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HomeMy WebLinkAboutBuilding Permit #1021-15 - 962 TURNPIKE STREET 6/8/2015 I t%f` BUILDING PERMIT 6 NoRtN Q��, LED 16 q•y0 TOWN OF NORTH ANDOVER �2 ��'� h 4, APPLICATION FOR PLAN EXAMINATION Permit N i Date Received �SsgArED cHus�`��� Date Issued Vi-� P— l IM/PPORTANT: Applicant must completeallitems on this page LOCATION "l((� ✓ Pri PROPERTY OWNER �� Print 100 Year Structure yes no MAP PARCEL:00211'' ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9,6ne family ❑Addition ❑Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'Septic D4,Welli Floodplain p Weflands i U�/at rshedl4®istnct - - - - DESCRIPTIOF WORK TOB ERFORMED: G Id tifion- ase Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: 6 -®2D?116) Exp. Date: .—�� -0-3 —) ,I. Home Improvement License: 2- _Exp. Date: b - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ g FEE: $ 0 — D � i j, Check No.: Receipt No.: � 0c NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 4nar iC _d r p,"�, c e �, P i,L', sk c c F s 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 o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 FIRE DE.PAR+1°IIOIE;NT TernpgD�umpster on site' ypes` '3noo d'�.: ' sgoo Street Located Fire Dep.artrnent si nature/date # ; Py-�Sip;' t+t,�-air+ —g-.. T?•, ~ e �c 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 ease) ® Notified for pickup Call Email 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 46 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) 4. Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Location Na Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ a„ Building/Frame Permit Fee Foundation Permit Fee $ �,r Other Permit Fee $ ` TOTAL $ Check#ta�Ef ' `� Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 20,000.00 m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 962 Turnpike Stree 1021-15 on 6/8/15 Kitchen Remodel i r 1 NORTH ve . 0 Z " h ver Mass IiJAIS coc"Ic NVwtc 1' O S U BOARD OF HEALTH Food/Kitchen PER I' Septic System • THIS CERTIFIES THAT ........ .. „ ; . ,.., BUILDING INSPECTOR �� ...I.. .... �...,. ....... Foundation has permission to erect .....V ........ .... buildings on ....... . ......� pi .. .j. Rough t0be OCCU led as .............. ......... .......`............................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 ON S ELECTRICAL INSPECTOR UNLESS CONSTRU I Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display 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. Smoke Det. 2015-06-02 09:40 3480EX 6038940414 6038940496 >> yyyy P 6/8 X ck o—7 r tv, iN a, ............ 104;" 30" 42!r v Humma M Vmse BUSEVYW T cub vumeR NAME A PHONEPeul FlonleM787941112 dge H919 0, STORE#I ORDCR*U8M11328fi MEASURE TYPGJHO U BUTT la., ZIA CEILING HEIGHT qpk .2 pH'i:94 iW A2 11r'Vp W"fm Svt-i-i r HEIGHT:nW* TOP CABINET ALIGN:64* ID' V) (D GAWNF-i MANut-AC I URI:WTVIlle DOOR NAME tOVERLAYW0n%WFWI OVOOVI 8qU" MOD!mnPle Flonts Kitchen P.000406202 HNISHM11heat BOX CONSTFtk)rTION:All P)yWgW C;gnstrwom Calling HSMht 04 112" 0'. (8darna 92 112-) GLASSAOFIGNote*: TOP MOLDING. Wall#3 BOTTOM MWANG:Ncne 1)Simple'L"ansped KMAso EXPOSED END APPLICATION:Futolturs enft2)Custunmi dosent wasil an Island 3)Add Uish washer 4)UsItIng ready to sell it IKSTALLERICUSTOMER NO'TES;ses noon in ma 5)Now Appliances 7-, CT OP MA I'(;(ftAL�GMnft SOFT :Gaw vftm EDGE PROFILE-Aevel m LN FI EDGEAS Final,But put on"old APPLIANCE SPECS NUT PROVIDED APPLIANCEIPLUMBING SIZES USED FOR DESIGN: R"HI(ShRATOR: Installer notes: W h X O.W0043 'TYPE:french door please confirm door wKftn on wall 03 RANGE.WX H X 030x36128 are bearna being removed? 04 H-w x H x anxiaxiois flooring staying? Specificallona of OTR will determine cabinetry aboveumic:413W2016 PRELIMINARY DESIGN FOR I`HhShN IAI ION O1,SHWASHEW24x34.5W4 NO I READY 10 SILL Does flooring go under cabinets or are we matching footprint. FINAL DESIGN MUST BE SUBMI I I W POK INSTALLER SITE VERIFICATIONconfirm all center lines. ANL]FORMAL REVIEW IIRIOK 10 SALt:. 