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HomeMy WebLinkAboutBuilding Permit #737-14 - 365 BLUE RIDGE ROAD 4/22/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: ' t Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page ,..I LOCATI PROPEI rt,nni iw 1Cai viu QLI UkAU1c MAP NO: PARCEL ZONING DISTRICT: Historic District LL Machine Shop Villa Y- yes no no no .TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition 11 Two or more family 11 Industrial A.Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTIUN Uf IIVUI^ M I U Ot rtMrUM1V1CU: '^'01 - V 0 Identification Please Type or Print CleMy) -- OWNER: Name:��� Phone: A AA, --n /11AU1 GJJ. _. CONTRACTOR Name: e� J tk Phone: 1 Address. Supervisor's Construction License:C S 0 J-866 3 Exp. Date:.._dcd `le Home Improvement License: 4/7 qC. Exp. Date: ' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASEN $ 25.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: e -Z fi Receipt No. NOTE: Persons contracting with unregistered contractors do not have ;Signature of Agent/Owner Plans Submitted LJ Plans Waived ❑ _ Sigpature_ of contra Certified Plot Plan C Location 8 1�� No. '— Date z Check # �q 2� TOWN OF NORTH ANDOVER Certificate of Occupancy . $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted ❑ -Plans Waived ❑, y=_.Certified Plot Plan ❑ Stamped Plans ❑ TYPED _:SEWERAGEDiSP:OSAL Public Sewer Tanning/MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales Food Packaging/Sales ❑ Pxivate (septic tank, etc:_ -❑.. - _ Permanent D 3inpster on Site ❑ THE -FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE:APPR=OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Conservation Decision: Comme Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW To'vvAo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT --'-,Temp Durnoler on site yes.. no Located -at 124,Mair; Street Fire Departine►it signature/date--`' COMMENTS - dimension - Number of Stories: Total square feet of floor area, based on Exterior dimensions.$3` -Total- land -area., sq. ft.; ELECTRICAL: Movement of.Meter locat'ron,.niast-or service drop requires approval of glectrical Inspector Yes N® DANGER ZONE LITERATURE: Yes No 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 2010 Building Department The fol Owing is a=list of -the required.forms to be -filled out for -the appropriate. permit to .be obtained. Roofii,g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ VlJorkers Comp Affidavit ❑ Photo Copy Of H.I.C. And/O'r C.S.L- Licenses ❑ Copy of Contract o 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 Surveyed Plot Plan ❑ Workers Comp Affidavit o 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 o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 o 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 apw• al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 mo 64 rA O J W LL O oc Q m N Y "O O I.�L E N 'yam Q (n O d LA Z Q J m O N C 7 0 w OC ECA U LL O N z Q Z mN -i d K LL oc O y Z a U � LIJ OA d' U i In LL ac Q V LU M _ ZZ Q to 7 d' LL z W C C a LU LLI LL L L m z U1 In }j N _ r, � o °a y V O L Q y d E _ � C � / O ci i cn ' 13 ID m ' 4)_ • 9 C i = d O °� O O cm N O � m oo ° z CLC0 w = o �- L CL tm � � �a � L 0 - CD O C� m cn W = m O O uj n CL=7 O LV U a O am m 0 co> C 0 nov JLa O 44*10, 1.6 V LU O CO Z d L o O v Z CL CO .N Q I __ T Q •� 0c'OF W F C> W E tD a i (D O +-' Cl) .� .r W O �+ O O ^/ O Z L = ° X LU a CL �Q Cl) � � m m c W J .V J m Z Z! CL O }w,; m r W o v V U) c 0 m C O O Z O Q JLa O 44*10, Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 1 151,300.00 m $ - $ 183.60 Plumbing Fee $ 22.95 Gas Fee 100 comm. $: 10.0..00 Electrical Fee $ 22.95 Total fees collected $ 329.50 365 Blue Ridge Road 737-14 on 4/22/2014 Finish 250 sq. ft. of attic space to expand bedroom mezzainine From:J.T. O'Neill FaxID:978.688.7001 Page 2 of 2 Date: 12/6/2013 09:44 AM Page:2 of 2 OP ID: JT CERTIFICATE OF LIABILITY INSURANCE DA121062013Y) 12106/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the. certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Durso &Jankowski Ins Agcy LLCP 198 Massachusetts Avenue North Andover, MA 01845 Durso &Jankowski Ins. Agcy. CONTACT NAME: HONE FAX AIC No Ext): AIC No): E-MAIL -ADDRESS: CUSTOMER ID N: FAYCO-T INSURERS) AFFORDING COVERAGE NAIC R INSURED ','Fay.Construction Co. ) INSURERA: Main Street America Assurance 14788 Charles A. Fay, Jr. 20 Beresford Street INSURERB: NGM Insurance Co 14788 A Lawrence, MA 01843 INSURER C: MPP48851 INSURER D: INSURER E pREMISEs Ea occurrrence $ 500,000 INSURER F CLAIMS -MADE � OCCUR COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR LTR TYPE OF INSURANCE Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER PO ICY FF MMIDDIYYYY POLICYEXP MMIDDIYYYY �. LIMITS 't� 1600 Osgood Street suite 2035 GENERAL LIABILITY North Andover, MA 01845 EACHOCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPP48851 06/07/2013 06/07/2014 pREMISEs Ea occurrrence $ 500,000 CLAIMS -MADE � OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 r. - J ENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 2,000,000 o POLICY PRO LOC $ B AUTOMOBILE LIABILITY ANY AUTO M1T9239C 12!18/2013 12/18/2014 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ 100,000 X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ 300,000 PROPERTY DAMAGE $ 100,000 (PER ACCIDENT) $ NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE STATU- 'T'_ TORY LIMITS ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Carpentry Residential & Electrical Wiring CERTIFICATE HOLDER CANCELLATION TOWNNA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Noreen AUTHORIZED REPRESENTATIVE 1600 Osgood Street suite 2035 Durso & Jankowski Ins. Agcy. North Andover, MA 01845 ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of .Massachusetts DepartmentofIndiistriglAccidle is Office ofluvestdgations 600 Washington Street .Boston, MA 02111 www.mass govIdia Workers' Compensation Insurance Affidavit: BuildersiContractors/ElectriexanslPhimbexs ApMlicant Information Please Prkt Le�ably Name (Businesslorganization!individual): U if .Address: B -em es <<d City/State/Zip: � VuWki 6 r /-1 (4- Phone #: 9-7F P ,) k ?e35 - Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New cbnstraction employees (fall and/or part-time).* have !tired the sub -contractors 2.1 am a sole proprietor or partner listed on the attached sheet. 7• ❑Remodeling ship and'have no.employees These sub -contractors have 8. ElDemolition working forme in any capacity. workers' comp. insurance, 9. E] Building addition Wo workers' comp. insurance 5, ❑ We area corporation and its 10.[] Electrical repairs or additions required.] officers have exercised.their 3. 1 am a homeowner doing all work right of exemption per MGL 1111 Plumbingrepairs or additions myself. [No workers' comp. c. 152,§1(4), and we have no 12.❑ Roofrepairs insurancere edemployees. [No workers' �'. a 13.❑ Other comp. insurance required.] KAny applicant that checks box#1 must also fill out the section below showingtheir workers' compensafioapolicy information. Homeowners who submit this affidavit indicating they bie doing allwork and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must attached as additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employe that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self-ias. Lic. #: Expiration Date: rob Site Address -,I T City/state/zip: wdo L1e,'1 Attach a copy of tho workers' compensationlaolley declaration page (showing the policy number and expiration date). Failure to secure coverage as reguiredunder Section 25A ofMGL o.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 IieYebyertify under the painenalties ofperjury that tree information provided aboYe is true and correct, Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermffffAcense # Issuing Authority (circle fne): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbinglnspector 6. Other Contact Person: Phone #: Fay Construction 20 Beresford street Lawrence, MA 01843 E-mail fayconl@comcast.net Name / Address Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma, Estimate Date Estimate # 4/8/2014 160 Job location Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma Customer Phone Terms 978 806 7725 Description Qty Rate Total Railing and hand rail: install oak post top of stairway --oak rail and primed 85.00 85.00 balusters from post to closet wall --oak railing from post to stair case bottom. Trash Removal: Dumpster 1 450.00 450.00 Materials: all materials other than sky light and wall board I est. to be 1 3,500.00 3,500.00 (:g" F--�& 4///q//4/ Total $15,330.00 Page 2 h E f Ch Fay Construction 20 Beresford street Lawrence, MA 01843 E-mail fayconl@comcast.net Name / Address Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma, Estimate Date Estimate # 4/8/2014 160 Job location Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma Customer Phone Terms 978 806 7725 Description Qty Rate Total Provide materials,labor,permit and inspection for the renovation of 3rd 1 400.00 400.00 bedroom and stairway closet area and the 400 sq. ft. area of unfinished attic area as discussed ( Permit cost and inspection time ) Stairway and bedroom wall: remove separation wall between attic stairway and 20 85.00 1,700.00 bedroom --remove and replace treads and risers --install landing in instead of 1 st step. finish off stairway with stringer trim --tread and riser returns --base cap moldings. Oak treads --primed risers and trim Attic area floor prep: Remove 1/2 plywood --pull back insulation --install 2x8 12 85.00 1,020.00 floor joist front to back --install 3/4 advantec sub floor glue and nail Framing: 2x4 wood -about 80 ft. of partition wall --frame for full length closet 24 85.00 2,040.00 with 2ea. 4 ft. door openings front of home --sky light framing --ceiling joist and strapping Elect. Install rough and finish elect to code --pull up 2 l 5a. circuits from 24 85.00 2,040.00 basement--cable--phone--closet lighting --5 recessed lights --3 way top and bottom of stairway --storage switch and lighting Insulation: r-19 back side of all partition walls r-30 with proper vent foam 6 85.00 510.00 panels in rafter bays r-38 flat ceiling area. Blue board and plaster: 1/2 board with 1/8 skim coat all new areas --smooth 1 1,900.00 1,900.00 walls and ceilings --skip trowel closet. Sky light installation: supply and install a Velux manual 3006 inch venting 1 1,600.00 1,600.00 unit --remove roof shingles --install ice and water shield and flashing kit --install new roof shingles. Doors and trim: Install 2 ea. 4ft un.i-pair 6 panel door units ( closet ) 132" 6 85.00 85.00 panel attic storage. install 5 1/4" speed base all finished areas. Total Page 1