HomeMy WebLinkAboutBuilding Permit #527 - 457 BOSTON STREET 1/6/2011�I
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LOCAT\O OWNER NTNG pl Res\dentIIa\
PROP • I, I PPRCE USE
MPP - PROP • a1
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� IMPROVEMEN
rtn�t TYPE �
New guy\d\n9
Add\tion
Alteration t
RePa�r, reP\acemen
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Septic Wer
WaterlSe _
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es\dent,
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No of units'•
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AOR Name �� EXP Date'' yY -A at t i
.IRAC ate (11
CON ri �� t EXP D
ddress' on Ljcense
A r,s GonstrvCt�� a Ph°ne'
SUPerv�s° ent \'cense Reg. No' ON $125.00 PER S.F.
e 1tnPrO\jem ED CCS? BASED
N°m NGINEER E TotA� ESTIMAT
C'(IE of TH
RGNI�E R $'000.00 FEE' �, j ant' fund
P $12 00 PE guar
Address LE: B��-1 G PERMIT: Rece\pth °e access t
DUdo not av
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FEEproeGt Cost' isteyed contractor _e vont ctO-r
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With S�9
Permit N0: s
Date Issued: I—A, ,
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this naize
LOCATION_:S ,51 �J'� li
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Print
MAP NO: Z1iTPARCEL:L" OONING DISTRICT: Historic District
Machine Shoa
yes
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 Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
wa - est;b s+d'!`i : f t�t..� P.�rrw•-�- .aycil ��y't Lws,ti..- '
�►'� fW Wlrl�! �i�,eat��.,J'�1 .c, � f!4S. �r 1GGc,if /� 5.« IRa�r P%+�. ;
Identification Please Type or Print Clearly)
OWNER: Name: �t &- K"n Pas&,vs Phone: g:�'S ` 585- 000;,
Address: 4157 Inas 6-6t W6
CONTRACTOR Name: ,.-l.� Ll.�le.•c.� �.srtr'x••,,,�';1� Phone: �'l-�5 S- Sal- r�7S„Z
l rpfd-07 'Pi, Csl 4/ S
Supervisor's Construction License: too 382 t Exp. Date: 2% /G /2612 -
Home Improvement License:
. Date: IZy/ 2 a/
ARCHITECT/ENGINEER 1 %� Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ —9�' 3Atip ate FEE: $
Check No.: Xhlall,
Receipt No.:_3�
NOTE: Persons contracting with unregistered contractors do not have access t guaranty fund
Signature 9f Agent/Owner Si nature of contractor
Location-�I Xx A n /&,(,
No. &?2� A Date
TOWN OF NORTH ANDOVER
L
s
o ; . Certificate of Occupancy $
._,__. s
'+ cmust Building/Frame Permit Fee $
Foundation Permit Fee $ "
Other Permit Fee $
TOTAL $
Check #�
23643
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Taming/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
COMMENTS
HEALTH
c
COMMENTS
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Com
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 3134 Usgood 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-$1000 fine
NOTES and DATA — (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
plans Submi
t
ted
OF SEWS Plans
Public Waived
Sewer GE DISPOSAL Certified —�
well Plot plan �
Private (septic tank Tanning/Massage�o Stamped Plan,
etc. Tobacco Sal dy Art S
Permanent Dum Sw�'ng Pools
Aster on site Food Packa-'
THE
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PLgNNING 8$ MENTq,� er- to
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Of APPeais. P`d e e d
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Planning Bo • o P� \,�\ed O,�rp G . P r O{ Qt°p\oaa\el Ssua,�
and Decision. N Or Q�a ab\ei o� l�'F PP s ��Oc to �
° GeoC�eCs opy °� G� a�\ �\G p
Conservation D ° �roko G{ Goat kpl\,, \e s l\�C P'Pp \Ge deed plodua00(\
I De O Q O eG °r ��a eer pep
Water n. o G°pG�°Ga\Gu�a� Go Ip pq�r °� F\je
DPW Sewer Conne o \00dcaG �ret9 J\�s dot r O �c
d eck \da sig ��I)
�' Town Enginee • S.
