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HomeMy WebLinkAboutBuilding Permit #005-12 - 323 CHESTNUT STREET 7/1/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ©��)�f2 Date Received Date Issued: G l IMPORTANT:Applicant must complete all items on this page LOCATION ;Z 3 112 Print PROPERTY OWNER (2AZ1. -4 Unit# Print MAP NO: '�? PARCEL:,�_/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial R"Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11 Septic ❑ Well ❑Floodplain ❑ Wetlands d Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO E PERFORMED: g -0-dukevs ZX V4-TCft1A (A1SU0t,-r> -&A 1JA_—L6 (Identification Please Type or Print Clearly) OWNER: Name: C_>K 1,U�l M. GALLAdStA Phone: (=5- I8GS Address: `?,2$ C_tt>tSTuuT CONTRACTOR Name: 1-rr< d lac Phone: 01-'8 2�14 -426-2, Address: 80 cAto {�� G"�i�loov I�d�l Cil�3q.5 Supervisor's Construction License: a4-4S4 Exp. Date: 3 Home Improvement License: ® 2,-,,Q Exp. Date: 6, 12-01126)2 ARCHITECT/ENGINEER ► 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: $ 2.11 C1 Y3• 61-� FEE: $ Check No.: 2413 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tUthega fund ;Signature of Agent/Ownert Si- of of contractor ■ Location 3�2 3 No. /`20 _�� Date NORTIy TOWN OF NORTH ANDOVER - 1 O O w } ° Certificate of Occupancy $ �+s E�� Building/Frame Permit Fee $ . no ncNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 24668 ^ Bu0'14g inspector 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 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 ai 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 i i r 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 2011 June/mi i J - 1 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 j ❑ Building Permit Application o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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: Doc.Building Permit Revised 2008mi NORTH Tomm of 0 v , dover, Mass., COCMICKEWICK 0 ARATEO P'PIL C7 S Ur ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......'Y.lie.4 '... ....................................... ........................................................... Foundation has permission to erect........................................ buildings on rte- a,. ... .. .. 5'�iv...................................... Rough �� /'- C � b E Chimney to be occupied as..............., �......1 ...r .r...... li.4t.� �...................... ..:r�.. .. .... ��` ....:..... provided that the person accepting this permit shall in every'espect 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. 2 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough .............. ., •4,1.��+� d-�.W.1 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 Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MM 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name(Business/Organization/Individual): � Address: ] City/State/Zip:A 60VU— MA 0) Phone#: 214 Are y an employer?Check the appropriate box: 1. I am a employer with 2 4. Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sh%et.# [7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers'comp,insurance 5. El We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10.0 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' comp.insurance required.] 13.9�Other *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. 83.E Expiration Date: g 2 (� Job Site Address:_Zzs Csir U`i'fi' C- 1'_ Ci /State/Zi ty p 1..Q.61D' Pqk 01645: 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. 1 do hereby certify un er t a' s penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: q 9s 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 Inspec 6.Other tor 5.Plumbing Inspector 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 Cornnwr[Wealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.4 617-727-4900 ext 406 or 1-877-"SAFE Revised 5-26-05 Fax#617-727,7749 www.mass.gov/dia �0°R00'rs *fig' a '�'�' 6atdoesnetineUedesO,ad,ra :. yteso, (e pretaet 6tLeO�oeaf A$ Homt�vn�. Cn4e6.aetmr7atY' m�waart�esidi2'1`7YI1�sbouldfMobteiaa Aad �on-jjor= 47.4 umhobfenafi=copyby eo =Informatfon rmnc ' ��t�mtredeaPbtta>rieeBoottdd�ea, x. � �H �TkluT - Gtylf..aaa sbme ZiyCb& ,J �t3merhome iE�000�Phttae '� ane NIA l.�Addei (tw - r „ V a.urctra.;., ttar � rlDorSS.iVam6er 'q ���,� p.'+ol®r•.t.w�. wrs4tys, �nU.e,.c (�'seioact,8tbe.odce�oaoep]gp�,���tlP�,�,itedgsaeoCmr�bie `�°t �rLaxaAdaGootl�:v y PL OF Wcw-u- (Offlunwhosemeamwmm aea�aeabaoksspamlts wm be I heyaadn�e�u. Coa ,l a,;m =emdea frr m dee F+md MG'E,dapter 1,�� _ t>f nss wGm .�1 begin eonn,q� _. i "' — ' �sasactia3 wod�vrtRbep�y TotaltbntiaetPsiceandPaytaentt3ebedale _ lbe Cometnragters to perfofat the wady fttmistt ahememiat Md labor A � wed abovefar the total �Ymmtswll]be made taxpridtog to the fotlowingsebe� • s-�adG2_._�on siguinB (tanto acrid U3 ofthem[sE . 