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HomeMy WebLinkAboutBuilding Permit #867 - 34 WATER STREET 6/29/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;Z One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 'R Repair, replacement ❑ Assessory Bldg ❑ Others: Demolition ❑ Other in `%�✓' ', �"�f�'Sk „d'`� ':. @h P£ 3" }^f,t DESCRIPTION OF WORK TO BE PREFORMED: "'rzz n V-0-MAeT% tee (--A\ intAs W'WS -ru cA R'E ±5-J Type or Print Clearly) OWNER: Name: ne: 6Wt ARCHITECT/ENGINEER �� IA Phone: N1 A Address: /Vl Reg. No. M FEE SCHEDULE: BULDING PERMIT: $12.00 PE 1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: FEE: $ /D 765/.Gy Check No.: 0,' C7 Receipt No.: NOTE: Persons contracting--Qth unregistered contractors do not have access to the guara fund Signature of Agent/Owner ignature of contractor Plans Submitted X Plans Waived ❑ Certified Plot Plan ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Stamped Plans ❑ DATE REJECTED DATE APPROVED CONSERVATION ❑ COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Fff DATE REJECTED DATE APPROVED ❑ ❑ 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 ❑ 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 Located at 384 Osgood Street 1 t D i��4RT11 iT Tem Dmp ter ora�st es n� y Located a� 11airStre '10, up?trarridn't.sigFlaturQlate .� "fie 4 <"x-\.Jii%1,�YIENTS 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 A 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 <a --Building Permit Application -u—Workers Comp Affidavit -a- 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 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 New Construction (Single and Two Family) ❑ Building Permit Application Li 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 o Engineering Affidavits for Engineered products 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:BPFORM07 Revised 2.2007 Location JZ70' No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 2 0 6b 2 - ;v Buildi�(g;kspector UD s: J ��. O � c �- 0 0 z A O o � a 0 C a CM3 V •dam CLo R R U w : O m w cn w w x w� o cn v Q o cn CD s Qv W m O o Q -- H �.1� Q E c QO O m . m c CL= E �mo a 3 z O c I � h m a = c h 1p O `Eca o R CLL.) m y m NIP CD OyCL•: C O Q p •_ O _O Ln O C h O O Z O ` .r if v 00 CZ O c Q i O C •O = O ae C N CD W 0 .Ori= � dJ O W A r O N •d= O Z cz = r m •y -0 Q O C.3 .O O ®'.0 c CLMCOD d m O� = w � ` H � O $ dim > V% z 0 am O as ■ L O � v Z Q. O - H ® C O QM ''I � .0 W Q ■� LA O O CO m C O O CD Z O� � 3 CD 0 0 m O Off. Ii cnQ ca C C Z O CL V COD � C C C CL CO3 a c �- 0 ��m c o � c N O_ C CM3 V •dam CLo R R _ c O O : O m CD s Qv W m O o Q -- H �.1� Q E c QO O m . m c CL= E �mo a 3 z O c I � h m a = c h 1p O `Eca o R CLL.) m y m NIP CD OyCL•: C O Q p •_ O _O Ln O C h O O Z O ` .r if v 00 CZ O c Q i O C •O = O ae C N CD W 0 .Ori= � dJ O W A r O N •d= O Z cz = r m •y -0 Q O C.3 .O O ®'.0 c CLMCOD d m O� = w � ` H � O $ dim > V% z 0 am O as ■ L O � v Z Q. O - H ® C O QM ''I � .0 W Q ■� LA O O CO m C O O CD Z O� � 3 CD 0 0 m O Off. Ii cnQ ca C C Z O CL V COD � C C C CL CO3 a Maintenance Made Simple,. Seroonq your entire home. Client Name: Arthur Gordon Project Address: _ 34 Water St. City, State, Zip: _ North Andover, MA, 01845 Telephone (H): 781-254-3301 Telephone (C): ------------------ Estimate Date: 6/28/2007 MMS SR #: _ Estimate Valid Thru: Estimator: Contractor: 7/28/2007 Maintenance Made Simple 908 Salem Street Total Materials: $1,270.00 Groveland, MA 01834 Total Labor: $7,177.00 Ph: 978-373-7227 Fax: 978-373-7299 Total Estimate: $8,447.00 7 -scope,/SjJecifi ateria s' .. 1 Sheetrock Supply and install new sheetrock walls and ceiling $250.00 g. $1,475.50 2 — Plaster Plaster all walls and ceiling $250.00 $1,005.00 3 Tile Ceramic wall the shower area and 5 It upon the rest of the walls $85.00 $1,440.00 4 Floor— Install new subfloor $211.00 $732.00 5 Floor Install ceramic floor $200.00 _ $775.00 6 _ Plumbing Installtoilet,tub, —_ --_ $55.00 $150.00 7 Permits Permits and drawings — ---- — $200.00 $675.00 8 Misc Nails,caulk,screws — $100.00 9 Carpentry Extend bathroom 3ft x 4ft — — — ------ $140.00 $540.00 10 --- - ----- - -- - 11 Carpentry Frame in window 1 $50.00 $100.00 -- - --- - --- ------- _ v Prices can change up to 15% due to material costs changing Estimated Sub -Total Material: $1,270.00 Estimated totals: $1,270.001 $7,177.00 Maintenance Made Simple 908 Salem Street Total Materials: $1,270.00 Groveland, MA 01834 Total Labor: $7,177.00 Ph: 978-373-7227 Fax: 978-373-7299 Total Estimate: $8,447.00 7 Maintenance !Ulacle Simple., Servicing your entire home. MMS Service Request #: Terms & Conditions: 1.) Materials purchased for the job will be charged in addition to the labor costs. These materials are guaranteed to be as specified. All materials carry a warranty as specified by the manufacturer. A nominal mark up might apply to certain jobs as a warranty cost. In addition, some jobs may also incur rental charges for specialty equipment. 