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HomeMy WebLinkAboutBuilding Permit #019 - 30 OAKES DRIVE 7/10/2008 r1ORTH BUILDING PERMIT o0tt,�° TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 0/ / Date Received �SSACHU5�� Date Issued: -/Q 6 IMPORTANT: Applicant must complete all items on this page LOCATION 30 ct�s Ifc.J r 1 u-e— �} ` Print PROPERTY OWNER_ #'"CtL) 4ed S�V6 Y-V\ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building <Zne family Addition Two or more family Industrial + No. of units: Commercial Rep r, replacement Assessory Bldg Others: Demolition Other Se Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED:1l _ . t � o� , f- �)&Nin �st-f r A l w i 0 S't-/V c-�U \ Choo, T S CPG( �,jMS �Zep1cl e& +o X ( s A i1-©(C4�iO4S. lit c e 1 Identification Please Type or Print C early) OWNER: Name: �cr U` Phone: Address: ;!0 S Or i vC. /v dckl-re— CONTRACTOR Name: rhC,vx C VM ( &1krr7� J_LC Phone: t,03- nF-9GE3 Address: 106 66� 1 CI D2 rti f� o -30"7 I Supervisor's Construction License: CS U7 ES 1 91 Exp. Date: R'LaaZq2522 Home Improvement Licenser' /3 Q 5`L1 SExp. Date: 3 o o ARCHITECT/ENGINEER A I - 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: $ 30,J000 FEE: $ �� y Check No.: �-( 3 I Receipt No.: 0130 NOTE: Persons contracting wi u st red contractors do not have access to he ara ty fund ignature of Agent/Owner Signature of contract 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 j INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i 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 signature/date 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 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 G ` Location —?o No. �/ 9 Date leo-el NORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ �7s'••• tt�' Building/Frame Permit Fee $ sACIM Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 2 • J V /, Building Inspect6lr/ NORTH TO" of oAndover o No. -mw+Y •4 o dover, Mass., +7 ' 1 a - aLA � O COCMICMEWICK V AERATED P ,�5 S BOARD OF HEALTH PERM -IT T D Food/Kitchen Septic System THIS CERTIFIES THAT...9.0A.r.%10c—.k......... .. ............................. BUILDING INSPECTOR Foundation has permission to erect........................................ buildings on ... 0.........L .115'..... .Ikv...-.......................... Rough to be occupied as... '!!...rV...1? .........if�4_v%l..................�. .................................................... 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 Final 3 / O PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TS Rough ......................... .. ..............................:................................................ 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. CAMARA CUSTOM CARPENTRY i-lx. REG.# 130545 PO Box 1923 LIC.#045604 Salem,NH 03079 (603)898-8683 Proposal PROPOSAL SUBMITTED TO: Paul and Barbara Hedstrom DATE: 6/12/08 PHONE: 978-683-2176 STREET: 30 Oaks Drive CITY-STATE:North Andover,MA JOB NAME:Bathroom Remodel/Kitchen Makeover JOB LOCATION: Same DATE OF PLANS: Plan#5 by Maeve Cullen 6/4/2008 __ JOB PHONE: Same We hereby submit specifications and estimates for: Remodel existing Master Bath and refurbish existing Kitchen to include: • All necessary permits and inspections. • Demolition and disposal of all bathroom fixtures,floors and two walls.Demolition and disposal of kitchen counters,appliances and backsplash. • Necessary rough and finish plumbing to code to update existing plumbing as follows:Kitchen-Install one new undermount kitchen sink with faucet,dishwasher,ice and water line,disposal.Bathroom-one new undermount bathroom lav with faucet,one new toilet,new 5'x3'copper shower pan(included),two shower heads and two valves.All new fixtures and appliances to be installed at existing locations only and are not included. • Necessary rough and finish electrical to code as follows:Kitchen-Install new cook top,oven,dishwasher,refer,disposal with new switch,new under cabinet lighting including adjacent desk area,replace Recessed lights with new pendant type lighting,downdraft.Bathroom-Install new lighting over vanity,install new bathroom light fan combo(included).All new fixtures and appliances to be installed at existing locations only and are not included. • Make necessary framing modifications for new 5'x3'tiled shower stall. • Drywall type wall finish for all new and open walls.Includes moisture resistance sheetrock and waterproof tile backer. • Paint walls and ceiling,bathroom only. • Install necessary underlayment for bathroom floor. • Install new bathroom vanity per plan#5. • Tile bathroom floor,new 5'x3'shower stall including shower ceiling and kitchen backsplash.Patterns,borders,niches and specialty tile are extra.Total Tile Allowance...$7.00 per square ft materials only. • Miscellaneous kitchen cabinet work:install wood panels on new dishwasher and refer.Cut cabinet above refer as necessary.Install cabinet at existing compactor location. • Install all new kitchen appliances. Does not include:Plumbing or electrical fixtures,appliances,cabinets,counters,upgrades to existing mechanical systems,dedicated circuits if necessary. -----_._.._._-----------._._. la- ---_.