HomeMy WebLinkAboutBuilding Permit #281 - 23 ELMWOOD STREET 10/15/2007 BUILDING PERMIT "O oT" qti
T WN OF NORTH ANDOVER �? °��', oL
4 .� 'A
APPLI ION FOR PLAN EXAMINATION
Permit NO: I Date Received fl ' ' o� X94`°`""""`" *
��SSACHUS�
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATIQ�1
Pnnt
"PROPERTY OVIINER
r Pnnt r a
MAP�Ifl k PARCEL ZONING D°ISTRICTHistonc flrstract es ho
c f rMacliine Shop Vallage y s no moi`
TYPE OF IMPROVEMENT PROPOSED USE
Reside Non- Residential
Ne Building tatLamily
AEd! Two or more family industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
5 lAell k 1=leodplarr Wetlands< =� Watershed District
`Nater/Si✓wer . ' f m _ _ A kz r}
WO
DESCRIPTION OF TO BE REF RMED:
RFK
g'aYYJ\ , I;tAVU
Idep ifica�pn Please� Tyle or Print CSSarjOWNER: Name: DCA\'\'%t1K y)� Phone:G 1 -q s� ` d
Address:
�CO:NTRACTORNarrie ,. ` gxw` • M Phone:� 4 7
J
Add ,ess .� {T► #M�. 11 i'V
Supervisor's Construction trcense �= 1=xp Date n
�Flome lrri'prAD went License r . cp _;Date
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: $ r � FEE: $
Check No.: 2 - Receipt No.: �
9.
NOTE: Persons contracting w't unr g' ed contractors do not have access to the a a and
SigraataJre of Agent/C3wner Signature of contractor
Location c lrna
No. Date
MORTM TOWN OF NORTH ANDOVER
3?O�tt``O I•,�O
O
9
• s Certificate of Occupancy $
;�s'•^°''t�
Building/Frame Permit Fee $
E
sACMUs �
Foundation Permit Fee. $
Other Permit Fee $
TOTAL $
Check #
20668
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
1=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
DA REJECTED DATE APPROVED
CONSERVATIO
COMMENTS U•�
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zonirtj 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
Located at 384 Osgood Street
FIRE DEPARTMENT =TempeDumps#er ori site yes'
Located at 124 I�ain`Street:
Flire Departmen7.
t �gnature/date _ '
COMMENTS . . �' Q: ww'S "' � Uu`1`} i l '� ' FQcu ►rmw� f
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
i
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 Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o 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
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o 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
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o 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 DEPARTMENT:BPFORM07
Revised 2.2007
NORTiy
0 over
Town
0
n - LAK
o . �` dover, Mass- a3 �aGf
�.
COC MIC HES V
S RATED
BOARD OF HEALTH
PERMI -T. T D Food/Kitchen
Septic System
�h , BUILDING INSPECTOR
THISCERTIFIES THAT........................................................................ IAS. ..........................................
Foundation
has permission to erect...... .............................. . buildings on 3
Rough
to be occupied as..�. ..�t..a..........Ad....... ..... .......... ..�d...+... !I4.... ...:.................
Chimney
Ch'
provided that the person accepting this permit shall in every r�spect conform to the terms of the appl tion on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
49(9 1 110
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUC T TS ELECTRICAL INSPECTOR
Rough
........ ... ................................................ .................. Service
BUILDING R
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
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.
NORMAN
PROP ERT I ES
& DEVELOPMENT
MA CS License#:87851
MA HIC#: 151799
Real Estate Broker MA/NH
Project Address: Danielle Beulieu&Yasmine
23 Elmwood Road
North Andover,MA
Home Addition Proposal
We hereby propose to furnish the permits, insurance, labor, and materials to complete the following
addition project as described below:
Foundation,Framing,Roofing,Siding Insulation
1. 12'x 13' addition off the left rear of the home integrated with repaired sunroom
a. Approx 6'foundation walls for frost protection
b. poured concrete floor
2. 2"x6"exterior wall construction,2"x10"roof construction with plywood sheathing
3. 2"x6"pressure treated sills
4. 1/i fir plywood sheathing for roof,7/16"OSB sheathing for walls,Typar vapor barrier
5. Rubber Roof over new addition and repaired sunroom
6. Fully insulate exterior walls and ceiling
7. Siding to match
Windows,Doors,Slider&Interior Finish
1. Customer chosen windows per allowance
2. Two interior Huttig 6 panel doors with hardware for bedroom and bath
3. One bifold doors for bedroom closet
4. 31/2"colonial baseboard trim,21/z colonial window trim
5. 1/2"Blueboard&Plaster finish,prime,and paint with Benjamin Moore
Plumbing&HVAC
1. Install duct work to supply heat to bedroom
2. New Bathroom inside of new master bedroom
a. Vanity/Top/Faucet
b. Shower/Tub and Toilet
c. Exhaust fan to exterior of home
Electrical
1. Per Electrical Building Code
2. Customer to supply lights and fans,contractor to install
Allowances: 14,
fid � �q,�Sin 2aa rn
• Windows: $500 bile
• Vanity/Top/Faucet/Toilet/Tub or Shower:$1200Ale f-
• Flooring: FA0"kir`
1. $ ��!-ef r n r��jFi`rCt��{jLcGC
2. Q�7l�J__.__a I..,.t,;n��l , ., ,,.,m
y�o7'�uxa so: rr.rf:ae oQae vvai y ,T%/CC'
• Loam and seed disturbed area-Customer responsible for watering new grass
NORMA
PROP ERT IE5
& DEVELOPMENT
Exceptions:
• If current FHA furnace cannot handle the load to properly heat the new master
bedroom and new furnace may need to be installed for an extra cost
We hereby propose to furnish the plans and approvals in accordance with the specifications above for
the sum of: ($21,750.00)Twenty one thousand seven hundred fifty dollars.
