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HomeMy WebLinkAboutBuilding Permit #292 - 32 PARK STREET 10/17/2007 BUILDING PERMITof "°RT" q `'t1.lO yb• tiO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:2 Date Received ��SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATPON av r a s >�Pnnt t e r f PIRDP.ERTY 01NNER'a not NIAPP`10 tPARCEI_ ZONING DISTRI'CTl,'Nistoric Distract yes �o Machine Shop Utliage °yes "no 4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family industrial Al No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Se tic 1Ne11 Floodplain Wetlands 1Natersed Dstnct ', P -11(atr/Seuuer t r DESCRIPTION OF WORK TO BE PREFORAIED: denti catiDinPI se Type or Print Clearly) g OWNER: Nam Phon ; 75)697,P01 Address: CONTRACTORNarne.. :Phon/ Address; ` &.> - f �4 Sly eN1SOr SOnStrUCttOn LICenSe Exp Poore Imp�o�rerner,t License �} « E�cp ;nDate ARCHITECT/ENGINEER Phon &63 C9`Z S7 C�®� Address:_ ��.o -� CZE`-e- Reg. No._-5 FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ) EfZ7 Total Project Cost: $ al l r ") FEE: $ Check No.: �0 Receipt No.: NOTE: Persons contracting with unregiste ed c ntractors do not have access to the guaranty fund Signature o ,Agent/ wne ;Signature of contracto i I 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 DEPARTMENT:BPFORM07 Revised 2.2007 i LocatioZ No. C Date "a ©� MaR,►, TOWN OF NORTH ANDOVER D Certificate of Occupancy $ ' °, <«mss_.. •' � sAcNus<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #10-4z- 20698 Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CN M-2►1 TS Address: � � G AX__Q >� City/State/Zip: Wt-QA-o �t,, _V`'u"L,,- Phone #:���� �� raa:--.�- Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2,al 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' l3.❑ 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 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: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature,t l� Date: Phone 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ' OFFICE OF BUILDING INSPECTOR t r :•. tlil TOWN OF NORTH ANDOVER '�`~• ' CONst UCTION CONTROL PROJECT NUMBER: PROJECT TITLE:— VP w_ /MAAPj, t� PROJECT LOCATION;_ V� ILL-Alit p�j�t�1� Life, 15 NAME OF BUILDING:_ NATURE OF PROJECT: IN ACCORDp NCE WITH ARTICLE 118 OF THE MASSACHUSETTS STATE BUILDING CODE, REGISTRATION NO.= S j,_j q— BEING A REGISTERED PROFESSIONAL ENGINEERlARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT D ARCHITECTURA ,9 STRUCTURAL 0 MECHANICAL 0 -tr FIRE PROTECTION Q ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE:PROPOSED USE AND OCCUPANCY, I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC 13ASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 1113.0 1. Reviser,for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the Wmtraetor in accordance with the requirements of the constnichon documelt(g, 2. Review and approval of the quality control procedures for all code-required contmIled materlais. 3. Be present at intervals appropriate 10 the Stagd of constriction to become,generally familiar vAMhe progress and quedity of the work and to determine, in general, if the warts Is being performed In a manner cavi tent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. / SKNAIiE SUBSC BED AND SWORN TO BEFORE ME THIS DAY OF -tg- NOTY PUeL! MY COMMISSION EXPIRES 'Z V/ •r E k -I' Regulations and Standards ,,. 'Board of Building License Construction Supervisor U 'Ppoj. .S 97154 I s Birti�d to 51811974 Tr# 97154 `' tr�tiQn 51 % 010 0tsietion 00t �f CHRISTOPHER HAi-E 11 GREEN.STREET 'z r Commissioner METHUM MA 01844 - NORTH 0 of over o - M VA No. pZ 9 ZON C" o dover, Mass. LA COCMICKEWICK �oRATED 1157 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............ F.10. .............................................................................................. ........................... Foundation has permission to erect........................................ buildings on ..3. ....... �1�..kw......... .....a............... Rough to be occupied as..........mm.........&A.r.o.o.m.4..........=.*,r...... ....... . .�.�..�. . . ...... 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 PERMIT EXPIRES IN b MONTHS ELECTRICAL INSPECTOR UNLESS.'CONSTRUTS Rough ........... ................................................................. Service BUILDING IN ECTOR 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 FIREDEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE Smoke Det. - I COMMONWEALTH OF MASSACHUSETTS QF ELECTRICIANS REGISTERED MASTER ELECTRICIA ! ISSUES THIS LICENSE TO E . F .P . ELECTRIC ERIK F PIERMATTEI b 20 BURKE STREET HAVERHILL MA 01830-310 i 18265 A 07/31/07 9674 _ ... ---------------------- ............. -IN ---- -- *N STATIr OF MAINE i *lt DEPT OF PROFESSIONAL'&FINANCIAL REGULATIONINELECTRICIAN$'_EXANIING BOARDLICENSE#,MS60019345 ., i ERIK. F. PIERMATTEI i MASTER ELECTRICIAN ISSUED Jan 18, 2007 EXPIRES Jan 31, 2009 I� 1 i PL VIBERS AND GASF$TTERS LICENSED AS A-MASTER PLUMBER DANNY A DUNK! � 4 INDIAN RD EAJf.;KINGSTON NH 03827-2143 - n CONTROL# j' t" Q '-? IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 239 Causeway St., 5th Floor,Boston,MA 02114. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. CJ32iInD32! 32�nIdNOIS 009-fZ9 LOZ) 5£00-£££b0 3NIVV4 't11Sn0nd N011`d1S 3SnO.H 31VIS 5£ i NOI1tf1f1J3Lt 1V10N dNl� �dNOiSS3�obd=10 1N3W1btld31 I 3NJ'VW a0 3.LVIS ---- -... I� . Haleys Home Improvment Contract to perform job for North Andover VFW All work to be completed as mentioned in estimate and layed out on plans, any work beyond our control or can not be foreseen from plans will be extra charge to customers. Work to be only interior and does not included exterior ramp, front entrance way,or stairs. All subs to carry insurance and licenses.All materials to complete job mentioned included in price less any responsibilities of customers. Haley's to pull all needed permits to complete job.All fee's connected to permit will be the responsibility of customers. Payments to be as followed 25% upon signing $15,525.00 Additional 10% upon demo complete$6,210.00 Additional 25% upon rough plumbing and electric $ 15,525.00 Additional 15% upon doors and wallboard $ 9,315.00 Additional 10% upon flooring and ceiling $ 6,210.00 Remaining balance upon completion $ 9,315.00 stomers Estimate to remodel V F W North Andover Bathrooms and foyer 32 park street Remove all walls, flooring,fixtures, ceilings,and doors as layed out in plans. Complete all demo work and remove debris from site. Construct new walls and partitions with all materials and construction as stated on plans. Install all rough plumbing and electric rough per plans. Close up walls with gypsum and plaster. Install all new acoustical ceilings in entire area's affected from demo and as stated on plans. Install new doors in baths and foyer area's. Install all new lighting fixtures,wall outlets,FDA's, and all needed switches to operate such.Reconfigure old wiring to conform to new areas. Install new bathroom fixtures and lav's in both baths with all needed hand rails,partitions,doors, and hardware. Install new flooring in entire areas as presented on plans. Install new baseboard heat in all spots as needed .install all needed moldings around doors and floor area.All new construction walls and area's affected from demo to be painted.All materials to be used to complete project will be that of which is on plans. All materials included.in this estimate.All labor to complete job mentioned included in price.Any work not mentioned in this estimate asked to be performed or work which is beyond our control will be extra charge to customers.All such work will be put in written and paid for in advance.All work will be done in.accordance with mass codes and per plans received. All subs on job will have all needed insurance and licensed to complete job. Haley's will carry all insurance and licenses to complete job.All work will be done in a professional manner not to disturb business.All debris and trash as a result of construction to be removed from job. Total cost to complete job mentioned $ 62,100.00 sixty two thousand one hundred dollars. ACORD DATE(MM/DD/YYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 08/31/2007 PRODUCER Phone: (978)475-0400 Fax: (978)475-2171 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION THE HOWE INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 PUNCHARD AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ANDOVER MA 01810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual HALEY'S HOME IMPROVEMENT INSURER B: C/O CHRISTOPHER HALEY INSURER C: 11 GREEN STREET METHUEN MA 01844 INSURER D: 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 TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE - POLICY EXPIRATION LTR INSR DATE MM/DD/YY' DATE MM/DD/YY LIMITS GENERAL LIABILITY MP078993 09/06/07 09/06/08 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurence) Is 500,000 CLAIMS MADE[X] OCCUR MED.EXP(Any one person) Is 10,000 A PERSONAL&ADV INJURY Is 1,000,000- GENERAL ,000,000GENERAL AGGREGATE Is 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG. $ 2,000,000 PRO- POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ 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 17 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ Is WC STATU- WORKERS COMPENSATION AND TORY LIMITS OTHER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Town of Andover 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, IT'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: Vld . UUiS ACORD 25(2001/08) Certificate# 3519 ©ACORD CORPORATION 1988