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Home My WebLink AboutBuilding Permit #515 - 50 BRADSTREET ROAD 1/22/2007Permit NO: I Date Issued: I _0 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received or O Exp. Date: 2�zq Zo Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family. ❑ Two or more family No. of units: ❑ Industrial IMPORTANT: Applicant must complete all items on this page I LOCATION � B 4S f �" v" Lk Print PROPERTY OWNER Print MAP NO.: �'� PARCEL: ZONING DISTRICT: TVPF AND ITSF. OF RITII.nING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Exp. Date: 2�zq Zo Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family. ❑ Two or more family No. of units: ❑ Industrial Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only ON OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) i jig OWNER: Name: L -e_e fie, M Phone: Address: CONTRACTOR Name: -V:: V1,1< D «s A°y c\ Phone:41)..": Address: L --A 9,_4 �74 . t �� `^ �s C–\ t1 a Supervisor's Construction License: (2�E' al 2-1 Exp. Date: 2�zq Zo Home Improvement License: iJ SP `T S Exp. Date:?�—,ng ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ C99 FEE:$ �-- Check No.: Receipt No.: I �f Page I of 4 Oqtft 01% wo- 04 O CD O aUO-) (D Q- E 0 a) a) LL O E a. 0 co c E Z 0) LL 0 Cc$ 2 co c cis -0 a. i 0 . c 0 -j < m 0 0 C) LL 0 Oqtft 01% wo- 04 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ (septic tank, etc. ❑ Permanent Dumpster on Site ElPrivate Electric Meter location to project 1�T/1TT _ 1. 11 = L. 1 r.au"a cantructtng wtin unregisterea contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor PlI ans 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Si nature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 DEPARTMENTMITORM05 Page 4 of 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 e17 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LejZibly Name (Business/Organization/Individual): PQvt/r L-11 l,. �) 1 C Z ' V i7Y �N_ Y N f�� LPIA �'"l Address: ,� �'s�wn Pc'"J tai City/State/Zip: A:k,�.sCr. UN Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Xmployees (full and/or part-time).* 2. 1 am a sole proprietor or partner- ship and have no employees working for mein any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. $ These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have. exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I ant 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. #: Job Site Address: Expiration Date: 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 againsttlie violator:- Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins.uzance coverage verification. I do hereby certify under the pains andpenalties ofpeijury that the information provided above is true and correct- Signature: orrectSignature: �i� Date: / / Phone #: 46'2' ?61 V t.l i -I 9 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 6r 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 legalentity, 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-contractor(s) name(s), address(es) and phone numbers) 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 thatthis 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 rr,•ast 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. Anew 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-NIASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia A I D J • z 0 n F-4. c-6 T 9 w O O O L Z o. O y CD � c c C CO3 10-0 CD di ME m m � Z CD O� �3 O i m O a a cm< o =� c ev CA) CL 0 O c Z s CL V CO) O c CL c C40 cm uj ck U) W 19 W U) a a a w w a w w u x u a w w" w pG w" rz a is W 6 cn 0 cn D J • z 0 n F-4. c-6 T 9 w O O O L Z o. O y CD � c c C CO3 10-0 CD di ME m m � Z CD O� �3 O i m O a a cm< o =� c ev CA) CL 0 O c Z s CL V CO) O c CL c C40 cm uj ck U) W 19 W U) PROPOSAL Eric DuBois, Owner Phone: (603) 362-6480 Date: 11/13/06 NOVA KITCHENS LLC Fax: (603) 362-8449 GENERAL CONTRACTING 7 Island Pond Road Atkinson, NH 03811-2129 Massachusetts Construction Proposal Submitted to: License # 052746 Lee Bluemel Terry Buchanan Home Improvement 54 Bradstreet Rd. License # 115786 North Andover, Ma. 978-975-5565 w.978-687-7947 hereby submit this proposal for the following: Main Bath: Prep job with plastic zip wall system to control dust. Protect all hardwood floors in work area. Remove and dispose of total bath area. Plumbing: Update plumbing to code. Install customer supplied sink, toilet, shower controls and bathtub. Supply and install tile backer board for shower. Electrical: Lighting: Install customer supplied decretive fixtures. Supply and install Panasonic fan/light vented outside. Update all wiring to code. Insulate all outside walls, and inside walls with R13 for sound control. Supply and install plaster on walls and ceilings with smooth finish. Supply and install plaster on ceiling only in small room below bath. Supply and install moulding on door and window to match existing. Install customer supplied tile and grout on floor and shower walls. Install customer supplied cabinets. Int. and ext. painting is not included at this time. Provide dumpster for all job debris. Supply all job permits. 