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HomeMy WebLinkAboutBuilding Permit #1180-2016 - Exception 5/11/2016 q 1 A-adtA NORTH '9 BUILDING PERMIT o t,eo 1• TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION * yy* Permit No#: ) k7 Date Received �l RA°HAre°`rPay(5 gSSACH�15�� Date Issued:::61 II V9 1(,I ORTANT: Applicant must complete all items on this page LOCATION e�Lt �T P=rint. PROPERTY OWNER Print 100 Year Structure yes no MAP�PARCEL0631 ZONING DISTRICT: . Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential I ❑ New Building W6ne family ❑Addition ❑Two or more family ❑ Industrial ❑ ration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 11Floodplain ElWetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: T;6W2*:: 1119621 IdVatifwation ase pe or Print Clearly OWNER: Name: 04 —t--D 114;,4 il Phone: Address: Contractor Name: �- T Phone:. l Q[ Email Address: _ Supervisor's Construction License: 1' Exp. bate: Home Improvement License: Exp. Date:: 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: $ Iso FEE: $� Check No.: 4d-�2 C1 Receipt No.: �(p NOTE: Persons contracting with unregistered contractors do not have access the guaranty fund ignature of Agent/Owner Signature of contra Location I P I i No. ' u— ` Date , • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# r 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 Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - 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 A Planning Board Decision: Comments r Conservation Decision: Comments Water& Sewer Con nection/si nature& Date Driveway Permit DPW Town Engineer: Signature: - Located 384 Osgood Street FIRE DEPARTMENT Temp Dumgster ons situ yes _ _ no 'Located at 124 Maln Street - - A fire Department signature/date 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.s100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email I Date Time Contact Name 3 Doc.Building Pennit 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 I ❑ Building Permit Application j ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 Li 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 o 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:Building Permit Revised 2014 1 I COMMENTS — r1 NORTH - 1 : :. .� . : ver h ver, Mass, & 261 Coc"Ic"9WI[w`�1' 7.9 °RATED S tl . BOARD OF HEALTH Food/Kitchen PERMIT T LD{ Septic System THIS CERTIFIES THAT ........................ ..t 1�e.%�....... aBUILDING INSPECTOR . ..................+D ...... . x aFoundation has permission to erect .......................... buildings on ......1....I�...... �... ........ ��.............. Rough to be occupied as 1. � .......eteno .. ....................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI7RT.S Rough � Service .............. .. . ................................... Final BUILDING INSPECTOR 1 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. KTM Properties,LLC sl 25 Spaulding Rd Suife 17-2 Fremont,NH 03044 �. ca Phone: (503) 895-0400 IT 1E `1,4 Fax: (603)253-2600 AServrice Provider for"� <. Company Representative: Customer Info: Mark Minasalli Job#:N/A(80409059 Beato) (603) 234-4320 3480-Beato,Felicia Markjn@ktmpi-operties.com 9 Fern Wood Street; Job Number: N/A (80409059 Beato) North Andover,MA, 01845 (978) 869-1308 (978) 681-0847-mobile VERIFICATION ESTIMATE 3/5/16 FDesc7nption VERIFICATION ESTIMATE 3/5/16 total: $0.00 DEMOLITION Description Interior Protection Protection of floors,walls and doors,and dust abatement and clean up. Debris Removal Construction debris removal and haul away Removal of Countertopse Remove laminate, solid surface, stone,quartz,or tile countertops. Removal of Cabinetry Remove walls, base and tall cabinets. Cardboard Removal Remove cardboard and cabinetry debris. lAppliance prep Remove appliances,Hood fan,microwave, sink prep, DEMOLITION total: $1,200.00 CABINETS Description Permits Permits Wall Cabinets Install Wall Cabinets Base Cabinets Install Base Cabinets Tail Cabinets Install Tall Cabinets Wall/Base Fillers Install wall/base fillers Tall Fillers Install Tall Fillers Knobs/Pulls Knobs/Pulls Installation CM Crown Molding Toe kick Install toe kicks at base cabinet Shims Install Shims as needed Hole-and pennitrations Make penetrations as needed Dishwasher panel Install Dishwasher panel includes any blocking COUNTER TOP DOES NOT INCLUDE COUNTER TOP INSTALLATION CARDBOARD DISPOSAL PRJCING IN THIS CATERGORYDOES NOT INCLUDE CARDBOARD DISPOSAL. CUSTOMER.IS RESPONSIBLE. KTM CAN PROVIDE IT FOR ADDITIONAL FEES CORBELLS INstall corbells to support countertop CABINETS total: $2,235.00 ELECTRICAL Description Dishwasher Wire dishwasher with existing power present add cord-and box with outlette Microwave-New Circuit Run a new circuit for a dedicated microwave hood(installer provides components) Electrical Permit Supply electrical permit and inspections ELECTRICAL total: $900,00 Total for all,sections: $4;335.00 Total: $4,335.00 The above signature does not commit either party to the sale of the above listed items only if this contract states Preliminary Estimate as one of the first lines.The signature represents a full understanding of the price and scope of labor for the categories listed only Prices are subject to change based on the final design;layout of the kitchen and unforeseen conditions. We CANNOT start the work at you job until the necessary permits have been procured and a signed "Dial 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 lam-4pm,unless other arrangements have been made prior with KTlvl. Plumbing&Electrical work is based 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 be delivered in kitchen area or adjacent space on same level,which must have heat. If cabinets have to be moved by KTM,additional fees will be charged. Countertop templates require you to be onsite,no exceptions! ge*9� re Date Company Authorized Signature Date ateCust eDate This estirna.te was last edited by Mark Minasalli ((603) 234-9320,Markm@ktmproperties.coin)on March 45, 2416. The estimate may be withdrawn if not accepted within days. - cust wants white subway tiles for back slplash -- - -- "- - - -- - NEED TO ORDER BACKSPLASH TILES AND - '- MEASUREANDINSTALL working copy 1584" cust has not seen samples yet,asked for Tessera Ice Whfte,'4X4 glass tiles. - - 1 1 12'J47;" SKU#1000-526-370 Measured by s/o from Merola(sample PO 80522148) Mark Minasalli in rkminasalli@yahoo.com 603 234 9320 - - -- - - Felicia Beato - - - 9 fern wood st _. North andaver ma 12 15-WF W3012BUTf 15WF' . po BOd09U59 ' Legend - - - WR3312BUTf 1: B21 . Notesl 1 5 DISH-106 GE.GAS.3 4 ' (821L) ceiling height 89 1f2 — 2: SB30l3UTT.W soft 83" �..:�_- ---------... (SB30BUTT.W) • appliances a glass - - : - - 3: BEP3L - .- fridge 33 x 70 m upper sink single 24"dish 30"gas (BEP3L) 24"dish washer 33 x 70 ,.-......,._--__.,._._....,,__- washer range 4: BD15.3 aver range micro - i (BD15.3) 30 gas range over range micro 5: BF3 - - _ (BF3) .. _ N n' i .. -4 nfi _--- O Wall cabs will go to soffit,no crown ,f -5 1 ; N N Thornton full Door stype i coops absolute black - - - CURRENTKMPROMOS -- -- - 'Ir 7f " - - - - 10%off until feb 17 AND BMSM pantry 24-84 p U242484BUTf.4ROT- rt" - - cust likes small c-top under window, ggs ...^ this needs supports model#i LPAB008 HD-conn -- - -- _ - -- - NEED TO ORDER SUPPORT - - - fits with wen door open. check height is there enough room under window for c-top and stoolslctialrs I I The Commonwealth of Massachusetts r: Department of bdustrialAecidents �- ; I Congress Street, Suite 100 Boston, MA 02114-2017 ? www.mass.gov/dia V,rsrrkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED tt'ITH THE PER4IITTLNG AUTHORITY. Nalne (Business/Organizationilndividual): rql � Address: City/State/Zip: fT1 V,k rn, Phone 4: Arc�yoployer:'Check the appropriate box: I Type of project(required): j I. - ployer with _employees(full andior part-time).* i 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in i 8• ieemodeling any capacity.(No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.(No workers'comp.insurance required.]' 10 [1 Building addition d.❑I am a homeownerand will be hiring contractors to conduct all work on my property. I will i ensure that all contractors either have workers'compensation insurance or are sole I 11.0 Electrical repairs or additions proprietors with no employees. ! i , 12.Q Plumbing repairs or additions �. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. -[hese sub-contractors have employees and have workers'comp.insurance.t j 13,[]Roof repairs I F We are a corporation and its officers have exercised their right of exemption per NIGL c. i 14. Other 151 a 1(.4.).and we have no employees.(No workers'comp.insurance required.] *.any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Ftomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicative such. +Coptractors that check this box must attached an iidditional sheet showing the name of the sub-contractors and state whether or not those entitie0ave employees. If the sub-contractors have employees they must provide their workers'comp.polio t umber. fain an employer that is providing workers'compensation insurance for m}i employees. Below is the policy and job site information. �— Insurance Company Name: Policy#or Self-ins.Lic.9: ,� r, ) L"1`l I I Expiration Date: Job Site Address: City/State/Zip: ` Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). � Failure to secure coverage as required under NIGL 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 fol-warded to the Office of Investigations of the DIA for insurance coverage verification. I do Itereby cer jy i er th dins and penalties of perjury that the information provided a ove is rue and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official I City or Town: Permit/License 4_ 'J DATE(MMIDDf rr1Y) CERTIFICATEOF LIABILITY iNUNCE �1i;12o,5 THE CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS iCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOE ED I3Y THE POLICIES BELOW_ ,His CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETINEEN THE ISSUING IN§URER(S), AUTHORI7rr] REPRESENTATIVE OR PP,ODUCER,AND THE CEl?T1F(CATE HOLDER IMPORTANT., If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAPIED,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 he certificate holder in lieu of such 9ndorsement(s). PRODUCER CONTACT MARSH USA,INC. pHp AX E p T'NO ALLIANCE CENTER o t :A No 3560 LENOX ROAD,SUITE 2400 E-MAn- ATLAM'A,GA 30326 MDRESS. = QIsuffim AFFORDING COVERAGE NAIL o 100492•HomeD.G01.16.17 INSURER A:&adfa51111 urMCompany 8T INSURED INSURER a.Ln(d1 Ameiiiw itw neP Co 1653.5 THD AT-NOME SERVICES,WC_ DBATHE HOME DEPOT AT-HOME SERVICES muRER c:NewHanlpsflue hs Co 01 ?B30 CUMBERLAND PARKWAY,SUITE 300 INSURER D_Mna�NaftW 10SMIM CdMp2riy 017 ATLANTA,GA 30339 - ENSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATLA374664&14 REVISION NUMBER:6. 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRI TYPE OF INSURANCE OL SUB POUCYEFF POLICYE%P LIMITS . D POLICY NUMBER 0 A X COMMERCIAL GENERAL LIABILITY (31-04887714-06 03N1016 03!0112017 _ � EAcr,ot,cuRRENCE s, 9,goo,660 '� I I GLAIMS4AADE OCCUR OAGAAGETD RENTED S 1,000,000 PREMISES omrran= HI 1 OF POUCY XS MED ply one cul g EXCLUDED OF SIR:51M PER OCC PERSON&ADV INJURY s 9,OW,000 GEWLAGGREGATE OMIT APPUES PER I GENERAL AGGREGATE 15 8,Of10,000 X POLICY 11PERCT 17 LOC PRODUCTS-COMPlOP 4GG -'a 9,000,000 e OTHER- 13 THERB AUTOMOBILE LIAMLJTY BAP 2938663-13 ImilairJ016 031002017 Cos 1,000,000 I X ANY AUTO aw LY IWURY(Perpersmr) S ALL OWtEDSCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Paraccident) s AUTOS AUTOS NON-OWNM PROPERTY DAMAGE S HIRTO ED AUS AUTOS eraeeltlen UMBRELLA LIAB OCCUR EACH OCCURRENCE 1 5 EXCESS LIAB CI.AIM3 MADE AGGREGATE S OED I I RETENTIONS s C WORKERSCONUIENSATION 5519215(AOS) 0310112016 03(01/2017 X PER WC01DTH= AND EMPLOYERS LUU31LIiY STATUTE ER G ANY PROPRIETORIPIABMIT/EXECUTIVE YIN N!A C015519217(AK KY,NH,NJ,YT) 0310112016 03101/2017 EL EACH ACCIDENT 5 1,006,000 tManddory IrtOFFICERRAER EXCLL1Dl�? WC0155t9216(FL) 03(0112016 03/0112117 1,000,000 D (MandatoryirtNH) FLLOISFJISE-EAEME't0 S if ya,descebe iaidw DESCR[PTONOFOPERATIONS below Contnued on Adftioral Page ELDISEASE-POCYLIMIT S 1,000,000 OESCRIPTION OF OPERATIONS I LOCATIONS 1 VELICLES(ACO RD 101,Additlonal Remarks Schedule,may be attached IF mom spaco is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION TND AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEIIID BEFORE OBA THE HOME OEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATUtNTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Ing Masashi Mukherjee S'Lcttitiat�� ©1988-2014 ACORD CORPORATION. All rights reserved. F,f) DUD n L Plaza - Su',t, .5 117 0 G j I �-U f-- 2116 B,D 3 t o n 0 , 0 HornC/ lmprO-' - Pagisuation: 12SB93 Type: Supplement car, ExDhticn: 81016 THD AT HOME-- SERVICES, INC. RICHAFRD FALLONE 2090 CUMHPILAIND PAIRWNAY SUTT-6-i ATLANTA, GA 30339 Udat Address and return card. Lelark reason for chane,p Address J Renewal Employment Lost card --K Business License or registration valid for indlvidul use on:' - before the expiration date. If found ret-urn to: lmp.Rovam.-wr CON.J.TRACTOR. Ofce OF Consumer Affairs airs aadB-siless R gliaa g i s tra Typ-2: 10 Parlc P laza-S uil 51-70 supplam-3,,; Card Ros.on.N l—k 0 L L.5 ID A 7 "10 Ni3 i: � CE- E H 0 N,,l E DEPOT A-1 F JO M E CHARD FALLONE 590 CUNIB=�FLA�I!D PAR AY S Undersecretary Not li wit wit'out signature ,�AATX, GA 30339 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Canstructiun Supers icor License: CS-020261 ANTHONY R PETI]NO 1 FIRST ST MEDFORD MA 02155 t r. Expiration Commissioner 05/16/2016 �:�lc ((rvttJltnr�if?Prr/fr/c�r'l[NJJ��tYl�ii'//.; --office of Consumer Affairs&Business Regulation MEIMPROVEMENTCONTRACTOR egistration: 160139 Type: Expiratgnr 6/25/2016 Supplement C KTM PROPERTIES,LLC. ANTHONY PETINO 25 SPAULDING RD SUITE 17-2 FREMONT,NH 63044 Undersecretary