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HomeMy WebLinkAboutBuilding Permit #639 - 79 BEAVER BROOK ROAD 5/21/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: —x 6 IMPORTANT: Applicant must complete all items on this Daae I LOCATION e Prin PROPERTY OWNER dSrtlaki 4,4pea Print MAP NO: Q(; J PARCEL: 3,'C— ZONING DISTRICT. Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial X Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: U l Identification Please Type or Print Clearly) OWNER: Name: gri 4M /-IeI4Ie z Phone: 0 Address: CONTRACTOR Name:i4H< (i(, 568 Sa3 0g3 G -cf// Supervisor's Construction License: /sG ! S Exp. Date: 031 16eo lay /0 Home Improvement ARCHITECT/ENGINEER Phone: Address: Reg. No. d FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ %b► co z 0,0 FEE: $ J-'yy �- Check No.: / d '� / Receipt No.: Jokys NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund oe Signature of Agent/Owner Signature of contracto Location -7 1 ael No. 4�; Date TOWN OF NORTH ANDOVER 40 Certificate of Occupancy Fee C Building/Frame Permit Foundation Permit Fee Other Permit Fee TOTAL Check # 2 2 ob 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEi 1TH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS. Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 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 2.2008 aA Oa as c O w v V) o c .� p w O w C U G x Q+ p w G w x y E� w p w chi co C w" a O p w w z A W w w ° cn Q E cn O z c y- `® c c o ` O h O G_Oi V Cc nc MD c O oco y � o co CD sCD r y 4Sal 0_ X. ts cmCD81 cmCDA m 49. m C= Lft y W v CD Z cm :2. C c CO O cc "0 ' a c h W •; �..-m KCD - d1 m m cm N S y O to ._ Z o. o Q CDcam C = m m o O n.2H +-' h m W_ 00 4; :5 mo . RD c H .y .� � Ili m c LUui = �E ca � h LU m CDcm C#* CL m� O s -06.- Cc 8 O O t fil Rk O O co L O � w Z o. O CO) CD CM I O O E 'm cc CD a� CD Cc O d cmQ ca C cc o � v dca 0 C CD �..� y O C C cc y ..f >� gtiiu / The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 NJcashington Street Boston, MA 02111 r , www nmss gov1dia . Workers' Compensation insurance Affidavit Builders/Contractors/Electricians/Plumbers P icant Information. N (Business/O'Wiration/individual):_ f Address: City/State/Zip: Phone Type of project (required): 6. ❑ New construction 7. KRemodeling 8. ❑ Demolition 9. ❑ Building addition I0.❑ Electrical repairs or additions 1 I .❑ PIumbing repairs or additions 12.❑ Roof repairs 13.❑.Other g ompensatron pmrcy mtomtanon homeowners who submit this affidavit indicating they are daring all work and then hire outside contactor; must submit a new affidavit indicating such. ;Contractor; that check this box mustartached an add•tionsl sheet showing. the name of the sub•co-mractom and their workers' Fo corn,. r' ,. •:cJ information. I mn an employer that is provrding.workers' compensatron information. insurance for my employees: th &clow is &e)70&7 mean job site Insurance Company Policy # or Self -ins. Lie. 6uec-TyG' bSia Expiration Date:_ Job Site Address:_ 75 City/Statezip:r tU Attach a copy of the workmA ers' compensation policy declaration page (showing the policy number and expiration dated . 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 anal 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 pf perjury that the information provided above is trtae and correct -- G'pz;,S77 t?}j`jcial use only. Do not write in this area, to be completed by city or town off ceal 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 #- Are you an employer? Check -the appropriate box: I.&l am a employer with �L_ 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a.sole or have hired the sub -contractors listed proprietor partner- on the attached sheet. t ship and have no employees These sub -contactors have working for me .in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its re9mred.] 3. ❑ I am a homeowner doing officershave exercised their all work right of exemption per MGL myself [No -workers' comp. C. 152, § 1(4), and we have no insurance required.].t .employees. [No workers' comp. insurance required_] :Any applicant that checks boz # I must also fill out the section below showin their workers' o Type of project (required): 6. ❑ New construction 7. KRemodeling 8. ❑ Demolition 9. ❑ Building addition I0.❑ Electrical repairs or additions 1 I .❑ PIumbing repairs or additions 12.❑ Roof repairs 13.