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HomeMy WebLinkAboutBuilding Permit #682-14 - 29 KARA DRIVE 4/7/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. Date R eceived /7// Date Issued: 'IMPORTANT: Applicant must complete all items on this page LOCATION r m IL PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO:0 r C} PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCARIPTION OF WORK TO BE PERFORMED: Lu (�-L_ No"r (2> C C - 4 Ar t, 3G! F_� �) Identification Please Type or Print Clearly) OWNER: Name: `ri ►J Phone:L/ Address:�� � � i� l� I OBD._ t� 6Y' et )V1 A- 0 C 9'q � CONTRACTOR Name: R�1-Ek-r- 1_406 -EV) 0 Phone: c7 -/7_76'F_" t(o -% Address: AN6Cr'� )tA A Supervisor's Construction License:. Exp. Date: �- Home Improvement License: M 17 1 0 Exp. Dater 1( i 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: $ �� FEE: Check No.: I q t® Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t guars ty fund . _ __ _ _.,_. _ Signature of Agent/Owvner -- Signature of contracto , Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - Plans Submitted ❑ 'Plans U1laived-❑. r.Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF=SEAMRAGE"DiSP-0-SAL, ` Public Sewer ❑ Tanning/Massage/Body Art ❑ ... Swimming Pools ❑ Well ❑ Tobacco Sales Food Packaging/S.ales ❑ Private (septic tank, etc.. Permanent Dinpster 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 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConnectionlS_i_gnature Date Driveway Permit DF W 'To` o lEnpneer: Signature: Located 384 Osgood Street FIRE DtPARTiI ENE - Temp Dumpster on site .yes no Located at-124Mair, Street Fire Departure►it signata'r`eldate COMMENTS, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area; sq. ft.: ..ELECTRICAL: Movement of. Meter. locat on, mast or service drop requires approval of Electrical Inspector Yes No DANGER.Z®NE 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 2010 Building Department The fol',3wing is'a- list of the required forms -to be filled out'for:the appropriate -permit to be obtained. Roofivg, 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 FireDepartment 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 apn,?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.Building Permit Revised 2012 Location No. ' 1 Date Check # MCI r . `. TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee $jam Foundation Permit Fee $ Other Permit Fee $ TOTAL $� M 1 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ %550.00 m $ - $ 114.60 Plumbing Fee $ 14.33 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 14.33 Total fees collected $ 243.25 29 Kara Drive 682-14 on 4/7/2014 Bath Remodel 7 mom ;o t u 'B O �- v ++ N O0 a). N _ W Z Z C 7 LL C O — C LL I= O W Z Z m d — LL O u Wa Z J V u W Q. as i N N 11 O w H Z Q �E co ILL 0 `Z r 4mo 0 0 H Q LL Q Q O m t u 'B O �- v ++ N O0 a). N _ W Z Z C 7 LL C U — C LL I= O W Z Z m d — LL O u Wa Z J V u W Q. as i N N 11 O w H Z Q O O CG co ILL Z W Q W W oc � L• 7 co O N N N 0 Y 0 N In J O u cn �E o Z: m o z CLc'0 - N_ o 7 • • '_ • A 3 �.. oo L Q a CD �M u 0 •N cm Q i i O •a = d Q O •O fn ` O O 2 m W_ _ 'D- O O o LUU) CL 0 FZ N N = W .E V d1 i U Q O O •, N 0 0 4= c O � O CL o " a 0 CL o V J U) W w CL W H W CL I.L Z 0 J V, w L.: U) c = C O O � o Q cc Q. as cc 0a o d • EC E °' L COL V °' CD s • O O 0 C 3 r CCo L m Nf� > _ ca _ o to OC CD > O N — 'a O 0 Cc = t U r Q cn �E o Z: m o z CLc'0 - N_ o 7 • • '_ • A 3 �.. oo L Q a CD �M u 0 •N cm Q i i O •a = d Q O •O fn ` O O 2 m W_ _ 'D- O O o LUU) CL 0 FZ N N = W .E V d1 i U Q O O •, N 0 0 4= c O � O CL o " a 0 CL o V J U) W w CL W H W CL I.L Z 0 J V, w L.: U) c Page 1 of 2 IJDLIN,0BEIRT LANGEVIN ®® Building & Remodeling, LLC 795 Dale Street North Andover, MA 01845 (978) 686-3607 HIC # 111990 FID # 26-0816298 JOB DESCRIPTION Bathroom remodeling 1.We will obtain all necessary permits 2.Demo bathtub, vanity, tile floor, and plaster walls sufficient to install new tub 3.Install cast iron tub, new shower valve, rough plumbing for lavatory 4.Relocate wiring for new light fixture above vanity 5.Durock in tub area to receive tile 6.Prep floor with durock to receive floor tile 7.Duct existing ceiling fan to outside 8.Install vanity, finish plumbing, new light fixture, wall tile in tub area, floor tile, wood Baseboards, and mirror 9. Reset existing toilet I O.Provide and install granite vanity top using a remnant from Napolitano Granite Co 11.New blueboard and plaster as needed 12.All cleanup and trash removal 13.Note that the job cost does not include the cost of finish plumbing and electric fixtures , , the vanity, and the mirror 14.To arrive at the job cost we are using an allowance for cost of tile at $7 per square foot �U Homeowner Information Contractor Information Name Company Name )j S� �4; g€fi�T )_ANG V1 " R)196: 6- ,J G -Icy t Street Address (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Name f— v`Z9 VD I �" F— ARA- S� 3cul j- tj y K) City/Town State Zip Code Business Address (must include a street address) N6 4N Dpi MA o i FL5 `1 `1� 7 A-� 5t-- I�k'>a. AN1W�►- V'1A D i � y' Daytime Phone. Evening Phone City/Town State Zip Code 5`0 7 2q 3 6�_`/-7s ������� r ;�_6-a7l4�;5� Mailing Address (It different from above) Business Phone Federal Employer ID or S.S. Number Law requires that most home Home Improvement Contractor Reg. Number Expiration date improvement contractors have n valid regnumber mber 0 9 ' U ;ZA 1 The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.) P1 C_ME 5E(-- /�ccM �ANr Ism JCk 7ESCid)P-Tioo Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be �, �� �,/ excluded from the Guaranty Fund provisions of [ / 1 // 1 Date when contractor will begin contracted work. MGI., chapter 142A.) �— q Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule� ��� U a The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: M Payments will be made according to the following schedule: 0e0 h3' upon completion of f WoR K y $ �J upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special ----tepaid-fery------_ ordered before the contracted work begins in order to meet the completion schedule.(**) $ L4 -P-1. NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty -Is an express warranty being provided by the contractor? No ❑ Yes (all terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. ll0 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES? 71 Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor. Homeowner's Signature ontractor's Signatu e +I1-t/I� c / Date Date IS a3 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor License: CS402685 ROBERT M LAN9-9VIN . - ' �'� " ► 795 DALE ST N ANDOVER MA 01845 Expiration Commissioner 02!2412016 C_��e �tn�unica�ccr�ev�/� o�fr'f[�auae�cc�e%/; Office of Consumer Affairs & Business Regulation ! - rME IMPROVEMENT CONTRACTOR egistration, 111990 Type: expiration: 2/11/2015 LLC ROBERT LANGEVIN-BLOLDING LLC. ROBERT LANGEV'^!- 795 DALE ST N ANDOVER, MA 01845 Undersecretary TSS www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Lelzibly Name (Business/Organization/Individual): C, w G— L Address: 01 �'ys City/State/Zip: ;fid- YV\A Phone S 3 b/© 7 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2 -1 n a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. # These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. nOemodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *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 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: Policy # or Self -ins. Lic. #:. Expiration Date: Job Site Address: City/State/Zip: 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 inay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert,(fy unq�r the pahp and penalties of perjury that the information provided *ove isltrue and correct.' Phone #: r / b gK^ 3 O o / Official use only. Do not write in this area, to be completed by city or town offciaL 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 #: The Commonwealth of Massachusetts Department of Industrial Accidents ill �I1_ U j1 Office of Investigations „ 600 Washington Street /E Boston MA 02111 TSS www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Lelzibly Name (Business/Organization/Individual): C, w G— L Address: 01 �'ys City/State/Zip: ;fid- YV\A Phone S 3 b/© 7 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2 -1 n a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. # These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. nOemodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *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 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: Policy # or Self -ins. Lic. #:. Expiration Date: Job Site Address: City/State/Zip: 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 inay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert,(fy unq�r the pahp and penalties of perjury that the information provided *ove isltrue and correct.' Phone #: r / b gK^ 3 O o / Official use only. Do not write in this area, to be completed by city or town offciaL 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 numbers) 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 cavy 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 pen-nit/license number which will be used as a reference number. In addition, an applicant that must submit multiple pennit/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 pen -nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen -nit 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 Fax # 617-727-7749 Revised 5-26-05 wwvv.mass.govldia