�tionis; nature Nyass Gh \r9 P teau\�e o aM
FjRE OEP r. Slgnatur;reef rd��N
I °cared at ARTNjE e. �r9 Stec p \e a
Fire at
24 gain street et Temp OU P\� dvt�`p t`or lS�rg \or \rG�
COMM went Signature mpster on site A01f orsttuc Ppp��G o Q�ar Gerses �uCredl ko
FLATS �aate C1e`N G r9 Q e��`osed Q G S L • �` ° 6e FLe
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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
0 Building Permit Application
Workers Comp Affidavit
hoto Copy Of H.I.C. And/Or C.S.L. Licenses
opy 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
o 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
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JILWARD1
CONSTRUCT IOW
4111MEMEW
DESIGN&REMODELING SOLUTIONS
T"lu>9.
man"AUQtum
****PROPOSAL****
YEAR WARRANTY ON ALL WORKMANSHIP
PROPOSAL SUBMITTED TO: PROPOSAL.Roaers.io.19.2010
Will and Jenn Rogers Date: November 21, 2010
457 Boston Street
No. Andover, Ma 01845
(978)989-0002 Page: 1 of 4
Dear Will and Jenn
We respectfully submit our revised proposal (# Rogers. 10. 19.2010) for the interior
renovations to your kitchen and living room ceiling at 457 Boston Street, No. Andover
Ma As per the proposal submitted by JLWC and the kitchen plan provided by Randy
Gordon. The permit fees for the project have not been included.
Demolition:
We will remove and properly dispose of the construction related debris as follows: We
will remove the cabinetry/counters, interior wall and ceiling finishes down to the framing
at the existing hutch location the exterior sink wall and the bathroom/kitchen wall. We will
remove the existing tile floor down to the subfloor to allow for hardwood flooring in the
kitchen area. We will remove the ceiling finishes in the kitchen and make alterations at
the remaining ceiling areas in the dining and living rooms to allow for new plastered
ceilings. We will remove the existing kitchen window to include interior and exterior
finishes to allow for a new window. We will move/alter the baseboard heat at the opening
(kitchen/Fm-Rm) as required. We will cut and cap the existing plumbing and wiring to
allow for the demolition of the spaces. We will provide a 15 yard waste container.
Waste Removal Allowance (JLW): $465.
Framing:
We will provide the labor and materials for the framing of the renovated spaces in the
existing kitchen and dining room. We will use 2x4 KD wail studs and blocking.
The G rrduaasave ngdu ` %�.���¢c8aet�et�s
Dfiep.
f i 1+1
r 600 Wasfainton Strea
Boston, MA 02111
Gy Fi www m ass.gov1d1a
Workers' Compensation Insurance Affidavit: Iwai&dears/Contractee°s/Eiectricians/piumbers
A��lic�i�t I�f®r�aati®n -- - Pie�se Prpn$ Le�ibiv
Name (Business/Organization/individual): L.) .. L_ .. I (A ccws'f"� ae wdf rt ,�hG
Address: 6D i C�OC¢Gr
Phone #: 9>e — 99 i / — d 7 Sa
Are yoy are employer? Check the appropriate box:
l + 2/1 am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
M 1ropne for or nrtner_ listed on the attached sheet.
Type of project (required):
6. ❑ New construction
7. [remodeling
8. ❑Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1 LEI -Plumbing repairs or additions
12 -El Roof repairs
i3.❑ Other
*Any applicant that checks box NI must alio fill out the section below showing their workers' compensation policy information.
t llorawwaers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit, new affidavit indicating such.
tCo Mctom that check this box must attached an additional sheet showing the name -of the sub-cofftr%d rs and state whetlw or not those entities have
employees. If the sub=o ntractors have employees, they must provide their workers' comp. policy number:
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
itrfornudion
insurance Company Name: ) ZZAA wa te)gy :�N u %6Ve C_. L .
