HomeMy WebLinkAboutBuilding Permit #159 - 42 VEST WAY 8/29/2007 BUILDING PERMIT tt�`° do
TOWN OF NORTH ANDOVER A p
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received `°RAT.o
�9SSACHUS��
Date Issued:
complete all items on this page
IMPORTANT Applicant must comp p g
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L�CATIf3N�� ti
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TYPE OF IMPROVEMENT MENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑ Addition ❑ Two or more family 0 Industrial
No. of units: 11 Commercial
KRepair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
atera �dD�str��r ,DESCRIPTION OF WORK TO BE PREFORMED:
,�� ,;�� -r- �✓�� ;&D oo/u/Jice
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
,fixr +f ^vrA -,V,5� ft R113
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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: $ 3� A
Check No.:T, Receipt No.: 0() 'SAL
NOTE: Persons contracting with unregistered contractors do not have access to the guar ty fund
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
DATE REJECTED DATE APPROVED
CONSERVATION ❑ . ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
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 Dririif4wav Permit
Located at 384 Osgood Street /
FIRE flf PARTMENT Temp;Dumpster� ti It
F
Locatea a# 124Mair street ' a ry
partrnent�signaturelda`te� ,
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.$10041000 fine
NOTES and DATA— (For department use)
.9 C 0 g "'A I,
❑ Notified for pickup - Date
........................................................ .................. ........................................................ ..._..._.._.......................................................
Doc.Building Permit Revised 2007
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 }
❑ 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
Li Certified Surveyed Plot Plan -
❑ Workers Comp Affidavit -
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o 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
a Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
i
1
' Revised 2.2007
Locationyor �A '
No. Date
I
�pRTM TOWN OF NORTH ANDOVER
F 9
` Certificate of Occupancy $
. � ; .
Building/Frame Permit Fee $ _
swCHus
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check # �
0544
Y
Building Inspector
NORTH
Town of over
No. 4:97
llk7
rte" dover, Mass.,�,
-C
OC ICHEWICK
ED
BOARD OF HEALTH
Food/Kitchen
PERMIT T Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT......... ............(w........................................................................................................ Foundation
lu 411f ....... ....W.64 on
has permission to erect buil .......... ..
to be occupied as..... 'c i.n,,s on . ................... Chimney
........ ......
. .... ...... .......... .. ... . . . ....... . . ..... .... . .... ....
provided that the peri�-Kacc this.'pt permit it..shall in every.respect.conform.to.the..term.s..o.f..the.application. ... ..on. ..filein 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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUOCNJS ARTS Rough
- %
........ .... 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.
13O
License.- C OF gU1L`J)j v
Nq C�NSTRUCTI p G REGljl_ .
IBu thmber CS=, 0724 N SUPERVISORS
date 1p%13/196q 25
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10f?3/Zp�
STEVEN P Restr�cteq z Tr-no:
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3p KOP SACKS 323.p
PEL NAM NH X3076 > f f
cm� �:
missioner
Regulations and Standards
Board of Building T CONTRACTOR
lugHOMEIMpROVEMEt4
Regstrat►on 127029
Ezp!rat�on $12412008
MODEL==ING
JACKSON BUILDING>&RSM $
JACKSdN�" � "' `a ••
STEVEN
UNIT 24 Deputy Ad�inistra
PELMAtar
1 INDUST NH 03076
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I Note:This drawing is an artistic Designed_6/7.12007
irrterpretationofthegeneratappearanceof ' ,:c«wowccs J 1?rinted:617/2007
i the design.it is not meant to be an exact — ---
1 rendition.
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l•d 'VV66099£09 suenals puy a01lel d9E:-V0 LO LO unr
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Office of Investigations
600 Washington Street
JW' Boston MA 02111
www.rnass.g ov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): kU/c.O/A, L.<<C
Address: / //L/0V87-6Z DA /t1,c- '#-2�t
City/State/Zip: P67L ff 4✓f NW 023076. Phone #: 16'03 0 70 DD
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.El am a sole proprietor or partner-
listed on the attached sheet. # F-1 Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. [:1 We are a corporation and its
required.] officers have exercised their
10.❑ 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 121-1 Roof repairs
insurance required.] t employees. [No workers'
13.❑ Other
comp. insurance required.]
*Any applicant that checks boz#l 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:7•01CbCtf k " %A�5 CO,
Policy#or Self-ins. Lic. 7 6 —Yl 7 `OZ Expiration Date: 11116,6
Job Site Address: yZ Il��7- t.O Al. d6zl1-W City/State/Zip:
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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify er th ains and penalties of perjury that the information provided above is true and correct
Si ature: 141&P-77'g-r/2 Date: eIZI5107
Phone#:
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 Inspector 5. Plumbing Inspector
6.Other
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-contractor(s)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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05
www.mass.gov/dia
l
ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE1/01/°'"7
01/o1/zoo7
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Doug Jones cfo Cedar Hill Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8800 E.Chaparral Rd,Suite 230 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Scottsdale,AZ 85250 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
NSUREO
Genesis Consolidated Services,Inc.Aft. IL�.suRL�A: Zuridl-American Insurance Company
Remodeling,LLC EmP:SP Jackson Building 8 INSURERB:
76 Blanchard Rd. INSURERC:
Burlington,MA 01803 INSURER D.-
INSURERE:
OVERAGES
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.
TYPEOFINSURANCE i8R POLICYEFFEC LVE POLICYEXPIRAMON
POLICYNUMBER Lam
GENERAL LIABILITY EACHOCCURR94CE s
COMMERCIAL GENERAL LL40 M aoaxenee $
CLAIMS MADE a OCCUR MEDEXP(Arwonepemm) $
PERSONAL&ADVINJURY $
GENERAL.AGGREGATE i
GENIAGGREGATELIMUAPPLIESPEIt PRODUCTS-COMPIOPAGG S
PIN PRO UTC.
AUTOMOBILE LULBILITY
Mrr
ANYAVTO (EamMerd)S LEu $
ALLOWNEDAUTOS
BODILYINJURY s
SCHEDULEDAUTOS (Perp—)
HIRED AUTOS _
ILYINJURY
NON-OWNEDAUTOS (Per ) S
GARAGELIABLLITY AUTOONLY-EAACCM84T S
ANYAUTO EAACx $
OTHBtTIWd
AUTOONLY: AGG $
EXCESSIUMBRE L ALIABILITY
EACHOCCURR>3NCE S
OCCUR CLAIMS MADE AGGREGATE s
S
DEDUCTIBLE $
REnaam S s
WORKERSC OMPENSATMANDX WCSTATU OTIL-
EMPLAYERS'LIABILITY -
A ANYPRoPRmTORI mmeiIE marnVE WC 45-76-517-02 01/01/2007 01/01/2008 F.1.FACHAcgDENT $ 1,000,000
OFFKUM AEMUROKCLUDED7 EL DISEASE-e►eYLPLOYEE $ 1,000,000
sP LPROVI rISbebw E.LOWaM-POLICYUMIT s 1,000.000
OTHER
Location Coverage Period: 01/01/2007 01/01/2008 Ca tiflcate#: 07MAM742834
CINnt#: 1965-NH
)ESCRWnCW OF OPERAIMM I LOCATIONS I V EIBCLES I E XC W BIONS AOUD BY ENDORSEMENT/SPEMAL PROVISIONS
Coverage is provided for only SP Jackson Building&Remodeling.LLC
b 30 KoWs Lane
Pelham,NH 03076
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF.THE ISSWNG INSURER WILL ENDEAVOR TO MALL 30 DAYS WRITTEN
I Industrial Drive Jackson rng&Remodeling,LLC NOTICE TO TILE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL
Drive
Unit 24 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE DISURER.ITS AGENTS OR
Pelham,NH 03076 REPRESENTATIVES.
'. ._ AUTHORIZEOREPRESENTATME
4CORD 25(2001/08) ( 0ACORD CORPORATION 1988
J aylor & Stevens Cab ine try L.L.C.
1 Industrial Drive #24
Pelham, NH 03079
Mass lic#0,72425 .;s"
H.I.C. #12702,9,
�4 -
CONTRACT July 29, 2007
Client/Owner Name: Val&Rich Lee
Client/Owner Phone number(s) 978-688-0837
Mailing Address: 42 Vest Way,Andover, MA 01810
Subject Property Location: Same
a�
Scope of work: •t',
Kitchen Remodel,-as per design:
e "
Demolition:
During demolition work areas to be sealed of from main house and
vented outside all work areas vacuumed during and at end of each
day,
All floors to be covered with hardwood flooring protective mats.
Removal of existing kitchen cabinets,counters.
Remove small section of wall on end of cabinet run.
Plumbing:
Demo/disconnect existing sink faucet and dishwasher.
Install kitchen sink same location with new PVC trap and new shut offs.
Install customer supplied new sink and faucet.
Install dishwasher and new water supply line to refrigerator.
