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HomeMy WebLinkAboutBuilding Permit #478-16 - 61 UNION STREET 10/14/2015io% Permit No4ak7& I '1 0 P Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 'ANT: Anblicant must comblete all items on this LOCATION �/ &T Print PROPERTY OWNER 60Z -V' 1?&'9 GAS —1 -Al Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes fO yam' ,' /�10RTF� OF,�i�Eo 'b ghc 6 _ no no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building `XOne family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly, OWNER: Name: '_I_�c, i� .ta �.� i3` �' S �'� ` Phone: gyrAd Address: ( 0/V,70 A) S / iv u Dat) (f A Contractor Name:Phone: �99q - 114J0 Email: Address: 9 r s nuc lYt ee+u.a /nA >y7 T_. Supervisor's Construction License:C'S CSI Exp. Date: i `7 Home Improvement License: Jo a 1 `% 9 Exp. Date: l� 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: $ 1110 0 50 - OLI FEE: $ �3 � Check No.: Receipt No.: S NOTE: Persons contracting with unregistered contractors do not have access to ua my fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming a Pools. t, well ❑ Tobacco Sales ❑ Food Packaging/Sales ti ❑ f Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature V COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Usgood Street FIRE DEPA RJTMEN Y ,t � ._i . i� Temp�pumpster L'ocatedlaf124iNJOiStCeet Fire+D;epatit ent;sgnature/date COMMENTS 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Emai Date Time Doc.Building Permit Revised 2014 Contact Name [k 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 4 Building Permit Application ,4. 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 OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 2014 Location �/ t/Wldfi < Date No. � Check # IM 4 TOWN OF NORTH ANDOVE%— Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector E9 * rA rA 1A�,1 W J Q W Q OJ m v U Y L0 Ln ++ a)L N U W N Z z 0 m @ C LL L O K C E t U _ O LL o U W a {/) z z m O. O d' _ c LL o W a Z J Q U U J W t : O K U � v Ln _ f0 LL O u W a H Z LA Q Q t O K _ O LL z W Q W o LU LL N L CD 6 z W Q1 +L+ N cu W E N O J O O O •� L Q. ai c d Q O ,, E Q L � � O d d r +0.+ E Le V N d � Q' J to d > _ L S N > 0 0 = C •� V Q N d L � E `~ O (D O Z Q. _�.- N 0 O •> O = o� Q' CL 0 ai C CD :i O C CD L d Q. O .0 O to V m O -p +�+ O O O O �. •� N •� :E.2 V V Q0 'a d °' •> ;� 00 t - Q. O C) i Z O G ui Z w CL ui W CL LS W O ^E W L O O G� Z N I � _ 0 N •� .E M M A •`• iY� OW`+ CDO c Q CL CD Q i_ V J .0- O Z 0 CL V N i CL U) CONTRACT D WIP!/ 9 Curtis Avenue • Middleton, MA 01949 • Phone/Fax: (978) 774-1430 • Email: lemaycc@gmail.com • www.lemaycc.com -Page 1 of 1 Submitted To: Bob &Deb Gesing Date: 07/07/15 61 Union St Location: Kitchen North Andover Ma 01845 Work Phone: We hereby submit specifications and estimates for: . Remove existing cabinet doors and drawer fronts. Modify existing cabinets to meet new layout. Build new base and upper cabinet at old Ref. location. Build new doors and drawer fronts and install new hinges reusing drawer slides. Install 4 recessed lights and ceiling fan. Install under cabinet lighting and lights over sink Install blue board over existing ceiling and skim coat plaster Complete trim work as needed and install crown molding in kitchen Prime and paint walls ceiling trim and cabinets with 2 coats finish Repair tile floor (Tile and grout by owners.) Install new sink and faucet provided by owner. Install new Garbage disposal , Install new baseboard heat Clean area and haul away all trash Material $1375.00 Plumbing $2300.00 Electrical $3550.00 Plastering $1800.00 Painting $2900.00 Labor $9000.00 Trash $125.00 Total cost $21,050.00 Not included in quote. Permits, Fan and lights at sink, Hardware, sink & faucet, Floor tiles and granite. Any additional work needed will be based on material cost and labor cost of $50.00 per man hour. Payable as follows.. $6,000.00 at start. $6,000.00 after rough inspections with balance upon completion All accounts are due and payable upon receipt. Finance charge of 1.5% per month, which is an annual percentage of 18% on all accounts over 30 days. All material is guaranteed to be as specified. All work to -be completed in a workmanlike manner according to standard practices. Any alterations or deviation from above specifications involving extra cost will be executed only upon written orders, and will become an extra charge over and above the Authorized Signa w(: estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our This Contract may be withdrawn us if not accepted within 45 days. workers are fully covered by Workmen's Compensation Insurance. ACCEPTANCE OF CONTRACT - The prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date �_ LEMACON-01 CONNIE1 CERTIFICATE OF LIABILITY INSURANCE DATE 1 71/161216/2015 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 COh TRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ie must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemer t. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Onnie Parent NAME: Elliot Whittier Insurance Services, LLC PHONE 978 977-4884 FAX 978 977-0850 75 Sylvan Street Suite B202 A/c No Ext ) ac, Not: ) E-MAIL Danvers, MA 01923 ennr2Fss• I fo(Welliotwhittier.com INSURER A: 4orfolk 8r Dedham Group 23965 INSURED INSURER B: tica National Insurance Group Lemay Construction Co., Inc. INSURER C: 9 Curtis Ave. INSURER D: Middleton, MA 01949 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER- REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TH EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDL ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY M EFF D POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEAl OCCUR R1368489A 07/ 4/2015 I 07/14/2016 EACH OCCURRENCE $ 1,000,000 RENTED PREMISES AMAGE ToEa occurrence $ 50+000 MED EXP (Any one person)_ $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER X POLICY ❑ JET LOC OTHER: GENERAL AGGREGATE $ 2+000+000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE. LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS ALL OWNED F—X X HIRED AUTOS AUTOS NED R1368489A 07/1412015 07/1412016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 + BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ �PeOPER r accidentDAMAGE $ A X UMBRELLA LIAR EXCESS LIAB HX OCCUR CLAIMS -MADE U1405570A 07/14/2015 07/14/2016 EACH OCCURRENCE $ 1,000+000 AGGREGATE $ 1,000+000 DED X I RETENTION $ 10+000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 44382 44 07/ 4/2015 07/14/2016 X PER 0TH - STATUTE ER L.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe atta Carpenter/Remodeling hed if more space is required) TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDIANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are register4d marks of ACORD s Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/individual): Address: q CO L'7 X3 100, City/State/Zip:MT9P tef 0 A) Are you an employer? Check the appropriate box: 1.1I am a employer with c _employees (foil andior part-time).* Phone #:!77k —92`%' %30 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.FJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] Type of project )required): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 0 Building addition 11. ❑ Electrical repairs or additions 12.. Plumbing repairs or additions 13. [] Roof repairs 1.4.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. fi 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 workeis' 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: Policy # or Self -ins, Lic. #: /414'Y % U ExpirationDate: ! Job Site Address: Z I 4)AJ i �S� City/State/Zip:. 90,P00-elt M O9 n1 �%S_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I dojaer-e—�y certify un the 4ins and penalties ofperjury that the information provided move isIrue and correct. 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 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: The Commonwealth of Massachusetts Department of IndustrialAccidents . d X Congress Street, Suite 100 Boston, MA 02114-2017 -^ . . �` www mass.gov/dia s Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/individual): Address: q CO L'7 X3 100, City/State/Zip:MT9P tef 0 A) Are you an employer? Check the appropriate box: 1.1I am a employer with c _employees (foil andior part-time).* Phone #:!77k —92`%' %30 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.FJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] Type of project )required): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 0 Building addition 11. ❑ Electrical repairs or additions 12.. Plumbing repairs or additions 13. [] Roof repairs 1.4.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. fi 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 workeis' 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: Policy # or Self -ins, Lic. #: /414'Y % U ExpirationDate: ! Job Site Address: Z I 4)AJ i �S� City/State/Zip:. 90,P00-elt M O9 n1 �%S_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I dojaer-e—�y certify un the 4ins and penalties ofperjury that the information provided move isIrue and correct. 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 1. 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=contractors) 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. ## 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Massachusetts - Department of Public Safety Board of Building Regulations and Standards r..__.__ r.._.... �,1/ILII tllllll 11 JUI/CI vI\III License: CS -051698 ROGER A LEMA) • �'r� •�� y 9 CURTIS AVE MIDDLETON MA Ol Y� Expiration Commissioner 06119/2017 :., Office of Consumer Affairs & Business Regulation j I rOME IMPROVEMENT CONTRACTOR egistration: 102679 Type:. Expiration: 7/2/2016 Private Corporatii LEMAY CONSTRUCTION CO. INC. Roger LeMay 9 Curtis Ave Middleton; MA 01949 Undersecretary OSHA 002311573 U.S. Department of Labor Occupational Safety and Health Administration Roger A. LeMay t ns successfully completed a 10 -how Occupational Safety and Health Training Course in Construction Safety & Health James Rodger 9/11/11 (Trainer) (Date)