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Home My WebLink AboutBuilding Permit # 10/13/2015 _...... ..._ _... ...,...._ ........ .... ....... _. _..... .... _...... The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Oficial Use Only .. Building Permit Number. I Date Applied, Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro erty Address: �� e 41'6-41.2 Assessors Map&Parcel Numbers :" _.1 t L la Is this an accepted street?yes '� no Map Number Parcel Number 3. Zoning Information: 4. Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) ---------- _,......,.,. Front Yard Side Yards Rear Yard ... ... Required Provided Required Provided Required Provided ........._._........._ _... .. --.._ _...... ._... ____ .......____ __.... i f 1.6 Water Supply: (M.G.L c.40, 1.7 Flood Zone Information: 1.8 Sewage Disposal System: §54) Zone: _ Outside Flood Zone? Municipal o On site disposal system Check if yeso Public o Private o SECTION 2: PROPERTY OWNERSHIP 1. Owner'of Record: Na (Print) City,State,ZIP vr,kne,o le-` , i , Beet 9 79 3 ,Q6 3 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK New Construction Existing Building Owner-11 O1.ccupied o Repairs(s) o Alter11 ations) o Ad11 dition Demolition 0 Accessory Bldg. Number of Other o Specify: Units Brief Descriptio of Proposed Work2: /a e r, r9 e. _ .— ...... ..._........... __ ........... -._.. ............ _ . .........................._ . - ...........-..._..__. _............. .... i NORTH town o2 t E A" Andover O - w' 4" to N®. 2A I h ver, Mass () o� COCMIC"t WIC. y1' reo #'*V S U BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT ` 10IM4....... BUILDING INSPECTOR ....... . .. . ... ..................................... Foundation has permission to erect .......................... buildings on ........ ...... .. .. ............... 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 6sw NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTA Rough Service ..............f.. ................................................... 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. ' The Commonwealth ofMassachusetts -- .Department of Industrial Accidents Office of Investigations. 1 Congress Street,Suite 100 _ Boston,11L1 02114-2017 www mass.g ov/dia Workers' Compensation Insurance Affidavit: ]3uilders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Name (Business/Organization/Individual): e Pl L}l C Address: n Zak" , Ll >e /01 City/State/Zip: /q / Phone#: 75' 2 2S Z10 0 Are you an employer?Check the appropriate bog: Type of project(required): 1, I am a employer with�_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. '®`-Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for mein any capacity, employees and have workers' comp.insurance.t. 9. E]Building addition [No workers'comp.insurance p• required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 1 l..F-1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. $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: 71 Policy#or Self-ins:Lica#:,6 &®t>/ - Expiration Date; /0 '" 1 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 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 certi under the pains and penalties of erju that the information provided above is true and correct. ie Si ature: -- �. --- ----- ----._—._.. Date. Phone#: .7� " 7 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#: ub-« i� i �:4� rrcuiYr 1-355 P0002/0004 F-852 IDEHULLU HOMES LLC 32 Benjamin Street Groweland, MA 01834 Tel: (978)372-5000 Fax: (978)372-8898 dehulInhomeskaol�.co_m,� Contract #156 THIS CONTRACT made the- 1-71111e, day of A%q. 2015,by and between DehuUu Aonws LLC . Hereafter called the Contractor and John and Planet Clark,hereinafter called the Owners. THE OWNERS,without invalidating the Contract,may order changes in the work consisting of additions,deletions or modifications;the Contract Suni will be adjusted accordingly. Such Changes in the Work shall be authorized by a written Change Order signed by Owner and Contractor and payable upon signing of such Change Order. Any Additional Work will not commence until the signing and payment of the Change Order. ALL MATERIAL is guaranteed to be as specified. All work to be completed in a workmanlike manner and in compliance with all building codes and other applicablo laws. Owners to carry all necessary homeowners or builder's risk insurance. Our workers are folly covered by Workman's Compensation Insurance. WITNESSETH that the Contractor and the Owners for the considerations named agree as follows: The,Owner shall pay the Contractor for the Contractor's performance of the Contract the Contract Sum of$16,970 (Sixteen Thousand,Nine Hundred and Seventy Dollars and no cents), A,down payment of$1,700 (One Thousand,Seven Hundred Dollars and no cents)is required to bind this agreement and is due upon the signing of this contract. The payment schedule will be as outlined on page three of this agreement. Each payment will be based upon invoices submitted by Contractor. The Owner shall make progress payments on account of the Contract Sum to the Contractor. Scope of Work The Contractor shall furnish all materials and perform all of the work on the property located at: 4 Pernbrook Road, North Andover, MA Contract#156 John and Diana Clark Page 1 of 3 ub-2u ib 'kJ:4b M11- 1-3bb P0003/0004 F-852 Work Performed— Kitchen YteYmodel-Location: 4 Pembrook Road,forth Andover,MA according to the following specifications: a) All necessary permits b) Remove section of wall from kitchen ( non carrying ) to family room. Build arch similar to picture provided by owner c) Remove kitchen cabinets d) Install new kitchen cabinets - owner to supply e) Remove existing the floor and underlayment f) Block off hutch area with sheetrock g) Remove trim, re trim kitchen window h) Remove kitchen sink, refrigerator, dishwasher, hood and stove i) Remove baseboard heat as necessary j) Re trim cased opening to entry way, remove electrical outlet and relocate if necessary k) Add PVC vent to kitchen sink t) Install new appliances, relocate gas piping to new stove location, relocate electric for microwave, install new garbage disposal - owner to provide all appliances m) Disposal of all construction debris n) Install one toe kick heater to kitchen o) Install pre finished hardwood floors in kitchen, owner to provide all hardwood flooring p) Install six recessed tights q) Install under mount cabinet lighting, owner to provide r) No painting included Contract#156 John and Diana Clark Page 2 of 3 08-20-15 13:46 FROM- T-355 P0004/0004 F-852 Contract _Price The owner shall pay the contractor for material and labor to be performed the sum of $16,970 according to the following Payment Schedule. I pAS F,-NT_SC)RDULE Payment One: Due at Contract signing $ 1,700 1 Payment Two: Second Payment Due $ 7,000 Payment Three: Third Payment Due $ 6,570 Payment Four: Upon Completion $ 1,700 Owner Contractor JOA Clary St Dehullu Dehullu Homes LLC Owner Diana Clark Contract#156 John and Diana Clark Page 3 of 3 _------------------- -1- ...._. ---- .. . .. .............. .__ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject propertv.,her/�by authorize �i ,� ✓ / 7 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date _...—._.... ...w__ _. NOTES: .— _ .........-. ...... ._. ...................._.._........................_...__..,.._...................._..... 1 An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at ww,wy ass.gov/oca Information on the Construction Supervisor License can be found at www.�v/i s _. -.1--.----.—.--.-1-1 ......___ _._........ 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/ porches Type of cooling system Enclosed Open i ..............---�.`...-- ...—-..........— ._......-....._.. ...... ...........................-..-. 3. Total Project Square Footage"maybe substituted for"Total Project Cost" /ZC U/6'ITUTTL012G!/PCLGLfL d�i�(�(-lX6JCLClZGQP.�6 Office of Consumer Affairs&Bdsiness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 118273 Type: Office of Consumer Affairs and Business Regulation Expiration: 2/21/2017 Ltd Liability Corporati 10 Park Plaza-Suite 5170 Boston,MA 02116 D LLU HOMES LLC. STEPHEN DEHULLU 32 BENJAMIN STREET GROVELAND,MA 01834 Undersecretary Not v'hd without signature �Aassachusetts -Department of Public Safety �- ;;—);rd of B:.ildrn ncgulations and Standard,,, € ti structioii Supertiiso , I & 2 Family License: CSFA-059703 � � �ti IJ Stephen M Dehullu �- 5 32 Benjamin Streeli 1,3 Groveland MA 01834 T fi � Expiration Commissioner 09/14!2016