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HomeMy WebLinkAboutBuilding Permit #940 - 119 KARA DRIVE 6/27/2012 BUILDING PERMIT °F No Dr bgti ° TOWN OF NORTH ANDOVER z h ''` `_'.,6 3 APPLICATION FOR PLAN EXAMINATION _ QA CocwK iww:w`V7' Permit NO. qL Date Received 'ts °Rw7Eo yea �5 Date Issued: ' !J/ �SSACHL) IMPORTANT:Applicant must complete all items on this page LOCATION Print RROP.ERTY OWNER M e t-C 'MAP NO` �-' ARCEL: ZONING DISTRICT:- Historic District yes no Machine Shop Village yes i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other - Septic. Well Floodplain Wetlands Watershed District Water/Sewer, DES RIPTION OF WORK TO BE PREFORMED: - Itle w F:`x-7-v h e,S A {/air 7-,'e S' Identification Please Type or Print Clearly) OWNER: Name: r'►'1 c-l-c e e 0//Y1 0,"1 Phone: 7�1 ,P/ Address: LIii' CONTRACTOR Name: nye o"� _`P.hone: 2J> Address: 7 Ot _ Qe�Ir at/ Ra/ 1h e f-_ .114, Supervisor's Construction License: ✓'2 0. Exp. -Date: Home.Improvement-License ��� y`5�9, '-Exp. Date: . 7 'a' '/.Z. , 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: $ FEE: $ Check No.: Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to e g aranty frl Signature of Agent/Owner. - Signature of contractor. 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 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 Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT =Temp Dumpst_er on site yes no Locate&at 124"Main'Street Fire Departrnent"signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 - Date i Doc.Building Permit Revised 2008 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 i ❑ Workers Comp Affidavit ❑ 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 ❑ 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/Crossection/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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location /! &�? zw No. f� Date ��-- • = TOWN OF NORTH ANDOVER 1.LED • Certificate of Occupancy $ � Building/Frame Permit Fee � Foundation Permit Fee Other Permit Fee $ TOTAL $ Check 4—�3 25466 Building Inspector From:Scott A Simoes FaxID:978.688.7001 Page 2 of 2 Date:6/27/2012 02:16 PM Page:2 of 2 OP ID: SS CERTIFICATE OF LIABILITY INSURANCE AT06127DIYYYY) 06!27/12 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(les) 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 978-688-7000CONTACT Durso&Jankowski ins Agcy LLC PHONEFAx 198 Massachusetts Avenue 978-688-7001 AIC No Ext: AIC No: North Andover,MA 01845 E-MAIL Durso&Jankowski Ins.Agcy. PRODUCER CUSTOMER ID p:GOUC+H-1 INSURER(S)AFFORDING COVERAGE NAIC q INSURED James Goucher INSURERA:Guard Insurance Group Four Old Bear Hill Rd INSURER B:MSA Group 14788 Merrimac, MA 01860 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 OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSINSR TYPE OF INSURANCE POLICY F POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY MPS61466 12/13/11 12/13/12 pREM SES Ewa a o«ae nce $ 500,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY F-10PERCof LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN AWC230646 12/07/11 12/07/12 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Carpentry - CERTIFICATE HOLDER CANCELLATION ANDOVE5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 36 Bartlett St Andover, MA 01810 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassachusetts _ - Department oflndustriglAccidents - Office Of investigations 600 Washington.Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contrcactolrs/Electrxcians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organ'rzation/Individual): 7 1 e_ ci C t'" , Address: 04 ,(7 e-c—r- � .i( /q/ - City/State/Zip: ,rein r f--�'.n11o_.c ,n,� o/�� Phone#: 2CP t? � � l J'' Are you an employer?Check the appropriate box: Type ofproject(required): 1-NJ am a employer with (` 4. ❑ I am a general contractor and I 6. []New constraction employees(full and/or part-time)* have hiredthe sub-contractors 2.EJI am a sole proprietor or partner- listed on the attached sheet. 7• E]Remodeling ship and.1ave no employees These sub-contractors have 8, ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 3.❑I am a homeowner doing all work right of exemption per MGL I LE]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and wehaveno 12.QRoofrepairs insurance required.]i employees.[No workers' comp,insurance required.] 