HomeMy WebLinkAboutBuilding Permit #800 - 60 WOODCREST DRIVE 5/31/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 0349
Date Issued: 4-"3 1 — ( i
Date Received
IMPORTANT: Applicant must complete all items on this Daae
m
Print
PROPERTY OWNER 4,vi`I- '�'> ' >,J
Print
MAP NO: /o -;?. PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes In
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
0 Addition
❑Alteration
ne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Commercial
epair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Other
❑ Others:
O1Septcd Well'
®Water/,Sewers
_
®Fflo�o p auiWet d
1
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s
® W�at"erAshedDistr
Ll�, (UK1r 11UN 91" . WORK TO BFYERFO
(Identification Please Type or Print Clearly)
O vJNER: P.larne:it1 at �- ► E'er _clsi� A f Phone
Address: La Lt� c,--<s`t' 0-r
CONTRACTOR Name: �6�s D / (; 9%-y` Phone: 97k1slel6«
Address: I Z L(
Supervisor's Construction License: 6 �- Z %--v Exp. Date: '7ZO 1 Zo/ t
Home Improvement License: j L/ S I � 3 Exp. Date: / Z /2- / Z7 ( -a
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Tota! Project Cost: $ �,06 < 00 FEE: $
Check No.:
ke Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
I"
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
f`
► DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zor�i:ng 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
t DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT.- Temp Dumpster on site yes no
' Located at 124 Main Stree'-
Fire Department 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
® Notified for pickup - Date
. i
Doc:.Building Permit Revised 2008mi
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtaine1.
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
Li 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
rnust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location e'0 �%y%� 1
No. A949 — Date � 1�
NORT►► TOWN OR NORTH ANDOVER
F �
9
Certificate of. Occupancy $
7�CH t� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2195
Building Inspector
E'RT11=:ICAT :.O;F`'LIA:ByLITY�
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IODucER 603.382:4600' • FAX' 603.^382'-2034'
THIS:CERTIFICATE.IS;ISSLIED AS;APON V �OF •RtrINFic T. L-
AND CONFERS RIGHTS UPON T}IE.CERTIFICAT.E
nsurariCe Sol utiOrls Corporation
ONLY .NO
HOLDER: THIS CERTIFICATE DOE'S .FIOT• AMEND, EXTENb.OR .
it l e Rd
TE COdERAG E• AFFbR D BY P L IE FLOW.
„
-THE
Narjial�ana' costa ,COVERA
su D Joseph Blanchet dba A B Custom Carpentry
INSURERA-Merchants 23329`
•124 Lake' St•
INSURERI3�'
Hav�rhii T MA 01832-11. 6'
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IN$UREI3 C: _
INSURER D:
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INSURER E: ;
;01WRAGES :..; .. ,..,:
TO THE INSURED NAMED ABOVE FOR THE POLICY,PERIOD INDICATED. NOTWT.HSTANDING
THE POLICIES OF INSURANCE LISTED BELOW: HAVE BEEN, ISSUED
AN,( REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T0, WHICM THIS CERTIFICATE MAY 9E ISSUED OR .
'BY HEREIN.IS SUBJECT TO ALL THE TERMS, EXCLUSIONS'AND CONDITIONS OF SUCH
MF4Y PERTAIN, THE INSURANCE AFFORDEDTHE POLICIES;DESCRIBED
PO].ICIES. AGGREGATE LIMI'fS.SHOWN MAY HAVE BEEN REDUCED BY AID CLAIMS.
TR
NS
TYPE OF INUUkANCE',
POLICY NUMBER, .
DAT$•
EFFECTIV
MM/D
OLICY PI ION
DATE' MM/DD
UM175
1.000; 00
BOPY05'0253'
07/07/2010.
07/07/2011
EACH occURREt+cs
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GENERAL LIABILITY
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COMMERCIAL GENERAL LIABILITY
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PREMISES Ea ocdurience
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CLAIMS MADE. X.; •OCCUR
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G=NERALAGORtGA�".',.;. �• " • `2;000;00
PROOIfCTS -COMP/OP AGG $ .` 2 , '000.OO
GEML AGGREGATE LIMIT AWPLIES PER
POLICY X PCRCOT'' •LOC
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BOP1050253'
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:07/0712010
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07/07/2011
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COMBINED, SINGLE LIMIT " $ ' '.
AUTOMOBILE LIABILITY
.(E9 aocid¢nt)" ; .
1. 000 000
ANY AU70
ALL OWNED AUTOS
BODILY INJURY $
(P9r *don)
A
UL D AUTO S
SCMED E
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HIRED AUTOS .
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BODILY.INJURY,' - $;
'(Per ecdoenl)
X'
NON-OWNED,AUTO$
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PROPEI;MDAMAGE
`(Per aai9enq ,
AUTO ONLY-EAACCIDEPfT t
C,AkAGELU>BILITY'
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ANY AUTO
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OTMER;TNAN . EA ACC' $
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AUTO ON
EACHOCCURR�NC) .i' S,
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EXCE65'/UMBRELLA LIABILITY:
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OCCUR . CLAIMS'MADE
AGGR> GATe:
DEDUCTIBLE
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RF MNTION S
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WORKERS'
COMPENSATION
TORY•LlM1AIrrs '.. ER :
AND EMPLOYER$' LUIBILRY
ECUTNEY/N
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ANY.PROP.RIt TOR/PARTNEkir--
OFFICERIMEMBER EXCLUDED? .
