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Home My WebLink AboutBuilding Permit #025-2011 - 54 SPRING HILL ROAD 7/1/2010 BUILDING PERMIT of pORTy ttLEO !1 TOWN OF NORTH ANDOVER o - - APPLICATION FOR PLAN EXAMINATION '` z Permit NO: �� ,,2 0l/ * : . Date Received J=1::: .SSgcHus Date Issued: IMPORTANT Applicant must complete all items on this page LOCATION x ,Pnnt;< 4- u s �«a R s l» 44. T X PROPERtTYO1NNE tMAP 2-'10� �� PARCEL�� ZON'ING�DISTRICT�." `His_tonc4D�stncf�'� � �; es�� '-} p ..� _.,.s 1�..-._*-r,�...��.. _' � v:v� � ra,�x •, - .,; MachmeF�hop;:Ui {yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration 'vl/' No. of units: Commercial Repair, replacement ✓ Assessory Bldg Others: Demolition Other ` }Septicr• >Well _ , �'�Floodplairi Wetlands , y w- .1 'l.W�atershed Dtrw;c . 3*Water/Sewer . + _ DESCRIPTION OFWORK TO BE PREFORMED: esa%0 d 1.a � CcFlea.- I lVe-V e zvq I n 4 wane �rN Identification Please Type or Print Clearly) OWNER: Name: 11 Phone: Address: ,'`tS rn A r'!1 TCONzTRACTOR�-Name` C� �„ fru key a�st�:r, Phone --` ,Srb2 i LV �r r Ff SupEr, .1ssor s'Corisfr coon' License r.' ( =FExp`IDate-� - , '.Homelm��ouement License' Exp !`_�„�,� ' 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. FEE: $ -11K d ' ° Total Project Cost: $�� 9 �� Check No.: /� Receipt No.: d f°,6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si``nature`of,A ent70wner ...zr� `' ` ::Signature of contract ur- 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 Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS 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: Located 384 Osgood Street FIREDEPARTMENT 3- Temp Dumpster on safe yes no pLocated at 124 MainStreet' q ` ire Department�signature/date f, w � ♦ 5' -t w t^car' e .,,'"i f` a I t' - COMN(ENTSz�� '. F t z y 1 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) i ❑ 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 o -Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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) ❑ 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 o 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 o 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 f ORTH Tovm of Andover 0 No. F over, Mass.,- 0 L..�' ls� COCHICHEWICK 11 It. RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT....... 6�116zv .............. BUILDING INSPECTOR .................................................................................................. .......................... Foundation .. has permission to erect.............. .. ...................... buildings on .. .. .......................... Rough to be occupied as........................... Chimney .......... . ...................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .......................*... . . . ................. ...................................... Service. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE J1 Smoke Det. i CABINETRY -Y DESIGN Proposal (continued) Electrical: By owner Flooring: Patch oak floor matching existing as close as possible. Sand and refinish kitchen and family room with three coats of oil based polyurethane. Nothing other than stated above is included. No appliances,tile,grout,painting or electrical in quote. Cost: $68,985 Terms: 30%down, 20%upon starting,40%upon delivery of cabinets, 10%upon completion S' ed: ner.1 �) Da Owner Date Richard F.Brown,President Date HIC License#15283 Option A. Deliver existing cabinets and counters to Maine add$300 to quote Note: Windowualifies for energy tax credit. q gY Cost of window installed is$1,750 x 30%=$525 tax credit Gillen—April 2010 56 North Putnam Street 0 Danvers, MA 01923 0 Phone 978-774-0002 0 Fax 978-774-7799 CABINETRY DESIGN Proposal April 30, 2010 Bill&Lynne Gillen 54 Spring Hill N.Andover. MA Home: (978)682-4927 Cell: (978)420-8407 We are please to quote you on remodeling your kitchen. All work is fully insured and all trash created by Cabinetry By Design will be removed by Cabinetry By Design. Cabinets: Supply and install Signature flush inset cabinets as per plan and sample doors. Cabinets are complete with matching Signature moldings for toe space and soffit. We will install owner supplied hardware and appliances. Counters &Backsplash: Supply and install mid price granite counters as per plan. Counters are complete with standard edge and sink cut out. We will tile backsplash using owner supplied tile and grout. Carpentry: Remove existing cabinets and counters and existing down draft. Supply and install Anderson