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HomeMy WebLinkAboutBuilding Permit #103-13 - 124 BRIDLE PATH 8/6/2012 BUILDING PERMIT NORTH OF�S%.nc 6�ti� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� Permit NO: Date Received �4`�R„rE,01 i�5 Date Issued: �J1-01 IMPORTANT:Applicant must complete all items on this page LOCATION - / Pint PROPERTY OWNER 61// 0, Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village :yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial vAlteration No. of units: Commercial K Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District DESCRIPTION OF WORKTOBE PREFORMED: y / Ilk- exls14, ����i� �^, ig�rl� 7��� eew sy6�✓e� > -� �. � Identifi ation Please Type or Print Clearly) OWNER: Name: ezzz Dr�rvsl,y Phone: 7/ g's 7-2Y74-" Address: CONTRACTOR Name:A&`4/, 1 �;,, Phone: 7/ %3 Address l� Supervisor's Construction_ 'License: x/670 Exp.. Date: .7-7/6- Home Improvement.License: -Exp. Date: 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: $ �: c�©a,_ b 0 FEE: $ 7i`��•� Check No.: Receipt No.: �o' T NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ow,ner % j�� ' Signature of contractor d Location t� i No. Date Lo j TOWN OF NORTH ANDOVER 4 ' Fw SC [ Certificate of Occupancy $ Building/Frame Permit Fee $ �- � Foundation Permit Fee $ b Other Permit Fee $ t TOTAL Check# L 25586 Building Inspector i Plans Submitted ❑ Plans Waived-F] Certified Plot Plan ❑ Stamped Plans ❑ TI'PE-0F`-.SEWERAGEDISP0SAL-- Public Sewer ElTanning/MassageBodyArt ❑... ..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: DATEAPPROVED PLANNING & DEVELOPMENT 0 ❑ COMMENTS .CONSERVATION Reviewed on Signature i i 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 Nater & Sewer Connection/S9nature& Date Driveway Permit DPW'Towiz Engineer: Signature: Located 384 Osgood Street FIRE [3EPARTi!llFa�T =-Temp Dumpster on site- yes.. . :.. no Located7bt 124 Mair, Street Fire ®epartmer-itsigriature/date - COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: t ELECTRICAL: Movement of Meter location, mast or service drop requires approval of ectricalIns Inspector Yes No i EI � k DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department apse) I' ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 I i Building Department artment be filled out for theappropriate The following is a list of the required forms topermit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work a 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 o Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract a Floor/Cross Section/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 o Certified Proposed Plot Plan a 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 o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 9 g NOTE: All dumpster permits require signn 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 g then Registry et this recorded at the g ry of Deeds. One copy and proof of recording that the appeal period is over. The applicant must must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of � � _ s ndover No. ® �o IZ.. ��� h ver, Mass, o � IC�. 1. A_ COC NIC MI WICK V J,9 A�'VA TI* 11V���(5 S U BOARD OF HEALTH PERM 'I�T T D Food/Kitchen Septic System THIS CERTIFIES THAT ..W.B.01......D'2l�!�r�.. BUILDING INSPECTOR Foundation has permission to erect ......................... buildings on ..... 'Wq... ��•••••••• ••• ••••••• Rough to be occupied as ........ .... ... .............. L.M*4 . ................................. 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 PERMIT EXPIRES , NT S ELECTRICAL INSPECTOR UNLESS CONST CTI T TS Rough Service ........ ...................................................................... Final BUILDING INSPECTOR GASINSPECTOR 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 ✓ � d 130 Centre St. Estimate Danvers House Danvers, Ma. 01923 978-423,-8463 8463 Bill & Me lans Meg Orky 124 Bridle Path Rd. 4/27/2012 N. Andover, Ma. i Project Description Total This estimate is for the following work. 17,400.00 Bathroom remodel Hi Bill & Meg, It was nice meeting the both of you last week. Here is the estimate for your bathroom remodel. If you decide that this fits your budget and that you would like to proceed I will change this into a contract along with any changes that you may want to make. Once you have picked out all your choices then I would want to review them and I will have my tile installed come by to figure all the tile quantities for you. If you have any questions or if I have forgotten anything then please do not hesitate to e-mail me or give me a call. Regards, Mike Goodwin i Scope of work; We will apply for the proper building permits. We will frame in for a 3'x5' shower with 42" high walls on two sides, a bench i Total Signature mfgoodwincompany@gmail.com Pagel Mass.CSL #081670 Mass. HIC #105029 130 Centre St. Estimate Danvers House Danvers, Ma. 01923 978-423-8463 Bill & Meg Orlansky 4/27/2012 124 Bridle Path Rd. N. Andover, Ma. Project Description----------- seat escription— --------seat and two recess soap niches. A 2'-6" wide pocket door opening will be framed and the hardware installed. The HVAC ductwork will be boxed in. An Anderson transom window will be installed above the shower and the siding patched in around it. The ceiling exhaust fan will vented to the exterior. The exterior walls and the ceiling will get new fiberglass insulation to meet state building codes. The shower walls and the floor will get Durock the underlayment. The walls and ceiling will be blueboarded and veneer plastered. The shower walls will be tiled and grouted. The bathroom floor will be tiled and grouted. The windows and door will be trimmed out in 2-1/2" colonial casing and 3-1/2" pine baseboard installed. A 6-panel pine door will be installed in the pocket door opening. The new vanity, mirror and utility cabinet will be installed. The glass company will come out after all tile work is completed and measure for the shower glass and return in a few weeks to install it. Electrical Our electrician will rewire the vanity area to include 3 wall sconces, 3 GFI receptacles, wire the new exhaust fan, install two 5" recess lights on the ceiling Total Signature mfgoodwincompany@gmail.com Page 2 Mass.CSL #081670 Mass. HIC #105029 130 Centre St. Estimate Danvers House Danvers, Ma. 01923 978-423-8463 waa 9 Bill & Meg Orlansky 124 Bridle Path Rd. 4/27/2012 N. Andover, Ma. Project Description Total and one light in the shower. Plumbing Our plumber will rough in the new shower drain and liner, install a new single control shower valve and shower head, relocate the water lines and drain for the two vanity sinks, install the fixtures and the toilet. Install a new baseboard heat cover. All rubbish will be removed from premises. The work will take about 4 weeks to complete. References ar eroudl given p y g upon request. Homeowners will provide the cabinets, mirrors, plumbing fixtures, wall lights, exhaust fan, tiles and grout. All tile work is based on a single size the for each area. Marble, glass or decorative patterns may have an additional labor charge. Town permit fees are additional and will be billed separately. An allowance of$2300.00 is given for the shower glass company. No painting is included. Total estimate: $ 17,400.00 Payment schedule; i Total ' Signature mfgoodwincompany@gmail.com Page 3 Mass.CSL #081670 Mass. HIC #105029 130 Centre St. Estimate Danvers House Danvers, Ma. 01923 978-423-8463 f i Bill & Meg Orlansky 4/27/2012 124 Bridle Path Rd. N. Andover, Ma. Project Description Total A deposit of$ 5000.00 upon starting. A payment of$5000.00 upon starting of tiling. A payment of$ 5000.00 upon completion of all tiling, plumbing and finish work. Balance of$2400.00 is due upon completion of shower doors. Extra; To install an electric mat floor heat with thermostat will be an additional $1850.00. This includes running a new line from the basement electrical panel, wiring it, installing a wall thermostat, installing the mat, the tile installer covering with thinset. Total Signature mfgoodwincompany@gmail.com Page 4 Mass.CSL #081670 Mass. HIC #105029 1 130 Centre St. Estimate ate Danvers House Danvers, Ma. 01923 978-423-8463 Bill & Meg Orlan@ 124 Bridle Path Rd. 4/27/2012 N. Andover, Ma. Project Description Total Total $17,400.00 Signature mfgoodwincompany@gmail.com Page 5 Mass.CSL #081670 Mass. HIC #105029 Bill Orlansky 124 Bridle Path I II N. Andover, Ma. I II 978-687-2876 L 132421 R__� B2421 R Contractor: Mike Goodwin 7 Holt Rd. Epping, NH 03042 o 978-423-8463 AS ting 8xBathroom 8 o 00 pocket door N N tiled shower 08/06/2012 09:11 9786833147 PAGE 01/01 CORO� CERTIFICATE OF LIABILITY INSURANCEDATE(MMMMYYYY) 8/6/12 i THS CERTIFICATI_ 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. THS Ci=RnFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVEEOR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If trio certificate holder is an ADDITIONAL INSURED,the policy(es) must be endorsed. If SUBROGA71 N 15 WAIVED, subject to the terms and condtions 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 endorsemen s PRODUCER C NT T NAME: :M.P. Roberts Insurance Agency PHONE FA :1060 Osgood ,9txeet -MAIL978 683-6073 al: (978) 683-3147 j ADDRESS: 'North Andover*, MA 018415 INSURE,R(S)AFFORDING COVERAGE NAIC# INSURER A:L o--r-£olk A Dedham INSURED INSURER 9:AIM Mutual MICHAEL GOODWIN INSURERC: MF GOODWIN INSURER 7 HOLT ROAD INSURER E: EPPING, NH 03042 ---'- INSURER F: eOVERAGES CERTIFICATE N UMBER- REVISION U R:: THIS IS TO CERTIFI'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEM'iLUEP��ET NAMEDERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYHS C) ME VVCfH i � ECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 8Y Ti�D 6EREIi SUSCI TO ALL THE TERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICES.LIMITS SHOWN MAY HAVE BEENli�LeRLTR TYPEOF'INSURANCE POLICY NUNHER Lt OFNERAI.UABILnY R0714141 4,127/12 4/ 7/13 ACIiOCCURRENCE' 8 1, 00,00CI X COMMERCIAL CENERALLIABILITY I DAMAGETO RENTED CLAIMS-MADE Fil OCCUR NLD E)F(Rryone persanl, S___ 50000 ---• _.._.—_ PERSONAL&ADVINJURY s 1,000,000 GENERA,AGGREGATE is 2,000,000 GFN'L AGORMATE I.IMIT APP LIES PER PRODUCTS-CDNPrOP AGG 3_J OOO 000 PR X POLICY O- LOC -- S AUTOMOBILE LIABILITY (Eonccip rt,) E ANYAUTO BODILY INJURY(Per person) a ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Por xcldenr) $ NON-OWNED PROPERTY D"Or HIRED AUTOS _AUTOS R er oeeidont S UMPELLALIAEI OOCUR EACHOCCURRENCS S ExCES6lIA8 CLAIMS_MADE AGGREGATE, --- 9 DED RETENTION S .. $ WORKER$COMPEM ATION VWC6015175012012 2 15/12 2/15/13 X WE STAT U- DTH• AND EMPLOYERS'LIABILITY YIN --T.ORY..LIMITS _ ANY PROPRICrdR1PAATNER/EXECUTNE E,L,EACIiACGOEM S 500,000 OFFICERMEM9ER EXCLUDED? Nf A (MandefMinNN) EL_DISEASE-EA EMPLOYEE 500 000 �. uyyee deseieeuJ�dor _ OESCRIPTIONOFOPERATIONSDeIow E.L.DISEASE-POLICY LIMIT S 500 000 DESCRIPTION Of OPE)iATIONS I LOCAr.oN5 f VEMCLES(Attach ACORD 101,Addldonal ReneMro Schodulo,If may, epece Nsregtarsd) ORTIFICATE HOLceR CANCELLATION SHOULDNY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORD NCE WITH TME POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED IEPRESENTAME ®1988-2010 ACORD CORPORATION_ All rights reserved. ACORD 25(201 a10S) The ACORD name and logo are registered marks of ACORD Phone: Fax: (978) 688-9542 E-Mail., usiheSsRegula tion Office of Consumer Affairs O B CTOR OME IMPROVEMENT CONTRA` TYPe: —fin egistration: 105029 Individual %piration: .7/16 p14 `- GOODWIN JR. MICHAEL F. Michael Goodwin Jr. 7 HOLT RD. UndersecretarY EPPING,NH 03042 i 4 . +�. Massachusetts- Department of Public Safetc Board of Building Regulations and Standards Construction Supervisor License License: CS 81670 -- MICHAEL F GOODWIN 7 HOLT RD EPPING, NH 03042 _ Expiration: 8/8/2013 Commissioner Tr#: 2951 The Commonwealth of Massachusetts Department of Industrial Accidents 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 Legibly Name (Business/Organization/Individual):� ��/ Address:, City/State/Zip: /' &/). Phone#: 3� Are you an employer?Check the appropriate box: Type of project(required): 1.RL I am a employer with -3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors ? Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, []Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their ri ht of er MGL 11.❑Plumbing repairs or additions exem tion 3.❑ I am a homeowner doing all work g p p myself. [No workers comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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. 1 I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G / Policy#or Self-ins.Lie.#: yw�-6�j51,9701,2-0l2— Expiration Date:,;��3-)3 Job Site Address: l�—V �i 1 /011 0�`4City/State/Zip: 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 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. I do hereby certify under the pains nd penalties of perjury that the information provided above is tree and correct. 1Date: Si ature: ' Phone# 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#: 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 of public 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 may be 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 burn 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.11 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax## 617-727-7749