__----- ------- -----.. - ---- -m------._T. We Propose hereby to furnish materials and labor-complete in accordance with above specifications,for the sum of: Twenty Four Thousand Two Hundred Nineteen dollars($24,219.00). Payments to be made as follows:5%down 30N@ start.30%(&mechanical rough ins 30'/o@ completion of the 5%upon completion All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra J �l charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. 3 Our workers are fully covered by Workman's Compensation Insurance. This proposal maybe withdrawn by us if not apcep. d within 21 ays Authorized Signature Acceptance of Proposal- The above prices,specifications and conditions are satisfactory Sign re and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Signature C Date of Acceptance: V Ir/VO/GV UO 1V.VV 1'Rtl ACORQ CERTIFICATE OF LIABILITY INSURANCE 07/0MlO2008h o7/os/zoos Dum (603)898-6320 FAX (603)898-$269 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION y Insurance Group - Salem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 0 Mair? 5t - Suite 1'03 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ilem' NH 03079 Irr'i Truhn INSURERS AFFORDING COVERAGE NAIC# RED Camara Custom Carpentry, LLC INSURER A; Western World Ins Group 031,32 9 Diana Drive INSURER 8: Travelers Indemnity Co Salem, NH 03079 INSURER C! INSURER D: _ INSURER E: VERAGES iE POLICIES OF INSURANCE L STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING JY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR 4Y PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS$U$JECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH 7LICIES.AGGREGATE LIMITS PtHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A001 TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVEDOMOPOLJCY IEXPIRAYrON LIMITS GENERAL LIABILITY NPP1009140 03/01/2008 03/01009 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 11 is I $ 50,00 CLAIMS MADE 01 D1]OCCUR MED EXP(Any one Perron) $ 5,000 PERSONAL&ADV INJURY $ 1,000.0001 GENERAL AGGREGATE $-2.000.00 GEN'L AGGREGATE LIMIT API)LIES PER: PRODUCTS-COMPIOP AGO $ ].000.00 000,00 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 3 ANY AUYO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per peroon) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per arddem) -- PROPERTY DAMAGE (Per eccldeno GARAGE LIABILJTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC $ AUTO ONLY: AGO_ $ EXCES&UMMMLLA UA6IUTY EACH OCCURRENCE $ OCCUR F CLAIMS MADE AGGREGATE y DEDUCTIBLE $ RETENTION I $ WORKERS COMPENSATION AND RU87355889208 03/24/2008 03/24/2009 Xw0STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERM-XECUYivE E,L.EACH ACCIDENT $ 100,00 OFFICEWMEMBER EXCLUDED? It yea,daedi6e under E.L.DISE"E-EA EMPLOYEE $ 100 00 SPECIAL PROVISIONS below OTHER E.L DISEASE-POLICY LIMIT $ 500 ,000 IRIPTWN OF OPERATIONS!LOCATIONS I Ve"ICLF,51 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 31IFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Paul & Barbara Hedstrom BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 30 Oaks Drive OFA KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVE& N. Andover, MA A D PRE 3RD 25(200910$) QACORD CORPORATION igen 0 0 OD N \\\ GJ n z m z 00 i M - �Pla�Q ow�11 a cocl11S 061Y II E'tS ({ crCc q'� S}' �� Note:This drawing is an artistic MAEVE CUILEN CID Designed: 6/4/2008 j F x P� interpretation of the gcncra!Appearance of JACKSON Printed. 6/4/2008 �o j 1 o Cat the design. It is not meant to be an exact KITCHEN C�,j hG���� rendition. DESIGNS N�,,J fi► I-ed s 6vf- sill /gi n�� The Commonwealth of Massachusetts r Department of Industrial Accidents ' ~ha� '> Office of Investigations ...., 600 Washington Street Boston, MA 02111 www.nzass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): rulsi>vl CQ026V LL '(L Address:z 60)� Vj a'3 City/State/Zip: SC e�J ly 4 U � �7 Phone #: Coo3 E- g� Are you an employer?Check the appropriate box: Type of project(required): 1.WL.I am a employer withA P`r 4. Tam a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ 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.❑ Roof repairs insurance required.] t employees. [No workers' I3.❑ Other comp. insurance required.] +Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. numeowners who subniit.tiiis affidavit indicating ti-icy arc 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: 7/k/_e L,,,(—s 1 /)d e(m i �y ro, Policy#or Self-ins. Lie. #:_( � ]{ y 0 a p Expiration Date:_2 ? I Job Site Address: ?U (D: ICS f n U 2 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 Me pa. s and penalties of perjury that the information provided above is true and correct Si nature: Date: U v Phone#: - Official use only. Do not write in this area,to be completed by city or town gfficial. 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-contractors)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 burn 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 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05. Fax# 617-727-7749 www.mass.gov/dia