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HomeMy WebLinkAboutBuilding Permit #834 - 107 ROCKY BROOK ROAD 10/17/2011 BUILDING PERMIT oF�t,,�,NORTH,,bgtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 47 Permit Received Permit NO: Date Re '� 04 +� �gSSACHU`�E� Date Issued: a IMPORTANT Applicant must complete all items on this page ,a .�• v'� � c-;��°" �` ..�^#,}� ��' a, � c'a T ....� aa'y--' .a- io r �',,,„?°s..fi > a,; c' ;•1 '4q-fi+ � d� . #,d, '� ,' xc� 3 LOGI'�I�t ate{ Y 6 , P :;wt ��..- >��#: a��s `zr'�ar� �. s,.r x ,xa- .f�T1t �., �• �£ '^�� ,Z, � -r3z`-'='�' �i."s-4Y,�,; r � '"�`h ..'U,�-�, ,�+� �a t � Y" 'w p�'wJ'x t? .c�F a�" t r?'� ,�'..; S+ �., i's-�•s-�.'x a a� s�� 'av;-��at'�,r'F''4;. ���� ' •�s�'.,p,,an�`�'`:��� ����r n mgr: ` fr av�u?c �^r s �a-'���+.�f����y�"s� �s=�-�, +� � &x:���•�"�*P�nLLtt,��-`���� �i`����'*'�' ,��"�,,�"r ,"sT"�""a"w'# ",'c,��amx"`s. ''.�� `^zt. " ,"t?' � t*�' ' e ��,. ���'p -,.° `� •#�-:a it'�,s�r.. tx -f e'•� �t � ��aA�,`"�t �� �, ��`. fUTAP �1 � b P TYPE OF IMPROVEMENT PROPOSED USE - Residential Non- Residential New Building One family 4 Addition Two or more family Industrial Alteration No. of units: Commercial L. I epair, replacement Assessory Bldg - - -Others: Demolition Other -s+..s•,'r Sys ,� `q .{�iptaC Drell �eiWeLlan.a t> '$ ,-.;IS'r{� 4•:;'a•,+ •n ..`ue sws 's;^sr.',+, "� s - a ^ 1 1�U� tersh�edastrict Seri, °°' ' Water-�S�eweT rs ,"`'�. -a ras `� s�`^+� "„ fa„`zxy -'.*i',.-g„ azy," s. ' a'` .. '•" °" '' k "a,- ' s, s, DESCRIPTION OF WORK TO BE PREFORMED: bm _z�wo,�9/5-z Identification Please Type or Print Clearly) OWNER: Name: - - Phone: Address: -3- wt _50�`+� i�` r�,•, Y: ' �rm ,� y� '''.s••C�4 ,s"p„ ,.�- � �:• m "N, OR CO#� Name �a. , . Pone A. x 5 p', 4mum "'->"#% 173: o- S`z"#� ` � � " ` � a� � "�a-µ ... .. "'x r-y yr� u ��P vrx 1 s�° � ;"a''n 3 e ��•...r x +c'.s' .+ta+• r .. .a�f,. �r.-"•. C ,. - -�' rr.� � d;,uc. .,..x¢; .h.:+°s sa '`i�s,'ST§. e°3'.;.j -s'. x '-t"? �, ����1.x.`^�kvr.`"�,w�;�;.. .` �'`q�'.,�,��#�k k :,,€�,.oak E. «a� Lcene � � �_ 9"'a#er ~�'.� ,�" aWd'a�,z^•4 aw^e nc�•vw#� ` .��3 5k .."xAs, e�,r'£�`�,"'qtr�.a �J;� � t.G-1, �"',,,�'rx °t'w'r �. , ,��`" � �'���4.3 r`i �' � -4F wa- ' a �..?� �;...a "y.'.� er== ''-�: ,a �, s a k��,rr .�,�,.,-. :<... �, rY�ti� -a` •'� ' �wgz�. ,�*� �a�'y� a € .d>ac`.xe+, + "'y.1 e �r+a �,� �a#.''�-;, r� .� t��.��r� a,�` *.,. + :a} '�. �.,4�F*.�•n �,y+'F"3 x�.a.�' rt�' -�'- ' -�,"�y"w"�- s<� -7C'� > E �x m Irn rr veen# icense : � t �. ffi ,�r s�`:`�=-,v:d�.x� p ARCHITECT/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. Total Project Cost: $ o�0 000 . 0 O FEE: $_ Oi�� I Check No.: I 1`[. Receipt No.: y NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owner Signature of contractor ". 1 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools I 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 ,F I - Zoning Board.,of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water Sewer Con nection/sii nature &Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street jfi FIRE DEPARTIVIT��'V ferr�p umpteron se des gnno d located4L-1 24latn streeAM t x: f d i i 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 j MGL Chapter 166 Section 21 A-F and G min.$100-$1000 fine NOTES and DATA— (For department use II i i is i ❑ Notified for pickup - Date Doc.Building Pemiit Revised 2010 l Building Department 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 ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ 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 ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C..And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass„check Energy Compliance Reportlicable If Applicable) PP ) ❑ 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 j ❑ 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 j 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 2008 Location/04 1004.1/n 4. No. Date fj HORTy TOWN OF .NORTH ANDOVER _ 0 9 + ' Certificate of Occupancy $ �ss�►cMusttBuilding/Frame Permit Fee $ 7 Foundation.Permit Fee $ Other Permit Fee $ TOTAL } $ Check # Building Inspector K. 24720 FORTH ® O 1' . No. _ M _= o dover, Mass.,. 1� • < T O t- LAKE T COC HICHEWICK ED BOARD OF HEALTH Food/Kitchen Septic System _ BUILDINGPERM. 1T T D INSPECTOR_ -- THIS CERTIFIES THAT�....... . �.k1we-tw.- u.... ""' Foundation is has permission to erect ............................ ........ buildings on .......1.1..0!......... . ..... . ..r ... ...... Rough t0 be Occupied as....... ...... .. ................................................................................................ Chm iney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final, 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 CONSTRUCTIO Rough ......................... .............. ...................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. PROPOSAL#2 Jay&Kathryn Sherlock 107 Rocky Brook Road North Andover, MA 01845 C 978-390-6660 H 978-683-4615 kjsherlock5@yahoo.com June 9, 2011 � Master Bathroom Remodel Work-to be completed includes: • Demo of existing ceiling and floor. Removal of existing toilet,tub and vanity. • Reframe for new shower size. Reframe for new tub. • Complete all plumbing required. • Complete all new electrical, including new Panisonic Light/Vent unit. To include all new lighting. • Install Electric radiant floor heat. • Re-insulate walls behind shower. • Install new tile floor. • Install new baseboard heat covers. • Install new baseboard. • Hang new blueboard ceiling and plaster. Smoothcoat ceiling over tub area. • Install new cast iron shower base. Tile shower walls. Carpet protection in bedroom during remodel. • Install kick-heater below vanity. • Install new electric sub-panel. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 14,040.00 Note: This quote does not include any plumbing fixtures,vanity,tile, Grout or granite. Custom access panel in front of tub not included. Terms: $4,680.00 upon signing of contract(not to exceed 1/3 of total contract price) $4,680.00 due after plastering Work to begin on o /7 , $4,680.00 when job complete Job to be completed on - ,i Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-704-1165 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. DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPACES! Date d Iq 11 Homeowner sSignature - �� PROPOSAL#2 Jay&Kathryn Sherlock 107 Rocky Brook Road North Andover,MA 01845 (C)978-390-6660 (H)978-683-4615 kjsherlock5@yahoo.com June 9,2011 1 Master Bathroom Remodel Work to be completed includes: • Demo of existing ceiling and floor. Removal of existing toilet,tub and vanity. • Reframe for new shower size. Reframe for new tub. • Complete all plumbing required. • Complete all new electrical,including new Panisonic Light/Vent unit. To include all new lighting. • Install Electric radiant floor heat. • Re-insulate walls behind shower. • Install new the floor. • Install new baseboard heat covers. • Install new baseboard. • Hang new blueboard ceiling and plaster. Smoothcoat ceiling over tub area. • Install new cast iron shower base. Tile shower walls. • Carpet protection in bedroom during remodel. • Install kick-heater below vanity. • Install new electric sub-panel. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 14,040.00 Note: This quote does not include any plumbing Mures,vanity,tile, Grout or granite. Custom access panel in front of tub not included. Terms: $4,680.00 upon signing of contract(not to exceed 113 of total contract price) $4,680.00 due after plastering Work to begin on o l7 1 1 $4,680.00 when job complete Job to be completed on 7 ,� Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-704-1165 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. DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPACES! Date Homeowner s Signature The Commonweradth of Massachusetts Department of£Ztd1wh al Accidents Office of£itvestzgatians 600 Washington Street Bostorz, MA 0211, WWW.Minsurance Affidavit:4sseov/din Workers' Compensation�ns ' ADolieant TnlForl�tation BniIders/Contractors/Electricians/ Plumbers Please Print Lm*I)IV Name(Btts;nslOrgmiyon/lt,dividtial): �/ U Address: p City/State/Zip: �,/DO/�� PhoneJ F2. I employer?Check the appropriate_p priate bow employer with 4. ❑ I am a general con�cto and I Type of project(required):Y=(firIl and/or part time).* have hired •the . � 6- ❑New construction sole proprietor or partner- listed oa the attached sheet ? 7. 2Remodefing Ship and have no employees These sub-.contractors have working for me in any capacity. workers' eo 8. ❑Demolition [No workers' mp'ice. comp• insurance 5. ❑ We are a corporation and its 9. []Building addition Id] officers have exercised their'. 10•❑Electrical repairs 3.❑.I am a homeowner doing all work right of ex or additions Myself exemption per MGL 11.[]Plumbing repairs or additions Y [No workers'comp. c. 152,§I(4),and we have no insurance required]t employees. [No'workers' 12.[]Roof repairs COMP•insurance requfi-.,d.] 13.❑Other :A-n,a ==that c,hec m bot#1 msst alst,a-acct the 5---d=e Homeowners who suhmitthis affidavit in 'dir.•` -`=-•:'�"o��s'co M+:... .:,w .. 'Contractors that sne�,'• cat:ng the;ar_tle�an ararl and thea hi- atuside a r••���c-- 4^n. this box must attached an ad&fioaal ahem sho Q con -= submit a new affidavit indicatiq such. the name of the sub-coattsct and their wodcets comp,pow tr� law an employer that is proa'idiag workers'compensation insW informaSon. ance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.-T"r.- _��'�O 7c'? f 74�! n j apffation ' �� / D i'2— Sob Site Adchess:��,�,rj/ City%Stn o Attach a copy of the workers'compensation oli d ��' Policy declaration page(showing the policy number and Failure to secure coverage as required under Section 25A of M expiration date). fine up to$1,500.00 and/or one- CsL c. 152 can lead to the imposition of criminal Of up to$250A0 a da Y�imprisonment,.�well�civil penalties of a y against the violator. Be advised that a co of e�ties in fOrm of a STOP WORK ORDER and a nne Investigations of the DIA for copythis statement may be forwarded to the of of insurance coverage verification. • 1 do hereby Berk f3' p ' pe>talfies ofFe1MJ' t the information Provided above rs true and correct Sie: Date:_ - - Phone D hd use c o >tiy. Do not wruc in this areq to be completed by any or town official City or Town: Issni� Perndtucense# Autbority(circle one): Z.Board of Health Z.BuildingDepartment 3.City/Town ,• 6. Other Clsk 4.Electrical Inspector 5.Plumbnze' o Inspector Contact Person:. Phone ne i ®® CERTIFICATE OF LIABILITYINSURANCE OP ID NEMA DATE(MM/DD/YYYY) 05/18/11 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 pollcy(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 Macdonald & Pan ione Insurance NAME: g FAX P.O. Box 428 ac,No,Ext): (A/C,No): 104 Main StreetADDRESS: North Andover MA 01845 CUSTOMER ID#: CIiRI,3-5 Phone:978-688-6921 Fax:978-688-5350 INSURER(S)AFFORDING COVERAGE NAIC# INSURED iNSURERA: Preferred Mutual Ins Co 15024 Christo her Rivet INSURER B: 207 Winer St. North Andover MA 01845 INSURER C: INSURER 0: 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,TERMOR CONDITION OF ANY CONTRACT OR-OTHER DOCUMENT-wrrH 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP 0170 57 01 05 09/26/t. 09/26/11 �ISE�S(Eaoccurrence) $100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY J JER& 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 $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION we AND EMPLOYERS'LIABILITY Y/N TORY L MI 3 ER ANY PROPRIETOR/PARTNER/EXECUT E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? /A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ EFT_ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover AUTHORIZED REPRESENTATIVE - Osgood St No Andover MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i k' Massachusetts- Department of Pi,:.,., Sai°ct�, , . " = Board of-Ftdidinor RessuSmacxts:tifd Spar,vw ti t orisCruction:Supervksor Licenser# License:.CS 72173r. Rest;icted.to:..,00 s CHRISTOPHER F. RIVET 207 WINTER ST,. N ANDOVER, MA 01845P90 t —` >. .;?Expiration: 6121201,2 } - r (bniniissilPiie' Tr##: 27092 A.��vm Office of Consumer Aaa airs Bi(sines R�tip o VCHOME IMPROVEMENT CONTRACTOR Registration: .,,-,139962 Type: Expiration: -41812013 Ind'Wual PHER F-ATV- T`�= =1Fj CHRISTOPHER RIVET--,.�-_� 207 WINTER ST.N.ANDOVER,MA 01845 . Orf Undersecretary r:o-