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HomeMy WebLinkAboutBuilding Permit #754-15 - 36 BEAVER BROOK ROAD 4/2/2015BUILDING PERMIT No Dr b TOWN OF NORTH ANDOVER �? y'' - " 96 c' (/ APPLICATION FOR PLAN EXAMINATION J �o �~ R 1• Permit No#. Date Received �gssgc►+ug���y Date Issued: d� IMPORTANT: Applicant must complete all items on this page LOCATION print -- PROPERTY OWNER kikrew .6*'Ll PC,1 5v ca i Print loo Year Structure, yes MAP 1. PARCEL:0� ZONING DISTRICT:. Historic District yes foo Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District . u Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identificati9fi -PI se Type or Print Clearly OWNER: Name: d� IR��'s, Phone- 775-,?a7-5WW Address: 3G ©ea✓y /��do�( /� ��t� �o✓%. 019`5 Contractor Name: `Jc rrre�r.,�oe.Phone:. C1 7' Address: `I -�sqA-,P-m J-- GtF&j Supervisor's Construction License: CS- C���a'-?_`1� Exp. Date: i Z1.1 zo S 1 Home Improvement License: _ Exp. Date: "7I V I-zo' S 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: $ l C� L ( 6b, FEE: $ � 2-tb Check No.: W91 Receipt No.: Z&b NOTE: Persons contracting with unregistered contractors nom gc5a*fto the guaranty fund Signature of Agent/Uwner /151gnature of contractor _ _ I '36 Location - - L I? •.-' No. � � 1 Date 1 Check #' � 11 2660 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Plans Submitted ❑ �r 'J�_ If Plans WaivedEl Certified Plot Plan ElStamped Plans ❑ TYPF' � F 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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS, Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 11 Planning Board Decision: Conservation Decision: Comments Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster,on site yes no Located at 124 Main Street Fire Department signatureldate Dimension y i J. Number : of Stories_ Total square feet of floor area, based on Exterior : cVrnensions. - a Total land area, sq. ft.: n _ ELECTRICAL: Movement of Meter location, mast or service drop requires' proval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU 1 t5 and DATA — (For department use ❑ Notified for pickup Call Emai Date Time Contact Name I Doc.Building Permit Revised 2014 ;' i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 Doc: Building Permit Revised 2014 a Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 101,460.00 m $ - $ 1,217.52 Plumbing Fee $ 152.19 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 152.19 Total fees collected $ 1,621.90 36 Beaverbrook Road 754-15 on 4/2/15 water damage repair _v, C S CO) n -0 O CD Z -0 CL r - Q �• y _ `0 O O v D CL Cr CD CD O CD CL O �. S• m CM CD � v N O z CID 0 � O 71 CDO CCD in- .a z� mm C/� ic ;u Cl) 0 m Z x a Cl) 55 �m C Cl) < C0 to m � CD. CL O CD 0CD � O .=n«, n Z0 _3 CO) -I O O N .Wy C T. m m CD W CD O - r-11. Cl) N = CD m CD 2 � � O CL C n CQ O O down* rt n •� �' �3 CD CD c 0 CD O N c Z C OCD a ? CD CO) Q Vl 0 � � o' < Q Q . = 0 CL CD N CD 3 O' Q CD y WQ < P : �? rt 0 -1cl N x Q ru LnW z O G �1 >V ° T N CD T F. CD T °� W po Dq �' �S CDS N VI P) N T Q \ 7C S C.) O � rn mG1 m m D � � 1 DC C DCU Mj r C W z W C C z rD 3 rD :3r- W O > O i n -+ N x Q ru LnW z O T = cm S T N Du Dq 3 T F. m W 7' T °� (' 7 (D K po Dq �' T 3 fl_ D) ? VI P) N T Q \ 7C S rn mG1 m m D H Z H rn r m n y rC) Mj r C W z W C C z rD 3 rD :3r- W O > O i n -+ N v (A ( rn m z n 0 n 0 0 _ y 0 * b's N l` Buerube Construc on 771 Salem Street Groveland, Ma 01834 Proposal Submitted to: Andrew & Shannon Parisotto Job Address: 36 Beaver Brook Rd. North Andover Ma. 01845 We hereby submit specifications and estimates for: Master bathroom Fully Licensed & Insured Phone: 978-994-3452 www.Berubeconstruction.com Phone #: 775-636-0162 Water Damage Repairs Demolition of ceiling, the floor and tub surround. Removal of the lav sinks and cap off the plumbing pipes, Removal of granite top and backsplash. Remove all vanitys and baseboards, Install new insulation in ceiling then install 1/2" blue board and plaster and patch all walls as needed. Install new vanitys, granite top and backsplash then drop in the sinks and re -hook up the plumbing. Install new tile backer and ceramic floor allso tile the top of the tub surround then grout all joints. Install all new baseboards then we can paint entire bathroom on the ceiling, walls and trim work. Install new lights, towel bars, mirrors, toilet and hardware. Master bedroom and closet Removal of all baseboards thru out bedroom and closet, then removal of all of the hardwood flooring, Screw down all of the sub floor, Install new hardwood flooring and finish, Install new baseboards thru out bedroom and closet, paint the ceiling, walls and trim work, Reinstall closet shelves. 2nd Floor Hallway and closet Removal of all baseboards thru out hallway and closet, Removal of all hardwood flooring and screw down sub floor, Patch all walls and ceiling as needed, Install new hardwood flooring then sand and finish floor, Install new baseboards thru out hallway and closet, Paint ceiling,walls, and trim work, Install new recessed light trims and bulbs. We Propose hereby to furnish materials and labor --complete in accordance with above specifications, for the sum of: $101,460 Respectfully Submitted by: Scott Berub Acceptance Signature: ��� Date of Acceptance: 3�a�115 NOTE: This proposal may be withdrawn by us if not accepted within 30 DAYS. 2nd Floor Bedrooms The hardwood flooring will be re -finished thru out all bedrooms and closets, then we will touch up walls and trim work as needed. Staircase in foya Sand and re -finish treads and landing, Then we will paint all skirt boards, risers and ballisters. Open foya Removal of all baseboards, hardwood flooring thru out foya and closet, Screw down sub floor and install new hardwood flooring then sand and finish Install new baseboards and patch any walls and ceilings as needed, Completely paint ceiling, walls and trim work, Install new recessed trims and bulbs. Front office Removal of all baseboards and hardwood flooring then screw down sub floor Install new hardwood flooring then sand