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Home My WebLink AboutBuilding Permit #284-13 - 54 VEST WAY 10/10/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: /Z— MPORTANT:Applicant must complete all items on this page - 1 LOCATIONS TY USS 'PROPERTY 01NNER s - - Print3 100�Year;:Old,Structure yest MAPsNQ.; D_ ARCEL /._ D ZONI,NG�DIS�TRICIT _ Hiistonc_1Distnct esu n'o� Machiiie_,Sho,pVillage) yes, no TYPE OF IMPROVEMENT PROPOSED USE f Resident' Non- Residential ❑ New Building ne family / ❑Addition ❑Two or more family ❑ Industrial ❑Al —ration No. of units: ❑ Commercial 40kepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - - - - - -- - ------ ❑ Septic: DqWC 0 Floodplain, ❑°1Netlands1 ❑ WatershedlDistr cft a 1NaterlSew.er¢; DESCRIPTION OF WORK TO BE PERFORMED: Identificatiof Please Type or Print Clearly) OWNER: Name: gac — Phone: '3 Address: y l/<tT (,�t//a�Y n��2 'CONTRAC +OR' Name �<�1'a.v �C�v /�a+�!. p%f Ptone:. c'! , Address: $u ;ervisorxsConstruction License= d S l Ex Date - - Ez Date Homealm �rovement:License,:: _ /o®�� 9 _ p � �l!j_//�_ ARCHITECT/ENGINEER ,f1/C; 14-- Phone: Q� Address: Reg. No. Y FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ `J 000 FEE: $ � Check No.: 12zy Receipt No.: � � NOTE: Persons contracting with unregistered contractors do not have access to the aranAvfund SignatureofAgent/Ov►rner► �, Signatu�e�of contractor Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ St pe 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 Siqnature COMMENTS HEALTH Reviewed on Signature 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 TIRE DEPARTMENT -, Temp Dumpster on site yes no Located at-124,M5in;.Street. , . `Fire Depa�ti ent-signature/date COMMENTS i 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 I I U Notified for pickup - Date Doc.Building Permit Revised 2010 I 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) ❑ 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) o 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 i 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: Doc.Building Permit Revised 2012 Location �F No. r0- `I Date 1 • TOWN OF NORTH ANDOVER �M � • e Certificate of Occupancy $ q Building/Frame Permit Fee 40 Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check# 2' 4Z 25805 "Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 305.000.00 m $ - $ 360.00 Plumbing Fee $ 45.00 Gas Fee 100 comm. ! $ 100.00 Electrical Fee $ 45.00 Total fees collected $ 550.00 54 Vest Way 284-13 on 10/10/12 Replace Kitchen Counter and Cabinets Replace Bathroom Fixtures in 2 Baths NORTH Town of t E ,, 4 ndover p �► h ver, Mass, b o coc , I .CK 1. .40, S U BOARD OF HEALTH . Food/Kitchen P, ERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .......41.�xa .......................................................................... Foundation has permission to erect .......................... buildings on ..�1�.. :... . �F ../N...� ............................................ 1 1 7 / y� Rough to be occupied as .............1/.:lCyf� t;..'?.l`.v l�.::�:......: .......... �?`;{::f .A.�^[lyy�� "jr," &q7.6................ Chimney provided that the person accepting this permit shall in every respect conform to the t7rms 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR S Rough .......................... Service .............................. ........... ......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. FSEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 s� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1pra/S 061% Address: 761 67�cr City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors Z.F, I am a sole proprietor or partner- listed on the attached sheet.# Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. w ers' comp.insurance. 9. ❑Building addition [No workers' com .insurance 5. We are a corporation and its P u-e i re d. 10. Electrical repairs or additions u' officers have exercised their � p required.] o 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] i employees. [No workers' 1311 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 thepolicy and fob site formation. tsurance Company Name: :)licy#or Self-ins.Lie.#: Expiration Date: ►b Site Address: City/State/Zip: ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). t ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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. /01 to hereby certi&ander the p nd penalties of perjury that the information provided above is true and correct. nature: Date: 1) tone#: 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): I.