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Home My WebLink AboutBuilding Permit #42-12 - 45 CRICKET LANE 7/19/2011 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Y Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION '15 (fq:-" c k -e- V L,a ,�� Print PROPERTY OWNER M -P--03 & IV 5 Unit# Print MAP NO: 10 PARCEL: "o l`l ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial RIAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic �j We11 ❑Floodplain 0 Wetlands 0 Watershed District . ater/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: ►-i-ef� fz-e Q t CQ,�3•'�e �� S-) --e-1- V.s� (Z 5 4- C4 (Identification Please Type or Print Clearly) OWNER: Name: r�-,Q �-o z is ; ✓ter Phone: 2 sy3 Address: `l S C C CONTRACTOR Name: �� /N-k -e S ca Phone: a a Address: AP\'e-- d-J 5''� E�e-'�' /y . ./ <✓ Supervisor's Construction License: s W 1 1 Exp. Date: �O 7 Home Improvement License: ? a a Exp. Date: ► 19 l k 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: $ SI C)0`o FEE: $ . 6Y6 Check No.: Ci , Receipt No.: qt�:96 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agerit/Owner-_ Signature of contractor Location No. Date/ LORTN TOWN OF NORTH ANDOVER 3? ,,so .�'��0 ,. , O F w 9 Certificate of Occupancy $ ZT .1cMus CHU tt�' Building/Frame Permit Fee s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 9 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 2011 June/mi 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 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: Doc.Building Permit Revised 2008mi ,qORTM Town of No. p Y,� ' - ;.�.F.. over, 1Vlass., ' I 0 LAKE COCMICKEWICK V %A0RATED S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T Dw • BUILDING INSPECTOR THIS CERTIFIES THAT.......1'�l.t.L.......a.a.bilwo.............................. .............................................................. Foundation has permission to erect........................................ buildings on ..gr......er)'&. r......... Rough AAo to be occupied as....,. ........(.`!'!rw�.................... ....................................................................................... Chimney provided that the peson accepting this permit shall in every respect conform to the terms of the application on file in 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 Final SOPERMIT EXPIRESIN 6 THS ELECTRICAL INSPECTOR UNLESS CONS�'RU ONS �'S 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. 'tido+.�achtrsetts_ Roar'cirtf t ._:n{irairtrrrcnt.r�t'p Bui,tlrn",j Rv,, uhlic.Safete Construc;io atlatirrna.`ciritl.� ; n ShPerDisor St tr}clartdti-. . _ License: cs 54718 License DAMES M TESTA 5 APP LETON ST N ANDOVER y MA 01845 (ur'rmssiuni•r ExPiratio ,.. z, n: 6/8/2012 rr�#.: 29825 e Offeo ��-_� � °ftii _ Reairs gistrationt*'�EMENT CON7.R4C ss Regutatio Expiration.,,; 120296 ACTOR TEST TYpe`,` t 1 dt`U19l2011 q BU1LDl 3dua1 _ �^ Tr;.t 290924 JAMES TEST tG REA,IOpE PPLETON S N qT E CI1�jG NDOV 01`4 ^�> Undet3eeretary I I ! 1 : , - - '- - -- - -- i , I , • 1 : I I : L I : i — I , IF- : : I I : fi : tt r , i ! i : : : : I , I ; t i I 11 i I. v I i I : ; I - ; i I i I , i ,i - - - - - - i ' �1 SQ" i i-E-D I I , ( - - _ - , , --- ; - - - ----- - -- -- � - - - - . ----; , tai _ I I ! I ; , : I , I i i I I , - -- - KUM 6S !G - i I , I : I ! I - - 7-7 . _ - i I T I i I I I 1 __ _ I , ' I t• ��-� � '� �� I I cc -- --..------.._._-.-----— -- - Cj _ 1 - - —Z` -- - ------- --- --- -- ----.. -yam \�jyr i I I I I i I ' • j I : I I I } � i I i � I � 1 i I � I_-!-�_ ! i -----1- ' 1 --f r -r--•---I I { F-1-1 l � ! ! 1 ELECTRICAL : Remove all old wiring in the kitchen area . Rewire kitchen to code. Supply and install recessed lights. Supply and install under cabinet lights. Note : There is no allowances for light fixture other than the one specified . INSULATION : Install R 15 insulation with a vapor barrier on all the exterior walls. Insulate the walls in the bathroom for sound. PLASTER : Hang %" blue board on the ceilings and the walls. Skim coat plaster will be applied to all the walls and ceiling in the kitchen . CARPENTRY : Install all the kitchen cabinets and molding as per the designers drawings. Install new trim in the kitchen around the windows and doors to match the existing trim in the house. Installation of all kitchen appliances. Remove the slider and install a french door. Replace the exsisting kitchen window. TILE : . Install and grout tile for kitchen back splash . Note : No allowance for tile and grout. Labor and adhesive only. A finance charge of 11/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. 1 propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of: $27,329.00 Twenty Seven Thousand Three Hundred and Twenty Nine Dollars One-third to start, one third after insulated , one-third upon completion. Authorized signature c" I reserve the right to cancel this contract if not accepted in_30_days Signature Signature DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES T E,;'�� TA Building and Remodeling 5 APPLETON STREET NORTH ANDOVER , MA 01845 HIC Lic. 120296 Expires 11/19/11 (978) 682 2023 CSL Lic. CS 54718 Expires 6/8/12 _ Proposal July 18, 2011 Proposal Submitted To: Mel and Pat Robbins Home Phone: (978) 682-2253 45 Cricket Lane North Andover, MA 01845 Job: Remodel kitchen Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. DEMOLITION : Remove all cabinets and counter tops. Total gut all the walls and the ceiling in the kitchen. Remove the existing flooring down to the sub floor. PLUMBING : Remove a strip of heat in the kitchen and add a kick space heater. Note : There is no allowances for plumbing fixtures for the kitchen. A finance charge of 1112%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of: $27,329.00 Twenty Seven Thousand Three Hundred and Twenty Nine Dollars One-third to start, one-third after insulated , one-third upon completion. Authorized signature :2 1 reserve the right to cancel this contra if not accepted in_30_days SignatureF"4' ,1/-�y"��& - Signature DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information �—+ Please Print Legibly Name(Business/Organization/Individual): -- - !e .S-�✓-L Address: 5 �- City/State/Zip: 0l Phone#: ''7 g- � Fre n employer?Check the appropriate box: _ a em to er with 4. Type of project(required): p Y ❑ I am a general contractor and Ioyees(full and/or part-time).* have hired the sub-contractors 6' ❑N construction a sole proprietor or partner- listed on the attached sh%et. # T• Remodeling nd have no employees These sub-contractors have8. ❑Demolition ing forme in any capacity. workers'comp.insurance. orkers com .insurance 5. 9• ❑Building addition p ❑ We are a corporation and its ed.] .officers have exercised their 10.❑Electrical repairs or additions . 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 required.]t 12.0 Roof repairs insurance re ] employees.mployees. [No workers' comp.insurance required.] 13•❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 tlae policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: , 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi the pains and penalties ofperjury that the information provided above is true and correct. Si nature: Date: tti' <t Phone#: -?,W- Lo$ `� O� 3 EOther only. Do not write in this area,to be completed by city or town official. n: Per # hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector:5. lumbing Inspector son: 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 apartinents 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 an please do not hesitate to give us a call. Y y questions, The Department's address,telephone and fax number: The CoI-ntnonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1877-MASSAFE Revised 5-26-05 Fax#617-727-7749 vvww.mass.gov/dia i i NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: u 5- c r: c lcz - - L--,- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) ignature of Permit Applicant 7 1 taotj Date lq ;5s �e