HomeMy WebLinkAboutBuilding Permit #483 - 21 FRENCH FARM ROAD 2/15/2008BUILDING PERMIT a
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: �
Date Issued: 2zfd
IMPORTANT: Applicant must
Date Received
all items on this
LOCATION C t. -\ L 11 I t^ N to 13.E
pp Print
PROPERTY OWNER t\ t 4 P r ISTl G A -f �
Print
MAP NO: PARCEL: ZONING DISTRICT: 1-listoric District
Machine Shop V
yes no
ves no
TYPE OF IMPROVEMENT
of
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h T
1e */
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family 'k
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK i O tit FMtr-UMM1=U:
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e—e.titl pUrf F X+5TH^W flur'\a.-. v ek 'W (\ f6>C7
Ide tification Please Type or Print Clearly �i
OWNER: Name: R ui P 1 T) o -� Phone: Iq ]
coNTRACTOR
ti..::..-�,. ...ane:
Address: 1,_N000\ O n ma11
Supervisor's Construction License:— t ,) Y Exp, Date: f 1Ya
Home Improvement License: 1 I b $ . _ Exp. Date: i a
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: $ d'� 6 O O (3 FEE: $
Check No.: 3 S Receipt No.:. 9,5`O
NOTE: Persons contracttqg it u regi t ntractors do not have access to the guaranty and
Si
Signature fconactognatureofA14 �_A
41 Location ;? / TFMG Gi , G'��iL, /
No. Date 2— // 6/0 q'
TOWN OF NORTH ANDOVER
0:�.ae :•'�yO
Certificate of Occupancy $
Building/Frame Permit Fee $ 2 �Z
SACHUst
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
20
Build' g Inspector
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
r' CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
DATE REJECTED DATE APPROVED
DATE REJECTED DATE APPROVED
Comments
Zoning Decision/receipt submitted yes
Conservation Decision: Comments
Water & Sewer Connection/signature & Date Driveway Pppi2it
Located at 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes,
Located at 124 MainStreet
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
MGL Chapter 166 Section 2 1 A —F and G min.$100-$1000 fine
NOTES and DATA — (For department use)
No
63
Ls e 3
6✓1 N -
�OV--Ios ,
❑ 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 Permi fi L_
❑ Workers Com ffidavit
❑ Photo Copy Of .. r 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 DEPARTMENTWITORM07
Revised 2.2007
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Stone Technologies, Inc.
5 Draper Street, Woburn MA 01801
Tel :781-358-6800 Fax:781-358-6504
QuoteNo.
HAL -34519-0
Date
1/23/2008
Customer
HA112 - Halco Kitchens
Customer Rep,
Brian
Ref Number
Goff
Salesperson
Shawn W
Project
ORO VENEZIANO GRANITE 3CM
Model
Sq. Ft.
Quote Good Until
2/22/2008
Terms
Total Weight
0.00 lbs
Product
Sq. Ft.
The StnnPTach Wa%r U
Quote
Bill To
Tlm or Mark
Halco Kitchens
650 Broadway Route 99
MALDEN , MA 02148
Tel: ph. 781-324-6462 fax
781-324-3118
Ship To
None To Date
MA
Category
Desoription
Quantity
Measure
Description
Kitchen Countertop
1.00
Size
Strsight Top 1104 1 /2" X25 1/2" Island Top 90"x 30" Upper
Bar Top 73" x 22 1/2" Straight Top 66 1/2)" x 13" Si(aight
Top 65 1/2" x 13"
Custom shape
ORO VENEZIANO GRANITE 3CM
67.00
Sq. Ft.
Backsplash
Size
4" 9acksplasll Q 1 1/4" tllicknoss
1.00
Backsplash
ORO VENEZIANO CRANI fF 3CM
6.00
Sq. Ft.
