HomeMy WebLinkAboutBuilding Permit #622-15 - 47 PARK STREET 1/23/2015I "
BUILDING PERMIT 0
��t IED 167 �C
TOWN OF NORTH ANDOVER. o
APPLICATION FOR PLAN EXAMINATION
` e
N
ermit No#: Date Received
ArED
�gSSACHUs���y
Date Issued:
I ORTANT: Applicant must complete all items on this page
LOCATION"
_Print
PROPERTY O ER
Print 100 Year Structure yes 0
MAP _PARC ZONING DISTRICT: Historic District yes no
Machine Shop Village yesno
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
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
OWNER: Name:
Address:
ut)k-#rcir i 1UN Ur VVUKK I U t3E PERFORM
i%1 4 A 1 — A -
- Please Type or Print Clearly
Contractor Name I (vWP
Address:
a rnone:
4/7✓-ers /� C)
Supervisor's Construction License: 0�,' 51,(_Exp. Date: 2. -- (-I- - 1 t,
Home Improvement License:
ARCH ITECT/ENGINEE
Exp. Date.: 4, —
Phone:
Address: Reg. Ply._ -
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON 125.00 PER S.F.
Total Project Cost: $o6c) , 0-0 FEE: $
Check No.: ?� i 3 Receipt No.- � l
NOTE: Persons contracting, ith unregist :;torsdonot,,have�-accesstothheguarancfund__ --, _4Signature of Agent/Ovvner nature of contracto
I
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Typp 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 Reviewed On
COMMENTS
CONSERVATION
COMMENTS
f�
4 HEALTH
COMMENTS
Signature
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Con nection/Sicinature & 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 signatureldate
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
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 Applicationeiz—
-1, Workers Comp Affidavit
.o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o ,Copy of Contract -,-// '5"--5" �,�,.��
❑ 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/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
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: Building Permit Revised 2014
Location 4:7- A,(Lkn s;7—
No. Date
Check#�5�32—
TOWN OF NORTH ANDOVER %'
Certificate of Occupancy $
Building/Frame Permit Fee ��6:q
Foundation Permit Fee $
Other Permit Fee $-
TOTAL $
Building Inspector
f
0 *
uj
=
OC
a
0
m
v
u
Y
'D
LL
v
N
In
Y
{%j
N
z
z
0
m
C
O
(�0
C
0'
LL
t
j
o
C
E
:E
U
is
c
LL
O
W
CL
vi
zLL
m
g
a
t
o
to
c
O
a
z
J
a
OC
w
tV
DD
o
ai
N
m
C
m
oc
OLLI
W
a
N
?
N
�
�h0
7
o
w
_
n3
LL
Z
a
a
W
C
ui
LL
N
L
:3E
m
o
CU
a)
N
.�
p
Q1
o
VI
n
VI
y
3 o
U o
r E CL
m
�sYY a U)
CD
�d
r Yz C .w O
<u W
J=
E-
0
ANG _l�P t� i
CL E
N L
im a
O d = s
O �
L
C
O —
0-0 >
O
E o
O
> o
m
VO oc
c = = E
Q i L w - .O
a> a) N
= ai
F- O m v m as
ri 2
W 'a O O
La CL= ui= -W -W 0
LL N N 2%MWM9 W O
W .�
CL
• V d O 'a m +•+ Q
N U) so`'" c O
I=— t o aoc>
9,
•N
w
N
0
E
O �
z
O N
_ a
N O .-
•E m m
a �— .�
M
O
V i
Q Q.
CL 0-
�a
oma=
V J cv
•CLOS
Cz
0 cA
ca r_
_m
Q.
O
a
Z
z
0
m
I=-
0
Cl)iF-
Z
Cl)
W
CL
z
X
UJ
0
V
I—
cn
OC
W
LU
9,
•N
w
N
0
E
O �
z
O N
_ a
N O .-
•E m m
a �— .�
M
O
V i
Q Q.
CL 0-
�a
oma=
V J cv
•CLOS
Cz
0 cA
ca r_
_m
Q.
100',"
,I
21 f 30"— —30"— - 18^
66" - } - - 3.4-41"
3 ; 18" 1 ..
� I I
I I
I j
- ..eE! L
..e-e0ll
Il
e 9E l --
w
CA
W
XI
i
N
VJ
y,
a e �.
0
1
1'T 'y H•
p N
OD
n �
O
O O
0
i
00
nOz
W W
c0
-4
0
i
o/meq\
Cil
A ,
0,
�Ln
N
A7 N N.
� N
OD
n � �
�
" a
A7 0
1
O
NIS
D.
o Q
o CD �.
OD
b a�
0)
�
O
0 y
W
r+
N14
rod
0
d..a
m
�~
E
�•
N �
fro
100',"
,I
21 f 30"— —30"— - 18^
66" - } - - 3.4-41"
3 ; 18" 1 ..
� I I
I I
I j
- ..eE! L
..e-e0ll
Il
e 9E l --
w
CA
W
XI
i
N
T
vi
1
OD
i
00
CD
W W
c0
-4
N
i
Cil
0,
N
N
� N
OD
�
1
O
NIS
OD
0)
�
O
I
W
N14
0
100',"
,I
21 f 30"— —30"— - 18^
66" - } - - 3.4-41"
3 ; 18" 1 ..
