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HomeMy WebLinkAboutBuilding Permit # 6/4/2015 BUILDING PERMIT taoRTy OF,z�Eo�6Iq'O TOWN OF NORTH ANDOVER o� 6 APPLICATION FOR PLAN EXAMINATION 6 q�� � [M1[Hew �O µ -_ •Q Co lnNf `y Permit No#: Date Received �9Q�RgrEo PPp��S SSACHUS� Date Issued: I ORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER riz"7y �ep, T 1/1�" Print 100 Year Structure yes no MAP _PARCEL: / ZONING DISTRICT: Historic District yes Machine Shop Village yes. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building +`One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .f ^""srt' y7 : , ,; rF',° ✓' aa`»' , r 'F'°-ire �4; 'r' e"trc D IOU,, «f ❑ Flood ,lama ..pWetla ds , t, ,,,Yr q, WatershedDistnct l p, p F , f .; /, "`°'.<. "'x a`Ff r,cs'r s r �' +uf 1r`` ®Wafer/Sewer °, f , DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: ���''' Y7_5'—e96_,9-7 Address: % 151, Contractor Name: 0P . _ 4,Phone: Email: st✓ emon Address: Supervisor's Construction License: 67e�16/.3 Exp. Date: 3 -f - 116 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$125.00 PER S.F. II Total Project Cost: $ Z� _FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the 61arantyfund t%O R TH Town of Andover ® 0% No. , LANE h Ver, ass, S ) 2.011�7 COC NI CNEW.CK �dS U BOARD OF HEALTH Food/Kitchen PERMIT T LIEW Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .... � �........ �.. ............. ............ .. .................. ......... Foundation has permission to erect .......................... buildings on ..%41......... ....k... .... .............................. Rough tobe occupied 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTgT RTS Rough Service ............ ... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy PuildinRough 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. DENTS BOUCHER CONSTRUC77ON 13 PLEASANT"ST GROTON, MA 01450 978-250-9493 Proposal Tanya Gould 04/01/2015 29 Blue Ridge Rd. Job type: Kitchen Remodel North Andover, Ma 01845 H(978)975-0657 cell (508)320-6179 tanyagouldl@gmail.com Page No.-1—of 1—Pages We hereby propose to furnish material and labor for the completion of: KITCHEN REMODEL: 1. Remove all cabinets and tile floor. 2. Install new wood flooring chosen by customer(allowance $3,300.00). 3. Install owner supplied cabinets. -1. Extend kitchen ceiling approx. 12" to include 5" crown moulding. 5. Install new granite tops(allowance$5,000.00). h. Plumbing will be to code &include hook up of owner supplied appliances and new sink and faucet(allowance for sink and faucet$1,200.00). Electrical will be to code and include hook up of owner supplied appliances and new lighting(allowance for lighting- recessed cans &rope and labor, $1,000.00). 3. Remove wallpaper in kitchen area and paint all walls and ceiling. a. Install 3" black granite under fireplace. 0. Install owner supplied backsplash tile. 1. There will be a$600.00 allowance to work with heat issues. 2. Retrim cased opening between kitchen and front entry. 3. Does not include cabinets or appliances. 4. Remove all debris from job site. �E PROPOSE to furnish material and labor-complete in accordance with above specifications for sum of. Thirty Three Thousand Seven Hundred Eighty ( $33,780.00) aycnent To Be As Follows: $10,000 AT START OFJOB AND BALANCE PAID UPON COMPLETION U material is guaranteed to be specified.All work to be completed in a hstantial workmanlike manner according to specifications submitted, Authorized Signature: �r standard practices. Any alteration or deviation from above specs volving extra costs will be executed only upon written orders,and will 'come an extra charge over and above the estimate.All agreements nrtingent upon accidents or delays beyond our control.Owner to rry fine,tomado and other necessary insurance.Our workers are fully Note:This proposal may be withdrawn by veered by Workmen's Compensation Insurance. us if not accepted within-30-days. CCEPTANCE OF PROPOSAL-The above prices,specifications and rndidons are satisfactory and hereby accepted. You are authorized to Signature the work as specified.Payment will be made as outlined above. ATE OF ACCEPTANCE_ Si ature f 2015 gn "Committed to Excellence" .. 276;• _.. 124-1" 2V, p.., 28" ..41 " .. 3.I" r. 24" 74 A 33n 53 .! I I I i I I ' ..,.. .7721" IA � I 123" W,i IN,;.'W2033 IN.2W2833 N IN.?_VJ3133 IN.SCW2533R j 24.PISHUFP3g1N2SR ZFIPVFIN.2B23,25 IN.I.S II i v r:, I V N tz z f LyZaUV�� Z O ro W o m q..-. O Y- W m y {m O ' :`• 1d612PR w m �n II _. i t;�• m , "Pay Q IIJ. 7 SUF3-38J�Qgp [iy °. V t tN,2R4V3812 `� r' S/ 3 �Cj)✓ .. i q2^ 31d^ .3�". ,- ... 68•f" j I A 49v" j . .. 1 Ali 871n i, ...21v� 31 y" I 36" 69", .... . 137" .. .� `ellfnalE-__...._.._....._.._Y___._.' ..._._..._....__.__.�...___......._..............__..-_t.__._:_____._......,.._-_.._...._•._._.,._._._�_.......__...._..._._.._,...__._.�_...___.__..___..._____..._..»__.._._.._.____..____.__,__..._...t dimensions_size designations Kitchen Designs This is an original design and must Designed: 11/21/2014 given >.e subject to verification on Unlimited Ile. not be released or copied unless Printed: 1/$/2015 Job site and adjust>inent to fit job applicable fee has been paid or job conditions. order placed. I Finkle-Ciould2 ,_. Ail Drawing#: 1 Scale : 0 1/4 1' III 276 —----- 124 _2811— N, CO 19 CO U V 000 00: rI I ={- IIr v JII a .- a -. - L C\1 IN C") I CY) E0 j -2 311 87a ------ 104 2 .All dimensions size designations Kitchen Designs— This is an original design and must Designed: 11/21/2014 1 given are subject to verification on Unlimited 11c. not be released or copied unless Printed: 1/8/2015 job site and adjustment to fit job applicable Bee has been paid or job conditions. order placed. ii Finkle-Gould2 ----------- awing Scale 0 1/4" 1 � E The Commonwealth of Massachusetts Department of IndustrialAccidents i d 1 Congress Street,Suite 100 Boston,MA 02114-2017 .�� www.mass.gov/dia �O1M SV.v Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERNHTTING AUTHORITY. Applicant Information / Please Print Lel;ibly Name(Business/Organization/Individual): 0� �f /A- Address:— AAddress: / / City/State/Zip: ��'� ®� � ` Phone#: 9 7 Are you an employer?Check the appropriate box: Type of project(required): 1xI am a employer with_ L_employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. MRemodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11. Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole ❑ proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.F]Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL o, 152,§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. 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 ant an employer•tliat is pr•ovidirtg lvorkers'corttperisation insurance for•my employees. Below is the policy and job site information. n Insurance Company Name: L -v,(,, f"� yam%�' Policy#or Self-ins.Lie.#: we �'j� � _U Expiration Date: 7 T/®/� Job Site Address: / /J/ / i l r City/State/Zip: 41e17,_4 �'_Ze� �' f{ 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 certify under the pains and pe alties of perjury that the irtforntation provided above is true and correct Signature: Date: Phone#: _ S, 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: INSURANCE AR INFORMATION PAGE 175 Berkeley Street Boston,MA 02116 Issued.by LIBERTY MUTUAL FIRE INSURANCE 16586 Policy Number WC2-31S-36 1214 .014 Issuing Office 0160 NEW OF: WC2-31S-368214-013 Issue Date 06-15-14 Account Number 1-368214 Sub Account 0000 1. Insured and Mailing Address DENIS P BOUCHER DBA DENTS BOUCHER CONSTRUCTION RISK ID 260525 13 PLEASANT ST GROTON,MA 01827 Status 01 - INDIVIDUAL Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE 2. Policy Period: The policy period is from 07-31-2014 to 07-31-2015 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100, 000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per$100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 500 (MA) Total Estimated Annual Premium $ 2, 749 Premium will be billed ANNUAL Producer 0004-01003$ BROWN & BROWN INSURANCE OF NEW HAMPSHIRE 3 HOLLIS STREET PEPPERELL MA 01463 WC 00 00 01 A ©1987 National Council on Compensation Insurance,lnc. WC 00 00 01 B (NJ) Ed. 07/01/2011 All Rights Reserved Page 1 of 1 Insured Copy i%iJii /I l f rind l �� � {I 11141 i� %�i�G Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 114800 Type: DBA Expiration: 10/26/2015 Tr# 244685 DENIS BOUCHER CONSTRUCTION DENIS BOUCHER 13 PLEASANT ST GROTON, MA 01450 Update Address and return card.Mark reason for change. Address [] Renewal [] Employment Lost Card SCA 1 0 20M-05/11 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 114800 Type: Office of Consumer Affairs and Business Regulation ,.' xpiration: 10126/2015 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 DENIS BOUCHER CONSTRUCTION DENIS BOUCHER 13 PLEASANT ST ' GROTON,MA 01450 Undersecretary of vali ut signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction 5upert-i.s-or License: CS-004613 DENIS P BOUCI" 13 Pleasant St , Groton MA 01450 Expiration ' Commissioner 03/19/2016