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HomeMy WebLinkAboutBuilding Permit #536-14 - 291 MASSACHUSETTS AVENUE 1/13/2014Permit N0:,7 � — Date Issued: /f q BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION „ Date Received TYPE OF IMPROVEM ❑ New Building ❑ Addition I<Iteration repair, replacement ❑ Demolition PROPOSED USE Residential One family ❑ Two or more family I Industriai No. of units: ❑ Commercial ❑ Assessory Bldg ❑ Others: ❑ Other Septic o Well Q Floodplain q Wetlands,,, ❑ Watershed District C-later/Sewer kmg�41',' &,Z4�e f�,e. C.) k;,_e_Ai C V,,v, 4� p.7� G✓ir�da�.✓ /�S7a /�a�h Oc�s d/, wi,��av✓ �r� �hc �f,GGL fi•r//. /l,eGr_ �l9� 544ri� Identification Please Type or Print Clearly) OWNER: Name: Phone:'M(- Address: vZ% 44_fS eve ova CONTRACTOR Narne: lahone7- .W Address: Supervisor's Construction License:. Exp. Date - Home Improvement License:Exp. Date: 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: $ 00 2 O FEE: $ & - Check No.: Q 1.3 Receipt No.: NOTE: Persons contractinw�ith ;unregist ed contractors do not have access tot a guaranty fund �n:-•--�---- T1WN`0F NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION I. Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page TYPE OF IMPROVEMENT, PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑ Two or more family ❑ Industrial ❑ Addition No. of units: ❑ Commercial ❑ Alteration ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition Septic ❑Well ❑ Other 0 Floodplain ❑ Wetlands. - - E! Watershed District Water/Sewer WnPW -rn RF PFRFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: A Address: CONTRACTOR Name:. - Phone - Address: Supervisor's. Construction License:. _ Exp. Date Home Improvement License:..- 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted Plans Waived ❑ Certified Plot R. n.[�- Stamped Plans ❑ - -- -_. - ---- - t� Building Department The fol ,3wing is =a -Ust of h6 required.forms to be filled out for the. appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o 13!.Ading Permit Application Li Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C'.S.L Licenses L3 Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster. permits require sign off from Fire -Department prior to issuance of Bldg Permit Addition Or Decks L3 Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract U Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) o 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 a Workers Comp Affidavit a 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 o 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Buili,ing Permit Revised 2012 L Plans Submitted ❑ Plans Waived,[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE -OR SEWERAGEDiSP:OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑:..-..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 & DEVELOPMENTS ❑ ...- . ❑ COMME 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 Water &Sewer Connection/Signature & Date Driveway Permit DPW Tow;! Engineer: Signature: FIRE M= FI Located at ,1 2.1 Fire.Departmey qM-M.ENTSt Located 384 Us ood Street r NTz "Ternp:DumpstEr on site yes not. . Street ;.�-"-t+a'�xS'�,. . x Vit, 72y r��y.,.� ��?'!y� L'* Fer w .t e.: Sc-4�.,w�� �, � �y .. '.r�ttkr•��1+ `� ��' Y' "At};;s ,7 a;%�'t.- ' }trl�: �x'#�� ,� �i,?*tX�aY';`ii '�," i"4'?'z' i%P:�ft '*L �t�itt +yk� ,+o. "� * t °.•4n ri. � �, rt�,'�,f»•�•j-' ,�.�...3- r re - *�4.,���'"���W�+;�;h�i �$�'r,�b,''i�l, l.,'�` aY *.+ld ar;•v ;v''� ,., .' a1. � �-�'"•'.' Y"„�', F �'i"�i.. �_'� �z ="Dimension - Number of Stories:_ .Total land area, sq. ft.: R Total square feet of floor area, based on Exterior dimensions — 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.$10041000:fine NOTES and DATA - (For department use El Notified for pickup - Date Doe.Building Permit Revised 2010 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 54,000.00 m $ - $ 648.00 Plumbing Fee $ 81.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 81.00 Total fees collected $ 910.00 291 Mass Avenue 536-14 on 1/13/2014 Kitchen Remodel Locatio,Q'? My :k.7 AV No. 5 4 # f Date f s � � Check # R ! 