Loading...
HomeMy WebLinkAboutBuilding Permit #160-2016 - 51 HAY MEADOW ROAD 8/5/2015 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: `� Date Received aq- �DateIssued: IMPORTANT:Applicant must complete all items on this page LOCATION �Pl 'g 1> 0 Ccl w Print PROPERTY OWNER K iW �E E i✓O 5 Print 100 Year Old Structure yes no MAP NO: PARCEL:_ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 0 Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: /-6,5 7` Phone: 7 Address: Supervisor's Construction License: ��f 73 Exp. Date: Home Improvement License: f U G O a Exp. Date: 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: $ IV 5, (/, / e) • FEE: $ 5LH•C%)�) Check No.: D'I 5D Receipt No.: �A �Y Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner v� ignature of contractorw�/� �✓ . I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board &Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Lonservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on siteyeas no Located at 124 Main Street: Fire Departinent-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 NOTES and DATA— For department use EJ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fohowing 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 o 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 subm:?ted with the building application d Doc: Doc.Building Permit Revised 2012 1 (� Location , 1M E' d VW—� No. O — Zo ky Date . - TOWN OF NORTH ANDOVER • C"�I"�'D-slb- 1� Certificate of Occupancy $ _ Building/Frame Permit Fee $ ��— Foundation Permit Fee Other Permit Fee $ TOTAL $ r 11 Check# 730 �; 16 2 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 45,610.00 m $ - $ 547.32 Plumbing Fee $ 68.42 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 68.42 Total fees collected $ 784.15 51 Haymeadow Road 160-2016 on 8/5/2015 Remodel Kitchen r 1 NORTH - : w: nc . " ve". O No. 166- 20' 't soh ver, MasSA,,,,Ak '5 .MI5 COC NI CNl WIC.. y1• A°4ATE0 ►PP,��(5 s U . BOARD OF HEALTH Food/Kitchen P E T L D Septic System THIS CERTIFIES THAT .... ... aj BUILDING INSPECTOR .PY ( .......... ....... .... I° V...�tr1 ....... ... ............................. p i .1 �., � pUt ... Foundation has ermission to erect.................:.:...... buIdings on . � .... -* ` Rough to be occupied as ........... .. ��................k . ..... ..�a�........................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STARTS Rough Service .... .. ... ............ .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Repuired to Occupy Building 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. COTE n8, F0STERzu- CtJSTOM BU LD1 NG + REMODE LI NG This agreement made this 24'day of April,year two thousand and Fifteen by and between Cote and Foster Contracting,Inc.herei�fter called the Contractor and Ralph& Maureen Enos,hereinafter called the Owners, witnesses that the Owners intend to remodel the existing kitchen at the address of 51 �iaymeadow Rd.,North Andover,MA. Now,therefore,the Contractor and the Omer, for consideration hereinafter named,agree as follows: i ARTICLE 1 The Contractor agrees to provide all the If bor and materials to do all things necessary for the proper construction and completion of the work shown and described' on drawings. The drawings and specifications are the basis of the contract. ARTICL> 2 In consideration of the performance of the contract,the Owner agrees topay the Contractor, in current funds as compensation for his services hereunder$45,610.00 to be paid as follows: P�--Payment 1 -$2,500.00 at signing of con Tact Payment 2-$8,000.00 at start of demo cabinets and counters Payment 3 -$8,000.00 at start of mechanicals Payment 4-$8,000.00 at start of cabinet install Payment 5-$8,000.00 at start of tile Payment 6-$8,000.00 at start of finish mechanicals Payment 7-$3,110.00 at completion of project ARTICLE!3 Final payment on contract amount as agreed above to be paid within ten(10)days of project completion or occupancy. If final payment has not been made within this time a 10%charge per month on the balance due will be charged. All minor punchlist items will be complete as part of the one year warranty on the finish product. Failure to pay balance within ninety(90)days may result in leg action. Initials: 20 Aegean Drive • Unit 15 • h lethuen,MA 01844 Tel: 978-682-6518 • Fax:1978-682-1221 www.coteandfosIer.com I ARTICLIi 4 1 Additional work above and beyond the contrast agreement: All additional work done to be quoted at the time the client requests the work. The work will be done and billable at its completion. The client has ten(10)days to pay the additional cost after he or she has been billed for it. Initials- In witness whereof they have executed this agreement the day and year first above written. i v Ralph Enos, Owner Ma reen Enos,Owner William T. Foster DBA Cote& Foster i 4 I i i r i I l i 1484' — _ — 69a"– 33"—' —233" 24"—u—51e" , 24'--,r-24"—, 45e" iiL— 63a" 2I";—{--•-33"— ?4----f- 33"-1� I 85ia" —i � W2433 -.1.>.-..�..- .,-... (7��.,�2 _.. _...... .r I � W2433 a �l N --- N { n — I SCHROCK TRADEMARK ?� BWB21 CNTYSB33 24 DISHW; B33RT HUTTON DOOR MAPLE WITH WHITE PAINT 3-BASE FARM SINK CABINET CL 11) (2) (:3) 4 PLYWOOD CONSTRUCTION SINK MODEL WHITEHAVEN F330' U CEILING HEIGHT 93' 29 11/16 X 21 9/16 X 9 5/e TO BE TRIMMED N N HANGING HEIGHT 87" ON SITE OPEN SOFFIT SHAKER CROWN FOR CROWN MOLDING — '}} SMLR FOR LIGHT VALANCE 4-BASE CABINET WITH TOP DRAWER AND DOUBLE ROLLOUT C(7/. TRAYS 1-SUPER LASY SUSAN 5-PANEL FOR BACK OF ISLAND CO co c� 4 OUTSIDE CORNER MOLDING FOR 3DB15B36RT 3DB15 2-BASE DOUBLE TRASH CABINET EDGE SPLEGS(SPOOL LEG)TO BE APPLIED TO THE BACK OF THE ISLAND DOORS APPLIED TO BACK OF ISLAND ONLY N N co (5 r r N m i' N N BP9634':SCRSGR"--"C' ' 6-WALL CABINET ABOVE REFRIGERATOR 21"DEEP 7-WALL GLASS DOOR WITH MATCHING INTERIOR u t7 I LL LL ? I W33 1 2 d' O d If. � w ' N N -w25ty—; 1 —�i -°� 165 .�fa .165�"--- 31"— _33. 1"-- 1 34" All dimensions_size designations 20 20 1� This is an original design and must Designed: 5/8/2015 given are subject to verification on TECHNOLOGIES not be released or copied unless Printed:'5/12/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. ENOS KITCHEN FINAL All Drawing#: 1. No Scale. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r Please Print Legibly Name (Business/Organization/Individual): C d V /-'� � Address: 41) / 1 N 7)A2 City/State/Zil),Al 7—hZV%(Al_ Phone#: 4 Are you an employer?Check the appropriat e Type of project(required): 1.❑ I am a employer with 4. a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet.# emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.EJ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 131-1 Other comp.insurance required.] kny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. Lsurance Company Name: LCL iy)Il E AL c ,C— %1- -2!--A/ P U.5 L/ Aicy#or Self-ins.Lic.#: Expiration Date: 1?1) —J,-5 - b Site Address: -4-/ /�• City/State/Zip: Ale R /�-N,bD r£2 -UA;L ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ie 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to hereby certify under the pains and penalties of perjacry that the information provided above is true and correct. nature: Date: Lone#: ��• ��� � y�d Official ztse 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: 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 evised 5-26-05 xxnxnx:mace ttnx��r�ia 7 ® DATE(MM/DD/YYYY) ,4 CERTIFICATE OF LIABILITY INSURANCE 5/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. 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). PRODUCER CONTACT Victoria Lowes, CISR NAME: MTM Insurance Associates PHONE (9'78)681-5700 FJAIC No Firth o:(978)681-5777 1320 Osgood Street ADAE :vickiel@mtminsure.com INSURER(S) AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED INSURER B AIG Casualty Company Cote br Foster Contracting, Inc INSURERC: 20 Aegean Drive INSURER D: Unit 15 INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 master List REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR TYPE OF INSURANCE POLICY NUMBER MM/DD//YYYY MM/DD� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE ToRENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE Fx�OCCUR BOP2722545 2/31/2014 2/31/2015 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea BINEDaccidentSINGLE LIMIT 11000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED X SCHEDULED 2370166 02 2/31/2014 2/31/2015 BODILY INJURY(Per accident) $ AUTOX HIRED SAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per acc dent Medical payments $ 5,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION X WC STATU- OTH- DRYLIM AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA 004962937 6/20/2014 6/20/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Property Coverage BOP2722545 2/31/2014 2/31/2015 Business Personal Property $40,491 Scheduled Equipment 2/31/2014 2/31/2015 Contrctors Equipment $169,928 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CIC ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS11125on+nn5ini Tho Armin 1 noma nnA Inn^*ro rania+ararl m2rka of Annion