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HomeMy WebLinkAboutBuilding Permit #762-2017 - 212 HAY MEADOW ROAD 2/6/2017TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No: 76a` - )-0/ 7 Date Received "17 Date Issued: i2_ ErP, c / BRORTANT: Applicant must complete all items on this page LOCATION: P, tint, PROPE, RTY�01/VNER� ✓�2`t�aGt►AtP�2Y - ��—' Printt900�Ytkf mg Structure yes o MAP NO; U �y PARCEL: --"-7ZONJNG, DISTRfCT �r Historic; ®istnct ye_s: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1' One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Rt Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ESeptic; ®V1/ell' " ©Floodplain, O Wetlands; Watershed District q Water/Sewer. - - DESCRIPTION OF wOKK i O tit rtK1-UK1V1cu: ire,14G0 !Lr--P4oY,&rl©y4 Identification Please Type or Print Clearly) OWNER: Name: sj4jA kA A, O-q!3eT�J M xt PLP Ps2.`l Phone: 509--7'71(,- '6009 Address: 2►2 .�lo--rannaD� a -D CONTRACTOR Name- 6TeT+karL.4 A 41L( Rhonei: q'IT4, AL. -7 Address: w - Supervisor's Ggnstruction: License:. Date: 1.- i -_ 1? Horne, improvement License: 1 Z 4 -1 T2 - Exp: ®ate: - -7-- t a. _ ARCHITECT/ENGINEER (tieLiviAS '7�i'Cye- UAt., F,, LLG Phone: `i lt- Address: S I'1 4 t4onT1-4 ea 4 UL. V Q .Ia crsi3uaY 1A)1r Reg. No. 3 3 'q 5 `f FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASEDDON $125.00 PER S.F. Total Project Cost: $ 4 S , `I 4 o FEE: $ % T Check No.: / t 7 2'` Receipt No.: 315'/40 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Ignature of.Agent/O;wner> >:: Sig �atu:re;:of contractor' t:_._ Plans Submitted aj �ans Waived ❑ Certified Plot Plan ❑ Stamped Plans W Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE -OF .SEWERAGE DISPOSAL Public Sewer ElTanning/Massage/Body Art E]... 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 ❑ DATE APPROVED ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed Sianature A � d 7i + -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ,Conservation Decision: Comments Water & Sewer Connection/ermit DPW 'Iwvv�z_, Engineer: Signature: FIRE DEPARTMEN' T - Temp Dumpster on site Located at 124 Mair.,' Street Fire Departmerit signature/date COMMENTS Located 384 Osgood Street yes no 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: lies No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NU I t5 and UA I A — (For clepartment use IJ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department Tine folowing 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 40TE: 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casos if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the; apr),al 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.Buhding Permit Revised 2012 f' Location r (.Ig M I[,+ No. -7t`o ' �-G J�i Date a - 76/ 7 Check # ,r £ b TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ (/ Building Inspector O K ct Y O Z J 2 LL O OC Q O m c t aV o +a)+ ? V) v C a)OL V) 0 U coif Z Z J m C O F L0 t � Tp c 0 u W ca/f Z z m J Qr a� _ LL 0 V a N Z a U V W W E a)CU _ V) LL r �0 r L.L Z w a W 0 W D_ LL v m r ti i Y < ' J Z � c Y O Z J 2 LL O OC Q O m c t aV o +a)+ ? V) v C a)OL V) 0 U coif Z Z J m C O F L0 t � Tp c 0 u W ca/f Z z m J Qr t D C' _ LL 0 V a N Z a U V W W t Z3 C' a)CU _ V) LL O u d Z N Q C7 :3 R' L.L Z w a W 0 W D_ LL v m O Z N r Y N O cc O 3 a o 2 ai > Q 0-0 W a CO O cZEZE o0 0 O v Z CL O Cl)4r7 •,.Z' Qi W �' yamC+ O Cl) _ G = wQ L p mm �P tc �� O a a 0 '—' CL J O AW �- m N V c v = N� •ti a) L cn W 1"40 o-0 > 0 O ' c, c v _ �, a Z V ca LCL �r.2 LLI 0 V CL CL E o U)�+ O rLNZ C H y = O O AW Z0_ ALV cc a, '> o c W J V V 'r.LOcc -J _L�- aZ a� CL " __ o v OCL o a _ = _ Q i O cc W = -0woo uml 2 Q c I-- am t) Q o� mom, Q FE t O H CL U > 1/31/7 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 655760.00 m $ - $ 789.12 Plumbing Fee $ 98.64 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 98.64 Total fees collected $ 1,086.40 212 Haymeadow Road 762-2017 on 2/6/17 kitchen renovation PROPOSED FINAL PLAN All dimensions size designations given are subject to verification on job site and adjustment to ft job conditions. Silk- Steve (John M).kit NOTES -STEVE WILL BE SUPPLYING OWN CROWN MOLDING FOR CABINETS TO MATCH ROOM -ISLAND IS NOW 96'%24' WITHOUT COUNTER. WATH COUNTER ISLAND SHOULD BE AROUND 130'x42' -HUTCH AREA DIES INTO WALL WITH FILLER, GLASS HAS BEEN REMOVED FROM WALL CABINETS -THERE WALL BE 5 LEGS SUPPLIED FOR THE ISLAND AND 3' WOE SOLID STOCK THAT WILL RUN TO EACH ONE TO GIVE IT A MORE FINISHED LOOK SOLID STOCK PIECES ARE LADLED AS FILLERS -CABINET THAT HOUSES MICROWAVE WILL NEED TO BE CUT TO SIZE. SEE APPLIANCE SPECS AND SELECTED CABINET. -BACK OF ISLAND WILL BE COVERED WITH 2 46' AUTHENTIC PANELS. -BASEBOARD WILL WRAPA ROUND BACK AND SIDES OF ISLAND This is an original design and must not be released or copied unless 2020 applicable fee has been paid or job 1 order placed. All Designed: 10/20/2016 Printed: 1/31/2017 #: 11 No Scale. 4".tt e4i".-1zk 43,1si ( 8^] 1 1 ✓l Z : l it All dimensions size designations given are subject to verification on job site and adjustment to fit job conditions. SUL Steve (John M).kit This is an original design and trust not be an or copied unless 2 A AO applicable fee has been paid or job I1 2 order placed. El I IE r WIDE AND WILL NEED T APPROX 7 LIED BY SCHROCK AND IS T/ LL SEE ATTACHED SPECS Designed: 1020/2016 Printed: 1/31/2017 f!: I I No Scale. -T- _--83"" -- __21 "" All dimensions .size designations given are subject to verification on job site and adjustment to fit job conditions. Steve 18" )NG WALL APPROX 1-1/2" 3ETWEEN WALL CABINETS . UNITS WILL NEED TO BE i'OWN TO 1-1/2 WIDE This is an original design and must not be released or copied unless 202 A applicable fee has been paid or job 20l order placed. El 3 Designed: 10/20/2016 Printed: 1/31/2017 #: i ] No El Model Baer m WOOD HOOD BLOWER, 500 CFM BLOWER500 E� • 500 6hl twlri 1 • Ore ymrw=* t97hi • Sound MIN a x 81 Ones. 5'7+ •hyo 20 wo (12 vok.64 bose) h*p h* included. ist • Irsaola5an mffsms, wa *, and ie*ia�mafm ird ded. • Sam ad* finish. n5ft-i Thee speed p sh kutmo mWWWAStwo onol hle &*M der safepease Mm. Cmpfik w1b d Wood floods and Holder. • Des06 for use in aI ' iors up b 60,000 BRIO. WERED WOOD HOOD BLOWER iwN7 naom I �1 WNi 19rh� �0 2rh' TW1gLOWBt250 WOOD HOOD DUCTLESS CONVERSION KR;AND FILTER KITS " 21'x7' Round Pipe 7'x6' Reducer i •L GONYFR " al �91OVYE(M3j 2.1 [ 1661 11661 11661 1 1661 i • bw WCa pnW Podmpe ha 3vW d Wedfm aed Gla mdA • 6-fto avat. • 11'ear wamly. r • Said sonny is 6 sm. s. 1 • uses 31 sap • Tim 40 wolf m*abm kht segued, bud nal kduded. • Cmipdiie w1h d Wood Hoods and Hmdk • Sirs metak exterior W. • Irxidet rersmtohle 3slnsosba Ode geese fila. TOBLOWER250 2.1 874 814 814 874 • Range Hood Uffoom t Pochoye km 2spad *0 mid (an wih fOWmi • 7"diia dewed. i • l yeaara wdy • Sand mfng is sones. • His 2.1 arras. • lwo 40 watt taxdrlabro 10 iegitd, bud rd i dsded. • Uwaft wih d Wood Hoods o d Heads. • SirarneldeadawNish. • Iaddrmes vo* 6kdx rsler Ode grease fila. ( I a 661 1 1661 1 1661 874 1 874 VER y CONSION S�rxvcKl 2.0 280 280 : mN 280 [280 280 280 E� flLTER250/390 OS 1 2 3 4 15 6 7 4.0 4423 4423 44231 4423 6423 4423 4423 WERED WOOD HOOD BLOWER iwN7 naom I �1 WNi 19rh� �0 2rh' TW1gLOWBt250 WOOD HOOD DUCTLESS CONVERSION KR;AND FILTER KITS " 21'x7' Round Pipe 7'x6' Reducer i •L GONYFR " al �91OVYE(M3j 2.1 [ 1661 11661 11661 1 1661 i • bw WCa pnW Podmpe ha 3vW d Wedfm aed Gla mdA • 6-fto avat. • 11'ear wamly. r • Said sonny is 6 sm. s. 1 • uses 31 sap • Tim 40 wolf m*abm kht segued, bud nal kduded. • Cmipdiie w1h d Wood Hoods and Hmdk • Sirs metak exterior W. • Irxidet rersmtohle 3slnsosba Ode geese fila. TOBLOWER250 2.1 874 814 814 874 • Range Hood Uffoom t Pochoye km 2spad *0 mid (an wih fOWmi • 7"diia dewed. i • l yeaara wdy • Sand mfng is sones. • His 2.1 arras. • lwo 40 watt taxdrlabro 10 iegitd, bud rd i dsded. • Uwaft wih d Wood Hoods o d Heads. • SirarneldeadawNish. • Iaddrmes vo* 6kdx rsler Ode grease fila. ( I a 661 1 1661 1 1661 874 1 874 VER y CONSION S�rxvcKl 2.0 280 280 280 280 [280 280 280 E� flLTER250/390 OS 46 46 46 46 146 46 46 FIM500 OS 269 269 264 269 [269 269 269 Must arch ducod fits wiM510N h ( kd fa props fihafim b moom add nimb filesded adwuA Was md. • Fi1MM/d90 required when MUM is used wish TVr7�LOWH M/19Vl�LMM90. • RUMO0 regamd Am MNYW ON a used with StOWERS00. i •CONV9t51 kludm(1)21"x7"mundpke,(1)a45mkcolor, (1)wbik=Wsol�tyde,(1)o*§GWbad, (1)7"x6"re8rmand 1 istdoton i�nrffnrx `I I I Effective February 15. 2016 Model ` WAINSCOTING, 341 /2" or WMN1534.5 401/2" HIGH 1 WAM1834.5 WAIN21343 1 WAM24343 WAIN1540.5 34rh- 40'h WAIN1840.5 WMN2140.5 WAIN24405 .1s.19•,- 121', 24• M IS34s WAMIS405 M10343 WAMII8405 Mt21345 WM21405 IN24AS WAMI24405 g MOM I "fll�l . t WMW34s WAINB040s WM6M.5 WAW72405 343h' 40Th- WAM3034.5 2.3 N/A N/A N/A 887 1973 1022 1 2 3 4 {5 6 7 1.2 N/A N/A N/A 556 1 608 1 640 611 1.4 N/A N/A N/A 576 1 647 681 633 1.7 N/A N/A N/A 627 1703 739 691 1.9 N/A N/A N/A 768 1050 817 846 1.4 N/A N/A N/A 1071 11041 1106 1155 1.7 N/A J N/A N/A 1091 11080 1147 1177 1.9 N/A N/A N/A 1142 J1136 1205 1235 2.2 N/A N/A N/A 1283 11283 1283 1390 WAM3034.5 2.3 N/A N/A N/A 887 1973 1022 973 WAM3634.5 2.8 N/A N/A N/A 939 j] 047 1100 1030 WAIN4834.5 3.6 N/A N/A N/A 1144 (1 309 1361 1259 WAIN30403 2.7 N/A N/A N/A 1408 1428 1466 1525 WAIN3640.5 3.2 N/A N/A N/A 1468 X1508 1555 1591 WAIN4840.5 1,3 N/A N/A N/A 1880 [1910 1930 2043 a Ond Wdb WAIN6034.5 45 N/A N/A N/A 1349 ;1571 1622 1488 WAiN6040.5 53 N/A N/A N/A 2292 2312 2305 2495 0 201 fWAIN7234.5 5.4 N/A N/A N/A 1554 1833 1883 1717 f WAIN7240.5 63 N/A N/A N/A 2704 '.2114 2680 2947 • Fd ftloy S* o*- • Pad is I 1/2'M iadudi+p Boas. NonaMoIN dads ore mW to 3/4'M mi and de Gane. • FGrsh raeF,id; st &A. � • �r.�,� bodcs as mt fkrekd. but ore ceded b paerde wapirg anti dotting. A) faces onl edges sai be fimlted. • If ado( 6 Dow in Ardt/Cathedrd door *1r, Pad WE hm 5puae doom • For ase o0 has or Ards, albdr pmol bPmx4 be pad bore have lrmrgh be ieide of the op" cak d. • Fasrd opomfiaq be wort hoods used for be pad Gore fungi dadnw to the ad can be canoe0led bdW the doors and dam harts. Padud Cade Ond Wdb Icerher of 0006 Naha 0f Frame Ceder Sties on wdth Yale.. 15" 1 0 141/2- 41 "WA8l18.. W018- 18" 1 0 17112- 71 "WAI R. MR. 21" 1 0 201 WAIN24_ 24" 1 0 231 " WAGV30_ 30" 2 1 141 " WAINX. U. 1 1 1 1 171/2- t _ WAMN3., 48" 2 1 23 T WA9160_ 60" 4 3 141 " WA0t72_ I 71" 3 1 2 1 231 " Dora h* on 341/2" NO pads is 291 /2". Door height an 401/2" liar MA is 351/2". Effective February 15, 2016 t9'h' 34W • Oren oob w hm ImiMtd mk mMay not baW wft oW Akin ow". B Werk 1�. A rAtdm. Befir fafte � Ewen nmdactua spedimfiom. 3 • far bu" appionm ssrppod OUMST1llV 6 ndu in 24" deep own mkLh (see pogo 515 fm &clot), hrrtwi na be id ded who deph 24' . , 24', 2r, or 30' a maditd IiiaJd 1Mdttt He ght Hiatt Model BASE OVEN CABINET 8030 1 2 3 4 B033 B036 t9'h' 34W • Oren oob w hm ImiMtd mk mMay not baW wft oW Akin ow". B Werk 1�. A rAtdm. Befir fafte � Ewen nmdactua spedimfiom. 3 • far bu" appionm ssrppod OUMST1llV 6 ndu in 24" deep own mkLh (see pogo 515 fm &clot), hrrtwi na be id ded who deph 24' . , 24', 2r, or 30' a maditd IiiaJd 1Mdttt He ght Hiatt 8030 14" 181/2" 191/2- 271/2- 1 2 3 4 y 5 6 7 17.7 971 971 1 911 1 971 1971 971 971 i4.6 1024 1024 1024 1024 11024 1024 1024 21.1 1095 1095 1095 1095 1045 1095 1095 t9'h' 34W • Oren oob w hm ImiMtd mk mMay not baW wft oW Akin ow". B Werk 1�. A rAtdm. Befir fafte � Ewen nmdactua spedimfiom. 3 • far bu" appionm ssrppod OUMST1llV 6 ndu in 24" deep own mkLh (see pogo 515 fm &clot), hrrtwi na be id ded who deph 24' . , 24', 2r, or 30' a maditd IiiaJd 1Mdttt He ght Hiatt 8030 14" 181/2" 191/2- 271/2- 8033 27' 311/2- 191/2- 271/2- B036 3(r 341 191/2- 271 " gj% I i W = BASE DISHWASHER CABINET, 2C 46 1/2- NIGH 2r = nh• W N Q m 34'h' o+h' BASE BUII<TdN MICROWAVE CABINET with DRAWER 24' or 30', 24' \Z " °� wa °11 liw 88=4 21" 221/2- 13 7/8" 16 71r 8Q6MM 27" 281/1" 13 7 160- BASE 67 " BASE MICROWAVE CABINET with DRAWER amamm 1Aedd °w wift °%i H w 8111MD2434 21" 221/2" 16" I6" 811W01734 24" 25 1 16" IS - MMM 27- 231 /7- 17" __ '2O` BDW2748 1 19.3 11298 11298 1 1248 I 1298 111298 1 1298 1 1298 • Be sue to install mM IW sfidd tot moles will be appIM • Hmdwoad venm on pl7wood wilt bo isle order. i • Re dww plywoad Goer. • Maikw-martwidth's251/2". • If orddtd wih Heirbmring Ted-ique, wet rat fdstoe sandslrargh dnmteristra. BBMWD24 ( 14.1 11274.11274 11274 I 1274 111274 I 1274 1 1334 BBMWD30 17.4 1512 1512 11512 1 1512 111512 1 1523 I 1598 • Fm k" appka suppat, OO60dt13T 6 kkd d in 24" deep mbneh (see page 57S fm &tib), but A no be nduded when deem a modq'ed. • lkum* oke finetwo bdwemtop ddam fwmdiopofmbk is191/8" fapmfidare6rad193/4'for fdatn6r.Besue to ve* orad aWarae heat, Bop req rlmserk, and ow Ims wiir mhnet wa raons. BMWD2434 14.4 1342 1342 11342 1 1342 JJ342 1 1342 1 1403 BMWD2734 16.1 1463 1463 1463 1463 '1463 1466 1539 BMWD3034 17.7 1591 1591 1591 1591 1591 1604 1683 • lladrrmd yen m opoad w1h nmdiq -deer i Brim. • Fii sw ittedm sbdmd. • m*mw * wod fin. 4w Effective February 15, 2016 DESCRIPTION MODEL PRICE TULIP LEG, JTULIPLEG 522 341 /2" HIGH . . . t 131hl 31/1-0 a T 36th' T Spo& 1 A f RusSc �qoa Texbad lEWted Alder Aider 0� lmnrtfde lalinM " Ihama(oi 1 TULIP JTUi1PLEGT 585 40 1/2- i / 131/21 l 31/2-0 a 11w I 401E 21511 1 FWA Todmigm � tleidoo� 111a& ICgA t> Z _ %bw TdAw Alda Atilt O k lfmde l *de " %am" DESCRIPTION MODEL PRICE C—URN LEG,.-- - �_ - JURNLEG - 846 351/4" HIGH • _,3Va'I 3r/r® T �Qa AIN 16C 351(1 O� $� 1915/6 411/21 1 FW* i tlrieom { URN LEG, 421/4" HIGH 1311;1 3rA'� 13 T /2- 421/1 2615/21 4111W +JURKLEGT • Tile fHltT:l� EJ�ES ill�l[Oi� L71ES Ott SIdE VIEW 61ozEd edges er�mted 6Y OROVIS �(le Yiery AMVIIIgS. 888 Effective February 15, 2016 w /)L W NQ FD Date TOWN OF NORTH ANDOVER RECEIPT This certifies that ....................... haspaid .......................................................................... for Received by ..... ..... 0/r%—� ..................... Department........//. ,............................................................ YVKTE: Applicant CANARY: Department PINK Treasurer The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P. o. sox 1025 State Road, Stow, MA 01775 //W PERM.IT Date: C;2n ��yofTM) (HApplicable) Dig Safe Number In accordance with the provisions of KG.L �tDaw Chapter 10as provided in section 5 2 7 CMR 3 4 2 This Permit is granted to: Full name of person, Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of structure 3=: dumpster be 25' from structure or covered with tarp or plywood Restrirxions: at end o f workday at o7/.) ( Give locadondiy street and no., or descn'be in such manner as to provied adequate identification of location ) Fee Paid S S�_ This Penmi will expire( Signature oP ermit ( Tule ) ®� TWUR PERMIT NII LST. RR C_CIALCPIC'_I inn mi V 0ACTPt1 i 11 nri THF PRFMLCPQ 411111111111111 02/03/2017 08:50 6178470006 COMMONWEALTH INS PAGE 01/01 SILKSTR OP ID: RR CERTIFICATE OF LIABILITY INSURANCE DATELMMIDD/YYYY) 02/03/2017 HIS CERTIFICATE IS 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 13 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the Certificate holder In Ileu of such endorsement(s). PRODUCER Commonwealth Ins. Partners LLC 25 Newport Ave. EXt N. Quincy, MA 02171 Commonwealth Insurance NANMTEACT PantanoNonKahle Inc PH NE . s17-847-0005 ac NO: 617-647-0006 �ADIMFSS: vvkrev@aol.com INSURE s AFFORDING COVERAGE NAIC N PUDCYFXP MMJD Y INSURER A: Utica First Insurance CoMLIny 15326 A INSURED Stephen Silk DBA Renovation & Restoration INSURER 0: INSURER C: 33 Perley Road INSURER D: North Andover, MA 01845 INSURER E : DAMAOF9 Ea occurrence $ 50,000 INSURER F: V'0Vr_"QF_5 CERTIFICATE NUMBER: RE SIGN w lluRr-a. THIS IS TO CERTIFY THAT 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILT R TYPE OF INSURANCE JimaLIMITSIDONY POLICY NUMBER POLICY EFF PUDCYFXP MMJD Y A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a occuR ART -6095463-00 02/03/2017 02/0312016 EACH OCCURRENCE $ 11000,00 DAMAOF9 Ea occurrence $ 50,000 MED EXP (Anyone person) $ 5,00 PERSONAL & ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a PRO- [7JECT LOC PRODUCTS • COMPlOP A00 S 2,000,00 S OTHER: AUTOMOBILE LIABILITY COMBINEO SINGLE LIMIT $ Ea accident BODILY INJURY (Par Person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Par accident) 5 ( NON -OWNED HIRED AUTOS AUTOS PR PER- Y DAMA E Peraeedonl 6 $ UMBRELLA LIAe OCCUR EACH OCCURRENCE 3 EXCESS LIAR CLAIMS -MADE AGGREGATE 9 DED RETENTIONS $ WORKERS COMPENaAT10NPER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER1EXECUTIVE OFFICERIMEMBER EXCLUDED? El N I A OTH- 87ATUTE ER E.L. EACH ACCIDENT $ 61, DISEASE - EA EMPLOYEE S (Mande" In NN) K es, doaeION under DE RI TIONIbo OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 8 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Romarka Schedule, may be atbrehed K more apace Is requlted) Phis certificate is hereby isaued as evidence of existing insurance :overage. Town of North Andover 120 Main Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101 ) The ACORD name and logo are registered marks of ACORD Terms Agreement Payment Receipt Payment Confirmation YOUR PAYMENT HAS PROCESSED AND THIS IS YOUR RECEIPT Your application will be processed in the next 3-5 business days. Please visit www.mass.gov/homeimprovement for more information on the Home Improvement Contractor program. Your account has been billed for the following transaction. You will receive a receipt via email. Office of Consumer Affairs and Business Regulation - HIC Registration Program Ten Park Plaza, Suite 5170 Boston, Massachusetts 02116 (888) 283-3757 Transaction Processed Successfully. INVOICE #: 19504d86 -7d80 -4f79 -b1 2c-27696ddd2b2b Description Service Fee Amount Registration Fee - Reapplication $3.53 $150.00 Guaranty Fund Fee - 0 to 3 Employees $2.35 $100.00 $5.88 $250.00 Date Paid: 2/14/2017 8:09:54 AM Payment On Behalf Of STEPHEN A SILK Billing Information First Name: Stephen Last Name: Silk Address: 33 Perley Rd City: North Andover State: MA Zip Code: 01845 Phone Number: (978)886-0447 Email Address: scuba—silky@comcast.net Important Information • If you pay less than the required amount due you will not have satisfied your obligation. • Please call 888-283-3757 if you have any questions regarding this information. Total Amount Paid: $255.88 Print Receipt artment Of Public Safety Massachusetts Regulations and Standards Board of Suilding e License -sof Construction Sup tl EN A SILK` STEPH 33 PERLEY ROAD MA 01845 NORTH ANDD Expiration= lr�� C/ �� 11113(2017 Commissioner -milrazuuMr /u nessRegntation Ofrice of Consn6►er Afia►C09TRAC-FOR TYpe: Vrwlrr- T E`�E tMPRO 176182 eg�strau0n. DBA 72512015 olplration' TORATION RENOqI f &RES STEPHEN SILK STEPHEN S%LK q da e�rseeretarY 33 PERLE VES MA pJ84 NO. ANDO °may sJyv� www.massgovldia V1�a�:kex's' Compensation J[r��xance,A�fidaviii:Br�Sdex�s/Contra OA-DTHOl�T�Y-ixiczans/�'lzmabex's. TOBE� THEP� iPTaacePrint J Name(Business/Ozgtizaiion/Individual): f- i� �Y�'F +�'iy ► OgA�(�� Address: 1*111� P City/State/.Zip: D-�I bo il�9 M A o e a y Phone #: Asepon an employer? Chack the appropriate box: 1.❑ I a., a employer With employees (full andlor pari idme). 2.[kIamasoleproprietororParine h' and hatenoemployeesWorkingfor mein any capacity. jNoworkers' comp. insurance required ] 3.0 I am ahomeowner doing allworkmyself- [Noworkers' comp. iosuranceregnired ] i 4.n I am ahomeowner and will be hinng conizactors to conduct an work onmy property. I VIM ensure that all cacfors either workers' compensation $7surance or are sole o,[ proprietors wlthno earigioyees. 5.0 I am a general contractp � , - lhav ees an hape wcorkersc o listed attached sheet These snb-coniraotors have employ 6. [1 We am a corps rgion. and its offrcershave exercisedtheirrigiai Pf �emPfl°nPA 1 G. and.' have no empldyees. [No woz7rers' comp. insurance required ] Type ofzproject (req ir8a '7. ❑ 1�7evi'constriiciion g, ®,Remodea' g 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or. additions 12, gd-plumbg. repairs or additions 13•. L] Roof zepairs 14.0 Other we. *Any apPhcaatfihat cher�s box#1 m%isi also �Il ouEthe seciionbelow showmgtheu workers' compensation policymfoffiafion _ i Homeowners who submrithvq affidavit md�catmgthey are doing all workth fame of the sobhire a coonfracfors and sta_tewh�.-ether or nothosemes�c •ems h Meeh. (Contractors that checkthis'65oXmusf attached'anadditional sheetshowing olio mer_ _ .. .._ _ .. _ employees. Ifthe sub-coniiactors have employees, they must provide their workers' comp. P Y , • • • . - , X arrz an employer^ iliat isp>*oviding�vo�kers' compensation insur'anceformy employees Below is tFiepoZicy arzdj'o� site information. Insurance Company blame: ExpirationDate, policy # or Self -ins. Lic. #:. ` \ f� (Oro ro lob Site Address: I Vyj �P�C Czty/StatelZip: 1 V l Attach a copy of�he'�axJfers' comp nsationpoliey declaration (showlagib.epolicy number and expuatxoz+. date). to $1,500.00 al Failure to secure coverage as required underevil enaltiesMGL c. 2xn the form off OP WORK ORDERar -violation Iand a fine ofnp to $250.00 a and/or one-yeaT impxisonment, as -well as p fihis statement may be forwarded to the Office of Investigations of the DTA for insurance day against the violator. A copy o coverage verification. pclo Fiereby ceY " uncFet' tlzepains andpenaliies ofpetjur`y tFiat the informotion p.^ovidedabove is tr've arzy, correct Phone #: official use only. Do not -rate in this area, to be completed by city orr town Official. permit/License # City or Town- Tssuing Authority (circle one):cruor �. Pluzmbing )Cnspeetor ,.Board of k(ealth 2. Building Department 3. Ciiy/Town CIerJ d. Electrical Lasp 6. Other Phone Contact Person: The Commonwealth of Massachuseds Depaltment of IndashialAccidents _ X Congress Street, ,S' &t 100 M . - : Boston, MI 02114-2017 °may sJyv� www.massgovldia V1�a�:kex's' Compensation J[r��xance,A�fidaviii:Br�Sdex�s/Contra OA-DTHOl�T�Y-ixiczans/�'lzmabex's. TOBE� THEP� iPTaacePrint J Name(Business/Ozgtizaiion/Individual): f- i� �Y�'F +�'iy ► OgA�(�� Address: 1*111� P City/State/.Zip: D-�I bo il�9 M A o e a y Phone #: Asepon an employer? Chack the appropriate box: 1.❑ I a., a employer With employees (full andlor pari idme). 2.[kIamasoleproprietororParine h' and hatenoemployeesWorkingfor mein any capacity. jNoworkers' comp. insurance required ] 3.0 I am ahomeowner doing allworkmyself- [Noworkers' comp. iosuranceregnired ] i 4.n I am ahomeowner and will be hinng conizactors to conduct an work onmy property. I VIM ensure that all cacfors either workers' compensation $7surance or are sole o,[ proprietors wlthno earigioyees. 5.0 I am a general contractp � , - lhav ees an hape wcorkersc o listed attached sheet These snb-coniraotors have employ 6. [1 We am a corps rgion. and its offrcershave exercisedtheirrigiai Pf �emPfl°nPA 1 G. and.' have no empldyees. [No woz7rers' comp. insurance required ] Type ofzproject (req ir8a '7. ❑ 1�7evi'constriiciion g, ®,Remodea' g 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or. additions 12, gd-plumbg. repairs or additions 13•. L] Roof zepairs 14.0 Other we. *Any apPhcaatfihat cher�s box#1 m%isi also �Il ouEthe seciionbelow showmgtheu workers' compensation policymfoffiafion _ i Homeowners who submrithvq affidavit md�catmgthey are doing all workth fame of the sobhire a coonfracfors and sta_tewh�.-ether or nothosemes�c •ems h Meeh. (Contractors that checkthis'65oXmusf attached'anadditional sheetshowing olio mer_ _ .. .._ _ .. _ employees. Ifthe sub-coniiactors have employees, they must provide their workers' comp. P Y , • • • . - , X arrz an employer^ iliat isp>*oviding�vo�kers' compensation insur'anceformy employees Below is tFiepoZicy arzdj'o� site information. Insurance Company blame: ExpirationDate, policy # or Self -ins. Lic. #:. ` \ f� (Oro ro lob Site Address: I Vyj �P�C Czty/StatelZip: 1 V l Attach a copy of�he'�axJfers' comp nsationpoliey declaration (showlagib.epolicy number and expuatxoz+. date). to $1,500.00 al Failure to secure coverage as required underevil enaltiesMGL c. 2xn the form off OP WORK ORDERar -violation Iand a fine ofnp to $250.00 a and/or one-yeaT impxisonment, as -well as p fihis statement may be forwarded to the Office of Investigations of the DTA for insurance day against the violator. A copy o coverage verification. pclo Fiereby ceY " uncFet' tlzepains andpenaliies ofpetjur`y tFiat the informotion p.^ovidedabove is tr've arzy, correct Phone #: official use only. Do not -rate in this area, to be completed by city orr town Official. permit/License # City or Town- Tssuing Authority (circle one):cruor �. Pluzmbing )Cnspeetor ,.Board of k(ealth 2. Building Department 3. Ciiy/Town CIerJ d. Electrical Lasp 6. Other Phone Contact Person: 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 bite, express or implied, oral or written." An employer is d'effi6d as "an in:dMduA partnership, association, corporation or other legal entity, or any two or more Of the foregoing engaged in a joint enferprise, and including the legal representatives of a deceased employer, or the receiver'ox 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 orbuilding appurtenant thereto shallnot 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 applzcantwho has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, M(3L chapter 152, §25C(�) states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 s-O'contractor(s) name(s), addresses) and phonenumber(s) along with theircerdficate(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 thatthis 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 Indusfrial:Accidenis. Should you have any questions regarding the law or if you are xequired 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 atthe 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 p ermitAicense 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 (ifnecessary) and under "fob Site Address" the applicant should write •"all locations in (city or town)" A copy of the affidavit that has b eon officially stamp ed 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 notrelated 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727.7749 Revised 02-23-15 wwwmass.gov/dia Stephen Silk Renovation & Restoration North Andover, MA 01845 MA License # CS -098533 HIC License # 176182 08)886-Q�47 CONTRACT: To: John & Mary Beth Malolepszy Re: 212 HayMeadow Rd. North Andover, MA Date: Nov. 25, 2016 SCOPE OF SERVICES: Kitchen Renovations • Provide structural engineered drawings Remove wall @ dining room/ family room • Remove wall @ kitchen/ dining room • Remove wall @ family room entry hall • Remove closet/ pantry @ kitchen • Enlarge opening @ kitchen/ living room • Structural framing per engineers drawing • Install 2 new casement windows @ kitchen per kitchen plan • Framing as needed/ required • Insulation as needed • Relocate ductwork as needed/ new kitchen exhaust • Blue board/ plaster as needed • Crown molding throughout (match existing) • New casing/ trim as needed (match existing) • Refinish hardwood flooring @ entire 1 st floor, remove/ replace approximately 140sq. ft. of 3" strip oak flooring @ dining room, 2 finish coats • Exterior siding/ trim @ new window installation • Paint entire 1 st floor ceilings, walls & trim. Price is based on 3 different colors on walls. Kitchen/ dining room & entry hall, family room & living room only. • Faint new work @ exterior affected by construction • Install kitchen cabinets per plan • Tile backsplash installation • All permits/ fees • Temporary protection during construction • Final cleaning PI mbin • Remove sink drain to wall • Water piping to above toe kick, make safe during construction • Disconnect dishwasher plumbing • Remove/ relocate heat @ existing dining room • Install temp. loop as needed to maintain heat system operation • Install new drain piping and water piping within new sink base to accommodate new fixtures • Ice maker/ water line for refrigerator • Install/ connect faucet • Remove/ replace existing disposal • Remove heat @ entry hall & cap off Electrical • Sub panel • 14 recess LED lights • 14' LED under cabinet led lights • Receptacles and arc fault breakers to code • Wire for electrical stove • Relocation of receptacles and switches of demoed walls involved in the scope of work • 5 Dimmers • 1 USB receptacle • Wire for 3 pendants over island • Wire for 2 table lights • Wire for hood vent • Wire for micro in island • Wire for 2 convenience receptacles on sides if island Not included: Permit Fee NIC• Cabinets/ hardware • Granite counters • Tile • Plumbing fixtures • Light fixtures @ island PP vment Schedule • $25,000 Deposit upon signing contract • $20,000 Upon rough inspections • $15,000 Cabinet installation/ paint completion • $5,760 @ Final inspection/ punch list completion Terms and Conditions Contractor agrees to furnish all necessary labor, tools, equipment and materials to complete the work outlined in the scope of services. - Contractor shall provide copies of a valid builder's license and proof of liability and worker's compensation insurance prior to commencement of any work. - Contractor agrees to complete the Scope of Services in a timely and professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. - Contractor agrees to clean all debris from construction only and to keep the job site in a clean and workable condition at all times. - Any materials, products or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner (monies denoted in bold next to categories are included in overall price and will be drawn from to pay for materials and installations) Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices. - Anything not specifically mentioned in above scope of services will be billed at $65 per hour, plus materials. - All materials/labor supplied by Silk Renovation/Restoration are warranteed for lyear from date of completion. Mary Beth Malolepszy Silk Date N Z y -n -_-1 O O � : -n Z ODV�i� G')�_ WmCn�=D G7 -° m D -°oo- U)Z z- „ --q m m m B22 D - HEADER B221 n T-0" MAX rn � 00 W ti o N c J y O m -� O Cn m 0137. C/) G7 � m C -)NP r - TI � w' W C/n --- - d2 z --- r0 m r Z ;; r C/) U) r � p nn , ��� a el*,. b� G G r Q ; +/ fit p` PROJECT NAME: PREPARED FOR: m 0 21.2 HAY MEADOW RD STEPHEN SILK P NORTH ANDOVER, MA 33 PERLEY RD Alinas Structural NORTH ANDOVER, MAGINEERING LLC w 579A North End Blvd. I Salisbury, MA 01952-1738 978-465-6436 wwwgelinasstructural.com I danlftlinasstructural.com ra ,— C/) D � � JOIST z D � < 0 POST OR N0 r LALLY o O COLUMN.Az POST 0 PLATFORM fi FRAMING z JOIST G t M I Y. zDMA 5 <L O CD a" �? G c m� Z �,( O m in � D O, to r s r z p PROJECT NAME: PREPARED FOR: H o 212 HAY MEADOW RD STEPHEN SILK p NORTH ANDOVER, MA 33 PERLEY RD Allnes Structural NORTH ANDOVER, MA GINEERING L L C 579A North End Blvd, I Salisbury, MA 01 952-1 738 ( 978-465-6436 www.gelinasstructural.com I danlg@gelinasstructural.com cngmDrno 0 .n nm y W G ZrCCfn to -{pr r-Ipr sn o a � AN�o '9 omi 3 3 cfDi `~.3. m �, oo, m o,o= 3 o m m a 0'0 m m 0_. m m m m y DW) m m -, w w O a w w o v c N n w r m m> j 0- r 0 r O' rr 3 0=8 w t0 a�=a Fw (n o Oooi �O m mr o o o w w 0 o M a) 0 3 Dw w�M 3 T o m 3 y m o a n r w w a n w w o n 9: n Q D w Q0 .� 7ra� 3t0 0 �, ti 3 a prrto an pan -i o y Tw W Z m W I' 'mvca 00Vi03 G)m to c3 W �cCD 0 m o w� x'vaN N O n S O N O N y N O 1^ m t0 � (D w Swam - C, N 3 „� 3 s3 g n o s� a � m ib.)y ea w 7 a p 9, w O -n 7 'W -1 r C O O O tD W V CD �. 3 �"cp 7 6 -n O O N V 3 0 0 0 O ? 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CL N G Z +J -� d 7 N w (Oj, N '^ O F- 11 I'1 11 w m -1 J O 1W O n O r O (7' 6 H w 6w mph u 0 0 m vvv n IO" _ o o -I z D �� 3 111 TY N < OVi O O) T O Q. N a N O �N�O)CD I'I^wry cp cp 00 (n�O W O C u N 'xJ (n ('.�•� t071 O W m Y' p• m O. w. N N V N 6 n lV (ll _ -0 111000 m w �CANW 'm om < -n (D o -0 11 = J�r) D 0) (0t0 W 7OOD WV Nw00 OWQ O OD O : O ' . yw3 O CA N m O a.AN WN,N tan N, N 0 V 0 n w �O (� w o 0 o A Cr.' m o a W c c 3 -0 3 0 0 D 3 n VNA Qo.nSo�,�aD m °i o 0 Am wrmcnp7.0 <Zm _Cy3 p CD c w o na ni m O r3 p - Z G �T M!cD 000rw aannor° 0) Oa2m PO Q o Ncnm-o) r Oco C o p G) X00.0 �s to W °-) m V N n = O N (0 C3 N N O O O O O J .il m w �3 r O � r- 0 0 0) O W D rn a y\ m � p PROJECT NAME: PREPARED FOR: a 21.2 HAY MEADOW RD STEPHEN SILK o NORTH ANDOVER, MA 33 PERLEY RD Alinas Structural NORTH ANDOVERMA GINEERING L L C 579A North End Blvd. I Salisbury, MA 01952.1738 978-465-6436 www.gelinasstructural.com I danlg@gelinasstructural.com