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Home My WebLink AboutBuilding Permit #9 - 84 SUGARCANE LANE 7/3/2007Permit NO: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ND DESCRIPTION OF WORK TO SE PREFORMtU: a t / 5 n, Identification Please Type or Print Clearly) OWNER: Name: L(5,q S o--VJ Phone:g%1-199, -'a I1 I 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: $ 000 FEE: $ Check No.: 1 Receipt No.: ow 3� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner-o Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION - ❑ COMMENTS HEALTH COMMENTS X DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED TYPE OF SEWERAGE DISPOSAL Public Swer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ r Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments, Conservation Decision: 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 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 a Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 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 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 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 The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: t Bui de s/C ticant Information ontractors/Electricians/Plumbers ^� ' ...arc rani Le 1Dl Name (Business/Organization/Individual): J o, w� C 5 �' Address:_ ._�;- PA P 1 ,1 i-cj'i City/State/Zip: No L ' Phone #: `3 7 l Are you an employer? Check the a pproprtate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor employees (foil and/or part-time).* 2. I am a sole proprietor or and I have hired the sub -contractors listed partner- ship and have no employees on the attached sheet, t These sub -contractors have working for me in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation 3. ❑required.] I am a homeowner doing and its officers have exercised their all work myself. [No workers' comp, right of exemption per MGL c. 152, § 1(4), and we have insurance required.] t no employees. [No workers' comp ins. Type of project (required): 6• ❑ New construction 7. ® Remodeling 8. ❑ Demolition 9. ❑ Building addition 104:1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs lance requum.] 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. tContrsctors that check this box must attached an additional sheet showing the name of the sribc contractors and must su - - wmp. pomy m ormation. I 4m information. an employer that u providing workers' compensation insurance for my employees: Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page showin t�he�o let number and ex iia Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the imposition of criminal en on datea 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 penalties an of a Investigations of the DIA for insurance coverage verification the Office of r,1_ s.._... --• - ��• �•J wager me pains and penalties of perjury that the information provided above is true and correct. ativ~ Off7cial use only. Do not write in this area, to be completed by city or townofficia City or Town: Permit/License # Issuing Authority (circle one): - L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector nspector .Other 1a%/v7 Contact Person: Phone #: A co ' C V LU O N y = 3 CL ,7a G _ A :Q a �om V y r Cf) a �>L CE �IP41^ CD m o CL ' � V w z H E c 0 :moo m V, C=3 , is O O me E m lie qt: ts cm Cos O m 3 r=... v / O: vs Of� m � y m Cf) H m = O Eo r W U :a�� C/) = o Em w SO ...: CS, O� m yZ O cm ~ U C3 nc c m .o =m.. 3 N ~ H ma ~ m COD s F.. •H a� o E Z N CL. m32 O� _ ` y O Ne U O v .TIT P4 CO) coMA .E O O a� v M CL h O O V CO2 C O v i 0 v a� CL CA c CO Q! C O•� CID m R � "O � o 0 Q �. a o a vmQ c J O .O O O Z co O. CO2 C _ uj tr�iw YO U) ce W W 19 W U) a2 °o w U aco v cC/)w p o o w v C X U C w O o C2 C w a W W o c2 v c� X,C x o do o C2 c C w z W w v M z°ED co D 0 cn A co ' C V LU O N y = 3 CL ,7a G _ A :Q a �om V y r Cf) a �>L CE �IP41^ CD m o CL ' � V w z H E c 0 :moo m V, C=3 , is O O me E m lie qt: ts cm Cos O m 3 r=... v / O: vs Of� m � y m Cf) H m = O Eo r W U :a�� C/) = o Em w SO ...: CS, O� m yZ O cm ~ U C3 nc c m .o =m.. 3 N ~ H ma ~ m COD s F.. •H a� o E Z N CL. m32 O� _ ` y O Ne U O v .TIT P4 CO) coMA .E O O a� v M CL h O O V CO2 C O v i 0 v a� CL CA c CO Q! C O•� CID m R � "O � o 0 Q �. a o a vmQ c J O .O O O Z co O. CO2 C _ uj tr�iw YO U) ce W W 19 W U) a )ING REGULATIONS -ION SUPERVISOR 54718 Tr. no: 145.0 Commissioner o tan ar s o .� � ti San Qoar o p1 mg CONTRACTOR HOME IMPROVEMENT Ftegistra lion: 120296 rano 111912007 TESTA BUILDING w P. JAMES TESTA z�r ST ;,hew. 5 APPLETON i N.ANDOVER, NIA 011345 r ,�droinistrator TESTA Building and Remodeling 5 APPLETON STREET NORTH ANDOVER, MA 01845 (978) 682 2023 FAX / PHONE Proposal June 21, 2007 Proposal Submitted To: Chris & Lisa Hanson Home Phone: (978) 794-2121 84 Sugarcane Ln. North Andover, MA 01845 Job: Fire Restoration Job Description: Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION: PLUMBNG : Clean fireplace bricks with muriatic acid. Remove and replace the gas fire place with the same unit. 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: $ 27,996 Twenty Seven Thousand Nine Hundred Ninety Six Dollars One third to start one third after insulation one third u Authorized I reserve the right to cancel this contract if inot accepted in_30_ days Signature —)Z,14i� Signature Proposal ` y� ELECTRICAL: Repair the open wires and replace all receptacles and switches that got wet. Replace 7 recessed lights that got wet. Replace all new recessed light trims in the whole basement. INSULATION: PLASTER: CEILING: FINISH TRIM: removed. PAINTING: Insulate the basement walls with R- 19 Kraft face insulation And insulate the ceiling .with R-19 unfaced Hang '/Z blue board and plaster all disturbed walls. Drop ceiling will be hung in the finish basement of all the disturbed areas W. All molding and doors will match the existing replace all wood paneling that was Paint all area that were effected by the smoke and fire. CARPET: Remove and replace the carpet on the stairs and in the office area. Replace the carpet in the rest of the basement. L ocation r CA Aj-e- - No. Date 40RT#q TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S Check # 20364 62=� - - "'3ftilding Inspector