U
Policy # or Self -ins. Lic. M 7-1 3�, 7 So SS Expiration Date: 7/Z g 2a /
Yob Site Address: %V761�" �Jf'y City/State/Zip:�,)
Att%ch *-copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to seem 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 DTA for insurance coverage verification.
I do hereby ceofy under the pains and penalties of perjury that lite information provided above is true and correct
Official use only. Do not write in this area, to -be completed by city or town official
City or Town:
Permit/License #
Zz 6./2671
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 #:
2. I am a so a pp
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
fNo workers' comp. insurance
comp. insurance.l
required.]
5. ❑ We are a corporation and its
3, ❑ T am a homeowner doing all work-
officers have exercised their.
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, §l(4), and we have no
employees. [No workers'
comp. insurance reauired.l
Type of project (required):
6. ❑ New construction
7. [remodeling
8. ❑Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1 LEI -Plumbing repairs or additions
12 -El Roof repairs
i3.❑ Other
*Any applicant that checks box NI must alio fill out the section below showing their workers' compensation policy information.
t llorawwaers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit, new affidavit indicating such.
tCo Mctom that check this box must attached an additional sheet showing the name -of the sub-cofftr%d rs and state whetlw or not those entities have
employees. If the sub=o ntractors have employees, they must provide their workers' comp. policy number:
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
itrfornudion
insurance Company Name: ) ZZAA wa te)gy :�N u %6Ve C_. L .
U
Policy # or Self -ins. Lic. M 7-1 3�, 7 So SS Expiration Date: 7/Z g 2a /
Yob Site Address: %V761�" �Jf'y City/State/Zip:�,)
Att%ch *-copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to seem 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 DTA for insurance coverage verification.
I do hereby ceofy under the pains and penalties of perjury that lite information provided above is true and correct
Official use only. Do not write in this area, to -be completed by city or town official
City or Town:
Permit/License #
Zz 6./2671
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 #:
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6 -Use solid stock to fill around bar fridge to lowered floor
i!t
I�
--- — 183," -
_6
1:�D-TEPF01-2987L
(D-TEPF01-2987L)
2: D-TEPF01-2987R
(D-TEPF01-2987R)
3: BWB21-2
(BWB21-2)
4: SBLC36-L
(SBLC36L)
5: RW3615-BD
(RW3615BD)
6: W3333 -BD
(W333313D)
7: WD2433-L
(WD2433L)
8: SB36SFTFWD-BD
(SB36SFTF)
9: D-B363401FWDBD
(D-6363401 FW DBD)
10: B24ROTS-BD
(B24ROTSB)
11: DB36-3
(DB36-3)
12: Wit 833-L
(W1833L)
13: WMCC1833R
(WMCC1833R)
14: W3633 -BD
(W3633BD)
15: W3612 -BD
(W3612BD)
16: B27ROTS-BD
(B27ROTSB)
17: 827ROTS-BD
(B27ROTSB)
18: UC308724ROT-BD
(UC308724)
19: T01 D315 -870 -BD
(T01D31587D)
20: W2733 -BD
(W27338D)
21: W2733 -BD
(W2733BD)
22: B18 -L
(B18L)
23: BPOB18
(BPOB18)
24: B18ROTS-R
(B18ROTSR)
25: 13-34CGPL5434
(D-34CGPL5434)
Verify dimensions in the feild and adjust accordingly.
Depending on final ceiling height, hopefully 88", I
set wall cabinets at approximatley 87". '
Dynasty leaves a 1" above door to mount moldings.
Use 1-7/8" scrown8 to ceiing
�J
-q) 1-0ven cabinet and utility have loose toe kick platforms.
I
i
2 -Trim tall end panels to 29". Pull 24" deep cabinet forward.
