HomeMy WebLinkAboutBuilding Permit #34 - 224 FRENCH FARM ROAD 7/14/2009 BUILDING PERMIT NORTH
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TOWN OF NORTH ANDOVER l-�rb,~,'' _ oA
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
��SSACHUSE���
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION_ t�V-�"'l iG () �ew''"
PROPERTY OWNER ll!St PCit t (�� LYYJ/�jf!�
Print -
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residenfa Non- Residential
New.BuildingOne famil
Addition Two or more family Industrial
Alteratiori No. of units: r Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
,<w4 dl rev art Lvc��l
h�)e a�i. k i' i�
Identification Please TT�alilllla_IA
Print Cle y)
OWNER: Name: / l(S Jy► i� Phone: q 7f-�=7 qq_log�
Address: OR ai-m
CONTRACTOR Name:__ LJ d l ? Phone: ?�' 917�—,&, / --?y
Address; i ""� If a- elelh f I 119. -
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER �;AC) 4 hqrea(1-f._S Phone:_
Address: Pi ti t? T-s 1 cun d P d NeWb!L! 144g. 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: $ 60 , 375 FEE: $
Check No.: Z 3 Receipt No.: 2,()(t'�2
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
signature of Agent/Owner yndwl Signature of contractor_
Location
_1 w
No. � � Date -/jf
NORTH TOWN OF NORTH ANDOVER
0 • tS
` Certificate of Occupancy $
Building/Frame Permit Fee $
�cMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # Z 3
22226
Building 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 -
CONSERVATION Reviewed on Signature
f. COMMENTS
e
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dompster on site yes no
Located at 124 Main Street.
Fire Department signatureldate
COMMENTS
'i
Dimension j
i
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)
i
i
❑ Notified for pickup - Date
Doc.Building Permit Revised 2009
a
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
❑ error P lication
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses_
❑ Copy of Contract
❑ r roposed Interior ork
l avits 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)
r. ❑ 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
o 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
i
Doc:Building Permit Revised 2008
General Contractor
ESTIMATE
Contractor/Supervisor Lic. # 065280 Joe Blanchet
Home Improvement Lic. # 145193 124 Lake Street
Pully Insured Haverhill, MA 01832
978-994-6134
Date of Estimate: July 13,2009
Client Name: Ed McMillan Job Location: same
Address: Old Farm Road
North Andover MA.01845
Phone: 978-794-1089
Description of Work:
• Remove and Install new kitchen cabinets according to home owner's plan
(Home owner is G.C.)
• Install LVL in main carrying wall that separates kitchen from dining room
according to engineered drawn plans.
• Remove and replace existing drywall on kitchen ceiling to allow for new
lighting.
• Ceiling and walls will be a skim coat finish.
• Remove and replace kitchen window with new.
• Install two steel beams and lally column in basement as it is on the plans
drawn by the engineer.
• Repair sheet rock on basement ceiling.
• Install baseboard and window trim.
Debris: A.B. Custom Carpentry will responsible for removal of all debris into rental
dumpster.
Permits: Permits needed for construction are: Building
T �
Owner Responsibilities: They are the General Contractor,Permits,painting, cabinets,
Engineered Plans, steel beams,
Additional Work: Any unseen damage, alteration or deviation from above
specifications involving extras or vendor price increases will be discussed and will
become an added charge over and above the estimate. Work performed at$55.00 per
hour/per man Laborers will be$22.50 per hour/per man.
Total Cost of Estimate: 23,500.00
Payment: A deposit is required before work can be started. Starting payment will be
1/3 of total and a 1/3 after framing inspection. Final payment due after final inspection.
on •actors Signature Date
Homeowners Signature Date
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Circle Insurance Fax:978-777-4898 Jul 14 2009.09:15am P0011001
DATE(MMIOO/YYYY)
ACOR >w CERTIFICATE OF LIABILITY INSURANCE 7114/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Circle Business Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
247 Newbury St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Danvers, MA 01923
978-777-7030 INSURERS AFFORDING COVERAGE NAICA
INSURED Joseph Blanchet .INSURER A Scottsdale Insurance
124 Lake Street INSURER e: ZURICH AMERICAN
Haverhill, MA 01832 INSURER C:
!INSURER D:
94-6134 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWrrHSTANDING
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
i POLICIES.AGGREGATE LIMITS SHOWN MAY HAVESEEN REDUCED BY PAIDCLAIMS.
"MR %D131L L7R "RD TYPE F I POLICY NUMBER POLICY
A IC MEWDDN ) PDA MM/DD LIMITS
GENERAL LIABILITY TE EACH OCCURRENCE S 1 00Q QQO
COMMERCIAL GENERAL LIABILITY UAMAUE
PREMISES Ea OCWNACB S 1,000 000
CLAWSMADE OCCUR MEDEXP(Anyoneperwn) 5,000
X CLS1416404-08 9/1./08 9/1/09 PERSONAL BADVINJURY S 1 000 0001
GENERAL AGGREGATE $ 2,000.000
R
GEMLAGGREGATE LIMIT APPLIES PEIPRpOUCTS-COMPIOPAGG S 2,000c000
POLICY j R LOC I
AUTOMOBILEMABILITY 4 COMBINED SINGLE LIMIT b
ANYAUTO I(G'QC049M)
ALLOWNEDAUTOS BODILYINJURY S
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BOOgYINJURY
NON-OWNED AUTOS I (PerWIdON) I S
i
PROPERTY DAMAGE S
(PereCGldent)
',?ARAM LIABILITY AUTOONLY-EAACCIDENT S
ANYAUTO OTHERTHAN EAACC'$
+ AUTOONLY: AGO S
EXCESSA)MBRELLA LIABILITY EACH OCCURRENCE S
OCCUR �{CLAWSMAOE I AGGREGATE S
S
DEDUCTIBLE S
RETENTION S S
WORKERSOOMPENSATIONAND TORYLIMfTS ER
EMPLOYERS'LIABILITY
ANY"0MIET0FWARTNEFKXECV7IVE ; UB-5617C190 9/6/08 9/6/09 ELEACH ACCIDENT S 100 QQQ
B OFFICERMEMBER EXCWDED7 I EL DISEASE-EA EMPLOYER S 100,000
xyee desvbeundo,
SVEtLIALPROVISIONSmow E.L,DISEASE-POLICYUMtT 4 500 QQQ
OTHER I
1 1
I
DESCRIPTION OP OPERATIONS/LOCATIONS I V EHICLES I EXCLUSIONS ADDED BY ENOOR5EMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Town of North Andover DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL10 DAYS WRITTEN
1600 Osgood Street Building 20
NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL
Suite 2-36 MAPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
North Andover, 1A 01845 REPRESENTATIVES.
Attn: Brian Leathe AUTHORIZED REPRESENTATIVE dQ 17
Fax# 978-688-9542
ACORD25(2001108) (DACORD CORPORATION 1988
V40RTH
TO" Of t �r 4Andover
0
C' A K E =Y dover, Mass.,
COCMICME WICK y1.
RATED C5
`s E BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......... ' .r.. 1n...............................
"" Foundation
has permission to erect......... ........ ....... buildings on �`#►� �.............. Rough
4;
to be occupied as I. �� I � Vf� ...... .... �!!!Q.. Chimney
.... Ch' ne
provided that the person accepting this permit shall in every res ct conform to the terms of the applicatlelf on f118 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 CONSTRCV i&TS 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 T
No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
BROOKHAVENI
FRAMELESS CABINETS
SQUARE EDGE WINFIELD/RAISED
WITH OPTIONAL FRAMED 208"—
DRAW1-IEADS ON ALL"A"DRAWERS 3.. 3„ 3,,
LACE WHITE ON MAPLE FOR KITCHEN 39:" 36" 313" 45" 27" 27"
AND TALL CABINETS/CANDLELIGHT
ON MAPLE WITH A BLACK GLAZE FOR
FINISH ON ISLAND ONLY 377'— 71 43 a" 551"
CEILING HEIGHT 93"HANGIITT—
.. *21
EXCEP G HE RE INDI" 37'--" 36" 18" 17 30" ;e' 36"
EXCEPT WHERE INDICATED
FOR CROWN MOLDING
STACK MTT 803/MRP 858
......................................._........_..._.....-- APPLIANCE CHOICES:
MCR 8218 __ -.... �__ ,..... -USE CLV 8 WITH MRP 858 Oo o COUNTERTOP DEPTH
FOR UNDERCABINET W313013 . W273061
DSP OprupC AC273 6R REF JENN-AIR FRENCH
LIGHT VALANCE W361824 DOOR W/DISPENSER
ODSPL
OPTIONAL DECORATIVE SIDE 3D1834 1D18341 2 ,0tS O
PANELS ON ALL EXPOSED ENDSBSC303427 O ` �? MODEL#JF12089AEP
OF CABINETS
- G _ SINGLE WALL OVEN UNIT
2 C`-----------------------------------
30"ELECTRIC BUILT IN
PLAN # PTN PTN w CONVECTION OVEN
BAE0424L O BAE033424R O o
JENN-AIR MODEL#JJW9530DDP
0 O
ai W i SHARP CONVECTION MICROWAVE
v MODEL#R-930CS
WrrRIM KIT
JENN-AIR WARMING DRAWER
1-HANG AT 90" __-:.:::.-.:.:-:.-:.—.:—.: -.:- MODEL#JWD6030CDX
44"
ODSPR 3133034- -'24L-BFRIDG 6303034 - m !I l4 U-LINE WINE REF.
2-CUTLERY DIVIDER ODSPL wo: - MODEL#1175BEV
IN TOP DRAWER X:
E DCS 36"COOKTOP
A 0O
QF QFCBO 34 MODEL#CTD 365
34 D
3-TILT OUT TRAY IN STAINLESS STEEL w VENTAHOOD
TFB -__— ----�" TFC 34; w w
°� MODEL#BH134SLD-SS
4-FULL HEIGHT DOOR a _
WITH TRAY DIVIDER
ISLAND WITH DECORATIVE
PANELS ON SIDES AND BACK ---
5-DOUBLE OVEN WITH MBB 8412 FOR BASEBOARD
UNIT/NEED SPECS MOLDING/FRENCH COUNTRY 0
TURNED POSTS WITH BOXED I�
FILLERS 6"WIDE X 8"DEEP
6-DOUBLE WASTE
BASKET UNIT
O O
7-ANGLED FILLERS
ON EACH SIDE OF T2D188413L
SINK(27"DEEP) ODSPR! ODSPL T2D188413R ODSP47
WITH SPLIT POSTS
APPLIED TO FILLERS
4" �
8-TYPE B CLEAR GLASS
MULLION DOORS WITH
1/4"GLASS SHELVES
9-MODIFY BOTTOM DRAWER if
TO BE SHALLOW TO ALLOW
FOR OUTLET FOR WINE
REF. tO
All dimensions _size designations given are JANET MAGLIA This is an original design and must not be Designed: 4/17/2009
subject to verification on job site and JACKSON released or copied unless applicable fee has Printed: 4/17/2009
adjustment to fit job conditions. KITCHEN been paid or job order placed.
DESIGNS
ALLISON'S KITCHEN PLAN 13 All Drawing #: 1
The Commonwealth ofMassachusetts
Department of Industrial Accidents
.. Office of Investigations
600 *ashingfon Street
'YA
z/ Boston, MA 02111
www_nwss gov/dia .
Workers' Campensation 1wiu-ance Affidavit: Builders/Contractors/Electricians/Plumbers
A p Iicant Information.
Please Print LeQibl
Name (Business/orgmizafion/individual):
Address:
City/,State/Zip:
Phone#. .
Are you as employer?Check.the appropriate box:
I.❑ I am a employer with 4. ❑ I am a general contractor and I Type of proled(requires:
employees(full and/or part-time).* have hired the Mb-contractors 6 ❑Now construction .
2..❑ I am.a.sole proprietor.or partner- Iisted ori the attached sheet. 7. ❑Remodeling
ship and have no employees These subcontractors have
working for me in arty capacity, workers' comp.insurance. S' Q Demolition
[No workers'comp,insu ance.. 5. ❑ We are a corporation and its 9. Q Building addition
required.] officems have exercised their 10•❑Electrical repairs or additions
3.Q I am a homeowner doing all work right of exemption per MGL I 14 Plumbing repairs or additions
myself[No•workers'comp. c 152, §1(4),'and we have no
insurance required.].t employees.[No workers? 12•❑Roof repairs
COMP. insurance acquired.] 13.Q.Other
`AT1Y aPPiicRM tient d=ks boi#l must also firl out the section below ahowin their workers moor
t Homeowner¢who submit this affidavit indi®ting they ars doing all work ando then h outside conmetors pmsdion Policy information,
- xConoseton;that check this box mustarteohed an additional sheet such,
slowr' must submit a new oftidavit indicating h,
tzg rhe name of the ant-corrtraetors and their workers'ea-.pclia;infomsnion.
!mist an et Tiojrer tkat is pr?vidinrworkers,¢omperrsatfosn insurancor
information. e m1' iP�y Below is the policy andjob site . .
Insurance Company Name:
Policy#or Self-ins.Lie,4:
Expiration Date:
Job Site Address:
. City/StstelZip:
Failure to
Attach a copy of the workers'compensation policy declaration page(showing the policy Dumber and expiration da
secure covte).
coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal
fine up to$1,500.00 and/or one-year imprisonment, penalties of a
of up to$250.00 a day against the violator. Be advisedthata copy ofpenns statement may be forwardede form of a �RK ORDERand a fine
Investigations of the DIA for insurance coverage verification. of
Ido Hereby certify under thepains andpena/ties ofpedWy ghat the information provided above is true and corTra
ST it1T'e: .
Date:
Phone k
ficial use only. 7110110write in this area,to be comply or town o
by�J' ffwiaL
City or Town- Permit/License#
Issuing Autho 'g one:M3'1. Board of Healthlding Department 3.City/Town Cleric 4. Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person• Phone#:
Information a lad Instructions
Massachusetts General Laws chapter 152 requires all emp 3 oyers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"..:every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,assooiation,corporation or other legal entity,or any two ormore
of the'fomgoing engaged in a joint enterprise,and includir-tg the legal representatives of a deceased employer,or the
receiver ortrustee 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 wdrk on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or rto construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence air compliance with the insurance coverage required."
Additionally, MOIL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter im any contract for the performance of public work until-acceptable evidence of compliance with the insurance
requirements of this chapter have been preso t d.to the corrtracting authority."
Applicants
Please fill out the workers'compensation•affidavit compi-m—tely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)arrd phone numbers)along with their certificates)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not requir odito carry workers'cflrnpensation insurance. If an LLC or UP does have
empioyees,a policy is required. Be advised that this afiidemit 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 appI%cation 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 Deparhnent at the nuzzrber listed below. Self-insured companies should enter their
self=insurance license number on&e'appropfiate fine.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department hes provided a space at the bottom
of the affidavit for you to fill out in ti►e event the Office of Investigations has to contact you regarding the applicant
Please be sum to fill in the permittlicense number which vvilI 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:infonnaiion(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 starnped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for futxtre permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license; or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investiptions 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.
ne Depamnent's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Fmdust W Accidents
Office of Iavestaipt;ions
600 Washington Street
Boston, MA 02111
TeL #617-7274900 ext 406 or 1-977-MASSAFE
Fax#617-727-7744
Revised 5-26-45 wwwmem.gov/dia