HomeMy WebLinkAboutBuilding Permit #622 - 325 APPLETON STREET 5/14/2009Permit NO: Z z
Date Issued: <AlAq
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
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PROPERTY OWNER:
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MAP NO: PARCEL: ZONING DISTRICT: :Historic I
-�lMachine
yes Ano
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family /--
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
FlW
oodplain etlands
iYV
Watershed,District F
Water/Sewer 4---
DESCRIPTIO OF WORK TOB PREFORMED:
e )( f'1_1� r ('('\J S �do C - &A,-)
Identification Please Type or P in Clearly)
OWNER: Name: ��2�' C��y-(� Phone:
If
Address: T j� �U� J -7-
10,
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ON
CONTRACTOR Name:
Address:�_ o G.. �./.
Supervisor's„Coristruction `License: - Exp.' ate
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Home lmprovernent:License: txo.4bate. .
ARCHITECT/ENGINEER
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: $ , �� FEE: $
Check No.: Receipt No.: d J1'
NOTE: Persons contracting with unregistered contractors do not have access1t?qhgguara1ty fund
Location /or
6A Date
No.
kORTN
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
CH
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # // V
22U66
Building 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
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
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 ors special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
P P 4 P PP
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 2.2008
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Cornerstone Building
Services
36 Baltimore St
Haverhill Ma
978-372-3979
Submitted To:
James Clayton
325 Appleton St.
N. Andover Ma
978-975-7390
Start Date 6/1/09
Demolition:
Remove existing counters and cabinets in the kitchen.
Remove the pantry doors and shelving.
Dispose of all debris.
Job Description
Remodel Kitchen
Cost $43,500.00
Finish Date 6/12/09
Plumbing_
Install new dishwasher, garbage disposer, and refrigerator purchased by homeowner.
Install a new faucet purchased by homeowner.
Install a new single bowl under mount sink purchased by Cornerstone.
Electrical:
Install 3 under cabinet lights.
Install 3 recess lights: 2 over the peninsula, 1 over the sink.
Install outlet for the garbage disposer.
Cabinets:
Install new Cabico cherry cabinets in the inset style according to the existing layout.
Install knobs purchased by homeowner.
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Counters:
Install new granite tops in the kitchen.
The color will be Golden Beach or Golden Persa according to homeowners choice.
Tiling_
Install new ceramic tile on the back splash areas.
Tiles will be purchased by homeowner.
Materials Used: -Cherry cabinets, Granite counter tops, Stainless steel sink.
-Total Cost of the project $43,500.00
-Cornerstone Building Service's will warrantee all work for
1 full year from the starting date -- 5/09/09
780 CMR R6 and MGL c 142A
-Cornerstone will obtain a building permit for the project.
-Cornerstone will remove all debris that was generated by
the project.
Payment Schedule.
-$23,500.00 Down
-$10,000.00 At cabinet installation.
-$10,000.00 At completion.
All home improvement contractors and subcontractors shall be
registered and that any inquiries about a contractor or
subcontractor relating to a registration should be directed to;
r 1 � .. _ � 'q. �� .. �.Qa .. «,. .. ,'�. '. nom, �• ./", ��. .:
'
Registration Division, Program Coordinator
One Ashburton Place Room 1301
Boston Ma 02108
The homeowner has by law 3 days to cancel this contract.
MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14
There is no acceleration clause in this contract.
No work shall take place prior to the signing of the contract
and the homeowner receiving a copy.
Agreement of Contract: 5/06/09
Do not sign this contract if there are any blank spaces
The -contractor and the homeowner hereby mutually agree
in the event that the contractor has a dispute concerning
this contract, the contractor may submit such dispute to a
private arbitration service which has been approved by the
Officer of Consumer Affairs and Business Regulation and
the consumer shall be required to submit to such
arbitration as provided in MGL c 142A
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Agreement or the above statement 5/06/09
Owner:
Contractor:
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Arashington Street
Boston, MA 02111
c i www_mms.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business//Organ ization/Individual): l'i UL
Address: b�q
vc/
City/.State/Zip:_ %%� u er � -, t f A4 01930 Phone #.
Are you an employer? Check the appropriate box:
1. Q 1 am a employer with
4. ❑1 am a general contractor and Iemployees
Type of prefecF(required):
(full and/or part-time).*
am .a:sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet 2
6• Q New con2�
7. 42-Remodelship
and have no employees
These sub -contractors have
8. Q Demoliti
working for mein any capacity.
[No workers' comp, insurance
workers' comp, insurance.
5. ❑ We are a corporation and its
g, ❑ Building addition
required.]
3. ❑ I am a homeowner doing
officers have exercised their
10. F7 Electrical repairs or additions
all work
right of exemption per MGL
I I.Q Plumbing repairs or additions
myself. .[No•workers' comp.
insurance required.] t
�N ]
c. 152, § 1(4), and we have no
.employees. [No workers'
12. Roof
❑ repairs
comp. insurance required..]
I3.❑.Other
rr — •• �w• �•� ro -x tt I muse also nu out ttie section below showing their workers' compensation policy information.
t homeowners who submit this affidavit indicating they are doing all work and than hire outside con
=Contractors that check this box must attatractors must submit a new affidavit indicating such.
ebed an additional sheat s`rcwir g the name of lire sub -contractors and their workers' cam" pclic- information.
J antan employer that is prourdtng workers' compensation insurance for mJ' employees: Below is the
information P oli cJ' artd job site
Insurance Company Name:.
Policy # or Self -ins. Lie. #:
Expiration Date:
Job Site Address: City/statezip:
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 MGI; 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.
l do hereby c uu er-the pains and penalties of perjury that the information provided above is true near correct
Si tore: C/ V J01,
Date: 3 cy
/-7_
ficial use only. Do not write in this area, to be completed by city or town ofciaL
City or Town:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector
6. Other S. Plumbing Inspector
� Coniact 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 ormore
of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trusts of an individual, partnership, associatiorn 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-contractor(s) name(s), address(es). mind phone number(s) along with their certificates) 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 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, nottthe 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 nuaa ber listed below. Self-insured companies sh-ould enter their
self insurance'license number on the•appiopriate 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 NwilI 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
policyinformation (.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 starnped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for fiAire 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 bum leaves etc.) said person is NOT. required to complete this affidavit
The Office of Investigations would Ittike 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 # 617-727-4900 ext 406 or 1-8.77-1%CkSSAFE
Revised 5-26-05 Fax # 617-727-7744
www.mass.gov/dna