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HomeMy WebLinkAboutBuilding Permit #558-11 - 300 PLEASANT STREET 2/10/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IlVIPORTANT:A licant must complete aII items on this age 1 LOCATION 360 s �� Pr t PROPERTY OWNER, Act«���Q �� � ✓��/� - —� Print MAP NO:'PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building 3,10ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Aepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other Sep p Y",]li ` 01 loodplau�} t®Wetlands? I ',®�Watersheistr'ict ; � a- f i ter/S ewer DESCRIPTION OF WORK TO BE PERFORMED: Z2 le, Ezelc .4Uz 0-4 y Identifi ahon Please Type or Print C} arly) OWNER: Name: e9 C6 IJ-,e iy /i Phone: Address: c3oo /��S' •c� _ U/2 a p/L CONTRACTOR Name: i Phone: 97�-2s'�P C1A��' Address: "64,1 2i9 C-� Supervisor's Construction Licenser S 10lUV7-2 Exp. Date: Home Improvement License: 1 ��7� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF`THE TOTAL ESTIMATED COST B SED ON$925.00 PER S.F. I � aq ! ID Total Project Cost: $ :� � / FEE: $ caWL . 52 ti t No.:Receipt Check No.: p NOT Persons c my ti with unregistered contractors do not have access to the Panty fund - t/Owner:: :;- ..: .:. :_ Signa __. - = i .77 re:of�Agen _.__ :__ -.: ..� _..:::: a. . . .. - -- ---. ure_ofcontrac__r>� �. ..- � ;�- i i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGEDISPOSA Public Sewer L�,/ TanningwassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY - INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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 Water & Sewer Conn ectl®,0/Signature&Date Driveway Permit DPW Town Engineer: Signature: Lodatd `-384 Os goo Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Deparlanent 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 o Building Permit Application ❑ Certified ed Surve ed Plot Plan n ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses D . 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 g 10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals zat the appeal e pp period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording • lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi F Location„�� 4 No. Date o?o.NOoT•,h�c TOWN OF NORTH ANDOVER F w E A Certificate of Occupancy $ ' s,cHUsEtt' Building/Frame Permit Fee $ p i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # J 238L6 Building Inspector NORTH '9 Tovm of 6Andover No. 5�d y 'Zv dover, Mass., dn2 —/ O COCMICHEWICK V SRATED.P �Cy BOARD OF HEALTH Food/Kitchen Septic System -PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT........�..... CI!L� c>LQ'�'"-�'�.................0 .5....vc`' e".r. ..................... """""""" Foundation has permission to erect.....:.......... ..... buildings on ..-........ Rough .... .. ...V�..... ...0 4V"_ 77 ......... . t0 be occupied.as ............... - - Chimney .... �- ............. ..... ........ ...................................... ......................... ............. Ch e 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 offthe Zoning or Building Regulations Voids this Permit. Rough Final _ PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ST TS ELECTRICAL INSPECTOR 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. The Commonwealth of Massachusetts c Department oflndustrialAccidents _= a In Office of Investigations � 1 * l" } U., r � 600 Washington Street ; e 1t Boston,MA 02111 fy www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information . Please PrinfLe ibl Name(Business/Organization/Individual): > r Address: / p City/State/Zip=* C6 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I ama' employer with 4. ❑ I am a general contractor and I 6. ❑New construction tnployees(full and/or part-time).* have hired the sub-contractors 2. I airs a sole proprietor or partner- listed on the attached sheet. # 7. Remodeling ship and have no employees These sub-contractors have S. ❑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 10.0 Electrical repairs or additions 3.❑ I ain a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp, c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] 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 anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid 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: 2111// 2,11 CYF'i Policy#or Self-ins.Lie.#: Vfil C60f/O'� 3(a Z rX1,Q Expiration Date: Job Site Address: ,�/.-4�l�c/�� / City/State/Zip 4124 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 maybe forwarded to the Office of Investigations of the DIA for insurance*coverage verification. I do hereby 11 u the in anil penalties ofpeijury that the information provided abo a is tr a and cot`rect.' F Si natur6: p Date: / Phone 4: Official use only. Do not write in this area,to be completed by city or town offlcia[. 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 numbers)along with theircertificates) 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. [fan LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confinnation 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 Iaw or ifyou 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 pennit/lieense number which will be used as a reference number. In addition,an applicant that must submit multiple�-permitllicense 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. Anew 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 yo please do not hesitate to give us a call. u in advance for your cooperation and should you have any questions, The Department's address,telephone and fax number: The Commonwealth of Massachusetts Dgpartrnmt of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MAA 02111 Tel.#617-7274900 ext 406 or 1-877-M A.SSAFB Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia I Bob's Home Improvements Bathroom&Kitchen Remodeling Ceramic Tile, Wood Floors, Painting& Wallpaper, Additions Zt�ns,0all; Jim &Jackie Rosenvanilli 300 Pleasant St. North Andover RE: Kitchen Replace existing kitchen door with same style door and retrim if necessary. Install new cabinets as per layout from Norfolk factory direct. Texture sand finish on existing flat finishing ceiling. Skim coat existing walls where necessary before installing cabinets. Paint kitchen and hallway to color chosen by customer (paint purchased by contractor). Install bead board paneling% ways on wall along side of existing door. Install under cabinet heat exchange to replace section of baseboard heat under window. Remove existing window-prep for wall cabinets finish porch side of wall to match existing paneling as close as possible. Add hardibacker board over subfloor to prep for new tile retile kitchen floor. Electrical- • Install old work recessed can lighting as needed. • Install any additional outlets over counter if needed per code. • Change existing plug sockets. • Reinstall microwave • Reinstall existing under cabinet lighting • Take light fixture in dining room area and install over island. Plumbing- • All necessary plumbing to include connection of sink drain and fixtures. • Connect water line for fridge and dishwater. a;•. ylassach+(,sctts- Depat•tmcnt of Public Safcl 1 Board of Suildin�� Rclaulations and Standa4ds. ! Construction Supervisor License _ License: S 90047 ROBERT D DROUIN T 250 SAWMILL DRIVE DRACUT, MA 01626 Expiration: 9/30!2012 Tr#: 1963, ,("ommissiuncr . Office of Consumer Affairs& psiness ?egula"tion .19 HOME IMPROVEMENT CONTRACTOR Registratio:--`-•4784$ Tr#- 287`16 E piratwn 8115/201.1 , - Type i :DBA BOB'S HOME IMPROVEMENTS ROBERT DROUIPJ 250 SAWMILL DRIVE . DRA CUT,MA 61826' Undersecretary I i • Install new garbage disposal (provided by customer) • Add new gas line for new stove. TOTAL PRICE: $8380.00 Method of Payment • $500.00 due upon agreement • $2000.00 due @ start • $2000.00 due after ceiling textured and floor prepped. • $2000.00 due after rough electrical and cabinets installed. • Balance due @ completion Acceptance of Proposal I hereby acknowledge and accept the price and terms for the above-mentioned work. I also accept and agree to pay all court costs, legal fees, due interest and lost time accrued by default