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-contractor(s)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 .vised 5-26-05 , PEARSON RENOVATION INC. 76 TRASK STREET BEVERLY MA 01915, 978-828-0123 MASS. BUILDERS LICENSE#050929 MASS.HOME IMPROVEMENT#100275 CONTRACT Richard & Kathy Selbst 508-532-3090 10/10/2012 54 Vest Way N.Andover Ma Remove and replace existing kitchen cabinets and counter tops Existing appliances to remain and will be re-installed in the same location New cherry cabinets natural with raised panel overlay doors New granite counter tops with stainless under mount sink Remove and replace existing toilet sink faucet vanity and top in 1s`floor half bath Remove and replace existing toilet sink faucet vanity top and shower in 2nd floor bath TOTAL CONTRACT PRICE$30,000 Date work will begin 10/15/2012 Date work will be completed 12/1/2012 Payment schedule Initial payment $10,000 due on signing of contract Payment 2 $10,000 due after cabinets are installed Final payment $10,000 upon completion of all work The law requires that all home improvement contractors and subcontractors shall be registered by the Director of Home Improvement Contractor Registration,and that any inquiries about a contractor or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulations,10 Park Plaza, Room 5170,Boston,MA 02116(617)973-8700. It is the contractor's obligation to obtain any and all necessary construction-related permits,should the owner secure their own construction-related permits or deal with unregistered contractors the owner shall be excluded from access to the guarantee fund. Unless otherwise noted in this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Acceptance of Contract . DO NOT SIGN THIS CONTRACT IF THERE ARE BLANK SPACES The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work Signature as specified.Payment will be made as outlined above. Date of Acceptance /,011012PI. Signature You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which 4be his main office or branch thereof,provided you notify the contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation form for an explanation of this right �► "TRAVELERS J One Tower Square, Hartford, Connecticut O6183 BUSINESSOWNERS COVERAGE PART DECLARATIONS CONTRACTORS PAC POLICY NO.: I-680-2279R82A-ACJ-12 ISSUE DATE: 04-04-12 INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA POLICY PERIOD: From 05-27-12 to 05-27-13 12:01 A.M. Standard Time at your mailing address. FORM OF BUSINESS: CORPORATION COVERAGES AND LIMITS OF INSURANCE : Insurance applies only to an item for which a "limit" or the word "included" is shown. COMMERCIAL GENERAL LIABILITY COVERAGE OCCURRENCE FORM LIMITS OF INSURANCE General Aggregate (except Products-Completed Operations Limit) $ 2,000,000 Products-Completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit - $ 1 ,000,000 Each Occurrence Limit $ 11000,000 Damage to Premises Rented to You $ 300,000 Medical Payments Limit (any one person) $ 5,000 BUSINESSOWNERS PROPERTY COVERAGE DEDUCTIBLE AMOUNT: Business owners Property Coverage: $ 1 ,000 per occurrence. ..� Building Glass: $ 1 ,000 per occurrence. BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months Period of Restoration-Time Period: Immediately 0 = �— ADDITIONAL COVERAGE : �— Fine Arts: $ . 25,000 m o= Other additional coverages apply and may be changed by an endorsement . Please o� read the policy. o� SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT MP TO 01 02 05 (Page 1 of 02) 007098 TRAVELERS!" One Tower Square, Hartford, Connecticut 06183 RENEWAL CERTIFICATE :. COMMON POLICY DECLARATIONS POLICY NO.: I-680-2279R82A-ACJ-12 CONTRACTORS PAC ISSUE DATE: 04-04-12 BUSINESS: CARPENTRY INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA 1. NAMED INSURED AND MAILING ADDRESS: PEARSON RENOVATION INC 76 TRASK STREET BEVERLY MA 01915 2. POLICY PERIOD: From 05-27-12 to 05-27-13 12:01 A.M. Standard Time at your mailing address. 3. LOCATIONS: PREM. BLDG. OCCUPANCY ADDRESS (same as Mailing Address NO. NO. unless specified otherwise) 01 01 CARPENTRY 76 TRASK STREET BEVERLY MA 01915 I 4. COVERAGE PARTS AND SUPPLEMENTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: COVERAGE PARTS AND SUPPLEMENTS INSURING COMPANY Businessowners Coverage Part ACJ o_ o= " oO 5. The COMPLETE POLICY consists of this declarations and all other declarations, and the forms and endorse- ments for which symbol numbers are attached on a separate listing. 6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions. POLICY POLICY NUMBER INSURING COMPANY o= o= DIRECT BILL o� 7. PREMIUM SUMMARY: SUBJECT TO AUDIT , o� - Provisional Premium $ 1 ,676.00 Due at Inception $ W— Due at Each $ NAME AND ADDRESS OF AGENT OR BROKER COUNTERSIGNED BY: STATE FUND INS AGCY INC X1072 100 SUMMER ST 16TH FLR Authorized Representative BOSTON MA 02110 DATE: IL TO 25 08 01 (Page 1 of 01 } 007095 Office: ELMIRA NY SRV CTR DOWN t Massachusetts- Department of Public Safct}- Board of Building Regulations and Standards Construction Supervisor License License: CS 50929 DONALD A PEARSON 87 RIVERVIEW RD 4 GLOUCESTER, MA 01930 Expiration: 10/10/2012 Commissioner Tr#: 3444 U/rc �prl��r�craicrcje�rlf�afe�illas.tac�«sel�.: — - Office of Consumer Affairs&Business Regulation_ License or registration valid for individul use only ME IMPROVEMENT CONTRACbefore the expiration date. If found return to: kWTOR gistration: 100275 Type: Office of Consumer Affairs and Business Regulation piration: 6/45/2014 Private Corporatic: 10 Park Plaza-Suite 5170 Boston,MA 02116 PEARSON RENOVATIONS,INC. Donald Pearson 87 RIVERVIEW RD. GLOUCESTER,MA 01930Unf� ' dersecretary �`'1�Tot valid without signature