Payment as follows:
Project Start date: $12,000
Rough ins inspected: $6,000
Job Completion: $3,750
Start Date: Immediately
All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to
specifications submitted,per standard practices. Any alteration or deviation from above specifications involving extra costs
will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements
contingent upon strikes,accidents or delays beyond our control. Owner to carry fire and other necessary insurance. Our
workers are fully covered by Workmen's Compensation Insurance. If either party commences legal action to enforce its rights
pursuant to this agreement,the prevailing party in said legal action shall be entitled to recover its reasonable attorney's fees and
costs of litigation relating to said legal action, Ever
a court of competent jurisdiction. All ledge and other
unsuitable excavated material to be remo the contract price.
Authorized Signature `�' -'� 10/02/2007
mmi,ne. t�Ott _ carmz� C)
4
6'O"X 6=6"SD
04
4'-1 112" 5'-11„ 1 '7" �� 4=4 112"
28'-0 -�`
k _1
? N
\T Existing Sunroo,
k
1
=o" Permit Pulled b
New Bedroom
" N to Repair W N
k k
_I a
0
0 � �
I 1
to1�
V
2"x 10" Roof Rafter 16 O.0
1/2 CDX Plywood Sheathing
Rubber Roof
Soffit Vent
2"x 6"Double /� 2"x 8"Ceiling Joist 16"O.C.
Top Plate
1/2" Blueboard/ Plaster Finish
2"x 6" Exterior Walls 16"O.C.
R-19 Insulation
1/2 OSB Sheathing
Typar Vapor Barrier Concrete Slab 4"
Crushed Stone Base 4" Foamular
/Insulation-R-20
2"x6"PTSill r
Poured Concrete Footings and Frost Walls
10"Thickness, 6' Height
Finished Grade Footings: 10"x 22"
> 8"from frame
Ir
?`R-S-cI�LfiS 03: 13P FRUI,I PHAN`LiF INISL NCE ACo 97e3720431 TO:16vt's9742R75 ( , �
ACORDN E TIfii T OF L LABILITY INSU ANC DATCIMu)DD.�rYYY,
PRODUCER G 5 0 7
- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
paneuf Ins. Agency, Inc. { ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE
P-0. Bax 1296 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4iTEF
Haverhill, Ma. 0I831 THE COVERAGE AFFORDED SY THE POLICIES BELOW.
--_ _
__ INSURERS AFFORDImG COVERAGE _ NAIC a
h6UPE❑ - --v_ . ---_----- ;,-UREf,A National Grange Mutual, _ _.��-
Michael. Ryan Norman DBA INSURE.R8 Acadia Insurance 4
Norman Properties & Developement fNSURERC —
10 Kelleher Ave.
Plaistow, NN 03865 INSUaERE
COVERAGES '
TKE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOA THE POLICY PERIOD INDICATED NOT`JVITHSTANDING
ANY REOUIRLM.E NT,T ERIA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED QR
"+I.AY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AQGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS
INSR VIDDL FCEtCV EFFECT{VE PQLICV£RBIHAT1074
YYP;rI�E'�11$1RI t { POLICY N41Ii6'BIL !�
�f ..ted—T ! 4ATE[(ADD/YY) OFT S,(Il(�1fr�Q;Ytl) LIAf
:ty-IE1N"AL LMBIUTV tt n/nc 11/29/07/^�t5 Iry-g#EACti OCGURREnCE E 500,000,n� t� n
. "`xI GOMNE FICIAL GENERAL LIABILITY P 092417 1 1.�29/06 i 1 I f 2 7/0! 1 ` � aus:c_/oncaf F SGu r vGU.
CLAIMS MADE L}CCUR I,
i Ilzo EY,P(A. /me pwzo.) s 1010001
PERSONAL A A0V I11URY s 001000.
' i GENERAL AGOREGATC s 1.,0-00,0_0_0
�yQENL AGGRE(G'AAT'E u;VlR APPLIES PER j P?QDIKTS-GOASPrOP AGG f r 000,00 0
,;XX POLICY I Pte _ tOGCT
-
j � {AUTOA;ODILE LIABILITY ANY AurD -#-
I I { ;COAIBIHEO SINOd.E LIMIT
,� { � {Eo®ccalortl S
. �.�ALL 014k-ED AUI OS •`-y "—__-- -- -.
{BODILY INJURY
I y
SCHEDULED AUTOS I j Ift pamm) s I
HIRED AUTOS }
I {80DILY!NJURY t
NON-OVYNED AUTOS --
`"-; 1 PROPERTY DhNAGI-.
iWar acadaml 5
^GARAGE UABILTTY 1 . --------_
I AUTO ONLY-EA ACCIDENT S
ANY AUTO
�� I jOTHERTfgAN -
t I I AUTO ONLY AGG I S
C ��XCES:+UMDR£4LC CItHtttTY I { j EACH OCCURRENCE __ g
OCCUR �GLAl1AB IAAOE i : I AGGREGATE
---�DEDUCTIBLE
NE"E""ON t i '----t---- ----
f$
aB WORKERS COMPERSArION AWL) T ,� q - INC SPAT"U !4TH.. i
EN.PLOYER9 L4BIUTY C 2$—2$-0 0!..}x 9 3-{ t ¢YytaiT.s
AVY akOPRiETOILPARTIGRtEkECLJTA/E { Qo 102/I4/07, 02fl-dI( 08 f'L EACH ACCIDENT S ,Q_ .�..._.�
O�10ER'.M5LIBER EXCLUDED7 {
I y"dascnea,x/do� i EL DISEASE EAEPAPLOYEE S l on oon
OPTHER FCIAL PROL t5t0�7$Oalace 1 i E L DISEASE-PDLICY OMIT F �(}Q 001 1-.
I "'-tet
DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES I EXCLUSIONS AIDED or E7IOORaEmENT t SPECIAL PROYLSIONS
Carpentry Dwelling l
i
1
CERTIFICATE HOLDER
CANCELLAT10N
SHOULD A14V OF THE ABOVE D£SCRIMED POLIaES BE CANCELLED BEFORE THE EXPIRA?SON
DATE TOEREQF.TfW t9SWNO INSURER V,4LL ENDEAVOR TO FAIL �/ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,RUT FAILURE.TO OO SO SMALL
IMPOSE NO CaLLISAT(BN OR QX91LITY .NY KIIIO UPON THE NJSUftER.lis AOENT5 pG
REPRESENTATW
AUTHORIZED REP ti As1v
ACOPO 25(2001!0$) 6 AGLryRO CORiPORATION 1988
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information EE Please Print Legibly
Business/Organization Name: Vc� fIc Js VVkc-.
Address:
City/State/Zip: .'UZ Phone#: f `J'9 74 Lf
Are you an employer?Check the appropriate box: Business Type(required):
I.14 1 am a employer with employees(full and/ 5. ❑ Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,ete.)
employees working for me in any capacity.
[No workers'comp.insurance required] S• ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have I0,❑ Manufacturing
no employees.[No workers'comp. insurance required]
4.❑ We are a non-profit organisation,staffed by volunteers, i I.F-1 Health Care
with no employees.[No workers'comp.insurance req.] 12.❑Other
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
1 am an employer that is providing workers'compensation insurance for my emplovees. Below is the poflcv information.
Insurance Company Name:
Insurer's Address:
City/State/Zip: �i
Policy#or Self-ins.Lic.# W!C Expiration Date:
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
tine 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.
1 do hereby certify,under englties of perjury that the information provided above is true and correct.
1�//�
Signature: _ - ``°` i Date.
1� t -p�1
Phone#: ��� �� { 7 1-t _ � 1
Official use only. Do not write fit this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
Board of Building Regulations and Standards
i* Construction Supervisor License
License: CS 87851 ,
Birthdate: 9/23/1980
Expiration: 9/23/2009 Tr# 2544 !
�. Restriction: 00
MICHAEL R NORMAN i
10 KELLEHER AVE
PLAISTOW, NH 03865 Commissioner i
:_//L� 1�67n4J2P9bl(IClJ.LL/t• 6�/l�(.(.6WQ.l1LCGfELl4
Board of Building Regulations and Standards
- HOME IMPROVEMENT CONTRACTOR
Registration: 151799
Expiration: 7/5/2008
Type: Individual
MICHAEL NORMAN .
MICHAEL NORMAN
10 KEL.L_EHER AVE
PLA!-STOW, NH 03865 Deputy Administrator