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HomeMy WebLinkAboutBuilding Permit #177 - 119 KARA DRIVE 9/7/2006 TOWN OF NORTH ANDOVER NORTFI APPLICATION FOR PLAN EXAMINATION 0-(.to 6 OL i Permit NO: Date Received + ? e« �A04 cocmc we . 1. � Argo Date Issued: — �SSACHU`��� IMPORTANT: Applicant must complete all items on this page LOCATION !7 - Print PROPERTY OWNER M e h C PC- e e e�iYI ex l Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Repair, replacement 0 Assessory Bldg ❑ Commercial 0 Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED :l�►r>-�ci �e H, ,Car ca ,ktc L E . ,e-i e o le F/oma I- >< c-, -Z-SiW(l /web.! �.� �a�M 1/a.v,"ry 7oi Identification Please Type or Print Clearly) OWNER: Name: M 1-c /-,L e e- M Phone: Address: //9' ��� 1-c, CONTRACTOR Name: =C.-M e S ca n Phone: ? 7,? Address: `t` odd e e..-r- f ` (I Supervisor's Construction License: 0 2 FS Z © Exp. Date: AD 2 0 Home Improvement License: /D 3 ys�l Exp. Date: I� O ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PFIRMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED S BASED ON$125.00 PER S.F. Total Project Cost :$ LTZ,�O o -9 FEE:$ I Check No.: /1, ' Receipt No.: Page 1 of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11❑ Tanning/Massage/Body Art ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregist d contractors do not have access to the guaran d Signature of Agent/Owner (� ignature of contracto - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ amped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Drivewav Permit Temp Dumpster on site yes_n> Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required LProvided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Paw-,4 of 4 Location Yq G2, 4 ��`1 No. Date 3�b� f TOWN OF NORTH ANDOVER F w 41 P ° Certificate of Occupancy $ �'�s'••' E<� Building/Frame Permit Fee $ L I Mus Foundation Permit Fee $ { Other Permit Fee $ TOTAL $ Check # Building Inspector NORTH Town of _: s over �Vj O on•w.w� '�y` J`� 1 o. =_` dover, Mass., - LA COCMICMEWICK A0RATE� P`V S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ......... ...... .. ............................................ ................ Foundation has permission to erect........................................ buildings on ... ../f......... aOr .�r........... .... �r�........ Rough to be occupied as.. ...... .,1!�!��..... 0..�.� ......... .. . .. . ................ ... .� Chimney provided that the p rson acceptin his 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 144.000 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS 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. • - ��; .i.<"n 3J77)'7n)7f1lnCI�C/J o�'�/,Q.s,3�7.Cftl�hi BOARD OF BUILDING REGULATIO 3 License: CONSTRUCTION SUPERVISO Number: CS 028520 Birthdate: 10/24/1955 Expires: 10/24/2007 Tr. no: 486, Restricted: 00 JAMES N GOUCHER 4 OLD BEAR HILL RD MERRIMAC, MA 01860 Commissioner ..__._ ....... . .- e yr omt `i �faeaac�uaells Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 103459 Expiration: 71812006 Type: Individual JAMES GOUCHER James Goucher 4 Old Beat Hill Rd. Administrator Merrimac,MA 01860 { BOARD OF BUILDING REGULATIONS AND STANDARDS Thomas L.Rogers HOME IMPROVEMENT CONTRACTOR PROGRAM Director t ROOM 1301 C I!�c ONE ASHBURTON PLACE BOSTON,MASSACHUSETTS 02108 Marian E.Doyle Program Manager lug To All Home Improvement Contractors: INSTRUCTIONS FOR COMPLETION OF RENEWAL FORM It has come time for you to renew your Home Improvement Contractor Registration.soon aspossible er to renew your to prevent yourrr registration, you must complete the enclosed application and return it to this o ce. Please make the from lapsing. The renewal application contains the information thatc t on compwas letely.letely. Pleasett d to this f pay particular attention necessary s listees on the d below. 1ines provided. Please read DO NOT FORGET TO SIGN ANDiDATE THE APPLICATION. to the nems list Item 1:This MUST be the current name of the business that is listed on the contract. If this has changed, you must obtain an application for new registration by calling (617) 727-7532, extension 20046. If the business name does not include the last name of the responsible person,you MUST also submit one of the following: (a) a copy of the DBA certificate from the city or town clerk, OR (b) a copy of the incorporation papers with the name of the officers from the Secretary of State's office. Item 2:This is the mailing address of your business. If you have a Post Office Box or RFD address as the mailing address,you MUST indicate a street address on line number 4. Item 5: The following is a list, in order, of possible applicant types: Individual, DBA, Partnership, Trust, Private Corporation, Public Corporation, Limited Liability Partnership, or Limited Liability Corporation. The only way to apply as an individual is when using the name of the responsible person. The remaining selections require the proper documentation as indicated in items 1 and 7. Although the name of the business must remain the same, the applicant type may change with the appropriate documentation(i.e. DBA certificate, incorporation papers,etc.). Item 7: If you have more than one employee,there MUST be a federal identification number listed for question number 6. For the purposes of this application and 780CMR R6, the number of employees shall include all construction related employees who worked 20 or more hours on the payroll in the weekly pay period prior to the filing of this renewal form. Item 9: If the name in item 1 is anything other than an individual, (i.e., a corporation, partnership, etc.) the name of the individual person responsible for the home improvement contracting work of the entity must be entered on line 9. If the person so named holds a construction supervisor license and owns 10% or more of the business, the applicant is exempt from the registration fee. Item 13: If the responsible person holds a valid Construction Supervisor license,no fee is required. If you do not have a valid Massachusetts Construction Supervisor License,you are required to pay the registration fee of$100. and No Guaranty Fund payment is necessary for this renewal, unlessincreased If the number of