HomeMy WebLinkAboutBuilding Permit #484-14 - 92 MOODY STREET 12/5/2013r-- 4
BUILDING PERMIT
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION ;
Permit NO: C I Date Received
Tap
t�
Date Issued: /Ls
CNUS
IMPORTANT: Applicant must complete all items on this paize
LOCATION 9
-G�
1 Print
PROPERTY OWNER Q0,Vy` Wy -, S
Print
MAP NO: 6 / PARCEL: ZONING DISTRICT: Historic District ye no
Machine Shop Villaqe v s no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Wne family
❑ Addition
❑ Two or more family
❑ Industrial
WAlteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
G(Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
Up" S l S" kA, -J .
OWNER: Name:
Address:
Alc wk C-�k
Identification Please Type or Print Clearly)
S"Icxl :r.�
« &t,*-CJc -
Qo.\\j-�� LD0\ S Phone: 91$-50a—di i$
CONTRACTOR Name: Q ` -79-`10 13SlPhon � K City TcV. A �M
Address: b :5�0c-t
Supervisor's Construction License: C5 _O� al S Exp. Date: 0,3 I it 1y
Home Improvement License: `., t �\ S Exp. Date: Q a Jay j y
ARC
"t
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 16 , VO v FEE: $ «- at 4
Check No.:_ j�4 7 7 Receipt No.:
NOTE: Persons contracting wit re is ed contractors do not have acce to the guaranty fund
Signature of Agent/Owner Signature of contractor��
Na. r
Plans Submitted -0 '
F �
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE_OF°-SEW-ERAGEDISPOSAL-
Public Sewer ❑
Tanning/MassageBodyArt ❑ ..
.Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc.. ❑
Permanent Dampster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
...:.-DATE REJECTED
PLANNING & DEVELOPMENT
DATE:APPR-OVED
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
t
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes-..
Planning Board Decision:
Comme
T Conservation Decision: :Comments
Water & Sevier Connection/Signature &Date Driveway Permit
DPW To`v. Engineer: Signature:
Located 384 Osgood Street
FIRE DEPAKTM,F_fVT - Temp Dumpster onsite -yes .—no—
Located-at 124,Main Street -
Fire Departure'4-pignature/date ' b
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
Ll Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The following is =a -list of the requlred.forms to be filled out for the appropriate. permit to .be obtained.
Roofing, Siding, Interior Rehabilitation Permits
U ._ Building Permit Application
o 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 cascs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apv,>al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Bui!ding Permit Revised 2012
Location
No. Date
/767
TOWN OF NORTH ANDOVER
s
Certificate of Occupancy $
Building/Frame Permit Fee $�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
y
Check # Z?_� 2--
2 G '1 9--,
Building Inspector
Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
$ 16,400.00
m
$ -
$
196.80
Plumbing Fee
$
24.60
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
24.60
Total fees collected
$
346.00
92 Moody Street
484-14 on 12/6/13
-Breezeway Remodel
CA
m
m
m
m
m
CO)
m
CD
0 z
CD O
CL r
Q �.
n cQ
o
00
CD
om*
a
CCD O
CD
Q_ v
CO CD
.a
0
N
CD
CD
-v
CD
CDN
O
z
CCD
O
CD
A C
z
m rn
c� cn -
0 --q�. O M
zX
a Cl) �
;am
O�
N-Cwn z
� 2
b Cl)
cn
W
C
r
v
z:
N
m
O
< n = p a) 2
O moo
� < CD � ti C
a cD Q: O CD 0 •
0�a.0 3
O CA S1 T
-'' O O �•« Q O 117
'•r h ? O
-i•+ CD O Cl) CD 0
N O -W 'a N CD 2
`° •
CD a
O O > 1
O .O -f
coto CL
O
N, O O
O O 3 Cs
CD cCDD
_ <D -a
EL
0
o v, -
CD 0, 5. -0
occ
z0CD
Cr
O �CD CA
" a
a
Ko
< 0 Q U)
C O O
(A C y CD
O ?L
CD
CL.
CD
SU
U) A
O y �a0'
� a
c
V)
fD
K
O
co
C
3
fD
0
cc �
;v
O
C
3
H
m
O
70
z °
=r.
0
=r
w
O
C
S
i
�w
n +
CD
.o
O
C
S
M
C
W
G1
Z
LA
V
n
0
9 �` 1•+
S
7
<
O
C
S
O
c
7
d
O
:3
C
p
M
iZi+
m
Q
0
fD
O
Lnn
m
3
O
O
0
CL
'
O
>
Q
2
D
q
x
C) N
5-0
nom'
-0a
C
Cl)
0 ci
� °r
sa o
CL
vs
N
3
O
N
(D
�+
V)
fD
K
O
co
C
3
fD
m
myZ
m
Zi
T
O
N
;v
O
C
3
H
m
O
70
-rt
O
N
(Ln D
2
w
O
C
S
m
m
D
Z
M
n
0
T7
7
�l
.o
O
C
S
M
C
W
G1
Z
LA
V
n
0
-i1
°>
S
7
<
O
C
S
O
c
7
d
O
:3
C
p
M
iZi+
m
Q
0
fD
O
Lnn
m
3
O
O
0
CL
'
O
>
Q
2
D
q
x
ISI
0
C
I1
The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
Address:
Ci
R
6 it S0 Phone #: I")
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 14. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
required.]
