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Home My WebLink AboutBuilding Permit #373-12 - 208 CARLTON LANE 10/26/2011 (3) TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 2_0b CPAZ1 P_7_ I LAQ-T Print PROPERTY OWNER TYK F 2_7-2_c-i_rAgc ty Unit# Print MAP NO: b PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes n 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 4_ISeptic .Well' O''Flood'plav el Fs, I [j'Watershedl Disct q Water/Sewer DL5CRIPTION OF WORK TO BE PERFORMED: d (Identification Please Type or Print Clearly) ' OWNER: Name: T1A 1'27 Z C=;M (�I Phone: 97� `7 9 Address: h CONTRACTOR Name: MLS IGL_ Phone: 17t Scdo Jro2 Address: 101 WE5)� klV)01� S77 /" ERP j 6AC � • V ��j(� Supervisor's Construction License: 0�3!� a[b Exp. Date: 1 "1 Home Improvement License: 'I&Ui (1=1 Exp. Date: "Z- C--2013 ARCHITECT/ENGINEER W,6� Phone: Address: 41� Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ JZ % �� FEE: Check No.: YY_�3 Receipt No.: � NOTE: Persons contracting wi h unregistered contractors do not have access to the guaranty fund Sigrature of Agent/Ovvne !t fi , nature of.contracto .. -..... .. .. _.. ... ...:. ... 1. ....' .. .. ... .'.'.. .. .. ... .. .... .... .. .. ...... ... .... .. ... 1 ,� - �.� y n .. . .. ., .-." : - -. .. o. - .. _ . .. . ., ..... . . .... .. Locations 1" '� `�� . No. Date �/ >; ?o',Nc oT.,tio TOWN OF NORTH ANDOVER ►� 9 ¢ . .�..�� ; Certificate of Occupancy $ .�,b <�'� Buildin /Frame Permit Fee $ � ' j Ss�cMust Building /Frame Permit Fee $ Other Permit Fee $ iI : >'. TOTAL $ -. � r ` Check # � :.I q2j�—�� ,-* j,. . g Id ' Building inglnspe for 2.47 64 . . ..._ - _. .. x - - - _ - _._ - 11 ;` . h .. r - . Plans Submitted' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Fpublic F SEWERAGE DISPOSAL ❑ Swimming Pools 0 ewer ❑ Tanning/MassageBody Art ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE FORM E ONLY INTERDEPARTMENTAL SIGN OF DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ COMMENTS Si nature CONSERVATION Reviewed on f COMMENTS HEALTH Reviewed on Si nature COMMENTS Zoning Decision/receipt submitted yes Zoning Board of Appeals:Variance, Petition No: -- 4 Planning Board Decision:------------ Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date DrivewayPermit 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 �y T-n ren �T�,T�. °, CY A`T-LC 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi �� 7-mc, 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 pp 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 CIerks 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 NORTH To Of _ over ., A11% No. 1 }( z^ -- - ass. os 4. O '- LAKE j. coC MI C ..C: AERATED PPS\ �� BOARD OF HEALTH U Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............� ..•.... ............................................................ Foundation has permission to ere buildings on ..e?0�.......00-r-LIUM1091401.ft � Rough ......................:............ to be occupied as...... al. !!!�.1........... ....... ..r!!!�� ,�....................... .... ....ff�.....��An.: • 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 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. i TODD MICHEL CONSTRUCTION, LLC 109 WEST MAIN STREET MERRIMAC, MA 01860 (978) 346-0464 CS LICENSE#069490 HIC LICENSE# 138046 PROPOSAL SUBMITTED TO: Lisa and Jim Fitzgibbon DATE: October 4, 2011 ADDRESS: 208 Carleton Lane GOOD UNTIL: 60 Days North Andover, MA START DATE: TBD PHONE: END DATE: TBD Thank you for allowing us to quote your project. We propose to furnish all material and perform all labor necessary to complete the following: PROJECT DESCRIPTION: Materials and labor to remodel basement including storage space, craft/game space, TV space, finish stairs and trim details • Frame walls,partitions, closets, etc. • Insulate walls and miscellaneous locations with foam and fiberglass as needed • Install electrical plugs as per code • Install 10 can lights as located by Homeowner • Install two phone jacks and two cable TV jacks • Drywall with moisture resistant drywall • Install decorative stair rails and columns • Install all doors,trim, and decorative trim,window seats, etc. • Install 2 X 2 revealed edge suspended ceiling • Install ceramic tile in all finished spaces (tile provided by Homeowner) • Paint all walls and trim as needed OTHER SERVICES: PLANS AND SPECIFICATIONS BUILDING PERMIT APPLICABLE INSURANCES REMOVAL OF DEBRIS PRICE: Todd Michel Construction, LLC, agrees to do all work as described above for a total price of$32,800.00 (Thirty-two Thousand, Eight Hundred and 00/100 