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Home My WebLink AboutBuilding Permit #378 - 280 JOHNSON STREET 11/7/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION e�3J Permit N0: Date Received Date Issued: Il RORTANT:Applicant must complete all items on this page LOCATION . t PROPERTY OWNER Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District (es no Machine Shop Villageno100 year-old structureno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial aeration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other 'IMT 5 ept ®We �` = _Fyloodpl ' ®Wetland 's © Wa�hed ►is rictg ' �W� '� � DESCRIPTION OF WORK TO BE PERFORMED: (IdentificatiPlease a or Print Clearly) OWNER: Name: ��1 Phone.<4 7� Address: CONTRACTOR Names�e� e� Phone 7e_39 Address: 34 Supervisor's Construction License: �b��3 Exp. Date: Home Improvement License: Exp. Date: a_11_1 f i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $r�'� v� • c�e� FEE: $ sq Check No.: Recei No.: NOTE: e\ersons contracting wit� r�grstered cont s no a the guaranty fund �S gnature:of Agent/Owner - S gnatu're of icontiactorr:'.` - j Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Pfahs-E]-' 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 DATE REJECTED DATE APPROVED it PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS .o 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 Town Engineer: Signature: - Located 384 Osgood Street FIRE DEPARTMENT - Temp Duximpster 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. 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 ® Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 ❑ 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 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 Doe: Doc.Building Permit Revised 2008mi i Location �`r No. 2 Dated L-- I • - TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ �n Other Permit Fee $ TOTAL $ s Check# 25920 Building Inspector Enter construction cost for fee cal- North Andover Fee Cakulaflon Construction Cost $ 299500.00 m $ - $ 354.00 Plumbing Fee $ 44.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 44.25 Total fees collected $ 542.50 280 Johnson Street 378-13 on 11/7/12 Bath Remodel NORTIj ' - Tow . . � , tEl, A- ic . - ve- No. _ LI N. h ver, Mass, 19;62! COC NIC Nl WICK �� A04ATE 0 1 Q 5 S u BOARD OF HEALTH Food/Kitchen .PERNUT LD Septic System THIS CERTIFIES THAT ..............1.. ...I.I .. BUILDING INSPECTOR Foundation has permission to erect . ... buildings on . T..h'*kVNA.&Aw...t.. ......... ........ ... ........ ..... Rough to be occupied as ........ .........Y � =..4 ................:................. 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 3S PERMIT EXPIRES IN 6THS ELECTRICAL INSPECTOR UNLESS CONSTRUCT N A T 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 I Street No. 3 SEE REVERSE SIDE Smoke Det. � C The Commonwealth ofMassachusettsfu 0 , - bepartmint of Xndustpial Accidents Office oflnvestiga&ns 600 Washington Street Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance Affidavit:Buildiers/ContractorsIFIectricians/Plumbers A hcant Information Please Print Le Name(Business/Orgaraationwivi&d)• ! eel-\ Address:441 (� - City/State/Zip: e % (jA<- Phone#: Are yo n employer?Check the appropriate box. Type of project(required): 1. I am a employer with 21' 4. ❑I am a general contractor and I ' 6. ❑New construction employees(full andtorpart time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. g, ElBuilding addition [No worl€ers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Blectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself[Noworkers'comp. c.152,§1(4),andwehaveno 12.[]Roofrepairs insurance required,]t employees.[No workers' -13.❑Other comp.insurance required.] *Anyapplicant first checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ale doing all work and then hire outside contractors must submit anew affidavitindicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy h6nmation. I am an employer that is provulm* workers'compensation insurance for my employees Below is thepollcy and job site information. --r Insurance Company Name:, Policy#or Sel£-ins.Lic.#:�i� "3�C�a Q 1p Expiration Date: oi 3 Job Site Addr=2-kc nc�Ytgl&A Zhu City/State/Zip:' ,w1 . 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 o.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 DTA for insurance coverage verification. Ido hereby i nde aloes perjury that the inforrnadon provided above is true and correct - J Si afore: Date: P one#: 7--)9 7?54 Official use only. Do not write in flits area,to be completed by city or town offrcial 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 - - - ContactPerson: Phone#. Page 1 _of RODDEN CONSTRUCTION License#28538 47 Prescott St. N.Andover, Ma.01845 Expires:09105/2013 978 687 2934 PROPOSAL TODAY'S DATE JOB NAME 10117112 Duncan and Polly Pyle DATE OF PLANS/PAGE#'S JOB LOCATION 2&0-Johmon St.