HomeMy WebLinkAboutBuilding Permit #129-15 - 131 SANDRA LANE 8/5/2014 S LSUILUINU IJLKMI I r oc
TOWN OF NORTH ANDOVER °
t APPLICATION FOR PLAN EXAMINA * -
1 r � *
Permit NO: 1 ' Date Received
°gArID rPP`
Date Issued: — SS^cHus��
IMPOlk TNT- Applicant must complete all items on this page
LOCATION . 13 Sa "v ol, L In.
Print
PROPERTY-OWNER 7A-e'4- II
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h Print
MAP NO: bA PARCEL: V ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Res' ential 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
❑y�Water/Sewer
1`�t.�e V w F�o v, o �w��^�. •►ChJ • r"� w. w �A o►c-%, \k %A
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Identification Please Type or Print Clearly)
OWNER: Name: —rayL- L. ZAMS Phone: 978-655-,531 l
Address: 1,31 cSGYYIG ra L.Gt-n -1 J0?t/A
CONTRACTOR Name: Phone:
Address: j\1 0 V
O
Supervisor's Construction License:
Exp. Date:
CS - 10to o� � 5 - `1 '
Home Improvement License: Exp. Date:
\1`tloCoS
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS DON$125.00 PER S.F.
Total $Cost:Project Projy 10 FEE: $
� ,
Check No.: IA Receipt No.:
NOTE: Persons c r cting with unregistered contractors do not have ac ss t the guarantyfund
Signature of Agent/Own ignature of contractor I
T
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
PLANNING & DEVELOPMENT Reviewed On Signature_
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
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For department use)
❑ Notified for pickup Call Email
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Date Time Contact Name
Doc.Building Permit Revised 2014
Building Department
The following is a list of the required forms to b
q e felled out for the appropriate permit to be obtained.
Roofing, 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
Li Building Permit Application
❑ Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan
Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li 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)
Li Building Permit Application
o Certified Proposed Plot Plan
o' Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic ullc Cal
y culatlons (If Applicable)
L3 Copy of Contract
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineeredp roducts
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance was ors special permit P P required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must thenet this recorded at the Registry g g y of Deeds. One copy and proof of recording
must be submitted with the building application
lication
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Doc:Building Permit Revised 2014
Enter construction cost for fee cal- North Andover Fee Cakulation
Construction Cost
$ 24,832.00 m
$ - $ 297.98
Plumbing Fee $ 37.25
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 37.25
Total fees collected $ 472.48
131 Sandra Lane
129-15 on 8/5/14
Master Bath Remodel
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� NORTy
Town of n
No. _ * -
,f , h ver, Mass,
0 Ams
COC ChlwKw y1'
044 ED r`P�,`'�5
U BOARD OF HEALTH
Food/Kitchen
T LD Septic System
THIS CERTIFIES THAT ....................PERMq
L ,,,,,,,,,..,,,,,,,,,,, BUILDING INSPECTOR
0...... ..... ... S. ...............
,�. .., �.� I.A.0............ Foundation
has permission to erect .......................... buildi gs on ... ....... ......
/► Rough
to be occupied as .........�,4.4-....�,. ....... ....................................�...:................................. 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
r PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI TA Rough
I Service
................ ... ..... .... ... ... ............................
Fina
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.
A
Date: 8/4/2014
ESTi ��TE
KMT Construction and Design To Jonathan Mandell
CSL#CS-106092 131 Sandra Ln.
6 Pleasant St. North Andover, MA
Wakefield, MA 01880
(781) 726-3316 _
Thank you for the opportunity to submit an estimate for work on your home. Below is an itemization
of the work necessary to complete the proposed job.This estimate only includes the work items
listed below. Any additional or unforeseen work will be presented to the customer along with
options on how to proceed, and will be subject to a separate invoice billed weekly. Our rate for time
and material work is 48.00 per hour.
.:k.
Demo -Removal of existing partition walls
-Removal of existing bath fixtures
-Removal of sliding door unit
-Disposal of all job related trash
Insulation -Fireblock all penetrations through floors and
ceilings
-Insulate exterior wall with R-13 insulation
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Framing -Frame new partition walls
-Frame for double pocket door
-Remove and replace bath subfloor as
necessary for plumbing
-Frame for custom shower stall with bench
-Frame in pass through
-Frame sliding door opening for a single ;
casement style window
Walls+Ceilings -Rockboard installation in shower stall area
-Blueboard and plaster installation—smooth
finish—walls and ceiling
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Tile -Tile installation in shower stall with bench Customer supplied tile f
-Tile installation on floor including closet
Electrical -Switches and wiring for vanity light/sconces, j Vanity lighting
heat/fan/light unit customer supplied
Install 11 recessed lights in master bedroom,
bath,and closet with dimmer i
-Code required outlets i I
All fixtures customer
Plumbing -Re-pipe bathroom supplied
-Shower valve installation
-New toilet installation
-New double sink,faucets and water lines
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Window -Install Andersen 400 Series Casement Window
with all interior and exterior trim
II.
