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HomeMy WebLinkAboutBuilding Permit #163-14 - 24 LANCASTER ROAD 8/19/2013 TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION fq Permit NO: I Y f Date Received 1 I Date Issued: — F IMPORTANT: Applicant must complete all items on this page LOCATION Z L/- L aAc4 7Ci— koc cc Print /� PROPERTY OWNER 1 SC:, i� Akvn-- P- -TTo.il Print 100 Year Old Structure yeso MAP NO: PARCELDA� ZONING DISTRICT: Historic District yes (�nono Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ©-One family ❑Addition ❑Two or more family ❑ Industrial [?Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DES RIPTION OF WORK TO BE P RFORMED: A c Ad oc�l AUc.JJ/' 4A, Identifition Please Type or Print Clearly) OWNER: Name: '3/1070--) Phone: Address: ZL� Ac.,, fM �( tde's , Z'1( rr: CONTRACTOR Name: C�1��1� i S�� c�5 Phone: &g?Y)7/S`-7 U Address: �O 13Ox "i0 7 { f�ie71 l r4!`'/ Supervisor's Construction License: C.S ' c?,S' A Z S'y' Exp. Date: -7/Z 6'7-5– Home Improvement License: Exp. Date: 4 /I// ( Zy/4� 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: $ 6Ot v vv _ y d FEE: $ Check No.: �U Receipt No.: �� i NOTE: .Persons contracting with unregist red contractors do not have access to the guaranty fund i Signature of Agent/Ow � Signature of contractor Plans Submitted ❑ s Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-_OF`.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMtlm'TS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair, Street Fire Departmeid signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on 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 and DATA— (For department use LJ Notified for pickup - Date E I Doc.Building Permit Revised 2010 Building Department The foliowing 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 ❑ 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) ❑ 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 apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Builjing Permit Revised 2012 LocationC�Y 144Z'�194� No/(.08 l Date • - TOWN OF NORTH ANDOVER • `GED} ` . Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL `� $ CheckIp� e- Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 603000.00 m $ - $ 720.00 Plumbing Fee $ 90.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 90.00 Total fees collected $ 1,000.00 24 lancaster Road 163-14 on 8/19/2013 Remodel Kitchen and Bath The Commonwealth of Massachusetts -' Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 UV www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): e-n Xv---1 48v CJ`3 C Address: ACS dj oY, 90 - City/State/Zip: 1-4 e_r�t ycn MA ©! YW Phone#:��z ��.f" 7 o 7 Are you an employer?Check the appropriate box: Type of project(required): 1.[-I am a employer with q 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. �• [ 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. El 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 12.0 Roof repairs insurance ]ired.re q ut 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. t Homeowners who submit this affidavit indicating they aie 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: ACC �1 0 S t///,t,tn( t Policy#or Self-ins.Lie.#: W C Z Z 000 V 16 TQ S Expiration Date: Job Site Address: LGin,ca snl' City/State/Zip:�� -ncto Lk,-, Al 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 cert' under the pains and penalties ofperjury that the information provided ab ve is true and correct. Simature: eC LJ Date: 1 C� / Phone#• Com--M 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 Instrnctions 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 bum 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 Mo ssa chu setts Department of Industrial Accidents Office ofInVestigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877,MASSAFB Revised 5-26-05 Fax#617-727-7749 www-mass.govldia NORTF{ Town of E ndover 0 "t Ah , ver, Mass, va COC NIc"t WICK �d A0R{TEO j`PP��(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD?W§�r4v . Septic System 1�-THIS CERTIFIES THAT .........L(A. .....*....... ..... fi.r* BUILDING INSPECTOR Foundation has permission to erect ........ ................ buildin s on .�.......�.Gc�lCa. ......�w/�..6 Rough to be occupied as ....... . ,R4... ...... ........'T.....'.3r......�G•44....... 1 ..�............ 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 INA MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUcjr&NsT S Rough Service ........ ...... ........................................................... 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 08/19/2013 13:30 19785212751 ANTHONY&MALCOLM INS PAGE 01/02 �DATEYYY) CERTIFICATE OF LIABILITY INSURANCE 13 CERTICER (978)373-5623 FAX (978)521-2751 ON Y AND CONFEATERS NO RIGW S UPOAS A N THE CERTIFICATE TER OF ION ANTHONY & MALCOLM INSURANCE AGCY-, INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3 S0. CENTRAL ST. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BRADFORD, MA 01835 INSURERS AFPOKIDING COVERAGE NAIC# IN9URED Century Builders, Inc. INSURERA: Nautilus Insurance Company PO Box 907 INSURERe: Acadia Insurance Methuen, MA 01844 INSURER C: Western Surety Company INSURER D: INSURER E: 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DA' PouCY EFF CTIVE POLICY EXPiRAT1ON LIMITS TYPE OF INSURANCE POLICY NUMBER GENERALLIABtLITY NNa47368 04/01./2013 04/01/2014 EACHOCCURRENCE S 1,000,OOO DAMAGE TO RENTED $ 50 OQQ X COMMERCIAL GGNL•RAL LIABILITY CLAIMS MADE aX Or;CUR MED EXP(Any one person) $ 5 0O PERSONAL&ADV INJURY S 1,000,000 A GENERAL AGGREGATE $ 21000,000 G6P1 L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG E include POLICY jElqr LOC ACOMBINED SINGLE LINT AUTOMOBILE LIABILITY $ (Ea pceldenl) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per pccldent) NON-OWNED AUTOS PROPERTY DAMAOE $ (Por accident) AUTO ONLY-EA ACCIDENT S GARAGE LIABILITY ANY AUTO OTHER THAN EAACC S AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ L S DEDUCTIBLE $ RETENTION $ wT08/ 6/2014 X WORKERS COMPENSATION AND WC202000016806 08/16/2013 ATU- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 100,000 B ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERNEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEES 100,000 11SPECs,IAL deseribe underPROVISIONS below E.L.DISEASE-POLICY LIMB 1$ S001000 OTHER opening Bond - 22168722 03/30/2013 03/30/20 .4 $5,000 C own of Methuen DESCRIPTION OF OPERATIOtiS 1 LOCATIONS)VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS eneral Contracting TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDFAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover Building di ng Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Buil Osgood Department . OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, No. Andover, t. 01845 AUTNORIZEDREPRESENTATIVE [Frederick Malcolm Jr. JA ACORD 25(2001/08) FAX: (978)688-9542 CACORD CORPORATION 1988 i 4�s A. CENTURY BUILDERS, INC PO Box 907 Methuen, MA 01844 Proposal Date: June 18, 2013 Proposal Submitted To: Work To Be Performed At: Lisa&Kurt Bratton I Same 24 Lancaster Road I Telephone: (310)482-7239 North Andover, MA I Email: KurtLisaLucygymail.com Scope of Work: To provide material and labor to remodel the Kitchen, Powder Bath, Living Room, and Sun Room as follows: Kitchen ($11,500.00) • Remove cabinets and store in garage • Build pantry closet • Patch hardwood floor as needed • Sand, stain and finish floor • Plumbing and gas fitting per plan • Electrical wiring, recessed and accent lighting per plan Powder Bath ($1,990.00) • Demo and removal of existing flooring. • Supply and install 2 '/2"x 3/4"red oak hardwood flooring • Sand, stain and finish floor • Supply and install new white elongated, comfort height toilet Connect plumbing to vanity sink and faucet Living Room ($8,860.00) • Pull up and dispose of existing carpet. • Remove wall between kitchen and living leaving approximately 2 feet for existing switches and repair ceiling. • Remove textured ceiling and make smooth • Supply and install 2 `/2" x '/4"red oak hardwood flooring and weave into existing kitchen hardwood floor. • Sand, stain and finish floor Sun Room ($3,400.00) • Demo and removal of existing floor. • Supply and install 2 '/2"x 3/4"red oak hardwood flooring. • Sand, stain and finish floor Not included in this quote: o Any painting or paint preparation. o Any cabinetry, vanities or tops. o Vanity sink and faucet. o Kitchen sink and faucet o Appliances and Appliance Installation o Light Fixtures other than specified recessed and accent lights. o Any unforeseen work such as major rewiring or plumbing. o Any unforeseen structural work or rot. We propose to supply all material and labor as specified for the Total Sum of Twenty Five Thousand Seven Hundred and Fifty Dollars, ($25,750.00). We anticipate it will take 3 weeks from start to finish to complete all work. Please return a deposit of$8,000.00 with signed agreement. An additional $8,000.00 will be due upon the installation of the hardwood flooring(installation only)and the balance will be due upon completion. Respectfully Submitted By: AA-�—V6—'1,�— Glenn T. Saba (978)815-7073 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. �l Signature: _ Date: Signature: Date: Remainder of Page Intentionally Left Blank Q KITCHEN WINDOW SLIDING DOORS 131 - 6" 71 DW i % i 14g, - Off T r! � � 1 FAMILY 1 ROOM 1 } DOWNDRAFT DOUBLE GAS COOKTOP OVENS � � P A � •-_ 36" _y Ou' MIC IN, REFR REFR '- art - 611 DINING HALL ROOM TO BRATTON FOYER DESIGN BY: K2 TOP VIEW 2D MICHAEL JAM JUNE 4, 2013 1-978-689-41 } S `� �vi . z 9RATTON DESIGN E K2 SINK VIEW MICHAEL JUNE 4, 2013 1-978-6E i LIL, ! i .1i a i n ','7. , 3 BRATTON DESIGN B1 K2 OVENS VIEW MICHAEL J JUNE 4. 2013 1-978-685 +t' i 77 I i s r I f i t r- y 4 SRATTON DESIGN K2 REFR VIEW MICHAEL JUNE 4, 2013 1-978-61 Q ® ✓�' �"a,. d'C:-,,.y.,. Aa .9PriY�G n iF a l.. ,.;�g- s i., ,M�� .tee: y��5.'v,'" d .'.�. 5 BRATTON DESIGN 13Y: K2 FURNITURE VIEW MICHAEL JE JUNE 4, 2013 1-978-689- 7M � O w d. R i ..................................... .... t 1 I 6 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-051254 \\.-`:.' GLENN T SABA 8 BRUSHW OOD DR ° s Atkinson NH 03811 j'""� Expiration Commissioner 04/17/2015 Office�f o;E"mer'"A airf�"r's fi ines� egulac�oo, License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the-expiration date. If found return to: Registration: ,t122505 Type: Office of Consumer Affairs and Business Regulation Expiration: ,`971;1/2014 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 G„ T.,SABA 7 ;; GLENN SABA n 8 Brushwood Drive ATKINSON,NH 03811 -' Undersecretary !!! Not valid without signat e