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HomeMy WebLinkAboutBuilding Permit #760-15 - 107 ROCKY BROOK ROAD 4/6/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIONS4 - ........... Pnnt! tl?ROP,ERTY.OJNNE.., . � _ — _ n� Print _ oo)- ar old Structure F yes MAP NO _Q3PARCEL' ? :.,ZONING DIS�T,RICT Histone Distnct� yes �, y _. _ W-, , . MachmeShop,village yes i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family El Addition El Two or more family 11 Industrial ❑AI ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑`Septics=` ❑.Well _ Floodplaim ;Wetlards= ® UVatershed=District= x i - r - _ ❑,Water%$ewer.. _ n T - s DESCRIPTION OF WORK TO BE PERFORMED: ©ori ,identification Please Ty e or Print Clearly) OWNER: Name: .S11fi lVev C Phone: Address: ' W .gib 'r •n 'w.d ��/ f .*r7 CON! BRAC; OR,¢{Nam � / >t� `1 Phone SO y® � -t, ., �S K r 'Address:,r-�'�_ � �/.�iJ �� •._� I.__- �_=l �'iy�._�, .� --- - � j Supervisor's Construction'Llcense �al Expr .Date Horne�lmprovement=L==-Icerise _T I: � TT F Exp Date_ _ _ ARCHITECT/ENGINEER Phone: + t 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: $ `f '� FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tot a guaran fund I, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TYPE OF°-SEW-ERAGEDiSPOSAL Public Sewer Swimming P Tanning/Massage/Bodyg ools ❑ Art ❑. . 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 .:. DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT- ❑ ❑ COMMENTS :CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Tow;-, Engineer: Signature: Located 384 Osgood Street FIRE D'EP,aI3TIl� T = Temp Dump'ster on site yes. no Located at,124KMair,°Street ^;` Fire { DeparPen siggaturelddt& 1� COMMENTS .. 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-$1000.1'ine NOTES and DATA— (For department use l i i I i ® Notified for pickup - Date E i Doc.Building Permit Revised 2010 Building Department �I The fol(',)wing is-a list of the required.forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application I i ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract Li Mass check Energy Compliance Report o 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 apuaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buil,ding Permit Revised 2012 40 exlL, Location No. Ila Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ 3 Other Permit Fee $ TOTAL $ e� r i Check# 2861 Building Inspector. F NORTH own of . � _E Andover No. (Vol- 1 *,� o - Mass,h ver, _4 COCLCMWICK s- AOR�TE0 r'?p,`'�� S BOARD OF HEALTH Food/Kitchen PERMIT T LD . Septic System THIS CERTIFIES THAT ................. .S. .6 .�...:.... - BUILDING INSPECTOR ... . . ...... ..... .................... ............ .. Foundation has permission to erect .........................Ouildings on ..I... . . .. .. .. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. . Final Olt PERMIT EXPIRES IN MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST S Rough Service .......... ...... ..... ....... ....... .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin Rough Display in a Conspicuous Place on the Premises —Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. . e&b i"tftw. &MUUC&M PROPOSAL Jay&Kathryn Sherlock 107 Rocky Brook Road North Andover,MA 01845 (C)978-390-6660 i (H) 978-683-4615 kjsherlock5gyah.00.com December 28, 2014 Bathroom Remodel Work to be included includes: • Acquire Building Permit • Removal of existing tub,toilet,vanity,tile floor. • Complete all required plumbing. • Install new Panisonic Light/vent unit. • Complete all electrical. • Install vanity. • Install new Kohler KI 184 Tub. • Install DenseShield Tile board on tub walls. • Install tile on shower walls. • Install DenseShield tile board on floor. • Install new file floor. • Apply smooth coat plaster to ceiling. • Install new baseboard heat cover and baseboard. • Install new toilet paper holder,towel bars. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 9,000.00 1 Note: This quote does not include any plumbing fixtures,vanity,tales,grout, granite, or paint.If current vent is not properly vented,we will heed to address_. Custom Shower Enclosure will be an additional$ 1,850.00. Terms: $3000.00 upon signing of contract(not to exceed 1/3 of contract price) $6,000.00 when job complete Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115, (H)978-794-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel:617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as outlined above. Date Homeowner Signatur Date /_ Contractor Signaturq Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative.to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the con mer hall be required ta submit to such arbitration as provided in Massachusetts General Laws,Chapter 142A. lomeourier's Signature Contracto s Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL Chapter 142A)and other consumer protection laws(i.e. MGL Chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of al exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted or nota applicable.cable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing ng and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law",contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or(888)283-3757 I OP ID:SHHE CERTIFICATE OF LIABILITY INSURANCE F (MM/DD/YYYY) 09/30/13 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 Phone:978-688-6921 CONTACT NAME: Macdonald&Pangione Insurance PHONE FAX Fax:978-688-5350 P.O.Box 428 (A/C.No.Ext): AIC No): 104 Main Street E-MAIL North Andover, MA 01845 ADDRESS: PROMichael Pan CUST OMMER Ione g CUSTER ID#:CHRIS-5 INSURER(S)AFFORDING COVERAGE I NAIC# INSURED Christopher Rivet 207 Winter St. INSURER A:Preferred Mutual Ins Co 115024 North Andover, MA 01845 INSURER B: INSURER C: INSURER D: 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 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 O ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IADDL SUBR POLICY EFF POLICY EXP INSR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP 0180 57 0105 09/26/13 09/261/j -PREMISES DAMAGE ToEa occurrRENTE-ence) $ 100,000 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN%AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X I POLICYLI PEC�RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS I�$ 1$ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE_ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OH-1 AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT I$ (Mandatory in NH) If as,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I`LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA 01845 AUTHORIZED REPRESENTA IV Michael Pangion I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo ai'e registered marks of ACORD The Commonwealth of Massachusetts Departfnent ofIndustrial ial Accidents Office of Investigations UT 600 Washington Street Boston,MA 02111 wipip.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Eesibi Name(Business/Organization/Individual): .�j Address: 0 City/State/Zip: C:�,r r r '/< Phone : Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction F mployees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• [-�'jtemodeling ship and have no employees 'these sub-contractors have S. []Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑'Roof repairs insurance required]i employees. [No workers' 13.❑Other comp.insurance required.] Any applicant that checks box rl must also fill out the section below showinc,their workers'compensation policy information. 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 their workers'comp.policy information.. am an employer that is providing ivorkers'compensation insurance for my employees. Beloiv is the policy and job site riformation. nsurance Company Name: ji 15,42 fC cj 'olicy 4 or Self-ins.Lic.;=: ( moi% ;�'G 4" ��'ci t � Expiration Date: ob Site Address; fJ '2 ZC6<V ,� p,0�� City/State/Zip:/Y, kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ine 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 f`up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certtyfy it der he pains and p allies of perjztry that the information provided abo a is true and correct. � . isnature: Date: 7 y /S r v 'hone#: f`', ';• cS� // `� Official zzse only. Do not write in this area,to be completed by city or town offzciaL City or Town: Permit/License a J Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone r: Massachusetts -Department of Public,Safety Board of Building Regulations and Standards Construction Supervisor License: CS-072173 p�p CHRISTOPHER F-RIV.ET " 207 W INTER ST, A,.' -1 N ANDOVER MA 018454 Expiration Commissioner 06102/2016 `�onrrxrtrzu_mrr�/�c�r'��r3�i<r•�a�r(�f ati1. Office ofConsi4ier Arf1 is S Business Rebuiti�on ,` >9 ME IMPROVEMENT CONTRACTOR }. registration 139962 Type expiration9/812015 Individual: CHRISTOPHER F.RIVET l t r CHRISTOPHER RIVET f 207 WINTER ST. o N.ANDOVER,MA 01845Undersecretary I i