ployeessnow have found your business in a new payment grouping based on the chart listed below places you in a new category, subtract the amount previously paid from the amount due and submit a CERTIFIED CHECK or MONEY ORDER for this amount. Guaranty Fund Contributions Zero to three employees $100.00 Four to ten employees $200.00 Eleven to thirty employees $300.00 More than thirty employees $500.00 Be sure to include all the proper documentation or the processing will be delayed. All payments must be made in the form of certified checks or money orders to the "Comm Massachusetts" u separated heturned with this form. Payments for the Registration Fee and the Guaranty Fund must be made w 'y` \ The Commonwealth of,Massachusetts Department of Industrial Accidents Office of Investigations El ,ts i 600 Washington Street Boston, ,Vf 4 02111 t ;� WWW.t11aSS.gUVIdla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ,_kpplicant Information Please Print Legibly Name (Business/Organiiatitill/Individual): ,address: — C ity'State/Zip: MCP— -.gym i C A1/4 o1,f6® Phone #: 't�"17e Y? r2Are you an employer?Check the appropriate box: Type of project(required): 1.P' m F1E]1 aa employer with f q. I am a general contractor and 1 6. New construction employees(full and/or part-tune).* have hired the sub-contractors .❑ I am a sole proprietor or partner- listed on the attached sheet. ' [� Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for Ine in any capacity. workers' comp. insurance. y, ❑ 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 I.❑ 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' 13.0 Other comp. insurance required.] "Any applicant that checks box 111 nwst also till out the section below showing 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. I am an employer that is pro vitling workers'compensation insurance far my emplgyees. Below is the policy and job site information. Insurance Company Name:__ V_' y 0. Nf U' �"�_y/0 --- --- Policy li or Self-ins. Lic. 4:— A. /.�3 Expiration Date:__L.Z/ 7 0 Job Site Address: l--c' �� City/State;Zip:__/l/. �oy'e� NI/� ,attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1,500.00 and/or one-,year imprisonment,as well as civil penalties in the Form of a S'T'OP WORK ORDER and a tine 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. 1 do hereby certify t der the pains t penuthat the information provided above is true and correct. Si m:thtre: Date: t)/jic•ial use only. Do not write in this area,to be completed by cit f or town nlfic•ial. City or Town: Permit/License# Issuing,authority(circle one): L Board of Health 2. Building Department 3.City/Town Clerk -t. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: _ PROPOSAL r JAMES GOUCHER Pa a No. I—ILL 1—ILLP CARPENTER/BUILDER All home improvement contractors and subcontractors engaged 4 Old Bear Hill Road in home improvement contracting,unless specifically exempt f rom registration by provisions of Chapter 142A of the general laws, Merrimac, MA 01860 must be registered with the Commonwealth of Massachusetts, (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 617-727-85",OWW ers who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guarem Fund Provision of MGL c.142A. I Lic.# 028520 MA Reg. # 103459 TO: PHONE: 978-681-9889 Marc and Laura Freedman DATE : 5/31/06 119 Kara Dr. North Andover, MA 01845 JOB NAME/LOCATION: a Same We hereby submit specifications and estimates for: , Renovations in family room and mudroom. Work to include: 4 Remove existing closet and patch walls. 1 Remove floor tile in front of closet and install plywood to raise floor level to match surrounding floor. 4, Remove carpet and wood flooring in new mudroom and dispose, remove baseboards and install new plywood ? underlayment. Install new ceramic floor the and reinstall baseboards. a Remove existing cabinets, sink and counter in bar area and dispose. Install new cabinets and granite counter. Install new bar sink and faucet(labor only). Remove carpet in family room and dispose. Install new prefinished hardwood flooring in rear section of family room. Install new carpeting in front section of family room. Paint family room walls, ceiling, doors and trim. Remove existing vanity and install new vanity and granite top. Allowances: ceramic floor tile- $3.50 sf, carpeting, padding and installation- $22 sy, cabinets and counter and counter installation- $6,000, plumbing- $500, painting- $3,800 Proposal does not include electrical or additional cost to remove parquet flooring in mudroom if glued down, Pg. 2 of 2 Work schedule Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about 7/15/06_(date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by 8/30/06 (date).The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of I Year following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors, Employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair, correct,replace,or cause to be remedied,repaired or replaced,such damage or such defect in materials or workmanship.The forgoing warranties shall survive any inspection performed in connection with the agreed-upon work. WE PROPOSE hereby to furnish material and labor-complete in accordance with the above specifications,for the stun of: Twenty three thousand, six hundred twenty four dollars( $23,624.00) Payment to be made as follows: $5,000 when cabinets ordered, $6,000 when work begins, $6,000 when mudroom and door work complete and$6,624 upon completion. All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra Authorized charge over and above the estimate.All agreements contingent upon strikes,accidents or delays Signature - beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our workers are fully covered by Worker's Compensation insurance. Note: This oposal may be withdrawn b s if not accepted within 30 days Acceptance of proposal- I have read both sides of this document and all attached documents and accept the prices, specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined above. You,the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. Signature Date of Acceptance: Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is-greater. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES