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HomeMy WebLinkAboutMiscellaneous - 1511 GREAT POND ROAD 4/30/2018 (2) G TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r` Date Received Date Issued: ILI C 7 O IMPORTANT:Applicant must complete all items on this page LOCATION 15 11 Cy,? ,� Print PROPERTY OWNER AILS-CA �4 �� 1 Print MAP NO:4_2n- PARCEL: 2-0 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building L-I`One family 0 Addition ❑Two or more family ❑ Industrial 0 Alteration No. of units: 0 Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r D�F`loo�lin� ®Vi7etlands � ;Watershed�District� � x t5eptic' u�.. . j afer/Sewer ,�._��� - - - �•-, �.�.:_'�.�.::.�.. '.��`�,.�,� � DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: _I tA�'�'+ a Phone:61't ,� Address: 1E,_11 G. CONTRACTOR Name: � 1 e.� �•,— ��\<'��' �� Phone(L � �31� Address: ��t2 C is �c� ,�5 ►� 4c'��\� ���c7�e (�(� S _ l Supervisor's Construction License: '�kL:2�1_Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ � —FEE: $ Check No.: 3�� ,L Receipt No.: �•3�" �1�_ NOTE: Persons contracting with unreg; tered contractors do not have access to the guaranty fund --------------------------- - - - - SignatureAofAgent/Qvne . ` �:. � -- •. :=:>__.`i�natu�e_ofcontractor` .: _ _ i 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 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals 'gat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording Inst be submitted with the building application Doc: Doc.Building permit Revised 2008mi 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 ® Notified for pickup - Date Doc:.Building Permit Revised 2008 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL . Public Sewer ❑ Swimming Pools Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY - INTERDEPARTMENTAL SIGN OFF'- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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 Enginebr: Signature: • Located 384.Osgood Street FIRE DEPARTMENT Tdmp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COABdENTS Location s No. ' Date N'G O Tq TOWN OF NORTH ANDOVER 3?O•?t`• •,hO O h A 9 * i Certificate of Occupancy $ Building/Frame Permit Fee $ ACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23 / 4.3 - Building Inspector The Commonwealth of Massachusetts t Department oflndustrial Accidents Office of Investigations � 600 Washington Street .Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Legibly Name (Business/Organization/Individual):T�` (oesa (Cj, Address: �-.�'� �Y��,�� A, City/State/Zip: tV. A!&xK,.t`(d , 6 k k;k S� Phone#: 9 Tf (o' 6' 7,-)?34- Are you an employer?Check the appropriate box: Type of project(required): 1.[rl am a employer with i - 4. 0 I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7• ['Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I atn a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]i employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: k �,�� � Policy#or Self-ins.Lic.#: ( (L) �'♦''r (� ?�?S Expiration Date: !l t t t Job Site Address: tJ�l I ���k Cj, , City/State/Zip:-� AjA" 6((a%` Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties 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 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 the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t&Vains andpenalties of peijury that the information provided above is true and correct.' z 7�s Sign 1. �� Date: �(] Phone Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authoritp(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or.on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications inany given year,need only submit one affidavit indicating current ' policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia ORTH TO" Of - 1Andover o -o dover, Mass., I ) ^ 26 - 1 O LAK COCMICMEWICK 7,p A°FATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT......... ......tllIA-46./..........Y..VAR..... .............................................................:....................... Foundation ...... buildings .............. Rough has permission to erect............. g ,� �—�►. r�..�ti..�....��. .................... son .... ...�....�.�....... . ... . �-.. to be occupied.as l Chimney ........... ...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC ST TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. F I RODUEN WNS I HUU I IUIV R 47 Prescott St. ,North Andover,Fula.01845 PROPOSAL Page NO. 1 O office 978 687 2934, cell 9783370690 i of 1 Pages r"! PROPOSAL SUBMITTED TO: PHONE 617 875 7703 DATE 03/22/10 NAME. Alison Martin JOS NAME Alison and Saddu STREET 1511 Great Pond Rd. STREET CITY North Andover CITY STATE STATE Mass. We hereby submit specifications and estimate for: Supply materials and labor for a total kitchen renovation.Remove cabinets,counters,wall sections,and the entire plaster ceiling including the soffit area. I Remove and replace kitchen window.New unit to be Andersen casement sized to ft existing opening.Fatten out garage wall to eliminate jog.Relocate door from.Install new door unit to garage similar to existing.All new blaster areas and patches to be blue board with smooth finish.Erect new organization area in I corner near garage.install new cabinets supplied by owner.Re-install appliances both new and existing.Install beadboard to center island.Granite counters are to be supplied and installed by others and are not included In this estimate.Plumbing and heating will include all labor and materials to install two new toe space heaters,all hookups of new and existing appliances,and ralocating some heating and plumbing lines.There may be an additional charge if plumbing 111 lines are discovered in the soffit and need to be relocated.Flooring will include patching In where the walls and center island wave removed and then sanding the entire kitchen emu and applying three coats of oil finish.Electrical will Include materials and labor for all new fighting,switching,wiring of appliances,and relocating some existing wiring,The electrical allowance for all materials and labor is 4,000.00.Supply materials and labor for a file backspiash with an allowance of 600.00 for material and labor.This agreement includes all necessary permits and all job debris will be removed.There is no painting included in this proposal. -=t.�'� �aF,:a,+fH,�.e-*.:,-au,�,iir+c��mu:!2sc*v�,��n^'.� .. ,.:,.. •:.;, - �.. We hereby propose to famish labor and materials-complete in accordance with the above specifications, for the sum of twenty five thousand eight hundred ninety two _dollars{$ 25892.00 )with payment to be made as follows: job start=10,000.00, Plaster-00,000-00, Completion=5,892.00 All material is guaranteed to be as specified. All work to tie completed in a workmanlike manner according to standard practices. Any alteration or from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the agreements contingent upon strikes, accident or delays beyond our control. This s t to acceptance 15 ^ days and it is void thereafter at the option of the undersigned. Authorized Siignature -- ACCEPTANCE OF PROPOSAL. The above prices, specifications and conditions are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. ACCEPTED: Signature - DATE 03/22/10 Signature *E-Z Contractors Forms Fenn No.EZ 110 6 a' ----37Z -30T. --30'— J M - 'r- W361824 co 24 o; TEP-2490-WO 3DB12 tu TEP2490-WD a i3 irl V aLVDFF34.5 BLVDFF34.5 ...... 4) 7 BED BED mcl W co_ SCHRO,^,KTRAGF-MARKCOt4SfRtJCIION.7 M UPGRADE To ALL PLYWOOD BOX PLEASANT 14"DCMCRSTfLE W. WMrfE PAINTED MAPLE CEILING HEIM14T QW 1 ANG AT 980" CONTRACTOR TO BUILD HAI V WALL EXCEPT FOR TALL PANTRY 40 j12-jqawsmernooma ANA AND OVEN CABINET HANG AT W PLAN#3 PAINTEDiNo PANELING USE sFLA FOR SOFFIT USE INsCROWN FOR cRO%qN mrLowr, I-FULL HEIGHT DOOPJPULL OUT PLAN 03 TRAY 0FVfl)EFJ FOR COOKIE SWt:ETS CUTTING BOARD&ETC. 2-TWO ROLLOUT TRAYS TFt3848424SSR OCD308424 M4 2" 54f' esig1r,W 7nJ20 I I) 11AAGLIA This is an original design and mistAll dimensions -size designations Printed:8/25/2010 JACKSON not be released or copied unless given are subject to verification on ta KffCI-W—Nf i applicable fc--has been paid or jo Job site and adjustment to fit job conditions. DESIGNS,orderplaced. Drawing 4: Az SON AND HADDU*S KITCHEN'I All 1 h ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 11/29/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NORTH ANDOVER INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MJ FOSTER INSURANCE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 163 MAIN STREET INSURERS AFFORDING COVERAGE NORTH ANDOVER MA 01845-2415 INSURED INSURER A:CITIZENS INSURANCE CO Michael Rodden INSURER B:HANOVER INSURANCE Rodden Carpentry INSURERc:ACE PROPERTY & CASUALTY INSURANCE 47 Prescott Street INSURER D: North Andover MA 01845— INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS T DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(An one fire $ 50,000 CLAIMS MADE a OCCUR ZBN8605683 02/01/2010 02/01/2011 MED EXP(Any oneperson) $ 10,000 -PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECOT 7 LOC B AUTOMOBILE LIABILITY ADN8336670 07/16/2010 07/16/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY X SCHEDULED AUTOS (Per person) $ 100,000 HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) $ 300,000 PROPERTY DAMAGE (Per accident) $ 100,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ EMPLOYERSOMABLS�ON AND X TORY LIMITS ER E.L.EACH ACCIDENT $ 100,000 C WC1760133 01/01/2010 01/01/2011 E.L.DISEASE-EA EMPLOYEE$ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT TOWN OF NORTH ANDOVER FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 120 MAIN STREET INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE N__(`1 .. ,�'�+.,�`'� NORTH ANDOVER MA 01845- � ` �,,�11'\`\ll`�i\�11 ACORD 25-S(7/97) ©ACORD CORPORATION 1988 Pg_,�-INS025S(99lo).ol ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 The- Commonwealth of Massachusetts Department of Fire Services - Oce of the State.Fire Mars Office hal P..0.Box.1025 StatoRoad,Stow_W.01775 'APPLICATION. FOR PERMIT - Date: N. Andover .Permit�No Dig Safe Numb (Cityor Town.) . (MApplicable) La accordance-with the provisio=of M.G-L.. Chapter 10 as provided in section 527 CMR .34 applicatioa is-hereby made Start Date ' by Fullpame of persoq Firm of Co ®rjticn)'State clearly Address �1J .( �f' �,��• purpose for (Street or P.O.Bcx City or Town) which equectcd • For pcnnissioato locate dumpster for construction/rennvat-inn /rlemnl i t—tnn ismqucstcd - . of buildin�- Cammefitr: dumpster must be 25 ' from structure or 'covered when n-ot i•n use - at (Give location by street and no.,or desen a in such manner as.to provied adequate identification of location) Name of competent-operator Cert No. (IfAppficable) Dat-Issued-rejected (Signature Applicant) Date of erpiratian Z of — [ Fee$ 50 -00 Paid 'Due The C®mmonwealth of Massachusetts Department-of Fire Services Office of the State Fire Marshal P.O.Bax 1025 St lte'Road,.Stow,NU 01775 ' PERMIT Date: North Andover )Permit No .(Cityof Town) (Lf Applicable) Dig Safe Num er In accordancimith the provisions of M G-L-1 Lt.8 Chaiiter-1-CL as provided in section S 7 7 (MR 34 Start Date This Permit is granted to:. Full name of person,Firm or Corporation Permissionto locate dumpster - for construction/renovation/demolition of building. Comments.- dumpster. must be • 25 t from structure if unable to place with required Restrictions:clearance dumps-ter must be covered with plywo*od or tarp end of 'work -day .at (Give location!by street and or describe in such manner as to provied adequate identification of location) FeePaids 50 .00 Fire Chief This Permit will expire- Si Aature of offical granting permit) Offical granting permit (Tide)