Finish Carpentry -Vanity installation
-New baseboard throughout
-Install double pocket door for closet/bath I
entry '
-Install bath accessories,towels bars etc.
4 i
Paint -Paint all new walls and ceilings
-Paint master bedroom
-Paint living room ceiling
-Paint new exterior siding around window
Estimate Total 24,832.00
We require a deposit of one-third the total job cost to commence work,the second third when
halfway to completion, and the balance when fully complete.This estimate includes permitting fees
and waste disposal costs. If you have any questions please do not hesitate to contact us. Our goal is a
positive construction experience for all our customers, and to this end we value communication.
Thank You
qua- aa.Q..
- -- �fe�ioa�z��waxcrseaCf,zo�Ca•�;tac�r�oclfi
Office of Consumer Affairs&Busidess Regulation
- ME IMPROVEMENT CONTRACTOR
_registration: .174665 Type:
l• xpiration: _3/8/2015.:. Individual s
i JOSEPH L.THOMAS J.),
JOSEPH THOMAS
I 12 WEST WATER ST gam_
WAKEFIELD,MA 01880
111 Undersecretary
L J
'"'""'����".•�`:-......,....� . Department of Public Safety ;
Nlassach:usetts -Dep -
' Board of Building Regulations endtan.5a�g f
. _
1+ construction Supen.isor kar ,
1 Ucense: CS 106092f, '
f JOSEPH L THOM,"
25 EARL STREET
Malden MA 0214$
Expiration.
` �• �—' 05104!2015
Commissioner
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131 Sandra Ln.
Proposed Floorplan t
.July 7, 2014 �
shower
a
C) closet
^' 3' 4" Pr
`~ 3' 3" ft
I�
a `~ 3' 8" ft
van it"
C)
152.54 ft2 M
4- M
linen -
cabinet
12' 4" ft
170.33 ft2
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The Commonweaft ofAfaassach.usetts -
Devartm-ent of-Indusftracl-Accident
• •
Office a,f'Inve,��iga OW
640 Washington.,S'&eet
Boston,MA 02111
www.massgovtdia -
WQrcl exs'Compemagoul usurranep-ATidadt:13tgder.-ICoutractors/Electrczcxans[Pl*Pex.0
A. ixeant lWormab o u Please Print)Ge 'bl
Name,(Businossforganization/In„&idual): 6 f•
Address: W a�s ) W4
City/State/zip, � L k'1-Q A01 , Phone:gx �-S - 5 ao
Are you[an.employer?Cheek the appropriate box: Type of project(required)
L❑ I a employer with.________. 4. d I am a general contractor and I 6. Q New construction
mployses(fullancl(oxpaxttime).* havehiredthesu-b-conixactoxs
2. I am a sale propxietar ox paztp.er
listed on the attached sheet. 7• E emodeling
ship and`havano.employees These sub-contractors have S. ]Demolition
working forme in any capacity. workers'comp.insuxauce. . 9. Building addition.
[No workers'camp.insurance E]�l 5. e are a corporation and its 10.0 Electrical repairs or additions
xaga red.] officers have exercised-their
I[l I am a homeowner doing all work right of exemption.per MGL 11.[]Plumbing repairs or additions
myself.UTO Workers'comp. c.152,§1(4),andwehaven.o 12.P Roofxepairs
insurancerecluixed.]t employees.[No workers' 1311 Other
comp.insurance required,]
Any applicantthat checks box#I must also fll ouiihe section below showingtheir vTorkem'compensationpolicy infozmation.
t Homeowners who submittbis affitdavlUndicatingthey go doing all.workand then Mre outside contractors mustsubmit anew aifdavitindloatiiig such.
tContractors that checkthis boFmust attached as additional sheetshowingthe name of the sub-contractors andtheirworkers'comp.policy information.
Finian ernproye.rthid ispYovidillg wo,rkers'carnge kation insuranee for Y employee. Below i thepoliey rcncijob SVC
in,farmadon.
Insurance CompanyNama%
Policy##or Selz ins.Lic.#: Expiration Aate:
rob Site Address: CitylStatelZip:
Attach a copy aft tewoxlters'compensation-policy declaration page(showing.th.e policy number anal expiration.crate).
Failure to secure coverage as req.=c(Lmder Section 25A.ofMOL o.152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00and/or one-year imprisonment,as well as civil.penalties in the form o£a STOP WORD ORDER and a�n e
of up to$250.0 0 a day against the violator. Baadvisedthat acopyofthis statement may beforwaxdedtothe OfCc0-of
Investigations of the DTA.for insurance coverage verification.
.ado itereby cefto d Ile lalns and4penafde4 oi,verlwy ttlatthe information provided above is true and eorrea, -
Si afore: Date: S `'
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Phone#: - 10
Official use only. Do not VIM in iNs area,to he colrryleted by city or town ofcild �
City or Town'
Permi�tlLicense#
DsuingA.utthority(circle cne):
1.Board of Health.2.BuildiU9.Deparimend 3.Cityffova Clerk 4.EIectrical bspector 5.Plumbing hspector
6.Wher - - -
information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fox.their employees.
Pursuant to this statute,an ernployee is deflu ed as"...every person iii the,service of another under any contract of h1re;
express or implied,oral or written."
An erytploye is defined as"an individual,partnership,association,corporation o> othexlegal entity,or anytwa oxrttoxe
of the t6reg4ing engaged in a joint enterprise, n '
g J xp ,a d mncludin thele al xe xesent ' e
g g p atxv s ofa-deceased ein to ex ox time
� xecei . � .�' �'.
vex or trustee o a
� fan.individual,partuership,association oxot�b.exle al en' em z
g tzty, toying em to ees. However rhe
p p y
owmrofadwalhghousehaviugnotmorethaathreeapartments audwhoxesidesthere` ortheocc
� upant ofthe
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or onthe grounds orbWlding appurtenantthereto shallnot because of such employmentbe deemedta be an employer."
MGL chapter 152,§25C(6)also states that"every state or local Jicensing agency shall�rvMold the issuance or
renewal of a license or permit iq operate a business or to construct buildings in the commonwealth.fox any
a licant who has not ioduced. cce
pp P a ptable evzdence of compliance with the insuraxice coverage requixed:'
Additionally,MGI;chapmtex 152,§25C(7)states`Weither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpubliic workuntil acceptable evidence of compliance with the insurance
requirements of this chapterhave beenpresented to the contracting authority,"
Applicants
Please fill out the workers'compensailon affidavit completely,by checking the boxes that apply to your sitaafion and,if
necessary,supply sub-contractors)name(s),address(es)andplionenumber(s)along with their eertiffoafe(s)of
insurance. Limited Liability Companies(LLC}or Limited Liability Partnerships(LU)v&hno employees other than,the
members oxpartners,axenotrequiredto canyworkers'compensationinsurance. HanL7 C orLLP doeshave
eznPloyees,apolicyisxegt:dred. Be advised that-tI6affidavitmaybe,submittedfotheDepartmentof 1'ndustrial
Accidents for confirmation of insurance coverage. also be sure to sign and date the affidavit. The affidavit should
be retumedto the city or town thatthe application fox thepermit or license is being requested,xtot the Da�artment of
Indusfrial Accidents, Shouldyou have any questions regarding thio law or if you are xequked to obtain a*orkers'
compensation policy,please call the Department at the xmmber listed below Self insured companies should enter tb err
self insurance license number on the appropriate Jive. `
City or Town Officials
Pleasebe sure thatthe,afizdavit is complete andprinted legibly. The Department has provided a space at the bottom
of the affidavit foryou to fill out iu the event the Office of Tuvestigations has to contact you regarding the applicant.
Please be-sure to fail in the permif/licenm number wMohwill be used as a reference number, In addition,an applicant
fhatrnusf submitmulfiple permit/license applications in any givenyear,need only submit one affidavit indicating current
Policy information(rf necessary)and under"Yob Site Address"the applicant should wxite%1110ca&M in (city or
town)°'A copy ofthe affidavit thathas boon officially stamped ormarred bythe city ortownmay bepxovided to the
applicant as pro ofthat a valid affidavit. on file lox future permits or licenses. Anew affidavit rmst be filled out each
year.Where a home owner or cifi2en is obtaining a license ox permit not related to any business or commercial venture
(i.e.a dog license orliermit to burn leaves eta.)saidperson is NOTrequired to complete this affidavit.
The office of Investigations would like to fhank you in,advance for your cooperation and should you have any c�tzestions,
Please do not hesitate to give us a call.
The Department's address,telephone ajd faxnumber.
a
6b Waft ei�t
�Qaton, 02111
AM Qr-
Revised 5-26-05 FM 9 617MM749
Locationy2
No. W Date
s
o - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee _
x � Foundation Permit Fee $
f Other Permit Fee $
TOTAL $
Check#
27857
Building Inspector