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HomeMy WebLinkAboutBuilding Permit #594-13 - 76 OLD VILLAGE LANE 3/6/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � ' l� Date Received Date Issued: ` IMPORTANT:Applicant must complete all items on this page LOCATION 76_ --ot_t7t/' IAC z T Print: _ PROPS_RTY OWNER, _._ �2�< Print 100 Year Old Struct re• yes MAP`NQ`:� PARCEL:2011 ZONING QIST�RIGT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial "Iteration No. of units: ❑ Commercial Plepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Welles ❑ Floodplain ❑W tlands ❑ Watershed District, e-Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: P UJO r 4l, )5 x(,r-r/ fc,l,1e,-i GA I3,,,ve < /9049 ACty C0J Atmel �>7 1V8 Y�� 1f� d o w rc, r/L;es— AIC)CL a ice AIUA,yl r v CJ nui S IldV-e ' b #ft4 J 01,44 f a /, Al or-.? . GA4 f v 4-1r r �N { Identification Please Type or Print Clearly) OWNER: Name: I rL 2 `Lr Phon 7� r'� 2 �/Z I Address: 76 01-D I t.LO i A-"E No fLTW I CONTRACTOR Name: 2+ P— Ri—t-J-ergs. Phone: !? 78 kTZ 5i�`CT Address: © r! j f AJ r C) - A 2 . Supervisor's'Construction License:_ CN f D Exp. Date: /� /� FO/Y Home,Improvement License. 02 C3. _ Exp. Date: Zf Zoi 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. I Total Project Cost: $ ,�f7y FEE: $ Check No.: Receipt No.: NOTE: Persons contracts unregis red contractors do not have access to a guaranty fund c I 6lgnature'of Agent/OwnerSignature�offconfractor 1 Plans Submitted ❑ Plans Waived LifiedYlot Plan ❑ Stamped Plans ❑ i ii 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 DATE REJECTED ' DATE APPROVED I PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments r Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow, Engineer: Signature: Located 384 Osgood Street FIRE`:DEPARTMENT - Temp Dumpster on site yes no Located at'124.Main"Street Fire Departinent•signature/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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use El Notified for pickup - Date i Doc.Building Permit Revised 2010 1 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 o Building Permit Application �. o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 Addition Or Decks ❑ Building Permit Application � Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit I ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And + Hydraulic Calculations (If Applicable) I ❑ 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 t ❑ 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 r ❑ 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 j that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording J must be subm;tted with the building application Doc: Doc.Building Permit Revised 2012 I Enter construction cost for fee cal- North'Andover Fee Calculation Construction Cost 26,00,0.00 m $ - $ 312.00 Plumbing Fee $ 39.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 39.00 Total fees collected $ 490.00 76 Old Village Lane 594-13 on 3/6/2013 Kitchen Remodel, Make 1/2 bath smaller The Commonwealth of Massachusetts - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lease Print Applicant Information ibly Name(Business/Organization/Individual): C uS QOM U�L�PIs 'lY Address: X 9' City/State/Zip: eel 1-1141,4 ti0 36 7k Phone#: Are you an employer?Check the appropriate bx: Type of project(required): 1.© I am a employer with 1_ _ 4• u 1 am a general contractor and I 6, 0 New construction employees(full and/or part-time).* have hired the attasub-ched sheet. 7. remodeling 2,Q I am a sole proprietor or partner- listed on the attached sheet.� ship and have no employees These sub-contractors have S. E]Demolition working forme in any capacity. , workers' comp.insurance. g, Q Building addition [No workers' comp.insurance 5. L� vie area corporation and its 10.Rflectrical repairs or additions required.] officers have exercised their right of exemption per MGL 1 L Plumbing repairs or additions 3.1 I am a homeowner doing all work c. 52,§1(4),and we have no 12.Q Roof repairs myself. [No workers comp. employees. o workers' insurance required.]t 1311 Other 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. tContractors 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. r- I Insurance Company Name: r MA T LeS ti / Policy#or Self-ins.Lic.#: /4 P Pc' Expiration Date: fo � O L (/t LL R? /� City/State/Zip: A/v t TfV Job Site Address: 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 under the pains and penalties of perjury that the information provided above is true and correct. Date: Si ature: 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): LL6.Other of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 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 ofpublic 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMassochusetts Department of Industrial.Accidents Office of Investigations 6.00 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877,MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mtass.gov/dia NORTH Anctover ownoi No. 1594. ' ih ver, Mass, • }� .3 Y O LAN! /1. C OC NIC Nl WICK � S V BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System THIS CERTIFIES THAT ........0....Lr.�* ... ,,,, BUILDING INSPECTOR ..... :/lam L has permission to erect ... Foundation ... .................. buildin son ..... .......�/ ... ... Rough to be occupied as ../t. ........ ... .......� .. v ...... .. .. .... ...... ........................ .......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and B;ff44ix s to th nspection, Alteration and Construction of Buildings in the Town of North Andover. Oen## ♦� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough. �' Final PERMIT EXPIRES IN 6 MONTHS , ELECTRICAL INSPECTOR �• UNLESS CONSTRUC N §TAIRTS Rough Service .......... DA ....... .......................................... 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 AC�® DATE(MMIDDIYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 02/25/2013 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 Colleen A Coughlin Charles J Coughlin Insurance -- 14 Dinley Street pH'IV�N o . (978)957-3588 FAX No P.0. Box 10 E-MAIL colleen cou hlinins.com ADDRESS: @ g Dracut,MA 01826 INSURERS AFFORDING COVERAGE NAIC#_ INSURERA: Main Street America Assurance Company 29939 INSURED Custom Builders by D&R Construction, Inc. INSURER B: NGM Insurance Company 14788 P.0. Box 817 Liberty Mutual Insurance Co. 15628 Pelham,NH 03076 INSURERC: Y INSURER D: INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP /YLIMITS LTR POLICY NUMBER MM/DDYYY MMIDDIYYYY A GENERAL LIABILITY MPP6846V 06/22/2012 06/22/2013 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED 500,000 PREMISES Es occu rence) $ _ CLAIMS-MADE IV OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO-JECT F� LOC $ B AUTOMOBILE LIABILITY B1 P6846V 07/23/2012 07/23/2013 CEaOMaccldenBINED qSINGLE LIMIT 500,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accidenp $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC5-31S-386142-012 06/08/2012 06/08/2013 WRY LIMITS O H AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN � N/A E.L.EACH ACCIDENT $ 100,000 D? OFFICER/MEMBER EXCLUDE (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If es,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover,Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE Q �✓ /� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r. I Pct_ V Z � )Z , L9Ak- ?i a/ ©C9 . O _ pct z- G000-- a D-& R Builders, Inc. -...-.. _ ADDIT1oNS •VINYL SIDING• KITCHEN/BATH REMODELS. Richard Arseneault Dan Montmarquet 12 Virginia Ave 20 Kienia Rd Lowell, MA 01852 Hudson, NH 03051 -(978) 454-8706 (603) 883-2514 Proposal Submitted to: Phone:978-618-6242Date: 1-13-13 Mark&Dierdra O'Leary 978-621-3902 Street: e-mail:deeoleary@comcast.net Old Villiage Lane City,State&Zip: Job Location: Norht Andover, Mass Same Architect: Date Of Plans: Job Phone: PROPOSAL Kitchen remodel; Demolition; Remove all wallboard,moldings, shelving, electrical, plumbing,in areas to be remodeled,remove non load bearing partitions from between laundry&kitchen& between bathroom&kitchen. Put all debris in dumpster. Remove window move opening to new location. Remove windows from sunroom area &replace with double hung windows. Patch siding in this area,new exterior trim. Frame kitchen window opening for 48"x48"casement window. Move washer& dryer& add a door to this area. Move fridge next to washer& dryer. Remove cabinets & relocate to new locations. Build new partitions to create new bath and laundry areas. Blueboard/plaster all new areas. Patch in all areas that were remodeled. Build new island using cabinets supplied by homeowner. Countertops to be provided by homeowner. Install backsplash tiles provided by homeowner,patch in floor tiles with tiles provided by homeowner. Stain grout to all be consistant. Add new base board moldings,new extension jambs, &new casings where needed.New bathroom door. Reframe %2 bath window to be a smaller window& install smaller window. Install new vanity,toilet& sink & all bath fixtures provided by homeowner. Electrical; Move&add new outlets& switches to accomadate new kitchen, bath& laundry layout. 2 recessed lights over island. 1 recessed light in bathroom, 1 florescent light in laundry. Patch in floor tiles with tiles provided by homeowner. Install backsplash tiles . Plumbing; Remove all fixtures, Kitchen sink,— oom sink,toilet, Laundry hook up, &Icemaker. Add all rough plumbing for new laundry, kitche sink, bathr om sink,toilet, icemaker, and add new toekick heater. Home owner responsible for Painti g, ountertops, e ectrical&plumbing fixtures,tiles, appliances. Total $18,500.00 Add$4,500.00 for 6 double hung,the ,tilt sash,windows with insect screens in sun room area. Tofal $26,000.00 L I We propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: $26,000.00 Payment to be made as follows: $8,500.00 TO START JOB,$8,500.00 WHEN ALL ROUGH FRAMING&ROUGH MECHANICALS COMPLETE,$9,000.00 UPON COMPLETION All material is guaranteed to be as specified. A]l work to be completed in a workmanlike manner according to standard practice. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tomado and other necessary insurance. Note:This proposal may wi awn by us if not accepted within 60 days. Authorized Signature Acceptance of Proposal-The above prices,specification,and conditions are satisfactory and are hereby accepted. You are ak as specified. Payment will be made as outlined above. c Signature= Date of Acceptance: Signature Office of Consumer Affairs&Business Regulation-Mass.Gov g Page I of I The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Home Improvement Contracting HIC Registration Complaints Registration# 143170 Home Improvement Contractor Registrant D+ R BUILDERS Registration Home Page Name RICHARD ARSENAULT Address 12 JEREMY HILL RD City, State Zip PELHAM, NH 03076 Expiration Date 06/21/2014 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Massachusetts -Department of Public Safety: Board of Building Regulations and Standards Construction Supers isor License: CS-065110 v';V'�-.�.s DANIEL D MO§TMARQUET I,r, r` 20 KIENIA Pj6 . : HUDSON N# 03051 � Expiration Commissioner 01/1512014 l AT—A20Go i1%n111 x��eLocation �(% ow / No. Date • - TOWN OF NORTH ANDOVER 'aS' 4T 1 • ` - Certificate of Occupancy $ Building/Frame Permit Fee Y�_ .. Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# 42-L'a 26193 bVillding Inspector