2.) All payment required upon completion of job. Large projects may require a scheduled payment pian with payments required upon completion of each project phase. Acceptable forms of payment include: major credit cards, checks and cash. if payment is not received at completion of job, the credit card on file will be used to pay balance owed. 3.) All work to be completed in a workmanlike manner according to standard practices. Maintenance Made Simple carries a limited one-year warranty on all work performed. Some exceptions may apply. Any akerabon or deviation from standard practices as directed by client will void all work warranties. 4.) Owner or customer to carry usual premises insurance. 5.) Maintenance Made Simple carries full General Liability Insurance. 6.) It is further agreed that in the event payment is not made as agreed above, interest on all unpaid balances shall accrue at the rate of 1 '%collo per month from the date work was completed. Additionally, if legal action is take to collect unpaid funds, the client agrees to pay all costs and expenses of collection, including reasonable attorney's fees. 7.) The client agrees to pay $25.00 for any returned check for insufficient funds or stop payment. 8.) The prices, specifications and conditions on this document are satisfactory and are hereby accepted. Maintenance Made Simple is authorized to do the work specified. 9.) While Maintenance Made Simple will make every effort to complete projects within agreed timeframe some factors may extend the project timeline. Acts of God, weather, special orders, material shortage, crew shortage, project changes and adjustments. Customer agrees to accept these delays due to these and other circumstances. 10.) 1 represent that if 1 am not the property owner, that I am authorized by the property owner to enter into this agreement. 11.) A facsimile signature is as valid as an original for the purposes of this agreement 12.) Each Maintenance Made Simple franchise is independently owned, operated, and insured. This contract is with the local Maintenance Made Simple Franchise. The Franchisor, Maintenance Made Simple LLC, is indemnified and harmless. 13) Each Maintenance Made Simple franchise is independently owned, operated, and insured. This contract is between the Client and the local Maintenance Made Simple Franchise. Signature accepts client agreement as listed, and authorizes Maintenance Made Simple to begin work. Client �\ Date 6129 ! t aintenance t ade Simple t, "I hereby acknowledge the satisfactory completion of all services rendered:" � ..Ak Contractor PaymentSchedule: Date Total Payment: $ $8,447.00 Large Project Installments: Payment 1: $2,589.00 To be paid when the following work is completed: To be paid when contract is signed. Customer is entified to a full refund if contract is cancled in writing with in 72 firs. Payment 2: $2,929.00 To be paid when the following work is completed: After first week of work Payment 3: $2,929.00 To be paid when all work is complete and satisfactory Payment Method: Check Cash Credit Card type: MasterCard VISA American Express Discover Credit Card # CID# Exp: I Checks payable to: Maintenance Made Simple MMS Copy - piece; fidngt back to office when LJ#n d The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber Aimlieant Infnrmst.n.. s Name (Business/Organization/individual): Address: City/State/Zip, Phone #: m Are you an employer? Check the appropriate box: I • tal I am a employer with�p 4. ❑ I am a general contractor _ employees (full and/or part-time).* '• ❑ I am a sole proprietor or and I have hired the sub -contractors listed partner- on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] ❑ I am a homeowner doing all officers have exercised their right work myself. [No workers' comp. of exemptibii per MGL c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required ] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks tax # t must also fill out the section below showing their workers' co I t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must sublicy mit aan'ew affidavit indicating such. jContractors 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. Lie. #: -� •�® ^� p Expiration Date: C A� Job Site Address: `'1 ltl ? r City/State/Zip: 11V 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. Ido hereby certify under the pains an en_ l f perjury that the information provided above is true and correct. n. , 62 . a �-�� -Official use only. Do not write in this area, to be completed by city or town of eiaL 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 #• 34 Water St, North Andover, MA Proposed Changes 1. Extend Bathroom 27"x40" See Proposed Floor Plan 2. Close off window by tub. See Existing Floor Plan and Proposed Floor Plan 3. Install ceiling vent fan, 50 CFM used intermittently. Vented directly outside. 