0orifirfln it cabinift need to go to coiling All dimcnqiona Ritito designations I Thiq is an original desii;n and must I DesiLmed, IS/3120 1-5 Simi am wbjvut w vvriflundun on I i out,be rclimicd or copied unlcq.c; i Printed:5/31/2015 job site and adjustment to fit job I I applicable fee has been paid or job order plavvd. 2015-06-02 09:40 3480EX 6038940414 6038940496 >> yyyy P 4/8 f KTM Properties,LLC 25 Spaulding Rd Suite 17-2 Fremont,NH 03044 , . Phone:(603) 895-0400 AServkePr�derjar. Fax:(603) 253-2600 n Representative: Pa Y Customer Info: Company Michals Joh#:N/A (80406202 Fiontc) (603)548-2469 3480-Fiontc,Paul pj@ktmproperties.com 962 Turnpike St, North Andover,MA, 01 845 (978) 794-1172-mobile PRELIMINARY ESTIMATE Description Dcmo Description Lead Test Lead Test for homes built prior to 1978. Interior Protection Protection of floors,walls and doors,and dust abatement and clean up. Debris Removal Construction debris removal and haul away Appliance Removal Remove Range,Range Hood,Dishwasher and Refrigerator. Relocate from space. Removal of Count,urtopse Remove laminate,solid surface, stone,quartz,or tilt countertops. Removal of Cabinetry Remove;walls,base and tall cabinets. Cardboard Removal Remove cardboard and cabinetry debris. Electrical Description Receptacle/switch replacement Replace existing receptacle/switch-includes upgrade to C7FCT(installer provides) Standard Switch New standard switch on existing circuit-installer provided Outlet tied to existing New outlet tied to existing circuit(installer provides components) Hood fan Wire hood fan on existing power Run circuit DW Run new circuit for dishwasher to panel Arch Fault Breakers Supply and install arch fault breakers as required by code l:lectrieal Permit Supply electrical permit and inspections Plumbing Description Install Sink Install double/single howl top mount sink w/faucet,disposal:within 3"of existing location(installer rovides shut off,traps,valves as required) Revent Sink Revent sink per code when no vent exists and inspector requires through root vent Cut/Cap Cut&Cap plumbing for new cabinet installation Dishwasher Plumb in dishwasher next to sink Permits Null permit,rough&final inspections-includes permit cost Plaster Repair& Patch We will repair the plaster from demo and electrical work,and plumbing vent work. (no ecilin repair or painting.) Movc Pipes into wall Move the pi. s that are in the pantry into the wall(Pex) 2015-06-02 09:40 3480EX 6038940414 6038940496 >> yyyy P 5/8 C:abinelts Description Wall Cabinets install Wall Cabinets Base Cabinets Install Base Cabinets I"ail Cabinets Install'Tall Cabinets Wall/Base Fillers Install wall/base fillers Tall Fillers install Tail Fillers Knobs/Pulls Knobs/Pulls Installation CM Crown Molding AssemblyVodifacation Assembly/Modification&install of,loose parts Toe kick Idstall toe kicks at base cabinet Shims Install Shims as needed Hale and pennitrations Make penetrations as needed EesS 3So' �?i+inai -80- Total O-Total for all sections:$11,478.00 Total- $11,47$,OU "&,r&-;-e-e o0 352�.CO The above signature does not commit either party to the sale of the above listed items.The signature represents a full understanding of the price and scope of labor for the categories listed only. prices arc subject to change based on the final design,layout of the kitchen and unforeseen conditions. We CANNOT start the work at your job until the necessary pcnaits have been procured and a signed""at to Expect Sheet"on file. Please contact us should you need a copy of this. REM NDERS;this installation quote is based on normal working hours 7am-4pm,unless other arrangements have been made prior with KTM. Pltunbing&Electrical work is hased on 2 trips-one rough and one finish;finish will occur after countertops. Code or local inspector requirements not mentioned in this estimate will be an additional cost. Cabinets must he delivered in kitchen area or adjacent space on same level,which must have heat. If cabinets have to be moved by K'N, additional fees will be charged. Countertop templates require you to be onsite,no exceptions! Company Authorized Signature Date Gusto f or Si r tune D .J ustomer re Date This estimate was last edited by PJ Michals((603)548-2469,pj@ktmproperties.com.)on April 28,2015.The estimate may be withdrawn if not accepted within days., i \ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 UWwww.mass.govldia- Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: �l'� Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.n I am a employer with employees(full and/or part-time).' 7, E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, []Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F-1 Building addition 4Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions ri. netors with no employees. 12.�Plumbing repairs or additions 5. a general contractor and I have hired the sub-contractors listed on the attached sheet 13.�Ro re at 5These sub-contractors have employees and have workers'comp.insurance.:6.❑We art;a corporation and its officers have exercised their right of exemption per MGL c. 14. r bk 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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 information. Insurance Company Name: � �/j r I l / Policy#or Self-ins.Lic.#: �/ D`�yJ l p! � Expiration Date: Job Site Address: qk2, Ti)"Ki City/State/Zip:&49! d_ V Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern and naNf erjury that the information provided above is:true and correct. Signa Date: Phone#: ^ if 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#: A�® CERTIFICATE OF LIABILITY INSURANCE DATE 12015 /YYYY) 02/242015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY-AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE ac NQ): 3560 LENOX ROAD,SUITE 2400 -MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW-15-16 INSURER A:Steadfast Insurance Company 26387 INSURED INSURER B:Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685-09 REVISION NUMBER:7 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD LIMITS A GENERAL LIABILITY GLO4887714-05 03/01/2015 03/01/2016 EACH OCCURRENCE $ 9,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISESS(Ea EoHowrrence $ 1,000,000 CLAIMS-MADE a OCCUR LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,000 X POLICY PRO-jECTLOC $ B AUTOMOBILE LIABILITY BAP 2938863-12 03/01/2015 03/012016 (CEO, BIcciNED tlentSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS eracci ent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS/JAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC017731493 (AOS) 03/01/2015 03/01/2016 X I WCSTATU- I OTH- AND EMPLOYERS'LU\BILITYTORY LIMITS ER C ANY PROPRIETORMARTNER/EXECUTIVE Y/ WC017731495(AK,KY,NH,NJ,VT) 03/01/2015 03/01/2016 E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) WC017731494(FL) 03/01/2015 03/01/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under Con tnued on Additional Pae 1,000,000 DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) _ EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE r of Marsh USA Inc. Manashi Mukherjee - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • � I • A3"�s;a.t::�cen�--,<�af; •rr;i o`+=u7;s.S�fesy . AN fiM1 V R:'LT;tiidu„ u FIRM!'ST :r ii�.LUFE3�131ki, �s.c1.� .. 1 ti L F ' j 4u eermllZiON es 'S�.tlf"'• ' ,::. .� v ��✓mer Aizai> and Business Reg Off-Ice of Con �laza - Suite 5170 10 P ark Boston,Massachusetts 02116 Home l.Provememt•ContractorRegi stration ' . r2"3i:lTdti�": 125893 TYP-: S+�PPlement Cara • �Diration: 8�,�018 unME SERVICES, INC. _--- -- RICHARD i ROLA aARKWn,Y SUITE 3Q0 -- - •-- _ __ _ 2000 CU}�,3ERLAND _ rcr = A ll�T?' GA 3339 d—s and return card. cnf _ L.c =nrd updmu 4� ��tnnl '3 ;✓mploym _..; rlddre� �J a „ o:nt=ni /./ s%a�on%alid forindrYidul uc �j;.'n,✓ " "'�" Uzttsc or rr� d return !. (airs&B°cln�sR :ullr,onr _.ion before the expiration dA.- Ti Coun lots Re,. '� OfCr.r c(Gvesu*cr OR –��– O1Tic cr Consumer At??irs and Bu= 1yac: 10 Pirk P1arx-5uitc517D Rc9'I'm to" •i26?93 suPp�pmont Gaal Borion,MA D2116 / ^.J ,T HOPE S1Z�G=S•1h%.• _pp 7h iROtA v>.lidwilhout si 1�.3-Rli•N., ✓ Not 20�GU rc.s _ -�•—�.. . J ,