❑.Other g ompensatron pmrcy mtomtanon homeowners who submit this affidavit indicating they are daring all work and then hire outside contactor; must submit a new affidavit indicating such. ;Contractor; that check this box mustartached an add•tionsl sheet showing. the name of the sub•co-mractom and their workers' Fo corn,. r' ,. •:cJ information. I mn an employer that is provrding.workers' compensatron information. insurance for my employees: th &clow is &e)70&7 mean job site Insurance Company Policy # or Self -ins. Lie. 6uec-TyG' bSia Expiration Date:_ Job Site Address:_ 75 City/Statezip:r tU Attach a copy of the workmA ers' compensation policy declaration page (showing the policy number and expiration dated . 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 anal 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 pf perjury that the information provided above is trtae and correct -- G'pz;,S77 t?}j`jcial use only. Do not write in this area, to be completed by city or town off ceal 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 Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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 includirig the legal representatives of a deceased employer, or the receiver ortrustee 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 an 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- focal licensing agency shall withhold the issuance or renewal of 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 performm►cc 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), acid 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' cornpensation 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 cityor 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 instrance"Iicense number on the'appropriate line. City or Town Officiais 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 vvilI be used as a reference number. In addition, an applicant that must submit multiple pennitAicense 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. When 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 pers6n is NOT required to complete this affidavit. The Office of lnvestiptions 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 of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-770 www.mass.gov/dia ACORD. CERTIFICATE OF LIABILITY INSURANCE 5ii3i2o DDIYY" (508) 359-4151 FAX: (508) 359-2114 William Palumbo Insurance en Inc. cy, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4 West Mill Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 250 Medfield MA 02052-0250 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Hartford Ins CO 19682 DAVID HEWEY D/B/A DAVID HEWEY CONSTRUCTION wsURERB:TWin City Fire Ins. Co. 29459 INSURER C: 534 EAST BROADWAY INSURER D: INSURER E: HAVERHILL MA 01830 OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN 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. AGGREGATEIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/D POLICY EXPIRATION DATE MM/D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300,000 PREMISES EaEo RENTED $ 300,000 A COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 08SBAII4026 1/1/2009 1/1/2010 MED EXP (Any oneperson) $ 10,000 PERSONAL 8 ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 600,000 X POLICY JE LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIREDAUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AG $ EXCESS/UMBRELLA LIABILITY OCCUR F1 CLAIMS MADE EACH C RR N $ AGGREGATE $ $ DEDUCTIBLE $ RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE WW R STA �U- TS OTR - E.L EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 08WECTK8088 9/11/2008 9/11/2009 E.L. DISEASE - POLICY LIMIT I $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECUAL PROVISIONS For evidence of insurance. Daveid Hewey Construction ACORD 25 (2001/08) INCn9G ,n,n- no.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE A C, LaRocca/TGARRY © ACORD CORPORATION 1988 Pane 1 M 11 Proposal - Estimate David Hewey - Construction 534 East Broadway Haverhill, Ma. 01830-2403 Tel. 978-373-6038 MA. Contractors License # CS 015613 MA. Home Improvement Contractor License # 117059 To: Mr. and Mrs. Brian Healey 79 Beaver Brook Road North Andover, MA 01845 03/26/09 ESTIMATE PROPOSALS FOR RENOVATION OF KITCHEN, FAMILY ROOM, BREAKFAST ROOM. Carpentry Labor: Job setup, remove existing kitchen cabinets, appliances, remove wallboard from areas In kitchen and breakfast room where new windows and doors will be installed, remove carpet from family room, remove tile from breakfast room, frame for all new windows and doors, open wall into breakfast room as per plan, frame pantry walls as per plan, move existing window to new location in breakfast room, install new Andersen gliding door unit as per plan, install new Andersen window unit as per plan, install siding and trim on exterior where new units installed, to match existing trim and siding, install all required insulation in outside wails, install all sills, casing, and trim on all new window and door units, install custom door for pantry, install custom shelving in pantry as per plan, build.and install 4 rollout units in pantry, build and install floating shelves on corner as per plan, install all new custom cabinets and related moldings as per plan and specs. from cabinet supplier, install appliances as per plan, hang blue board on walls and ceilings where needed, provide backing and framing for new overhead lighting, build back wall for "Entertainment Island", demo and repair areas to be opened for plumbing and heating in garage, final cleanup vacuum all surfaces in work area. ESTIMATED COST $ 241000.00 Carpentry materials: Frame stock 2x6, 2x4, 2x10, LVL, plywood sheathing, exterior trim, clapboards, flashings, house wrap, papers, nails screws, joist hangers, %" blueboard, insulation, finish pine, cabinet grade plywood, hardwood edge stock, door and window trim, sills, rollout hardware, 1- 3'0"x 6'8" interior door unit with obscure (frit) glass, passage hardware, 1- Andersen French Wood gliding door # FWG100068-4, 1- Andersen gliding window unit # G436-2 with custom grids, etc.. ESTIMATED COST $ 9,997.00 Plumbing: Joe Roy and Sons Inc. Install rough and finish plumbing for: 1 -Primary kitchen sink Fixtures and faucets by owner. 1 -Island sink 1 -Dishwasher hookup 1 -Ice maker hookup Gas piping for 1- cook top and gas fireplace. (gas pipe in fireplace now) STOCK AND LABOR $4,708.00 Add 2 sprinkler heads in breakfast room (location to be determined by fire dept.) Add $675.00 to this proposal HVAC: Joe Roy and Sons Inc. 1 -Add feed & return registers to sunroom tapping existing trunks in garage. (demo. and repair of garage ceiling done by others) 2 -Install venting for downdraft vent for cook top. STOCK AND LABOR $1,485.00 Electrical work: Gostanian Electric All wiring in kitchen area to be rewired as per plan and electrical code, recessed lighting TBD locations and type, pendant lighting rough in, all appliances as per plan, switching TBD by customer. STOCK AND LABOR $ 7,000.00 e STOCK AND LABOR $ 7,000.00 Plaster: Mark Worster Plastering Skim coat on all areas needed. 480 sq. ft. ESTIMATED COST $ 500.00 Hardwood floors: A&B Flooring Supply, install, sand and finish (3 coats), 600 sq ft. new white oak flooring in family room and breakfast room, sand and finish (3 coats) existing floor in kitchen area and in existing dining room. ESTIMATED COST $5,964.00 Tile work: Tile Expressions (Craig McGee) Install glass the on backsplash areas, supply adhesive and grout. (tile by owner) ESTIMATED COST $1,500.00 Counter tops by others (existing granite tops to be removed by granite co. before any cabinet removal will begin) Painting by others Appliances by others Central vac. System: Minor changes to existing piping where existing walls will be removed. ALLOW $ 500.00 Building permit: Town of North Andover Based on the estimated cost of job ESTIMATED COST $ 700.00 Engineering: Structural, beam between breakfast room and family room. ALLOW $250.00 Disposal: G. Mello Inc. Disposal Disposal of all job related debris, including appliances. ESTIMATED COST $1,500.00 Sanitary: Outside rented "Portable toilet" (If needed, customer discretion) ALLOW $450.00 Banqettte: Labor and materials to construct 6' x 8'- L shape banquette as per discussion. Unit to be constructed of %" cabinet grade birch plywood, to be painted, allowance for seat and back cushions included. Breakdown of cost follows: Carpentry labor and materials: allow $ 2,907.00 Upholstery, labor and materials: allow $ 3,300.00 ESTIMATED COST $ 6,207.00 Fireplace: Construct framework and sheetrock wall above existing brick fireplace, with recessed area for flat screen television, allow for cable wire, power, and sound. Tile installed around face of firebox and under stone hearth. Fireplace insert installed. Breakdown of cost follows: Carpentry labor and materials: Tile work: Wiring: Disposal: Fireplace insert (gas) Gas hookup by plumber. ESTIMATED COST $ 5,500.00 allow $1,200.00 allow $ 500.00 allow $ 400.00 allow $150.00 allow $ 3,300.00 TOTAL ESTIMATED COST OF ABOVE $ 70,261.00 Payment to be made: as per billed, weekly or bi-weekly progress billing to be paid within 3 working days of date of invoice. Authorized Signature Date �� �-r"`_ - Date J All work is to be completed in a professional manner according to standard practices. Owner to carry fire, tornado, and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. Acceptance of proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. Payment will be made as outlined and agreed to by contractor and customer Work is not guaranteed until all payments are paid in full. Note: This proposal may be withdrawn if not accepted within 60 days. Signat Signaturep, C Date of ac tance U