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HomeMy WebLinkAboutBuilding Permit #699 - 39 UPLAND STREET 6/15/2009Permit NO: 01 Date Issued: &4 f' r BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received �3 4 M * I �At - "V- I * IMPORTANT:'Applicant must complete all items on this page LOCATION ,� a n o �2 Print PROPERTY OWNER d Pnntti, MAP NO: PARCEL ZONING DISTRICT . Historic Machine t �_yes - �. TYPE OF IMPROVEMENT PROPOSED USE -e� Residential Non- Residential New Building One family Identification Please Tfpe Addition /Alteration Two or more family Industrial - ► � No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic We'll Floodplain Wetlands Watershed District = Water/Sewer ��.. e i DESCRIPTION OF WOR TO BE PRE MED: r, �(iS-b)n &,kce, -e� �,� C (0S i fl r � ' I'i8u-.; C4S 0oJ a Identification Please Tfpe or Printlearly) +Vj •�'� j OWNER: Name: ► � &cA n _ Phone: 61-7 1 Address: �a T -- q9 -763 ARCHITECT/ENGINEER_A s �� 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: $_ 25� Check No.: Receipt No.: I I NOTE: Persons contra ting with unregistered contractors do not have access to the g aranty fund ignatuce of Agent/Owner Signature of contractor,: ,i 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS f 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 L3 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) a 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 2.2008 Location �7 (/�r4 �crn /l J 7 - No. Kai Dater - TOWN OF NORTH ANDOVER 3? oAL s # Certificate of Occupancy $ �' b'•^° •'�� Building/Frame Permit Fee $ CHustt Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22'1,19 %Building Inspector The C ommon weaft of Massachusetts Department of Industrial Accidents Dice of Investigations 600 TTashingtnn Street Boston, X4 02111 c www m=s.gov/dia . Workers' Compensation Insurance Affidavit Builders/Contractors/Eieatricians/Piambers . �1D Aicant Inforexatian Name Address: cityst to/Zip:_ (DxwG WA- v Phone c/? #:. % I d J? Z EN9 Are y u an employer? Chmk.the appropriate bo= 1. = I am a employer with 4. ❑ I am a general contractor and I employees (fun and/or ptut-time).* 2. ❑ I am..a.sole proprietor or have hired the suircontiacxors listed partner- ship and have no employees' . on the attached sheet, 3 These subcontractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officershave exercised their right of exemption per MGL myself» [No•w.orkers' comp. c, LS2, § 1(4),'and we have no insurance -required.] t employee=s. [No workmza comp. insurance required.,] Type of Prgjeet (required): 6. ❑ New construction . T• remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs I317 .Outer `Any applicant that cjr boj # l must also fist out the section w. below ahoin their workers' iiosn ' t fiomeownera who submit this effi'davit indicating they are doing all WD* and them hie outside c nuactom p istnformahoa ;Cotttracwrs that check this bort tnustatkabed anadditional sheatsrg Elie name of the suh-t anttaetors show' , must submit a new affidavit indicating such rand their workers' corp• po=ic� ininm�ation. la .r2 et employerthivisivrnviding:workers,¢ompemadoriinsurance or infornsadon. f mJr enrploYees� Blow is the policy andjob site . Insurance Company Name:_ Policy # or Self -ins. Lie. #: J Expiration Date: Job Site Address:_ c��'� 4vi.c��dl . cityrstaie/z;p: X__ = c� Attach a copy of the workers' eampensation policy deciaratSoo page (showing the policy /9 number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500.00 and/or, one-year imprisonment, penalties of i of up to $250.00 a day against the violator. g advisedthat copy of thPeni s statement may be fores in the fbnn of a warded dOto etre p{fic of RK ORDER d a fine Investigations of the DIA for insurance coverage verification. I do hereby CV under elites o e fP rlwY gist the information Provided above is tri and correct Si titre: y 7 Date: Phone #: Ofj`icial use only. Do not write in this area, to he completed by raj, or town off curL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of lieaith 2 Building Department 3. City/T011- -Clerk 4. Electrical Inspector 6.OtbePlumbing5. Plumbing Inspector fl Contact Person: Phone #: Information a tad I�structions Massachusetts General Laws chapter 152 requires all emp 3 oyers 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 in do maintenance, construction or repair work oa 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 focal fieeusing-agency shalt withhold the issuance or reuewal of a license or permit to operate a business or oto construct 6iWings in the commonwealth for any applicant who has not produced acceptable evidencezit compliance with the insurance coverage required." Additionally, MOL chapter 152, §25C(7) states `Neither title 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 cornttracting 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), addrms(es): rind 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 orpartners, are not requiredlo carry workers' co-rnpensation insurance. Van LLC or LLP does have . employees, a policy is required. Be advised first this affidavit may be submitted to the Department of industrial Accidents for confirmatian 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-thDepartment of Industrial Accidents. Should you have any questions regarding the law or if you are requimd to obtain a workers' compensation policy, please call the Department at the nusanber listed below. Self-insured aorapani- should enterdm,ir self -insurance -license number on tile• 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 viIM bit-U§ed'as a reference nuigber. In addition, an.applicant that must submit multiple pennit/licw= applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under ".lob Site Address" the applicant should write "all locations in (city or town)." A copy of•fhe affidavit that has been,officiaily stamped or marked by the city or town may be provided to the appiicant 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 bum leaves etc.) said poison is NOT.required to complete this affidavit Tho 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 Commonwealth-& Massachusetts Departrnent of Industrial Accidents Office of Lnvesttibations ' 600 Washington Street Bosfon, MA 02111 TeL # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7749 Revised 5-26-(15 WWWmass.gov/dia oG/15/2009 09:15 FAX 8fU(t4V.1l0 � �/ CERTIFICATE OF LIABILITY INSURANCE D$ 1 06 15 `°r TONLY AND CONFERS'NO RIGH S UPON THE CER IFICATEION PRODUCERR�ICATE DOES NOT AMEND, EXTEND OR Durso 8 Jankowski Ina AgCY LLC }(OLDER THIS CE AFFOROEO BY THE POLICIES BELOW. Charles S • ta;aeLdone ALTER THE COVERAGE 196 MAssachusetts Avenue NAICN North Andover MA 01845 .978_Tg4_0313 INSURERS AFFORDING COVERAGE _,• phone: 978-692-5175 — INWRER_ A Guard Insurance 690_ INSURED INSURER B, INSURER C: 3l g9n� Homes LLC MISURERM street Groveland MnA 01834 nvsUReaE DVERAGES'WED NAMED ABOVE F THi POLICES OP INSURANCE TERM OR CONDITION 0 BEEN GNYRACT OR OTTHE HER (DOCUMENT WITH RESPECTORTO WHICH THIS CERTF+CATE MAY BE I�BB�UEO 0OR DIN ANY REQUIREMENT, MAY PERTAIN. THE INSURANCE AffOROnEA 13rY1RIT a POLICIES DESCRIBED IY PAID CLAMS 61IB.IECTO�EFfECti TO ALLTVIF RMS. EXCWSIONS AND CONDRIONS OF SU POLICIES, AGGREGATE LIMITS SHOWN -- SRRODR" ru¢rrYeNCE , POLICY NUMBER DATE IMMDDIYYYT DATE MMlOD1YYYY EACH OCC1IN�E GRNERAL LIABILITY COMMERCIAL GENERAL LIABILITY DLAIMSMADE LJ OCCUR G_EMLAGORRQATEPROR APPLIES PER POLICY Jecr LOC AUTOMOOILE IJABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON,OWNEO AI GARAGE LIABILITY i ANY AUTO e)(CE98 I UMBRELLA LIABILITY •� CLAIMS MADE OCCUR I—I DEDUCTIBLE RETENTION 6 LMDRKER9 COM TION AND I MPLOVERB• UAVILITY Y I N A RNY�P RIETORiPART,ERlEnCUTIIF-j DEWC911535 ,run�n CYI, I1RFfl'r MED EXP (Arty one"mr" u ;ER SONAL ILADI INJURY S GENERAL AGGREGATE 6 PRODUCTS . COMPIOP AGG 6 „ _ ... ..... COMBINED SINGLE LIMIT 6 (Ea e«IdnN BODILY INJURY t (Per person) BODILY INJURY S (Per eccidenl) PROPERTY DAMAGE S (Per eccidern) AUTO ONLY - EA ACCIDENT -6 GTHER THAN EA ACC S AUTO ONLY: AWI EACH OCCURRENCE _ !i AGGREGATE S S 10/25/08 10/25/09 E.L eACHACCIDENT 6100000 E,L DISEASE • EA EMPLOYEE 3100000 E.LDISEA3E-POLICY LIMIT 6500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 16PEGAL PROYI31{7I I6 No partner(IS) have elected coverage ----- "No partner(B) are covered by the workers , compensation policy." CERTIFICATE HOLDER Town of 19orth Andover 1600 Osgood Street North Andover NA 01845 !MOULD ANYOF THCABOIIe McRIEW MUMS M CANCELLED BEFORE TMe EXPIRAVOI NORTHI3 DATE THEREOF, TIME ISSUING INSURER WILL ENDEAVOR TO MAR, 10 DAYS WRITTEN NOTICC To THE CI°RTIPICATE HOLDER NAMED To THE LEFT, BUT FAILURE TO OO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, (M AGENTS OR (2009/01) I&Wfed marks of ACORD The ACORD name and logo are �4 6 Massachusetts; Department of Public Safety Board of Buildin„ RegulAtions and Standards o.onstruction Supervisor License.. License: CS 59703 Restricted'to . ,'IG STEPHEN-'DEHULLU W 32 BENJAMIN tST GROVELAND,.MA:01834. . . . . . . . . . Expiration: 9/14/2010 ------- T r#: 3975 <L Board of Building Regulandns and Standards HOME. IMPROVEMENT, CONTRACT -OR RegistMti6n' 11:8273 E -x, kaetonK�;--2-121/2011 Tr# 279446. : 10 In - ' . K �5-7!7-10 p tdyaway Cor orat 0 -1,zf J D. E R IUI L ILI IU H On M STEPHEN DEH 32 BENJAMIN STFtni GROVELAND, Administrator 67a 10, q ( 2D E s OD X�SI` - E 3. 14 boa z - Yard, _,a_ �U' pgQQvv :_ ADD ® A0 00 �13 04 -5,1. -TO 13 r7c, LAXt54 i�� Joe 1 UP/arid A N AN&vieea- Bul cm U LLQ 1-6mgs LL C 9 Z ben' a w", w 5.4. e* Ttt- q? S 37 2Sboca j r—o j �2 S( it - r Scott & Marissa McClintock June 10, 2009 THIS AGREEMENT made this 10th day of June, 2009 by and between Dehullu Homes LLC, 32 Benjamin Street, Groveland, MA 01834 hereinafter called the "Contractor" and Marissa McClintock, 39 Upland Street, North Andover, MA hereinafter called the "Owner". The Contractor shall furnish all of the materials and perform all of the work outlined in the attached General Specifications and Price Quote entitled Attachment A, pages one through two, annexed hereto and incorporated herein by reference as they pertain to the work to be performed on or at the property located at 39 Upland Street, North Andover, MA. The Owners shall pay the Contractor for the Contractor's performance of the Contract the Contract Sum of $21,600 (Twenty One Thousand, Six Hundred Dollars and no cents). A down payment of $2,160 (Two Thousand One Hundred Sixty Dollars and no cents) or 10% of the contract price is required to bind this agreement and is due upon the signing of this contract. The construction disbursement will be as outlined on page two of Attachment A. Each disbursement will be based upon invoices submitted by Contractor. The Owner shall make progress payments on account of the Contract Sum to the Contractor according to Attachment A attached hereto. The Owners, without invalidating the Contract, may order changes in the work consisting of additions, deletions or modifications; the Contract Sum will be adjusted accordingly. Such Changes in the Work shall be authorized by a written Change Order signed by Owner and Contractor and payable upon signing of such Change Order. Any Additional Work will not commence until the signing and payment of the Change Order. All material is guaranteed to be as specified. Al work to be completed in a workmanlike manner and in compliance with all building codes and other applicable laws. Owners to carry all necessary homeowners or builder's risk insurance. Our workers are fully covered by Workman's Compensation Insurance. All work is guaranteed with a one year builder's warranty. We the undersigned, have read, understand and agree to all the tos.above: ut, La Scott McClintock -Owner Date Stephen M. Dehullu - Contractor bate Dehullu Homes LLC Marissa McClintock - Owner Date ***DEHULLU HOMES LLC*** (978) 372-5000 ***DEHULLUHOMES@AOL.COM*** GENERAL SPECIFICATIONS AND PRICE QUOTE Scott & Marissa McClintock Attachment A Description: Remodeling of second floor bathroom, remodeling of existing breezeway into entryway and laundry room, construction of new 5 x 8 closet in master bedroom, and new tile installation in first floor bathroom; to include the following specifications: 1) PERMITS a. All necessary permits as required 2) SECOND FLOOR BATHROOM a. Remove wall between bathroom and closet, install new three piece white_fii.berglass shower and Symmons chrome shower valve b. Move front of existing master bedroom closet wall for shower, sheetrock and repair c. Add new fan/light vented to outside, medium grade d. Install tile floor, owner to supply tile, standard installation, cement board underlayment installed over existing linoleum, oak threshold e. Install new 30" vanity, owner to supply vanity f. Install sink/faucet, owner to supply sink/faucet g. Move hinge on bathroom door to swing to other side, patch existing hinge h. Install new white toilet, 1.3 flush per code, install towel racks L No painting included, will price upon request j. $8,000 3) REMODEL EXISTING BREEZEWAY INTO NEW ENTRYWAY AND LAUNDRY ROOM Replace four windows with new thermo pane windows to match existing in existing openings, block off one back side window where dryer will butt up against window, repair siding a. b. Replace front entry door and entry door to backyard area with two new 9 lite steel doors with aluminum thresholds c. Insulate floor and ceiling of breezeway, R19 floor, R30 ceiling d. Wire new laundry area for washer and dryer, outlets per code e. Build new % wall to separate front entry and laundry room f. Tile floor, standard installation included, owner to supply tile, cement board underlayment g. 5/8" fire code sheetrock on wall which abuts laundry room in garage h. Leave existing door from breezeway into main house I. Baseboard heat, install in laundry area and entryway j. Plumbing for new laundry, with laundry shut off valve k. No painting included, will price upon request I. $9,050 L VA 4 K ***DEHULLU HOMES LLC*** (978) 372-5000 ***DEHULLUHOMES@AOL.COM*** GENERAL SPECIFICATIONS AND PRICE QUOTE a Scott & Marissa McClintock Attachment A 4) New 5' x 8' closet in master bedroom: a. Insulate, sheetrock walls and tape b. New pocket door and trim to match existing c. Install prefinished hardwood flooring in new closet area d. Install one shelf and one hanging pole e. Install one 36" florescent light and one single switch f. Install one access door to storage area g. Labor and Materials included h. Painting not included, will price upon request i. Moving of heat to accommodate new shower j. $3,600 5) New the installation first floor bathroom a. New the floor %" underlayment installed over linoleum, tile installed over underlayment, standard installation included b. Owner to supply tile and grout c. New closet door to replace laundry chute access door d. New closet door for linen closet to match existing e. $950 6) Price Quote: This price includes the complete construction and remodeling of your o at 39 Upland Street, North Andover, MA according to these general specifications. For the su of $21,600 (Twe ty One Thousand, Six Hundred Dollars and no cents). 7) Payment Schedule: Down Payment 10% $2,160 Rough Frame $4,320 Rough Plumbing $4,320 Windows & Doors $4,320 Finish Plumbing & Tile $4,320 Upon Completion $2,160 Mr� F' ***DEHULLU HOMES LLC*** (978) 372-5000 ***DEHULLUHOMES@AOL.COM*** Ems'♦ x. w A O U W c O w aRi U) a ca a b p w X O c� V U � G w" a .� p w � G w a w w p a: cY C w p a p w G w ZW w w cq z cn cn -,; J&77 c c m c o L • O y 0 �10 O �+ +c C L- y ES r.. C m i:+ �w v CD • y-+ a y C.), - 1,- * O .4T` 6:m= 7O z all L L r O y m 3 cm m V • :o � c �, m a h 'm C O COD m '•� y m m m O cm C O Q H •� I: p,Ct � m or V y O t�.iCD =O O F- H 'D W = Or=... flL uml O A .Ma 'd= 0 C W .E c.2 ca cm C.3 m o m c VD a m- O-0 S (C A i y O O F. CD 0 C L Q Z co C. O y o c CD CM I Q COD in coCO2 CD W CD 0 G3 CL I.- CD CD CD CD 0 L M O d CL C Q C2 cccc CCO2 15 C CD CD CL. V y c C C C .c CO)CL G ul vI LU U) W W W U)