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Home My WebLink AboutBuilding Permit #352 - 137 LANCASTER ROAD 10/30/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:1515,:� Date Received Date Issued: LIAP MPORTANT:Applicant must complete all items on this page LOCATION 137 4at9695ei— PROPERTY OWNER_ ITT, Print Print f MAP NO: / 09 PARCEL:.ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE R2AUgggLI , Non- Residential New BuildingOne famil Addition Two or more family Industrial Alteratio No. of units: Commercial Repai replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 04 6Aa� r I e tification P ease ype or Print Clearly) OWNER: Name: Q Phone: 7 P 9(&)!"S � Address: CONTRACTOR Name: iarl ea W. Phone:603 "C;2.99- 7,507 Address: / 76 1T, 03 p Supervisor's Construction License: Exp. Dater 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: $ �G �3�_`'V FEE: $ Check No.: �� 5' Receipt No.: � � NOTE: Persons contracting with unregistered contractors do not have access tVthe uaranty d Signatureof 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 Signature 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 - Date 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 ❑ 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 a Floor/Crossection/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 ConstructionSin le and Two Family) � 9 Y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract Li 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: Doc.Building Permit Revised 2008 c NORTH � Town of 4 over . 3 � Z0 No. o dover, Mass., �d o LAKE �. COCHICHEWICK V SRATED PPG RC2 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING.INSPECTOR THISCERTIFIES THAT.............. . ............................. .................................................................................... ........................ Foundation has permission to erect...................... ................ buildings on ..�,< . ...... 1....................................... .............................. Rough to be occupied as C` 7 � � 45�e ,,.454.1` Chimney p : .........l ........................................................ provided that the person accepting this 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTION STMTS Rough �.......... ... ................. .....% ,.�..................... Service ILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building. Inspector. Burner Street No. SEEREVERSE SIDE Smoke Det. ,Y°•="v2^ {. ^RYk'°'r•�....v+x:...... :""_ amu„ ....viaµ. Ilk e, �, a Board of Building Regulations and Standards ` t" HOME IMPROVEMENT CONTRACTOR i t' • Registra3ron, 141834 E' _mtto a 2/17/2010 Tr# 263060 ' Y Ty OBA CUSTOM DESIGN GX RPE-W-1, _ 1 ; A RAYMOND LIRETTE 17 FORDWAY EX`f , �',�,' °' d! DERRY NH 03038 - Administrator x Massachusetts- Department of Public Safet-, Board of Buildinl-Regulations and Standards �f Construction Supervisor License License: CS 92527 — Restricted to:. 00 RAYMOND C LIRETTE 176 FORDWAY EXT. .DERRY, NH 03038 Expiration: 8/20/2011 (onunissirrnk'r Tr#: 4585 Custom Design Carpentry 176 Fordway Ext, Derry,NH. 03038 August 21,2009 Beth& Sam Martin 137 Lal'CAS er- 2d /1/, Amover/ YA Scope of project: Remodel Master Bathroom Town Permits: Custom Design will submit all applications to the town of N. Andover, to acquire permitting for the project. Pad& Protect: Custom Design will install dust barriers in area of demo, and cover rugs leading from entry door to master bath.All areas will be cleaned at the end of every day. Demo: Custom Design will remove tile flooring,sub flooring where needed, tub, shower stall,and cabinetry.And dispose all debris in an off site dumpster. Framing: Custom Design will build curb for new shower stall,and replace sub floor as needed. Walls: Custom Design will skim coat plaster as needed. And install Dura rock to prep walls for tile install. Flooring: Custom Design will install Valenza.Collection% solid Pradoo Natural flooring u Cabinetry: Custom Design will install Lariat Cherry Ebony Mist as laid out in design. Trim: Custom Design will in stall casing,and base board to match egesting as needed. Tile: Tile will be installed by Tile exedra,the price is based on a striate Pattern,if any changes there may be addisonal costs. Electrical: Dave Roberge will install one new vented light, and install blower unit for tub. Plumbing: Kevin Raymond will in stall all plumbing, fixtures and piping as needed. In quote for this contract is copper pan for shower. Home Owners are responsible for supplying, Tile and Grout,Vented light, Granite counter tops, seat for shower and any shelving,and curb for shower. All plumbing fixtures are between homeowner and Plumber to supply. Total Cost: $26,832.50 Raymo irette C m BethA Sam Martin Payment Schedule Deposit for materials $ 13,000.00 When demo of bathroom completed $2500.00 When Plumbing and Electricel is Roughed in $4600.00 When Shower is ready for tile $2500.00 When cabinets and Flooring installed $2500.00 When Finishes are done, Plumbing, electric, $ 1200.00 and Trim Final Payment at walk thru $ 532.50 �o� FROM (FRO OCT 30 2009 9:16/ST. 9:16/No. 6870093695 P 1 CERTIFICATE OF LIABILITY INSURANCE U t Ply 10/3 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A WATM OF 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gallant Insurance Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 87 Sim Street ALTER THE COVERAGE AFFORDED BY TME POLICIES BELOW. Nal,nchester MR 03101 PbLone:603-644-4663 Fax:603-434-0010 INWRERS AFFORDM COVERAGE NAICO im-5 msuRERA: Union Mutual Insurance 25860 INSURER B: Ray Lirette's Custom Design INSURER C: i "7nrt9a Xxtention IRIsi0: Derry IM 0NSU 038 INSURER E: COVERAGES THE POLICES OF INSURANCE tWW BELOW HAVE BEEN Ig MD TO THE INSURED NAMED ABOVE FOR TIE POLICY PERF I DICATED.NOTWmtsTANDING AW REQUIREMENT,TERMOR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH TNFO CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANC@ AFFORDEO BY THE FOLIMES DESCAMMO HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSKM AND CONOMONB OF SUCH POL.IC".AGGREGATE LANTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM& ILTTR TYIE OF INaURANCE POLICY NIBIBER pA DA E UwTS aEH>;IALLIABILm EACH OCCURRENCE 81,000,000 DAMUE RD leA X comwmiALcENERAi,tiAKITY 80 5078019 08/18/09' 08/19/10 PREMISEs feoo�axenw s50000 CLAIMS MADE a]OCCUR MED EXP(Anyone owHaol $5000 PERSONAL AADV INJURY S1,000,000 GUMPALAGGREGATE s2,000,000 GENLAGGREGATE LONTAPPLIESKA: PRoOUCTS-cowwAGG s2,000,000 POLICY PRO• LOG Mnvm=&E LABNJTY tCOH oSINGLE LIMIT S ANY AUTO ED$WdWO ALL OWNEDAUTOS BODILY INJURY SCICOULED AUTOS Ww"MOAI a HIREDAVTO$ SOOM.YINJURY f NON-OWNED AUTOS (�scCie�w1 (Remo ATYDAMAGE f (Fyl•oddanU GARAGIE L,AGq I Y AUTO ONLY-EAACCDENT s ANY AUTO OTHER THAN EA ACC s AUTO ONLY: AGB f EXCES!1 UMBRELLA IMBLITY SACH OCCURRENCE f OCCUR F-1 CLAIMS MADE AGGREGATE s f DEDUCTIBLE f RETENTION S f WORKERS TO YWNTS I ER. AND BMPLW49RW LJA NUff AW PROPRIETOWPARTNER/ Y/N E.L.EACH ACCIDENT $ oL ExaDEo u ? ONFyeF�I, E.t.DISEASE•FA EMPLOYEE s E.L.DISEASE-POLICY LIMTt I f OTHER OESCRPTNON OF OPERATwA I LOCATIONS I VEHICLES I EXCLUSIONS ADOOw BY ENDORSEMENT I SPECLAL PROVISIONS carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OESCMBED POLMIES N CANCELLED BEFORE THE GIVIRATION ANDOVSA DATE THEREOF.THE IMING BIELIRER WILL ENDEAVOR TO MAIL 10 DAYII WRMN NOTICE To THE CERTIFWATEHOLDER NAMED To THE LEFT.BUT FAILURE TO 00 e0 SHALL IMPOSE NO OBLIGATION OR LIABBRY OF ANY HONG RIPON THE INSURER,ITS AGENTS OR REFFIES TONn Of North Andover UT"OA1EHITATWEs. 1600 Osgood Street Worth Andover NA 01810 ACORD 26(2000101) O t 0-2000 ACORD CORPORATION. AS Aghte reserved. The ACORD name and logo are reglstwed marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): n (w c h' �� '7 Address: ' 7 City/State/Zip: Phone#:_6133 ' / — �•��7 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. 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 in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. Electrical re required.] officers have exercised their ❑ pairs or additions 3.❑ I 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' 13.❑ Other comp. insurance required.] a-uay applicant that Checks box ml aaiui�wav call out the SeCt1oIl below ShaWlltg their workers'nmmprnca+inn paliC��in fryinn. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: Policy#or Self4ris. Lic.#: Expiration Daze: 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 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. Ido hereby certify, nder the pa' nd alti Fury that the information provided abov i7,"�- Phone#: and correct Si afore: Date.. A 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 cant'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 pernut 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 Massachusetts Department of Industrial Accidents. Oi�ice of Inv°estiptions. 600 Washhgton.Street Boston,MA.021:.11 Tel. # 617-7274900 ext 406 or 1-977-MAS.SAFE Fax # 617-727-7749 Revised 5-26-OS www.mass.g.ov/dia Location �� ? No. Date NOATq TOWN OF NORTH ANDOVER Of .•° ,•'gyp F p • • Certificate of Occupancy $ �'�s •t<�' cMus BuildinglFrame Permit Fee $ %l2 s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ? 1h2 )Kj ding inspector