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HomeMy WebLinkAboutBuilding Permit #607 - 50 AMBERVILLE ROAD 4/12/2010BUILDING PERMIT `�tllD �bf �C TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION ~ Permit NO: Date Received ,} �SSACHV`��� Date Issued: 2 f� IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNERZ i, i _��Y�11Y- Print MAP 210 A9 PARCEL: /&' -ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residen-beL_____ Non- Residential New BuildingOne it Addition Two or more family Industrial eration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands WatershedDistrict Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED' 1e-7',4,ek,4 ell /9 ?" Identification PI ase Type or Print Clearly) OWNER: Name: /S��c--7'�/�.c.�f X /J 19 Phone: 1v7 Address: -3-0 1ryReieelle � CONTRACTOR Nam �A-/.GK-1i.4 Phone: Address _ _,/% AC%'ter Alt= a 1AAb1%$ /r// 4. d F'1-7 Supervisor's Construction License: S 3c).�-s-- Exp. Date: Home Improvement License: /1�5- SSS Exp. Date: G!''r93—c9k-,111 ARCHITECT/ENGINEER 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: $ 30, 500 FEE: $ -�76 Check No.: 237 Receipt No.: NOTE: Persons contracting with unre ' t e( contractors do not have access to the guar n fund ature of Agent/Own Signature of con �7 Location �—o No. 60 7 Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� "— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 229 r 9� Building Inspector `'�' (--Plans Submitte 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 COMMENTS HEALTH COMMENTS Reviewed on Signature nature L. 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: Locatea jts4 uS ooa 5treei FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 324 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 2010 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) o 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 2008 The Commonwealth of Massachusetts Department of Industrial Accidents Office of llnvestig¢tions 600 Washington Street Boston, MA 02.7-11 www mrzss-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers :Pplicant Information d 1 1 Naine (Business/Organization/Individual): Address:—//l/�- City/State/Zip: /,// R/�) D30�% Phone Ar e you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor (full and/or part-time).* and I have hired the sub -contractors employees m a sole proprietor or partner- listed on the attached sheetp and have no employees These sub -contractors have working for me in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all officers have exercised their _ work myself. [No workers' comp. right of exemption per MGL c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' Pomp. insurance required] ny applicant that chi Ys box. #1 mus± also :iii out the sectio` below shoo W- jj c -^eir worka-5, c Type of project (required): 6. ❑ New construction 7-A Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other omeownn who submit this affidavit indicating th r, °mF —O= Y eco m`ermation. t eare doing a.. worn and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additi onal sheet showing the name of the sub -contractors and their workers' Policy coin . o P P cy information. I um an employer that is providing workers' compensatio informatwn. n insurance for my employees. Below is thepoficy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: �/% S J�Q©�� Expiration Date: Job Site Address: J�Q U/`� �• y1 �V�j�ll�� 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 certify under the pain andpenaldes ofperjury that the�ey information provided above is true and correct �M Official use only. Do not write in this area, to be completed bi, city or town offciaL City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing inspector 6. Other Contact Person: Phone #: Information an- d 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 app rber ant thereto shall not because of suchemployment 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 coxnpliance 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 certificates) 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' comp ensation 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-rtarned to the city or town that the application for the permit or license is being requested, not the Deparr ent 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 permiits 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 (Le. 