� I I
I I
I j
- ..eE! L
..e-e0ll
Il
e 9E l --
w
CA
W
XI
ooa�
u
�o
�C
3
mw
��
AA
,
y�
mg
�
W
oW
E„
C �C9b
� 0 •�
0
0
��a�ago
ab a
�
e W
NoaoNOa0a
�
NONOr-a
T
z
0�°mwBWyro�CpC,yC•i^p
bv
H
O
�a9
r
w
e�j p
v
9 � m
a9
W
O
vMJ
C—mill
1111
Oac,f9'•.'�G'�cd
O
—1No
o
Y�wwv.����N�yynU-i
NoaoNOa0a
NONOr-a
�
H
C�g
O
�a9
r
w
y
e�j p
v
9 � m
o o
W
u_
1
1-
-
1_I
1�1
1_f
�
�o
a
Cd
b ^�
bJ)�
Aa
w
� 0
1
a
1-
a0
'G U .a
•
�
00
O
.ti U U a
or. "o
5
W
(No
x
0. z
NW
a
>:
• goo
���
O w
�o
a
Cd
b ^�
bJ)�
Aa
w
� 0
a
two
a0
'G U .a
OWd
00
�w,TJ
.ti U U a
or. "o
5
W
(No
x
0. z
NW
a
>:
• goo
���
O w
1 w O
G C
z
>�
0
a
a •., b
0
Poo b
�+
o
ani
b 'r
>~
.4
"RBB CONSMCMN
77 Centre Street
Danvers, MA. 01935
781-308-0658 rbsconstruction@gmail.com
Kevin and Nancy Fennessy
47 Park Street
North Andover, Ma.
12/29/14
Proposal: This is an estimate for renovating the kitchen at the above address. We will be working off
the attached kitchen designed by Doyon's of Reading. The hall to the bath will be sealed off with plastic.
The door to the living room will be covered in plastic with a zipper installed. A 15 yard dumpster will be
delivered and placed in the driveway. The existing cabinetry will be removed. The 2 walls where the new
cabinetry will go will be gutted to the studs. A new 400 series Andersen CN235 double casement
window will be installed over the sink. The shingles will be patched and the paint touched up in the
spring. The doorway to the living room will be widened by about 12" the floor patched, sanded and
receive 3 coats of polyurethane. The exterior wall will be insulated. The walls boarded, taped and
mudded, and any other areas requiring patching will be taken care of. The walls will be primed and
receive 2 coats of finish. The ceiling will receive 2 coats of paint. The new cabinets will be purchased and
installed according to the plan. The counters will be absolute black honed granite. A tile backsplash will
be installed.
The plumber will relocate the gas line, rough in for the sink and install a line for an icemaker. He
will connect the sink, the faucet, dishwasher, the existing disposal, the icemaker, and the new
oven.
$ 1,500.00
• The electrician will remove all the old wiring for the demolition of the kitchen. He will install 6
recessed lights in the kitchen, and 2 in the hall. He will wire for a pendant light above the sink.
He will install plugs to code along the cabinet and counter area. He will provide the wiring and
connect to the disposal, oven, dishwasher, microwave, range hood, and refrigerator. The
recessed lights and pendant will be on dimmers. (A line item will be added for Xenon under
cabinet lighting.) $ 2,700.00
• RBS labor: (I could try to keep it to $10,000.00)? $12,000.00
• Dumpster: $ 500.00
• Refinish the floor: $ 1,000.00
• *Materials budget: $ 2,500.00
• Counter top budget: $ 1,935.00
• LED recessed lights: $ 255.00
• LED under cabinet lighting: $ 940.00
All work will be performed in a timely professional manner. All work will be guaranteed for one year
from the jobs completion. Any unforeseen mechanical or structural issues will be evaluated and billed
out as an extra. Permit fees are an extra.
*Materials include all building, insulation and drywall. The tile, the window, all the trim and paint.
This price does not include the cabinets, appliances, sink, faucet, or hardware. This price is for insulating
the walls with Roxul wool batts. If the inspector insists on spray foam the will be a price increase.
Fennessey Kitchen Proposal Continued:
The total cost for this job is:
$23,330.00
Payments as follows: $1,500.00 at the contract signing to pull the permit and order materials. $7,000.00
when work begins. $7,000.00 after the rough inspections. $4,000.00 after the cabinets are installed.
$2,000.00 when the counters are installed. And the balance plus permit fees upon completion of all
scheduled work.
Owners acceptance:
Contractors acceptar
date 1/S ks
date
The Commonwealth of Massachusetts
Department of Industrial Accidents
07
Office of Investigations
600 Washington Street
Boston, MA 02111
U1 www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaffily
Name (Business/Organization/Individual): R 06 -yl,
Address:_4 GC n�Y`C
City/State/Zip:�D0fi,),eA, U/i D 112_?, Phone #: o e ^C)
Are you an employer? Check the appropriate box:
L ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. I am a sole proprietor or partner-
listed on the attached sheet. #
\\
II ship and' have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3111 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. F Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
I L ❑ Plumbing repairs or additions
12. ❑ Roof repairs
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.
tContractors 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:.
Policy # or Self -ins. Lie. #:
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 requiredunder 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify underth pains and penalties ofperjury that the information provided above is true and correct
J_ — 71%/ 11., / , .
Phone #: -71?) `T) 1 1OK' d�
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 -contractors) 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:
Tho Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Stroet
Boston, MA 0211.1
Tel, # 61.7-727-4900 oxt 406 or 1-877,7MASS.AFB
Revised 5-26-05 Fax # 617-727-7749
wWW-mass.8oV1daa