G536 sliding window as per plan. Window is complete with screens and grills and hardware in the finish of your choice. We will close up inside and out up to paint. Vent new hood to exterior. Patch ceiling as needed using blue board and plaster,owner to paint. Patch base boards as needed matching existing as close as possible. All work as per code. Plumbing: Disconnect existing and cap as needed. Upon completion install owner supplied sink,faucet,dishwasher, ice maker and gas range. All work as per code using PVC on waste and copper on water. Proposal continued on next page 56 North Putnam Street 0 Danvers,MA 01923 0 Phone 978-774-0002 0 Fax 978-774-7799 The C'ommonweczi'th of Afassachusetts Department o f Iidnstr.ial Accidents Ofjrace of�ytveskb ations 600 TfZashintrton Street Boston, .h14 62.111 did JA70rkers' Compensafion Insurance A s'bov/ Ap licant Information BuRders/Contractors/Electricians/Plumbers . PIease Print Legibly Name(Business/Organization/Individual): ` a c Address: City/State/Zip:_ y e;s rola 014�j Phone#: �� EE31 an employer?Check the appropriate box: a employer with 4. ❑ I am a a Type of project(required):' . loyees(full and/or part-time).* have hired the s6-contractors ntractor and I ontractors 6 ❑New eomstruction a sole proprietor or partner_ listed on the attached sheet x 7• ❑Remodeling and have no employees - These sub—contractors have king for me in any capacity, workers' con . ' 8' ❑Demolition p insurance. workers'comp: inctaranCe 5. ❑ We are a-corporation and its 9. ❑Building addition required-] officers have exercised their 10•❑Electrical a homeowner doing all work n t of ex repa>rs motions l£ �mptionPer MGL Il.❑Plumbing repairs oradditions [No workers'comp. c. 152 14),anal we have no ance required.]t employees_ 12•❑Roof repairs [No�'vorkersAte,rTlicant comp.Insurance required.] 13•0 Other t h �s boy;.41 me i:so M,oct rce secdva h=aw sita ::_it oo�^� mcc Y -don I3e-eowuers who submit this affidavit indicating thet,a_doing aL'ao n asci ' Y y..::.�..�j +Cont mctn:E that ch;-tEus box m-st a additional wen fiire outside contra tis a,*r 900 ui a -tt=-ced an a3 .conal sheet show' the - t n affidavit indicating such. same of e stkcrnt" tames and their w I am an employer that is providing workers'compensadon insurance or ork='comp,policy information in,formahom f my emPloyeea Below is the po Ucy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the poky number and expiration date). Failure to secure coverage as required under Section 25A ofMCl,c. 152 can lead to the imposition of fine up to$1,500.00 and/or one-year imprisonment,as well as Civil penalties in the form of a STOP W criminal penalties of a Of up to$250.00 a day against the violator. Be advised that a co WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. PY of this statement may be forwarded to the Of of Ido hereby cerfify under the pains and penalties of perjure th,zt theor f mation.provided above is true and correct. Signature- - Phone#: '9. 7 6—— 7 ;� [6. Other al use only. Do not write in this area, to be completed bj'city or town offciaL r Towu: I'ermit/Lieense# g,Authority(circle one): rd of Health 2.Ri lding Department.3. City/Town Cleric 4.Electrical inspector 5.PIumbinR inspectorct Person: Phone I0ormation an` d In.struc'ions 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 ptvrson 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 ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartnz ents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintc3rance,construction or repair work on such dwelling house or on the grounds or building appurtcnant 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 c&tnpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither tine commonwealth nor any of its political subdivisions shall enter into any contract for the.perfozmance of public work um-t:il acceptable evidence of compliance with the inc=ce 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'comp enation insurance. If an LLC or LLP does have- employees,apolicy is requirrA 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 i 4t'c.'uued to the City ortown+ilrsst the au�.urGauf3n for ilrE pert tor hce-me 2s being mquested,not the.DeDT.'Er"erit of Industrial Accidents. Should you have any questions regardtn g the law or if you are amu;,ed to obi a orlero' corrxpensation policy,please coil the Department at the number listed below. Self-insured companies.should enter their self-insurance license number m the appropriate line. Cite or Town Officials Please be suit-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 mast submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under`lob 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 pmt 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 oflnvestigations would bice 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 znd.,f a numbers__.. The Commonwealth. of i+�assarhusa4fs. DOPartment OfIndustrial Accidents Office of hre&tegatious 60.0 WashiaDton Street Boston,M_A 0211 I Tel. ## 617-727-4900 =t406 or 1-977 MASSAFE Revised 5-26-05 Fay,4 6.17-727-7749 urarvJ.mass._.govkha. 06/90/2010 23:19 FAX 9785922217 BKM,Inc 0 001 a DATE(MMIDOIYYTY) AC RD CERTIFICATE OF LIABILITY INSURANCE 7/1/2010 PRODUCER {978)532-5445 FAX: (978?532-2217 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE B.A. mcCarthy Insurance Agency, Inc. II HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Entrance 'Peabody MA 01960 _ INSURERS AFFORDING COVERAGE NAiC# INSURED INSURER A.National Grange 1n8 CO Cabinetry by Design Inc. _INSURERS: National Grange Mutual Ins Co 7-4789 56 NorthPutnam Street INSURERC:ACE Property & casualty Ins 20699 INSURER D: Danvers MA 01923 1 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAN DING 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, POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSR DO'L1 POLICY NUMBER OENERALLIABIUYY EACH OCCURRENCE $ 1,000,000 GEE EO COMMERCIAL OENERAL LIABILITY PREMISES IEo orzurr $ 50 A CLAIMS MADE 1zOCCUR 6834944 1/1/2010 11/2011 MEDE)(P(Anyoneperson) S 5,000 pERSONAL1,ADVINJURY $ 1,000,000 GEN6RALAGGREGATF $ 2,0001000 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea ancideRU ANY AUTO 8 ALL OWNED AUTOS KPB34944 1/29/2010 1/29/2011 BODILY INJURY S 250,000 (Per person) X SCHEDULED AUTOS " X HIRED AUTOS BODILY INJURY $ 500,000 (Por aooldenL) _ X NON-OWNED AUTOS PROPERTY DAMAGE S — - (Per aCCIdeM) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACG $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIAe1LITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S DEDUCTIBLE S RETENTION S WORKERS COMPENSATION WCRy LIMITS I I EEL STATU- OTH- C 1 BILITY AND EMPLOYERS LA YIN00 000 ANY PROPRIET RlExECUTIVE E.L.EEACH ACCIDENT $ OFFLCERIMEMBER EXCLUOE07 10/11/2009 10 11/2010 E.L DISEASE-FA EMPLOYE $ 100,000 (Mandatory in NH) 45B 06042 / Iryes,doscrbeunder E.LDISEASE-POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 16PECIAL PROVISIONS Refer to policy for excluaionary endorsement® and apeelal prv'vi9ion9. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAY9 WRITTEN Town Hall NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 30 SHALL North Andover, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 90,1W John McCarthy/L,G4 ACORD 25(2009 01) (01988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) The ACORD name and logo are registered marks of ACORD 06/30/2010 23:19 FAX 9785322217 BKM,Inc 121002 ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. EdiCion Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 8,000 Ref# Description Coverage Code Form No. Edition Date Uninsured motorist BI split limit UMISP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 0 20,000 40, 00 Ref# DescriptionCoverage Code Form No. Edition Date Hired Car Liability RLI Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $23.00 Ref# Description Coverage Code Form No. Edition Dat® Hired Physical Damage FIIRPD Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $3.00 Ref# Description Coverage Code Form No. Edition Date `SA06 *SAO$ Limit f Limit 2 Limit 3 Deductlble Amount Deductible Type Premium $2.00 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $338.00 9 Ref# Description Coverage Code Form No. Edition Date DIA Assessment DIASM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $282.00 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductlble Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductlble Type Premium rOFADTLCV Copyright 2001,AMS Services,Inc- 06/30/2010 23:19 FAX 9785322217 BKM,Inc Z003 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. I ACORD 25(2009101) INS025(200201) Ll ,ci v v - - --_ - -- -- - — - - - -- -- - 1I- 1 7- �� -- - - -- - .,�' V o -? +`6 - r. I� P• k� F��Q;S I Q Q�� i�NB l� r 4$ F! I _ I �- I T --- 7 �, -�-, - - - n I . !r=; a'a .tr�J j='I?s��✓ s syc� 7j f� I� - 11 � 1 �- ! - q 6V I Location No. — 2011 Date OfMows" TOWN OF NORTH ANDOVER �0 0 9 Certificate of Occupancy $ sACMUSES'�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 23066 -building Inspector