The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #150 - 21 IRVING ROAD 8/22/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 702P-,— IMPORTANT: ,— IMPORTANT:A licant must complete all items on this page LOCATION V(W .& Print /`l PROPERTY OWNER e C 7 !^.✓ ,� Unit# „� Print MAP NO:� Z— PARCEL: 6) ZONING DISTRICT: Historic District yes Machine Shop Village yep no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,KRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'Septic ❑We11 0 Floodplain D,Wetlands D Watershed:District El Water/Sewer DESCRIPTION,OF WO TO BE PERFORM 21 Le-,Yio Identification Please Type or Print Clearly) OWNER: Name: Phone: ??P— Address: 7P—Address: 2 V CONTRACTOR Name: eL M c t�: Phone: 7701:1 INK Address: a Y-1 ,-C- 1 Supervisor's Construction License: 2,?S p Exp. Date: ca 2 Xx Home Improvement License: _�D Exp. Date: c' Z 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: $ 61W! -;OLdD00 AZ1vL-F FEE: $_ Check No.: Receipt No.:� f C/1 ., NOTE: Persons ntracting with unregistered contractors do not have access to th uaranty f d Signature ofAgent/Qwnertu> Signature,o_ft ntractor Building Department The following is a list of the required forms to q 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 o Building Permit Application ❑ Certified Surveyed Plot Plan j Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract Li Floor/Crosse ctlon/Elevatio n Plan Of Proposed p d Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 o 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 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 submitted with the building application Doc: Doc.Building Permit Revised 2008mi J� 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i 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 j INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Q Planning Board Decision: Comments li 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. i 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 it NOTES and DATA— For department use I I, I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 1 Location CIE 3:-,Ly 1 No. Date �oR,M 01TOWN OF NORTH ANDOVER •.•o ,•,tib f 9 Certificate of Occupancy $ sACNUs c� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24494 Building Inspector r The Commonwealth ofMassachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA. 02I11 1UV www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Con>EvactorsAFIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/f adividual):�=Cl M e_t r," (— Address: O /�. -e /� City/State/Zip: ,M e `rnw_C M 19 Phone#:_ ? ,7e (Pc�So Are you an employer?Check the appropriate box: Type of project(required): 1.( T am a employer with�_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.i 'Remodeling 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 101-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.F1 Roof repairs insurance required.]i 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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lain an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �eJ C h Policy#or Self-ins.Lic.#: _T i9 w C / Z d�3.3 Expiration Date: /2Z2 Job Site Address: rR v City/State/Zip: Attach a copy of the workers'comp4sa,tion 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 7S1:doherebyee if under•the p • an alfies ofperjury that the informationprovided above is true andcorrect. ature: Date: F 2 Z,,- Phone#: 9 7e P Eco on y. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: 08/22/2011 11 :55 FAX 9787940313 DURSO&JANKOWSKI INS AGCY 002/002 -rte OP ID:SR Akft " CERTIFICATE OF LIABILITY INSURANCE OAT 08122DlYYYY) os/zzh 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAI_ INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of Such endorsement(s). PRODUCER 876-688-7000 CONTACT Durso S Jankowski Ins Agcy LLC PNON� FAX 198 Massachusetts Avenue 978-688-7001 c_No.@x"l AIC No$: North Andover,MA 01845 F-MAIL Durso&Jankowski Ins.Agcy. RdDu�BR -- u„�TOMERGOUCH-1 INSURER(I AFFORDING COVERAGE -_ NAIC0 •.,..,.____._.-...,...�...r...�...-------.._._,...—_....� ..—.r-`•.—'—•------••--------INSURER --T. _ INBURQD James Goucher :Guard Insurance Group Four Old Bear Hill Rd INGURLER 0:MSA G_roup_ - 14788 Merrimac,MA 01860 INSURER C: - INSURRR D: ^ INSURER E: ..� INSURER P! 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 15 SUBJECT TO ALL THE.TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS. INSR /Ypp OF INSURANCEADDLNUBR "y POLICY EFF POLICY E P POLICY NUMBER DrVYYY MM/DDIYYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,00 B X COMMERCIAL GENERAL LIABILITY MPS61466 12/13/10 12/13/11 PREMISES Ee oan oos9 - $ $00,000 —E]CLAIMS-MADE 7 OCCUR MED[XP(Any one person) S _ PERSONAL B ADV INJURY S W 11000,000 —. GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGO S 2,000,000 POLICY L PRO- LOC S AUTOMOBILE LIAHIUTY COMBINED SINGLE LIMIT $ ANY AUTO (Ea eccldenl) -- ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per eccldenl) S SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Parawident) $ NON-OWNED AUTOS g s UMBRELLA LIAB OCCUR EACH OCCURRENCE B EXCESS LIAB — CLAIMS-MAGE AGGREGATE $ DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY A ANY PROPRIEYORIPARTNER/EXECUTIVE YIN JAWC122833 12/07/10 12/07/11 E.L.EACH ACCIDENT 8 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E•L.D18EASE-EA EMPLOYCE S 1,000,000 Ifyon,tleeeribo under DESCRIPTION OF OPERATIONS below__t, E.L.DISEASE-POLICY LIMIT I$ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VENICLES (Attach ACORD 101,Additional Remarks Sebadule,It Mary■Paan in requlrsd) Carpentry- CERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OP 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. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD ='= Miissachusetts- Departnicnt of Public SjifetN Board of Building Regulations and Standards Construction Supervisor License i License: Cs 28520 Restricted to: 00 JAMES N GOUCHER 4 OLD BEAR HILL RD MERRIMAC, MA 01860 J" Expiration: 10/24/2011 (771— r#: 7105 Office�PZ�odsQ?1i'ci► ig �$ft�ihe�"5`R� 4 HOME IMPROVEMENT CONTRACTOR Registration: 103459 Type: Expiration: 718/2012 Individual JR' GOUCHER t James Goucher 4 Old Bear Hill Rd. : Merrimac,.MA 01860 Undersecretary NORTH An f T ®own ®ver .. No. 0 o , dover, Mass., a �- 1 Y - LAKE COCHICHEWICK %AERATED Cl MP9RBOARD OF HEALTH PER� M IT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THATL ...... ...............U.......... .. ..................................t. .IA.......................................................... Foundation has permission to erect........................................ buildings on .. A 't.t.vA4Ait,................. Rough I tobe occupied as..... ,._ ............... ......... .... .0�.. ....... �.. ... 4A0.*-. 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 qa— PERMIT EXPIRES IN 6 MONTHS 1 S ELECTRICAL INSPECTOR UNLESS CONSTRV Rough ....... ............................... ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIREE_DEPARTMENT Until Inspected and Approved. by the Building Inspector. Burner Street No. SEE REVERSE S O P E Smoke Det. f PROPOSAL JAMES GOUCHER Page No. 1 of 2 Pages CARPENTER/BUILDER All home improvement contractors and subcontractors engaged 4 Old Bear Hill Road in home improvement contracting,unless specifically exempt from Merrimac,MA 01860 registration by provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. (978) 346-8950 Inquires about registration and status should be made to the Director,Home Improvement Contract Registration,One Ash- burton Place,Room 1301,Boston,MA 02108 617-727-8598.Own- ers who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. Llc.# 028520 MA Reg. # 103459 TO: PHONE: 978-794-9550 Ted Harney and Sheila Pendelton DATE : 5/3/2011 21 Irving Rd. N. Andover, MA 01845 JOB NAME/LOCATION: Same We hereby submit specifications and estimates for: Renovations to 1st and 2n floor bathrooms. Work to include: 1St floor Remove ceiling and replace with new mold resistant sheetrock and dispose. Install new mold resistant sheetrock on wall to right of washer/dryer(owner to remove existing drywall). Build out recessed section of wall directly behind vanity and install new mold resistant sheetrock. Build out wall on front left side of vanity as required and install new mold resistant sheetrock. Reinstall baseboard as required. Install new vanity,top and faucet(to be supplied by owner). Labor and materials $1,877 2nd floor Remove tub and drywall around tub and dispose. Install new Sterling 4 pc. tub unit. Install new mold resistant sheetrock around new tub and patch up as required. Remove wall section to left of vanity and patch up as required. Build out recessed section of wall directly behind vanity and install new mold resistant sheetrock. Install new sheetrock over entire ceiling. Install new vanity,top and faucet. Cut out left side of vanity around heat duct and box in as required. Plumbing allowance to be $850. Owners to supply vanity,top and faucet,new Sterling tub unit and trip waste, and new tub/shower valve. Labor and materials $3,864 Proposal does not include painting, electrical work, installation of medicine cabinet or mirror, floor work or cost of permit if necessary. Pg. 2 of 2 Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 3 years following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, Employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall, at his own expense, forthwith remedy,repair, correct,replace, or cause to be remedied, repaired or replaced, such damage or such defect in materials or workmanship. The forgoing warranties shall survive any inspection performed in connection with the agreed-upon work.. WE PROPOSE hereby to furnish material and labor- complete in accordance with the above specifications, for the sum of. Five thousand seven hundred forty one ($5,741.00) Payment to be made as follows: $3,000 when work begins and $2,741 upon completion. All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra Authorized charge over and above the estimate.All agreements contingent upon strikes,accidents or delays Signature /"`r�� beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our workers are fully covered by Worker's Compensation insurance. Note: Thi oposal may be withdrawn by if not accepted within 30 days Acceptance of proposal- I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above. You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. Signature Signature Date of Acceptance: 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES