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HomeMy WebLinkAboutBuilding Permit #173 - 17 AMBERVILLE ROAD 9/4/2007 p0"UFO BUILDING PERMIT 0* '0,.,,`� q"o TOWN OF NORTH ANDOVER 0 M1 p APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received gc►+us��c Date Issued: r �� IMPORTANT Applicant must complete all items on this page 2 IV Na NN Mai IN WIN PX IN TYPE OF IMPROVEMENT PROPOSED USE -- Residential Non- Residential ❑ New Building ❑ One family ❑ Addition El Two or more family [I Industrial [AlterationSE-Ae-1 iv No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg E Others: ❑ Demolition ❑ Other 17 .c; p DESCRIPTION OF WORK TO BE PREFORMED: Identification Please.Type or Print Clearly) OWNER: Name: Phone: Address Of bra � �it c 3 � � s§�� ''� �. r.,� X74✓ ��� ��Qa�bk�� 9. " ��R��^.� a'� �; s ��5 441 4� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0ocD FEE: $ ZSZ Check No.: Q' )-- Receipt No.: a NOTE: Persons contracting with unregistered contractors do not have access to the guara fund S490 � S1g01'atue'oorcgtr Location No. Date Date MaRTM TOWN OF NORTH ANDOVER a s Certificate of Occupancy $ AC14U E<� Building/Frame Permit Fee $ sic Hus Foundation Permit Fee $ Other Permit Fee $ w TOTAL $ Check # �� 2 0 5 5 9 `� --- -- Building Inspector 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 Li 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMME"NTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer C® n ition/Signature& Date Driveway Permit Located at 384 Osgeod1S eth�1* FIRS DEP, 112TMEN : Ternp Ortrpset��r> slfe yesaX r 5 , 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 2007 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 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 I Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan i ❑ Workers Comp Affidavit - \ ; , ( _; - ' . ❑ Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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 I New ConstructionSin le and Two Family) ( 9 ❑ 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 o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 The Commonwealth of Massachusetts c I Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I v\Q-0))OUZ QA8 Address: Q 2 A^Q� City/State/Zip: "Tc4 Phone #: Are you an employer?Check the appropriate box: Type of project(required): general contractor and I 1.F-1 I am a employer with 4. 0 I am a g 6. E]New constructio �. Mployees(full and/or part-time).* have hired the sub-contractors [�' ; 7. Q'Remodeling [ 2. I am a sole proprietor or partner- listed on the attached sheet. � ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y P tY• 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 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 12,0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks boX#I must also fill out the section below showing their workers'compensation policy information. t 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. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: 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. 1 do hereby e pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone th 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-contractor(s)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 permit 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 Office of Investigations 600 Washington Street Boston,IIIA 02111 Tel. #617-7274900 ext 406 or 1-877-MASSA-FE Fax#617-727-7749 Revised 5-26-05 www.mass.gov<dia 28'2 2'2 --26' Fm"O I I I I I � I 1 I N � � I � I I •I I 8'8 I - I I j u S v v 2'7 J � 2'l 2 X1'9 4'4 SO i 2'5 i I I I I I � ti zo 13'4 90 a, 90 I a•. I I I • , 1 L"L, LLL T 1'1"1'5:14 2'5 10'11 21 LIVING AREA 15'11 ;I 840 sq ft NORTH Town of 0 No. 1 3 0 0, dover, Mass., . a /� COC M"A"KE 7�S RATED PP��°�� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �A..r THISCERTIFIES THAT......C... ....... ...........S....�1. BUILDING INSPECTOR Foundation has permission to erect........................................ buildings on.... .. K A............ Rough . . to be occupied as......... . ... Chimney 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 25�- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S Rough CM1 ry ....................... ................... .............. Service BUIL �Qt''�"!BI'ECTOR Final Occupancy Permit Required to Om4py 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 DEPARTMENTUntil Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Ted Grab — Interior Renovators Advanced Basement Finishing 1029 Humphrey Street Swampscott, Massachusetts 01907 781-842-0296 advancedbasement(a yahoo.com. ` "Federal Tax ID#200140136 MA Home Improvement Contractors Registration # 140838 Proposal To Renovate Basement jf-24-07 date HOME OWNER: Chirag Shah 17 Amberville Road North Andover, MA 4 PROJECT DESCRIPTION 1. Areas to be created in unfinished basement CONTRACTOR SHALL supply all new materials needed to erect, according to State and Local Building Codes, build all walls along walls to create and finish areas as designated on scale drawing. The areas are as follows. ➢ Family Room/Home Entertainment Area ➢ yz-�ateetx- ➢ Office/Studio Area ➢ Storage Area ➢ Furnish/Uiility Room ➢ Electrical Room 1 Z Ceilinm and Soffit Preparation ❑ Ceiling and beam soffits shall be prepared in a manner, according to code to accept the weight of"blue board". ❑ 1" x 3" spruce strapping shall be installed!(as needed) on;ceiling joist 16" on center to support weight of new blueboard ceiling. 3. Wall Structure Contractor shall create spaces by building walls as indicated (approximately) on scale drawing. All wall structure shall be built according to state & local building requirements. 5. Insulation ➢ All exterior walls shall be insulated so that all living areas and spaces are insulated according to code. The insulation value is R-13. 6. Electrical Work ➢ A Massachusetts Licensed Master Electrician shall perform all electrical work. This project shall include the following. ❑ Up to 17-6 inch recessed lights in living areas. ❑ Up to 3 dimmer switches to control all recessed lights. ❑ Light fixtures for all unfinished areas separately switched. ❑ Up to 2 cable/broadband wall connections. ❑ Up to 2 telephone wall connections. ❑ Electrical outlets through .living area per code.. These outlets are controlled by a GFI (ground fault) breaker. ❑ �;H E►IAFiPAI-�?Hfi�l@(l fnr " a' m. ❑ 3 6-foot electric baseboard heat units operated by 2 wall mounted thermostats. 2 7. Ceilings & Soffits ➢ All ceiling and soffit of finished areas shall be enclosed with %2 inch "blue board". ➢ All blue board shall be finished by the veneer plastering method to a smooth finish on walls and textured finished on ceiling. 8. Wall ➢ All walls of finished areas shall be enclosed with birch woodwork and finished with architectural detail as shown on sample. 9. Doors ➢ 6 PANEL DOOR— STORAGE AREA ➢ 6 PANEL DOOR—ELECTRICAL AREA ➢ 6 Panel Bi-fold—CLOSETS AND FURNACE ROOM ➢ All doors shall include standard hardware and doorknobs. ➢ All doors to be installed with casing similar to existing casing on the first floor. IO.Baseboard Contractor will supply and install new baseboard for all finished areas similar with existing baseboard found on the first floor. 11.Staircase Contractor will finish staircase area consistent with the other newly finished areas. ➢ Contractor shall open left hand wall to create half wall on staircase. ➢ Contractor will install new stair threads and risers designed to accept carpet. 3 12.Flooring ➢ This proposal allows for no finished flooring. Flooring shall be the sole responsibility of the homeowner. ➢ Th s pr po al oe include labor i to do r ceramic floor t' s 'n bat r m o er s p ti a an grow r s old. 13.Paintm ➢ This proposal allows for no painting. 14.Bam & Plumbing ➢ Co PW ➢ Contractor shall route laundry room "run-off' drain Airectly into main drain. ➢ Contractor shall adjust fire sprinkler system as needed and required by town. This portion of plumbing has a $500.00 allowance. A credit shall be given to homeowner if it shall cost less. In the event this does cost more, the homeowner shall be responsible for additional.fees. The contractor shall get one estimate from a licensed contractor, and, the home owner may also invite as many bids as he would like. 15.Scale Drawing ➢ Scale drawing attach shall be construed as an integral part of the proposal and agreement. I(. aterials Supplied b Home wn r ➢ Vpliedby in all to n fl res a d materials purchased and e Sink Sink FaucetCeramic Floor Tile 4 ❑ G ou fo •�Iile❑ a�•l e oom 17.Cabinetry ➢ Contractor shall build and install a "window seat" as indicated on scale drawing ➢ Contractor shall build and install built in bookcases, no more than-84eet wide and shall be floor to,ceiling 18.Permitting ➢ Contractor shall apply for or cause to apply for all* required permits. Homeowner shall be responsible for all fees and contractor shall invoice homeowner for said fees. Said fees shall be due immediately upon receipt of invoice. 19.Scone of Project Contractor and homeowner agree that the entire project is listed here or as indicated on scale drawing. Any other work will only be preformed after all parties execute a change to this agreement. 5 .?macro ' Project Investment $ 24.95 6 ➢ Payment Due with Agreement $ 1000.00 fvoo ➢ Payment Due when Project begins $8313:80 (330/0) ➢ Payment Due when "Rough Electric" is complete 7uoo $ 83+"0 (S36/6) ➢ Balance upon completion Commencement Date Project shall begin on or about07 and shall be completed on or about / 15 7 . These dates are approximate. Accepted by: Date: —Z -07 Chir fah—Home Owner Accepted by: Date.• Ted GiUb, Advanced 4asement Finishing 6 .. �'. 7 A BOARD BZJILD}MG t�ECrlL;4�1 { 1E� Llcesse C©NSTRUCTION SUPERW.1 I t Numb!16 089566 A3 ; 4.t StrM3tia#e 9211195.0 20,07 Tr.•no: 88566 RtV�St THEODORE B GRiS$ r't 4,ti 1029 HItMP•HREY � � f%' SWAMPSCOTT i coi imissioner b ` 677, O 11.1 -In .em.Af, IQ '� .. HOME IMPROV %ul+iallt II� EMENT CON TRACTOR 'Li Regrstra o9,c 140838 i�ef Expiration_`.-31/28/2007 .Boal pe.__',.Trrruate Corporation Bosh t ED BAS EN1E1itT F77 11E � AHI``I ?ORE GRI $ = =/ +OMPH REY`� � fP3COTT,MA3aQ71'r l Gi rfrt,� A d mi'n istr;�to r -