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Home My WebLink AboutBuilding Permit #501-14 - 340 SUMMER STREET 12/16/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION D / Date Received Permit NO: // Date Issued:/^^11` IMPORTANT: Applicant must complete all items on this page - LOCATION - - =- - - - - PROPERTY Ow. E, - _ pef J19 --)A — -/- - pr�6t' 100SYear' Old Structure yeas no ={ MAP NO`EIf I 7 NTNG DISTRICT +Histone -District yes no} - - MachtnePS.hg TYPE OF IMPROVEMENT ❑ New Building ❑ Addition A f ❑Alteration lv"-v epair, replacement ❑ Demolition ❑ Septic � ®Vtlell - S 'ROPOSED USE tesidential Non- Residential ne family ❑ Two or more family ❑ Industrial No. of units: ❑ Commercial ❑ Others: ❑ Assessory Bldg ❑ Other-. 0 Floodplain= ❑Wetlands -- Ll1Natersl ed Distr 1nIn0114 TC) RF PFRFORM,ED: I ( . OWNER: Name: Address:_ ARCHITECT/ENGIN wo Address: I Reg. No. FEE SCHEDULE: BULDING PETP: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ a FEE: $ Check No.: l� I Receipt NOTE: Persons contracting with unregistVd co ra do not have access to the g% my fund 1 oignature,�yi,eryC_, .. �' Plans Submitte r- ' Plans / aived El Certified Plot Plan ElStamped Plans El Plans Submitted Plans Waived ❑ -Certified Plot Plan ❑ Stamped Plans ❑ ..-T E.E OF=SEWERAGEDISP_OSAL' : Public Sewer ❑ Tann ing/Massageffio ❑ '- 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 DATEAPPROVED PLANNING &DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS c HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes - Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow;2 Engineer: Signature: Lto MIVI.E Located 384 Usgood Street T.ernpgD umpsr °n.sfe yes= t ; .'..:.no� l� __hh ro5�a }..t ..v` r'�.#�`v *. ^,. fir {¢.� �N✓w• �S k mt r fi..4 tt6 3.a ,� t -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 } 7. DANGER ZONE LITERATURE: Yes No MGL -Chapter 166. Section. 21A -F and G min.$100-$l000fine NOTES and DATA, — (For department use ® Notified for pickup - Date Doe.Buildinb Permit Revised 2010 Building Department The fdowing is''a Iist'of the required.forms to be filled out'foe the appropriate.permit to .be obtained. Roofivg, Siding, Interior Rehabilitation Permits o ` B:ailding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/OrC.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 submAted with the building application Doc: Doc.Buil j'ing Permit Revised 2012 Location✓ / No. �� c 7 Date l c G F Check # ( I 1 27181 TOWN OF NORTH ANDOVER i Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Enter construction cost for fee cal - North. Andover Fee Calculation Construction Cost $ 16,900.00 m $ - $ 202.80 Plumbing Fee $ 25.35 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 25.35 Total fees collected $ 353.50 340 Summer Street 501-14 on 12/16/2013 Bath Remodel I I I I cli 3 t-(4 CU waIA- er S � t lUdr� at-re_ 11/19/2013 `— � a i� O cJ � q_ FC(2 u re S S'att JOCC Nicole and Richard Lacoursiere Common Bath remodel C Z Item Description—Common bath: Segmented Pricing Permit, Demo: remove all common bath fixtures, flooring, bath/shower enclosure, tub, vanities, toilet, remove all tiles, and remove all debris from site. $1,500 Create a new remodeled common bath area: install a new cast iron style tub with front cast iron finished apron; new tiled walls with inset cubbie area placed low enough per discussions; install a new framelss style glass door and fixed glass panel per discussions; new shower head and mixing valve installed; new tiled floor included; new vanity, vanity top, vanity sinks included, new toilet in same location; new mirrors installed; full coverage painting/patching/skim coat of affected areas; Costs for all labor and materials Allowances shown below for the common bath segment is $8400. $8,400 Typical Allowance for CP Designs vanity cabinets to create new double vanity cabinet --$1200.00 $1,200 Plumbing: install new toilet and sinks, faucets, and new shower fixtures and valves; install a hand-held on a sliding bar. Electrical: At vanity location new wall scontzes installed on wall area, recessed light over the shower/tub area $2,100 Allowance for solid surface tops on vanities $900 Allowance for the frameless glass for the common bath tub area $800.00 $800 Total Project Costs with the above stated allowances: $14,900 Approxiamte 67sf floors and 65 sf shower walls Approved by: r Nicole and Richard Lacoursiere Red Tail - Steve McCullough Payment Schedule: Upon Signining and Approving the Scope of Work:$3 200 Upon Upon Start of Demolition of the bath: $3,600 Upon the start of Tiling: $3,600 Upon Substantial Completion: $3,400 Completion of Project: $1,1-00-- 12-11Tr Start Date is 13 and completion will be no later than 1/3/14; We will make our best effort to complete all but the punchlist, before christmas however. C�' # p9' �-3 3v P 9l8 /20 / s' (00� S �p A r )Jew -� ub (e- r�,c- ��,, r�-•� � S'� �,� Sir `�'2 ACORD1 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE] CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E)(TENp OR ALTER THE COVERAGE AFFORDED BY: TE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S),! REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: ' If the;ZHI —W holder is an ADDITIONAL INSURED, the. poTrcyrms) must be endorsed. K FUBROGATiON ISWE the terms and conditions of the policy, -certain policies may require an endorsement. A statement on this certificate does not certificate holder in lieu of such endorsement(s). PRODUCER NARIE:r New England Heritage Insurance Agency Group, Inc..WLE.W.781.438.5000 N 335 Main StreetEMAIL Stoneham, MA 02180 nrsoovewca Bi UMMA National Grange `Mutual 90URED, Mccullough, Steve IesuRa>B_ Travelers Indemnity. Co. DBA: Red Tail Construction C: 733 Turnpike St. Unit 192 DLSURERD: - North Andover, MA 01845 INSURER E : 91SLgaR F : ..w..r.�a..r�+ �cerrcrrw�111uQes.rlhctow 77-72 RFVLSK]W NUMBER: a infer rights .to the 781.438.5028 — 1 MCS THIS IS TO CERTIFY THAT THE POUCIES OF MSURANCE USTED BELOW HAVE BEEN ISSUED TO THE MSUKED NAMED 7WW 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 POUCIES DESCRIB_WIt 1N jS*UBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C_WMS• LIR TYPE OF BIS16tA0iCE INSR WVD POLICY NUNB6t — 10r1TS A GENERA.LIABRITY X COMMERCIAL GENERAL LIABILITY CWR1S4MDE noocuR X Addtl Insd with written contract 14P710 17I3I2Q'13 D7f081"-ff4. ; . $ .: 1.000, 0001 HIES Fr oaaurmeoe) $ 500, 0001 $ 5spm IALBADVRMURY $ 110001 tGENERALAGMEGATE s 2,000,0 GG&AGGREGATELINTAPPLIEsPEx POLICYX ,M n Loc PRODUCTS-COMPIOPAW $ 2,000,00 $ AMOMOBB.E LIABQm ANYAUTO �OgNED SCHEDULED AUTOS HIREDAUTOS A = ` BOfMY1N.RIRYXPapeison) $ BODRYMUURY(Pera=denQ S (Pg Q $ $ UNBREL AMB EXCESS LIAB OCCUR, CI AIMS MAGE EACHOCOURREPrCE $ AGGREGATE $ ow I I RETENnON$ B AND EMPLOYERS' LIABILITY Y- �/ N ANY PROPMETORIPARIT�R/DFZCCUTIy�� y�� OFRCEPWAR BER EXCLUDED? - (Mandat„y inwo Iryes, ear �ESf;R�TtON OF OP82ATIONS briar MIA 6KUB06070176-4-1 _4194=3_X01-� FH$ TORYL>�+Irrs ER E.L EACH ACCKWNT $ 500,000 E.L. DISEASE- EAEW $ 500, E.LD-POUCYLBU s 500 fl - DEscxnPrlaN of oP>:w►troRe r LACA71t1Ii5I 1!@rICLES (Atfacb ACORD gym, Adalnorw sa�ee, u acme spam is :arpentry iubject to the terms, conditions, endorsements and exclusion on the policy. Dertificate Holder is listed as an additional insured with written contract ML'R I ICR.N I G n%/ WCR FAX: 617.96.5.5313 sHou>:D ANY os=TR¢ABOVE ori POUCIES BE CANCELLED BEFORE nM EWUU M DATE TKff4EOF, manCE WD.L BE De.MaiM a ACCORI)ANCE WITH THE POLICY PROVBKM& Nicole to ursiere and Richard _ AUTHORIZED REPRESENTATM - Summec;st Nortih:Andoirer;'MA tdil l i am KellyMP ®1978-2010 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts - Department of Industrigl Accidents Office of Investigations 600 Washington Street .Boston, HA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name (Business/Organization/Individual): Address:`' City/State/Zip: (� U e one #: Are you an employer? Check he appropriate box: Type of project (required): 1. I am a employer with 4. El am a general contractor and I 6. F1 New construction ployees (full and/or part-time).* have hired the sub -contractors 2. am a sole proprietor or partner- listed on the attached sheet. t 7• emodeling 2.k 'p and'have no employees These sub -contractors have S. Demolition working for me in any capacity. workers' comp. insurance. 9. El Building addition [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 10. F1 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL I L ❑ Plumbing repairs or additions myself: [No workers' comp. c. 152,§1(4), and we have no p 12. Roofre airs insurance � ired. re q ui 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. 7'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 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 r6quiredunder Section 25A of MGL e.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 certo under the pains andp ?fltie perjury that the information provided above is true and correct. 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. PIumbing 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 ofhire,- 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 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: `Fila Commonwealth, of Massachusetts Department ofZndustdal .Accidents Offiee 003Vestigationa 6.00 Washington Strout Boston, MA, 02111 U. # 61.7-7.27-4900 oyd 406 ox 1-877 MASS.AFE Revised 5-26-05 Fax # 617-727-7749 Www.zn.ass,gQVaa �\ K \% /j Ll J� \? 2LLJ 1 \ § 5 ` pv� z + 5 \ \ co r #z . : Lu «LU . \ 9in 999\Q�2 u> � -, 2\ U» ®moo ?r cnRz 7� �\ � \ »� � � • � . 7 . \? 2LLJ 1 \ <m > a : Lu «LU . \ u> 2 u Z 2 O O. O F W LLI WCC 2 z Z Z Z W OF C u. a a Z Q OZ d' 0 m H W LU F - Q W mm J W LL L a0+ C d W +3 aV_+ Y T + O m N O O Z O \ U "O L C L L U 3 L — O W cu O O O a OJ 7 O O t9 O L O OO O O C O O 7 LL N L.L. D: U LL d' LL d' N LL d' LL m N N ^ CCS p env O 1- p U W y a'Q :C7 acp+ O JV G = ii �K uQ0 p [ ? N o o— Z p 3 _ IO C J E cn0 CDd L a m �, M U > c �'`ca� C4 W o __ (D > H = c .-oa > CO 0) C y Q C a Z n E c o ° V r�z cn yc cn r, . 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