Edge
1/2 BULL NOSE EDGE
54.00
Cutouts
SINK UNDEn MOUNT
1.00
Cutouts
CUUK TOf
1.00
Template/install
INSTALLATION SO FT
61.00
Ternplate/Install
TEMPLATE SO Fr
87DU
Item Subtotal
Shipping Charge
Other Charges
Price
$4,822.41
Page 1 of 2
Qty Extended
1.00 $4,822.41
$4,822.41
$0.00
$0.00
Sales Tax $241.11
Quote Total $5,063.52
Deposit Required $0.00
Stone Technologies Standard Terms and Conditions of Sale.
1. NI agreements are subject to change and no liability shall result from delay in performance or non performance In the event of strikes, delay of
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WOOdMOHS 0318H 8VI1 (AH01002-90-]30
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
r` Boston, AL4 02111
www.m.ass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
Address: q y r v r.
City/State/Zip: G 1 (� e A), pJ, 0 C 1 q �6
Phone.#:
Type of project (required):`
6. ❑ New construction
7. ® Remodeling
8. ❑ Demolition
9. Building. addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I Homeow:"ers 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 state whether or not those entities have
employers. If the sub-contractorshave employees, they must provide their workers' comp, policy number,
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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Tnvectivatinns nft},P T1Td f-,
a _ter__ •_
I do her certify u er the ains i
Si atur`e:
Phone #:
Officiatuse only. Do not write in th
City or Town:
U
area, to
of perjury that the information provided ab ve is true acnd correct
Date• �'` �
or town official
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
EtPerson:
4. Electrical Inspector 5. Plumbing Inspector
Phone #:
Areyou an employer? Check the appropriate box:
1. ❑ I am a employer with '
4. 0 I am a general contractor, and I
employees (full and/or part-time).*
have hired the sub -contractors
2.0 I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp, insurance
comp• insurance.$
required.]
5.�,] We are a corporation and its
3.0 I am a homeowner doing all work
officers have exercised their .
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance reouired.l
Type of project (required):`
6. ❑ New construction
7. ® Remodeling
8. ❑ Demolition
9. Building. addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I Homeow:"ers 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 state whether or not those entities have
employers. If the sub-contractorshave employees, they must provide their workers' comp, policy number,
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
Tnvectivatinns nft},P T1Td f-,
a _ter__ •_
I do her certify u er the ains i
Si atur`e:
Phone #:
Officiatuse only. Do not write in th
City or Town:
U
area, to
of perjury that the information provided ab ve is true acnd correct
Date• �'` �
or town official
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
EtPerson:
4. Electrical Inspector 5. Plumbing Inspector
Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employdrs 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."
i
J.
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 "ever state or local licensing agency shall withhold the issuance or
renewal of a license or permit to,bperatera 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, §25CO) 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 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 maybe 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 permittlicense 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 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
604 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext.4.06 or 1-877-MASSAFE
` Revised 11-X22-06 Fax # 617-727-7749
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DEC-06-2007(THU) IaA3 HALCO SHOWROOM
—27Y -
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12" 27-- _ 3 - 27}"
12 W2736BD WHAF3624 W2738BD
TA B2TRp i 58 �z�D_ pig
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(FAX)78132a3118 P.0011001
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12" 30"- 12"-
- - 127" - -- -
diony Zile. Ore '7(1 "4f1�� Thlx 64 in or;Kinal desiM and must not be
b x4c and ,eCnnatuGAe7 relcase<I or copied unless applicable fee
onx'• llsa lx:un hart or job tArder piaced.
111 A L C 0
Ralph do Patti Goff
21 French Farm Rd.
N. Andover Ma
S I•I 0 W R U U M
It
Date: 12 / 20 / 07
_r Product Description
• Cabinet Manufacturer.- Dynasty
• Wood Species and Color: Cherry with Burgandy Stain.
• Door and Drawer Stple: Artesia w/5pc Drawer face
+ Construction ofCabinetc Cabinets are -all.woodiconstruction.
+ Hei hts o Base and Walt Cabinets: height of Base Cabinets -will be 34in;
height'of Wall Cabinets will be 36in.
• _o1gMgAnnlicati6n: Large Solid wood crown.
