HomeMy WebLinkAboutBuilding Permit #926-14 - 8 EVERGREEN DRIVE 6/19/2014BUILDING PERMIT
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received
Date Issued: ACH
IMPORTANT: ADDlicant must comDlete all items on this -Dage I
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PR -e-Aff-Y, OVVNli�-R,!
MAR P A R C- E L- JI
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P (I h -t -.Q,�Qrrstry-cture �777�W- h
ZONIN.G'DISTRICT,.i----- -H
,J$tbna�Distric ye-& no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
0 Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
0 Commercial
"KRepair, replacement
El Assessory Bldg
11 Oth ers:
El Demolition
11 Other
D's olvVeIV
N'F bodplain! 0. andg--
EYWater-sh riot.
at
W e S -Wor
-
DESCRIPTION OF WORK TO BE PERFORMED:
er tic)
Identification - Please Type or Print Clearly
OWNER: Name: Phone:
Address:
CC
nt`ra.ct&,'N-dm--6:- Rho
hez
Ad d ro Q5 9
rV1
Supe Aw,�s C -oh
n 1-6 <5
--.2Exp
ARCH ITECT/ENGI NEER
Phone:
C- A 13) '. kl'- 5
Address: Reg. No.
I FEE SCHEDULE: BULDING PERMIT. $12.00 PER f000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ ;�-, T � - FEE: $—
Check No.: � ( !c — Receipt No.: ��� �4 'I -
NOTE: Persons contracting with unregistered contractors do not have Xcceh t
,q. theJ*xa0;And
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
-�o 70D
Buiiding/Frame Permit Fee s—
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check�l
27693.
",71luilding Inspector
Plans Submitted El Plans Waived 0 Certified Plot Plan 11 Stamped Plans F1
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Ail 0
Sw"Rming Pools 11
Well
Tobacco Sales 0
Food Packaging/Sales [I
Private (septic tank, etc. El
Pennanent Durapster on Site F1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
Ct',OMMENITS
Reviewed On
Signature
Reviewed on Signature
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
-P,
E P�q�u p n
mp T.
. . T . . . . . . . . .
reet
Located at .124,11. i 8
F.1 r-6 -P e
:,rn_ntAi'-hAt-r6/dAd,
N-Tts!
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.si 00-si 000 fine
NU I Lb and UATA — (For department use
LJ Notified for pickup Call Ema
Date Time Contact Name
Doc.Building Permit Revised 2014
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
u Building.Permit Application
Li Workers Comp Affidavit
• Photo Copy Of H.I.C. And/Or C.S.L. Licenses
• Copy of Contract
• Floor Plan Or Proposed Interior Work
Li 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/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
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
Ei Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
Li Mass check Energy Compliance Report
ci 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
Doe: Building Permit Revised 2014
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 25,583.00
rn
$ -
$
307.00
Plumbing Fee
$
38.37
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
38.37
Total fees collected
$
483.75
8 Evergreen Drive
926-14 on 6/19/2014
Kitchen Remodel
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The Commonvealth ofMassachusefts
DeparbuintoflndustriqlAceldints
Office ofInvesfigaflons
6#0 Washington Street
Boston., MA 02111
vwmass.go-pldla
Workers, Compensation bsurance Affidavit: BadersIContractors)Electri.cians�pli�mbers
ApCheant Wormation Please PrintLedblky
Name
Address: ST ,
city/statemp: L A es(,4 s- cL So q0 S Phone 4: q -A
Are yoix 2n exuployer? 0eck the appropriate box-
Type of project (required):
i. El i anka. employer with
4. El I am a general contractor and 1
6. Now construction
2. �eIloyees (Mand/ox part-time).*
lanl a S 01D Proprietor Or p artner-
have likedtho sub -contractors
listed on the attached shoot. �
7. Remodeling
ship anXlavano-employaes
These sub -contractors have
8. Demolition
-1
working for me in any capacity.
workers' comp. insurance
9. Building addition
[No work -ors, comp.;nsuranco
5. El We are a corp ora�on and its
10.[] Electrica I repairs or additions
required.]
3. El I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
I I. [I Plwnbing repairs or additions
myself LEO workers' domp.
c. 152, § 1 (4), and we have no
12.[] Roffrepairs
insurancerequired-) t
employe6s. [No workers'
13.[] Other
comp. insurance required.]
Mny applicant1hat checks box #I must alsof ill dutthosertionbef6wsho-wingthe!rWorTcers'compBusatioupoRry information.
THcruBowuarswho submitthis affldavit irAiGatinj they Ai� dping all worle and then hire outside contractors must submit a now affidaylt indicaffig suclL
TContractors that chookthis box must affached aa �'dditlonal sheet showM19the. name ofthe suhi-contractors and their -workers' comprolloyinfonnation.
lanz an employer that isproAdIng 117orkers'compensallon hisuranceformy employees. Be-lowisthepolicyanflabsye
information.
fusuiance CompaqyName%
Policy # Or S elf—inS. UG. M: Exo1ration, Date:
lob Site Address-, Jcitylstate/zip:
Attach a copy of the workers' compon'sation-policytleclaration page (showing-thepolley number and expiration date).
Failure, to secure coverage.as te 4 dunder Section 25A ofMGL o. 152 can lead to the, imposition of criminal penalties of a
- Tune.
fine up to $1,50 0.0 0 and/ox onet-year Imprisqment, as well as civil p enaffics in the form of a STOP. WORK ORDER and a fina
ofupto$�S �.a day against t�poolator. Be, advised that a copy of this statement maybe forwarded to the Office 0.
lavestigolons of*o DIA for iftyance, coverage verification.
I do It eA, bj A e 6. ki
lyj*,rai�_th
A.&Ins an dp en aftles ofperjaiy t1i at th e information pro videdab o Yq is frae an d e orrec 4
]?hone#:
Official use only. Do not write in Mis area, to he coiqleted by city or town official
City or Town: PerniffMcense 9
Issuing Authority (circle one):
1. Board of Health 2. BuildingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Rlumbing luspector
6. Other
ContactPerson: Phone
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Bracha Kishinevsky
8 Evergreen Street
No.Andover, Ma.01845
Ronald Finocchiaro
295 Merrimack Street
Lawrence, Ma 01843
Kitchen Remodel
Ron Finocchiaro is responsible for the following kitchen remodel at the address
Of 8 Evergreen street No. Andover,Ma 01845. The kitchen remodel consist of a
partial remodel no structural changes, all fixtures in same location.
Ron Finocchiaro is responsible for scheduling of -all sub contractors, permits, and
removal of all construction debris. Job description as follows:
Job Description
A. Removal of old kitchen cabinetry and counter tops
B. Removal of existing floor covering.
C. Rework subfloor and screw down
D. Prep floor with 1/4" cement board for ceramic tile install
E. Install ceramic floor tile (supplied by homeowner) straight pattern
F. Plumbing segment removal of existing sink hookup/ re connect sink
Install (1) toe kick heater unit
G. Install new kitchen cabinetry according to new design (Jackson Kitchen)
H. Install (6) recess can lighting according to kitchen design.
1. Vent stove hood to exterior.
J. All items listed above are in the total construction cost of $ 12,775.00
K. Permit cost is additional
. Any unforeseen or additional work will be subject to a change order agreed by
both the home owner and the contractor.
Payment Schedule
Total construction cost
Deposit to start work
Start Kitchen cabinet install
Balance on completion
dv
Homeowner
$129775.00
$59775.00-
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