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Home My WebLink AboutBuilding Permit #625 - 31 GLENORE CIRCLE 3/22/2011Permit NO: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued:9' ZZ — I t IMPORTANT: Applicant must complete all items on this LOCATION .31 G lcw0 +`= C r Print PROPERTX OWNER Dr cK �11 MAP 9W770 PARCEL:. ZONING DISTRICT: 2� - Historic District yes Machine Shop Village yes no no TYPE OF IMPROVEMENT PROPOSED USE Exp. Date: // /j /j/ Residential Non- Residential ❑ New Building LKOne family Exp. Date: ❑ Addition ❑ Two or more family ❑ Industrial C4Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other +❑+Septc 1yVell []1F1oo�dplaul. ®W,etlands f ' WatershedkUD istnct. I rNafer/Sedyver DESCRIPTION OF WORK TO BE PERFORMED: OK Identification Please Type or Print Clearly) OWNER: Name: Dr iq.r-#vv-y 7� Y Phone: Address: 31 G irweP-v--Civ- CONTRACTOR Name: Address: m C_ S AS Phone: '7,7S' 37.? 0V4, re. 01 Supervisor's Construction License: L S 4t 756 7 Exp. Date: // /j /j/ Home Improvement License: t T g V3 Z Exp. Date: ,q /to / t 2- ARCHITECT/ENGINEER Phon Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: 12.00 PER $9000.00 OF THE TOTAL ESTIMATED COS`TBASEDD ON $925.00 PER S.F. Total Project Cost: $� 0 U FEE: $/ _� r�_ o Check No.: Receipt No.: 9Y NOTE: Persons with unregistere -contractors do not have access to the guamy fund o:AC"A'i ;;'rIt li�inor ( iA �: � -- ----- : Ciifii fiiio' Location 1!5111 C-<�, No Date TOWN OF NORTH ANDOVER 04L ,6. Certificate of Occupancy $ Building/Frame Permit Fee $ 4CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23974 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DIS71?(Tanning/Massage/Body Public Sewer Art ❑ Swimming PoolsWell bacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY, INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED 0 DATE APPROVED El CONSERVATION Reviewed on Sianature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Comm 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use El Notified for pickup - Date Doc:.Building Permit Revised 2008 No 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 ° ngineered 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 rn all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals Chat 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: Doc -Building permit Revised 2008mi • V co 'a� c O = O y O "_. v V C. c O O j O c ;Z O Cc Ga Ea s +. c� o Q co) ..o m :cw O o v� . Qi CD c CL.. y ' � m CC L CD cm C m : C � 'd (T.0 ca �Em C. V L y = m � yCDa o V y O o Z tiC2 CL H = Cdam' F- �. CA)y o .O-. LL N D s O w H a .nZ c M�E v�vi C.3® p ® C CO C O O:p _ 0 L y. 0 '9 O C ft U C O 2 O c• L O C3 Z CO C. O 0 y C co O! COD i M a W u i�4 o w° " co w 00 . G w° A v U C w w a � w O aW. W W 0 A°G U� cn 0 o c a �1 cmQ O z c/) Q x c) V co 'a� c O = O y O "_. v V C. c O O j O c ;Z O Cc Ga Ea s +. c� o Q co) ..o m :cw O o v� . Qi CD c CL.. y ' � m CC L CD cm C m : C � 'd (T.0 ca �Em C. V L y = m � yCDa o V y O o Z tiC2 CL H = Cdam' F- �. CA)y o .O-. LL N D s O w H a .nZ c M�E v�vi C.3® p ® C CO C O O:p _ 0 L y. 0 '9 O C ft U C O 2 LLI LLI U) OC W LLI W N O c• L O C3 Z CO C. O 0 y C co O! COD O-0 �— O CO) co .e m m CD 0 co 0 003 cc O d cmQ c Cc ev CJ J .� FL o }? ca Z co O CL V ND cc c C C _cc CL CO2 .— LLI LLI U) OC W LLI W N 401ml 001A 261 Hyatt Avenue Bradford, MA 01835 978.372.0262 DR. HENRY & MAY TY 31 G,�ENORE CIR. NORTH ANDOVER MA. 01845 CONTRACT MARCH, 12 2011 SCOPE OF WORK: ATTIC PLAY ROOM • PLAY ROOM WILL HAVE 5'-6' KNEE WALLS WITH SLOPED CEILINGS UP TO EXISTING COLLAR TIES. • LAY % T&G PLYWOOD GLUED AND NAILED OVER EXISTING JOISTS • FRAMING OF 3 STORAGE AREAS AS PER PLAN WITH 30 INCH WEATHER STRIPED RAISED PANEL DOOR IF SPACE ALLOWS. • FRAME BENCH SEAT OVER TWO HEAT SUPPLY DUCTS • WALL FRAMING WILL BE 2X4 KD • INSULATION OF ALL AREAS AS PER BUILDING CODE • BUILD 8 PAINT GRADE BUILT-IN BOOK SHELFS AND ONE DRAWER UNIT IN STORAGE AREA ON RIGHT SIDE OF STAIRS • ATTIC STAIRS TO HAVE CARPET WITH PAINT GRADE SKIRT BOARDS AND HAND RAIL. • OWNERS CHOICE OF CARPET STYLE AND COLOR FROM VENDORS CHOICES ALLOWANCE OF 18 DOLLARS PER YARDS.AREAS TO HAVE CARPET ARE oma/ k 2r z .~ U 0 ' J \, CO / \ U 0 0 / . / ` � 2 \\\ a u . �.m » / / \ \/\�» m G E k \ . 2 �~ ƒ I.\ E .\ wIO . ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID AC DATE(MMIDD/YYYY) LYONS -2 01/21/11 PRODUCER Chase & Lunt LLC P O Box 590 47 State Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Newburyport MA 01950 LIMITS Phone:978-462-4434 Fax:978-465-6204 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Northland Insurance Companies EACH OCCURRENCE $ 1000000 INSURER B: Lyons Development Corp Catalina Lyons 261 Hyatt Ave Bradford MA 01835 INSURER C: 10/06/10 INSURER D: AMAGTUR PREMISES(Eaoccurence) $ 100000 INSURER E: PERSONAL& ADV INJURY $1000000 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. IN L'iHTR WP NSR TYPE OF INSURANCE POLICY NUMBER LI Y EFFE TIV DATE MM/DD LI Y PIRA N DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx-1 OCCUR WS053021 10/06/10 10/06/11 AMAGTUR PREMISES(Eaoccurence) $ 100000 MED EXP (Any one person) $ 55000 PERSONAL& ADV INJURY $1000000 GENERAL AGGREGATE $ 2000000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT LOC PRODUCTS - COMP/OPAGG $2000000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY OCCUR O CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS VIA EMAIL: danahi@comcast-net The Commonwealth ofHassachusetts Department of Industrial,Acciclents Office of Investigations 600 Washington Street Boston, MA 02111 �,4 y` www.massgov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): City/State/Zip:. 13 3' Phone #: V 8-. 37.2 _ 6,24.2 - Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 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. r ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. J4 Remodeling . 8. [( Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other *Any applicant that checks box B1 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 and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby cert' y under the p ins andpenaldes ofperjury that the information provided above is true and correct. —Signature: Date: 3111, /// 3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License Issuing Authority (circle one): 1. Board of$ealth 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other C ontactPerson• Phone MAIN OPEN AREA, STAIRS, AND STORAGE ROOM ON RIGHT OF STAIRS AS YOU ENTER. • PAINT PLAY ROOM WITH BEN MOORE BRAND APPLYING TWO COATS IN YOUR CHOICE OF COLOR. • ELECTRIC :LIGHT LAYOUT AS PER PLAN. PHONE, CABLE TO BE DECIDED LATER. • HVAC: WE WILL USE A MITSUBISHI SPLIT AIR HEAT AND AC COMBO UNIT ONE AND A HALF TON UNIT. • STORAGE AREA ON RIGHT OF STAIRS AS YOU ENTER WILL BE BLUE BOARDED AND CARPETED BUT LEFT UNFINISHED "COLD STORAGE". ROOM WILL HAVE BUILT IN CASE OF DRAWERS AS PER PLAN. • TOTAL FOR WORK DETAILED ABOVE $35,500.00 • PAYMENTS: THERE WILL BE 4 PAYMENTS 3 OF $10,666.00 EACH AND A FINAL OF $3,500.00 AT END OF JOB. • THREE PAYMENTS, FIRST AT START OF JOB, WHEN ROOM IS BLUE BOARDED, AND THIRD WHEN ROOM IS PAINTED. OWNER LYONS DEV OPMENT JIM LYONS DATE 3lal 1a0(1 DATE