❑ 1 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
em loyees and have workers'
mp. insurance.t
5. We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.]
Print
Type of project (required):
6. ❑ New construction
7. [Remodeling
8. M Demolition
9. ❑ Building addition
10.2"E'lectrical repairs or additions
11. Plumbing repairs or additions
12.❑ Roof repairs
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.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
Attach a copy of the workers' compensation policy declaration page (showing the policy_iDmbex and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of cn enalties 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 O d 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.
0
Phone #: � `� ' �l t C1 1 3 s V1
Official use only. Do not write in this area, to be completed by city or town offkiaL
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 #:
CONSTRUCTION
CONTRACT
This agreement is between Ross Courtemanche and Adam Leonard:
A & R Carpentry Date: 04/24/13
187 Mills Shore Dr. Project name: Remodel Breezeway/Built-In/Generator
Hampstead, NH 03841
Ross- 978-502-8238/ Adam- 978-490-7354
And David Louis
Address: %Moody St
North Andover, MA
Contractor will furnish all labor and materials to construct and complete the project described
above in a good workmanlike manner: Includes all work on attached proposal.
Owner agrees to pay Contractor the total sum of: $16,400 —this number can change if different
materials are chosen later by homeowner/and or spectrum of work changes
Payment Schedule
5
$11,000- Signing of contract (Pull Permit, Order Materials)
$j,000- First Day on site
$4,000- Completion of rough framing inspection .
$3,000- Completion of Final Inspection of breezeway
$3,400- Completion of T.V. Room Built -In
Funds are to be disbursed by: David Louis
Work shall commence: Dec 2013
Change Orders: Price is to be determined before for any new work or work not on estimate.
Owner signature:
Date signed:
Contractor:
Date signed:
&J ft
A & R Carpentry
Adam Leonard 978-490-7354
Ross Courtemanche 978-502-8238
General Contractors
187 Mills Shore Dr.
Hampstead, NH 03.841
License Number 090250
TO:DAVID LOUIS
Eti �I11�.1tr�
DATE: NOVEMBER 6, 2013
FOR: REMODEL BREEZWAY/BUILT-IN/GENERATOR
DESCRIPTION I AMOUNT
TV Center Built -In ---Closet walls removed and made flush for built in.
Quad box added for plugs. Cable and plug location relocated to behind T.V.
Built in base to have shaker style overlay doors and spot for cable box/dvd 3890.00
player etc. Top of built in to have custom shelving. Built in will be paint
grade materials. Includes painting. Knobs/pulls to be supplied by home
owner.
Price is based on http://bloombety.com/built-in-entertainment-center/built-
in-enterta i nment-center-with-photo-frame/
Remodel Breezeway- Demo to studs. Insulate. Install 2 Fiberglass
Exterior Doors (Door to driveway to be half glass 9 light. Door to garage to
be 6 panel) Install new Anderson screen door to match front screen door.
Install New Bifold 6 panel on closet doors. Sheetrock and plaster walls. Trim
out doors/windows/baseboard to match existing house trim. Build closet
shelving system with metal wire shelving and closet pole. Build bench/cubby 10,020.00
built-in(price based on httl2://indulgy.com/12ost/wCNu2X2yD1/entryway-
builtins) Brackets on built in may vary in design. We usually buy these pre
made due to the fact that making them is costly.
Paint all Interior/exteroir walls/ceiling/doors/trim.
Electrical -Install new light/switches/plugs (Light supplied by home owner)
Heat- Install forced hot water toe -kick heat under bench of built-in.
Generator- Install 30 amp manual 10 circuit transfer switch with outside 1690.00
cord and plug for generator. (generator supplied by owner)
450.00
350.00
$16,400.00
Massachusetts - Department of Public Safety :
Board of Building Regulations and Standards
Construction Supertiisor ^-
License: CS -090250
ADAM M LEONARD
187 MILLS SHORE ROt1D wit
Hampstead NH 03841` ,
y
i 11 w \,
Expiration
Commissioner 03/11/2014.
�il�Ccreaa�.iu�ella '
Office of Consumer Affairs & Bdsin.ess Regulation
HOME IMPROVEMENT CONTRACTOR
_y Registration: 171215 Type:
Expiration: .2/2812014 'Individual
A LEONARD
ADAM LEONARD
187 MILLS SHORE DR.. _
HAMPSTEAD,, -NH 03841 4 r�
Undersecretary