HomeMy WebLinkAboutBuilding Permit #697 - 29 MILLPOND 5/10/2006Of NORTH 1h
p TOWN OF NORTH ANDOVER
`_ •' APPLICATION FOR PLAN EXAMINATION
SSACMUS�
Permit NO: Date Received:_ —06
Date Issued:
nn IMPORTANNT: Applicant must complete all items on this page
LOCATION -1 4' '� PO4 -9-k
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PROPERTY OWNER
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MAP NO.: " 5-A PARCEL: Print ZONING DISTRICT: Q!e & , t7. i�J� Vrt�4 y
TYPE AND USE OF RIJii.DING
HISTORIC nlgTRICT VF.0 r-1
TYPE OF IMPROVEMENT
PROPOSED USE
Exp.
Date: o`Z'/� �%
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
❑ One family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
Vhh )UKIF 11UN UP W UKK I U tits; FKhP.UKMhD
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Identification Please Type or Print Clearly) j`h(
OWNER: Name:ne: ,
Address: `L Ul
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CONTRACTOR Name: SJC= 17o C, Phone:
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Address: �l � Vn c" 10 Et(Ye- QU001 1rr1A. lii�r '7
Supervisor's Construction License:
d!R�a C-1,2
Exp.
Date: o`Z'/� �%
Home Improvement License:����
a �%
Exp.
Date: 7 /t3 _.��
ARCHITECT/ENGINEER Name: Phone:
Address:
Reg. No.
FEE SCHEDULE: BOLDING PERMIT. • $10.00 PW]O00.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.R
Total Project Cost :$ fid, /�� �� x10.00=FEE:$,,,��-- - ''�
Check No.: �f,6 Receipt No.: �l d
Page 1 of 4
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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:BPFORM05
Page 4 of 4
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools El
Public Sewer
❑
❑
Tobacco Sales
Food Packaging/Sales - El
Well
❑
Permanent Dumpster on Site ❑
Private (septic tank, etc.
NOTE: Persons contracting with unregistered contractors do not have access to
k -A0 �� 1
Signature of Agent/Owner tNa (� Signature of Contv
Plans Submitted ❑ Plans Wad ❑ - Certified Plot Plan
THE FOLLOWING SECTIONS FOR OFFICE USLrONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS •
HEALTH
COMMENTS
Plans ❑
DATE REJECTED DATE APPROVED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer connection signature & date In
Temp Dumpster on site yes—no— Fire Department signature/date 3 —'/�s 06
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback(
Front Yard Side Yard Rear Yard
Required Provided Required
Provides Required
Provided
WMENSION
Number of Stories:
Total land area, sq. ft.:
NUItbSanaUAIA — Ivor
Page 3 of 4
Doc- INSPECTIONAL SER
Created 1MC. Jan.2006
Total square feet of floor area, based on Exterior dimensions.
Location CA ` ��t P b a d
No. (jj D Date 0 G�
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NORTH TOWN OF NORTH ANDOVER
°1 a Certificate of Occupancy $
Eta' Building/Frame Permit Fee $
s�cHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
1911 86 Bwlding Inspector
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AR WCIP - Liberty
�Iut>VI:a.I� Workers Compensation and
ISSOING OFFICE 354
INFORMATION PAGE Employers Liability Policy
ACCOUNT NO. SUB ACCT NO. LIBERTY MUTUAL Mut Lal Insurance
ns mance INSURANCE CO -
165s6
1-355978 0000
POLICY NO. TD/CD SALES OFFICE CODE SALES CODE N/R 1ST
WC2-31S-355978-015 XX X WESTON 102 REPRREESEN ADTIVE 3000 1 YEAR
Item 1. Name of B T POWERS HANDYMAN/CONTRACTING SERVICE FEIN 20-0644868
Insured
Address 523 MAIN ST RISK ID 106898
READING, MA 01867
Status 03 CORPORATION
Other workplaces not shown above: SEE ITEM 4
Mo. Day Year Mo. Day Year
Item 2. Policy Period: From 09-15-05 to 09-15-06
12:01 AM standard time at the address of the insured as stated herein.
Item 3. Coverage
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here:
MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits
of our liability under Part Two are:
Bodily Injury by Accident 100,000 each accident
Bodily Injury by Disease 500,000 policy limit
Bodily Injury by Disease 100,000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
SEE END WC 20 03 06A
D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE
Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating
Plans. All information required below is sub'ect to verification and change by audit. LINE 110Premium Basis Rates
Estimated Per $100 Estimated
Code Total Annual of RE- Annual
Classifications
SEE EXTENSION OF INFORMATION PAGE
Minimum Premium $ S00 (MA
Interim adjustment of premium shall be made:
Thi otic including all endorsements Issued then
Total Estimated Annual Premium
ANNUAL
vith. is hei
s p y countersigned by SEE ATTACHED FOKM l'/lu
Authorized Representative Date 10-19-05
Loc. Code I Term. Oper.
10-19-05
GPO =4030 RI
Audit Basis Periodic Payment Racine Basis 1 Pot. i LG_ I iome State Dividend I NEW BUSINESS
NR I MA I NEW
Copyright 1987 National Council on Compensation Insurance
INSURED COPY
WC000001A
1.
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration ;146329
Expjration 4/13/2007
Type Pnvate Corporation
BT POWERS HANDYMAN CONTR
ARTA `-PNEft
523 MAIN STS,,
READING, MA 01867 Administrator
— B.T. Powers Handyman Services
523 Main Street, Suite A
Reading, MA 01867
(78 1) 438-8453
BILL TO
Nancy Maddox
29 Mill Pond Road
North Andover, MA 01845
DESCRIPTION
Scope of work to be done:
Estimate
DATE
ESTIMATE
5/9/2006
645
TERMS I PROJECT
Kitchen Remodel
1. Demo kitchen (walls, ceiling, wood flooring, *remove old tile floor, Electrician to remove old wiring, rough out new outlets, switches, Install
GFrs & recessed lighting, Plumber to install new gas line for stove, reinstall new plumbing for sink disposal, dishwasher & ice maker.
Plaster will board & plaster using 5/8 board to exterior walls & 1/2 board to all interior walls & ceiling ** ceilings - include living room area.
Walls will be primed & painted to customers choice of color. Cabinets will be install ** cabinets supplied by customer. Granite counter tops to
be measured & install by granite co.
Flooring - the will be install for kitchen & dinning area ** customer supplied tile
** Items supplied & paid by customer - cabinets, file
* * * All other supplies will be covered by contractor & by Subcontractors.
NOTE: Estimate is based on basic cost of materials. Changes or additions will be extra cost to final billing
Fuel charge
Disposal Charge
Specific materials for job
primer, paint, screws, nails, caulking, misc..
If estimate is acceptable, please sign and return one copy. A deposit of 50% is required.
Please note this is only an estimate. Labor and materials may
vary due to hidden problems or additional work.
Signature
For you convenience, we
now accept MC, Visa and
American Express
Total
$20,135.00
Proposal No:
B.T. Powers Handyman / Contracting Services, Inc.
523 Main Street, Suite A
Reading, MA 01867
(781) 438-8453
(781) 942-2452 — fax
CS # 085343
Date: (J6
This Proposed Agreement is between B. T. Powers Ha dymanlContractor Services,
Inc. (hereinafter the "Contractor"), and t✓ (hereinafter
"Customer").
Contractor hereby proposed to furnish all materials and equipment, and perform all labor
necessary to complete work as outlined on attached Estimate #—�-
All material is guaranteed to be as specified, and the work outlined on Estimate
# j � will be performed in accordance with the drawings and/or specifications submitted
for the work and completed in a substantial workmanlike manner for the agreed upon sum of
($S s / 6� x ) with payments to be made as
follows:
a) A deposit of fifty (50%) percent with acceptance of Estimate;
b) A thirty (30%) percent payment after the work is mid -way completed; and
c) A twenty (20%) percent payment upon completion of the work.
Any changes involving extra cost of labor or materials will be submitted to the Customer in
the form of a written Change Order. No work, as outlined on the written Change Order, will be
performed unless a signed copy of the Change Order is received by the Contractor, along with
payment as outlined below.
.1
Acceptance
I understand that by signing this Agreement I am authorizing you to perform the work
described on the attached Estimate, for which I agree to pay the amount stated in said Proposal
and according to the terms thereof. I understand that any changes involving extra costs of labor
or materials will be executed only after submission and acceptance of a written change order
and such extra costs will be paid in accordance with the following terms:
a) A fifty (50%) percent deposit upon acceptance of the Change Order; and
b) The remaining fifty (50%) due upon completion of the work detailed in the Change
Order.
Dated:
by: - nu"I mall I'N
0
'K�)c-j
Print Name:
plc
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Dated: CI -91d G
Title: President
FEB -17-2006 FRI 01:69 PM FAX N0. P. O1
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NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with therovision of MGL c 40 S 54, a condition of Building Permit
at: o�vt t, & is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
60 0 Ob 1 A)A
Fire Department Sign off•
Dumpster Permit
(Location of Facility) /
''gnature of Permit Applicant
Date