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HomeMy WebLinkAboutBuilding Permit #591-14 - 60 PATTON LANE 2/12/2014 O� pORT11 q y BUILDING PERMIT 4�`• `eO 4°'bio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received `0 ATED CHUS Date Issued: M ORTANT: Applicant must complete all items on this page LOCATION (00 40i H-dn L�4�I✓2 Print PROPERTY OWNER Z Print MAP NO A) PARCEL: ONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KOne family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: @(Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Remove dn.e W;wdow lied 4 -f - �'-IYSr A'tl •veW 1—W bt9VK SIA/k Q&LtM0gw -iv;A✓dv14/, -vAe hwN ,4 (�� k/+(1 �efweei k,'fdel , Liv,w9 2? r , zwlrtio lVekl Icl ',v-eff Cm IVIgoy)' Tv,d.4 ,vetl �`'fyhc� dddlz be-fweeo A('&Aeg cyd a1'v,`'v_c ROM, G he w A-+ 1 ffa A 0,1r ` Identification Please Type or Print Clearly) OWNER: Name: Iii A ly� d- At n t'A lJ<+uZ Phone: Address: LL �e CONTRACTOR Name: f Phone: 7r'l -9/3-30U9 Address: , I CII �C St b4NVMJ r^9- 0192-3 Supervisor's Construction License: Exp. Date: Cs- aP?mz Home Improvement License: 3 a Exp. Date: ��f lis � ARCHITECT/ENGINEER 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: $ / FEE: $ f� Check No.: Receipt No.: NOTE: Persons cont acting with unregistered contractors do not have access to the guaranty fund B�Signature of Agent/Owner.- "�/-A MA Signature of contractor ,V'~L^ 'Jill r. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER--.--- . Print no-, - MAP NO _ PARCEL:_ ZbNING DLSTRICT Historic District yes no Machine Ejhpp Villageri yes no. TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well ❑ Floodplain ❑Wetlands ❑ Watershed District L. 1Natet Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR "Name _._ r _ P.,,hone: s _; Address: Su.pervisor's Construction License - Exp. Date: Home lrriproyement License: _ _ _- _. Exp. .Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;SignatureofrAgent/Owner. . - S�g�ature of,contractor_. �" Plans Submitted Li � Plans Waived ❑ Certified Plo Plan ❑ Stamped Plans ❑ Building Department rhe foK,wing is-a_list of the required.forms to be filled out for:the.appropriate-permit to`.be obtained. Roofip,g, Siding, Interior Rehabilitation Permits o Bdailding Permit Application o Workers Comp Affidavit U Photo Copy Of H.I.C. And/OrC.S.L- Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered red products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Sprinkler Plan And o Floor/Crossectlon/Elevation Plan Of Proposed Work With S p Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buil jffig Permit Revised 2012 . 1 , Plans Submitted ❑ Plans Waived ❑ "Certified Plot Plan ❑ Stamped Plans ❑ 5 Public Sewer Tanning/Massage/Body Art Swimming Pools ❑ Well Tobacco.Sales ❑ •Food Packaging/Sales ❑ i Private(septic tank, etc..-- - ' - - . Permanent Diimpster on Site El THE,FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ._,DATE REJECTED DATE.APPR-OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature d COMMENTS i 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 Toivo Engineer: Signature: Located 384 Osgood Street FIRE DEPA TI Ir NT -.-Temp Dumpster on site yes no Located at124Mair Street Fire Departine►�t signature/date COMMENTS r t I' .---Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I _ :Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGERZONE 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 Doe.Building Permit Revised 2010 r Location U No. Dat • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ • ' .», a � E Building/Frame Permit Fee $ Foundation Permit Fee $� „4P,AVn Other Permit Fee $ A TOTAL $ + f CheckCD #� �} ..� 2 7 2 %i 8 Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 38,000.00 m $ - $ 456.00 Plumbing Fee $ 57.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 57.00 Total fees collected $ 670.00 60 Patton Lane 591-14 on 2/12/2014 Various Modifications r' , NORTH Ae - _ ve- . No. S - I_ Iq h h ver, Mass, _a, COC MIC MI WKK S U BOARD OF HEALTH PERMIT Food/Kitchen L D i Septic System THIS CERTIFIES THAT .:................... .. ............ ..... .� .. ....... .......................................... BUILDING INSPECTOR /►� ��. % �. Foundation has permission to erect ........ ................. buildings on ...�I.�....... ... ....... ........ ``' .......... ... Rough e • to be occupied as ...... .. ... .......... 4. ...... ............QlA. ..... .......... Chimney Odd provided that the person accepting this permit shall in every resp ct 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT I T TS 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. SEE REVERSE SIDE Proposal K.L.A. remodel & const. 19 Clark St Danvers, Ma 01923 781-913-3009 Jn.rich@hotmail.com Job# 014-02 Prepared For: Kenia and Escipion Baez 60 Patton Lane Estimate: *Demo wall in middle of kitchen. Install new blue board drywall on the wall and on the ceiling. Both the ceiling and wall to be patched in with new skim coat of plaster. Remove cut tile against wall and replace with new tile. (tile to be supplied). Remove all trash. *Demo door and wall between kitchen and dining room. Frame an opening to fit a 4'x6'8" primed French door with full clear glass. Patch the wall with new blue board and plaster. Patch the floor with a piece of oak between dining room and kitchen. Trim the new door with new casing to match existing trim. Remove all trash. *Demo existing closet door in kitchen. Prepare opening to fit new cabinet pantry and trim outside of pantry with supplied trim to match cabinets. *Demo existing kitchen window. Frame a new opening to fit a new and wider casement window. The window will be approximately 62" wide and 41" in height. (that is the closest sized window to 68" without going over), to install a window sized to fit for the cabinets. Install new window. Install new trim on inside and outside of window (if applicable). Patch back in all the siding around new window with cedar clapboards. Remove all trash. *Remove existing window in kitchen to be able to extend cabinets. Insulate in the opening. Patch inside with new blue board and plaster. Patch in the siding on the outside of the house with cedar clapboard to match existing siding. *Install new cabinets and island. Install cabinet moldings above cabinets to ceiling. *Install new tile backsplash on all applicable walls. Tile and grout is to be supplied by homeowner. *Install a new 36"x6'6" solid thermatrue fiberglass door in the basement. Build walls and opening to fit that door. Insulate and trim both sides of the door. *Move one output of central vacuum from dining room wall, down that wall to past the new French door. *Make sure all appliances are put in their respective places. *Plumbing includes install of sink faucet, DW install, fridge ice line, plumbing under sink and move and install new toe kick heater. *Electrical will include under cabinet lighting install, pendants over island install moving of any wiring needed new wiring needed and recessed lighting. The price for this job is $19,000. This price includes permit, trash, plaster, plumber, electrician, materials, and labor. ***All materials are guaranteed to be as specified. ** *All materials, labor, and taxes are included in price. Thank you for your business. Jeff Rich K.L.A. Remodel and Construction Proposal K.L.A. remodel & const. Danvers, Ma 01923 781-913-3009 Jn.rich hotmail.com Job#014- Prepared For: Contract and Payment Schedule: Construction Part: Phase 1, includes t/2 of materials, trash, and permit Deposit= $1,800. Labor= $1,800. This includes removal of window near door, demo of wall, framing of French door opening, basement door/walls, patching of tile floor where needed, moving of the vacuum port. Construction Part: Phase 2, includes French door install, kitchen window install and patching in the clapboard siding on outside of house. Material Payment= $1200 Labor= $1,300. *After the kitchen window is installed, I will schedule the plaster guy to come o e in and put skim coat on all affected areas. This should be in the March 6th or 7th depending on actual delivery of window. This part of job will be a payment of$800. Kitchen Part: The labor in this part is to be split up three parts. First payment after half completion= $2,700 Second payment after completion= $2,000 Third payment after inspection= $700 *Plumbing Part: Total price is $1,600 Plumbing price is to be split into two payments. This split to be determined by plumber. Split maybe 70/30. *Electrical Part: TBD Date: Homeowners: !� Contractor: IA L& f Q/Y1 61)sf/ jc�,dtl Deposit Date: February 11, 2014 Received 4 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (.Business/Organization/Individual): Address: l� CjFrR k &+ City/State/Zip: bPrA(V ° /1 6 O l°1 Z3 Phone#: 7, (—913 -.700 q Are you an employer?Check the appropriate box: Type of project(required): 1 119I am a employer with (�_ 4. ❑ I am a general contractor and I employees full and/or part-time).** have hired the sub-contractors 6. ❑New construction � P 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑'Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.: 9. F1 Building addition required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself o workers'com right of exemption per MGL Y � P• 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C l� Policy#or Self-ins.Lic.#:¢[\NC_q00-"_7dM70 7 a 61 qil - Expiration Date: Job Site Address: �� � /� -it��. City/State/Zip:Iry ANdrit��2 /�'h'� 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 cergify under the pains and enalties o e 'u that the in ormad n provided above is true and correct: Signature: L42 __. Date Uy Phone#: 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#: 6�?- License or registration valid for individul use only Mee of Consumer Affairs&Business Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR i Office of Consumer Affairs and Business Regulation istration: 145'324 DBA oxil Tye' S 10 Park Plaza-Suite 5170 iration �211f21 .... Boston,MA 02,116 K.L.A.REMODEL& Jo CNBU� l©I`ll i a JEFFREY RICH 19 CLARK Sl y r,''` �� DANVERS, MA 01923 Undersecretary of veli without signature i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-088883 ``` �.� JEFFREY N RICE 19 CLARK ST Danvers MA 01923 °✓_..�+.��.r51 . " "� Expiration Commissioner 02124/2016 AC40RO CERTIFICATE OF LIABILITY INSURANCE 7(MM/DD1YYYY) 2/12/14 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 NAME: Circle Business Ins. Agcy, Inc PHONE FAX 247 Newbury Street E-MAIL ' (978) 777-5619 A/ No: (978) 777-4898 ADDRESS: PaulaHalas@CircleInsurance.net Danvers, MA 01923 INSURER(S)AFFORDING.COVERAGE NAIC# INSURERA:Travelers Insurance INSURED INSURERB:Safety PropertV & Casualty KLA Remodeling Construction INSURER C:AIM Mutual Jeffrey Rich INSURER D 19 Clark St INSURER E: Danvers, MA 01923 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WVD POUCY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 6800E62352A 2/8/14 2/8/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TOPRE MISFS(Ea REoNTED $ 300,000 CLAIMS-MADE Fil OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PE R PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC B AUTOMOBILE LIABILITY 6222545 5/18/13 5/18/14 COMBcN"ED'SINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL 0 WNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AWC4007028707 4/1/13 4/1/14 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ICE F C N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job: 60 Patton Lane, North Andover, MA 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. City Hall North Andover, MA AUTHORIZED RE PRE SE ATI E Janet Nic , Account Executive 988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: )utlook Outlook Page 1 of FILE U DOWNLOAD PRINT FIND Your complete office in the cloud. 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