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HomeMy WebLinkAboutBuilding Permit #582 - 46 OSGOOD STREET 3/7/2007 �T 0 BUILDING PERMIT of "o Dr;,�� i �� -� `' o•`h TOWN OF NORTH ANDOVER ?44='`''- APPLICATION FOR PLAN EXAMINATION Y Permit NO: Date ReceivedSS US Date Issued: -3 07 IMPORTANT: Applicant must complete all items on this page v1' LOCATION6 Print PROPERTY OWNER kfrHgw1i �,�cn�Ir � 12vss �c�r/O�1E Print MAP NO: PARCEL: 1_J ZONING DISTRICT: HISTORIC DISTRICT a no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9 One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial XRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Public Sewer ' ❑Water D Mood Lam 'Q Wetlands El Watershed District71 DESCRIPTION OF WORK TO BE PREFORMED: 6li'7CAy"r�✓, _0^1.13/A' Al s Identification Please Type or Print Clearly) OWNER: Name: ATH�z y r, Le ctr i r c J ss 1, H2I Phone: /O,79 2- &12 G. Address: G voa 01e4� .CONTRACTOR Name:.:AArr Un1!1 Phone. 2.7p - fo kA. -' 7 9 Address /7 c ��/l�� /r/r . '�/©a�%� /�. cit /s` Supervisor's Construction License; G 5 - ,b 71 7 Exp. Date 6'.P — Home improvement License-./,y Exp: Date: ARCHITECT/ENGINEER `'-' Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 O E T ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S'3aw, - eco S3 r©o," EE: $ 63(-_— Check No.: ®�� Receipt No.:�50 2x NOTE: Persons contracting ith un egistered contractors do not have access to the guar and Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑_ _ Certified Plot Plan ❑ Stamped Plans ❑ 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 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature&Date Drivewav Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS 7 r 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 j L3 Notified for pickup - Date ..............................._............_.................................. ...._........._.................._.__..._....._............: I .............................._..............................._............................................................_..__...................... .........._..........._......................................_........ i 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses • Copy of Contract v Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses U Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) v Mass check Energy Compliance Report (If Applicable) L3 Engineering Affidavits for Engineered products New Construction (Single and Two Family) a Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the j 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 2.2007 Location No. _r"fz Date ? NORTIy TOWN OF NORTH ANDOVER O?O:,f``D ,•,h0� + + Certificate of Occupancy $ ..___. �'�s"••°''�c<' Building/Frame IFrame Permit Fee $ � s�cNust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 200463 Building Inspector r r NORTH f o Of t 9 gAndover No. - - - -_ 4EA dover, Mass., T O�A COCMICHEMCK s RATED PPS �y BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... .... .Q .... Q.C.A0I..e................................................... ............................... Foundation has permission to erect. ................................ buildings on ....y.i....C�S.�..Q.Q ' Rough to be Occupied as.. .4*aMRI � ��t gth'e"terms 40V.. mney trovided that the erson acce in this ermit sh II in every re eccon�orm to of t application on file in final his 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 3 BN T EXPIRES IA6ENTHS Final PEELECTRICAL INSPECTOR UNLESS CONSTRUTS Rough Service BUILDING INSPECTO 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. Smoke Det. SEE REVERSE SIDE PROPOSAL Desmond Construction, Inc. P.O. Box 41 North Andover, MA.01845 508-523-7258 Date: 3/5/07 Page 1 of 2 TO: Job Site: Ross and Kathryn Lochrie same 46 Osgood Street North Andover, MA 01845 978-682-8120 DESCRIPTION TOTAL Kitchen Remodel Item 1 -Demolition Remove existing kitchen cabinets. Remove wall in kitchen/utility room area. Item 2-Frame Frame utility room walls, ceiling and floors. Frame existing kitchen floor. Item 3-Electric Install outlet and switches per code. Install 12 recessed lights, 1 T.V. Cable Item 4-Plumbin Install new sink. Install gas line to new stove, run master tine to refrigerator. Item 5-Insulation Insulate walls with R-13, ceiling with R-19,floors with R-30. Item 6-Windows Install 1 small window, 2 large, size to be determined. Item 7-Hardwood Floor Install hardwood flooring,width to be determined. Item 8-Finish Carpentry Install base board trim and window casing. Item 9-Paint Ceiling and walls receive 1 coat primer,2 coats finish.Wood work to receive 2 coats finish. Item 10-Cabinets Install kitchen cabinets. Total: $43,000.00 NOTE: 1. Homeowner to purchase: Kitchen cabinets, plumbing finish $43,000.00 PROPOSAL Desmond Construction, Inc. P. O. Box 41 North Andover,MA.01845 508-523-7258 Date: 3/5/07 Page 2 of 2 TO: Job Site: Ross and Kathryn Lochrie same 46 Osgood Street North Andover, MA 01845 978-682-8120 All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of $43,000.00 with payments to be made as follows: 5% upon signing $2,150.00 20% upon start $8,600.00 Remainder upon request per project progress $32,250.00 An interest charge of 1.5%per month will be applied to any balance due 30 days after completion of this project. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over an above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on the above work to be taken out Desmond Construction, Inc. t Respectfully submitted-.-- /Per Matthew Desmond NOTE:This proposal may be withdrawn by us if not accepted with days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as speci d./Payment will me made as outlined above. Signature: G Date: Signature: Date: I / The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Qe''fif"4 COvrfti✓�irce/ �,yc. Address: /A City/State/Zip:AA/ gAlyevc� N4, glpyr Phone.#: 91 Are you an employer?Check the appropriate box: Type of project(required):. 1.i] I am a employer with_�_ 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' insurance.# 9 E]Building addition co [No workers'comp.insurance �• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[I Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no 13.0 Other employees. [No workers' comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infommtion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors 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 information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: F �.ru��� 1r �� ,s esr.� 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 e. 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 under t e ins and penalties of perjury that the information provided above is true and correct Signature Date: "moi Phone#: Official use only. Do not write in this area,to be completed by city or town ofjlciaL 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." I 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 fine. 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 permittlicense 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 bum 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 11-22-06 www.mass.gov/dia a Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 143109 Type: Private Corporation Expiration: 6/18/2008 DESMOND CONST. INC. MATTHEW DESMOND 19 UPLAND ST N. ANDOVER, MA 01845 Update Address and return card.Mark reason for change. JPS-CA1 Co 50M-05/06-PC8490 Address ❑ Renewal ❑ Employment R Lost Card BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 072487 Birthdate: 03/22/1960 Expires: 03/22/2008 Tr.no: 19915 Restricted: 00 MATTHEW F DESMOND- 19 UPLAND ST N ANDOVER, MA 01845 Commissioner ACORD CERTIFICATE OF LIABILITY INSURANCE 03/0/200' PRODUCER (978)372-2790 FAX (978)373-2281 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sullivan Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 487 Grove I and Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill , MA 01830 INSURERS AFFORDING COVERAGE NAIC# INSURED Desmond Construction, Inc. INSURER A: Commerce Insurance 34754 19 Upland Street INSURER B: AIM Mutual Insurance Company North Andover, MA 01845 INSURER C: INSURER D: INSURER E: 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONI TR NAR LIMITS GENERAL LIABILITY ZS1282 07/07/2006 07/07/2007 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 PREMISES(Ea occurence) CLAIMS MADE [Y] OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,000 POLICY PROJECT PLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND AWC7019598012005 08/23/2006 08/23/2007 1 WcsTArU- oTH- EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L:DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ONSTRUCTION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Town of North Andover OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Diane Fraiol i/DNF ACORD 25(2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108)