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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 BUILDING PE t�eD IT to ". oF� ,bu'�10 TOWN OF NTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION ' Permit ✓ Date Received ryR"�RArED �SS•�cwus�R Date Issued; IMPORTANT: Applicant must complete all items on this page r "r LOCATION PROPERTY OWNER Utz Print 100 Year Structure yes no MAP PARCEL: , ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 10" NE��..1x'1r Vm'Lerftr,.IlIG,,Iai� 11Gn,;eIf✓iJr�up,'(FNa rGVir�N^r!Nlrldrll�esfird�ri� &1) �tsl DESGRIPTOFV�ORERFORMED: rrt.�r.i,cii/runt-��/'�/1f/iiiJ/J/�✓r'1l�/,o�"f'r,',/,��'r/�;,`f!(�e�//G,;!//��`/ mn� -41��&y4zp' ,,..:. NO r Id tifi 'on- ase Type or Print Clearly OWNER: Name: Phone: Address: ' Contractor Name: 6 �&g Phone: 2.� '/ Email: 4,4 Address: . Supervisor's Construction License: _Exp. Date: , 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. Total Project Cost: $ mg FEE: $ Check No.: Receipt No.: id- NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ,,.-.,..,/..Lrtls e/rit��r ii�/ron.iiy�if/�"rr//,.r�//;-,. �(/l�r"/"/"G?,�?Tr,,�/,m„rir,,„¢<m/,//rc,,i a.r�n,,/�J/�i�o%rr/,��L'�—/i///T/��"/rlrrr i7/,�""�„—/fp/”%. /r////ii��.�,/�/,%4,"�'%�//rri,%,/r//�!//,r. .,r r✓..i.,.,..,..',,rr, rc//�/ci,,a`,r,,.,, ,,,rr//ii/r/h< f/%crrT//r:ii/ .�, % G -Town of Andover tkoRTH ® zi . 0 d? _ - - i h s��1 O LAI(Q h Very fs.L7Sy 'SJtArJe go 01616 COCNICnl WICK RATED S U BOARD OF HEALTH Food/Kitchen rER Septic System r L D THIS CERTIFIES THAT ........ .. BUILDING INSPECTOR ................ ..................... . ............... Foundation has permission to erect ..... .............. .... buildings on ....... tuf ..... ... t ik Rough to be 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 ON S ELECTRICAL INSPECTOR LESS CONSTRU I Rough ` Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Islay 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 C71 '9 0-- -210:6"' _..................gg.r _,....... 7Q. d7;., 104:" 3011 SS qll 42;�'1 �6iiiS«auk;"c;ts��abii»I��li' ; ,.,�... _ _ .:ii ,5..ie�A!'ui!'';�w:; }"✓; 'ly 1' W3838 BUSEW38fUT' ; tlpe Here CUSTOMER NAMES PHONEPsuI Ffonte/87879411712 / I w„� j STORED 1 ORDER034801513286 %/%%////f%/%�//�;; i' ";. /�ta ( �' � �jn618XJ4 ul-1 dU1I MEASURE TYPE:Tt10 �-y 1l1 ly 830 BUTT''BWBTtB•1. :::+ !, iGl$WNI�+n CEILINGHEIQH'i:w4 tr81119212"toimams S�” Dyy/) �47aX9u+/Fyt2 8 J f EIGHTmone i TOP CABINET ALIGN:84" m m I1�,m,�; % — //!//!/l/�11, CAWNF I MANUFAC 1 UREK:TVdle DOOR NAME/OVERLAY Monteolfull oyenayl square Fiorito Kitchen WOODWnple `. t .r../m. P.0 80408202 FINISH:Whe9l £j,5 Coiling Haight 94 1/2" 6-, BOX CONSTRkjGTION:AII PI ywaod Cenahuaflon I n ��1° � !t• (Beams 92 1/2") GLASS:None tD [ ">,qNOW TOP MOLDING, t)simple"L"shaped Kitchen Wall N.r BOTTOM MQLC+ING Norre v 2)Cunlumui doeent wanl all Island EXF USED END APPLICATION:Fumftum ends ,I J 1 iii 3)Add Dish washer iNSTALLERICUSTOMERNOlES:x"notfsinrod o �/ ? 4)Nereadytsell E I/ 5) awAppllencesjr CTQN MAI't1'tlAl:firantte COLOWGia110 Wone SUFT:48 I% J m: EDGE PROFILE-:Bevel LN F I EDGEA9 Final,But put on hold I AFYLIANU SPECS NOT PROVIDED APPLIANCEIPLUM13ING SIZES USED FOR DESIGN: HLFHIUERATOR: Installer notes: WX H X D.38x70x33 TYPE:french door please confirm door width on wall#3 RANGE.W X H X D30x38x28 are beams being removed? 0'IH•W X H X D:30X18X15DAI•E:419U/241b Is flooring staying? Specifications of OTR will datennine cabinetry bbove PRELIMINARY DESIGN FOR NRESEN IAIION DISHWA8HER:24x34.5x24 NO I READY 10 SELL Does flooring go under cabinets or are We matching footprint. FINAL DESIGN MUST BE SUBMI I 1 EU FOR confirm all center lines. INSTALLER SITE VERIFICATION AND FORMAL REVIEW PRIOR 10 SALE. confirm It cabinets need to go to tailing All dimensions size dcsignatinns I i This is an original design and nnlst I Designed:5/3A,10 1.5 Mivell;1re tiubjvut W verification un i taut ba r41v;+yed or copied unless i Printed:5/3/2015 job site and adjusunent to fit job applicable The hus been paid or Job j wnditiona♦ order p)avv-d. I •n nnnn• ♦ I♦♦.- ..... L. 1 I T1. l�..♦.. 2015-06-02 09:40 3480EX 6038940414 6038940496 >> yyyy P 4/8 Alk KTM Properties, LLC rel 25 Spaulding Rd Suite 17-2 Fremont,NH 03044 "." r:°r Phone: (603) 895-0400 � �; Fax: (603) 253-2600 \ A Semite ftWckr* ' ., Company Representative: Customer Info: k PJ Michals ,lob#: N/A (80406202 Fionte) (603) 548-2469 3480-Fionte, Paul pj@ktmproperties.com 962 Turnpike St, North Andover,MA, 01845 (978) 794-1172-mobile PRELIMINARY ESTIMATE Description Demo 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 Mange,ilange Hood,Dishwasher and Refrigerator. Relocate from space. Removal of Countertopse Remove laminate, solid surface,stone,quartz,or We 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 GFCT(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 I'lectrical Permit Supply electrical 2ermil and inspections Plumbing Description Install Sink Install double/single howl top mount sink w/faucet,disposal:within 3" of existing location(Installer provides shut off,traps, valves as required) 1tevent Sink Revent sink per code when no vent exists and inspector requires through roof vent Cut/Cap Cut&Cap plumbing for now cabinet installation Dishwasher Plumb in dishwasher next to sink Permits Pull 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 ceiling repair or painting.) Move Pipes into wall Move the pi .es that are in the pan!ry into the wall(Pex) The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Foston,MA 02114-2017 www.rmass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pltimbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: City/State/Zip: one#: �� �✓ Are you an employer?Check the appropriate box: Type of project(required): I.n I am a employer with employees(full and/or part-time).* 7. New construction 2.[_J I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity,[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 E]Building addition 4.❑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,❑Electrical repairs or additions p netors with no employees. 12,Q Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F-1 RO,of re ars Thesesub have employees and have workers'comp.insurance.t w m 14. ther 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. I52,§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 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 2Contractors 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. � w. /� o v //�� Insurance Company Name; � I �'—�/ ' Policy#or Self-ins.Lie.#: Wc�_ Expiration Date: � Job Site Address: 2 T4�k-hCity/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 MGL c. 152,§25A is a crinunal 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 certi and naltie perjury that the information provided above is true and correct Si a 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 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#: CERTIFICATE INSURANCE DATE(MWDDIYYYY) 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 PHONEExtle Nc No): 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 THD AT-HOME SERVICES,INC. INSURER B:Zurich American Insurance Co 16535 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 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. /NSR ADDLSUBRTYPE OF INSURANCE INSR MD POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A GENERAL LIABILITY GLO4887714-05 03/01/2015 03/01/2016 EACH OCCURRENCE $ 9,000,000DAMAGE TO RENTEU- '.. X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrenceI $ 1,000,000 CLAIMS-MADE a OCCUR LIMITS OF POLICY XS MED EXP(Any one person) S EXCLUDED '.. OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,000 X I POLICY PRO- LOC $ ',.. B AUTOMOBILE LIABILITY BAP 2938863-12 03/012015 03/01/2016 (CEO,accidentMBINED SINGLE 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 NON-OWNED PROPERTY DAMAGE $ '... HIREDAUTOS AUTOS PeraccZi '.. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ '.. C WORKERS COMPENSATION WC017731493 (AOS) 03/01/2015 03/01/2016 X WCSTATU- OTH- AND EMPLOYERS'LIABILITYORY LIMITS C ANY PROPRIETOWPARTNER/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 NIA WC017731494 FL (Mandatory In NH) ( ) 03/01/2015 03/01/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 It yes,descr be under Conitnued on Additional Pae 1,000,000 DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 ',.. of Marsh USA Inc. Manashi Mukherjee _1vLaNAv n.i z e�c ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD o`.pub[%c Safety 3C-afU Di'Gf::.:�r.ri . .:%J:a;a.�.,., e',�]f✓Y.::�ftl :LRTf IN–Y R PL. lio aV—'4^ NWI:DFiVX M,% u � 4U1'Z.40'GCOO • rermri�ern�s i ro ��•� `ltJ/ sumer and Business R � • price of Con Suit .70 10 P ark Plaza - o Boston,Massachusetts 02116s�aon � P xovement•Contractor R��' H.om� uuP . , . R.�3islra'�"; 525893menl Card • TYpo; SuPp� • c��iration: 8!3,2058 S=RVIC;::S, INC. ---- --- RICHARD i rZOIP U}JISE�IAI�D PARK�`JAY SUITS 30.0 . .. _`_.... 1, GA _0339 -- dr urn card. r.r8 \l Updott Aid�s an �tnpjoyrncnt '� g rn cc+al ' don, valid for iodiYidul 7 ^viltion` U-crsc or rre s If found return `• berore the expiration da:� jinn's Re.. -� OC rc cf Cocsvacr;. OR airs and 8 ^y _y�iT G7N 0miice o{Consumer All {0H. UhPROTppc: 10 Pirk p1a a•Suitc5170 o.•G�S.I�g L•a`,'or: .'26�93 SuppIemenl Card Boston,MA 02116 T^,0 AT HOME S:-7t�AG�S,1NC•. _ t _POT AT t J1` S 2V1G-S ' RIC!-{ARD iRC1A •.�b.�1:�NAY S ��- aturc •-•- ' 26�CUff,3SRl�.ft�,, �% hotvilidwithouts, _ _._�-• h`TL� CO, 30339 Lcocruc ..._ _� , .f