..
E L DISEASE - Eb EMPicIYEE ,S ,..
(Muitlato y In NH),.
jjyos.ebeu(be under,
E.L. DISEASE -POLICY LIMIT .$ .: •.
SPEGtIAL PROVISIONS below
I OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES) EXCLUSIONS ADDED BY pNDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION.
SHOULD ANY OF TME ABOVE: DESCRIBED POLICIES BE gANCELLED BEFORE THE.EXPIRATtON
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' 10 :. ' DAYS WRITrEN
'
NOTICE TO THE CIERTIFICATE HOLDER NAMED TO TME LEFT, BUT' FAILURE TO DO 3O SHALL
Town . of-North AndOV er
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, rr5 ApENTS OR
Attn. Building Department
120 Main St
REPR> SENTAnVES,
AUTHORIZOREPRESENTATIVE '42 LW44_
`
North Andover, ''M4 `01845
1 wlana,
MAi4W ana . CdstAjMLD
®1988-2009 ACORD CORPORATION. All rights.reseived.'•
Ai�oRD.25 (2008101) :FAX:., • 978.688.9542....
'The ACORb name
arid logo are registered marks ofQCORb .
10 'd 9c:01 L LOZ l0 A 8 W
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA. 02111
�,„ s�• ' www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plumbers
Applicant Information Please Print Lezibl
Name (Business/Organization/Individual): J of s%
Address: / Z Y �c, �—
City/State/Zip: Phone #: T 2k -
Are
k -
Are you an employer? Check the appropriate box:
' 1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).'
have hired the sub -contractors
2. EP l am a sole proprietor or partner-
listed on the attached sheet.
ship and Have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] i
employees. [No workers'
comp. insurance required:]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. ❑ Plumbing- repairs or additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box 41 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 their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and joh site
information.
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 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 ofthis statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains andpenaldes of perjury that the information provided above isntrue and correct.
Official use only. Do not write in this area, to he 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Persoi
Phone #:
11
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JOSEPH G
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Expiration.
912012011
Tr#: 4294
Ofrce a�fze i��?y�
HOME IMP nsu►ner At'fairs & °�
Busi "c2a����
s Registration. EMENT CONT ness gegulatian
° Expiration; t<, �i45193 RACTOR
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individual
JOSEPH 'r r = _'�
124 LAKE ST
LAIVCh/E.T�
ATKjNSON
MA 08 \ 1-
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Undersecretary
Permits: Permits needed for construction are:
Additional Work: Any alteration or deviation from above specifications involving
extras or vendor price increases will be discussed and will become an added
charge over and above the estimate. Work performed at $55.00 per hour/per man
Laborers will be $22.50 per hour/per man.
Total Cost of Estimate: $ 3600.00
Payment: A deposit is required before work can be started. Starting payment will be
1/3 of total and a 1/3 after framing inspection. Last payment due after final inspection.
;fnltors Signature Date
S6
wn rs Sig ature at
A.B. Custom Carpentry
General Contractor
ESTIMATE
Contractor/Supervisor Lic. # 065280
Home Improvement Lic. # 145193
Fully Insured
Date of Estimate:
Client Name: Anita Djemoun
Address: 60 Woodcrest Dr.
North Andover Ma 01845
Phone:
Owner Responsibilities: Pick Wall Color And wallpaper
Joe Blanchet
124 Lake Street
Haverhill, MA 01832
978-994-6134
Job Location: same
Description of work. Bathroom 6' x 2'8" x 8' Cover and protect all bathroom fixtures.
Remove All wall paper and wall paper border. Remove ceiling drywall. Remover ceiling
insulation. Clean with Clorox Germicidal bleach. Replace ceiling insulation with 9" Batt
insulation. Replace ceiling with 1/2" drywall. Tape and skim coat with a texture to match
existing as close as possible. Ceiling will be painted two coats with Glidden bright white
ceiling paint. Replace wallpaper and border with wallpaper picked out by owner. Paint
window trim.
Laundry Closet 5' x 2'6" x 8' Protect floor and tape up plastic to keep dust down.
Remove washer and dryer. Remove cabinets. Remove ceiling drywall. Remove ceiling
insulation. Clean with Clorox Germicidal bleach. Replace ceiling insulation with 9" batt
insulation. Install new 1/2 drywall to ceiling. Tape and skim coat with texture to match
existing as close as possible. Ceiling will be painted two coats with Glidden bright
white ceiling paint. Reinstall cabinets. Reinstall washer and dryer.
Garage 21'2" x 23' x 8' Protect door opening to house with plastic. Remove damaged
ceiling drywall 32 square feet. Remove ceiling insulation. Remove damaged wall drywall
approximately 32 square feet. Remove wall insulation. Clean removed drywall area with
Clorox Germicidal bleach. Replace ceiling and wall insulation. Replace ceiling and wall
drywall. Tape and skim coat to match existing. Paint all ceilings and walls two coats with
Glidden bright white ceiling paint.
Debris: A.B. Custom Carpentry will responsible for removal of all debris.