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HomeMy WebLinkAboutBuilding Permit #411 - 28 STAGE COACH ROAD 11/30/2009 Lill TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION r Permit NO--4, m—a.Q Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page TION " ctiGcr _ PROPERTY x Y r -MAP NO: 'A# CEL ZOT INO:DJSTRICV' '- =listo��c District yes n� r . W r P = Machine S}iop1;age yes ono _= - - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Ad�in Two or more family Industrial ItNo. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic. 1N11 Flo©dpla� n 9w14etlands 1�Vaterseri District Water/Sewer _ xEl = _ _ DESCRIPTION OF WORK TO BE PERFORMED: + Ca Z 1 P S 'Identification Please Type or Print Clearly) OWNER: Name: c... Phone: Address: CONTRACTOR Narr e _ �Rhorie _7k-1 w J s - rt Address: _ J x L_ �. 5upervisor's Construction License: ., Exp. ; ,. d - Flome Improvement icanse. Exp. 'Date. /Z _ ARCHITECT/ENGINEER Phone: Address: Reg. 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: $__ 7��• o d FEE: $ Check No.: o 7 Receipt No.: �Z Ce S� NOTE: Persons contracting with unregistered contractors do not have acce t t ;gu? my fund ignature.of Agent/Owner Signature ofcontractor I Plans Submitted Plans Waived Certified Plot Plan StampedPleps TYPE OF SEWERAGE DISPOSAL ,. s Public Sewer Tanning/Massage/Body Art Swimming Pools 4 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 i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments i Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engifieer:Signature: ._.- Located 384 Osgood Street _ ,FiREMEPARTmtNT -T6thp�Dum�pster on;- ite �yes�� no 'Located at 124 MainsStreet Fire.Departrn fit.signature/date c tLL 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) t I i ❑ Notified for pickup - Date .._....__........._.__..._..........................................................._.._.._.........................._._.............................._....__.._.._..................................._.............................,............................._._.........................._.............................................._.._...-......._...._........._.__.._..._............................................................. Doc:.Building Permit Revised 2008 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 o 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 cs ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit I� ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ 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 ` f 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 o Photo of H.I.C. And C.S.L. Licenses o 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: Doc.Building Permit Revised 2008 Location No. Date 3 HORT1y TOWN OF NORTH ANDOVER 3? CAL .. • Certificate of Occupancy $ Mss Building/Frame Permit Fee $ V:: Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22657 Building Inspector »::: ::..:......................:..:.......:>:...;...::'::. .:..:...,:;., .,:.. ;...::: :: :: ::; =.DATRMMIDD/YY) lL IN TM :..:..::..:....: :..:......: ........ 11/30/09 PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCHEX INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 150 SAWGRASS DRIVE ALTER THE A RDE Y THE POLICIES EL . ROCHESTER,NY 14620 COMPANIES AFFORDING COVERAGE COMPANY A GUARD INSURANCE GROUP INSURED COMPANY DAVID REITANO REMODELING AND BUILDING B DAVID REITANO 56 PLEASANT STREET COMPANY METHUEN,MA 01844- COMPANY D ::::. ... ...... .............................Wsiii ...... . ....... .. ....... 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 REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU13JECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MWDDIYY) DATE(MMIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ =AAIMS MADE CUR PERSONAL&ADV INJURY $ OWNERS&CONTRACTORS PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one Erre) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: £ACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACHOCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND wCSTATU oTIl TOR '.TY R R A EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000.00 THEPROPRIETOR;" Q INCL PARTNERSrEXECUTNE DAWC014590 06/11/09 06/11/10 EL DISEASE-POLICY LIMIT $ 500,000.00 OFFICERS ARE: ®EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEMCLESISPECIAL ITEMS :::::.�:::.. ... SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF NORTH ANDOVER EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BUILDING DEPARTMENT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1600 OZGOOD STREET NORTH ANDOVER,MA 01845 BUT FAILURE TO MAILSUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTUeWED REPRESENTA VE :ATiARD:�rS ofNOR0 , tT : 4 over .. O No. y tizs dover, Mass., /_.��- C l T O LAKE coCMICMEwiCK V A0RA T E D `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT �r�-6ow A(,�t.-,�e,,Q BUILDING INSPECTOR Foundation has permission to erect........................................ buildings on...Z ...... cvr4-G .......................... Rough to be occupied as.....�.��. .��. ........ ...................... Chimney . ...... ................................... .......................................................... .... provided that the person accepting this permit shall in every respect conform to the terms of the application 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR. UNLESS CONSTRUC TARTS Rough ...::..............-7.....,. ..........:.... 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. - a ds dsr Board of Building�R.egulat�od eNis Supe"', license a� Construction .°' CS 23365 license Tr# 12834 121412009 . r Y,s �astrlat�on , r 4 DAVID REITANO x �J { TP .,e, ssioneY ST mm T o 56 PLEASAN METHDEN MA 01844 HOME IMPROVEMENT CONTRACTOR Registration: 108782 Exp'ration� $25/2010 Tr# 274971 l` Type P-$jr�ute Corporation t ?t i iT DAVID REITAN REMODEL&--BUILD David Reitano 56 Pleasant St Methuen,MA-01844 Administrator i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elect�icians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: c?ke__( 1M Phone#: Are yo an employer?Check the appropriate box: Type of project(required): 1. Are am a employer with_ 2 4. ❑ I am a general contractor and I 6. ❑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. T 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]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 12.0 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: �} y y� �l Policy#or Self-ins.Lic.#: IAJ U Expiration Date: a O b Job Site Address: rpt c (t� c 6, c N �d���1 City/State/Zip: 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 Si2nature: Date: 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.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- 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 hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or 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 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 to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public 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 sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(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 that this 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 Industrial Accidents. Should you have any questions regarding the law or if you are required 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 at the 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 permit/license 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(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 stamped 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 not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations 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. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.11 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wuvw.mass.gov/dna i b GENERAL CONTRACTORS 56 Pleasant Street Methuen, MA 01844 Phone/Fax: 978-688-3944 Company Email: DavidReitano@verizon.net Proposal Date: 8/6/09 Submitted To: Mr. and Mrs. Percival 28 Stagecoach Road N.Andover Ma. Home: Work: 978-655-1373 Mobile E-mail job Description: Kitchen renovation We herby submit specifications and estimates foi. Demo kitchen area completely including removal of exsisting cabinets,counters,tile floor,soffits above cabinet area and open walls approximatly 36"to 48'off floor to accomadate new electrical. update electric including new recepticals,switches,undercabinet liting,re-wire new appliances supplied by owner and 10 recessed li+.es Plumbing will be inspected and updated were needed including water supplies,shutoffs,water to frig and drains also including gas connections. All venting from appliances will be properly routed thru metal duct work to exterior. All walls and ceiling damaged during construction will be replastered and blended into exsisting. Install cabinets and counter as shown on plan including misalaneous mouldings and hardware. Floor will be prepared for new tile surface install new the floor throut kitchen and dinette area Backsplash will be the Pantry closet will be removed and replaced with new,..style to be confirmed. Third floor utilty entry will be replaced with a 6 panel smooth masunite door unit properly weatherstripped. Half bath located off kitchen will have ceramic tile installed,..exsisting toilet will be removed and replaced after tile installation. All debris will be removed from jobsite Below allowances included in overall price cabinetry-$6900.00 granite counter $3600.00 10 recessed lites sink-$450 faucet-$450 the- $140,0.00 Above total $23,700.00 Pending -additional cabinet to left of entry area J � *Contractor is responsible for allowances mentioned, anything that exceeds these allowances - Homeowner is responsible for. *Homeowner is responsible for paint and stain *Please review this proposal carefully for any items which may be missing. Contractor is not responsible for items not mentioned here. *Please do not hesitate to contact us if you have yue Aion (___. Thank you for considering us for this project - ____ _ __ David Reitano Workmanship Completely Guaranteed/Sullivan Insurance (Please sign and return one copy) C - ------- -- ------ Date: Sig nature: _ __ i Signature: ------------------------ Date: ------------