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HomeMy WebLinkAboutBuilding Permit #1096-15 - 3 Village Green 6/24/2015 1 NORTh BUILDING PERMIT 0F�t,eD "+o TOWN OF NORTH ANDOVER 2 hF .46�6 APPLICATION FOR PLAN EXAMINATION Y �j �A��D m" Permit No#: t '�� Date Received 7RA�a1rED �Y CHUS�� Date Issued: �SSA IMPORTANT:Applicant must complete all items on this page &4�6 LOCATION Arint PROPERTY OWNER �/�/ f\ Print 100 Year Structure yes(noMAP C O�PARCEL: ZONING DISTRICT: Historic District yenoMachine Shop Village yeo TYPE OF IMPROVEMENT PROPOSED USE ResiSkntial Non- Residential ❑ New Building Erbne family ❑Addition ❑Two or more family ❑ Industrial ❑Wation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic p WeIL gkFloodpla n Wetlands [Ji Watershedy District Water/Sewer _ DE PTION OF WORK TO BE PERFORMEQ: Identification- Please T pe or Print Clearly OWNER: Name: APhone: Z Address: v`�J i � N ! 1/0' diek ` �. /' II r Contractor Name: Phone: Z)bl ,,fZ" _/��z Email: Address: Supervisor's Construction License: —oz 12V Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� FEE: $ Check No.: 7� 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o tuar n un Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swfi-nming 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 o U FORM PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS i 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 `0onservation Decision: Comments Water& Sewer Connection/ Permit DPW Town Engineer: Signature: Located 384 Osgood Street PART'S MERIT 6JTernD fx� ,�r I FIRE DE A.R�4 .I� p . umpster�on s to ye 1-1114- 'Ino C tt d at#1P24Mairi Sty ee t, "`R Fx,ire aa 14, tune%dam v - # 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 Call Email DateTime Contact Name Doc.Building Permit Revised 2014 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 4. 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application Certified Surveyed Plot Plan 4. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 NORTH Town of _ ? a. Andover h ver, Mass, (A.-JL COC NIC Nl WICK 7 RATEO ►.P ,`�5 S u BOARD OF HEALTH s Food/Kitchen.PERMIT T LD " - , Septic System 'CHIS CERTIFIES THAT f-.10......"i ' .` 4� BUILDING INSPECTOR .... ............ has permission to erect ....... ................. building&on ...�......��.. . ,.. � .. Foundation Rough tobe occupied as ................ . . .. Keymjel.... ........................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final 0n file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and C'01struction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST S Rough Service .... ....... ................................................ Final BUILDING INSPECTOR I GASINSPECTOR Occupancy Permit Required to Occupy Buildine Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Kece raved CO -IU - It) KTM Properties,LLC 25 Spaulding Rd Suite 17-2 Fremont,NW 03044 Phone:(603) 895=0400 Fax 603 253-2600 AService Provider ford ( ) Company Representative; Customer Info: Dana Cook Job#:N/A(80406176 Maccorkle) (603)921-1507 3480 Mnccorkic,Brian&Barbara Dana@ktmproperties.com 3 Village Green Dr, North Andover,MA,01845 (978)270-1798-mobile Demo Description Permit Cost of permit,plans and fees Lead Test Lead Test for homes built prior to 1978. Interior Protection Protection of floors,walls and doors,and dust,abatement and clean up. Debris Removal Construction debris removal and haul away Appliance Removal Remove Range,Microwave.Hood,Dishwasher and Refrigerator.Relocate from space. Removal of Countertops Remove laminate,countertops. Removal of Cabinetry Remove walls,base and tall cabinets. Cardboard Removal Remove cardboard and cabinetry debris. Demo total:$2,250.00 Plumbing Description Temp Sink Install/hookup temporary sink,faucet: includes 48"temporary top,sink, faucet,strainer baskets Connect to undermount Connect to under mount or integral bowl sink w/faucet,disposal:within 3"of existing location.