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Home My WebLink AboutBuilding Permit #800 - 612 SALEM STREET 6/5/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: v Date Received °t \� A�HATED pPP��(� TYPE OF IMPROVEMENT PROPOSED USE I Residential I Non- Residential ❑ New Building U-0ne family P/Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other \ DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: 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: $ /Z �o () lt)/L--LCM&i¢ EE: $ Oa' O Check No.: `� 0 Receipt No.: -�2-6 o'1(v 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Conservation Decision: Water & Sewer Connection/S Located at 384 Osgood Street Comments Comments Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. fit, U Total land area, sq. ft.: J V 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 M NOTES and DATA — For department use ❑ Notified for pickup - Date ......... ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Doc.Building Perriiit Revised 2007 Location 4k2 s No. do d Date � 40RTN TOWN OF NORTH ANDOVER :. Certificate of Occupancy $ `,� �0��•0 I°. ss<+cHust<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 20261 Building Inspector y C F CO) CD .cis Z Cp O CZ d d a� 0 o v a� c "� CD O CD d O O O co CD O CO2 n� C O C CO2 d CD O CD y CD CA I O CD O CCD � c z �° pri d I c d �? dO m N o CD • n 7°o N � Ctc A o � C yo' T O m n =r of C', N y O O ?� p • _ = o C', o mp o O Z�.e�s • W CL a L= �. to CL O �� m o Go • US no r C_ d�I a. N ;W : N C ?' c d OC d > Go C > m :•. c IE m CA N N `� 7 1 CD � H O . oil c v mo ID H G CDm to m CL's C! n �! � c z �° pri d I o �? ;oz �? a o t m n ]- 7°o o 9) '" E5 0 y 0 0 c I Finish Work a Specialty Robert C. Bailey Quality Workmanship Building & RemodelinFree Estimatesg 0 B 638 13UUUers License �- . OX Home Improvement North Andover, MA 01845 Contractor #100239 Telephone (978) 682-7087 TO Mr. & Mrs. Marc Beliveau 612 Salem Street North Andover, Mass. 01845 L I L JOB LOCATION same I BILLING PAGE NO. DATE DATE COMPLETED TERMS CONTRACT PROPOSAL OF __�_ PAGES XXX JOB DESCRIPTION: Recreation Area (Basement) All parts of this quotation are based upon field measurements of the proposed lower level and preliminary meetings with the home owners. The contractor shall partition off an area in the presently unfinished basement consisting of a 13'-6" x 20'-6" recreation area and a 13.'-6" x 18' tele- vision viewing area. All existing 2x4 framed interior walls and partitions shall remain intact. Exterior foundation walls within the proposed finished area shall be framed with 2x4 studding extending from the basement floor to existing 2x6 kneewalls. All lower partition plates shall be pressure treated stock. All wall studding shall be 16" on center unless otherwise noted. The existing central vacuum unit shall be removed from the basement area and re -located into the center stall of the garage along the interfacing baseemnt/garage wall area. The contractor shall provide additional piping and elbows to make this transition possible. Electrical power for the unit (new plug) shall be furnished and installed by others. There is no provision in this quote for electrical work, lighting fixturesi, cable television outlets, phone jacks, etc. The existing four awning window units shall have primed extension jambs and 2'/2" colonial casing trim applied to complete finished trim throughout the area. All exterior walls shall be insulated with R-13 kraft faced fiberglass insu- lation. Such insulation shall also be used in the dividing wall between the proposed finished basement and the unfinished furnace/utility area. The existing two (2) ally columns shall be enclosed using lx6 prefinished pine and a half wall parition on each side as illustrated on the submitted plan. Both sides of each half wall shall have 1x4 pine beadboard installe and a 1x8 top cap of preprimed pine. Approximate wall height for the half walls shall be between 42" and 48" (owner preference). All studded wall surfaces within the recreation and television viewing areas s.hall be blueboarded using '/Z" panels followed by the application of skimcoat plaster. All finish painting of walls and trim shall be by others and is not part of this quote. There is also no provision in this quote for the installation of wall to wall carpet or other flooring materials. osed area shall Existing forced warn air ductwork within the propbe enclosed using 1x12 pre -primed pine stock on the verpical faces and the instal- lation of suspended ceiling gridwork and tiles to match the remaining Finish Work a Specialty Robert C. Bailey Quality Workmanship Building & Remodeling Free Estimates #025620 L`N�Rrf'(A'X�Xfg (Aois 0. Box 638 Telephone (978) 682-7087 TO Mr. & Mrs. Marc Beliveau 612 Salem Street North Andover., Mass. 01845 L Builders License Home Improvement Contractor #100239 7 F I L DATE DATE COMPLETED TERMS CONTRACT I PROPOSAL JOB DESCRIPTION JOB LOCATION same 7 I BILLINGI PAGE NO. _ 2 OF 3 PAGES Recreation Area (Basement) suspended ceiling format of the finished basement ceiling area. The existing downdraft vent for the kitchen range shall be re -located into the perimeter banding joists instead of the present kneewall location. There shall be no direct access from the furnace/utility area into the recreation room. The make the transition in wall thickness from the present 2x6 kneewals to the proposed lower 2x4 studded walls, the contractor shall install a 1x8 pre -primed finger joinedbpine board to serve as a decorative shelf. All top plates of 2x4 walls d. All baseboard trim throughout the finished basement shall match that of the existing basement foyer area. The contractor shall furnish and install CloseMai L-shaped shelvingcorner standarhe ds (double', and brackets (white) along the lity room as illustrated on the submitted plan. Standards shall be located at 16" intervals with adjustable shelving consisting of 3/4" x 12" Melamine flakeboard. All front and side edges of the shelving shall be banded using white vinyl adhesive stock. The contractor sahll supply five shelves per section of 8' ¢ 6" wall areas as previously outlined. The ceiling grid system shall consist of Armstrong white wall angle, a standard residential main runner system,, and 2' tees. All parts of the suspended ceiling structure shall be supported at 24" intervals by the use of metal anchors secured to floor joists and approved ceiling wire. All ceiling tile shall be Armstrong 2' x 2' tiles with an allowance of $2.00 per tile. If the owner selects an upgraded tile, the additional cost of the material will be reflected in an addendum to this original quote. The contractor shall be responsible for obtaining the necessary building permit from the Town of North Andover for work as outlined in this pro- posal. All construction debris generated by this project shall be disposed of by the contractor off site. The re -location of the existing outside faucet supply line presently in the rear kneewall area shall be the responsibility of others and is not part of this quote. Access to the cleanouts (2) along the kneewall shall necessitate a slight 3" jog along the asar wall suppliednbythe andlinstalledoo f a by the conged - rac or. Robert C. Bailey Building 4 N"'* 0 Andover, MA 0184 North 5• Telephone (978) 682-7087 F Finish Work a Specialty Quality Workmanship Free Estimates 1111% B o X 638 Builders License #025620 Home Improvement Contractor #100239 TO 7 F & Mrs Marc Beliveau JOB LOCATION Mr. • 612 Salem Street same North Andover, Mass. 01845 L I L DATE I DATE COMPLETED TERMS CONTRACT PROX X XAL BILLING PAGE_ � O� POF AGES 5/17/ 7 JOB DESCRIPTION: Recreation Area (Basement) Any air conditioning and/or heating comdtnsand haslto belmovedttofaccommodate overall ceiling height and uniformity the ceiling shall be the responsibility of others and is not part of this quote. Payment Schedule $2000 down payment due upon obtaining the building permit and re -location of the central vacuum unit. installation of half walls, $3000 due upon completion of all wall framingi, and securing of bottom walls plates. $3000 due upon completion insulation (skimcoat) and andutheainstallation of $3000 due upon completion of plaster utility room shelving. rid and tees. $2000 due upon completion of suspended ceiling g Remainder due upon completion of work as outlined. Hereby Propose to furnish labor and materials complete in accordance with the above specifications for the sum of $ 14 584.99 Fourteen Thousand Five Hundred eighty-four and ----- With payment to be made as follows: Dloaca Cpp above schedule All material is guaranteed to be as specified. All work is to be completed in a workmanlike Authorized manner according to standard practices. Any alteratnp r deviation from above Signatur specifications involving extra costs will be executed onlyu on written orders and will become an extra charge over and above 6�1 the estimate. All agreements contingent upon Note: This proposal may be strikes, accidents or delays beyond our control. Owner to withdrawn by us if not carry fire, tornado and other accepted within 3 (1 days. necessary insurance. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are Signature authorized to do the work as specified. Payment will be made as outlined above. Signature G� Date Accepted ISSUED BY THE STOCK INSURANCE COMPANY HEREIN CALLED THE COMPANY COMPANYGRANITE STATE INSURANCE 1 PENNSYLVANIA MARK BUNKER S GLENDALE ST 1AVERHILL, MA 01832-0000 ;EE NAME AND ADDRESS SCHEDULE — WC990610 AGENT NUMBER POLICY NUMBER 71410-0000 wC 845-02-15 1 I. /• 104MMember Companies of American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.V. 10270 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INFORMATION PAGE - a. ,..- WILLIAM C SULLIVAN INS AGCY 487 GROVELAND ST HAVERH II LL, MA 01830-0000 11SURED IS N D I V I D UA L PREVIOUS POLICY NUMBER ITHER WORKPLACES NOT -SHOWN ABOVE: SEE NAME AND ADDRESS SCHEDULE — WC W 0610 TEM 2 POLICY PERIOD 12:01 A.M. standard time at the Insured's mailing address FROM 12/27/06 TO 12/27/07 PEM 3 A. Workers Compensation Insurance: Part One the of Policy here: p cY applies to the Workers Compensation Law of the states listed MA S. Employers Liability insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1 000, 000 each accident Bodily Injury by Disease $ 1 .000 000 policy limit Bodily Injury by Disease $ 1 .000 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT — WC200306A EM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Estimated Total Rate Per Code Number Remuneration $100 OF Re- aAnnual ❑ Estimated Premium 3 Year muneration Annual ❑ 3 Year EE EXTENSION OF INFORMATION PAGE — WC7754 AXES/ASSESSMENTS/SURCHARGES '_NSE CONSTANT MUM PREMIUM WHERE APPLICABLE BY STATE) . � ue . merim aotustments of premium shall be made: Semi -Annually 1-1 Quarterly INDORSEMENTS (FORM NUMBER) MA Monthly DEPOSIT PREMIUM SEE ATTACHED FORM SCHEDULE — WC990612 TOTAL ESTIMATED PREMIUM N '07/07 ASSIGNED RISK 66 le Date Issuing Office $18 Authorized Represent"e WC 00 00 01 EMPLCyYER: NOTICE OF ASSIGNMENT COMBO I.D. ROBERT C BAILEY BUILDING & REMODELING CONT 000558974 INC 499 WAVERLY ROAD COVERAGE GROUP NORTH ANDOVER, MA 01845 0576842 The Waiver of Our Right to Recover from Others Endorsement is available on Pool policies. Contact your agent for details. AGENT W C SULLIVAN INS AGCY INC OR 487 GROVELAND ST PRODUCER: HAVERHILL, MA 01830 AGENCY FEIN: 043289021 CLASSIFICATION OF C CARPENTRY -DWELLINGS - THREE STORIES OR LESS CARPENTRY -DETACHED ONE OR TWO FAMILY DWELLINGS ROOFING NOC & YARD EMP, DRIVERS CARPENTRY NOC EMPLOYERS LIABILITY 1000/1000/1000 LOSS CONSTANT - STANDARD PREMIUM EXPENSE CONSTANT TERRORISM CHARGE RISK MINIMUM PREMIUM ESTIMATED ANNUAL PREMIUM DIA ASSESS. 4.25 EST. ANNUAL PREM. PLUS ASSESSMENT INSTALLMENT BASIS: Annual COMMENTS Coverage effective 12:01 AM on 12/27/06 CODE 5651 5645 5545 5403 9812 0032 0900 9740 0990 STATUS OF EMPLOYER Corporation Coverage under this assignment applies to Massachusetts operations only. For coverage outside of Massachusetts, contact the appropriate Pool or Plan for that state. INSURANCE COMPANY: AIM MUTUAL INS CO MS. JUDITH BARRY 54 THIRD AVENUE BURLINGTON, MA 01803-0970 (800) 876-2765, Ext: 8704 TOTAL ANNUAL REMUNERATION -------------- $0 $0 $0 $0 STIMATED PREMIUM 9.03 $0 9.03 $0 47.57 $0 16.48 $0 $75 $125 $142 $0 $500 $575 $0 $575 DEPOSIT PREMIUM: $575 THIS IS NOT A BILL Add endorsement WC 00 03 08 to this policy. An approved Form 153 - Affidavit of Exemption for Certain Corporate Officers or Directors - was submitted with this application. Corporate officer's exemption is effective 1/5/07. DATE OF NOTICE: The Workers' Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street • Boston, MA 02110 (617)436-9030 • FAX (617)439-6055 • www.wcribms.org 1� WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA►T16N PAGE Associated Industries of Massachusetts Mutual Insurance Company Burlington, Massachusetts NCCI NO 26158 (800) 876-2765 ITEM 1. The Insured Robert C Bailey Building & Remodeling Cont Inc Mailing Address: 499 Waverty Road North Andover POLICY NO. 1W60113230i2006 PRIOR N0. I NEW BUSINESS MA 01845 (Na. Street Town or City County State Zip Code ❑ Individual ❑ Partnership M Corporation ❑ Other FEIN 01-0677913 Other workplaces not shown above: 2. The policy period is from12/27/2006 to 12/27/2007 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1, 000, 000 each accident Bodily Injury by Disease $ 1,000,000 policylimit Bodily Injury by Disease $ 1, 000, 00 0 each employee C. Other States Insurance: Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating pians. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Persloo Estimated No. Total Annual or Annual Remuneration Remuneration Premium INTRA 576842 SEE EXTENSION OF INFORI 4ATION PAGE Minimum premium $ 500.00 As indicated, interim adjustments of premium shall be made: ® Annually ❑ Seml Annualiy ❑ Quarterly ❑ Monthly I guar esumawo Annual t'remium s 575.00 Deposit Premium $ 575.00 MA Assessment Chg. $308.00 x 4.1920% $0.00 This policy, including all endorsements, is hereby countersigned by aw, 01/25/2007 Authorized Signature Date GOV GOV KIND PLACING CLAIM NAMESAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP William C Sullivan Insurance MA 5403 1 1605 Inc WC 00 00 01 A (11-88) 487 Groveland Succi Includes copyrighted material of the National Council on Compensation Insurance, Haverhill, MA 01830 used with its permission. Schedule of Endorsements Remarks: AIM -1 A Dividend Classification Endorsement ATM -2 Endorsement No. AIM Mutual Policy Conditions Endorsement WC000000 A Policy Conditions WC000113 Issued to Terrorism Risk Insurance Extension Act Endorsement WC000404 Robert C Bailey Building & Remodeling Cont Inc Pending Rate Change Endorsement WC000414 Notification of Change in Ownership WC200301 Appl Lim Liab WC200302 MA Assess WC200303 B MA Notice WC200306 A MA Lim Other States WC200307 Massachusetts Assigned Risk Pool Eligibility WC200401 MA Pend Prem Change WC200405 MA Premium Due Date Endorsement WC200601 MA Canc WC200604 Massachusetts Policy Definition This endorsement is attached to the policy indicated below and is effective on the date stated herein, at 12:01 AM., standard time at the address of the Insured as described in the information page. Policy No. Group Expiration Date of Policy Effective Date of Endorsement Endorsement No. VWC 6011323012006 12/27/20Q7 12/27/2006 Issued to Additional Premium Return Premium Robert C Bailey Building & Remodeling Cont Inc ISSUED BY: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY Countersigned Authorized Representative The Commonwealth of Massachusetts Department of Industrial Accidents quo Office of Investigations 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: u Bder s/Contractors/Electri ' A licant Information dans/Plumbers ,Q Please Print Le 'bl Name (Business/Organization/Individual): /l, d�r� � Ci � � �/J' � � � Address: City/State/Zip:/Z/, kk�d Ilk -If Phone k S 3 Are you an employer? Check the appropriat7am 1. ❑ 1 am a employer with 4. a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6' �Remodelmg construction 2. ❑ 1 am a sole proprietor or partner- . listed on the attached sheet. 1 7. ship and have no employees These sub -contractors have working for me in any capacity. Workers' comp. insurance. g" ❑Demolition [No workers' comp. insurance 5. a are a corporation and its 9. ❑ Building addition required.] officers have exercised their 10.0 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), () 4 and we have no insurance required.]t y e 'es. [No 12.[] Roof re a' employeworkers' pairs comp, insurance required.] 13•[] Other *Any applicant that checks box # I 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 job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. r a_ L ••••• � y a 98Jy anaer the pains and yp�►�alties o perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town ufjicraL 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: �US_/a Phone #: