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HomeMy WebLinkAboutBuilding Permit #629-2017 - 21 FRENCH FARM ROAD 12/9/2016BUILDING PERMIT ,/�Iv TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: & q- % —2017 n,qtp [-.c;i im- 19- 1' 0) t ab j Date Received TYPE OF IMPROVEMENT PROP SED USE Resicibritial Non- Residential 0 New Building k-6ne family 0 AdFiti El Two or more family El Industrial .1h a 1, D Alt ation No. of units: 0 Commercial N,Kepair, replacement El Assessory Bldg El Others: 0 Demolition 0 Other 0Septie Well:- , Ibo,p pnEWetidh9 Floodplain. 9Water1-s-fi dIsffi6t EIV-Vqt6r/-S.eWer..- cl- OWNER: Name: 1\ Vk\ Address: 'D, RIPTION OF WORK.TO BE PF=KFUKML1J. - Please Type or Print Clearly' C6) and T,L G-Ontr;8b-tof- Name: 0.7 Address,- 1371 OLD C.A Supervisor's Construction License: -..-..Q)I--- Exp. Dater: a,0 1. H- ome I License: ARCHITECT/ENGINEER Address: Dpte,., (0 1 V Phone: FEE SCHEDULE: BULDING PERMIT: $IZ00 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. ac ss ebmareafund C) SidnatUre of cofifr�5cto,�.* Location P ( F r.- ;,A C No. (9 'Irl- 700 Date i -I' - '7 - '17� 0 / (-' TOWN OF NORTH ANDOVER Certificate of Occupancy $— Building/Frame Permit Fee $1 Foundation Permit Fee Other Permit Fee TOTAL Check# < I 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 ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature, CONSERVATION Reviewed on Sianature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Placining Board Decision: Conservation Decision: Comments 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 -Nmension Number of Stories: Total square feet of floor area, based 6h 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 Doc.Building Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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 DOTE: 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 t Doc: Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 3,700.00 m $ - $ 164.40 Plumbing Fee $ 20.55 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 20.55 Total fees collected $ 305.50 21 French Farm Road 629-2017 on 12/9/2016 bathroom remodel CD 0. CO CO CD CD rmllLO LTJ O i CA n 0 CD CD CD N O O CD a CD A cn m cn O 00 U) x_Ma U) = < -a , CD 0 .0 .� Q. C.) i71 o 3 N. N 0 0 .+ c. 0 m W 0 -a 0 CD CD x 0 m D v o 0 � (0 CL v cn. o � �3CD CD C) 0 < CO O O. N — "''O� N Ca O O• � =r rt n O = n O Qco 0 N X < N = :� O ;�,� :A �C CL Im •< CD w0 ;� U) 0 s 0 O cm 0 c CD CD y crtD �� •� i► co� C.) y . 0- CD o 0 0 0 0 CL V1 MW T .Z7 T N :Z T Za T (i a7 T VI T C �� O 3 fD O O O j =rO O (D O °—' � °—' < °—' °—' rD (D ac oma opo a Q z 0 0 L m 'O m G1 — N v o v z z v Z D H O 3 �m m O m m m r 0 0 O = 0 Oft C O � C 0 0 home owner. Job Description cont: J. Install vanity and linen cabinets according to design. K. Install 2 1/Z" colonial trim to window unit and door unit. L. Install 4 1/4" colonial base boards to bathroom area. M. Install shower glass door unit. N. Install towel bars and toilet paper holder. O. Vent out new fan and light unit. P. Disposal of all construction debris. Electrical segment E1. Move GFI oulet for new cabinet layout. E2. Remove old heat light unit. E3.Install new fan/light unit. Plumbing segment P1. Remove fiberglass shower unit. P2. Disconnect vanity sink and toilet unit. P3. Install copper pan to shower area. P4.Install Kohl mixing valve (supplied by home owner) P5.Install new toilet unit (supplied by home owner) P6.Install new faucet fixture to sink (supplied by home owner) All items listed above are in the total construction cost of $13,700.00 Permit is an additional charge. Ralph Goff 21 French Farm Rd. No.Andover, Ma.01845 Ronald Finocchiaro 187 Old Gage Hill Road Pelham, N.H 03076 Bathroom Remodel Ron Finocchiaro is responsible for the bathroom remodel at the address of 21 French Farm rd No.Andover,Ma. 01845. All construction and scheduling of sub contractors permits and inspections are our responsibility. Any unforeseen damage or additional work is subject to a change order agreed by both the contractor and home owner. The following is a job description of work to be performed. Job Description A. Demo the complete bathroom, walls and ceiling covering, floor and fiberglass shower unit. B. Install 1/2" blue board to wall and ceiling area with plaster finish smooth. C. Frame a 5" curb for the shower area to receive copper pan in shower area. D. Install rubber membrane in shower area. E. Install 1/7," cement board in shower wall area and on curb. F. Red Guard water protection to shower wall area. G. Install '/Z" cement board to floor area. H. Install ceramic tile (straight pattern) to shower wall area. Tile and grout supplied by home owner. I. Install ceramic tile to floor area (straight pattern) tile and grout supplied by Ho ow 'r Roi{ Fino hiaro D.B.A • • Q -l Felp-N -4-" ScALE. ,6C)v Zk,MA. o1%141, OP ID: LANK �coRv� CERTIFICATE OF E LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/08/2016 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(ies) 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 endorsement(s). RODUCER Phone: 978-688-6921 acdonald & Pangione InsuranceFax: 978-688-5350 )4 Main Street orth Andover, MA 01845 ichael Pangione CONTACT NAME: PAICHONE Ext E-MAIL ADDRESS: PRODUCER RONAL-6 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # ISURED Ronald Finocchiaro INSURER A: Preferred Mutual Ins Co 15024 INSURER B .Safety Insurance Company 295 Merrimack St Lawrence, MA 01843 INSURER C INSURER D: DAMAGE PREMISESS (RENTED 100,000 Ea occurrenceL_ INSURER E : X COMMERCIAL GENERAL LIABILITY INSURER F: rcoTrt_If1AT= ul Innrxl=Q• REVISION NUMBER: ♦VvCrx/117GJ 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. ISR TR TYPE OF INSURANCE ADDLISUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISESS (RENTED 100,000 Ea occurrenceL_ X COMMERCIAL GENERAL LIABILITY BOP 0100 71 59 14 11/15/2015 11/1512016 MED EXP (Any one person) $ 5,000 CLAIMS -MADE a OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED AUTOS SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB HCLAIMS-MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATUS OTH- T DRYLIMITS ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) / A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Evidence Of Insurance CERTIFICATE HOLDER CANCELLATION Town of North Andover Osgood St North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts _ Department of IndustrialAccidents M X Congress Street, Suite 100 Boston, MA 02114-2017 - - www mass gov/dia • 7 a'M sJ'vv VQa kers' Compensation jusuxaned davit: Builders/Contractors/Elect cians/Plumbers. TO BE MYD WIM THE pEl2MTTT NG AUTSORi� X. Name (Business/(jrgatiization&dividual): KQ) 0 b 1.a_ t '_' P c Address: City/SiatelZip_ T ���• N ©307 b Phone #: Axe you an employer? Check the appropriate box: 1.1]a employer with employees (full and/or part-time).' 2. am a sole proprietor or partnership and have no employees Working for me in ca achy TNou'orkmrs' comp. insurance required.] �)P2 �Y P doing all work myself [No workers' comp. insurance required.] t 3.E] I am a homeowner 4.F]I am a homeowner and will be hiring contractors to conduct all work on my properEy. Twill ensure that all contractors either have workers' compensation insurance or are sole proprietors withno employe6s. 5.r]I am a general contractor and I Have hiredthe sub-conEractors listed the attached sheet These sub -contractors have employees and have workers' comp. insurance.t 6. ❑We are a corporation and its. offices have exercised their right Of 'exemption per MGL c. 2 1 4) a Vwe have no employees. [No workers' comp. insurance required] Type of pro'ect (required): 7. ❑ N "donstnYciiOn 8, emodeliiig 9. ❑ Demolition 10 ❑ Building addition 11.[] Electrical repairs or. additions 12. [I -Plumbing repairs or additions 13%[]Ro6frepairs 14.[] Other 15,§( *Any applicant that checks box#1 must also fill out the section below showmgtheir -Workers' compensation policy information Homeowners who sub�tivs.amf . ust attached additional shegshowing the all -work name of en the scuba contra tors antors submit whether or not thoseen ties have h Contractors that check employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. dingworkers' compensation insurance for my employees. Below is thepolicy andj�ob X am an employ' that is Pro -VI site information. Insurance Company N, ExpirationDato' Policy # or Self -ins. Lxc. It _ � c� r�A 2 �• � _City/State/Zip: �% Q , ry "•• � a � � Job Site Address: a I � P� Attach a copy of the workers' compensation policy declaxation page (showing the policy number and expiratio'n date). to 0-00 Failure to secure coverage as require d nalties2inthe form of as STOP WORK ORDHR and a fine of up to $200.00 a and/or one-year imprisonment, as w P day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do liereb certi un ep enalties ofperjury that the information provided above is true and correct: Date: 1 ll Si ature: Phone #: in this area, to be cornpleted by city or town officiaL Official use only. Do not write City or Town- permit/License # Issuing AuthoX ity (circle one): 1. Board of ff ealth 2. Building Department 3. CityPJlown Clerk 4. Electrical Inspector 5. plumbiug luspector 6. Other phone #: Contact 0 int y >J 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 defuied as "an individual; partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enferpzise, and including the legal representatives of a deceased employer, or the receivet'or trustde 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 ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dweliirig 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 Iocal 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 applica) ttwhti has not produced -acceptable evidence of compliance with the insurance coverage r'equi'red." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter intp 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 ceiiificate(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 IndustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a urorkers' compensatiori policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lino. City or Town Of6.cials 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 BE 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 w or to 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite MO Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-I5 www.mass.gov/dia ,;? 1, m O Ocj Z O n O Z Z O O n C) w m n x oO a.am F: aoi ami to n r D." o °I 3 0 �� O OO =nT %t O 9 5� � ? . � W c ,ohm y m o n - w cn -1 N O o 2 mrO ... _ n 1Gy' 1 Cd� o:f, m = coo 4 Z C 0 D < A ooi v o `& 3 eCD ~• . ' N O J ....: •fir v � C� CL c rn N R W fllCL .o ...: ,;? 1, m�0 r n v Z DOr r y n to aoi ami to n goo �o viii 0 3 =nT != � ? z � W c m o n 0 N O o 2 mrO N C b 2•m m = coo 4 � v 0 D < A ooi v o `& 3 N O J _ v � C� CL c rn N R W fllCL � n Vi L0 d M a.: 00