(Installer provides braided supply lines,shut off valves,piping and traps as needed) Cut/Cap Cut&Cap plumbing for new cabinet installation Dishwasher plumb in dishwasher next to sink Permits Pull permit,rough&final inspections-includes permit cost Gas Appliance Prep Install basic gas stove without conversion kit. (Existing stove natural gas to new natural gas [stove) Plumbing total:$2,040.00 Electrical Description Receptacle/switch replacement Replace existing receptacle/switch-includes upgrade to GFCI(installer provides) Outlet tied to existing New outlet tied to existing circuit(installer provides components) Appliance Prep Electric appliance preparation(installer provides components) Dishwasher Wire dishwasher with existing power present add cord and box with outlette Microwave Wire microwave and install box with outlet on existing power Arch Fault Breakers Supply and install arch fault breakers as required by code Electrical Permit Supply electrical permit and inspections Electrical total: $1,920.00_ Cabinets Description Design Dated 6-10-15 Installation based on design dated 6-10-15 Wall Cabinets Install Wall Cabinets Base Cabinets Install Base Cabinets all Cabinets Install Tall Cabinets Wall/Base Fillers Install wall/base fillers Knobs/Pulls Knobs/Pulls Installation Base End Panel Install base end panel Crown Molding Install one piece crown molding not to ceiling. Adjust Base Cabinets Adjust Base Cabinets-shim, scribe raise block install plywood to accommodate flooring. Scribe Molding Install scribe molding Cutlery Divider Install cutlery divider Cabinets total: $1,668.00 Appliances Description Dishwasher Install Dishwasher Gas Range Install free standing gas range Microwave Install over the range microwave Refrigerator Install refrigerator Appliances total: $1,100.00 Total for all sections:$8,978.00 Total: $8,978.00 t` - q,,022 ad 7_rk- roP The above signature does not commit either party to the sale of the above listed items.The signature represents a full understanding of the price and scope of labor for the categories listed only. Prices are subject to change based on the final design,layout of the kitchen and unforeseen conditions. We CANNOT start the work at your job until the necessary permits have been procured and a signed"{f%at to .Expect Sheet"on file. Please contact us should you need a copy of this. REMINDERS:this installation quote is based on normal working hours 7am4pm,unless other arrangements have been made prior with KTM. Plumbing&Electrical work is based on 2 trips-one rough and one finish;finish will occur after countertops. Code or local inspector requirements not mentioned in this estimate will be an additional cost. Cabinets must be delivered in kitchen area or adjacent space on same level,which must have heat. If cabinets have to be moved by KTM, additional fees will be charged. Countertop templates require you to be onsite,no exceptions! A /J 7 IIS 7,X�A'l G~ / Co�tul�r ized Signature Date ustomc ignature 1bat6 Customer Signature Date This estimate was last edited by Dana Cook((603) 921-1.507,Dana@ktmproperties.com)on June 10, 2015.The estimate may be withdrawn if not accepted within days. Cabinets Description Design Dated 6-10-15 Installation based on design dated 6-10-15 Wall.Cabinets Install Wall Cabinets Base Cabinets Install`Base Cabinets Tall Cabinets Install Tall Cabinets Wall/BaseFillers Install wall/base fillers Knobs/Pulls Knobs/Pulls Installation Base End Panel Install base end panel Crown Molding Install one piece crown molding not to ceiling. Adjust.Base Cabinets Adjust Base Cabinets-shim,scribe,raise,block,install plywood to accommodate flooring.. Scribe Molding Install scribe molding. Cutlery Divider Install cutlery divider Cabinets total: $1,668.00 Appliances Description Dishwasher.Install Dishwasher Gas Range Install free standing gas range Microwave Install over.the range microwave Refrigerator Install refrigerator Appliances total:$1.,100.00 Total for all sections:$8,978.00 - Total: $8,978.00 q,©zz 1� rV The above signature does not commit either party to the sale of the above listed itcros.'rhe signature represents a full understanding of the price and scope of labor for the categories listed only. Pricesare subject to change based on the final design,layout of the kitchen and unforeseen conditions. We CANNOT start the work atyour job until the necessary permits have been procured and a signed"What to Expect