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Home My WebLink AboutBuilding Permit #386-2017 - 64 Kingston 10/11/2016�I ��PNS SCA+��►� S I /7w"1� p VfI I „ * .(oED BUILDING PERMIT ;`- O�<ttt"E ..�6,61'� TOWN OF NORTH ANDOVER 3 - c o a APPLICATION FOR PLAN EXAMINATION Permit No#: -Mo- ;-o17 Date Received /0-//- 3 o/ -Ar- A �SSACHUSE� Date Issued: t o l - a o ; IMPORTANT: Applicant must complete all items on this page LO:CATI'ON (p4- Y�j aur, V tc.�.A. -*aE a °Prmt P--ROPERTYOWNER'= �� .- �----------- . St�u�ture' yes, no;; PARC.EL:._._. ZONING DISTR'CT _ H]S_IIQ i'O District� yes no Machine Shop Village_____.Yes nom'. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 9,0ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 21�epair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other 0 Septic 01Ne11r +Floodplaina X J Wetlandsm g Watershed Dis#nct. t Water/Sewer__ _ DESCRIPTION OF WORK TO BE PERFORMED: -- R-3/� /16 Identification- Please Type or Print Clearly OWNER: Name: Phone: 0171;,-8bZ-22.To Address: t� ki _ � S , Z& C 0tractbr Name N � _ } I4wr mA;L Cc,;a,-_®Address,;, rl Lz114�,�=,� Superv�'s.or Hone Im'-rouement;License _ t^ b Zc. —_ p:: R p __ Ex ®ate: t zz x__11 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ('11.1000 FEE: $ a 0 L/ Check No..- // 0.5- Receipt No.: 3 / 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of.A ent/Uw, j" Signature of contractor- Plans SubmittMPlans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/si nature g Date Driveway Permit DPW Town Engineer: Signature: G - Locate u FLRE.DEPARTMENT Te ®umpsterf onsite: 4y � d Osgood mpn � esu �,no� g./ Street gzLocated�at 1�2�4�Main�.Streef -"""""' "` Fire�Departmentai'gnature/date r� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name = Doe.Building Permit Revised 2014 i1PA4ildin � ment The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ W rkers Com oto Copy Of H.I.C. And/Or C.S.L. Licenses r'Co.p° of Contract >� 1,�'rloor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issua ce of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 173000.00 m $ - $ 204.00 Plumbing Fee $ 25.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 25.50 Total fees collected $ 355.00 64 Kingston Road 386-2017 on 10/11/2016 kitchen remodel aORTFt q BUILDING PERMIT _ 0?O't�Veo wt�6hO p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h Permit NO: Date Received S�cF+us Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Ag,,' Vo rt }- , t f eve P ' t PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic Well D Floodplain D Wetlands ❑ Watershed District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: e e C Phone: 2 2 2-SO Address: 4 \t n s G r\ ' CONTRACTOR Name: Phone: W c'I Address: cc wad Supervisor's Construction License: Exp. Date: � -vS�y �4 t2 6 � I � Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING P RMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o0c. FEE: 1 � $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gua, ntyr and Signature of Agent/Owner Signature of contractor ,7 NORTIHI '9 Town of Andover No. ver, Mass, / O ♦/ o/ C OC.KC Kl WKK � 'P�� S u BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ..............:;TAW.........C.. .04!t.t4,4p,.,1,,.....,.. ... ,,,...,. ,,..... BUILDING INSPECTOR has permission to erect .......................... buildings on ... .y...k.�.A .�. N.. ,� . Foundation Rough to be occupied as .... � �► t �1......... ,�. • #ZM!h/ A�L 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 CONSTRUCTI N STARTS Rough ...................... Service ........ .. .............�. .. 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. 7 .. JOB KITCHENS BY-f0MBC0 SHEET NO. { of 1875 Main Street CALCULATED BY DATE TEWKSBURY, MASSACHUSETTS 01876 r (508) 858-0700 CHECKED BY DATE SCALE 7 } _ i i ........... ................... ........... ................. .......... ... ....... i ! i F ; a a ........ ............................... .................... ............... .......... ............. ....... ......... .................... i e , { .......r; ........... ! ; .! F i i ....... ... .. ........ ............................ ......... ... i rt a ............x ' t ' ... ..... ............ i _ >,z i I ...:.... ...:... ... _ ... ..... _ _ .... . 1 . _ _ : ..... ..... �� : . i } . 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I ftil- . :. ......: } C .. r :................................................ ,........ .... .... ....... .. ... ........... - - ... .... ...:... .... P i f i ... ..i.... i ! ' i. .... ..... ... : ............. . � Pil000CT�S•1�Irc.GrokaMw.Oipt.ToOAd RgNETOLLiREE 1-004 1 11 33" 904 4 27,V'rr C rr 75J11 3 r r r 24�� - 2 rr 3011 3011 X LL W2430 W3018-HD ^�� N � A W DWR DISH-IQ6 SB30 B30 B v X w x _ M CO M - �� M O O - M � M M ACO R36-L n ❑ DB21 RATN�GE..I�IGAS.�3�0-.-.-.BWBKlB-. . . L - - IL�ILJI ILJI_JI All dimensions-size designations This is an original design and must Designed:8/3/2016 given are subject to verification on not be released or copied unless Printed: 10/7/2016 job site and adjustment to fit job �OwO applicable fee has been paid or job conditions. '2J order placed. cheever3 All Drawing#: 1 I No Scale. KITCHENS i BY . . LLC 1445 Main Street Tewksbury, MA 01876 Proposal Date: 9/23/16 Name:Meghan Cheever PO#:099 Address:64 Kingston St City:No.Andover,MA 01845 Quote for:Cabinets • Cabinet Brand:Cubitac • Door Style and Finish:Newport Latte Pewter Glaze • Wood Species:Maple w/MDF • Price inc.Tax and Delivery: $5,625.60 See Cabinet Items List: (Attach opaque order form,signed by purchaser,if required) Quote for:Countertops • Surface Material and Name:Granite-Azul Platin • Backsplash:Same as above • Allowance:$2,000 See Countertop Diagram: Quote for:Hardware ' • Hardware Brand:To be Determined • Style and Finish: • Allowance: $250 See Hardware Items List: Note:Prices are subject to change upon final choice of materials,layout,and counter top template. We propose hereby to furnish the materials complete in accordance with the above specifications for the sum of. $7,875.60 ALL SALES ARE FINAL Payments: 50%to place order 50%balance upon befo e 'very .1 Authorized KB'L Signature Acceptance of Proposal ?` The Commonwealth of Massachusetts A. f Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA.02114-2017 www mass.gov/dia a^M SV•� y9orkere Compensation insurance Affidavit:BuildersJContxactors/Electricians/Plnxnbers. TO BE FILED WITH THE PERMCTT'NG AUTHORITY'- Please Print Le bl A ''licant Information gg �� i Name(Business/Organization&dividual): 10 P't4+1C Hct / �1 Cit E)o j ��t 1 tl.VACz [) LL Address: Phone#-. 508 City/State/Zip: �A. Are you an employer?Check the appropriate box: Type of project(required): am a employer with_ ees(full and/or part-time).* 7. E]New'constr&tion l. em P to Y 2.❑I am a sole proprietor or partnership and.have no employees Working for me in 8. El Remodelifig any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.] 10❑Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will I1.❑Electri ensure that all contractors either have workers'compensation insurance or are sole cal repairs or additions repairs or additions proprietors with no employee's. 12T[]Plumbing 5.1-11 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13'.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.0 Other 6.❑We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),andwe have no employees.[No workers'comp.insurance required.] *Any applicant that checks bbk#1 must also fill out the section below showing their workers'compensation policy information: checks i Homeowners who sthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such - t an additional sheet showing the name of the sub-contractors and state whether or not those.entities hav $Contractors that check this fiox must attachee employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: `� Expiration Date: q-15--1 Policy#or Self-ins.Lic.#: (�,CC cn., n I4SU f� —Zig ISA. 7 City/State/Zip: q0__1x d16` Job Site Address: compensation policy declaration page(showing the policy number and expiration date). Attach a copy of the,workers' .00 Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a foie up to$1,500 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. X do Hereby certify under t pains andpenalties ofperjury that tit information provided above is true and correct. J Date: V� t Si afore: _ Phone#: 4 S Z v official use only. Do not write in this area,to he 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 Phone#• Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is'defuied as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivef'or trustee 6f an individual,partnership,association or other legal entity,employing employees..However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local Iicensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage requiired." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for theperformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidenis. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant thai must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write•"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Massachusetts Department of Public Safety I I§oard.of Building Regulations and;-Standards Licenser CS-059064 Construction Supervisor JOHN C MARCHESE 31 SHERWOOD DRIVE <,r METHUEN MA 01844 +' s c: Expiration: I Commissioner 1210412017 I rte° �L t:e At r K sm+ss h Uf ice e.Con - CTOR H ME IMPROVEMENT CONTRA, Ty r.t Ri gistration: 5118207 Individual Expiration: '12j017 Jb JOHN MARCHESc 31 SHERWOOD DR y ;,�; 01844=, . Underseeretary MA ' METH0 N; Ltce*�sP'or'registr tion valid for rnc;tndsl uetyr ,�y Gefor+the-expiratioIf' .o:df -j Office of-Consumer Affairs and Business_Regulatio'W 10 Pay Plaza Su t 170 l's Boston,MA 02116 #., . . { + re.. of valid witho (g I Location b W No. 3 Pe) -7 Date /a . i/ ;- 4 i 6 ._s. • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $90 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# //OS `i U 2 2 " Building Inspector