Fixtures and faucet supplied by homeowner.
S. P.Jackson Building and Remodeling 7/29/2007 Page 2
Electrical:
Supply and install (1)micro circuit
Supply and install outlet for fridge
Supply and install power for electrical stove
Supply and install power for dishwasher
Supply and install under cabinet lights
Wire and install pendant lights over island controlled by existing switch leg
Wire and install pendant light over sink
Supply and install(7)halogen lamps in existing recessed lights
Demo of area where new fridge is going
Relocate(1)phone jack to new desk area
Supply and install (2)outlets at new counter space as needed per code
Permit Fee Up to$50.00
Not Included:
Changing of kitchen devices which are existing
Smoke detectors
Carbon Monoxide detectors
Requirements of electrical inspector
Hardwood flooring:
Includes labor to supply and install 2 1/4"prefinished red oak strip flooring in
kitchen/dinette area up to laundry hallway.
Wall and Ceiling Finishes:
Wall and ceiling to be patched where wall has been removed.
Cabinet installation:
Includes labor for cabinet installation as per drawing supplied by Taylor&
Stevens Cabinetry
Cabinetry by Taylor & Stevens Cabinetry:
Cabinetry, and counter tops quoted separately.
Total Contract Price $17,940.00
S. P. Jackson Building and Remodeling 7/29/2007 Page 3
Terms:
lSt payment due upon signing contract $2,000.
2nd payment due upon demolition complete $3,000.
3rd payment due Rough plumbing&i rough electric complete $6,000.
4th payment due upon cabinets installed $3,000.
5th payment due upon flooring installed $2,400.
Final payment due upon completion of work $1,540.
General Requirements:
Permits and Fees:
S.P.Jackson building&Remodeling, L.L.C. shall make application for building,
plumbing and electrical permits. In the event that zoning or other issues preclude
issuance of the permits,the owner shall be responsible for making application for
variances,reviews,etc, in order to obtain permit.
Insurance:
S.P. Jackson Building&Remodeling, L.L.C. shall submit proof of insurance to
Owner of$2,000,000 General Liability insurance and Workmen's Compensation
insurance for all employees. Owner shall provide adequate general homeowner's
liability insurance to cover cost of work and associated protection as owners see
necessary. General liability for any subcontractor shall be set at$300,000.
General Contractor shall submit within 10 days of request a copy of proof of
insurance of General Contractor and of all subcontractors.
Verification:
General Contractor shall collect all verification inspections from municipal,
electrical,and plumbing inspectors and present to Owners. Owners are allowed
free access to inspect work at their own risk of injury.
i.
I .
S. P. Jackson Building and Remodeling 7/29/2007 Page 4
Warranties:
General Contractor shall comply with Massachusetts Warranty guidelines. All
installations shall be warranted for a period of two years after issuance of
certificate of occupation provided payment is made in full. Subcontractors are
responsible for presenting General Contractor with appropriate warranties,
manuals andrtinent product
pe p information as requested,to be complied and
presented to owner upon completion of project.
Additional Work:
Any changes in these specifications or reference documents shall be accompanied
by a written additional work authorization form with price quoted signed by S.P.
Jackson Building&Remodeling L.L.C. and homeowner prior to starting the
additional work, or shall be executed on a time and materials basis at$75.00 per
hour/per man plus materials.
Interim and Final clean up and Debris Disposal.
Debris shall be removed and disposed of at approved landfill.
-Definition of allowance:
The cost allocated in the proposal for a particular item. An allowance is usually
provided for those items,the cost of which, is dependent on personal preference
and o ncr sciection,or in fhc inability and partiality of ascertaining a firm figure
on a particular element of the work that may be executed by a third party. If the
item costs more than the allowance, a charge for the extra cost markup is added to
the contract. If the item cost less than the allowance, a credit for the savings is
deducted from the corresponding payment per the t:,ament schcdule.
T, (we),the undersigned; unider%tand.and accept the above L'IAU'tLL:
712�0
Owner's Signature liate
5/1
Owner's Signatu Date
-710 -7
S.P. jack- . Building& Rernodeling L.L.C. Date
32 Mammoth Rd.
Pelham, NH 03076
603-880-9944
Lee Residence
42 Vest Way
North Andover MA
Cabinetry
(DiamondDistinc o Montgomery Kitchen
Kitchen&island w/ w/Paint
Liberty end panels $8,095.18
delivery $200
Total $8,295
Countertops
71 sf $3,550 special colors
Granite Bianco Sardo
TOTAL $11,845
S