4. Toilet location to be moved by plumber. See Proposed Floor Plan 5. Fire Stop all walls with 2x4 blocks 6. Install insulation in exterior wall. Proposed Materials Used 1. Ceiling vent fan 50 CFM used intermittently, vented directly outside. 2. 5/8 Ceiling wall board. 3. '/z moisture resistant wallboard around tub. 4. '/z sheetrock rest of bathroom walls. 5. Ceramic wall tiles 5 ft. up from floor, except shower/tub area will be from edge of tub to ceiling. 6. Sub floor material 5/8 plywood covered with 'h cement backer board 7. Ceramic floor tiles. 8. Insulation for exterior wall is RI 1 Room Dimensions 1. Ceiling Height: Approx 7ft. 6 inches 2. Room with: 40 inches at one end, 67 inches at other end. 3. Room length: 1 10 inches s \a*M rt 6144 1 S-7 v _ fle Zro-ex.�szo�zu�ea�`z o�✓�iaacac/uurell` Board of Building Regulations 5nd Standards Construction Supervisor License ... License. CS 96927 Birthdate: '7/21/1968 Expitat,10 7/21/2010 Tr# 96927 Reitridon:.3=00 GEORGE SHEPHERD 3 POLLARD AVENUE. LOWELL, MA 01850 Commissioner �" :' �/LC Vr P997/7ro9ttOt,[ICUt o���!!Gtid6cLC/Li6titX4b _ - Board of Building Regulations and Standards ®xj HOME IMPROVEMENT CONTRACTOR Registration. 143727 Ekpi ration: 7/23/2008 Type. T:Z.M,, HOME MAINTANGE GEROGE SHEPHERD 14 SHAMROCK RD. i BILLERICA, MA 01821 Administrator , s DATE (MMIDDIYYYY) ACORDM CERTIFICATE OF LIABILITY INSURANCE 1 06/28/2007 PRODUCER (978)352-4990 FAX (978)352-8991 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Fabri & Rourke Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 65 C tra 1 St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. en Suite #2NAIC# Georgetown, MA 01833 INSURERS AFFORDING COVERAGE INSURED Maintenance Made Simple INSURER A: Essex Insurance Co. DBA: Kevin Tighe INSURER B: 908 Salem St. INSURER C: Grovel and, MA 01834 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSJANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED T16 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS O POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR_LM DD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE Of INSURANCE POLICY NUMBER GENERAL LIABILITY 3CW9695 05/30/2007 05/30/2008 EACH OCCURRENCE 1, DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITYCLAIMS MADE a OCCUR MED EXP (Any one person) $ EPERSONAL 8 ADV INJURY $ ] , AGENERAL AGGREGATE $ 2 , PRODUCTS - COMP/OP AGG $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC X POLICY JECT ` COMBINED SINGLE LIMIT $ (Ea accident) AUTOMOBILE LIABILITY ANY AUTO I ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WC STATU- OTH- TORY 1 IS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E -L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ It yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Town of North Andover Building Inspector 146 Main Street North Andover, MA 01845 ACORD 25 (2001/08) FAX: �yia)naa-o�Yc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS/WREN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAIL E SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN INDj�E INSURER, ITS AG OS OR REPRESENTATIVES. n, Arman rnRPnRATION 198 ISSUED BY THE SUNNI COMPANY HEREIN CALLED THE COMPANY AGENT NUMBER POLICY NUMBER COMPANYGRANITE STATE INSURANCE i 1111 WC 439-75-51 1 /13 1:1. 11 PENNSYLVANIA K MAINTENANCE INC Go8 SALEM ROVELAND,SMA 01834-0000 SEE NAME AND ADDRESS SCHEDULE - WC990610 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INFORMATION PAGE 01MMember Companies of American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y, 10270 FABRI & ROURKE INSURANCE AGENCY INC 65 CENTRAL ST STE 2 1 uEUMUL I UWN PIA U1055—Z411 Al INSURED IS PREVIOUS POLICY NUMBER CORPORATION I NFW OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC 0610 77771 ITEM 2 POLICY PERIOD 12:01 A.M. standard time at the insured's mailing address FROM 08/28/06 TO 08/28/07 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed In item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Coda Number Remuneration MV Annual ❑ 3 Year $100 OF Re- munerotion Premium Mv LA Annual �.3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 J TAXES/ASSESSMENTS/SURCHARGES �� $363 D y 1© EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) $ 284 MA MINIMUM PREMIUM 5500 MA TOTAL ESTIMATED PREMIUM —$-8,-986 It indicated below, interim adjustments of premium shall be made: 11 Semi -Annually E] Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS (FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 09/28/06 ASSIGNED RISK Issue Date 39967 m Issuing Office Authorized Representative WC 00 00 01 0 N 0 0 Y U O J m O N O 0 0 CD N O 0 0 O O N D J W U i 00 00 N N co co O m o0XWU) O o J c c t6 N N Co 1*' Y O N O a O U c V U am a O O u7mcpv7 aci a c�WUS O Z O Q 0. 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