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HomeMy WebLinkAboutBuilding Permit #700-14 - 295 CANDLESTICK ROAD 4/10/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received LOCATION_. ' R-R- -ORCrk NO/ /,- IMPORTANT: App ILI must complete all items on this Az "fv*~ 44 lies- Yo <19E .TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building �e family El Addition El Two or more family 0 Industrial te'Alteration No. of units: El Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: 11 Demolition 0 Other Septic 'a ,W. fiDESCRIPTION OF WORK T FORMED: ZQ n�lle—rolj BE PER 0 if MY ROW 73 40eW 17&AA%eeW9 O*Wbf A17W gr?t" S4tWe-e 4/v Si .rz- eW^wz.,e% 11r -r- /x Identification Please Type or Print Clearly) OWNER: Name: Phone: AV14 -r-f -00,7' Address: e7r' CfiAZ407e-jr 4A. 11-AtA,,AcvC7e To- R kDONTRA ;Phone Fw 1!r3le- <- ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BA-,fD ON $125.00 PER S.F. Total Project Cost:$ Z9,1'7,11 FEE: r Check No.: Receipt No.: NOTE: Persons contracting wi unregistered contractors do not have access to 0qrgutqrqntyfund Plans Waived ❑ Certified Plot Plan El Plans Submitted e Stamped Plans El �y TOWN OF NORTH ANDOVER il Certificate of Occupancy $ Building/Frame Permit Fee . $3j Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted L7 PlansWaived'❑ Certified Plot Plan ❑ Stamped Plans ❑ TWE:OF.;SSEWER-GE I}ISPOSAL- Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. .Swimming Pools ❑ Well ❑ Tobacco.Sales -Food Packaging/Sales ❑ Private (septic tank, etc.- ❑ .-- -permanent Dempster on Site ❑ THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE.APPR-OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS T HEALTI3 Reviewed on Siqnature COMMENTS 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 Toivz Engineer: Signature: Located 384 Osgood Street FIRE MIr DEPART_Ni :='Temp Dumps#er on site :yes no Located'bH24 Mair, .Strde_ t Fire"Depa`rtine►�t 5 ' - 4 -- , . ignature/date � _ ' :,. COMMENTS .-.-Dlii ensIobi 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 ONE LITERATURE: Yes No MGL -.Chapter 166 Section 21A -F and G min.$100-$l000.fin.e NU I t5 and UA I A — (dor department use LJ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foi,!S ing W a list of_the required.forms to be:filled out foe the. appropriate. permit to'.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ B.tailding Permit Application a 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 apr).,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building permit Revised 2012 The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations IF 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: Ay,3�l�✓ fT City/State/Zip: Phone #: �' P�� •0 324 Are you an employer? Check the appropriate box: 1. am a employer with 4. ❑ I am a general contractor and I _� 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 ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. 1:11 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] f employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 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. tContractors 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 pollcy and job site information. Insurance Company N OV.. Policy # or Self -ins. Lic. #: �G,f Expiration Date: Job Site Address: ty 444W,04' 4/ 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert,#Xn d444dp 9JV andpenalties ofperjury that the information provided a0ve is true and correct. Phone #: /l'ZDi" 03Z4 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 #: OP ID: BR '41� �"* CERTIFICATE OF LIABILITY INSURANCE DA) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 01 /13/2014 01/13/2014 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 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 Durso & Jankowski Ins Agcy LLC 198 Massachusetts Avenue North Andover, MA 01845 Durso & Jankowski Ins. Agcy. CONTACT NAME PHONE FAX A/c No Ext): AIC No): E-MAIL ADDRESS: PRODUCER pREVI� CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Ace Home Medics LLC 57 Harold Parker Road INSURERA: INSURER B: Andover, MA 01810 INSURER C : Utica Mutual Insurance Company INSURER D: 4687243 INSURER E: 09/27/2014 INSURER F: MED EXP (Any one person) $ 10,000 COVERAGES CERTIFICATE NUMBER: REVISION IUt1MRFR- 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. ILTR TYPE OF INSURANCE I ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER MM/DD/YYYY MMIDD�Y LIMITS I I GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE lxl OCCUR 4687243 09/27/2013 09/27/2014 DREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PR0. LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED BODILY INJURY (Per accident) $ SCHEDULED UTAUTOS SCHEDULED AUTOS PROPERTY DAMAGE $ (PER ACCIDENT) HIREDAUTOS $ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMEER EXCLUDED? N / A 4687246 09/27/2013 09/27/2014 X WC STATU- OTH- TORY LIMI S ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatoryin NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) carpentry - CERTIFICATE HOLDER rAnIrF1 I ATInnI NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE I I — 464� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor D8A License: CS -100212 MATHEW S PRE", TE f` 57 HAROLD PAIUMR ANDOVERMA 0181b ` Undersecretary ANDOVER, MA 01810 Expiration Commissioner 03123/2016 -7 /� rrr rir yeit. r/t� r �lu Business Regutahon ptficc of Consumer Affairs.& TRACTOR ; MENI CON Type-. pNVE IMPR4v �f��tegistration: 153165 tVjxPiration: 1116/2014 D8A a�%I MAT PREVfTE HOME MEDIC MATTHEW PREVITEy- PARKER ROAD":g--�'--�� 57 HAROLD Undersecretary ANDOVER, MA 01810 f Office: 978-207-0326 JF rax:978-207-0329 IYf;sl"Ct ;Fi r fi'vEtiEEt3ttl[ C(jE1F --ytit�e'.tt€ iForta�ttie€1[csC:s)y1: HIC; Lic. * 153165 construction S(mcr.:i.,ic. 9100212 .51titnatelAgreemetlt 9: 2257D i3`ate: FebruatT 23; 34(4 :Scope of Renovation _ __ _ Partial bathroom renovation to include the removal ofthe existing plumbing fixtures: building of a new enlarged showcr enclosure, doubic vanity, i toilet, medicine cabinets) or mirroi(s), new electric radiant heat and tile on bathroom floor and the installation of other bathroom accessories. - --- 57800 s 13 a' �� SI ERVI -Remove existing fiberglass shower enclosure, toilet, vanity, flooring (to the existing subfloor) and ceiling (bathroom walls to remain) ¢iVyAR€ A ''s Home Medics, LLC �'•;!'t'1 .<.i lam; • � - --'. s. �'3':.. i� Cost EstimaenlAgreertaent farServices North Reading MA Proposal Submitted 7o.- 1 Kris Kosheff 295 Candlestick Road North Andover, MA01845 f_:781-532-4014 EN1. %..'oshi'fi:it`conrra>t tact Job Location: 295 Candlestick Road North Andover, NIA 01845 Bathroom Renovation _ :Scope of Renovation _ __ _ Partial bathroom renovation to include the removal ofthe existing plumbing fixtures: building of a new enlarged showcr enclosure, doubic vanity, i toilet, medicine cabinets) or mirroi(s), new electric radiant heat and tile on bathroom floor and the installation of other bathroom accessories. - --- 57800 ;Carpentry. Construction ht the existing full bathroom use will: and Administration -Remove existing fiberglass shower enclosure, toilet, vanity, flooring (to the existing subfloor) and ceiling (bathroom walls to remain) i -Remove suhflooring in proposed shower area for plumbing relocation - Modify floor framing as is necessary for new plumbing route -Instill new subfloodrig where necessary -Install electric radiant heat mat and thermostat l i -laviall kali niche -install water proof sbuwcr base and stone banker in showzr area, rrili rucl is and on bathroom fluor Install mater proofing membrane and sealant on shower. vvalls,.wall. niche and shower tloor install new file over bathroom floor and on ahotver floor -Install stone slabs _{or ('l,) bench lop and ("1) curb Relocate and install new fanilight combo in bathroom ceiling I -Install new medicine cabinet(s) or mirvor(s)- vanity, finish millwork, paper/ towel+curtain rods and other bathroom accessories -L"xistin r bathroom door and window will remain; new exhaust fan wf.11 be vented tothe exterior Proposed show r:mciosure will extend into the existing window casing i prelusive of proactive communication with clients and suppliers as will as permitting, administration & coordination or entire ro'ect. Numbing Plumbing work to 2800 -Disconnect existing fixtures fix demo -Rework plumbing for new shower location and sive and new shower head location -Replace all shut of valve's to siWks and toilet 1 -install now toilet, double sinks, faucets, drains, shower valve, standard shower head and handheld -Provide all necessary permit and inspections; test all work for proper operation. _ Electrical Electrical work to: $1300 -install new tanilight combo in new location . -Add (1) GPI at vanity location i :Add =cssed light in shower area Replace (2) sconce vanity lights, add (1) sconce vanity light t Install circuit and wiring fnrclectric radiant hent !-Provide all ecce son permit and ins[ections; ice all work for proper operation_ fang &Plaster Hang newblueboard on bathroom coiling and on walls where necessary; plaster newblueboard smooth 5500 ,Prep, Prime & Paint ;Prep, prime and paint bathroom walls, ceiling and trite; two coat finish. $I lot) Shouwr Glass Allowance?Approximate cost for glass shower Panels andror door. Actual cost tube determined kvhen personal selections are made or approved. _ _ '1800 6howe,--. Solid Surfaces 'All granite or solid surfaces will be teniplated, -applied and installed by StoneCne as per their quote 9127I1 hot tial! nal ii?sta!! the hench r(,oncl $8247.63 !car)) top. 111M will install. the Bench lop andeurh rop and will work closely with SiotR7OAe to coordinate template, fabrication and installation. BuiidingMaterials Shower pan &, wall kit, insulation, electric heat matand thermostat, subflooring, tile backer board, framing lumber, water proofing membrane and 53199.37 1,sealam, fan venting and louver door, thin set, fasteners, adhesive and othe related, mise. materials necessary. Unless othemise preferred and !specified, homeow-ner(s) wil supply tile, grout, will melte, curner soap dish, vanity, mirror or medicine cabinet(s) and finish electrical and {plumbinefixturts(except recessed light) but A1W, will assist with suppliers, del;'vertes pickups. Di P., On. site disposal containerfor old building materials and related debris. _ 13550 !building Permit Fec !Building permit fee; based on 512/51000 of mal pmiect rust. 5324 .__ L _ _ Taal 52772t Additional '!'eras and Condhions: I i glue upon start; L'3 due upon completion qj plasterinc: 1.-6 dem prior to completion: halan;:e due tq�un cnmplelion. Pricds are. bused an tandard remoo71 & in,wilarivn. Addia mal work mqy be required due to rondiiinns that we enmxit.lee or predro, changes ti> the.scnpe of work urto tine f tialtaallan or mod? icaoon vispeo l,codons. Airy trork over and above tlratdea'cncwdltercaiflhebilled gcct,rdni 1y.14,7pnarlirvnlru%ardOdaret[['em.ro'7ak•ptcrtrtsof urrvork.ffyrutlntiotxant!} sapfctarry,rburtid,pleaseinllralhetr..___ ..,, c o stl vl ha c� cf / z3 t 7a s � "�}�2� e js �>7 �} `fid `t r � c ! 74Tk'clt.& ['lorrrintte flee flare: dies•. LLC. n i/1 a 1 u�arrarry on all icorknonship. i n+ . , provide year Thankyou very much for mur consideration. We greatly appreciate your business and took- forward to providing you with exceptional quality, in ca professionai; neat, timely and efficient manner. Our number one goal is your complete satisfaction. Aecealted: The above prices, specifications and .J �C31 `:;:conditions are satisfactory, and are hereby accented. Signature ate Ace home Medic ; LLC is authorized to do the work as specified. -.Payment will be made as outlined Signature Date DVe. ;y" En_* in J �9 LJJ Z Z c O a c O LL L bD O > 41 C E t U c6 c LL p H W O. z C7 Z a t m O K _ m C LL O U N z Q V cJ w t CA 7 O d' U •i 4J V) C LL O a Z . N t pp 7 O cr C LL H z LU a n LU D oWC LL N C 7 m Z *' N d �-+ V) v Y O E VI x J W x p m c Em v v v Y \ U a •,_, O Q LL V) in J �9 O LU Z Z �M W U) Cl) F.. O Cl) E !^ L W Z r CL s W > aU) U) Xz o w O � U a, cn oCCn W az m � 0 O N d s y.. 0 z • 0 Q J O s W O Q� L O O C� z N ' o � W Q _ N i •V W 0 caoC- a CL CD Q ._ U Jca 'a ��- o U)z � v U) ca i c CL O i N O •a c � o Q. _41, (1) Q +•" C `U O O Ea �L L y O N o 0 C 0 V N O C CL inJ W > C i N N d O d C yQ s � S 0 O O Z C Q' c o y O C.M QCD M C's•cn :o=E as Q Qi � •O N � V m O � •'a� O .N 0-0 N Q d •> y_ _ s Op O Q. o U , O LU Z Z �M W U) Cl) F.. O Cl) E !^ L W Z r CL s W > aU) U) Xz o w O � U a, cn oCCn W az m � 0 O N d s y.. 0 z • 0 Q J O s W O Q� L O O C� z N ' o � W Q _ N i •V W 0 caoC- a CL CD Q ._ U Jca 'a ��- o U)z � v U) ca i c CL O Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 273721.00 m $ - $ 332.65 Plumbing Fee $ 41.58 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 41.58 Total fees collected $ 515.82 295 Candlestick Road 700-14 on 4/10/2014 Bath Remodel