• Glass DoorApnlicatian: Glass will -be applied over dry bar( -.Si
ass vvitl be
purchased sepratley).
• Countertop Type and Edge Detail: Customer will supply oh there own
• Sizes Allowed torAyvliancec:36" Refridgerator , 36" Range top,. 2411
Dishwasher, 30" Built in Oven with Convection microwave Combo, 30"
warming drawer (built-in).
• ALL CABINCTS- WILL BF PRDPYDE_D AS -TO FLOORPLANAGRE
UPON AT TIME OF SIGNING CONTRACT.
Vanities: None.
• Total costo Materia • 15,397.41
• Denoszt: $_ 7,94$.70
• Due ai'time ofdeliu rv: 7.94A70 —
G50 Broadway • Roulr 99 • Maldcn,MA 02148
Te1cphonc.781-324-6462 Vax.781-329.3118
CHUHA CONSTRUCTION COMPANY, INC.
44 BRYANT STREET
MAWEN, 1AA 02148
781-321-7222
December 27, 2007
Proposal submitted to:
Ralph and Patty Goff
21 French Fane Road
North Andover, MA 01845
Kitchen Renovation
Demolition
• Remove all existing cabinets, counter tops and plastered soffitt above cabinets.
• Remove pine wainscoting.
• Take up ceramic the floor in front hall to sub floor.
Rough Framing
• Install %"x2 %" wood strapping 16" on center over existing brick wall in kitchen.
Electrical
• Disconnect existing appliances.
• Wire according to code as needed for new appliances as shown on cabinet plan.
• Supply and install ten recessed lights.
• Supply and install under cabinet lighting at main counter area.
• Install wiring with switch for lighting over island (Light fixtures to be supplied by Owner).
Plumbing and Heating
• Remove existing sink, faucet, garbage disposal and dishwasher.
• Relocate drain as needed for sink.
• Install new faucet, dishwasher and garbage disposal supplied by Owner. (Kitchen sink and
installation supplied by others).
• Remove existing baseboard heat and install new smaller profile baseboard heat if adequate
enough to heat room.
Blue Board and Plaster
• Install %" blue board with skim coat plaster over existing ceiling, over strapped brick wall
and on walls where wainscoting was if needed. (Walls to be smooth finish, ceiling to be
sand finish).
Painting and Staining
• Remove existing wall paper in kitchen.
• Prepare walls as needed and apply two coats of Latex paint.
• Paint existing trim with one coat of primer and one coat of Latex paint on kitchen side.
Interior Finish
• Install baseboard as needed to match existing.
• Install kitchen cabinets and moldings. (Cabinets and moldings supplied by Owner).
• Counter top by others.
Flooring
• Patch existing hardwood floor as needed.
• Install new oak flooring to match existing in front hall and approximately 3'x12' area strips
in family room.
• Sand kitchen floor and new floor.
• Apply one coat of sealer and two coats of polyurethane.
• Remove all trash and debris.
• Price does not include cost of building permit.
We propose hereby to furnish material and labor — complete in accordance with above
specifications, for the sum of: Fifteen Thousand Nine Hundred Dollars, ($15,900.00).
Payments to be made as follows:
$5,000.00 at start of job.
$4,000.00 after rough inspections.
$3,000 at start of cabinet installation.
Balance upon completion.
David M. Chuha, General Contractor
The above prices, specifications and conditions are satisfactory and are hereby accepted.
Chuha Construction Company is hereby authorized to do the work as specified. Any
changes to the above specifications must be requested in writing by the property owner
and accepted by the contractor, with the change in the contract price, if any, reflected on
such change order. Itwe agree to make all payments to the contractor as stated herein. If 1
fail or refuse to make payments as specified herein, l understand that 1 shall be
responsible to pay any and all costs involved in the collection of any amounts due,
including reasonable attorney's fees and costs. Balances due and payable over 30 days
past the completion date shall be subject to charges of 1.5% per month of the unpaid
balance.
AGREED AND ACCEPTED THIS DAY OF 2007.
Property Owner Property Owner