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HomeMy WebLinkAboutBuilding Permit #890-14 - 365 BLUE RIDGE ROAD 6/10/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: sib t� Date Received Date Issued: 1 " q IMPORTANT: Applicant must complete all items on this page LOCATION':-CalU� - PROPERTY OWNER Le Print 100 Year Old Structure MAP NO:Dpq ZU—'4- ZONING DISTRICT: Historic District Machine Shop Village yes no ye no ve(l no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial C51!Wteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11 Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer - or Print Clearly) OWNER: N ArlrJreee• �2� (�C 992,- 1v gal VVV. CONTRACTOR Name: Phone: Address: Supervisor's Construction License: CS 0 �-*e6 3 _Exp. Date: �-;201' Home Improvement License: l'i Exp. Date:/5 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �o��� FEE: $-- Check No.: -1 I Receipt No.: NOTE: Persons contracting with unregistered contractors do not h� a acc ss to the iaranty fund Signature ofAgent/Ovuner ig�ature o Plans Submitted L -i Plans Waived ❑ Certified Plot Plan ❑ Stamped Location -5(.P65 -B�V-S— R-4aw;, IQJ Date No. Sq 0— 14 Check #2>919 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Building Inspector b r Plans Submitted ❑ Plans Waived -0 ." "_.Certified Plot Plan ❑ Stamped Plans ❑ TYEE_OESEWERAGEDISPOSAL" - Public Sewer Tanning/MassageBodyArt ❑ .. Swimming Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ Private.(septic tank, etc__ . ❑ - permanent Dempster on Site ❑ THE..FOLLOWING SECTIONS FOR'OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE. REJECTED . PLANNING & DEVELOPMENT` ❑ COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments Zoning Decision/receipt submitted yes Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Todv.2 Engineer: Signature: Located 384 FIRE DEPARTt E� "NT Temp Dumpster on site yes no Located -at 124 Mair, Street - Fire Departure►it signatur_"eldate } COMMENTS r Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. :_Total land area; sq. ft. -ELECTRICAL: Movement'of.Meter. locati:on-, 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 NUTES and UATA — (For department use El Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fol iwing is a li'stof the required.forms to be filled out for the appropriate. permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Li Building Permit Application ❑ 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 ❑ 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 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo;�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.+.ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 123000.00 m $ - $ 144.00 Plumbing Fee $ 18.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 18.00 Total fees collected $ 280.00 365 Blue Ridge Road 890-14 on 6/10/2014 Finish Basement E9* It w 0 0 Fi O Z m CDZ NW �//••��V CL W F- a. a. vv .N E O Z 0 N O � I � � � 0 � to .E m m 0 a 0 t ^W0 �+ ' + im O 0 Q a. Q a OM v J 0-0 }; Z O CL V 0 1 1 � � OF- O F- o °C Z V W W O W 2 tail v1 H (� U LL Z Z z l VV a °c Q O Z O Z Z U W Q 0 m Cf- Q 0 W co LU LL v � m C .� a W >. O O N cv a t c t u t N + v Y O a Z 7 E to C 7 � c : v O O LL N L.L. �' U LL C LL �' N LL LL C0 N N E9* It w 0 0 Fi O Z m CDZ NW �//••��V CL W F- a. a. vv .N E O Z 0 N O � I � � � 0 � to .E m m 0 a 0 t ^W0 �+ ' + im O 0 Q a. Q a OM v J 0-0 }; Z O CL V 0 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 ACRO OF LIABILITY INSURANCE DATE (MMIDDIYYYY)CERTIFICATE 112/06/2013 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 LLCPHONE 198 Massachusetts Avenue North Andover, MA 01845 Durso & Jankowski Ins. Agcy. CONTACT NAME: FAX Arc No Ext: AIC No: E-MAIL PRODUCER CUSTOMER ID q: FAYCO-1 INSURER(S) AFFORDING COVERAGE NAIC p INSURED Fay Construction Co. INSURERA: Main Street America Assurance 14788 ` Charles A. Fay, Jr. INSURER B: NGM Insurance Co 14788 20 Beresford Street X COMMERCIAL GENERAL LIABILITY Lawrence, MA 01843 INSURER C: MPP48851 06/07/2013 INSURER D: INSURER E: INSURER F : 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-.- INSR LTR TYPE OF INSURANCE Building Department POLICY NUMBER POLICYE MMIDDIYYYY POLICY P MM/DDlYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPP48851 06/07/2013 06/07/2014 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS -MADE 51OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 'GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 2,000,000 RO POLICY ECT LOC $ B AUTOMOBILE LIABILITY ANY AUTO M1T9239C 12/18/2013 12/18/2014 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Perperson) $ 100,000 ALL OWNED AUTOS BODILY INJURY (Per accident) $ 300,000 X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ 100,000 (PER ACCIDENT) $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEF—] WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 77 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 TOWNNAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Noreen 1600 Osgood Street suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Durso & Jankowski Ins. Agcy. ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i. Fay Construction 20 Beresford street Lawrence, MA 09 843 E-mail faycon7@comcast.net Name / Address Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma, Estimate Date Estimate # 6/5/2014 164 Job location Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma Customer Phone Terms 978 806 7725 Description Qty Rate Total Basement: 600 sq.ft of previously finished off area to be cleaned up and reconfigured with 22 ft of partition wall. Building and elect.permits: 1 400.00 400.00 Remove carpet and pad-- suspended ceilings --baseboard and trim-- electrical 8 85.00 680.00 wiring. strap ceilings with 2 1/2" pine --layout and construct 22 ft partition wall --frame 20 85.00 1,700.00 for closet at drain clean out. Remove existing electrical and install wiring for lighting and outlets --2 cable 14 85.00 1,190.00 locations --15 cans --18 receptacles. rough and finish. Install 26 sheets blueboard and plaster walls and ceilings. 1,900 1.00 1,900.00 Install 160 ft .5 1/4 speed base --casing existing window --install 2 closet doors ( 8 85.00 680.00 6 panel hollow core) Materials handling 6 85.00 510.00 Materials framing 1 850.00 850.00 Materials finish lumber and doors 1 450.00 450.00 Materials electrical 1 600.00 600.00 Painting by others ceilings--walls--trim $ 1200.00 by others 1 0.00 0.00 flooring carpet by others 66 yds @ 25.00 $1700.00 by others 85.00 85.00 Trash Removal: 450.00 450.00 Total Page 1 N. 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 # 6/5/2014 164 Job location Denise& Dale Beaudion 365 Blue Ridge Road N. Andover Ma Customer Phone Terms 978 806 7725 Description Qty Rate Total Owner: Fay Construction------- ------- Home owner: Dale Beaudio--------- ------ Total $9,495.00 Page 2 a 0 C2 m W, M ON .v ON The Commonwealth of Hassachusetts - Depa>rtmentoflndustriglAccidiie -is Office of Investigations 600 Washington Street Boston, .MA 02111 www.mass gov/dia Workers' Compensation bsurance .Affidavit: BuiXders/Cont°actors)FIectr icians/PZumber.$ A.ppheant Mormation Please PrintLedbXy 'Name (BusinessfOrgani'zaiion/Tnd%vidual): (Pk_ . Address: 40 & -"Ali C14W 3 City/state/Zip: Phone #: 9 ,?p pap 9,e 3S^ Are your an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. El I am a general contractor and l b. ❑ New contraction employees (full and/or part-time).* have hiredthe sub -contractors 2.0 lam a sole proprietor or partner- listed on the attached sheet: 7• ❑Remodeling These sub -contractors have 8. ❑ Demolition ship and`haveno.employees working forme in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised.their 3.01 am a homeowner doing all work right of exemption per MGL 11. [] Plumbingrepairs or additions myself: [No workers' comp. c.152, §I(4), and we have no 12.Q Roofrepam' irisuraucareqaire4.1i employees. [No workers' comp. insurance required.] 13.[] Other Mny applicant that checks box #I mustOsofill out the section below showing their workers' compensation policy information. ?'Homeowners who submitihis affidavit indlcatingthey hie doing allwork and then hire outside contractors must submit anew affidavit indicating such. lContractors that checkthis box must attached au additional sheet showkgthe name of the sub. -contractors and their workers' comp, policy information. I am an employer that isproviding workers' compensation insurance for my employees Beton is the poliey anu' job site in, formation. insurance Company Name: Policy # or Self ins. Lic. #: Expiration Data: f �✓�ity/State/Zip: ���7 Job Site A,ddxess: r ; Attach, a copy of the workers' compensatlonipo y declaration page (showing the policy number and expiration date). Failure. to secure coverage.as requiredunder 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 WORD 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 o£ investigations of the AIA for insurance coverage verification. �1 11 X do hereby ?Cft� jy der do pain enalties of perjury that the informadon,provided above zs true and correct. natw G Phone /#:9, — ? official use orzly. 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 - - - ��e (paa�2aoursP.ci�� a��!ary�acfu�aeC� Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 147062 Type: Expiration: - 6/8/2015- Individual CHARLES A FAY JR. CHARLES FAY 20 BERESFORD ST. _ LAWRENCE, MA 01843 Undersecretary Massachusetts - Department of Public Safety Board of Building Regulations and Standards u Construction Supers icor License: CS -058663 CHARLES A FAY JR 20 BERESFORD 5T Lawrence MA 01$43 J Expiration Commissioner 05/1112014