�—
cleat as needed.
i
yy
N
3 -Use 3/4" panel on back of island. Trim height.
!
i
4 -Bar fridge sits on lower floor. Extend existing floor to
accomadate cabinetry. Reduced height drawer box
will ship loose with hardware. Install in the field, j
high enough to miss bar fridge.
{i
5 -Wall message center will need to be assembled. j
j
WMCC1833R insert will face great room. Install 1
pull out spice rack in the balance of the cabinet. i
j!
^ i
Mount door to pullout. Make knob look like butt doors.
6 -Use solid stock to fill around bar fridge to lowered floor
i!t
I�
--- — 183," -
_6
1:�D-TEPF01-2987L
(D-TEPF01-2987L)
2: D-TEPF01-2987R
(D-TEPF01-2987R)
3: BWB21-2
(BWB21-2)
4: SBLC36-L
(SBLC36L)
5: RW3615-BD
(RW3615BD)
6: W3333 -BD
(W333313D)
7: WD2433-L
(WD2433L)
8: SB36SFTFWD-BD
(SB36SFTF)
9: D-B363401FWDBD
(D-6363401 FW DBD)
10: B24ROTS-BD
(B24ROTSB)
11: DB36-3
(DB36-3)
12: Wit 833-L
(W1833L)
13: WMCC1833R
(WMCC1833R)
14: W3633 -BD
(W3633BD)
15: W3612 -BD
(W3612BD)
16: B27ROTS-BD
(B27ROTSB)
17: 827ROTS-BD
(B27ROTSB)
18: UC308724ROT-BD
(UC308724)
19: T01 D315 -870 -BD
(T01D31587D)
20: W2733 -BD
(W27338D)
21: W2733 -BD
(W2733BD)
22: B18 -L
(B18L)
23: BPOB18
(BPOB18)
24: B18ROTS-R
(B18ROTSR)
25: 13-34CGPL5434
(D-34CGPL5434)
1 1;
J.L. WARD
C0NSTRUCTIONf
,,, M11111FINEW
DESIGN&REMODELING SOLUTIONS
"NOWWWOMM
MUM "Auttam
****PROPOSAL****
YEAR WARRANTY ON ALL WORKMANSHIP
PROPOSAL SUBMITTED TO: PROPOSAL Rogers 1019 2010
Will and Jenn Rogers Date: November 21, 2010
457 Boston Street
No. Andover, Ma 01845
(978)989-0002 Page: 1 of 4
Dear Will and Jenn :
We respectfully submit our revised proposal (# Rogers.10.19.2010) for the interior
renovations to your kitchen and living room ceiling at 457 Boston Street, No. Andover
Ma As per the proposal submitted by JLWC and the kitchen plan provided by Randy
Gordon. The permit fees for the project have not been included.
Demolition:
We will remove and properly dispose of the construction related debris as follows: We
will remove the cabinetry/counters, interior wall and ceiling finishes down to the framing
at the existing hutch location the exterior sink wall and the bathroom/kitchen wall. We will
remove the existing tide floor down to the subfloor to allow for hardwood flooring in the
kitchen area. We will remove the ceiling finishes in the kitchen and make alterations at
the remaining ceiling areas in the dining and living rooms to allow for new plastered
ceilings. We will remove the existing kitchen window to include interior and exterior
finishes to allow for a new window. We will move/alter the baseboard heat at the opening
(kitchen/Fm-Rm) as required. We will cut and cap the existing plumbing and wiring to
allow for the demolition of the spaces. We will provide a 15 yard waste container.
Waste Removal Allowance (JLW): $465.
Framing:
We will provide the labor and materials for the framing of the renovated spaces in the
existing kitchen and dining room. We will use 2x4 KD wall studs and blocking.
Page 2
Plumbing & Heating:
We will provide the labor for the installation of the kitchen plumbing fixtures as follows:
We will supply and install water lines, waste lines tying into the existing vent and waste
lines for the sink, dishwasher and water to the refrigerator. We will provide a gas line to
the stove. We will provide and install a kick space heater at the exterior wall under the
sink base in the kitchen and we will alter the heat in the on the wall between the kitchen
and dining room to allow for the opening to be enlarged. The kitchen fixtures and
appliances (i.e. sink, faucet, dish washer, stove and fridge) are to be provided by the
owner and installed by JLWC.
Plumbing Allowance: $ 1,500.00. Heat Allowance: $800.00. Fixture and Appliances
Supplied By Owners and Installed by JLWC.
Electrical:
We have provided an allowance for the electrical portion of the project as per the
industry standard (schematic not available) the allowance includes six (6) six inch
recessed ceiling lights, eight (8) GFI receptacles, under cabinet lighting, one (1)
microwave oven, three (3) pendant lights one at the sink and two at the island area, one
(1) dishwasher, one (1) disposal, two (2) refrigerators, double wall oven and one (1)
cook top. One (1) dining room flush mounted ceiling fixture, receptacles and under
cabinet lighting at the dining room cabinets. We will remove and reinstall the flush
mounted ceiling fixtures in the living room and hall areas to allow for the new plaster
ceiling. We will use toggle type switches. All ceiling fans, chandeliers, pendants, sconces
or otherwise flush mounted lighting fixtures to be supplied by the Owner and installed by
us.
Electrical Allowance: $ 3,750.00.
Insulation:
We will provide and install R-15 fiberglass insulation at the exterior wall.
Walls and Ceiling:
We will provide and install '/2" blue board and skim coat plaster with a smooth finish to
the walls and ceilings in the kitchen and dining room areas to be renovated. We will
provide 3/8" blue board installed over the existing ceiling in the living room and hall
areas. We will patch and blend the wall areas where applicable.
Plastering Allowance: $ 2,236.00.
Interior Trim:
We will provide and install the materials and labor for the base molding and interior
window casing to match the existing in the kitchen and dining room areas that are
affected by the renovation. We will use stain grade base molding and window casing to
match the existing. We will provide and install 8010 Pre -primed 2 %" crown molding to
the ceiling perimeter in the dining room, living room and hall areas where the ceiling has
been re -plastered.
Page 4
Pre -Completion Checklist:
Homeowner and Contractor will review all work performed to insure that the project has
been completed as specified. Any remaining details will be part of this checklist. On
completion of these checklist items, the contract will be complete and final payment will
be due. Any issue that arises that is not listed in the pre -completion checklist will be
treated as warranty work and will not impact the final payment.
TOTAL COSTS FOR ALL ITEMS LISTED ABOVE $ 25,346.00
PAYMENT SCHEDULE:
WITH ACCEPTANCE OF CONSTRUCTION AGREEMENT
$ 5,069.00
PRIOR TO. COMMENCEMENT OF DEMOLITION
$ 5,069.00
PRIOR TO COMMENCEMENT OF ROUGH PLUMBING
$ 5,069.00
PRIOR TO COMMENCEMENT OF PLASTERING
$ 5,069.00
PRIOR TO COMMENCEMENT OF INTERIOR TRIM
$ 2,534.00
DUE AT CHECKLIST WALK THROUGHT
$ 1,268.00
AT COMPLETION OF CHECK -LIST
$ 1,268.00
ACCEPTANCE OF PROPOSAL: the enclosed prices, specifications and conditions
are satisfactory and hereby accepted.
Signed and Sealed: 4Date: 1( ^l 201 (�
r s t! gent
Signed and Sealed. ----- Date:
�.1
Signed and Sealed: duo� '.'A )1'1 ice;;
III 17 ho
1
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az
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_ = 1 14 15 12 13 i
I �O O I'i��--24R-BFRIDG 6
24.DISHW 10 ]� C
05
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± get spice rack pullout
r --
124 23 22
nk38�
l
I
Legend
Verify dimensions in the feild and adjust accordingly.