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., The Commonwealth of Massachusetts. Department of Industrial Accidents Office of Inv-estiegations 600. Washington Street Boston, MA 021.11 Tel. ## 617-72.7-4900 ext406 or 1-877-MASSAFF- Revised 5-26-05 Fax # 617-72.7-7749 vnvv'.In aSs.-z,ov/dia HOWE INSLRRNCE Fax:9784752171 Sep 23 2009 17:04 P.02 'CORQ C'ER'TIFICATE OF LIMILITY INSURANCE 7awam I ITME __ _ _ W r 'I « = Sre,..00ws . �a w� awed FaR 4i:E FSUCY PERiOI Pett AkY 06QYIWMW, TERM OR QW41TON OF ANY CDNTRACr OR QTHM QOCUM6NT WITH RE9PW TOV9*1ICN INS CgWiCAM MY gE 188M OR v wG iGTii: t r rttx: U ral r tr THE tWWE INSURANCE A(;EIyCY THIS CER311RCAT6 IS IBSUED AS A VAT IN OF IN11ORVATION 4PUNC AR AVE ONLY AND CONFUM NO RIGH UPON THE GERTIRCATII NIDLDM T3118 ClUtTlFICATE DM. WT AMM, M(TIM OR A CovoLum !.F€€ P=5 iY TIM M C= 13ELOW IN8UkER3 AFFORDING COVERAGE NMC If INSURED OMM 1AuA+al SCOTT LEMAY INSUI R B: DEA B LNaI1AY CONTRAG11Ntp INSURER C: . CID P{TNEIN JUNKYs INSURCiR D. ala LCMELL STREET METHUEN MA @5846 saws INWPA E: ITME __ _ _ W r 'I « = Sre,..00ws . �a w� awed FaR 4i:E FSUCY PERiOI Pett AkY 06QYIWMW, TERM OR QW41TON OF ANY CDNTRACr OR QTHM QOCUM6NT WITH RE9PW TOV9*1ICN INS CgWiCAM MY gE 188M OR MAY PERTAIN, TrE w8URAMCE AFFOW BY 'RIE POLICES OEBCRIMD MORON IS SUBJECT TO ALL THE TERLsg, ExeiLrS+DNs AND CONDITIONS OF SUCH pOLtCE4. AGGRfItiATE LfAUi6 CMQWN MAY HAVE BEEN RIMUCIM BY PND OLAIM'J MOAw M,TYPiFOFAWIRIANCE POlUoYNI mmm roHOYE AWnVE PC=EXPRA70M LEM ♦CCiIMEN E GENGRAL .umnvUP39006low x . 00mm mm 06hatAL UADAM S SOOrSOO CLAW MADE OCCUR m. mw wv aw P ww) 6 12,00 A x WMQ a NEN-OANrb WM _ J !� 1 PERSQNAL i ADV IMPURY 5 i jm o0 ' { I ! WNV M6 ABGRE 'M 1. lAw.$QD G&M AGGRMTE LM9T APPLIES PEW PRODUCT34MoeaJDP AM S 2&C%000 PQLI41+ PROS L.OG AUTOYOOI.S L IAwLMIY COMBINED SINGLE uwr ANY AM {Es aac"" 6 ALLOWNWAUTO$ - GODLY INJURY - SCHEQUL4QAUTOS paraen) _ IMW AVrO6 HON-OVV _ 9MV INJURY EDAUCQ8 P�iPEIiTYQAwKiE i AIRp CDEFR i ANV AUTO Ov"m THAN I AUTO ONLY` AGO I 17CCL /101ORDUAI48LMV GACIiOGCQIiRENCE g OM--Ult F-1 OLAMMADF, � - AGGRetfATE s g 000007s E S RPTBRiMU i WORK= CQUIPENSATIC)PI ERPI.CMERs•LIASIYSY AND �LM1ITJt OT�t am+ E,L. t;AC.lt AGCIDFtfT S on+muRpEric�or - t G.t_ "ror•� _• r+�gaYee e aR70MLwtm00Mgiabw ELD R'YL"r I! OTHI R: DEs pT I{ DP 11P&tATi Q j "CLUSIONE ADDED Sy EMDtiRBEMENTIOPEC" PRa1/IStONs3 CERTIFICATE.nom SHOULD ANY OF THE ABOVE C@SC MM PQUC= Ili CANOM= IEFOM THE -EXPIiAT10N DATE NMEOF, THE ISSUING I iMlWR W&L 9WEAUORTO MAIL 10 GAYS WRrrM4 NOT49 TO Mi 0WIPICATS NOLQER NAUeD TO THC, LEff.SWPALUME TO 00 RO SMALL MEAGGE NO 4et TION OR LLVUJW OF ANY IONO UPON THE RMPJiR. * s rwa.*= an MIEet+sUMU3vrwTttraY. AVYKW= R �II1OOf1: �f _ ACORD :512MM) # ACORD CORPORATION i9W .Z 6 Proposed Basement Remodel at 50 Amberville Road, North Andover The undersigned, being the property and homeowner at 50 Amberville Road is proposing to remodel an existing unfinished basement for recreational use. The proposed construction consists of a TV/game room, craft area with a wet bar, a recreational area, and a full bathroom (See attached plan). All proposed construction will be completed in accordance with town and state building codes. The proposed use of this addition is in full compliance with the North Andover Bylaws. In WITNESS WHEREOF, the undersigned Declarant has caused this certificate to be executed this 1 lth day of April, 2010. By: Anthony•uveia, Homeowner COMMONWEALTH OF MASSACHUSETTS ESSEX COUNTY April 11, 2010 On this 11th day of April, 2010 before me, the undersigned notary public, personally appeared Anthony Gouveia, Homeowner of 50 Amberville Road, who proved to me through satisfactory evidence of identification, which was O photographic identification with signature issued tyy a federal or state governmental agency, Ooath or affirmation of a credible witness, personal knowledge of the undersigned, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily. Notary Public My Commission Expires:l26 I (p i 1 Scott LeMay Contracting 11 Allen Rd. Windham NH. 03087 Bill To: Anthony Gouveia 50 Amberville Rd N. Andover, Ma 01845 I Project Basement remodel Page: 1 Invoice Number: 1001 Date: March 12, 2010 Description Amount Basement remodel is roughly 700 sq. ft. Description as follows: Framing: All walls will be 2x4 construction 16" o.c. with both the top and bottom tracks 25 gauge metal. Entire ceiling will be strapped to achieve highest point. One soffit will be framed to enclose entire lenght of HVAC trunk line. Five closets will be framed. A 71x8' bathroom will be framed. Electric: Install (18) 6" recessed lights. Install (2) circuits for electric heat in basement and bathroom. Wire plug for frig. and counter top circuit. Wire bathroom. Install switching and lights in closets. Wire cable and phone in 2 locations. Remove existing lights and wires not needed. Scott LeMay Contracting 11 Allen Rd. Windham NH. 03087 Bill To: Anthony Gouveia 50 Amberville Rd N. Andover, Ma 01845 Page: 2 Invoice Number: 1001 Date: March 12, 2010 Project Basement remodel Description Amount Install bath fan/light combo unit. Wire basement living area to local code. Dimmer switches will be installed on the finish. Plumbing: Bathroom One lavatory. One water closet. One fiberglass 1 piece shower unit. Plumbing: Kitchenette One stainless stel kitchen sink with faucet. One ice maker connection. Additional items include_ One condensate pump for heating unit. All trenching of concrete floor and patching. Insulation : All insulation will be R13 faced. _ Scott LeMay Contracting 11 Allen Rd. Windham NH. 03087 Bill To: Anthony Gouveia 50 Amberville Rd N. Andover, Ma 01845 I Project Basement remodel Description Page: 3 Invoice Number: 1001 Date: March 12, 2010 Walls that have been framed infront of an existing wall will receive a double layer of insulation. Walls: Entire basement will be blueboarded and plastered. Ceilings and closets will have a textured finish. Paint: Entire basement will be painted. (onwer to choose color) Doors: Ali 5 closet doors will be hollow, double doors, Atherton style 3' wide. Bathroom door will be a hollow single 2'8" door, Atherton style. Door leading into the mechanical room will be a Therma-True, 4 panel raised, insulated door. All casings on the doors and the 2 windows will be 2 1/4" colonial. Base moldings will be 5 1/2" speed base. Flooring: Roughly 250 sq. ft of carpet and pad will be installed and a carpet runner will be installed down the stairs. (owner to pick grade and color) Amount Scott LeMay Contracting 11 Allen Rd. Windham NH. 03087 Bill To: Anthony Gouveia 50 Amberville Rd N. Andover, Ma 01845 Page: 4 Invoice Number: 1001 Date: March 12, 2010 Project Basement remodel Description Amount Roughly 400 sq. ft. of laminate flooring will be installed with a moisture resistent pad underneath. (owner to pick type) 12"x12" tile will be installed in the bathroom. A marble threshold will be installed (owner to pick color of tile and grout) Countertop: An 8' countertop will be installed. (owner to pick color and cabinets will be an extra) Sprinklers: All sprinklers will be dropped to proper height. Allowances: 1,000.00 Plumbing 1,300.00 Laminate 1,350.00 Carpet 0 0 Vanity and top 2,000.0,0 Paint and mats. 175.00 Tile, mastic and grout Total of all materials stated and labor 24,325.00 Scoff LeMay Contracting 11 Allen Rd. Windham NH. 03087 Bili To: Anthony Gouveia 50 Amberville Rd N. Andover, Ma 01845 Project Basement remodel Description The cost of this basement remodel is $43.57 a sq. ft. 1-;S Invoice Number: 1001 Date: March 12, 2010 includes all permits, materials and labor to build a kick ass basementll does not include the additional cost of the customers adding cabinets under the countertop. does not include any unforseen damages due to insects or water. Amount I Massachusetts - Department of Public Safety Board.pf Building Regulations and Standards Construction Supervisor License License: CS 85235 Restricted .to: 00 SCOTT D LEMAY 11 ALLEN RD j WINDHAM, NH 03087 C .Expiration: 1/21/2011 ( +oioiisiunrr Tr#: 12670 �% >°noavnxoou��nol!!a o�� /�/%oeaaeiiueeb`,e Board of Building Regulatio s and Standards HOME IMPROVEMENT CONTRACTOR Registrat n 155555 Expiration 4123/2011 Tr# 282413 r >.. Type Indi�&dual SCOTT LEMAY NTRACTING ,EJ! SCOTT LEMAY Ff 11 ALLEN ROAD WINDHAM, NH 03087 - Administrator e W cc w x O w�� v L r ° , cn U zcn A a �� g w° c�° , v a U co w a r�° cc w a w U w rte° 05 w O w O n cz w w w w m� z cn v �' cn LLJ z ®R; U O O 2 O CLI) 0 co yy 0 V V co Q O y C C42 Q co .g m m CO C3 co C ~ _-9 co O 0 Q cc cm d o- c a h O=_..• C Cccc v J .� •C. 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