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Home My WebLink AboutBuilding Permit #82-11 - 27 MEADOW LANE 7/27/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z 1 / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION _ 01 f iricacic,.3 L,ctrsc. Print PROPERTY OWNER cxcinfin,}l��-,n� Print MAP 210 015 -6 PARCEL: 00 4' ,' ZONING DISTRICT: K j Historic District yes TYPE OF IMPROVEMENT r ' �aa _ New Building TYPE OF IMPROVEMENT PROR0,SED USE esidential Non- Residential New Building nefam' Addition Two or more family Industrial t ati No. of units: Commercial Assessory Bldg Repair, replacement Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer OF-5GRiPTiON OF WORK TO BE PREFORMED: ��ti Ren,c�La-�}tary Identification Please Type or Print Clearly) OWNER: Name: k�� i"oNTlC6� Phone: 172S 5S)3 Address: &') LN CONTRACTOR Name: S -t e u�,.Y r3,n s zw(- Phone: Address: )S 3Yh,62fr S' t t+))VttV Supervisor's Construction License: C S -7 *1g7S' Exp, Date:—/ 2q - 2oi ) Horne Iq$Gt4 2 . Date:I Z/ z ARCH ITECT/ENGINEER _ f3., ldicr 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: $ �J ,� ( S�� 'ko" FEE: $ �07 Check No.: -5&L11 Receipt No.: �-3 02�� NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contracto 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 COMMENTS HEALTH Reviewed on Signature COMMENTS 114 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 Dumpster on site yes no Located at 124 Main Street Fire Department siignatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes 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 2010 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2008 IW'�2 7?) Location J No. p2-- Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ \s�cwusE< Building/Frame Permit Fee $ �— Foundation Permit Fee Other Permit Fee J TOTAL Check # i 2326'u $ Building Inspector B CONSTRUCTION CONTRACT A. Date of Execution July 1, 2010 B. Parties Contractor: Steeplechase Builders, Inc. 153 Maple Street, Methuen, MA 01844 (978)688-5036 Owner: MA Home Improvement Contractor Registration # 145042 Federal Identification # 20-1906118 Contract executed by: Christopher D. Smith Principal, Director of Planning Steeplechase Builders, Inc. Karin Pantleon 27 Meadow Lane North Andover, MA 01845 (978)725-5513 C. Proiect Address 27 Meadow Lane, North Andover, MA 01845 D. Proiect Summary Kitchen Renovations E. Proiect Cost $54,065.00 X xoj M -�' - ofl011 20 (o Owner Signature(s) Date /) Contract Signatures Date CD m b CD A CD tz vv� m CD �rn�A A 144" Overall Cabinet Run 3d' � 36- ---f— 39' 36-4 12,E W3636 -12D PC3090-250 Bt8-24D 40818-241) L -- -- y m W3015 -12D W4836 -12P0 N O 812-246 �� n -30- , W V � W ll M I O N W cl OF N 61 m � I � (P cn m u� 0-0 x" v m p d ro I lam/ W ' o 3 $ o 00 n 3 �J Tv ' > BEP1.5.240. Nv J CD 2a TEP1.590-270 0 �- =, rr VJ I V _o O C � O � d O O r U ju C. L C O C � z � E7 144" Overall Cabinet Run 3d' � 36- ---f— 39' 36-4 12,E W3636 -12D PC3090-250 Bt8-24D 40818-241) L -- -- y m W3015 -12D W4836 -12P0 N O 812-246 �� n -30- , W V � W ll M I O N W cl OF N 61 m � I � (P cn m m fb Ol W s m N - = �v g o' TEP1.590-270 x" v m I W 3 I V 3 ' > BEP1.5.240. Nv J s a i 2a TEP1.590-270 m fb Ol W s m N - = �v g o' TEP1.590-270 k_ ala`%acituselt" - i)epal'tntcnt of Public safrt- Board of Buildin- Rc'i-mlatioW, Mud titaudaa'd. ConstrUcticr* Supervisor '-,cense License: CS 74478 Restricted to: 00 JOSEPH M CLEMENTI 153 MAPLE ST METHUEN, MA 01844 c „uuni..i�,ncr Expiration: 1 /24/2011 T r-: 8987 ✓ixe '(oomz�nzaxz«eczC(� a�'�,(�aoeacsvcav,(.t .- - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 145042 Expiration: 12/2/2010 Type: Supplement Card STEEPLE CHASE BUILDERS, INC. JOSEPH CLEMENT]L 153 MAPLE ST METHUEN, MA 01844 Administrator The Commonwealth of Massachusetts l Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual)::SAc4pkGV-14S,. G,Aidcu Ir - Address: 15^�pT City/S Phone #: q'2F- Are you an employer? Check the appropriate b x: L ❑ I am a employer with 4. [0I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurancecomp. insurance.: 5. 21"We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] fi c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] F6_,503C Type of project (required): 6. ❑ w construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. E] Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #I 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 state whether or not those entities have employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: ;D' l MCOA -) )—'N City/State/Zip:Noth. ArJ&.&/fts i al "4r 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 certify under the pains and penalties of perjury that the information provided above is true and correct. -26 - to Phone #: U 97 rx- Sidi 54 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. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Subcontractor Insurance List Mike O'shea OES Electrical WC8634496 Mike Burke Powerhouse Plumbing & Heating 04WECIT2480 Niko Zafirakis Candia Tile WC 1315373447-0109 Eric Lee Lee Carpentry WC1-31S-373195-019 Dave Beaulieu Beaulieu Cabinetry P0003900344502 v aa p►� GO j4 O w cn cn U a ° w a4 U cop w x 0 W w G 'iw x. 0 W W to w2 U) u. p d w w w a � CE � U) cn = � o a� c O � c � O L H O C O 8 v :V •Q C CD Ca C O Cc CA E Q CD CF _ts ts C2 a y o= • O O V «. u a m c CL -- w 6 CD'a L o m 3 1: y C71 m ,.cam _m y A : A"- y m Lc, o �,f act LZ acCD.c C.7 •y v'O j1Z `�CD c0 a Q m : C,* m C = m m r o :a oco •N CLI Z A c CD � Q CD cm CD y a C.3 -m Cl -S 0 a m I-- a Mo Z s d! c cm O W CD c m 0 cm c N O t O Z O A., 6 O I O cm h O 'D 0 •O •EcoC3 O m m CLI— w CD 0 0 CD , CD O o cc a CMQ H O �C CcCc CD c CD cm V CL h O C E c _cc cod uj 0 U) W W 19 W C4