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HomeMy WebLinkAboutBuilding Permit #111-15 - 147 HIGH STREET 7/23/2014 t3UILUINU rtKMI l �? ,- r. +•.-o o� TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received ATfO f' Date Issued: 123W �SSgcHus�� IMPORTANT:Applicant must complete all items on this page LOCATION /1/7 1111 s t-•CA 0124 S Print PROPERTY OWNER_ `o4//u_ Mor c q 5y--.> Print MAP NO: PARCEL ZONING DISTRICT: Historic District yesno I Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne 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 9-e.Yin.o4e- is i-cuu .SAmwa V �I4r6 D 14-.w+ !ri c C�cvsQ • R �Lce.�r�caaf! f)rv.tia11 wr+IIS TI%c Glvo✓ Identification Please Type or Print Clearly) OWNER: Name: ,�SaS�� Phone: og4,s Address: CONTRACTOR Name: Phone: Goa - 966- SoI� Address: 0, Supervisor's Construction License: Exp. Date: (5- 79 Home Improvement License: Exp. Date: le;-.7 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 $ / oFEE: $ /57V6� Check No.: Receipt No.: '�- Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor _ Location p, No. .R I J Date N . - TOWN OF NORTH ANDOVER Y�,-Certificate of Occupancy $ .. Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ R Check# 27839 Building Inspector b NORTF/ BUILDING PERMIT O*tz�E� ae"tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h f. u:'.f e Permit No#: Date Received �4"meq TEo�Pa"c5 �SSACHU`��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION a—=-- Print. PROPERTY OWNER Prf 100 Year Structure yes no MAP ._. PARCEL: ZONING DISTRI.CT: --.- Historic District yes no Machine Shop Village yes -no- TYPE o_ -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 El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: D- • Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor'Name: _ -Phone.- Address:- Supervisor's Phone:_Address:Supervisor's Construction License: _ _ Exp. Date:. 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature G.f A�,eot/OWner Signature of contractG_r: 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 ❑ Floor/Cross Section/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 I Doc:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swirmning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent 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 lil a i COMMENTS I HEALTH Reviewed on Signature COMMENTS 0 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 I 1 i �I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 12,810.00 m $ - $ 153.72 Plumbing Fee $ 19.22 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 19.22 Total fees collected 292.15 147 High Street 111-15 on 8/1/2014 Bath Remodel i II NORTH Town of : ? Andover No. - h ver, Mass, 0 'P 14cocroc«ew1c« 1- S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ........ ..� �h Vlllio VPV1.,s1„ BUILDING INSPECTOR ................. ...........................•••••� ...................................... � Foundation has-permission to erect .......................... build'n son ....... . ... ........... . . �.�....... ................... Rough to be occupied as p .............f6-f4 ...►............ ..............pp.....:....... Chimney provided that the person accepting this permit shall in every respect conform to the terms of thea 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 CONSTRUCTION Rough Service .. ..... ...... ................................. final 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. AYOTTE home Improvements, LLC Robin Morgasen&Sue Goley 147 High St N. Andover Ma 01845 Bathroom Permits Contractor obtain permit prior to construction Electrician and plumber to do same Demolition Install tarps to wood floors to protect Remove insulation from above bathroom and save Remove existing bathroom and closet door and save Remove existing trim from windows and doors and save Install plastic across doorway to contain debris Remove existing vanity and toilet(save toilet) Remove existing the from all walls Remove plaster from all walls and ceiling Remove existing tub Remove framed down ceiling from tub area Remove existing flooring and underlayment Electrical Install 24"recessed cans to bathroom Install 1-4"recessed light in shower Install new light box for new vanity light Install new outlet box for new GFCI Install new exhaust fan Install all rough wiring for switches,outlet, fan, and lights Install all fixtures and devices Plumbing Remove existing shower valve Remove existing shut=offs Ayotte Home Improvements,LLC 8 Emerson Road.Nashua,NH.03062 603.966.5018 ayottehi aAcomcast.net www.ayottehomeimpLQvements.com Install new Kohler Sterling white tub/shower unit Install new valve,tub spout,and shower head Install new vanity,top, faucet,shut-offs,water supplies,and drain Install saved toilet, shut-off and water supply Insulation Install new R-15 insulation to exterior wall Install new 4mil vapor barrier to wall Re-install insulation in attic after plaster work is completed Drywall Install new 1/2 moisture resistant drywall to walls and ceiling Apply tape to all seams Apply joint compound to all screws and seams Sand smooth upon completion Tile Install 1/2 file backer to walls above shower Install 1/2 file backer to floor Secure tile backer with backer screws Install mesh tape and flash all seems Install homeowner selected file in a running bond pattern Any diagonal,rectified,or patterned file to be subject to addition charges All tile to be set with 1/8 joints All tile to be set with TEC fortified thin set Above shower= 16 sq ft+4 pieces if bullnose tile Floor=40 sq ft Trim Re-install saved trim to doors and window Install chair rail to bathroom Allowances Tub/Shower $400 Fan $150 Total Cost$12,810 Ayotte Home Improvements,LLC reserves the right to use any and all pictures of above referenced project for marketing purposes. 'This proposal for services is valid for 30 days from the date of proposal;30-day lapse could result in a change in project price. Ayotte Home Improvements,LLC is licensed and insured. _��Z" r M oClientLnpro ents,LLC Ayotte Home Improvements,LLC 8 Emerson Road.Nashua,NH.03062 603.966.5018 avottehi(-komcast.net www.Uottehomeimnrovements.com Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-098389�� i ROBERT M AYO 8 EMERSONItD% NASHUA NH 0362 Expiration `.j••E••' 49/25/2015 Commissioner e W.-I towwwl01(o, �aaaac�urae(ld Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Type: egistration: 164594 k'VExpiration:..:,:10/26/2015 Individual ROBERT M.AYOTTE ROBERT AYOTTE 8 EMERSON RD. g NASHUA,NH 03062 Undersecretary S y'he Commonwealth of.ZVlassach.aseus - Department o flndusttigl Aceldats . • - O,ffaceofluvestigafeons ,S'treet 640 Washington. Boston,MA 02111 www.massgovIdla W(or kexcs'Compensation l suranceAffidavit:Buffdere/Co)itractor$)ElecWciansl�Ziivabexp Applicant ox�aatxo n Please Plant Le�tbl Name(BusinesslOrgan!zationftda`,viduai}: - .AAd&ess: •�'� Czb�rlSta�el p:_ /��►5��A �vfto-yk _ Phone It: ela 3-9" Are volt an employer?Cbteck the appropriate hOM Type of project(required): 1.[� I am a employer with 4. ❑I am a general contractor and I 6, E]New construction F mplayees(fulland(orparttitne).' have hired the sub-contractors 2. I am a solo proinietor orpartn.ex listed on the attached sheet: 7- Remodeling ship and`liavena•employees These sub-contractors have 8. ❑l]emolition working forme in any capacity. workers'comp.insurance. g, ❑Building addition. [No workers'comp.insurance 5, ❑We are a corporation and its 1o.❑Electrical repairs or additions xecltiired.� ofcers have exercisedtheir rz t of exemption or MGL 11..[(Plumbing repairs or additions 3.[l I ata a homeowner doing all work c A 2 14 d w have L Myself [�10 workers comp. ,§ ( 7� 12.p Roofxepairs insuran.ceregtzixed.]� employees..[Noworkexs' 1311 Other comp.insurance required•] Anyapplicantthatchecksbox#Imustalsof[Ilouithesectionbel6wshovaingtheirworkers'compewation.polzcy nfomiation. homeowners who submittI&affidavit iadicatingfhey go doing all.worKand then bite outside contractors must submit a new affidavit indicating such. Tcoiruactors that checktbis boxmustattached an addifionalsheet showingthe name ofthe suta.-contractors andtheirworkers'comp.policyMomiation. paneanexnployerthatisprovidi�tgWO-Ikeys'cOrnpensationinsuraxce,fo xnyex Ioyees: Below sthepalicyt tdja site T12,fD�'712ati0n. , lusuxance CompanyName;. policy#or Se1i 7ns.lsic.#: ExpzxatzonID lob Site Address: City/State mp: Attach a cope oltlteworkers' Vonsation•policydeclaration pag showing.the policy xtumbex and expixationt date). Failure to secure coverage as required under Section 25A ofMGL o.152 can lead to the imposition of criminalpenalties of a fine up to$1,500.00 and/or one,-Year imprisonment,as wallas civil,penaltles in the form of a STOP WORD ORDER and a-Un e of up to$250.00 a day against the violator. R e advised that a copy ofthis statement maybe foxwarded to the Office-of- investigations finvestigations ofthe DIA for insurance,coverage verification. ..l'do hereby certt uri r tiiepaing andPenalties o,f perjury that die info nationProvided alcove is ttfue and correct - 81 at Data: Phone lig 3 6 G -Ste/ Ofeial use only. Do not write in dais area,to be cowleted by city or town ofeiat City or Town: Permit/License 0 Issuing Authority(circle ono).' 1.130axd of Health 2.Eutidiug)Department 3.CitylTovm Clerk 4.Electrical Inspector 5.l'lumbingluspector f.Other - - - Information and Instructions - Massachusetts General Maws chapter 152 xequires all employers to provide workers'compensation for their employees. Pursuant to this statute,an errs,ployee is def mod as"...every person iri the service of another under any contract o hire; express Mimplied,oral oxwxitten.." An e&T1gyq is defined as"an individual,partnership,association,corporation or other legal entity,or any two oxmoxe of the foregoiug engaged in a joint enterprise,and includingthe'legal xepresentatives ofwdeceased epnployex,.orthe receiver o frdstee of an individual,partnership,association,ox other legal entity,employing employees. Idowever the owner of a dwelling house having notrnore than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction ox repair work on such dwelling house or onthe grounds orbuilding appurtenant thereto shalln:ot because of such employment be deemed to be an employer:" MUL 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 op erate a business or to constrict 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"Neitherthe c ommonwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpublie work until acceptable evidence of compliance with the insurance requirements of Us chapter have beenpresentedtathe confractingauthority.." .Applicants Please ii11 out the workers'compensailon affidavit completely,by checking tfio boxes that apply to your situation and,if ziecessary,supply sub-confractox(s)name(s),address(es)andphonenumber(s)alongwiththeir cextifeate(s)of insurance. Limited Liability Companies(LLC)ox M3mited Liability Partnerships(LMP)with no employees othar than the members oxpartners,arenotrequiredto can7workers'compensationinsumnce. IfanLl C orMLP doeshave employees,apolicy is required. Do advised thatthis aff-rdavitmaybe,submitted to the Department of Iudustdat Accidents for confnmation ofinsurance coverage. Also be sure to sign and date the affidavit. the affidavit should be returned to the city or town that the application fox thepeunit or license is being reque�ted,not the Dei mtnent of Industrial Accidents. Shouldyou have any questions regarding the law or if you are xequired to obtain,a workers' comp ensadonpolicy,please call the Department atthe number listed helow. Self-insured companies should enter their self insurance Incense number on the appxopriate line. City or Town Offleials Pleasebesurethattheafffidavitiscomple,teaudpxiutedlegibly. The Department has provided a space at the bottom ofth.e aftxdavitfoxyeuta fM out in the eventthe Office oflnvestigationshas to coutactyouxegardingthe applicant. Please be-sure to fff inthe permit/license number whichwill be used as a reference number. In addition,an applicant thatmust submitmultiple permit/license applications in any givenyear,need only submit one affidavit indicaffig cutrent Policy`informaffon(if necessary)and under"Job Site Address"the applicant should-mite"all locations in (city or tow:n)".A.copy ottho affidavit that has been officially stamped or marked by the city ox town may be provided to the applicantaspxoofthat avalidaffidavit•ison:Mae oxfahlrepem2Norlicenses. Anew aftzdavitmustbefilledouteach 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 orpermit to burn leaves eto.)said person is NOTxequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any quesi'tons, please do nothesitate to give us a call. The Depattment's address,telephone avd fax number: Tho CQr u QnW.tla ofMas a� - POpax(,eU,t QViRd-��Gxza1 Auddanta 600 W443r,•gt , x B0904,NTA 02111 T014&M-274900 Q 406 Qr-1-877AWS - Revised 5-26-OS FM#617-727-774 BOBAY-1 OP ID:TB CERTIFICATE OF LIABILITY INSURANCE DATE 0613 012 01 YY) 06/30/2014 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 endomeme s. PRODUCERCONTACT Phone:603-424-9901 NAME: Brown&Brown(Merrimack) Fax:866-848-1223 PHONE Fax 309 Daniel Webster Highway Arc No Ext): Arc No): Merrimack,NH 03054 E-MAIL House ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance 29939 INSURED Bob Ayotte INSURER a:American Zurich Ins Company 40142 Ayotte Home Improvements 8 Emerson Rd INSURERc` Nashua,NH 03062 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSR TYPE OF INSURANCE DL S B POLICPOLICY NUMBER MIDDY EFF POLICY WvD UY� LIMA GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( A X COMMERCIAL GENERAL LIABILITY MPP6741B 05/22/2014 05/22/2015 PREMISES Ea occurrence $ 500,00 CLAIMS-MADE I A I OCCUR , MED EXP(Any one person) $ _ 10.00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,0 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STA OTH- AND EMPLOYERS'LIABILITY T Y LIMITS ER B ANY PROPRIETOR/PARTNERIEXECUTIVE YIN N finUB-0414N25-9 04/23/2014 04/23/2015 E.L.EACH ACCIDENT $ 100,00 F OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 N yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500A0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U more space is required) *Bob Ayotte is excluded from Workers Compensation Coverages Job: Robin Morgasen, 147 High St., N. Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. N.Andover, MA 01845 AUTHORIZED REPRESENTATIVE 6PW ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD morCASGlJ �• A��1o�,yL I I I