Loading...
HomeMy WebLinkAboutBuilding Permit #21 - 215 OLD CART WAY 7/7/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 NLIED 1 q t D l6 16iti Permit NO: Date Received Date Issued: V� �4SSACHUS���� IMPORTANT: Applicant must complete all items on this page LOCATION! 5 O t C(:.A.,r-f LAJcA-y , -J& lgnd&-tr Print PROPERTY OWNER ✓'•'C. �s cel/ G �o c•��y Print MAP NO.: !� PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building One family ❑ Addition ❑Two or more family ❑ Industrial FAlteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only ESCRIPTION OF WORK TO BE PREFORMED / 1 l / T Lcrosf,Vu-eA a. T(. X S' 6,. SV1 Ul�-e�. 11�k.J 04 A-2 fy 3 T Q- Alav,,— Identification Please Type or Print Clearly) r L ; 4-W ha✓ GQc. oOWNER: Name: Phone: 9 76Y7 7/h Address: (5 CONTRACTOR Name:1� L-�c�r� CGy� d'4G�rUn r L Phone: 9 7 9a 'Z2 Address: SU G �G�a ti 2--e-e--ed 2z&Lr=r6 A2 Supervisor's Construction License: fl, Exp. Date: ��/G 2616 Home Improvement License: �3�1 �a Exp. Date: G/2Y ) 2,01/ T ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ Uy FEE:$ Check No.:��(/ Receipt No.: Page Iof4 i i TYPE OF SEWERAGE DISPOSAL Swimming Pools 11ElTanning/Massage/Body Art ❑ g Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �,�,, Signature of contractor. �OVT Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE,USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 4 COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS - r DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT -.Temp Dumpster on site yes no Fire Department signature/date - COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted Y es Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Si�nature& Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: NOTES and DATA—(For department use) I I I i i Page 3 of i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 cel orkers Comp Affidavit hoto Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 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:BPFORM05 Page 4 of 4 Location No. Date NORTH TOWN OF NORTH ANDOVER o� ,..° F 9 Certificate of Occupancy $ E Building/Frame Permit Fee $ Mus Foundation Permit Fee $ ,. Other Permit Fee $ TOTAL $ Check # 22 "i go Building Inspector NORTH ® of t 4 over . No. 2,/ - .,. dover, Mass., • 0 - LAKE COCFIICNE.C. V %�oRATED P'PG - 6 BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ch!111� ��... Foundation has permission to erect........................................ buildings on.a� ... r Rough to be occupied as........1•KA4! ... ... . Qwszlk ........ .............. 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 3� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TARTS Rough Service SP Final ..... ... ............... ................ BUILDING INR 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 FIRE DEPARTMENT' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ACORDCERTIFICATE OF LIABILITY INSURANCE OPIDCR °ATE.MRDAYYY) JLWAR-1 06/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone: 781-914-1000 Fax: 781-246-2601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual INSURER B: Technology Insurance Co. J. L. Ward Construction, Inc. Kathy Ward INSURER C: 50 Glidden Street INSURER D: Beverly MA 01915 INSURER E: COVERAGES 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 CONTRACTOR 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.AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR NGDL POLICY EFFECTIVE POLICY EXPIRATION LTR NSRDTYPE OF INSURANCE POLICY NUMBER DATE(MMAODIYY) DATE(MAMMY) UMRS GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 DAMAGE TO RENTED A R COMMERCIALGENERALLIAMLTTY MPP8989B 06/18/09 06/18/10 PR EMISES(EsomumMe) E 500,000 CLAIMS MADE OCCUR MED EXP(Arty one Iaveon) E 10,000 PERSONAL B ADV INJURY E 2,000,000 GENERALAGGREGATE E 2,000,000 GEN'L AGGREGATE UM R APPUESPER: PRODUCTS-COMPIOPAGO E 2,000,000 PRO POLICY JECT LOC AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT E 1,000,000 A ANYAUTO M8P8989B 06/18/09 06/18/10 (1. 0n") ALL OMJED AUTOS BODILY INJURY X SCHEDULEDAUTOS (P.Person) E HIREDAUTDS BODILY INJURY S X NON-OVMEDAUTOS (PeraatleN) PROPERTY DAMAGE (Per accitlenq $ GARAGE UABIUTY AUTOONLY-EAACCIDENT E ANY- OTHER THAN EA ACC E AUTO ONLY: ADD E EXCESSNhIDNELLA LIABILITY EACH OCCURRENCE E OCCUR CLAIMS MADE AGGREGATE E E DEDUCTIBLE E RETENTION E E WORMERS COMPENSATION AND x WC STATU- OTH- TORYLIMRS I I ER EMPIAVERS'LIABILITYB ANPROPRIETOR/PARTNER/EXECUTNE TWC3174315 07/28/08 07/28/09 E.L EACH ACCIDENT E 500000 Y OFFICERIMEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE E 500000 Ilyee,Msame Tatler SPECIAL PROVISIONS ENow E.L.DISEASE-POLICY LIMIT E 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY FJLDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DEECRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS MrTMN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER ITS AGENTS OR To whom it may concern REPRESENTATIVES. AUTHORIZED REP ATNF ACORD 25(2001/08) ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lepibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): ,�," YP P J 1.IJ 1 am a employer with S 4. ❑ I am a general contractor and I 6. [J 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. 1 7 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 10.E] 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' comp. insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy infonnation. 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A-64 ,'rC ,nT Policy#or Self-ins. Lic.#: 11A 8 8q g Expiration Date:,/ b Job Site Address:915 DyC Uty-+- w!+•y City/State/Zip: e. 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 hereby cer ify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: �i a Phone#: Cf f] q a(_ ��� 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 Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia �� = Massachusetts- Department of PUI)Ilc Safety BoclffBoard of Buildinl- Regulations and Standards HOME IMPROVEMENT CONTRACTOR Construction Supervisor License Registration: 139222 License: CS 63821 Expiration: 6/24/2011 Tr# 284953 Restricted to: 00 Type: Private Corporation JEFFREY L WARD J.L.WARD CONSTRUCTION,INC. 50 GLIDDEN STREET JEFFREY WARD BEVERLY, MA 01915 50 GILDDEN ST. BEVERLY,MA 01915 Administrator Expiration: 9/16/2010 ('nnuniseimer Tr#: 2308 Restricted to: 00 License or registration valid for individul use only 00- Unrestricted before the expiration date. If found return to: 1G-1 2 Family Homes Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Failure to possess a current edition of the I Massachusetts State Building Code is cause for revocation of this license. J valid without signature Refer to: WWW.Mass.Gov/DPS I f �. .. A IJ.L. WARD CONSTRUCTIOW DESIGN&REMODELING SOLUTIONS ****PROPOSAL**** 1 YEAR WARRANTY ON ALL WORKMANSHIP PROPOSAL SUBMITTED TO: PROPOSAL.05.22.09.1 Eric and Gaynor Checkoway Date: June 30, 2009 215 Old Cart Way North Andover, Ma 01845 (978) 764- 7710 Page: 1 of 3 Dear Eric and Gaynor : We respectfully submit our revised proposal (# 05.22.09.1) for the interior renovations to your master bathroom at 215 Old Cart Way, as per the proposal submitted by JLWC. The permit fees for the project have not been included. Demolition: We will remove and properly dispose of the construction related debris as follows: We will remove the existing interior floor tile & wall tile, whirlpool tub, vanity, shower stall, closet and portions of wall and ceiling to allow for the renovations. A partial gut of the areas required for the renovation. Waste Removal Allowance (JLW): $465. Framing: We will provide the labor and materials for the framing of the renovated spaces in the existing master bath; new shower and blocking for cabinets if applicable. We will frame for a small linen closet at the existing closet location. We will frame a wall between the toilet and the makeup area which will house a magazine rack, with a shelf and two storage drawers. Electrical: We have provided an allowance for the electrical portion of the project as per the industry standard (schematic not available) the allowance includes an electric radiant heat system in the floor, recessed lighting locations to be determined, vanity light, shower light, an exhaust fan and toggle type switches. All ceiling fans, chandeliers, pendants, sconces or otherwise flush mounted lighting fixtures to be supplied by the Owner and installed by us. Electrical Allowance: $ 3,000.00. Page 2 Plumbing and Heating: We will provide the labor and materials for the installation of the plumbing fixtures. p p 9 Remove and reset toilet, new vanity with double sinks, new shower pan, shower valves and rain head fixture. We will supply and install water lines, vent and waste lines tying into the existing. We will supply and install approximately six (6) lineal feet of Suntemp baseboard heat, tying into the existing boiler. Plumbing Allowance: $ 3,000.00. Heating Allowance: $250.00. The Bathroom Fixtures and counter tops will be purchased by the Owners and installed by JLWC. Walls and Ceiling: We will provide and install Y2" blue board and skim coat plaster with a smooth finish to the wall areas as needed for weaving into the existing, we will cover the entire ceiling in the master bath with 3/8" blue board and skim coat with plaster for a smooth finish. Interior Doors &Trim: We will provide and install 8009 FJP 3 5/8" crown molding to the ceiling area, apply new B225 Stafford trim to the window and doors (we will re-use the existing doors), and B400 base molding. All the interior trim materials are pre-primed white. Flooring and Shower Tile: We will supply and install tile to the floor area of the master bath, we will provide a "mud job" to the shower pan in the shower area (approximately 3' 6" x 5' 0") we will supply and install backer board to the walls and supply and install tile to the floor, walls and ceiling in the shower area. The tile material portion of the tile allowance is: $ 8.00 per square foot and there is approximately two hundred sixty nine square feet (242) of tile. Tile Allowance: $5,413.00. Painting: We will apply one coat of latex primer to the walls and ceiling, apply one coat of latex ceiling paint to the ceiling, and apply two coats of latex eggshell wall paint and two coats of latex semi-gloss to the interior trim (colors by owners). Clean up: I We will provide daily clean up and we will remove and properly dispose of all construction related waste leaving the home broom clean at the completion of the project. Page 3 Pre-Completion Checklist: Homeowner and Contractor will review all work performed to insure that the project has been completed as specified. Any remaining details will be part of this checklist. On completion of these checklist items, the contract will be complete and final payment will be due. Any issue that arises that is not listed in the pre-completion checklist will be treated as warranty work and will not impact the final payment. TOTAL COSTS FOR ALL ITEMS LISTED ABOVE $ 26,504.00. PAYMENT SCHEDULE: WITH ACCEPTANCE OF CONSTRUCTION AGREEMENT $ 3,924.00 PRIOR TO COMMENCEMENT OF DEMOLITION $ 5,728.00 PRIOR TO COMMENCEMENT OF ROUGH PLUMBING $ 5,728.00 PRIOR TO COMMENCEMENT OF PLASTERING $ 5,728.00 PRIOR TO COMMENCEMENT OF TILE $4,088.00 DUE AT CHECKLIST WALK THROUGHT $ 654.00 AT COMPLETION OF CHECK-LIST $ 654.00 ACCEPTANCE OF PROPOSAL: the enclosed prices, specifications and conditions are satisfactory and hereby accepted. Signed and Sealed: �2Date:_ C) Pr s e t! gent rR Signed and Sealed: 11 Date: I d/ Signed and Sealed: � Date: July 1, 2009 To Whom it may concern, We give Jeff Ward of JL Ward construction permission to obtain a permit on our behalf, for 215 Old Cart Way, North Andover MA. Sincerely, C C/-I c'ad ' Eric A. Checkoway Gaynor Checkoway i y i a N"j0SWf t '6)6 G� r r 1)X1 , ►Y 9,� it -