Dollars). Payments to be made as follows: (To be determined) Please note: IRS Form W-9 (Certification of Taxpayer ID Number)will be furnished by Contractor with first billing or by request at any time following the signing of this contract. Contractor's signature: 7 Date: 10 2 S") / 1 ACCEPTANCE OF PROPOSAL Timely decisions and selection of any products and fixtures that are the responsibility of the Owner must be provided in a timeframe reasonable to the progression of the job. Todd Michel Construction, LLC will work with the Owners to provide the highest quality products within the schedule and budget of the project,but is not responsible for job delays caused by Owners' failure to provide specific instructions,products, or product selections. To the extent permitted by law, if the Owners are in default due to failure to pay according to the Disbursement Schedule, the Owners are responsible for any collection costs, attorneys' fees, court costs, and all other expenses of enforcing the rights of Todd Michel Construction, LLC under this agreement. Note: Any hazardous materials uncovered during demolition and required to be removed by licensed professionals will require additional fees not included in this contract. The above price, specifications, and conditions are satisfactory and are hereby accepted. Todd Michel Construction, LLC, is authorized to do the work as specified. Payment will be made as stated above. Owner's signature. r Date: Z r OWNER'S RIGHTS AND BENEFITS: The owner may have 3- day cancellation rights under one or more of Mass. Gen. Law Chap. 93, Sec. 48; Chap.140 D, Sec. 10; and Chap. 255D, Sec. 14. The owner is entitled to certain rights and benefits under Mass. Gen. Law Chap. 142A. 2 ATE ACORDD'CERTIFICATE OF LIABILITY INSURANCE 10/26/2011 rn PRODUCER Phone: 978-346.6761 Fax. 978-346-9620 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION JOURNEAY INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 WEST MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MERRIMAC MA 01860 ALTER THE C V RAG O D BY E O CES BELOW, INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insurance Co 14788 TODD MICHEL CONSTRUCTION,LLC INSURER B: ACE Property&Casualty Insurance C/O TODD MICHEL INSURER C: 109 WEST MAIN STREET INSURER D: MERRIMAC MA 01860 INSURER E: COVERAGES 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. INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION LTR INA TYPE OF INSURANCE POLICY NUMBER DATE DD DATE DD LIMITS GENERAL LIABILITY MP14196F 04/01/11 04/01/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 500,000 PREMISES Eaocaee CLAIMS MADEa OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 PRO. POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION$ WO $ WORKERS COMPENSATION AND C45877589 02/25/11 02/25/12 oRvruMrrs OTHER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 B ANY PROPRIETORIPARTNERIEXECUTIVE - OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMB $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS Town Hall WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO North Andover,Ma. DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �-1-1-k 9 -� Attention: Derek Journeay ACORD 25(2001/08) Certificate# 7821 ©ACORD CORPORATION 1988 i Massachusetts- Department of'Public Sate#a' g Regulations and Standards ti ffice^ooe mer a ,,,��k� . Board of Or ae s on, Construction S.upervisoc License DOME 1 O.V.zB�IFENT CONT''.., it ` egistrd�it 8046 Type . License. C:S 69490 wily �pitatlan 1.3 Private Corporafis; s T 1C��lEL •. �3 .'. •� ; h TODD`S MI-C,EL y 1.09WEST MAINsT TODD N1iFEl: . MERRIMAC, MA.U860 109.:WEST"1 IN S MERRIMAC,IUTA Ol$' Expiration: 1-212972012 Commissioner Tr#: 10458 I I II i I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual)TPM l"/�\/--4 PL C0QS7 LX :aLLC Address: bci WF!�W_ lv City/State/Zip: 14ERR-1-PAL M# Q)&$ p phone#: 17b g3C) Gqz,_ Are you an employer?Check the appropriate box: Type of project(required): 1. D I am a employer with 5— 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. ❑ I 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 10.0 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' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 13.0 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 a new affidavit indicating such. lContractors 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 certify under/the pains and penalties of perjury that the information provided above is true and correct. Signature: �A�/' Date: Phone#: l 7 t-, Sb� `�"7 L42– 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#: