HomeMy WebLinkAboutBuilding Permit #877 - 115 MOODY STREET 6/17/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION �l o
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
. ti
TYPE OF IMPROVEMENT PROPOSED USE
Resiql6tial Non- Residential
❑ New Building One family
❑Addition ition ❑Two or more family ❑ Industrial
Iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK T BE PERFO MED:
-F:olL � ; � I � aD r— `
Identification Please Type or Print Clearly)
OWNER: Name: J\ S c-p- K. -TuomPs 6th Phone: 3KO 372.3
Address: D Nail N OVf-IZ of ��
CONTRACTOR Name: 141-o ,? �� Phone: b 3 �-3
Address: -9 O
Supervisor's Construction License:' Ste,¢ 2 Exp. Date: 7- 7 - 1144
Home Improvement License: �3 Exp. Date:
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: $ [J� FEE: $ �
Check No.: J :f> Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guartyntyfund
Signature of Agent/Owner ti Signature of contractor
Plans Submitted ❑ Plan aived Certified Plot Plan 11 Stamped Plans
Plans Submitted ❑ Plans 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
1
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
-+ I
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
I
DPW Tow; Engineer: Signature:
Located 384 Osgood Street
FIRE.DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Mair Street
Fire Departmerit signatureldate
r
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions_
Total land area, sq. ft.:
ELECTRICAL: Movement of Dieter location, roast 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
I
i
I
I
® Notified for pickup - Date
4
Doc.Building Permit Revised 2010
Building Department
'fine fol-awing is a list of the required forms to be filled out for the appropriate permit to be obtained.
R.00fivg, Siding, Interior Rehabilitation Permits
o Building Permit Application
o 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
o Workers Comp Affidavit
Li 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)
o 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
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o 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 apn,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must bP submated with the building application
Doc: Doc.Buh ing Permit Revised 2012
Location v v 7—
No. Date 6- 1—?L ' 3
• - TOWN OF NORTH ANDOVER
m Certificate of Occupancy $
Building/Frame Permit Fee $ �
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#-1—�—'
J
U " /_ Building Inspector
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
69900.00 m
$ - $ 82.80
Plumbing Fee $ 10.35
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 10.35
Total fees collected $ 203.50
115 Moody Street
877-13 on 6/17/2013
Remodel Bathroom
NORTH
Town of 2 �.. t E : ,� Andover
0
No.
o h , ver, Mass, �� '
coc MI CHl wlc,t
pDR�TED
s �
BOARD OF HEALTH
Food/KitchenPERMIT T LD .
Septic System
THIS CERTIFIES THAT I A!!".1...P.A.^.. ............................... BUILDING INSPECTOR
I ��
has permission to erect ....... buildings on ...Cm......10. ... .... 7........... Foundation
................... .....
Rough
to be occupied as ... .r1�....... Q.�. ........... i ..... ..�!/Lrrl. ... .�................... 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 CONSTRUCTION R 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.
SEE REVERSE SIDE
I
t Massacil
Board of 8u etts -Department of P
Constructionublic Safety
sapng Regulations and Standards .
License: Isor 1 &?F.imih
CSF,q-096462
2
AM -E
�-E a.
SALEIIT 0�NyE
Comrnissioner Expiration
07/07/2014
�ie�poa7v�7uy�ulscar!Cl a�C�/��cadac
Office of Consumer Affairs&Business Regulation
— ME.IMPROVEMENT CONTRACTOR
egistration: ;153859 Type:
xpiration: =1/18/2015 DBA ;
AARON M.SCARPELLO:HOME--IMPROVEMENT ?'1
�a
AARON SCARPELLO +'
2 MAGNOLIA AVE. g
SALEM, MA 03079 Undersecretary
i. -i
• j'
The Commonwealth of Massachusetts
Department of IndustriqlAccidinls
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib
Name(Business/Organization/Individual): � 4&-b
Address: C, S'� O
City/State/Zi327 Phone#: 6/Q 3 5-9 6:32
Are you an employer?Check the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
to; (full and/or part-time).* have hired the sub-contractors
2)!34ama sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑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.❑ 1 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.]t employees.[No workers'
comp.insurance required.] 13.[i Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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.
I am an employer that 1s providing workers'compensation insurance for 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
7-1
Ido hereby certto u er the pains and penalties ofperju tl he-information provided above 's true and correct.
Signature: �
Date: �7
Phonpe#: 6' 0 3 &2_0321
Q0321
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#:
I
AMS
i
Proposed bathroom remodel project:
Thompson
115 Moody St
North Andover MA
This agreement is hereby made and entered into this 5th day of May,2013,by and between The Thompson family,at
115 Moody St,North Andover.MA,hereafter called Owner,and Aaron M.Scarpello,of Aaron M.Scarpello Home
Improvements LLC,hereafter called Contractor.
The said parties,for the considerations hereinafter mentioned,hereby agree to the following:
1. The Contractor agrees to provide all labor and materials required to perform
the following work:
Remodel to 2nd floor bathroom
a. Removal of existing,tub/shower unit,vanity and sink and toilet
b. Remove existing file floor and shower walls
c. Plumb in a new acrylic or other light weight tub and faucet,(cast iron tub install will cost extra)
d. Install cement based backer over existing sub floor
e. Tile new floor(standard square pattern)
f. Install new tiled shower surround with soap niche built into the wall
g. Re-install toilet,
h. Install new vanity,sink and faucet
i. Install new fan/light in the ceiling and 20 amp GFI outlet near new vanity placement.
j. Reconfigure the vanity light placement to house a longer light strip
k. Repairs to all wall and ceiling surfaces damaged during the above mentioned renovations
I. Prep and paint the walls and ceiling 2 coats
Start' g at$6900.00
Remode 1 st floor bathroom
a. oval of existing si<bathrhan
b. Tile ne el and stic
c. Re-install toile,
d. Install vanity fr d changes to plumbing)
e. Install I' ar from uto wiring)
ing at$1000.00
'Note'The above price is for all labor,disposal,permits and materials not listed below. The following are
not included in this estimate:
Shower
Tile/grout
Vanity/top/sink
Faucets
Light fixtures/fans
Medicine cabinets/mirrors
Towel bars
1
Paint/primer
Toilets
Any other fixtures or design elements not listed above
The above estimate does not include any changes to the current smoke/CO detection system that may need to be
updated in some towns.
Please note this estimate does not include any unforeseen repairs that may be require to complete the job up to
current code nor does it include removal of asbestos containing materials or mold if found during the construction
process.
Payment schedule:
Down payment: 1000.00
Start date 3000.00
Rough inspections 3000.00
Completion of work 500.00
Final inspections 400.00
Finish Materials approx. $(This amount is subject to change based on actual choices of finished materials made by
the homeowner)
100%due at time of order(finished materials will be ordered and purchased at various times during the duration of the
job)
Some finished materials may not be able to be returned or cancelled once the order is placed and some may be
subject to a 20%restockingfee. These charges will be the responsibility of the homeowner if it is the homeowner
9 P ty
requests the exchange or return.
2. Project scheduled for TBD.Please be aware that although every attempt will be made to keep on schedule,
unexpected delays do to bad weather,labor set backs or any other emergency issues that may arise at my
other jobs sites can affect your start date.
4.The Contractor agrees to provide and pay for all materials,tools and equipment
required for the prosecution and timely completion of the work. Unless otherwise specified,
all materials shall be new and of good quality.Contractor warrantee's materials and craftsmanship for one year,if
manufacturers warranty does not apply.
5. In the prosecution of the work,the Contractor shall employ a sufficient number
of workers skilled in their trades to suitably perform the work.
6.All changes and deviations in the work ordered by the Owner should be presented to the Contractor,by
the homeowner in writing,the contract sum being increased or decreased accordingly by the Contractor.
7.The Owner,Owner's representative and public authorities shall at all times have
access to the work.
2
materials;or by neglect of the Owner,the time for completion of the work shall be extended
for the same period as the delay occasioned by any of the aforementioned causes.
10.The Contractor agrees to obtain insurance to protect himself,his workers and subcontractors against
claims for property damage,bodily injury or death due to his performance of this agreement.
11.This agreement shall be interpreted under laws of the Massachusetts.
12.Attorney's fees and court costs shall be paid by the defendant in the event that judgment must be,and is,
obtained to enforce this agreement or any breach thereof.
IN WITNESS WHEREOF,the parties hereto set their hands and seals the day and
year -T.
en above.
.5C41T rA.-MOMPS04 S /l Zot3
OWN S NAME I b OWNER'S SIGNATURE DTE
OWNER'S NAML OWNER'S SIGNA URE DATE
is Kv S a r MA of 94s
OWNER'SADDRE S
_Aaron Scarpellol
CONTRACTOR'S N E g��NT�RA&OR�'SSNATURE DATE
2 Magnolia Ave Salem.NH 03079
3
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 defined 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
receiver or trustee of 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 licensing 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 required"
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic 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 certificate(s)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 maybe 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 Accidents. 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
that 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachust-
Department of Industdal Accidents
Offlee of Investigations
600 Washington Street
Boston,MA 02111
Tel,#617-727-4900 ext 406 on 1-877-MASSAFE
Revised 5-26-05 Fax#617-727-7749
v ww.mas%govldia
JUN-14-2013(FRI) 12: 48 (FAX)9785572130 P. 001/001
AARON-1 OP ID: MP
111
o. CERTIFICATE OF LIABILITY INSURANCE OAT0rz
6114DIYYYY)
06/14/13
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 poliey(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).
CO TA T
PRODUCER Phone:978 688 8829 NAME:
Michaud,Rowe And Ruscak Ins. Fax:978 557 2130 PHONE
P.O.Box 188 C.No.Ext): �•_.,,_ (AIC,Nal:
North Andover,MA 01845 E-MAIL "-"—
aDDgpSS:.._.............. . .. .. .
Mark S.Rowe,CIC -INSURERIS)AFFORDING COVERAGE NAIC A
INSURER A:Harleysville Worcester Ins Co. 26182
INSURED Aaron Scarpello Home Imp, LLC INSURER e:Lib@ Mutual
Magnolia Ave. INSURER 0:,,,
Salem,NH 03079 ------
INSURER D:
INSURER E:
IMSURr:R
-
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
CCRTIFICATC MAY B8 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.
INSR AUUL SURR POLICY EFF i POLICY EXP
TR TYPE OF INSURANCE INRR wyn POLICY NLIM13Fp MMIDDIYYYY MMIDD LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 500,000
DAMAA X COMMERCIAL GENERAL LIABILITY SPP39723L 11/28/12 11/28/13 PREMISES RENTED
..._ _ .. rREMtsE3sEe occurrence b 50,000
CLAIMS-MADE, I OCCUR MED Far'(Any one person) $ 5.000
PERSONAL&ADV INJURY $ 500.000
GENERAL AGGREGATE S 1,000,000
GENAL AGGREGATE LIMIT APPLIES PER:
„•,• PRODUCTS-COMPIOP AGO $ 500,000
pOUCY PRO' LOG $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
r-a accidnm ___
ANY AUTO BODILY INJURY(Per person) S
AOEDUL[D
... AUTOS
BODILY INJURY(Per accident) S
_.• AUTOS
NON-OWNED -PROPERTY*UAMAC
HIRED AUTOS AUTOS Peraceidenl $
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
E1(CESS LIAR CLAIMS.MADE AGGREGATE $
DED ,.RLTENTION - --••_--- --- g
WORKERS COMPENSATION WeSTATU•TORY LIMITS 0TH.
AND EMPLOYERS'LIABILITY
B ANY PROPRIETORIPARTNERIEXECUTIVE YIN WC2S380493-022 04119113 04/19/14 E.L.EACH ACCIDENT $ 100,000
OFFICGRIMF.MBER FXCLUDFD9 NIA _..._ .
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE[ $ 100,000
If vee,describe under
DESCRIPTION OF OPERATIONS below I I F.L DISE-ASE•POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anaah ACORD 101,Addidanal Rcmarks Schedule,It more space Is required)
Carpentry — interior
RE: 115 Moody St., North Andover MA
CERTIFICATE HOLDER CANCELLATION
NORTH 13
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Building Dept.
384 Osgood Street AUTHORIZED REPRESENTATIVE
North Andover,MA 01845
01988-2010 ACORD CORPORATION. All rights rosorved.
ACORD 25(2010/05) The ACORD name and,logo are registered marks of ACORD