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Scope of Work 323 Chestnut St, North Andover, Ma. June 28th,2011 Overview: Repairs to water damaged sheetrock and insulation,kitchen cabinets and kitchen ceiling. Knee wall attic area above living room: Remove existing plywood decking to access knee wall/floor transition and install rigid insulation and I part foam to air seal. Reinstall plywood and dense pack cellulose insulation under flooring Attic above bedrooms: Remove all existing Fiberglass and cellulose insulation.Use 2part foam to air seal top plates of existing exterior walls at roofline.Install 12"of new cellulose insulation. Living room,Bedroom#I,Bedroom#2,and office: Remove existing sheetrock ceilings and sheetrock on exterior walls facing the street,except for the office where 1 sidewall will also have sheetrock removed.Remove all fiberglass insulation in walls behind removed sheetrock.Remove and replace existing window and door trim as required. Install new blueboard sheetrock and plaster finish in all areas where sheetrock was previously removed.Dense pack cellulose insulation in all walls where fiberglass insulation was removed. Paint all new work and all existing walls in all four rooms to homeowner color choice. Vent two existing bath fans to roof flappers with insulated duct. Kitchen: Remove and replace two existing kitchen cabinets and crown molding with new homeowner supplied kitchen cabinets of same size in same location.Existing under cabinet lights will be removed and reinstalled under new cabinets. Patch ceiling around one recessed light. Paint kitchen ceiling with one coat of stain blocking primer and two topcoats of ceiling white paint. Dispose of old cabinets. An onsite dumpster will be provided for the duration of the project.Existing floors will be protected during demolition and construction. Total price including all labor,materials and standard permit fees:$24,937.00 Dave Hope. President,HRH Construction,Inc. HRH Construction,Inc. 80 Campbell Rd,North Andover,Ma,01845. 978-314-7263 www.hncconstruction.net dave@hncconstruction.net NOTICE OF CANCELL TION i1 f.Unvlfl vlNJGllon tilt You may cancel this transaction,without any penalty or obligation,within three business days from tihe 1 date above. if You cancel,any property traded in,any payments made by you under the agreement,and any tiego- tlable Instrument execute by you will be retemed within ten business days following receipt by the seller of your cancellation notice,and any security Interest arising out of the transaction will be can• celled. If you cancel,you must make available to theseiler at your residence,In substantially as good condition --- ^ with due as when teeelved,any goods delivered to you under this agreement;or you may if you wish,compiY tisk. trhstrhlCtlolts of the seller regaMing the return shipment oP dte.goods at due seller's expense and If You do make die goods avallabie to the seller and the seller does not pick them up within twenty days of the date of your notice Of cancellation,you may retain or dispose of the goods whhout any further obilgatioo. If you fail to make the goods avalbble to the seller,or If you agree to return the goods to the seller and fail to do so,then you remakt liable for performance of all obilgadons under the contract To'cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice c, any other.written notice,or send a telegram to: - - •1-IJP�a cit t��r�r,��,{•_ /7 O• x S16 � Jot, veeeJn �. arts ��uaavre. t�v.t ' not later dun midnight of JrG o a ter rrxt>xsbn ce I hereby cancel tilts uans'action. FiomeoW,her's 9Cn�wra ate ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMA7DAYYY) 2/14/2010 PRooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION .Emond 8 Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 857 Turnpike Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ste.133 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED HRH Construction INSURER A Farm Family Casualty Insurance P.0.Box 5184 INSURER 8: North Andover, MA 01845. INSURER C: 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 ADEYLPOLICY EFFECTIVE POLICY EXPIRATION FINSURANCE POLICY NUMBER LIMTs GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 —4c COMMERCIAL GENERAL LIABILITY PREMISES RENTED occvlence $ 50,000 LAIMS MADE ✓❑OCCUR 2005X0775 1120/20,0 11/20)2011 MED EXP(Any ane person) S 5,000 PERSONAL 6 ADV INJURY 5 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COgP/OPAGG S 2,000,000 POLICY PRO-JFcT LOC AUTOMOBILE UABILRY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S 1,000,000 ALL OWNED AUTOS EX7DILYINJURY S SCHEDULED AUTOS (Per perxon) HIREDAUTOS 200104287 03/16/2010 03/162011 BODILYINJURY NON-OWNEDAUTOS (Peracddent) $ PROPERTY DAMAGE 5 (Per occident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ——EANY AUTO OTHER THAN EA ACC $ -- AUTO ONLY: _ AGG S D(CESSAlM3Rt.LLA LIABILITY EACH OCCURRENCE $ 1,000,000 OCCUR FICLAIMS MADE 2001 E1159 07/12/2010 07/122011 AGGREGATE $ 1,000,000 $ 1,000,000 DEDUCTIBLE $ 1,000,000 RETENTION $10,000 $ WORKERS COMPENSATION AND Vac STATU- OTH- EMPLOYERS UABIUTY ANY PROPRIETOR/PARTNER/FJ(ECUTIVE E.L.EACH ACCIDENT S 500,000 OFFlCERIMEMBE R EXCLUDED? 2005W6827 12/072010 12/07/2011 E.L.DISEASE-EA EMPLOYEE $ 500,000 tt yea,descrilro under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations by named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /> �/ �, ll:u�achusctts-Dcrrtfilet)t nl•PubliC�afch_ Bnart!ar Buiidin-, ' Rc�ulatinn,:uttl ti tandartis Cons::;uction &&.Par blsor License License: CS 57754 Restricted to: 00 WILLIAM D HOPE 1. ' 57 CHASE ST METHUEN, MA 01844 ` e`✓ _ f Expiration: 3/4/2012 t'unttui�sioncr Tr--: 18748 A" Officewe.'eon m'er° rs` in cgu aho`n& License or registration valid for individul use only -W HOME IMPROVEMENT CONTRACTOR before the expiration date_ If found return to: Registration: _-_101730 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/29/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116' HRCONSTRUC?IQN.INC_: =% William Hope 57 CHASE STREET:- g 6Py METHUEN,MA 01844= Undersecretary Not valid Asigmt s •