13.❑Other "Any applicant that checks box61 must also fill outthe section bel6w showing their workers'compensation policy information. Y Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. X am an employer that is providing workers'compensation Insurance for my employees Below is thepolicy ani'job site information. Insurance Company Name:. 4v a r Policy#or S elf-ins.Vic.M n Expiration Date: Job SiteAddress:_ l `l •�a t-c.. /� �'- City/State/Zip; N', 19,11 I, ye-r Attach a copy of the workers'compensation-policy 8eclaration page(showing the policy number and expiration date). Failure to secure coverage as requnred.under 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�yearimprisonment,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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 71doherehy cer fy nder thepains and n ties f erjurythattheinformationprovided abov is true anticorrect.►�-e'z- bate: cZ�cP / 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.BuitdingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: 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"...everyperson in the service of another under any contract ofhire,- 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 andwho resides therein,or the occupant ofthe 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 shallnot 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),addresses)andphone numb er(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. Iran LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox 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' compensationpolicy,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 printe dlegibly. 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 permithicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/licens0 applications in any given year,need only submit one affidavit indicating current PORGY information(ifnecessary)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. Anew 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 xequired to complete this affidavit. The Office o£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 anal fax number: Tho Commonw.oali of massachu f-tts - Deparimeat offhdustdat Accidapts _ Qf�icegf7�n,�estzgatiq.� 690 Was as Street Boston?MA.021 X X Tel,#f 17-72,7-4900 0A 406 or 1-•877:WASSM13 Revised 5-26-05 Fay,4 617"727'7749 I to"b' f 0 0 0 0 f Y� o � } Q _ o110 o In 0o r x ,l , L ,�/ .��orl1Y �3 _ y �0;,istration: Individual •Oum Ef' i Y'C - :3 - 1 ?rrIC1aC I�L101UJG `t_r UndersecretaryY \' w - Nlassachusetts - Department of Public Safer% Board of Building Rc�-ulaticins and St�ind.0 d Construction Supervisor License License: CS 28520 I I JAMES N GOUCHER 4 OLD BEAR HILL RD ' MERRIMAC, MA 01860 I exp ratiw, .0/24/2013 ('ulnmissiunct Tr#: 6011 NORTH Town o . t E : 1, Andover to 9q No. o T `AK, h ver, Mass, • C�� • COCHICN*WICK A0RATEO rP�,`�5 S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System k0tW _1001 ...................... BUILDING INSPECTOR THIS CERTIFIES THAT .......... ..... . ......... .... ...................... ............................... Foundation has permission to erect .......................... buildings on .....�.C.�'.�......... .1�.��s.....D . .......... Rough .. .. g to be occupied as .......... ..�.. ............ % ..... .. ......... Chimney provided that the person a eptl g 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 CONSTRU 10 S Rough Service ........... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 OO o o � _J i _ 4 Q 0 0 0o T x P L r � PROP0�3gL JAMES GOUCHER page No. 1 of 2 pages CARPENTER/BUILDER All4 Old Bear Hill Road home improvement contractors and subcontractors engaged m home improvement contracting,unless specifically exempt from Merrimac,MA 01860 registration by provisions of Chapter 142A of the general laws, must be registered with tts. the Commonwealth of Massachuse (978)346-8950 Inquires about registration and status should be made to the Director,Home Improvement Contract Registration,One Ash- burton place,Room 1301,Boston,MA 02108 617-72740598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Mind Provision of MGL c.142A. Lie.#028520 MA Reg. # 103459 TO: PHONE: 978-681-9889 Marc and Laura Freedman DATE : 2/24/2012 -119 Kara Dr. 