HomeMy WebLinkAboutBuilding Permit #836-76 - 456 SALEM STREET 2/16/2016Permit NO: �—
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
Iteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
sd Septic VNel)
CFPoodplain VVe#lands
❑Watershed District
a3,
r _.
.
r New Cax
C6
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
+t
1
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BAS DON $125.00 PER S.F
Total Project Cost: $_ 7� 060 FEE: $
— /)Z Check No.: _'1///, Receipt No.: fes,/
NOTE: Persons on ratting with unregistered contractors do not have accgs to guaran'p fund
�.
4
IN--( , E UILDING PERMIT _• 6 No 0 °T bq�'c
4s
TOWN OF NORTH ANDOVERfo
APPLICATION FOR PLAN EXAMINATION _
� 4 m
Permit No#. Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWN
Print 100 Year Structure
PARCEL: ZONING DISTRICT: Historic District
Machine Shop Village
yes no
yes no
yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
Septic, ®-We P y�I
Fl:oodplan ®Weflands
❑lWaters e r D'stnct
Wate/Se` �N
DESCRIPTIUN OF VVUMM i U tit Vr-MrUtUvir-u:
Identification - Please Type or Print Clearly
OWNER: Name: Phone:
AAArocc-
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License:
Home Improvement License:
Exp. Date:
ARCHITECT/ENGINEER Pho
Date:
Address: Reg. N
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: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
aCirrn.atizir.'AfnfdrinntrrL r;. a
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
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
r
P;ianning 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 Dieter location, waist 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)
LJ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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
4- Building Permit Application
� Workers Comp Affidavit
4. 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
NE: 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/Cross Section/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 .
OTE: 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
4� Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
TOTE: 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: Building Permit Revised 2014
0- .� *-, 'd .
"own of North Andover
layment Date Tuesday, February 16, 2016
)eposit Number 1602161
)perator Counter pc I
MCR (BUILDING INSPECTION) $564.00
0
'otal Paid $564.00
'ash $564.00
'hange $0.00
teceipt Number gov00004540
!/1612016 1:37:33 PM
lame 456 SALEM ST
'ashierld. treascoll-17
Certificate of Occupancy
Building/Frame Permit Fee.
Foundation Permit Fee
Other Permit Fee
TOTAL
C k#
hoc
7
Building Inspector
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 471,000.00
m
$ -
$
564.00
Plumbing Fee
$
70.50
Gas Fee 100 comm.
$
1i0.0i.,0&
Electrical Fee
$
70.50
Total fees collected
$
805.00
456 Salem Street
886-16 on 2/16/16
Kitchen Remodel
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a
Quote # 02012016
Campaniello Kitchen Replacement
Scope of work:
• Paint
o Ceiling & walls in kitchen
o All new trim work
1
a
o Touch up in hallway and bathroom as needed.
• Dispose of all debris
Key Notes:( prices based on)
• This quote is an estimate of the total project as written in the scope of work, and any
hidden issues such as rot, or insufficient framing, plumbing or electrical will result in
extra cost, to customer
• Electrical budget is based of REMODEL not REWIRE.
• Includes no appliance or Fixture budget.
• Includes Standard backsplash the and installation included $5 PER SQft included
• All materials purchased by and work subcontracted by I.H.S. with include 15%
Contractor fee.
• Dumpster will be onsite throughout duration of project
• Innovative Home Solutions will work with as little disruption to home owner as possible
Project Totals
$47,000
4
Break Downs
Demo/Prep
$2,500
$150
Plumbing / appliances
$1,500
$200
Gas
$800
Electrical
3,300
Cabinetry/Carpentry
$17,3
Quartz Countertops
,500
Farm House Sink
900
$250
Window Into Livingroom (includes framing,
$1,500
$500
drywall, trim, paint)
Flooring
$5,000
Tile Backsplash
$1,150
$300
Final Clean Up.
$300
Paint
$1,250
$350.