Sheet"on file. Please contact us should you need atopy of this. REMINDERS:this installation quote is based on normal working hours 7arn-4pm,unless other arrangements have been madeg rior with KTM. Plumbing&Electrical work is based on 2 trips-one tough and P � P g one finish;finish will occur after countertops. Code or local inspector requirements not:mentioned in this estimate will bean additional cost. Cabinets must be delivered in kitchen area or adjacent space on same:level,which must have heat. if cabinets have to be moved by KTM, additional fees will be charged, Countertop templates require you to be onsite,no exceptions! r Co uth sized Signature Date uston il;nature a p Customer Signature Date This estimate was last edited by Dana Cook((603)921-1507,Dana ktmproperties.com).on June 10, 2015. The estimate maybe withdrawn if not accepted within days. J J �V)_. 14N� N FVV2130L M120L "W3012.BUTT Budd WF-A1230 off floor 1t to -,-- -.. N ,.-" create a base cabinet ;6 14 P 1 r •� N N oe.aas.30-2 l �y `r ,Y Any measurement provided by NHx ., 27;" ;;' KTM Propertas are for • Caging Height 88 br8" design purposes only, it any a� Installation is to be completed by anyone other than KTM Properties. Vinyl Tde Floor l j (including the .n homeowner)verification of measurements and fit of design i C g are the responsibility of that installer. Mti t' o KTM Properties will not be responsible for any labor or rn material costs incurred it Install Is not done by KTM Properties. C N ' f '(�' Sb' "d. Customer taking Trash Cabinet CUSTOMER NAME: Brian MacCorkie because irs free CUSTOMER PHONE: 978-270.1798 I STORE: 3480 Vy}T1E? a , ORDER: 513066 MEASURE TYPE: Home Depot I CEILING HEIGHT: 89 5/8" SOFFIT HEIGHT- NONE TOP CABINET ALIGN: 851/4" 1 CABINET MANUFACTURER: American Woodmark DOOR NAME/OVERLAY: Portland Maple Square i WOOD: Maple I ° ' FINISH:Spice SOX CONSTRUCTION: Standard I t TOP MOLDING: Crown Molding BOTTOM MOLDING: NONE .-� EXPOSED END APPLICATION:Plywood Ends HARDWARE: KNOBS: Customer to Select PULLS: Customer to Select CTOP MATERIAL: Conan COLOR:Sandstone SOFT:23 EDGE PROFILE:Roundover LN FT EDGE: 13.75 All dimensions sire designations This is an original design and must rDesigned: 6/12/2015 given are subject to verification on not be released or copied unless Printed: 6/17/2015 job site and adjustment to tit job applicable fee has been paid or job conditions. f order placed. E (E i G SA2 All Drawing#; i No Scale. I -\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia _ ontractors/Electricians/Plumbers. Workers'Compensation Insurance Affidavit:Builders/C PERMITTIN G AUTHORITY.TO BE FILED WITH THE . A licant Information Please Print Le ibly Name(Business/Organization/Individual): Address: City/State/Zip: • ��� .Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑[am a employer with employees(full and/or part-time).' 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9 ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions p rietors with no employees. 12.[]Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 � f repairs "These sub-contractors have employees and have workers'comp.insurance. 14. Other litd 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. es. o workers'comp.insurance required.] e P and we have no employees.[N 152,§1(4), P '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 sbeet 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. /y Insurance Company Name:_' V Policy r or Self-ins.Lic.n: �/ � Expiration Date: Ah Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ((J� Failure to secure coverage as required ed under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 i aad,'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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi and naltie erjury that the information:provided above is true and correct Sio-na Date: I Phone#: i iOfficial use only. Do riot write in this area,to be completed by city or town official. City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Toarn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: " Phone n: i t I { I DATE I IAWDINYYY'1') ACORD CERTIFICATE OF LIABILITY INSURANCE 0212412015 'j;..THIS CS ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS r. GE AF CERTIFBY THE POLICIES ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR CT BRl THE THE SSU NGF INSURER(S),AUTHORIZED j4 TE OF INSURANCE DOES NOT CONSTITUTE A CONTRA BELOW. THIS CERTIFICATE `JJ RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to ndtUons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the the terms and co cerHflcate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: MARSH USA.INC. PHONE A C No Exll TWOAWANCE CENTER E-MAIL 3550 L ENOX ROAD,SUITE 2400 ADDRESS: ATLANTA,GA 30326 INSURE ELAFFORDEiNG OVERAGE NAIC A fast Insuran 26387 100492-Hom8C-GAW-15-ib INSURER A:Steadfast 16535 Zurich Ame cen Insu ance Co INSURED INSURER B. 23841 THD AT-HOME SERVICES,INC. New Hampshire Ins Co D3A THE HOfdE DEPOT AT-HOME SERVICES INSURER C 2690 CUMBERLAND PAWNlAY,SUITE 300 INSURER D Iiihoi,s National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685-09 REVISION NUMBER:7 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTYJTHSTANDING 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 SUBIECT TO ALL4VE TERMS. EXCLUSION'S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD L UBR POLICY EFF POLICY EXP LIMITS LTR TYPE Or'INSURANCE POLICY NUMBER MMJDD IMI,VDD 9,000,OOQ A GENERAL LIABILITY GI-0485714-05 031012015 03101(1016 EACH OCCURRENCE s X COM.I,!ERCIAL GENERAL LIABILITY PREMISES Ea oxvrre^� S 1,000,DOO EXCLUDED ClAIMS�LADE LIMITS OF POLICY XS� OCCUR � MED EXP(Any one person) S OF SIR:5W.PER OCC PERSONAL E ADV INJURY I s 9'003'000 GENERAL AGGREGATE S 9,000,000 PRODUCTS-COMP/OP AGG S 9,000,000 GEN'LAGGR=GATE LIMIT APPIJES PER: X7S PRO. POLICY - n.LOC COMBINED SINGLE UMIT 1,000,000 B AUTOMOBILE LIABILITY' BAP 2?3886 12 031011201503!012016 Ea acooent s BODILY INJURY(Per person) I S X ANY AUTO ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMC, BODILY INJURY(Per aCddenq S AUTOS AUTOS PROPERTY DAMAGE S NON-OWNED Pars- ON HIREDAUTOS AUTOS S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S S DED I I P.ETE N710NSVJ-_STATU- OTH- C WORKERS COMPENSATION WCD17731493 (AOS) 03/0112015 031012016 X C AND EMPLOYERS'LIABIUTY a 1 N WCOIT731495 AK,KY,NH,NJ, 03/012015 031012016 S 1,000.000 ANY PROPRIETORIPARTNER/EXECUTIVE❑ ( E.L EACH ACCIDENT I D OFFICER)MEMBER EXCLUDED? N NIA WC017731494(FL) 03/012015 03/072016 E.L.DISEASE-EA EMPLOYEES S 1' ' (Mandatory In NH) 1,000,000 If Yes.descnbe under Conitnued on Additional Page E,L DISFAsE-POLICY LIMIT S DESCRIPTION OF OPERATIONS be!u.v DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Alla Ch ACORD 101,Additional Remarxs Schedule,if more space Is regWmd) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES T-H= EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACS FERRY ROAD ACCORDANCE NCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIGD REPRESENTATTVE of Marsh USA Inc. I Manashi MukherjeeO`„`�` ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I 3a;>,..3::�:c�;�,e,F:artr:•r..r o`rua;;�Safaty nu 6'Z FIRST ST t' 'AM DFUFJ�MA pi 0511812016 1 F-ermrt Services 4U1 'L40-Z000 P•2 C4iY'�2�l1P�.C�r.� 1 ' Office of Consumer Affairs and Business Regulation 10 Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor'Registration Registration: 126893 Type: Supplement Card Expiration: Mt2016 THD AT HOME SERVICES, INC. RICHARD TROIA ---� 2690 CUMBERLAND PARKWAY SUITE 300 . . -- ATLANTA, GA 30339 - Update Address and return card.N12rk.reason for change. SCAT Co x-0-h _ Address �J Renewal ..mplo}r.�_c:: J :.crstCnrc. a. _;_ i0fricc of Cunsurutr AMirs&Business Rtgulation License or registration valid for individul use only before the expiration date. ff found return to: DOME IMPROVEMENT CONTRACTOR p C 5 Office of Consurner Affairs and Business Regulation Registration: .126993 Type 10 Park Plaza-Suite S I70 Expiration:. 81312016 . Supplement Card P Boston,MA 02I16 THD AT HOME SERVICES,INC. THE HOME DEPOT AT'AOME SERVICES RICHARD TR01A 2690 CUMBERLAND PARKWAYS X'FL5 �.,GA30339 Undersecretary Not validwi out signature f Location i 1��2-�PQv- �- e— No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ ■ Building/Frame Permit Fee r Foundation Permit Fee $�_ Other Permit Fee $ TOTAL $ Check# i 2658 Building Inspector