HomeMy WebLinkAboutBuilding Permit #610-15 - 20 COACHMANS LANE 1/20/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: J
Date Received° '
Date Issued: v
IMPORTANT: Applicant must complete all items on this Daae
LOCATION —_2.,0 �po �,/►�'ti s ��r
PROPERTY OWNERrint
MAP Print 100 Year Structure
PARCEL:_ ZONING DISTRICT:_ Historic District
Machine Shop Vi
i
L.
yes no\
yesno
yes no
TYPE OF IMPROVEMENT PROPOSED USE v—
Resid ntial Non- Residential
❑ New Building ne family
❑ ydition ❑ Two or more family El Industrial
Alteration
No. of units: ❑ Commercial
❑ Repair, replacement ❑ Assessory Bldg
❑ DemolitionElOthers:
❑ Other
❑ Septic ❑Well
❑ Floodplain ❑ Wetlands-
❑ Water/Sewer ❑Watershed Distract
DESCRIPTION OF WORK TO BE PERFORMED:
( a
an S� FI�Jl1
l) '7 N1
!a o!•
Identification - Please Type or Print Clearly
OWNER: Name: i,�� le � ,�' M 1,17er Ph�
one
Z�
Address: C'��1, ��s
Contractor Name: Phone: c 781- 3 7- 3 Z
17
Address: loor,'n 4,t�
Supervisor's Construction License: C 5, - 0 ?Ib g Y
Exp. Dater /°%9ApI�
Home Improvement License: 17Z /O sr
Exp:. a-ate:.z z z of
ARCH ITECT/ENGINEER _ d-fM^,grd
Phone: -
Address:
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMAIFEDEOSI;;&WED O .,,$125.00 PER S.F.
Total Project Cost: $ 5-G<9c73
FEES::
Check No.: j °'t,
NOTE: Persons cont acting with unregistered contractors do norpha a acce
ss tot e gun anty fund
Signature of
Signature ofacontra.ctor! - r�
Locatio2 o Co ft� ^— lgc�
No. � ! o — 1 �7 1 wkx Date
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee v -
TOTAL $
Building Inspector
P
Plans Submitted ❑
Plans Waived 0
Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑
sa�Pn ❑ Tobacco Sales ❑
Private (septic tank, etc. ❑ I Permanent Dumpster on Site ❑
Swimming Pools ❑
Food Packaging/Sales ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
r
COMMENTS
L
Reviewed On Signature.
Reviewed on Si nature
Reviewed on Si nature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comme
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'bri.=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 ana uH I H - krur uwP-1
❑ Notified for pickup Call Email
3
Time Contact Name
Date-- - - ------------------ -- ------------- ---—.-------
Doc.Building Permit Revised 2014
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
o 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
Doc: Building Permit Revised 2014
COMM—ENT'.
Enter construction cost for fee cal -
North Andover Fee Cakulatlon
Construction Cost
$ 54,903.00
m
$ -
$
658.84
Plumbing Fee
$
82.35
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
82.35
Total fees collected
$
923.55
20 Coachman's Lane
610-15 on 1/20/2015
Remodel 2 Bathrooms
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ln
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: 1414;Z.
City/State/Zip: 1�,1 4 210 Phone #: 72f - 3,!5� 7- 3 Z 17
Are you an employer? Check the appropriate box:
L ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have Hired the sub -contractors
2.am a sole proprietor or partner-
listed on the attached sheet. #
hip and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp, insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. F1 Electrical repairs or additions
I L ❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
*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 hire doing all work and then hire outside contractors must submit anew affidavit indicating such.
#Contractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
lam 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. Lie. #: Expiration Date:
Job Site Address: �� O fl—s;��n-y�l� ��-- 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.
I do herphy certify under thepains andpenalties ofperjury that the information provided above is true and correct.
Simafore: Date: / t0 l 5/-
i �r-.
Phone #: � 3 f2-
3 Z 17 -
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 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 02111
Tei. # 617-727-4900 ext 406 or 1-877:MASS.AFB
Revised 5-26-05 Fax # 617-727-7749
wvc W_Mass,goV1dia
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C -
I BELL
GENERAL CONTRACTING
10 Korinthian Way Andover, Ma
January 8, 2015
Contract for the remodel of both bathrooms at 20 Coachmans Lane North Andover Ma.
This contract is for the total remodel two bathrooms to be completed back to back by Isbell General
Contracting (IGC) for Michelle and Tom McCraw. This includes all work from demo and framing to final
paint and completion. All work will closely follow plans provided by Hammond Design. The total cost for
all the following work will be $54,903.
Demolition and protection: During each phase of the project all demo materials and debris will be
hauled out to an onsite dumpster provided by Isbell General Contracting. Where it is necessary for
egress, floor and wall protection will be provided, along with any plastic dust walls to partition off and
protect non work areas. The first floor bath will be gutted completely to the studs and subfloor,
including the ceiling. The second bathroom will be demoed where needed for the extension of the plan,
door installation, and to meet any plumbing or electrical requirements.
Carpentry: This includes all work from framing the new shower % wall and framing new windows, to
final finish trim throughout. All cabinets, fixtures, tile, and granite will be installed according to the
provided drawings. All cabinetry and fixtures, tile and granite, second floor tub and both commodes are
to be provided by the McCraws for both bathrooms. The fixed windows for the first floor and the added
door for the second floor will be provided by IGC, as will all insulation, substrate materials, glass for
showers, recessed lighting, bath fans, and floor heating mat for the first floor. All exterior siding will be
replaced to closely match the existing siding where the first floor window will be removed.
Electrical: All electrical work will be provided by IGC to include new lights both recessed and wall
mounted, bath fans, floor heating for the first floor, and outlets to code following the detailed plans
from Hammond Design.
Plumbing: All plumbing will include the demo of existing bath/shower locations on the first floor and
the installation of all new plumbing in both baths to follow the plans provided.
Plaster: All new blueboard and plaster will be installed throughout for the first floor bath, and where
needed for the second floor bath.
Tile: All tile to be installed according to plans for the first and second floors. IGC will provide all substrate
for the tile work.
Paint: All walls, trim, and ceiling to be painted with primer and two coats of Benjamin Moore paint to
the client specifications. All exterior painting will be performed as weather permits.
General conditions: Isbell General Contracting will provide a dumpster for the duration of the project. A
portable bathroom will be provided onsite for the duration. This contract includes all permit fees for
building, electrical, and plumbing. It is estimated that each bathroom will take roughly 5-6 weeks for
completion for a total of 10-12 weeks
Payment schedule: Given the back to back nature of this project, the payments can be broken up into
individual projects. I estimate the first floor to cost approximately $30,000, with the second floor
costing approximately $24000. Each bath will require a deposit of 1/3, a progress payment of 1/3 after
rough inspection, and 1/3 due on completion of each bath. Exact dollar amounts of each payment to be
determined.
Thank you for the opportunity to work on your home, I look forward to a successful project.
Accepted by:
Michelle and Tom McCra
Rob Isbell, Isbell General
w' Date:
Contracting: Date: ! I
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