Disposal
$525
Permit fee
$300
Total Kitchen Replacement
$4z'000
i
3
This contract is between (The "Home Owner") and
Innovative Home Solutions, L.L.C. (The "Contractor"), who is licensed in the State of
Massachusetts under H.I.C. license number 172639. Innovative Home Solutions
warrants that they currently hold a valid license under the laws and statutes of the State
of Massachusetts. Innovative Home Solutions LLC is working as General Contractor to
the Home Owner, and takes Responsibility for sub -contractors involved in the remodel,
Signature of this contract confirms customers understanding and agreement to
contract, as written in "scope of work" and "key notes" section of Quote #02012016.
Estimated Project Totals: $47,000, based of scope of work.
Project Address: 456 Salem Street, North Andover
Project Description: Kitchen Remodel
Payment: Payment shall be made in installments, on the agreed schedule benchmarks
to Innovative Home Solutions, L.L.C. with the final installment upon completion &
home owners full satisfaction of the services described in this contract. Extra worked
needed, upon discovery will be billed upon work completion
1. 25% Upon Contractural Agreement. (To place Cabinet Order)
2. 25% After start of Project
3. 25% Upon Delivery of Cabinetry
4. Balance Due upon completion and Satisfaction
IN WITNESS WHEREOF, this Contract has been executed with the intent to be legally bound.
OWNER
'Ovao6
Date
CONTRACTOR
4
Date
Innovative Home Solutions, L.L.C.
4 Birch st Billerica Ma 01803
1-(978) 8331120
0
08 Commonwealth of Harssrrch usetts
Department 0f1'ndustrial Aceldents
_.. .l Congress Street, ,Suite 100
r ` _Boston, AY ®2.114 .2017
www mass.gov/dza
,arkers, Compensation insurance .Affidfadt: )guiders/ConiraeLors/ElgctficlauslPXumbers.
TO BE MRD WITH TEE PERMITTING .A-fiTJ(®ESTX. „, _ _ _ _ n...—A ,
aia0e (Btitsin,ss/Oxganizat on/Xndividital): b YI r? k/� L°' `
.Address: RlI'e4 ST
City/State/Zip:
Areyon an employer? Checktl[e appioprlate box:
phone Zo 633 f/ZO
1, / i I am a employer with. _employees (fid) andlor part-tune).4'
?.E1 I am a sole proprietor or partnership and have no employees working for me in
any capacity. [Noworkers. comp. insurance required.]
I am ahomeowner doing all work Myself. [No workers' comp. insurance required.] t
4. ❑I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill
ensure that all contractors either have workers' compensation insurance or are sole
5.❑I am a general contractor and I have lvredthe sub-coktractom listed onthe attached sheet.
These sub -contractors have employees and have workers' comp. insurance.'
6. ❑We are a corporation and its offiggrs have exercised their right o£ exemption per MGI. c.
152 SIM and we have nq plgy6es. [Nb workers' comp. insurance required.]
Type of project (required):
7. New contraction
gc�qRRemodeling
9. ❑ Demolition
10 ❑ Building addition
11.0 Electrical repairs or additions
13. [] Roof repairs
14. [� Other
*Any applicant that checks Box ill must also fill out the section below showingtheirworkers' compensation policy information. atio
i Homeowners who siiliaf klris affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such.
ctors and state whether or not those entities have
tContre ctors that check this box must -attached an additional sheet showing the name of the sub-contra
employees. if the sub-con$racfors have employees, They must pro aide their workers' comp. policy number.
X am ars erriployer treat is pT ovidii�g worriers' compensation insurance fog' my e�nproyees ' Below is thepolicy arid jot site
information. /f `
Insurance Company Name: /7
1%UJ� 0b d R 1 2 �'Zb _l Expiration Date: -72.3�16
Policy #or Sel£ ins. Lic. #: p
W6 y �t �l fi/�l- City/State/Zip: )Gra fkdvvC.,•- 144-
rob Site Address:
.A.ttaclt a copy of the workers' eonapegasation. policy declaration page (showingthe policynUmberc and expiration date .
Failure to secure coverage as required under MOIL c. 152, §25A is a criminal violation punishable by a fine up to $1.,500.00
and/or one-year imprisonment, as we1L as civil penalties in the form of a S'T'OP WORK ORDER and a fn.e of up to $250.00 a
day against the violator. A, copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance
rn M.rgcrn VPAficatlon.
rjereby certify undertraepains
ofve37ur,; that the information
avove lS arue aicu wj. ���.
0211612016 13:41 LTB Insurance Agency
(FAX)7812210031 P.0021002
acoR� CERTIFICATE OF LIABILITY INSURANCEDATEI
MIDaw"r)
2/16/16
-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. TH18 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT, certificate holder Is an—ADWITOW INSURED, the pollcypesy-must be endorsed. If GUBROGA--nON 13 WAVED, 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 endorsemen
PRODUCER
RJEACT-•
LTS Insurance Agency
85 iRoad
Burllingtonngton,, M MA 01803
NE7 1 Rale (791) 221-0031
lien ltbinsurance.com
INGLIF&RIS)AFFORD1140 COVERAGE NAIC0
INSURER A. Prefosrad Mutual
BOP0100713051
IMURED
Innovative Home Solutions LLC
9 Porter Ave
Burlington, MA 01803
IN9uRpx e r Commerce Insurance
INaURERC:
INSURERD:
1NBURM E:
INBIIRER F
I+VYCrW\9C0 GLR I II'1lLA I C. N LIMUr•K• RFVIRIrmu NIIMRF;0-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIVED 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.
TYPri OF INSURANCE
P uCY NUMSER
4NEW"
immonrriwi
LIMTS
A
GENERALLIABIu1Y
X COMMERCIAL GENERAL Ll4BILITY
CLAIMS-MADE ❑X OCCUR
BOP0100713051
2/15/16
2/15/17
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED $ 300,000
MED EXP one anon S 104000
PERSONAL& ADV INJURY 6 1,000,000
GENERAL AGGREGATE S 2,000,000
GENT AGGREGATE L IMIT APP LIE 5 PE R
POLICYFT PR 1-1 LOC
PRODUCTS - COMP/OPAGO $ 2,000,000
S
B
AUTOMOBILE LIADIUTY
ANYAUTO
AAUUTOWNED a SCHEDULED
X HIREDAVTOS X AON08NMED
BBJD41
11/21/13
11/21/16
ascei tiQ L F L hM I T
6
BODILY INJURY (Per perwn) 6 250.000
BODILY INJURY (Par accldenq a 500,000
eraNMGE 91 100,000
$
UMBRELLA LIAR
EXCEaaLIAe
OCCUR
CLAIMS-mDE
EACH OCCURRENCE E
AGGREGATE 6
DED RETENTION
VIORKERS COMPENSATION
AND ENPLOYEFW LIABILITY Y I N
ANY PROPRIETORPARTNEPAXECUTNE
FFttrERIMEMBER EXCLUDED?
;Ylandabry In NH)
Dr8* dr urldar
DEB RIPIPTIO ERATIONebabw
A
N1
WC STATU-
E.L.EACH ACCIDENT
E.L. DISEASE - EA EWLOYEg 6
E.L. 018 EASE -POLICY i
EKSCRIP7IONOFOPERATIONS ILOCATION8IVEHICLES(AttuohACORD 101,AdAflandRenerlo8eneeule,Nmore*poop Isvogdred)
Job Desaription:IKitchen Remodel
Job Location: 456 Salem Street
rhe Workers Compensation certificate has been ordered and will be sent to you directly from
the carrier.
Town of North Andover
120 Main Street
North Andover, MA 01845 -
ACORD 28 (2010/06)
Mlone: Fax:
L
SHOULD ANY OF WE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED RE
Lina Tuaker LISU
® 1988
The ACORD name and logo are registered marks of ACORD
(978) 688-9542 E -Mail:
reserved.
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