payment. Customer Signature Contractor Signature HIC# 147848 CS#090047 k ;y To allow for slalla.og UP w .t V,7the fOor11 the loft c cz,.0 moldtng for this cw7rfwt trill be shwo" `.It•' 1 { Tlus owti Ml eif Evan U0ik ease The decorative side tammal fall cabinet will need to be mrd pttrtela will be a total of 3 cfaor ptrrlats bail!up by GC ctt elle to a;tgn s+ t y taxi wftt not perf coy line up with franc cabinet with ail nttxir txtisa colt rr K try i+ tt )"'.;• �\s: �t l lro =i - hd Yf!'r,,),i't• ,f•, tw...r 1.fiev}}.i: �� 3• k e. :r Solidi ^: t )?Cl4:t) StfvfOJCi T� by f IG bar cut Gr?site J t r >i i3tt'[ 4-4 ll2"Ill hetgnt 'r ;.fkOSt•' tt7 (r�wrap ufou:xt, ut,_tl,i_[...,:+i�;imtjCowl it313 . .,. n t r ...1 v. W, r :r - f beau 1143S if:it f.) %.1' :A... :r.....e.._ f "?t• . t ant ratty= . �' r.r. . e�34"Of the ' .. iriSiQ teff O f •wQ�' 6 ] ,.: ,;�• way up ._..._ .... F 5 Lai aK'1►Jliti Bead beato paneiirsp to be Cut on site by > § t and insauea on newly sheat soolied ottimnev—'As toFZ' ` Fc; f}j"vWfttatsrty GW height and small eavr- 3 w L nu*UV 10 wrap w ¢,' y e ` I ;; •. .arvtatd i0p oast of pnnt3kig w tall Ci ( v �^ ! I •r}; t ; 0 wrad piece approximately 25 10"high x c � :•tdvmDwhom cabinetry•;sbeing'mstatiarf t p' This pieta¢to bc:a cut off fujin laliu, tervc�,�r3a3a7 mo *1 400*r*LTha vote 1,. j ` r . L-144) ktin ttsA r} i= iii r i .•proN ded fotih8 5,des. - Nc ori chvtl y Wow r:u� 3D1 izt•.:a ;mt I y a p.Ri talie 4n 11-m front face of',.8is L tc ul la e t tht above the r {sF1 .. ...... R ;.z:p.la cr(ita3 nx,ttfe'li:.ut(ba a •�`'£�.� ` :r.bldf ercfawr,motdi EC.t•t i 4l nG'L ) t _F t nf:+j black cn C}rertY wood no div:vrtsirM ,l s,at`iec c i tcA faro of the 3"Salic;:aase r Ent s rtra•var ie'yfl go In erre a bng.3"sow base•ttotttuy • , t N r7 bank s IS"dot„, I y i 2t t tiz6C.,VS for&nr to ty of moving crvaa•. t,.....a o.vn%u a:ti,uneventiss ,t le cell ;ac:ne;r�'u 5c.r„'tu(ttsrS at S,'. sff of f 9 .. :~ , � . '•. ._ 3:•': all F>3n@i5 t7 to C17t d4Ktti Lin16 M 1� 3til t. # .,,_.....��ti.� � � tic:ta::t;;ai.:rz;i! : -„o'din tvSf"ht tc iw:tatted' 3ffl TKQt[Vlti' g t . .crus w.v^c+•••c err — j ^lwa!!)11.i' ca)dktfry t 9 �r `. I :Ri` CAttaiT3tiitNZWV3630 i. Cvvlawii I i -.. to i?:c:.y wood it i•.w�.at.�� . –' y`'yt*,..^ ^ .n.•F77777T77"= _ . M 1.fq to AF t- Y +a. ! /111 t{intentiur'pa.�tdou tkai antr ThGt is an art incl designand mttfl Desi . 11/1?!: , - given areM.' to vatrific ulm Ott not be rr itxsod or copiedenles9 f I'tinwd:2 I)Itoi 1 V z r= 'Job sitc end a4ur>s meet to tit job l applicable title has beat paid or it-At _ -'�" ii :n At ��,t A!♦X1AditllNLSf. prdCr Plued.' : 'Jwtt design tov_is.ned f I_-12 'All l ......�....:.Sa-d-e:1)511 li-`ReroivaliiSlwwpaaxkia - t C:t .y... ,f ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 06/29/2010 PRODUCER (978) 937-5747 THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE G.M. INSURANCE CENTER, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 850 CHELMSFORD STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LOWELL MA 01851- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:providence Mutual Fire In Drouin, Robert INSURERB:ASSO. Industries of Ma M 250 Sawmill Road INSURER C: INSURER D: Dracut MA 01.826— INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSR_ TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DDIYY) LIMITS A GENERAL LIABILITY CPP005848206 01/23/2010 01/23/2011 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY PREMISES E.occRENTurrence $ 50,000 CLAIMS MADE F1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I X TORY LIM Ti ER _ EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? vWC6011893012010 05/11/2010 05/11/2011 E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under 500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (978) 623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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,BUT -` FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE _ - INSURER ITS AG TS OR REPRESENTATIVES. AUTHORIZED ACORD 25(2001/08) ©ACORD CORPORATION 1988 INS025(=8).m Page t of 2