Loading...
HomeMy WebLinkAboutBuilding Permit # 10/9/2015 0.1 FORTH14, BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 01 Date Issued: I \ IMPORTANT: Applicant must complete all items on this page LOCATION -J—� 1 Prt PROPERTY OWNER T0I 7, -, S I 04�- 117 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential [I New Building El One family [I Addition [I Two or more family F1 Industrial El Alteration No. of units: [I Commercial 0"Repair, replacement El Assessory Bldg El Others: D Demolition [I Other M', ewn DESCRIfTrN OF WORK TBE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: tv Contractor Napq: -P,4 f -0 0 Phone: '2 Email: (1/-P ej i t� 11 Address: V Supervisor's Construction License: _Exp. Date:_ Home Improvement License: em) y Exp. Date: ARCH ITECT/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. �6y 0 FEE: $ --) Pr Total Project Cost: $ Check No.: 0 Receipt No.: C It NOTE: Persons contracting with ur r ere i ontractors do not have access t a guarantyfund -------­--­---------- aturp- nf r Signature of A Jusen Deveippment 7 MvIand /"Tnue Andover. Ma, 0l S 10 (979) 475.0563 Page I SeMcmber 2Z 2015 Jane i on NIaltzahn ! David Stroh 36 Appledore Lane, No. Andover 018.15 RF,: Contract proposal for new kitchen Dear Jane and David. The acceptance of this lever vvHI constitute confirmation of an agreement to remodel 3 our kitchen and family room locitec.at 36 ,-\ppledore Lane,North Andover The Architectural contract(preliminary) dra\vings and details were be provided by Jeff Peavey from the Kennebec Company dared 8,3112015, Jensen Development Corporation shall supply all necessary labor: materials, liability insurance. workman's compensation insuranec., and equipment to remodel ,,,out- kitchen and Runily room. Jensen Development Corporation Will supervise and direct all work- to be performed by them and shall be responsible for the acts and omissions of Jensen Davlopmem4 employees and all submnauctors and material suppliers fired by Jensen Dev,-Iopnieut. Jensen Dutlopmen Corporation WH guarantee the "urk to A The from defective materials or workmanship and W remedy any such dackmies appearing Min one year ofthe completion of the project.Jane and David shall be responsible for am. sub-contractors Wed by them and they also MY1 be responsible for an; mmuials supplied by flicern and or work Performed by them. All allowances referenced in contract assume that-,here will be no mwkwp an the allmvmce Ex rnawdak and Won NIrknip is included in the overall Contract. Invoices 1rorn pro,Wer shall be supplied if desired. .Any al lova anc,, not used vv ill be credited in full against other omMmuling payments, My arnown spent over the allowance and or additional work vxil I have a mark-Up of 18%CM that overage. Both parties agree that the scope of the contract can he changed by mutual agreement mid the price may be changed accord i n�,,jy to reflect those ill od fications. A nwhMn. Mgned by both parties, change order W be used before any such clumgm ncnr to contract. Pave 3 01sion off)-Finishes New 10 Inch dry wall as neer:e<.to (?CttCl1 in C'iiili`'s a1Kl Ms as n'edleCl. Them rs a nnk duct chase to he constricted for l:ilchen exilaust hood 2nT1Il� Co(nlli!,up through Closet aloo�tu and Contlnuinci through attic then cominuing thmugh the root. Where luta p)-,sses thl'ouuh Second Doin: Met we n 111 build a chase enclosure to conceal duct using'v:.D1= and then enclosure ten':i("painted. - Painting at i`AO"Y x,11 new dyr nH io be.primal. All i'ditchen. pantry, and wAsting ;tooth room salla and ec%gs r;) mceiv e two coats ben iv1oore late ihiSh paint. No other rooms or 1"ial Is to be painted, Vv indoi s and doors not to be?epahmd exeeht kitchen sink Mmv which we wH &_ pa nt as nexind once window has Kai Ill iv? We will re-paht baseboard trial in koch�nl and SmHy room, F.xr_erior box hay kitchen sink window trim in he reIminted and ani`netts-clapboards needed to patch m ill be painted once window has been move,No existing clahboads will he palated on this Man sink exterior wall. The existing, pantry, eabiti�t shall haxv all Me hnmes doors, dra"ry Anus and inuedor ni'upper cabinet primed and pailit_al us,in,finish ];tint prov;i 4d by the Kennebec Cabinet Colnpall}, The interior of this base Mina shall remain as a naaaal finish. Kitchen Cabinets by E;amebac per /31 2015 jr(Tress d mwhWs to be purchased k Jane and. David and delilyred to�Mic k the Kennebec Company, Cemmicowne the miiteriaiS;u17]licd by Jane and Da-,id and installed bv. Jcn n De"h;nent for the kitchen and pantry back: plash;: . Tile ull back soasli to be 2x6 rumd, bond. for 211 When back splint es int l'udi g rec-,ir "MI MOM;; butlers panwy and coi m"is left and right of Stovin Tie back splash to the tEm of the sm\T Shall 20 tilt'Rin_ning bond i�cri]'r1CLC1` with a l x6 p_dl file bord'r and dot (files) ' .tlrhn (lie! Created by 46 paned M Final si7o of'the.pane' 0 be detwilklad on in with _me and Md. Remove all Ceramic at hICIUM9 UndeA'luent plywood i7roin exhing Khchan 1'a i h, ,Roan.. Buders ]Call',' (.lona to tiubfloc ( \i, 7121i` Und.erlalinauis used owrsubf1ai won in iaH, .lel WN, tlonrs SubrIoQr 30 jicnv �i'ood door QH match Mishis of eX dra mood Doom, SuMAy and innmH 2 iF s v select grade reds oak randoin lengths "hh iiu lcll qhs.shc itr flim 116 "Ob -. Coats A lrcahytra arae in the G�llotvin i amnm hitChen Falnily Roan and ulll'er's PanwS time: Rudus Parul we NAU insmiI a "mod bottle!•to jaighlight Pantry area if de-_rrcd. To he cleterrnilied 1?rit>��W inStali by Jane alid ll<tiid. , r � Page 4 - Supply. fabWain and install hPQ Broxvn 3CNI gmnkc cowner tops "Ith ma sink cm ow, an edge dwaH udn,,,T jop,and bonorn' 1I , 0 inch back splash, 6or A or Wen pu 80 115 Kninehe AwN, inClUdin« ktChOnijjk \\indm\ sill and exisling pantry Cabil--et. ati'd installation of new granite cotwior tops in Kitchen and Pantry. OcludMg When Appliances incluclin< a proFessional Ventilalion liner Model PSLA)58and a AbbAa WE, 1.400 Uhl ivinore roof top ventilator u) be supplied by Jane and David and installed bv .)-ensen DnvQmvmCoT, )icaj Nprnbing: Kiwhen inks and Awen .shall be PH1Vh,-ts0d by .,,ane and David and hey arz, 110 ai"rangeto have rhom d1eli\erod To the sin fixturcs find Qpt netssaq Opitig 10 comwo nett/ Wivu Anh amd fuels including room-vent Avislaud oil, WAIGH-Ji-,]% Ammu new gas piping astwoRd W ii , rwye. Relocate dryu vent Q basernent ii1 cyeace peeClti sppCC'f,,)I,11 We chen', inSI-all your ent hood line.,- up throlly"I-1 oovll `]Cjlr C:OSet a-ld CNWM LW QmTh am f a yon nnv new HNAx 1.400 CTA I rocT top \undlamk 'Q' QW11 I.-IOG) CF,\1 top \�ndlator\\'t ntllel ti- - 0 gh[ 11 SUpfflV and jjjSMP the RIK"bu Ar make up air in Adyn. One Fan ch. N1- 111W CFS I makAJI) ,6vir An: and one Winch. 10-MIJAH 20 12. 20KV' eQcVc heater hi plan 1S t0 bring, in out,Sije jir Rm "Th Tis Ilmech nmkc air worn and A On rmm-n air dwt for 11'sl fllooi-: A11'im,Ji Q 111Ctal iliac( LCI Staj-,-d and in,31110t0d 1IC-A ClUct: All nlot'i! 1 W PkMe now: A is understood Tat diis affe c-1 flit ->peratio of xi ji 0 s conlduning syne,j) 111d thLit [jj(,,C is jj;,, in th C, C additic-11al AC. Par Provide all derno of e,,,istins, v,irij)g supply and install all WAng to meet the design intent Or new 1Wwn. Wry cabintry and lijabg uj mnriin, as is hcovexur we will relome Ace One OW101, 011 pmmy back sphsh to Me side "A! a buk sNash. WHM w be installed as needed ill 1ijtcl-cjj. Six nea\ reces,r,d li,111ts-I() be supplied and installodby JenseR Devolol-"nlent inclulng 1mv and tdms to be LipluoHn"m equal. Supptlind hmaH "AMg Nm all nnv W when appliances. SWA and Wall whbg Rm ne\ k'i,,chen e .xha,,,js( r (�i,tell_p lan and teinper& rriake LIP K q'stern, Please now: The We ill system in His proposal requhns 133.5 arlips, Ehle t() Till V\-C' r\-ilj be supplying and illsfajlhr�r q new sub p, -.0"t nCX_ - IXIVI�, asci j Ill ale' ill baSolli to eXi��60L! -1 Hi ( )L i Sonie circWts offinAn palml wer to Hnv RA panel w create VOLLA ,,, in exhlIng panel IN neiv breaker capabW of had required Am my"_0 up air *Win, SUIVI�: and install LED FkN N"M Un&r U&Mey HgMhg a, ult,cl- cabincts of,­�dtchc11. 7 0 10, ROOM, ()Ut1Q_,1s and sv'itchkcs leslhc,,Iicallv to tit ne"', cabinet layout anal to inert ci_,(jd I-jeeded island OwNts. Moy Swiwhing and vv, Ian Whive p­01161011t Iiidits o%er island. Pendants R) be supplied by Jane and David, *SUPP1Y Witching and "Iring Or i(ir-e lk-d-its over ki(cllen to he suppiied by Jane -and Davit.{. pi-ic SOI aSc)!) 1-)ePc,sn 11D be SIO-00010 to senate Pennit and Orderany _q)ecial ifcin-, An addidonal PaYMPT Of S 1 R00(100~hall be nmde once pennN has bewi issunj lyouny Acypted [p : Jane N(mi hfahzahn ye I, i _a�cj . --:-, — {)resident 1 ( 4 /,iI o 1-1 6110 _A � �~tIF?f7rCI1C� i _, . pro AS g"c r` 155UE DRAW B7 DATE TRANS ImAL To: DATE __ — NNEBEC - — - - omprry _ I L II e f 155UE DRALLN 9YDATE TRPIJSYITTAL TO, --___.-----DATE i _ _ KF NNESEG --- -K - ---- ---- ------ --- - FI DRAIN BY DATE TR495M[f TAL TO DATE KF,1 V l Ol lMEC r _ e i DRAN BY DATE I-AL TP DATE p K N�P-.per C 1 $ ,il r M»✓ y u a± Ul oui Wa°n. go° tei «ed i co ? cep ?do �n pOU �p �aUi- nOR uy6U pall gpl.i MAIN r � tl„ (A Y. ^X i e 4 Y k $ Ml f'` ' ie7nyG i'°x W h 5 a gg a da j a 44 rv`o <s C Faxserver 10/2/2015 4 : 36: 37 PM PAGE 2/003 Fax Server Client#: 989141 JENSEDEV DATE(MMIDD/YYYY) ACORD- CERTIFICATE OF LIABILITY INSURANCE 10/02/2015 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(ies)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 CONT Shelly Munger USI Insurance Services LLC-SCL PHONE g55 874-0123 FPxNo), 877-775-0110 A/C No Ext: AIC 103 Main Street E-MAIL ADDRESS: South Glens Falls, NY 12803 INSURER(S)AFFORDING COVERAGE NAIC9 855 874-0123 INSURER A:Commerce Insurance Company 34754 INSURED INSURER B:Ace American Insurance Company 22667 Jensen Development Corp INSURER C 7 Moreland Ave INSURER D: Andover, MA 01810-5007 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONDITIONOF ANY CONTRACTOR 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. LTRR TYPE OF INSURANCE NSRADDL WVD POLICY NUMBER POLICY EFF MNVDDIYYYY POLICY EXP LIMBS A COMMERCIAL GENERAL LIABILITY ZV9232 8/11/2015 D8111/2016 EACH OCCURRENCE $11,000,000 CLAIMS-MADE 11 CCGJR PREPAISES a..c ence $100,000 MED EXP(Any one person) $5,000 '.. PERSONAL&ADV NJURY $1,000,000 GEN'[ AGGRFGATF I IMIT APPI IFS PFR! GENERAL AGGREGATE $2,000,000 '.. PRO- POLICY F—I JECT [:]LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMDINCD DINGLE LIMIT Ea accicentl ANY AUTO BODILY INJURY(per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NDN-OANED PROPERTYDAMAGE $ HIREDAUTOS AUIOS Per acclJent UMBRELLA LIAB CCGJR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DFD I RFTFNTION$ $ B WORKERS COMPENSATION 6S62UB4531P25414 4/19/2015 04/19/2016 1,PTF. OTH- AND EMPLOYERS'LIABILITY TUTE FR ANY PROPRIETOR/PARTNER/EXECUTIVEY YIN E.L.EACH ACCIDENT $100000 '.. OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY I IN41T $inn nnn DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) **Workers Comp Information" Proprietors/Partners/Executive Officers/Members Excluded: Peter Jensen, Pre/Tres/Sec This Certificate of Insurance is issued as a matter of information only and confers no rights upon the (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S16389854/M16389838 SH MCX The Commonwealth ofM_ assa-Musetes Department of IndlustriadAceldents M.ti _ X Congress Street,Suite 100 Boston,MA 02114.2017 www.Mass.go-v/dia Workers'Compensation Insurance Affidavit:Builders/ContractorsfElectricians/Plumbers. TO BE PILED WITH TBG PERAffF NG A-UTE(ORITY- Aplilicant InformaK iPlease Print Le 'bl l / Name(Business/Organizatial): .Address: 7 G � City/State/Zip: Phone#: D Areyou an employer?Checktliec� p apropriatebox: Type of project(required): �I. T am a employerwith �`: employees(full and/or part-time).* 7. ❑New construction 2.[]lam a solo proprietor or partnership and have no employees Working for me in 8. ffRemo delirig any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3..Fl 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 ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions 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. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.msruance.t 14.[]Other 6.[]We are a corporation and its officers have exercised their right of exemption perMGL c. 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showingtheirworkers'compensation policy information. fi Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. ?Contractors that check this box must-attached an additional sheet showing the name o£the sub-contractors and state whether or not those entities have employees. Ifthe sub-coniractors have employees,%ey must provide their workeis'comp.policy number. X am an employer that ispidviding workers'compensation insurance for my employees.'Below is the policy and jab site information. Insurance Company Name; 4 C r C , Policy# or Self ins.Lia.#: ( 7 l7 S/ n 15 Expiration Date:__ Job Site Address- J I i (,_V( z 01 f City/State/Zip: Attach a copy of the workers' compensation-polley 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 foam 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 verificatio I'do hereby certi un r thepains andpenatties ofpei jury that the information provided ab v is true and correct. Si nature: Data: 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#: Massachusetts .:Department of Public Safety Board bf'Building.-egutations and Standards '<Constiuction Supervisor License; CS-083696 PETER JENSEN •,: i 5 PINECREST RIIIS` Andoyer MA 01830 IA I J ' J.•�,.� �l�,�Ge�.� Expiration Commissioner 07/19/2016 woo,"lam zcaeccll/a101111-wCeckeliet 0elee of Consumes Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR. egistration: 140345 Type: ';w P xpiration: 10/14/2015 Private.Corpore JENSEN`DEVELOPMENT CORP PETER JENSEN 5 PkECF EST ROAD Q_ _ ANDOVER,MA 01810 Undersecretary