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Home My WebLink AboutBuilding Permit #714 - 55 PILGRIM STREET 5/4/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: D Date Received �pORTM q O StLlC 16.6 O DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 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: $ 00 ! FEE: $ �6 Check No.: 6,11 Receipt No.: 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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) ❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Water & Sewer Connect Located at 384 Osgood Street DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ Comments Comments Zoning Decision/receipt submitted yes 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 2007 0 Location Pet 4C No. �� Date NORTH TOWN OF NORTH ANDOVER Of t"1D '•,h0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ,�— Other Permit Fee $ TOTAL $ Check # 201 `T3 -- Building Inspector / The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl 3 Name (Business/Organization/Individual): l Address: _ 42 7 :< City/State/Zip:/ ,�rV Dov? , �� Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6 ❑ w construction 2. �1 am a sole proprietor or partner- listed on the attached sheet. t 7• Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition required.] officers have exercised their 10.❑ Electrical repairs or additions 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.] t employees. [No workers' 13.❑ Other comp. insurance required.] . Ily UPPIwant teat cnecKs oox if t must also tut 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 am an employer that is providing workers' compensation insurance for my employees: Below is the policy and job site information. A i Insurance Company Name: _%/f iUf Policy # or Self -ins. Lic. #: e/;o -7 0/ fl ,�r Expiration 07 Job Site Address: s S .lClo- %j/%City/State/Zip: A01 4yv,, 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 er he pains d pe hies of perjury that the information provided above is tru and correct Signature: Date: 07 Phone #: S0 Oficial 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 #: ACORDTM CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 04/23/2007 PRODUCER MacDonald & Pangione Insurance Agency, Inc. P.O. BOX 428 104 Main Street North Andover, MA 01845 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Christopher Rivet 207 Winter St. N Andover, MA 01845 INSURER A: PREFERRED MUTUAL INS CO 15024 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'LPOLICY IN POLICY NUMBER EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY CPP 0130 57 01 05 09/26/06 09/26/07 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY AGE TO RENTED PREDAMMISES Ea occurence $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS MADE El OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY, $ . NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE;+ " (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $" _ EA'ACC $ ANY AUTO'..' - - - OTHER THAN • - AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND I WC STATU- OTH- MY—ST EMPLOYERS' LIABILITY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS certificate holder as listed below ••�--�•• 1iM19VGLLIIIIV IY - - ' ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF, THE ISSUING INSURER WILL-ENDEAVOR'TO MAIL 10 DAYS WRITTEN 120 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO -SO SHALL No Andover, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE wn�on n U ACORD CORPORATION 1988 REVISED # 4 PROPOSAL SUBMITTED John and Donna Callamaro 55 Pilgram.Street North Andover, MA 01845 (IT) 978-686-6853 (C) 978-314-8767 May 3, 2007 Work to be completed for Kitchen Remodel includes: • Permit Fee $ 275.00 • Locate 20 Yard Dumpster in Driveway. $ 500.00 • Remove all kitchen cabinets, counter top and sink. $ 800.00 • Remove ceiling in kitchen and hall. $ 450.00 • Remove existing kitchen floor. $ 800.00 • Electrical work: install 6 inch cans (8 each), 4 inch cans (2 each) Relocate switches in wall near hallway, rewire garbage disposal, Rewire dishwasher, add any receptacles required, install Halogen under cabinet lighting, all lighting to be on dimmers. $ 3300.00 • Relocate Plumbing for sink, dishwasher, and refrigerator. Any work required for new stove, hook-up. $ 2200.00 • Hang new blueboard in kitchen and hallway and plaster. Hang and plaster exterior kitchen wall were needed. $ 2300.00 • Install 3 Y8 crown molding in dining room. $ 400.00 • Remove existing kitchen window, reframe opening in new location, install new window, finish exterior. $ 1500.00 • Install kitchen cabinets. $ 1800.00 • Install new casing on six door openings $ 775.00 • Install new underlayment on kitchen( floor. $ 650.00 • Install new 2 IA Red Oak flooring. $ 2200.00 • Sand and finish floor. ( estimate) $ 700.00 • Remove three existing interior doors and replace with $ 1005.00 Solid core masonite doors. • Install 48" bi-pass closet doors. $ 425.00 • Remove flooring in hall. Install new oak and finish. $ 950.00 • One Harvey Casement window. $ 625.00 TOTAL LABOR & MATERIAL $ 21,655.00 Terms: $ 7220.00 to start $ 7220.00 after new ceilings installed $ 7215.00 when complete Submitted by: Chris Rivet ro 207 Winter Street North Andover, MA 01845 MA Lic. #CS072173, HIC #139962 (14) 978-794-1165 (C) 508-265-3115 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted: You are authorized to do the work as specified. Payment "I b made as outlined above. C10n Afi1rA ". Z/ Date 9 0 >> BOARD OF BUILDMN REGULATIONS License: CONSTRUCTION SUPERVISOR " �� ' Number. CS 072173 Birthdate'OF/02/1961 ' Expires 06x02%2008 Tr. no: 26821 Re�stnv 1 do CHRISTOPHER FiVET ' 207 WINTER ST (� 4 N ANDOVER, MA 01846 Commissioner ; s� _ ";oard of iiuilding iteguladons and' # r ?§ ' HOME IMP IROVEMENT GdNTRACTOR Registration: 139962 Expiration: t/8!2007 Type: indhAdual i CHRISTOPHER F RIVET I, GFiRISTOOHER RIVET x 207 WINTER ST. N. ANDOVER, MA 01845 A miaistrati{