-North Andover, Ma.01845 We propose hereby to furnish material and labor necessary for the completion of: Supply materials and labor for a total master bath renovation.Totally gut the area removing all ceiling, wall,and flooring materials down to the original framework. Frame in partitions to create new closet areas and shower wet wall as shown on the drawing submitted. Plumbing will be all new from the basement up and will include all rough and finish including setting all new fixtures. Electrical will include re-routing some wiring and adding new circuits if necessary. Finished walls will be blueboard with plaster skim coat. Finished floor to be the chosen by owner. Shower walls to be the over cement board and shower floor to be the mud job.Create a seat in the shower with material to be chosen by owner.A glass enclosure will be the entrance to the shower. Finished door and window trim to match existing. No painting is included in this estimate.All building permits and job debris removal are included.This project will be done on a time and material basis plus a fixed fee of$2000.00. Hourly rates for carpentry are: Mike=49.00, Paul=49.00, Dave=45.00.All materials and all subcontractors will be billed at cost with no markup.All invoices are to be paid upon submittal. We propose hereby to furnish material and labor-complete in accordance with above specifications for the sum of: Estimated cost of twenty nine thousand five hundred dollars ( $29, 500.00 ) Payment as follows: 2,000 00 at contract signing,all other invoices paid upon submittal All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance.If either party commences legal action to enforce its rights pursuant to this agreement,the prevailing arty in said legal action shall be entitled to recover its reasonable attorney's fees and costs of litigation relating to said legal action,as determined b competent jurisdiction. Authorized Note: this proposal may be withdrawn by us Signature if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, Signatures specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature C d�-�— Payment will be made as outlined above. Date of Acceptance YANW.THECONTRACTORSGROUP.CO.1 _ F _;4 W k. V -� C,4 C-t— 4(H4D fM ? 11 Mill 1 { { f � I { 1 { I { 1 �rd N { cLos 2-6«Y_2-c,f u G ala it -� ^C40RLY CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 11/07/2012 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 j 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). PRODUCER OS CONTACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC. (Al No, E%q: (978) 686-2266 FAx (� I,y):(978) 686-6410 M.J. FOSTER INSURANCE SERVICES ADDRE', cfernandez@nafins.com 163 MAIN STREET PRODUCER R ID R4ODDEN CARPENTRY CUSTOMEi" NORTH ANDOVER MA 01845-2508 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A MRCHANTS INSURANCE GROUP 23329 RODDEN CARPENTRY INSURER B :TECHNOLOGY INSURANCE CO 47 PRESCOTT ST INSURER C : INSURER D INSURER E NORTH ANDOVER MA 01845- INSURER F , 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) (MWDDIYYYY) LIMITS A GENERAL LIABILITY YBOPI054995 2/01/2012 2/01/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY _DAWGE TO RE D PREMISES Ea occurrence) $ 500,000 CLAIMS MADE �OCCUR / / / / MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO JECT LOC / / / / $ A AUTOMOBILE LIABILITY ACA7015515 7/16/2012 7/16/2013 COMBINED SINGLE LIMB $ 1,000,000 ANY AUTO / / / / (Ea accident) / / / / BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $PROPERTY DAMAGE rX SCHEDULED AUTOS / / / / HIRED AUTOS / / / / (Per accident) $ NON-OWNED AUTOS / / / / $ $ UMBRELLA LIAB OCCUR / / / / EACH OCCURRENCE $ EXCESS Lae CLAIMS-MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ / / / / $ B WORKERS COMPENSATION TWC3302016 1/01/2012 1/01/2013 WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/N X TORY LIMITSI ER ANY PROPRIETORIPARTNERIEXECUTIVE❑ / / / / E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMSER EXCLUDED? N/A (Mandatory in NN) / / E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under 500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ OESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 120 MAIN STREET AUTHORVED REPRESENTATIVE NORTH ANDOVER MA 01845- ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(2oo909) The ACORD name and logo are registered marks of ACORD