HomeMy WebLinkAboutBuilding Permit #454-13 - 200 BRADFORD STREET 12/7/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ��/�� Date Received
Date Issued: 1 4 v
IMPORTANT: Applicant must complete all items on this page
LOCATION C) C) 5 t.
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PROPERTY OWNER i�' y 1 Qt1 OrLi zatC3 C?� D 3Q-
,,, Print 100 Year Old Structure yes no
MAP NO: PARCEL ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Reside tial Non- Residential
❑ New Building ne family
❑Addition ❑Two or more family ❑ Industrial
Iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
[Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershe6District -
W Vater/Sewer
i DES RIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: PIXI-) I a e\A j= L i za ne+k 2 0..E-; Phone: G'-7 9 (o to L-4
Address: -Po r
CONTRACTOR Name: r\Awero-ows+, C&Phone: SQ 3" Q L4
Address: 13- A �00et-
Supervisor's Construction License: 5 -Exp. Date:_
Home Improvement License: Exp. Date: , aL. ( 3
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF E TOTALLEESTIMATE l rrj41MED ON$125.00 PER S.F. ,
Total Project Cost: $ L4 , ® FE
® . O L� tic.'� E: $ � 40
Check No.: /a , ` Receipt No.: 12602-
NOTE: Persons contracting wi unregistered contrkctors_do not have access to the guarantyfund
(Signature vof Agent/Owner. � � Sig nature.of'contractor
__
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Location
No. `I5 Date
• • TOWN OF NORTH ANDOVER
•
Certificate of Occupancy $
'' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
• j
26020 Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ TanningNassageBody 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
i
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Towp- Engineer: Signature:
Located 384 Osgood Stregt
FIRE DEPARTMENT - Temp Dumpster onyes np
Located at 124 Main Street /1
Fire Departinedt 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 Dieter 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
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Doc.Building Permit Revised 2010
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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
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o 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 Construction (Single and Two Family)
❑ Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o 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 submAted with the building application
Doc: Doc.Building Permit Revised 2012
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
4%000.00 m
$ - $ 480.00
Plumbing Fee $ 60.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 60.00
Total fees collected $ 700.00
200 Bradford Street
454-13 on 12/7/2012
Kitchen Renovation
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Town of ndover
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No. 4 13 * _
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COCHIC141WICK y1.
�f.9s RATED 11"P
U BOARD OF HEALTH
RM I T' T LDFood/Kitchen
PE . Septic System
THIS CERTIFIES THAT .......U.. .! P..l :.................................. ........... BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on �Rqe.do ..��'. ...S ..........................
Rough
to be occupied as ............. .. .t:frrr!l..........&-imeqV ................................................................ 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT STARTS Rough
Service.
..... ..... .�j . ....................
��1''�" ....--................ 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.
SEE REVERSE SIDE
CONTRACTOR AGREEMENT
THIS AGREEMENT made the 5th day of December, 2012 by and
between Robert Moore ,hereinafter called the Contractor.
137 Forest.St.
No. Andover, MA 01845
and Paul and Elizabeth Rosati
200 Bradford St.
North Andover, MA. 01845
Witnessed, that the Contractor and the Owner for the consideration named agree as
follows:
Article 1. Scope of the Work
The Contractor shall furnish all of the materials (except the cabinets,light fixtures and
appliances) and perform all of the work described in the Specifications entitled
Addendum A, as annexed hereto as it pertains to work to be performed on property at
200 Bradford St
Article 2. Time of Completion
The work to be done under this contract shall be commenced on or aboutJanuary 2nd,
2013 and completed within 2 months of start.Time is of the essence.
Article 3. The Contract Price
The Owner shall pay the Contractor for the material and labor to be perlorined under
the Contract the sum of $24,200.00 , subject to additions and deductions
pursuant to authorized change orders.
Article 4. Progress Payments
Payments of the Contract Price shall be paid in the manner following:
At Signing of Contract $6,000.00
I
Additional payments will follow Addundem A breakdown
Article 5. General Provisions
1 All work shall be completed in a workmanship like manner and in compliance with
P P P
all building codes and other applicable laws.
2) To the extent required by law all work shall be perfonned by individuals duly
licensed and authorized by law to perform said work.
3) Contractor may at its discretion engage subcontractors to perform work hereunder,
provided Contractor shall fully pay said subcontractor and in all instances remain
responsible for the proper completion of this Contract. Sub Contractors work for North
Andover Construction Co.;any extra work preformed by them will be billed as Extra
Work Orders.
4) All Extra Work orders shall be in writing and signed both by Owner and Contractor.
5) Contractor warrants it is adequately insured for injury to its employees and others
incurring loss or injury as a result of the acts of Contractor or its employees of
subcontractors.
6) Contractor shall at its own expense, obtain all permits necessary for the work
described herein to be performed. The Contractor will also be responsible for
implementing on- site work required of the Order Of Conditions (OOC) issued by the
Town Conservation Commission if one has been issued. The Owner will be responsible
for implementing all administrative conditions of the OOC including but not limited to
required recordings at the Registry of Deeds, bond postings, as-built plans or obtaining
the Certificate Of Compliance.
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7) Contractor agrees to remove all debris and leave premises in broom clean condition.
8) In the event Owner shall fail to pay any periodic or installment payment due
hereunder, Contractor may cease work without breach pending payment or resolution of
any dispute.
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9) Contractor shall not be liable for any delay due to circumstances beyond its control
including strikes,casualty or general unavailability of materials.
10) Contractor warrants all work for a period of 1 year following completion.
11) Contractor has given The Lead-Safe Certified Guide To RENOVATE RIGHT to
the customer. The customer has read and signed the pre-renovation form.
12) Any landscaping, driveways and sprinklers that we disturb during construction will
be repaired to the best of our ability within a reasonable cost. This excludes any work
that is part of the agreed contracted work and cost is included in the price.
14) If Owner chooses to have their own sub contractor perform work they will solely be
responsible to schedule work, delivery of materials and warranty die work performed. If
any damage to work that has been performed by or will affect the job performance of
North Andover Construction Co.,then die Owner will be billed directly for cost of
repairs.
15) In any case where unsuitable soils exist or ledge is found, an additional charge may
be billed to accommodate the additional costs.
Article 6. Other Terms: NONE
Notice:
All home improvement contractors and subcontractors engaged in home improvement
contracting,unless specifically exempt from registration by provisions of Chapter 142a of
the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries
about registration and status should be made to the Director, Home Improvement
Contract Registration, One Ashburton Place, Room 1301, Boston MA 02108.
Designated Registrants Name Robert Moore
Registration Number 162156
Salespersons Naive Robert Moore
Notice:
No agreement for home improvement contracting work shall require a down payment
(advance deposit) of more than one-third of the total contract price or the total amount of
all deposits or payments which the contractor must make, in advance, to order and/or
otherwise obtain delivery of special order materials and equipment,whichever amount is
greater.
Notice:
If the homeowner obtains his own construction-related permits for the work described
under this agreement, the homeowner is hereby advised that.in the event of a dispute,
judgment and nonpayment of the contractor, the homeowner will not be entitled to
make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L
SPECIFICATIONS
As specified in written quote. (attached)
ADDENDUM A PAGES 1 AND 2
GUARANTEE:
The contractor shall guarantee that he will make good, at his own expense, any defects
arising from poor or improper workmanship for a period of one year after completion or
provide the same guarantees from his subcontractors or from manufacturers of materials
and/or appliances installed in this home. This building will conform to all muiucipal,
state,and federal regulations affecting this work.
HOMEOWNER:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signed under seal this 5th day of December, 2012.
Signed ithe presence of-
By n e
By
Contractor
B
y --'z— --
Owner
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office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Type
Registration: '162156
V
Expiration:--j-126120.-1.3 DBA
NORTH ANDOVE,4, OIf�UCTCON CO.
ROBERT MOORE z> y
137 FOREST ST Gia
NO.ANDOVER,MA 01$85'=<> Undersecretary
Massachusetts- D t. t , -
cl a-i ntnt tt Puhlic Satets
Board of Building Re,-,u I at ions and Standards
Construction Supervisor License
One-and Two-Family Dwellings
License: CS 52483
ROBERT G MOORE
137 FOREST ST 0
N ANDOVER, MA 01845
An
Expiration: 2/6/2013
t'r unnr ksiuoc r' Tr#: 9582
North .Andover Constriction Co. 137 Forest street
Remodeling/Kitchens and Baths/Basements North Andover,MA
Robert Mare
Owner
i ♦r" 1 I
North Andover Construction Co. '
137 Forest Street
North Andover, MA 01845 50&509-9440
Licensed and Insured
bobmoorcO1845Ca, crizon.nct
Paul and Betsy Rosati
200 Bradford St.
North Andover, MA.01845
RE: KIICHEN REMODEL
PERMIT: Contractor is responsible for the permit and permitting process.
DEMO : Contractor to bring in a 30 yard dumpster for all debris. The cabinets,
countertops, flooring, doors,trim,the underlayment etc. to be removed and put in
dumpster. The customer is free to use the dumpster and acknowledges that no hazardous
material will be disposed of.
ELECTRICAL: The contractor will hire and pay for all the electrical work. The work
will include 3 -5"recessed lights, 2 additional outlets on wall, 1 outlet on island, 1
hockey puck light in glass cabinet, 2 lights over island, 1 light over sink,upgrade stove
outlet, remove phone line on wall,relocate switch in kitchen to hallway, add switches as
needed to control lights. The customer will purchase the 3 hanging fixtures. This proposal
does include the upgrade or cost of the electrical panel in the basement. It may be
necessary to upgrade the panel for the kitchen remodel.
PL.UMBBING: The contractor will hire and pay for all the plumbing work. The work will
include installing a stainless steel under-mount sink, faucet and strainer. The allowance
for these items is $600.00 and will be purchased at Peabody Supply. New shutoffs are
included. The customer will get the contractors pricing. Install new baseboard heat trim.
WOODWORK: Install a new entry door into the kitchen(allowance for door is
$500.00). Remove closet door,window trim, baseboard and trim from cased opening
into the dining room. Install, stain and poly new trim and doors.
FLOORING: Install a 3/4"x 3"to 4"pre-finished hardwood floor. The allowance for the
flooring is $5.50 a sq. ft.. The customer will get contractor pricing. Screw down existing
subfloor to eliminate any squeaks.
ADDENDUM A
CABINETS: The customer is responsible for the purchase of the kitchen cabinets. The
contractor is responsible for the installation.
GRANITE: The customer will select the granite from Gerrity Stone in Woburn. The
allowance for granite and installation is $5000.00. There will be no granite backsplash.
TILE: The customer will select the backsplash tile from National Tile in North Reading.
The allowance for the tile, grout and caulking is $250.00. The contractor will hire and
pay for the installation.
APPLIANCES: The customer is responsible for the purchase of the new appliances. The
contractor will install a dishwasher, stove,microwave with a recirculation kit and a
refrigerator.
PAINT: painting will consist of stripping the wallpaper,Patchin any holes,painting
the ceiling and walls.
The price for the Kitchen Remodel is $24,200.00
The following is a payment breakdown:
$6000.00 at start
$4550.00 after rough electrical
$4550.00 after floor installation
$4550.00 after cabinet installation
$4550.00 upon completion
AC PTED:
Paul Rosati Date Robert Moore Date
11 izabeth Rosati Date
ADDENDUM A
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Ulf. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information LPlease Print Legibly
Name (Business/Organization/Individual): Q Q. Ano 0 u e r-- G oro,5+r lJC T i Dnj C�
Address: 1 '3-1 S+
&%0—
City/State/Zip: r0,0 ea A d 0",p r- Q 1 g H Phone#: 509 50 cl CJy 1.l U
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
Kloyees
(full and/or part-time).* have hired the sub-contractors ,R,2. a sole proprietor or partner- listed on the attached sheet. I Lremodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their
10.❑Electrical repairs 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.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
�Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information,
—
F am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
?reformation.
:assurance Company Name: & G e— GL ry% ,e P 1 Coo PJ f l
?olicy#or Self-ins.Lic.#: (4)C, H G 3 Q' P5 i T I[ — A Q Expiration Date: �
d � ` ,ma
lob Site Address: ��® 13/`� � 'pr � + No•(,►n�OLWity/State/Zip: n d UJ('f' Qi gy,5'
attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
'do hereby cert' under the pains and penalties of perjury that the information provided above is true and correct.
.i nature: Date: I `al
'hone#: 5 C) A 5 0 R q t4 N C)
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
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
EZevised 5-26-05 Fax# 617-727-7749
www.mass.izov/dia
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