40-- 27219 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee ; $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector CERTIFICATE OF LIABILITY INSURANCE 1/10/2014D/YYYY> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER M P ROBERTS INS AGCY INC 1060 Osgood Street North Andover, MA 01845 ADDL INSD CONTACT NAME: PHONNo, Ext: (978)683-8073 Svc, No): (978) 683-3147 A ADAIL DRESS: sandi@mprobertsinsurance.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: NORFOLK & DEDHAM INSURED MICHAEL GOODWIN 7 HOLT ROAD EPPING, NH 03042 X COMMERCIAL GENERAL LIABILITY INSURER B: AIM MUTUAL INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUB WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS -MADE u OCCUR MIE,I PREMISES (Ea occurrence) $ 50,000 MED EXP (Anyone person) $ 5,000 A R0714141 04/27/13 04/27/14 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 2,000,000 PRO-JECT LOC ri POLICY 0 PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY$ Ea accident BODILY INJURY (Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS accident Per BODILY INJURY $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICERIMEMBER (Mandatory in EXCLUDED? N/A VWC10060151752013 02/15/13 02/15/14 X STATUTE ER EACH ACCIDENT $ 500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attachedif more space is required) AIM MUTUAL WILL SEND YOU THE WORKERS COMPENSATION CERTIFICATE DIRECTLY CERTIFICATE HOLDER CANCELLATION © 1988-2013 ACORD CORPORATION. All rights reserved. ACORD25 (2013/04) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET AUTHORIZED REPRESENT T E NORTH ANDOVER MA 01845 FAX: 978-688-9542 y or? tof © 1988-2013 ACORD CORPORATION. All rights reserved. ACORD25 (2013/04) The ACORD name and logo are registered marks of ACORD m m m m y m CO) m CD O Z m cn0 X 0 1 m O m x -v 55 cn z a� 0 cn O o� 3 �D N O O O O W Q co CD co _rt O 2. cn 3 rt o0� N =: < "0 CO) cD, o n Q rn c Cr)y. -i co =u�fl;Co Oo—CL 0 m W D• � H O —1 CD cD 2 0 mDI rt co _� O N, O O O rt rt SID n S �D : CD •a -q O O O C cQ vj rt • O y ooh a •� rt DCD i .L co �. CD O CD CD CL a *< CD 4.- FL. art:. l'D n � O � 0 rt rt C = m 7 CD N C N N rt 3 ? D CD CD S1 � 0 ID su o CL . L X, (D (n m - o Z co C :3°—' m= T O c aa T °—' N O 2 A (D ;a O S T °—' O ago S TI j °—' n =r 3 3 D .Z7 O M S T O = O_ d =' N (D a. n (CA n T O a \ n m m V D m -� > y -Ai O m m A m �-4 0 V C W V m 0 : C p Z m O M 3 (D W D D x Iw 41 ®s �lq" I' V' 130 Centre St. Box C-1 Danvers, Ma. 01923 Carl & Donna Backman 291 Mass Ave. North Andover, Ma. Project Description This estimate is for the following work. Kitchen remodel Scope of work; We will apply for the proper town building permits. The existing appliances and fixtures will be disconnected and removed. All the cabinets and countertops will be removed. Estimate 978-423-8463 The two walls that the cabinets are on and the ceiling will be stripped to access the areas for wiring and window framing. We will frame and install a new 18" Octagon window in the back hallway. A new Anderson window will be installed in the kitchen. We will install a Therma-tru fiberglass 9 -lite door unit in the back door, it will be a full -view with internal blinds. The exterior siding will patched in. We will install insulation on the exterior wall. The ceiling and the two walls will be blueboarded and veneer plastered. We will level out the floor in the area near the spare room, creating a small step into the room. Signature mfgoodwincompany@gmail.com Page 1 Mass.CSL 4081670 Mass. HIC #105029 Total 11/5/2013 Total 34,969.00 130 Centre St. Box C-1 Danvers, Ma. 01923 Carl & Donna Backman 291 Mass Ave. North Andover, Ma. Estimate 978-423-8463 Project Description The entire floor will be gone over with 1/4" luan to prep for a vinyl inlaid floor. All the cabinets will be installed according to the plans submitted by Bravo Kitchen. We will install new pine window casings and door casing around the new back door. The walls, ceiling, trim and doors will be primed and painted with Sherwin Williams kitchen and Bath paint. Plumbing; Our plumber rework the plumbing supplies for the new sink location, rework the venting for the sink to go up the right side of the window, install new shut -offs, install the sink, dishwasher, garbage disposal, gas stove and refrigerator water line. Electrical; Our electrician will re -work the electrical for the layout to bring it up to code. He will install 9 recess lights in the ceiling, 2 pendant lights, and Island GFI receptacle, a receptacle for the wine refrigerator and microwave hood, all the switches and dimmer switches. All the appliances will be wired and installed. We will upgrade the electrical panel to a larger panel or add a subpanel. Total Signature mfgoodwincompany@gmail.com Page 2 Mass.CSL #081670 Mass. HIC #105029 11/5/2013 Total 130 Centre St. Box C-1 Danvers, Ma. 01923 Carl & Donna Backman 291 Mass Ave. North Andover, Ma. Project Description All rubbish will be removed from the premises. References are proudly given upon request. Town permit fees are additional and will be billed separately, An allowance of $5500.00 is given for electrical. An allowance of $650.00 is given for the flooring material. The work will begin the week of January 13 2014 All work shall be completed in a workmanlike manner according to standard business practices. Any deviation from the above specifications involving additional work and materials shall be an additional charge. Total estimate: $34,969.00 Payment Schedule: A deposit of $ 10,500.00 is due upon starting. A payment of $ 10,400.00 is due upon Completion of plastering. A payment of $ 10,400.00 is due upon major completion of cabinetry and trim installation. Balance of $ 2669.00 is due upon completion. Signature mfgoodwincompany@gmail.com Page 3 Mass.CSL #081670 Mass. HIC #105029 Estimate 978-423-8463 Total 11/5/2013 Total 130 Centre St. Box C-1 Danvers, Ma. 01923 Carl & Donna Backman 291 Mass Ave. North Andover, Ma. Project Description Acceptance of Proposal: This proposal may withdrawn by either party within 48 hours of signing upon written notice. 41 Contractor: Date: Homeowner: 1 Date:-/-' SJ�� Signature mfgoodwincompany@gmail.com Page 4 Mass.CSL #081670 Mass. HIC #105029 Estimate 978-423-8463 Total 11/5/2013 Total 130 Centre St. Box C-1 Danvers, Ma. 01923 Carl & Donna Backman 291 Mass Ave. North Andover, Ma. Project Description Signature mfgoodwincompany@gmail.com Page 5 Mass.CSL #081670 Mass. HIC #105029 Estimate 978-423-8463 11/5/2013 Total Total $34,969.00 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 7 Print Form A� `'" www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): MF Goodwin Co. Address:? Holt Rd. -Epping MH 03042 Phone #:978-423-8463 Are you an employer? Check the appropriate box: 1. ❑✓ I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I 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. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t employees and have workers' comp. insurance.1 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *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 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: AIM Mutual Ins Policy # or Self -ins. Lic. #:VWC 601517501 Expiration Date:2-15-14 Job Site Address: 291 Mass Ave City/State/Zip: N. Andover, Ma 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 certi under the gains and enalties o EEUua that the in ormation provided above is true and correct gionatnre---------_----------- -__- Tlata /-`C�-/`7S Phone #:978-423-8463 Oficial 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 #• 9 x> Massachusetts - Department of public Safety Board of Building Regulations and Standards Construction Supervisor _icense: CS -081670 MICHAEL GOO�DWIN 7 HOLT RD Epping NH 03041 =Piration Commissioner 08/08/2015 t ��e tCarrcn2c�rcctea�f� o/�.'�Ccc4:;nc�crsnit ; _ Office of Consumer Affairs & Busifiess Regulation License or registration valid for individul use -only Fly iiOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: — Registration:.105029 Type: Office of Consumer Affairs and Business Regulation —Expiration— 7/96/2014 Individual 10 Park Plaza - Suite 5170 Boston, MA 02116 MICHAEL F. GOODWIN.JR Michael Goodwin Jr. j 7 HOLT.RD. EPPING, NH 03042 �— Undersecretary Not valid without signature Oct 25 2013 12:13PM Bravo Kitchens,Inc. 781 662 0869 p.1 -l''d 6980 299 TBG 'oujlsua4ojTA onejg Wdbi:21 Ei02 92 400 I MINIMUM r. - 17 1 rau ra r-:rr_. j• 1 n -l''d 6980 299 TBG 'oujlsua4ojTA onejg Wdbi:21 Ei02 92 400 E'd 6980 299 T6G •Ouj°sua4D'4iA oneJH WdET:21 6102 92 400 2'd 6980 299 TBG •Oul'suay0lTA oneuH Wd£T:21 6102 92 100