.00
Contract Cost Breakdown
• Cabinets; $22,919.00
• MA State Sales Tax $ 1,432.00
• Flooring $ 6,000.00
• Interior/Exterior Painting $ 600.00
• Material & Labor $26,723.00
TOTAL COST $57,674.00
Page 2 of 4
Contract Deposit Schedule
1. First deposit of $27,702.00 will be required for building permit, kitchen
cabinet deposit and start of construction up to installation of sheetrock.
2. Second deposit of$12,000.00 will be due upon delivery of kitchen cabinets.
3. Third deposit of$12,272.00 will be required to begin cabinet installation and
completion of all contract work.
4. Fourth deposit of $5,700.00 will be due upon completion of all work as
outlined in this contract.
Si ure of General C>vdractor-John Byrnes Date
Signature of Sigrfature of omeo er(s) Date
L
signature of Signature of(LIo eowner(s) Date
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Page 3 of 4
CONTRACT ADDENDUM
1. All contractors and sub-contractors shall be register and that any inquiries
about a contractor or sub-contractor relating to a registration should be
directed to: Office of consumer affairs and business regulation
Ten Park Plaza, Suite 5170
Boston MA 02116
(617) 973-8700
2. HIC License# 132770. Construction Supervisor License#40305
3. Homeowner's three-day cancellation rights under Mass laws.
4. All warranties on the owner's rights under the provisions of MGLc.142A.
5. There will not be any lien or security interest on the residence as a
consequence of the contract
6. An enumeration of such other matters upon which the owner and
contractor may lawfully agree.
7. Any other provisions otherwise required by the applicable laws of the
Commonwealth.
8. Permit Notice:
a. Any and all necessary construction-related permits
b. That it shall be the obligation of the contractor to obtain such
permits
c. That owners who secure their own construction-related permits or
deal with unregistered contractors shall be excluded from the
access to the Guarantee Fund.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
l �
Sig re of Genera Co ractor- John Byrnes Date
Signature Sig ture of/Homeowner(s) Date
ignature of Signature of eowner(s) Date
Page 4 of 4
1(
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Office o onsumer A a,rs s►nessegu a onl
HOME IMPROVEMENT CONTRACTOR
Registration: 132770 Type
It
Expiration: x/2013 DBA
TBOYRNES',BALDERS:--�
JOHN BYRNES 1X W` ,
> > _'
214 HAMPSTEAD P
METHUEN,MA 01844 i
Undersecretary
I
Massachusetts- Department of Public Safctl
AM Bom-d of Building Regulations and Standards
Construction Supervisor License
License: CS 40305
JOHN J BYRNES �
t
214 HAMPSTEAD ST
METHUEN, MA 01844
Expiration: 6/1/2013
('un,missiunc, Tr#: 17034
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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): �J A_3
Address: G lU &
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am mployer with 4. ❑ I am a general contractor and I 6. ❑�estruction
eloyees(fulland/or part-time).* have hired the sub-contractors2. Iamasoleproprietoror partner- listed on the attached sheet. t
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.❑Roof repairs
insurance required.]i employees. [No workers'
comp.insurance required.] 1311 Other
xAny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
P 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.
C am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
:assurance Company Name: NV 0 e Ann,
?olicy#or Self-ins.Lic.#: ROLExpiration Date:
lob Site Address: v ki
f City/State/Zip:
attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
►f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
do hereby certi td the pain nd penalties ofperjury that the information provided above is true and correct.
di nature: Date:
'hone#:
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#:
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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)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 may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also 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 and printed legibly. The Department has 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 permit/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. A new 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 burn 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 5-26-OS www.mass.gov/dia
DAT!(NWDDM/W)
ACORD. CERTIFICATE OF LIABILITY INSURANCE 10/19/2012
PRODUCER 978-686-0826 THIS CERTIFICATE IS ISSUED AS•A MATTER OF INFORMATION
JOANNE K MILLS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
156 HAVERHILL ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
METHUEN, MA 01844 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED IT; IN$URERA! N&D GROUP MUTUAL INS.GO R0404258A
JOHN BYRNES INSURER B:
D/B/A J&J BUILDERS INSURERC;
214 HAMPSTEAD STREET INSURER D;
METHUEN, MA 01844
INSURER E!
COVERA0 S
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 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,
POLICY POLICYEFF P N LIMITS
A OENERALIJABILITY EACH OCCURRENCE S 1MILLION
X COMMERCIAL OENERAL LIABILITY R0404258A 10/19/2012 10/19/2013 _ $ 50,000
CLAIMS MADE Ex-]OCCUR MED EXP(Any oneperson) S 5 000
PERGONAL d ADV INJURY S
GENERAL AGGREGATE $ 2MILLION
GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS•COMP/OPAGG $ MILLIONPOLICY PRO. LOC
JFCT
AUTOMOBILELIAEILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea aooldanq S
ALL OWNED AUTOS
BODILY INJURY 3
SCHEDULED AUTOS (Per person)
T HIREDAUTOS BODILY INJURY
NON-OWNED AUTOS (Per acoldenO
PROPERTY DAMAGE 8
(Per eccldeM)
OARAOP LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY; AGO S
EXCESSNNBRELLA LVi131UTY EACH OCCURRENCE 3
OCCUR FICLAIMS MADE AGGREGATE E
DEDUCTIBLE i
RETENTION s L
WORKGRa OOMPSN8AT10N AND rI-
EEL
EMPLOYERB'LIABILITY
ANY PROPRIETORIPARTNERlEXECUTIVE
E.L.EACH ACCIDENT S
OFFICERIMEMSER EXCLUDED? E.L
t .DISEASE-EA EMPLOYEE a
f yyae Ceecrlbe under
IS EMAL PROVISIONS below El,DISEASE-POLICY LIMIT E
OTHER
DE mpTION OF OPERATIONS J LOCATIONS/V6f11CLE0IEXCLU810N8 ADDGD BY ENDORORMcNT I SPECIAL PROVIaIONS
CERTIFICATE HOLDER CANCELLATION
aNOULD ANY OP THE ABOVE DESCRIED POL1C1Ell BE CANCELLED BEFORE THE EXPIRATION
DATE TH E F,THE ISSUING INSURER LL ENDEAVOR TO MAIL DAYS WRITTEN
TOWN OF NORTH ANDOVER NOTION NE CERTIFICATE HOLDER MED TO THE LEPT,BUT PAILURE TO DO 80 aHALL
120 MAIN ST, IMPOE N OELIOATION OR LIAYIUT Or,ANY KIND U T INSURER,tTa AGENTS OR
NORTH ANDOVER, MA 01845 R NTA V e
JA "
ACORD 25(2001/08) D CORPORATION 1088