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HomeMy WebLinkAboutBuilding Permit #303 - 22 AUTRAN AVENUE 10/18/2007 BUILDING PERMIT 0OORTH TOWN OF NORTH ANDOVER 0 0 to APPLICATION FOR PLAN EXAMINATION Permit NO: v Date Received Date Issued: �SSAcmu IMPORTANT:Applicant must complete all items on this page "',7 2i If " 0 )W6 136 .......... Rdiht, -"OW F- J )RZRT7TY WNER_-� p, MA 'NO` rt PARCEL QN-1 SIG IS RIaCT ins one Oistnct ng �, yes o in "'Z ,in TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential - New Building = One family Addition Two or more family industrial Alteration No. of units: 6-L Commercial Repair, replacement Assessory Bldg Others: Demolition Other C "k Septic Wetlands 2t' DESCRIPTION OF WORK TO BE PREFORMED: M_-j -oA , L_ igimn't IdendlVaRtion Please Type or Print Clearly) OWNER: Name: Phone: Address: CO RA ' - TOR -,P h" ,Addl ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (1 FEE: $ q 0 Check No.: Receipt No.: NOTE: Persons contracting unre d contractors do not have access to the guaranty fund r ig tcohtrattb W!­ ----!---­ A qjtUre�. A. a Location 2— 'G-2"7 &g ka No. 3a Date /0 0ORT01 TOWN OF NORTH ANDOVER F • Oy + Certificate of Occupancy $ ♦ i # s�cNUsEt�'' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ e` TOTAL $ Y— Check # �a 207GS Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools I Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planyning Board Decision: Comments r Conservation Decision: Comments Water $ Sewer Connection/signature &Date i Driveway Permit Located at 384 Osgood Street �F1RE�DEP.ARTM SIT Temp)'Durnpster on�i yes no Located at 124 gain Street • Fare,Depart ment si naturelidate COMMENTS W 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 2007 f I J 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 'I ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses D 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 7 that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 j I NORTH Town of No. 3kuz = _ y do �` over, Mass. T - LAKE COCKICKEWICK V ADRATED P �C:) `S BOARD OF HEALTH Food/Kitchen E -RMIT Septic System C t\ftU4%d0 BUILDING INSPECTOR THIS CERTIFIES THAT ......• •••••••••••�•••••••••••.•••••••.•••••••• Foundation has permission to rect.....4*.%*4W6' .......... .................... buildin s on .�.....N......... ... ..... .. ....... Rough t0 be OCCUpled i/. ..... ... .�..... .. ,.. ....� !�. . ...•i �...... ....... Chimney Ch' provided that th arson accepting this per d shall in every respect coform to the t of the application on file in Final this office, and to the provisions of the Codes and -Laws relatin to the I pec 'on, Aeration and Construction of Buildings in the Town of North Andover. MW PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 0y Z PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS-'CONSTRU T 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Fire Services Office of the State ,Fire marshal P.0.Box,102i..Stite Road;Stow,MA 01775 PERMIT �— North Andover Permit No Date: (City of Town) (Lf Applicable) EDate Nvm er In accordance with theprovisions of M:G.L.14 8.Chapter 1 (7 as provided in section 5 7 7 ('M$ 34 This.Periart is granted to. �� Full name of person,Firmor Corporation Perrnissioato locate dumps.ter for construction/renovation/demolition of building. ..Comments:. dumps.ter must be , 25 ' from structure if unable tolace with. re wired Restrictions'clearance dumps-ter must be covered with plywood or tarp end of work -day .at, -,,I- c-/ /7.,-7.K'0" (Give location by street and no.,ordescni, c rn such mann -s to provr equate identification of location) Fee Paid S 50.00 Fire Chief This Permit Trill expire /-o S r�rtature of o rcal antro ' �—_�� ( b g permit) Offical granting.permi[ (Title) LABOR MATERIAL WHO 22 AUTRAN ST DEMO $1,500.00 $1,000.00 CM I DUMSTER $0.00 $1,000.00 ROOF $2,000.00 $2,000.00 CMI OUTSIDESTAIRS $0.00 $0.00 NOT DOING OUTSIDE PAINTING $2,000.00 $800.00 CMI CONCRETE $500.00 $750.00 HAMILTON CABINETS $1,000.00 $3,400.00 HAMILTON/FERGUSON ROUGH LUMBER $800.00 $800.00 HAMILTON DOORS $1,000.00 $1,000.00 FINISH LUMBER $600.00 $400.00 PAINTING $1,500.00 $500.00 DRYWALL $1,000.00 $500.00 ELEC $1,200.00 $1,000.00 JIM OTTANI LIGHTS $600.00 $1,000.00 WATER HEATER $150.00 $700.00 CMI GAS PIPE $600.00 $150.00 HVAC $1,500.00 $2,200.00 CMI/F W WEBB ROUGH PLUMBING $1,400.00 $1,000.00 CMI FERGUSON FIXTURE $700.00 $1,200.00 TILE $350.00 $200.00 HALERAN WOOD FLOORING $1,200.00 $1,800.00 NUGEN CARPET $300.00 $500.00 TOTAL $19,900.00 $21,900.00 $41,800.00 2ND FLOOR ROUGH LUMBER $800.00 $800.00 HAMILTON DOORS $1,000.00 $1,000.00 FINISH LUMBER $600.00 $400.00 PAINTING $1,500.00 $500.00 DRYWALL $600.00 $300.00 ELEC $800.00 $600.00 JIM OTTANI LIGHTS $450.00 $300.00 WATER HEATER $150.00 $700.00 GAS PIPE $600.00 $150.00 HVAC $1,500.00 $2,200.00 CMI/F W WEBB ROUGH PLUMBING $1,200.00 $500.00 FIXTURE $700.00 $1,200.00 TILE $350.00 $200.00 EST WOOD FLOORING $600.00 $300.00 NUGEN SAND AND FINISH $0.00 $1,200.00 TOTAL $10,850.00 $10,350.00 $21,200.00 $63,000.00 0.012 $756.00 ABOVE IS ESTIMATED WORK FOR 22 AUTRAN AVE NORTH ANDOVER ABOVE WORK WILL COST THE HOME OWNER$50,000.00 CHEEVER MECHANICAL INC 10/17/07 ROY CHEEVER AMY CHE V R pORTq TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 1sStCHU`�tt Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please prt�r t DATE: I �� JOB LOCATION: Ay nll-rL-S 4- Number Street Address Map/Lot HOMEOWNER q-193- 32035S- q7 X873o?0 9 lime Home Phone Work Phone PRESENT MAILING ADDRESS - 2e-!j La �)'Os I',ad 117A 011 City Town State zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code on 108.3.5.1) DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which helshe resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeownce'assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that helshe understands the Town of North Andover Building Department that he/she will co with said procedures and "on procedures and comply minimum inspectr p rExluirements mP P requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Foam Homeowners Exemption TIOARD OF \PPEAI.S 6xx-95=11 C0NSER\".\Til\633-9530 TTEALTH 693-95.30 PLANNING 638-9535 s son C'AAI t-' I vv. l•� 1,v�9�jo� ss �.4V"!-AI<-\vzz N'q-I A --A OO14 IS S c M/S � � f ; L s � v Z , o6ts �— --------------------------- I------------------ Rex, c s �S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Ledbly Name (Business/Organization/Individual): C(( e-a-VV%_ tx, 1, C,_ Address: 44L S JZ,Z � ►�`( � ly,p T 1 c.�G� q City/State/Zip: _�yp S/"i d kt k4_ ftag Phone #: J l _Rt)—`) It 2 Are you an employer? Check the appropriat box: Type of project(required): ];A I am a employer with � 4. I am a general contractor and 1 6. E] 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein 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.] t employees. [No workers' 13.❑ 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. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 'ec E Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 21 h V -A)'A 4y-'- City/State/Zip: /V. A/✓t a 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 c if und=epainsandpenalties of perjury that the information provided above is tr a and correct. Si nature: Date: 16 2 Phone#: �- 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. BuildingDepartment 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 10/17/2007 11:05 AM FROM: Brown TO: 19788873535 PAGE: 001 OF 002 .ACORD, CERTIFICATE OF LIABILITY INSURANCE ioiii�2 0 PRODUCER (603)424-9901 FAX (603)424-3203 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown of N H, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 309 Daniel Webster Highway HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9 y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 1510 Merrimack, NH 03054-1510 INSURERS AFFORDING COVERAGE NAIC# INSURED Cheever Mechanical, Inc. INSURERA: Harleysville Worcester Ins Co 26182 41 Surrey Lane INSURERB Technology Ins Co Inc 42376 Topsfield, MA 01983-1318 INSURER C: INSURER D: 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 DD'L POLICYEFFECTIVE POLICY EXPIRATION LTR SR TYPE OF INSURANCE POLICV NUMBER DATE M DATE M D LIMBS GENERAL LIABILITY MPAOM2257 09/01/2007 09/01/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000,000 CLAIMS MADE a OCCUR MED EXP IAny one person) $ 5,000 A r1EIL PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ICY X' PRO- LOC JECT AUTOMOBILE LIABILITY BAOM2257 09/01/2007 09/01/2008 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ A 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 $ EXCESSIUMBRELLA LIABILITY BEOM2257 09/01/2007 09/01/2008 EACH OCCURRENCE $ 31000.000 X OCCUR ❑CLAIMS MADE AGGREGATE $ A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TWC314733700 09/01/2007 09/01/2008 WcYsLTLIMIATu- OTr+ RTS EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE ER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Inspectional Services BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Ostrich Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. No. Andover, MA 01845 AUTHORIZED REPRESENTATIVE n Julie Leves ue CPCU, ACSR/Ch ACORD 25(2001/08) FAX: (978)887-3535 DACORD CORPORATION 1988 22 Autran.Street N Andover.....Renovation Budget 10/15/07 1. Demolition-------Labor/Dumpster Cost (Allowance)o--- $3,000 $3,000 2. Second Floor Work----Reno Labor(Hamilton)(allow)---- $ 7,000 1 b,DA�$ S-U0 Reno Materials(CMI) (allow)-----$ 1,400 L v M Ib C-R, G w c3 f'P ri «''' Plumbing rough,finish(allow) ----$ 5,500 Lk�bcP-{' t"t-s ley CN-I HVAC new fwa system(allow)---$6,000 L A6 109- + MA-r-$ $HL L Electrical (allow) ------------------$ 1,600 Flooring Refinish (allow)----------$ 1,200 Ceramic Tile Work------(allow)---- $ 1,800 $24,500 $24,500 3. First Floor Work ------ Reno Labor(Hamilton) (allow) $ 14,000 20 LA- Reno Materials(CMI) (allow) $ 3,000 y, L �J Flooring(carpet/wood(allow) $ 6,000 Kitchen Cabinets (allow) $ 4,000 Plumbing rough,finish(allow) $ 6,000 LA Qo 7- tM'c' s S>1-1 c HVAC fhw system(allow) $ 8,000 ��'�°�- M4►k Electrical allow $ 4,000 Ceramic Tile Work(allow) $ 4,500 $ 47,500 $47,500 4. Exterior/Other------ Painting/Siding (allow) $ 5,000 Roofing (allow) $4,500 Exterior Mechanical Rm(allow) $ 2,000 M1 WA $ 11,500 $11,500 TOTAL $ 86,500 L,A-F�©R- C-LCLT' �i�e�oo (RT TO MTS ray cM - y 46 O 5600 T61-AL >U, 1 00 AI>�s f�Op �,.LLow (�c� py ►�kA M l►.�C�N� �<�T LAB5 - 4, �l14ArC - Iy,n00 PLt/\F� �,Soc� S5jgoo 1 PC-tZ►1-LAS �a-o� (—/a-�-�.c��1J �lo�a0