31/rs- a-rl Total - - - - $14.890.00 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. Drop cloths to be used in all traffic areas. Job area to be kept as neat and clean as possible at all times. Job to be completed in a timely manner. Payments to be made as follows: $2, 000.00 Deposit payable upon acceptance of proposal. $8, 000. to be paid at start of job. $4890.00 balance, due in full, upon job completion. F Respectfully submitted by: Eric DuBois Any alteration or deviation from above specifications involving extra costs will be executed only upon written order and will become an extra charge over and above the estimate. All agreements contingent upon accidents d our control. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date 2/0-1 Signature tss Signature If- .,02006 THU 08:58 FAX 21Dnl ACO 4Q - CERTIFICATE OF LIABILITY INSURANCE DATE IMM 04/06/2 6', PRODUCER (603)898-6320 FAX (603)898-8269 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Foy Insurance Group - Salem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 130 Main St - Suite 103 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSR 00' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PODGY EXPIRATION DATE IMMIDDArYl DATE IMMMOAFYI I YR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem, NH 03079 GENERAL LIABILITY E880015-8 04/01/ZU06 04/01/2007 Terri Truhn INSURERS AFFORDING COVERAGE MAIC # INSURED Nova Kitchens. LLC INSURER A: Concord General Mutual Ins Co 20672 7 Island Pond Road INSURER 11 " Atkinson, NH 03811 INSURER C CLAIMS MADE AI OCCUR INSUKtH Il b 5.000 INSURER E. l -I IVFYA(.Fi: THE POLICIES OF INSURANCE LIS'fE0 BELOW I IAVC BCGN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTI IER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL 7HE TERMS. EXCLUSIONS AND CONDITIONS OF SVCI I POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Town Of North Andover, Mass. BUT FAILURE TO MAIL SUCH NOTICE SHALL MPOSENOOBLIGATION ORLIABILITY INSR 00' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PODGY EXPIRATION DATE IMMIDDArYl DATE IMMMOAFYI I YR LIMITS AUTHORIZED 0 AriVE GENERAL LIABILITY E880015-8 04/01/ZU06 04/01/2007 *ACH OCCURRENCE S 1,000, 00 X COMMERCIAL GENERAL LIARII ITY OAMAGC TO RCW'CD S SQ 00 _P KMISkSJtaJx[umac � CLAIMS MADE AI OCCUR MED EXP iAny ono ponan) b 5.000 A _ PERSONAL & ADV INJURY S 1'.000'.000 GENERAL AGGREGATE S 2,000,000 GENT.AGGREGni6LIMII'APPIIF,SPER' I'K0uUCIS-COMM/OvA0G $ 210001000 POLICY PRO. JECT LOC -- -- -- AUTOMO&UE LIAB,Lr1Y C844711 -3 04/01/2006 04/01/ZQ07 COMBINED SINGLE LIMIT S ANY AUTO ICn accidunl) -----------.._ ._ 1,000,,00 ALI.OWN6UAU•iOS ROMLY INJURY .. X SCHEUULEUAUIOS {Pcrpmon) S A MOUILY INJURY X I IIRCD AUTOS•• — X NON-OWNFDAUT•OS IPm a Id"l) S PROPFRTY DAMAGE S — (Par or iannl) GARAGE LIABILITY---- AUTO ONLY CA ACCIDENT __-- ••• S ANY AU 10 OTHFR THAN Cil ACC S AUfO ONLY' ASC b EXCIESSIUM13RF-LLA LIABILITY EACH OCCURRENCE b OCCUR ❑ CLAIMS MADE AGGREGATE b DEDUCTIBLE _ - RETENTION S WORKERS COMPENSATION AND WCStATU- UIH- EMPLOYERS' LIABILITY TORY. LWTS FJ{ ANY PROPRICTORIPARTNERJEXCCUTWE I. EACH ACGIDkN'I $ OFFICER WEMBER EXCLUORD? E.L. DISEASE - EA EMPLOYEE S Aee, dee0Abe undat C.L. DISEASC • POLICY LIMIT b SPECIAL PROVISIONS behrw OYMEN DESCRIPTION OF OPERATIONS I LOCATIONS I VE HICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS nvvnu sa I'Cuu uual ( vim_ CACORD CORPORATION 1933 SHOULD ANY OF THE ABOVE DESCRIBED POLICIC•S BE CANCELLED BEFORE THE EXPIRATION DATE fKEREOF, THE ISSUING INSURER WILL ENDEAVOR YO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town Of North Andover, Mass. BUT FAILURE TO MAIL SUCH NOTICE SHALL MPOSENOOBLIGATION ORLIABILITY 27 Charles Street _ North Andover, MA 01845 OF ANY KIND TN RER, ITS AGENTS OR REPRF5F_NTATMES. AUTHORIZED 0 AriVE nvvnu sa I'Cuu uual ( vim_ CACORD CORPORATION 1933 ITGHEmS General Contracting Eric Dubois President Fully Insured MA Construction Lic. #052146 MA Home Improvement Lie. #115186 • Complete Kitchen & Bath Installation • Home Offices • Additions Office: 603-362-6480 Fax: 603-362-8449 7 Island Pond Road Atkinson, NH 03811 617- BOARD BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR Number: CS 052746 Birthdate: 02/04/1965 Expires: 02/04/2007 Tr. no: 7944.0 Restricted: 00 ERIC F DUBOIS 7 ISLAND POND RD G— ATKINSON, NH 03811 Commissioner .�rnoanmznreu�a�• n✓11u�ruGeil`b ' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 115786 Expiration: 4/13/2008 Type: DBA ERIC DUBOIS/NOVA KITCHENS ERIC DUBOIS 7 ISLAND POND RD ATKINSON, NH 03811 Administrator 4