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HomeMy WebLinkAboutBuilding Permit #574 - 77 COURT STREET 1/30/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received i Date Issued: 0 IMPORTANT:Applicant must complete all items on this page LOCATION :D':7 ( ®J r'* ----3 '�- Print PROPERTY OWNER e ! 3 SO S A-J , `/ w C. Print MAP NO: "S13 PARCEL: ,4J-3 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1*0ne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ® S phc' MW 4D F of odplain €D Wetlands `® WatershedDisti ict DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: IA-tr%% r S v s A a L y Phone: q7t CS 9 S-v i Address: -1-1 co.j r-4- 4 CONTRACTOR Name: 'Y>— 'e s Phone: 51$- Address: Supervisor's Construction License: 65 s 5 11-7 1 9 Exp. Date: 1 a Home Improvement License: I °� G Exp. Date: 1 % 11 ,9 / )0 , 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5-7, 31 T FEE: $ w —" Check No.: 0-� Receipt No.: NOTE: Persons contracting w' unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner :'" i'M'' �'.xu�c `"'` Signature of contractor; x„'� ;�=411, Location �/2T' No. Date NORTq TOWN OF NORTH ANDOVER F s 9 i y Certificate of Occupancy $ sCMUs Building/Frame Permit Fee $ Foundation Permit Fee $ ,i Other Permit Fee $ �' TOTAL $ 4 Check # `t I 2497 ' Building Inspector 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I CONSERVATION Reviewed on Signature COMMENTS i HEJ�LTH Reviewed on Siqnature N COMMENTS 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no j Located at 124 Main Street Fire Department signature/date COMMENTS i Dimension i 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 Doc:.Building Permit Revised 2008 i 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 ❑ 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 o Building Permit Application o 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) o 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 o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses o 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 o 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: Doc.Building Permit Revised 2008mi fr 4 L\ pffice of Consumer Affairs&Business Regulation — = HOME IMPROVEMENT CONTRACTOR Type. Registration:{-,x"120296 Expiratio 9/2013 DBA TESTA BUILDING_` REMpD,ELLNG JAMES TESTA / 5 APPLETON STRE��T- ` N.ANDOVER,MA.01845T T Undersecretary i . M,,satclt tttti- �Jt pkwtrncatt of Public'saf to Bitar•ct c?t"Buil��igtg,Rt-Fulatittna aa)tl Stantl.ti;tls ` Ceiistruction Supervisor:License License: CS 54718 n,- JAMES M TESTA , 5 APPLETON.ST ? 1 N ANDOVER,,MA 0:1845 w4 '; Expiration: 6/8/2012 x` C'uniinissiia�cr 29825 'Tr#•: :i:4 , FES TA Building and Remodeling Start date January 30th 5 APPLETON STREET Finish date March 9th NORTH ANDOVER , MA 01845 MIC Lie. 120296 Expires 11/19/11 (978) 682 2023 CSL Lie. CS 54718 Expires 6/8/10 Proposal January 29,2012 Proposal Submitted To: Herb and Susan Lynch Home Phone: (978)689-2850 77 Court Street North Andover, MA 01845 Job: Remodel kitchen Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. DEMOLITION : Remove all cabinets and counter tops. Total gut floor down to the sub floor in the kitchen ,trying to make it as level as possible. Plaster to remain on the walls and ceilings. CONSTRUCTION: Remove and replace slider that goes into screen porch with an Anderson slider that matches the one going to the deck. PLUMBING : Remove the radiators and supply and install a new kick space heater. Move the kitchen sink into the comer of the cabinets hook up the rest of the kitchen plumbing fixtures. Note : There is no allowances for plumbing fixtures ELECTRICAL : Add new circuits in the kitchen area where needed. Rewire kitchen to code. Supply and install 9 recessed lights. Supply and install under cabinet lights. Add a new sub circuit panel in the basement and eliminate the double breakers in the panel. Install 2 new ceiling fans that will be supplied by owners Wire all new kitchen appliances. Note : There is no allowances for light fixture other than the one specified . PLASTER : Patch any holes in the ceilings and the walls. CARPENTRY: Install all the kitchen cabinets and molding as per the designers drawings. Install new trim in the kitchen around the windows and doors to match the existing trim in the house. Installation of all kitchen appliances. FLOOR : Install Approx. 500 sq. ft. of 3 %inch oak flooring to match the flooring in the rest of the house. Sand and apply four coats of finish . COUNTER TOPS : Temple and install new granite counter tops for the kitchen area. Template and install new wood tops on the server and the desk area. TILE: Install tile along the back splash Labor and adhesive supplied Tile supplied by owner. VENTING : Pipe the exhaust blower for the stove. Will provide all duct work needed. THE HOME OWNERS WILL SUPPLY CABINETS AND APPLIANCES . THERE IS NO ALLOWANCE FOR PAINTING OR STAINING INTERIOR OR EXTERIOR ITEMS YOU WILL NEED TO SUPPLY I will supply you with all the sizes and the quantities you will need. Kitchen Kitchen cabinets Tile for the back splash and grout Stove Dish washer Refrigerator Kitchen sink Kitchen faucet Disposal Microwave A finance charge of V/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of: $37,318.00 Thirty Seven Thousand Three Hundred and Nineteen Dollars One-third to start, one-third after rough inspection , one-third upon completion. Authorized signature QC-L.— I reserve the right to cancel this contract if not accepted in_30_days Signature r �--� Signature DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 4 'L. t/J1 600 Washington Street VU Boston,MA 02111 r�c www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information . Please Prinf LeaiblY Name(Business/Organization/lndividual): 'Tt"S+viyi, Address: (N n +o•,j s' city/state/zip: Pig A m f Phone#:nlZq 5: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ 1 ain a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.[&I ami a sole proprietor or partner- listed on the attached sheet. # �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9 E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1Electrical repairs or additions 3.ElI ain a homeowner doing all work right of exemption per MGL _ 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no 12.nRoof repairs " insurance required.]f employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 91 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 aMdavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their Workers'comp.policy information. .lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Natne: 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 u to$250.00 a da against the violator. Be advised that a co of this statement may be forwarded to the Office of P Y g PY Y Investigations of the DIA for insurance*coverage verification. I do hereby cert" nder the pains and penalties ofpeijury that the information provided above is true and coilrect.' Si ature: � Date: 1��v 1'1 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#: / Information and Instruef ions 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 Iocal 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)naine(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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any.questions regarding the law or ifyou 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 pennit/lieense number which will be used as a reference number. Irl addition,an applicant that must submit multiple-perm it/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 pen-nit 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 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 of Massachusetts Department oflndustrial accidents Office of Investigations 600 Washington Street Boston,MA 02,111 Tel.#617-727-4900 ext406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-770 '� Ww w.mass.gov/dia AORTH ® of over No. . � o o , dover, Mass., ` ate 1'L COCNICHE WICK • SRATED P'P���� U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System alpT BUILDING INSPECTOR THISCERTIFIES THAT................................ ..........1Q.................................................�%....111 ........~................ Foundation has permission to erect........................................ buildings on .. �,t ............. Rough to be occupied as........... �.. ........ ...... ...... .......................................................................... Chimney ' e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final- 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR b UNLESS CONSTRUCON S Rough ...................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR ` ' _ Rough Display splay 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. SEE REVERSE SIDE smoke Det.