'T c' Andover,MA 01845 We hereby submit specifications and estimates for: Remodel 2'floor large bathroom. Work to include: Remove sheetrock walls and ceiling,floor tiles and bath fixtures and dispose. Remove wall between toilet and main bath area and dispose. Frame new approx. 3' wide closet in former small sink area. Prep walls and ceiling and install new sheetrock on walls and ceiling. Install new cast iron or acrylic tub and tub/shower valve in same location as existing. Install cement board on walls around new tub and prep for new tile. Install new file and grout on tub walls(basic design-no diagonal layout, inserts,borders,listellos,recessed niches, etc.). Prep floor for new file(install Ditra polyethylene membrane file backer over entire floor). Install new ceramic tile and grout on floor(basic design-no diagonal layout, inserts,borders,listellos, etc.). Install new 6 panel door unit on new closet. Install new 6' vanity with granite top,double undermount china sinks and faucets. Install new plate glass mirror on wall above new vanity. Supply and install new Kohler Wellworth toilet. Install new metal shell around existing heat element. Install new laundry chute door and trim. Install new baseboards and door and window trim. Install new fan/light unit in ceiling and vent to exterior. Install misc. wall fixtures to be supplied by home owners(towel bars,toilet paper holder,door hooks,etc.). Paint walls, ceiling and trim(home owners to supply paint). Allowances to be: $2,500 for plumbing labor and piping, $2,000 for electrical labor and parts(no lighting), $3,500 for 6' vanity with granite top,double undermount china sinks and faucets, $250 for tub/shower valve, $8 per square ft. for wall and floor tile. Proposal to include cost of permit(contractor to acquire permit). ,�; _W PROPO�3gL JAMES GOUCHER Pane No. 1 of 2 Paces CARPENTER!BUILDER Ali home improvement contractors and subcontractors engaged 4 Old Bear Hill Road in home improvement contracting,unless specifically exempt from Merrimac,MA 01860 registration by provisions of Chapter 142A of the general laws, //978 must be registered with the Commonwealth of Massachusetts. l )346-8950 Inquires about registration and status should be made to the Director,Home Improvement Contract Registration,One Ash- burton Place,Room 1301,Boston,MA 02108 617-727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fand Provision of MGL r—142A. Lie.#028520 MA Reg.#103459 TO: PHONE: 978-681-9889 Marc and Laura Freedman DATE : 2/24/2012 X119 Kara Dr. Andover,MA 01845 EWe hereby submit specifications and estimates for. Remodel 2 Id floor(smaller)bathroom.Work to include: Remove sheetrock walls and ceiling, floor tiles and bath fixtures and dispose. Remove portion of wall under stairs and dispose. Frame new wall under stairs, set back from original position to create larger space for new shower. Frame and prep remaining walls around shower and install new cement board on walls. Supply and install new Kerdi waterproof system on shower floor and pour sloped mortar bed for tile floor base. Prep walls and ceiling and install new sheetrock on walls and ceiling. Install new file and grout on shower walls and floor(basic design-no diagonal layout,inserts,borders, listellos, recessed niches, etc.). Prep floor for new tile.(install Ditra polyethylene membrane file backer over entire floor). Install new ceramic file and grout on floor(basic design-no diagonal layout, inserts,borders, listellos, etc.). Install new 6' vanity with granite top,double undermount china sinks and faucets. Install new plate glass mirror on wall over new vanity. Supply and install new Kohler Wellworth toilet. Install new pocket door track and hardware with new 6 panel door. Install new metal shell around existing heat element. Install new laundry chute door and trim. Install new baseboards and door and window trim. Install new fanlight unit in ceiling and vent to exterior. Install misc. wall fixtures to be supplied by home owners(towel bars,toilet paper holder, door hooks, etc.). Paint walls, ceiling and trim(home owners to supply paint). Allowances to be: $2,000 for plumbing labor and piping, $1,400 for electrical labor and parts(no lighting), $3,500 for 6' vanity with granite top,double undermount china sinks and faucets, $250 for shower valve, $8 per square ft. for wall and floor tile, $1,800 for shower door unit. Proposal to include cost of permit(contractor to acquire permit).