1: D-TEPF01-2987L
Depending on final ceiling height, hopefully 88",
(D-TEPF01-2987L)
set wall cabinets at approximatley 87". tt
2: D-TEPF01-2987R
Dynasty leaves a 1" above door to mount moldings.E I
(D-TEPF01-2987R)
_ Use 1-7/8" scrown8 to ceiing iii j
-- -- -
3: BWB21-2
- g
(BWB21-2)
4: SBLC36-L
e 1 -Oven cabinet and utility have loose toe kick platforms.
m �I1 orms.
(SBLC36L)
5: RW3615-BD
RW3615BD)
M
6: W3333 -BD
(W3333BD)
2 -Trim tall end panels to 29". Pull 24" deep cabinet forward.
7: WD2433-L
cleat as needed.(WD2433L)
8: SB36SFTFWD-BD
(SB36SFTF)
9: D-B363401FWDBD
3 -Use 3/4" panel on back of island. Trim height.
(D -B363401 FW DBD)
I,
10: B24ROTS-BD
II`
(B24ROTSB)
4 -Bar fridge sits on lower floor. Extend existing floor to
11: DB36-3
I accomadate cabinetry. Reduced height drawer box
N N i will ship loose with hardware. Install in the field, V
(DB36-3)
12: W1833 -L
ttt i high
hienough to miss bar fridge. ! i
( W1833L )
r
I
13: WMCC1833R
. 5 -Wall message center will need to be assembled. j
(WMCC1833R)
! WMCC1833R insert will face great room. Install
14: W3633 -BD
!!
I pull out spice rack in the balance of the cabinet.ya
(W3633BD)
Mount door to pullout. Make knob look like butt doors.
15: W3612 -BD
!
(W3612BD)
16: B27ROTS-BD
6 -Use solid stock to fill around bar fridge to lowered floor
(B27R
17: 627ROTS- B)
S -BD
(627ROTSB)
---L -
r j
18: UC308724ROT-BD
(UC308724)
19: TO1 D315 -87D -BD
(TO1 D31587D)
20: W2733 -BD
t
(W2733BD)
21: W2733 -BD
i
(W2733BD)
! I
22: B18 -L
(B18L)
23: BPOB18
-
�,'
(BPOB18)
24: 6618ROTSR)
30"-- 30" 2;"-
25: D-34CGPL5434
------ -- 1 83z--
(D-34CGPL5434)
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID AT
DATE(MM/DD/rNY)
1
JLWAR-1
11/16/10
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
TYPE OF INSURANCE
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Thomas Gregory Associates Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
601 Edgewater Drive S235
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Wakefield MA 01880
GENERAL LIABILITY
Phone: 781-914-1000 Fax:781-246-2601
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: National Grange Mutual 14788
AX
INSURER B: Technology Insurance Co.
INSURER C:
J. L. Ward Construction, Inc.
50 Glidden Street
Beverly MA 01915
INSURER D:
INSURER E:
PREMISES(Ea occurence) $ 500,000
COVERAGES
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD
POLICY EXPIRATION
DATE MMIDD/YY
LIMITS
AUTHORIZED RESENTA
GENERAL LIABILITY
EACH OCCURRENCE $1,000,000
AX
COMMERCIALGENERALLIABILITY
CLAIMS MADE a OCCUR
MPP8989B
06/18/10
06/18/11
PREMISES(Ea occurence) $ 500,000
MED EXP (Any one person) $ 10,000-
PERSONAL & ADV INJURY s2,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER,
PRODUCTS - COMP/Op AGG $2,000,000
POLICY JECT LOC
A
AUTOMOBILE
LIABILITY
ANY AUTO
M8P8989B
06/18/10
06/18/11
COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
A
X
ALL OW NED AUTOS
SCHEDULED AUTOS
M8P8989B
06/18/10
06/18/11
BODILY INJURY $
(Per person)
X
X
HIRED AUTOS
NON-OWNEDAUTOS
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
EA ACC $
OTHER THAN _
ANY AUTO
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
$
DEDUCTIBLE
$
RETENTION $
*
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
TWC3245285
07/28/10
07/28/11
X TORY LIMITS I I 'ETH
E. L. EACH ACCIDENT $500000
r
E.L. DISEASE - EA EMPLOYEE $500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
EVIDENC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Evidence of Insurance
IMPOSE NO OBUGA71ON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED RESENTA
ACORD 25 (2UU11U8) _�/Lt,, �, � v v (V AGORD CORPORATION 1
��. The coo mogewezntriu uy' Urss ac iggesett:s
�T p Deparimeku pf I nid@6stri aB Iy
Office gfInvestigations
600 washingform sfreea
rY. V -,V rr
��y I
Bosfon, MA 02111
B@ JwEFl,mass.gov1d&a
Workers' Compensation Ilnsurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aip�tie�nt Ienf®rtmg�ti®tn ---
-- -
P➢ease Print I�e�ibi�
Naf11e (Business/Organization/Individual):
L
Address: 6e) L/7! i c),ala4 �54/daer
City/State/Zip:
01,91.5 Phone e
— 9 i
Are yop aro employer? Check the appropriate box:
4 . I am a general contractor and I
� g
Type of project (repaired):
1. T am a employer with .�
employees (full and/or part-time).*
have hired the sub -contractors
6. El New construction
FR'
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
7. eemodeling
ship and have no employees
These sub -contractors have
8. ❑Demolition
working for me in any capacity.
employees and have workers'
comp. insurance $
9 E] Building addition
[1�io workers comp. insurance
required.]
5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
3, [J1 am a homeowner doing all work.
officers have exercised their, -..
11.❑ Plumbing repairs or additions
myself. [No workers comp.
insurance required-] t
right of exemption per MGL
C. 152, §1(4), and we have no
12.❑ Roof repairs
employees. [No workers'
13.❑ Other
comp. insurance rettuired.l
}Any applicant that chocks box ff 1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
teo"Mctors that check this box must attached an additional sheet showing the name of the sub-eont ac tms and state whether or not those entities have
employees. If the sub{ontractors have employees, they must provide their workers' comp. policy number.
1 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
ioformation.
Insurance Company Name: wd �g h N 5Gt✓444C-49- Lu
Policy # or Self -ins. Lic. #: M" L 3a, 41 So SS Expiration Date: % 2. g 2,o /
job Site Address: �c6►^ �Jt'y City/State/Zip:., f • �idGttt✓ /1 G� ftS
Attach sa copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Faihlre 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 Officeo€
Investigations of the DTA for insurance coverage verification.
1' do hereby cel fy under the pains and penalties of perjury that the information provided above is true and correct
Official use only. Do not write in this area, to -be completed by city or town ofllaL
City or Town:
Permit/License #
1J G / z6v
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
Boa► 4f �>SlitiK�'tti iff�ti'oo �n
HOME IMPROVEMENT CONTRACTOR
Registration: 139222
-i Expiration: 6/24/2011 Tr# 284953
Type: Private Corporation
J.L. WARD CONSTRUCTION, INC.
JEFFREY WARD
50 GILDDEN ST.
BEVERLY, MA 01915
Administrator
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
1 gYvalid without signature
ent of �. 1lassuchusctts - Dcpa�j� blic sidet"
itions and Stnn.(1 trds
'AVFW Board of Builttin., R�..
Construction Supervisor License
License: CS 63821
JEFFREY L WARD
50 GLIDDEN STREET
BEVERLY, MA 01915
( wnmi••i��nrr
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
Refer to: WWW.Mass.Gov/DPS
Expiration: 9/1612012
Try: 4423
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
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
M
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
hoto Copy Of H.I.C. And/Or C.S.L. Licenses
opy 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008