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Home My WebLink AboutBuilding Permit # 1/15/2016 BUILDING PERMIT Oo pgH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received ° ^� ti �9,yA°R�reo rea�,�ra ss�9CFCusE Date Issued: i IMPORTANT: Applicant must complete all items on this page / l r r / r, /' n �P 1 U1!✓l 1 !1f 7 Y! I / TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 470ne family ❑Addition ❑ Two or more family ❑ Industrial "Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other / r /./ � ;, r ,/„/// ,„ r / /, .r,;,/// ,/, r , /. ✓,,,o / ,.✓,,.... DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: I 1� 3�u HX Address: /� f/ /� 1./ /r r,r, // r, / ,.. ,r,. -✓, r r„%�.�,� ,. � I. � ,r/ / r r rr i / „/� r , r r / rr //J / MAN , rrr // / / r / /i r J, ,rr r r1 , ,/rr it 9 , r r / / / /%�)u<Nli�r/li�urili U//r1�uiArJi�...�/�iro0�/�i/Aixr�lulU%JroYri�rlrl�i rUl�t�rn7//rtiriu//n��pivrri/rte ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F. Total Project Cost: $ / ” FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to tl e guaranty fund j ;SignofAgent/Ovvner a Si nature af_contractor ature 'rva g NORTIy ot zx ndover _t own O L t _ :41 "2 • cocN1cMEWICK 1• d��Oo� Pay ys RATED I►? U Nook, BOARD OF HEALTH Ell M Food/Kitchen PERMI IMF Septic System TTHIS CERTIFIES THAT .............. .. .t.. .... BUILDING INSPECTOR ... ......... ... ........s .'. .w.................................... Foundation has permission to erect . ........................ buildings on QV.........�� . .......... Rough .. . to be occupied as ......16APOrtwo..... ............ ............................. .............................................. 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 o PERMIT EXPIRES IN 6 ONTH ELECTRICAL INSPECTOR RT UNLESSTIO RT Rough Service ................... ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. Krhk M SPECIALTIES, LLC 111603e94498594 Bill and Teresa Brosnihan North Andover,Ma Estimate Drafted: 10/7/15 s �S Job Description: Framing 1)Frame out approx 108 linear ft of wall space. 2)Wall height to be approx 811 3)Frame one utility closet to enclose water main and sprinkler main. 4)Frame one utility closet to enclose utilities in corner next to knee wall 5)Frame out opening in wall for access to furnace area. c 6)Frame half wall for shelf along basement wall with window. 7)Frame any bump downs needed to accept drop ceiling. G Insulation 1)insulate all new wall space. 2)all insulation to be used will have vapor barrier 3)install rock wool fire insulation where needed. Rough Electrical 1)Run all necessary wiring for all outlet switches and lighting. 2)Install all necessary are fault circuits. 3)lower and reposition smoke and carbon detector for new ceiling height. 4)Run coaxial cable for tv 5)Run all necessary wiring for electric baseboard heat. Sheetrock phase 1)Install approx 32 sheets of mold resistant sheetrock. 2)Tape mud and sand all walls to smooth fmish. 3)Prime all sheetrock installed. Paint Phase 1)Paint all walls with two coats of fmish paint. 2)Paint all wood work with semi gloss finish white. Doors and Ceiling 1)Install one Six ft bifold door to access furnace area. 2)Install one six ft or five ft bifold to access water main and sprinkler main. 3)Install 2 six panel swing doors. 4)Install approx 720 sq ft of drop ceiling. 5)ceiling to be installed is a 2x2 recessed panel with sand finish. Plumbing 1)Drop all sprinkler heads in basement to finish drop ceiling height. Finish electrical 1)Install all tamper resistant outlets. 2)Install approx eight 5"recessed can lights. 3)All can lights to be operated off of dimmer switches. 4)Install all necessary hook ups for cable tv. 5)Install approx 2811 of electric base board heat. Finish Carpentry 1)Install all 5,1/4 white speed bas baseboard throughout basement. 2)Install all trim around all doors. 3)Install approx 9"shelf along top of half wall. 4)shelf to be painted white. 5)Build and install custom built in. 6)Built to be installed in designated mud room area. 7)Built in to consist of cubbies,bench seat,beadboard,coat hooks,and draws/bins/cabinet style doors under bench seat. 8)built in to be constructed out of pine and painted white. Flooring 1)Contractor to lay tile floor in mud room area.(approx 80 Sqft) 2)Home owner responsible for remaining flooring throughout finished off space. 3)tile allowance is,$3.00 a sq ft. 4)grout to be used is a cement based sanded grout. 5)customer to choosegrout color. Total Job Cost=$18,225 *Total job cost includes all materials&labor). **Estimate includes all disposal fees. ***Estimate includes all sub-contract labor. ****Additional charges may apply due to unforeseen construction upon demolition. *****Payment schedule to be determined after agreement upon contract. ******This price DOES include permit fees. Sign Upon Agree ' n : r-, 1 I ' Ian Fenton ��\', Bill or Teresa Brosnihan Date Page 2 s r: r a The Commonwealth of Massachusetts Department of IndustrialAceidents d I Congress Street,Suite 100 Boston,MA.02114,2017 www mass.gov/dia SJ• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Ledbly Name (Business/Orgar&afion/Individual): Address: ` I�Al City/State/Zip: S'L1,E'.q) W 0307q_ Phone#: Ea()a qq Are you an employer?Check the appropriate box: Type of project(1•equired): 1.❑I am a employerwith employees(full and/or part-time).* 7. 0 New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q 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.❑Elect-leat repairs or additions proprietors with no employees. 12.0 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.) 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other 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 subriiif 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. Y am an employer Mat is providing wor•Ikers'compensation insurancefor my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: 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 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ]-do Hereby certify , dertp rin andpenalties ofperjury that the infor•rnation provided above is true and correct. Signature: Date: Web's 's Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone##: ��/`•L/0 CERTIFICATE ®F IA ILITY INSURANCE f (MMIDP/YYYY) /-3/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATMELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CER'TIF'ICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lien of such endorsement(s)- PRODUCER CONTACT serem.iah Lewis Bernard M_ Sullivan Insurance Agency PHONE - -(97$)356-5511 FAX No), (979)356-0214 12 xGarket St. E-MAIL ADDRESS'j ClewiSftulliVaninsurande.com P.O. Box 568 INSURER(S)AFFORDING COVERAGE NAIC a Ipswich MA 01938 _ „-,_- INSURERA Main Street America Ins, Co. 29939 INSURRD INSURrp 9: Ian Penton INSURER C — 5 6 N MAIN ST INSURER D; INSURER E' _ SALEM NH 03 07 9-2 434 INSURER F: COVERAGE$ CERTIFICATE NUM5ER;CL1512304357 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 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 TYPE OF INSURANCE w ' POLICY EFF POLICY AXP '.. LTR POLICY NUMBER MM DD M LIMITS COMM19RCIAL GENERAL LIAeILIYY EACH OCCURRENCE $ 1,000,000 '........ A —J CLAIMS-MADE C OCCUR pREMt E N « n $ 500,000 MI?T3040Q 11/1/2015 11/1/2076 MCC E.XP(Any ongperson) g 10,000 PERSONAL g ADV INJURY $ 1,000,DOD GEML AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 PRO-P POLICY 7 I X PRO- LOC PRODUCTS-COMPIOPAGG $ 21000,000 OTHER: Emp,oyMent PracGCes UeNity $ AUTOMOBILE LIABILITY COM811450 SINGLELIMIT I $ AC&pj ant) ANY AUTO BODILY INJURY(Per Person) I $ ALL OWNED SCHEDULED AUTOSAUTOS BODILY INJURY(Per aqi�denQ $ NON-OWNED PROPERTY DAMAGE $ H(REP AVY08 AUTOS (Per @S�9 n Is UMBRELLA UAS OCCUR EACH OCCURRENCE Is EXCESS LIAB CLAIMS-MADE AGGREGATE $ �— !WORKERS COMPENSATION STATUTE I I ETH AND EMPLOYERS'LIA12IL11Y YIN _ ANY PROPR16TORIPARTNERIEXECUTIVE 'E.L.tAC ACCIDENT D? ;S OFFICERIMEMBER EXCLUDEC NIA ----•-- (Mandafory in NH) E.L.DISEASE,EA EmPLOYeo S If yew,desaibc under --�- DESCRIPTION OF OPE"TION$below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEIIICLES(ACORD 101,Adalt(ona(Remarks 609009,may be attached if more apace is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCR(13ED POLICIES BE CANCELLED BEFORE Town o£ North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE WITH THE POLICY PROVISIONS. North Andoverr, MA 01845 AUTHORIZED REPRESENTATNE 0p Jeremiah Lewis/CHRISyrr p 198$-201$ACORD CORPORATION. All rights resin ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn7F onun 1 G00�AN WnVZ=OI SGOZ 6 024 B666996HR XtA 10Nd�al NUMITS " Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 178487 Type: DBA R & M SPECIALTIES Expiration: 4/22/2o16 Tr# 251201 IAN FENTON 56 NORTH MAIN ST SALEM, NH 03079 SCA 1 20M-05/11 Update Address and return card.Mark reason for change. C'p [] AddressRenewal ❑ [] Employment — [] Lost Card ;S'•,- ��n Of �n'�G Office of Consumer Affairs&Business Regulation License or registration valid for individul use only Fi NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: (� registration: 178487 Type: Office of Consumer Affairs and Business Regulation ,\ :7 xpiration: 4/22/2016 DBA 10 Park Plaza-Suite 5170 R&M SPECIALTIES Boston,ASIA 02116 IAN FENTON 56 NORTH MAIN ST SALEM, NH 03079 Undersecretary - 4N-otvaliod without signature Massachusetts DepartmentofPublic Safety da Board of Building Reye;^t`^ and �*, 4' Construction Supervisor License: CS-055336 1.� WCHAEL J DEByXEDETTQ 4 HEATHBROORD MERRIMAC MA 0186Q t= 0% Expiration Commissioner 08/25/2016