and finish, Install new baseboards patch all ceiling and walls as needed, Completely paint ceiling, walls and trim work, Install new recessed light trims and bulbs. Dinning Room Removal of all baseboards and hardwood flooring then screw down sub floor Install new hardwood flooring then sand and finish, Install new baseboards paint baseboards and touch up walls and trim work. 1st floor bathroom Remove pedistal sink, toilet, towel barsand lights, Patch all walls and ceiling as needed, completely paint ceiling, walls and trim work, Then we will install pedistal sink,mirror,toilet, towel bars, light and hardware. Hallway and closet Removal of all baseboards, closet shelves,light fixture and hardwood floors Then screw down sub floor and install new hardwood flooring then sand and finish, Install new baseboards and patch ceiling and walls as needed completely paint ceilings, walls and trim work, Reinstall closet shelves and new ceiling light. Kitchen Removal of all appliances, sink and granite tops and backsplash, Removal of all kitchen cabinets except the island that is staying, Removal of ceiling lights and crown moldings, Demolition of ceiling and remove all baseboards and hardwood flooring, Then screw down the sub floor, Install new blue board and plaster on the ceiling and install new crown moldings, Install new hardwood flooring then sand and finish, Install new kithchen cabinets and granite tops, reinstall sink and appliances, Fix back door trim and install new base boards, Patch all walls as needed then paint entire kitchen on ceiling, walls and trim work,install new recessed trims and bulbs and re hang lights fixtures, Instal all new hardware on cabinets. Living room Removal of all baseboards and hardwood flooring then screw down sub floor Install new hardwood flooring then sand and finish, Install new baseboards thru out room and completely paint ceiling, walls,and trim work, Install new recessed light trims and bulbs. Rear office Removal of all baseboards and hardwood flooring then screw down sub floor Install new hardwood flooring then sand and finish, Install new baseboards thru out room and patch ceiling, walls as needed,Completely paint ceiling walls and trim work, Install new recessed light trims and bulbs. Basement Living room and stairway Demolition of entire ceiling and remove insulation, Install new insulation then blue board and plaster ceiling, patch all walls as needed, Install new french patio doors with new exterior and interior trim, Completely paint ceilings, walls and trim work in the entire basement, Install new recessed light trims and bulbs. Not included in this estimate is the cost of the kitchen cabinets and vanitys Granite tops if they break when removing, Any new hardware, Light fixtures Plumbing fixtures, new towel bars, new mirrors, appliances,Ceramic tiles grout, Basement pad and carpets also the cost to install. Tile backsplash in the kitchen, Anything with the center island in the kitchen. All construction debri will be removed by dumpster. This entire job will be done in a clean and professional manor. Payment will be 1/3 upon starting, 1/3 when hardwood floors are installed and one coated and balance upon completion. Any extra's that may occur during construction will be addressed at that time and will have a sign invoice on how we will be payed for the extra work over and above the original contract price. Total contract price for work describe above is $101,460.00 The Commonwealth of Massachusetts Department of IndustrialAccidents a 1 Congress Street, Suite 100 t Boston, MA 021142017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Informationtt Please Print Legibly Name (Business/Organization/Individual): S cca 5e Cybe, Cg,( ock og y, Address: 71S(Aef-n 'j-�- City/State/Zip: Are you an employer? Check tfie appropriate box: Phone #: q7e_ 991-r_11-3 V57_Z 1. ❑ I am a employer with employees (full and/or part-time).* 2. © aam a sole proprietor or partnership 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 41-11 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no eoyees. [No workers' comp. insurance required.] mpl Type of project (required): 7. ❑ New construction 8. ©-REmodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. 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. 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify under the pains and pffialties of perjury that the information provided above is true and correct. SignatureDate: ,��.!%�i rr /��9,1�'�1�-- Phones ��9% 7"' 3 7 Sz 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 #: 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 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 Department's address; telephone'and fax number: �.. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ACORL7® CERTIFICATE OF LIABILITY INSURANCE D/mlIDD/YYYY) 4/1/2/2015 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 endomement(s). PRODUCER CNAONTAME: CT Cynthia St. Amand Insurance Solutions Corporation PHONE (603)382-4600 FAIC No;(603)382-2034 60 Westville Rd %Mss,cstamand@isc-insurance.com INSURER(S) AFFORDING COVERAGE NAIC p Plaistow NH 03865 INSURER A -.LibertyMutual 24198 INSURED INSURER B Berube Construction INSURERC: 771 Salem St INSURER D: INSURER E : /22/2016 INSURERF: Groveland MA 01834 COVERAGES CERTIFICATE NUMBER:CL154120978 REVISION Nt1MRFR- 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR aCP9571262 /22/2015 /22/2016 DAMAGE TO R-ENTO PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , OOO , OOO GEN -L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X I POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICERIMEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Job location: 36 Beaver Brook Rd N Andover NIP,. The Parisotto residence CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of N Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 1600 Osgood Street N Andover, MA 01845 Keith Maglia/CLS`-- 7—�Z--- ACURD 25 (2010105) INS025 ontnnm m ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Arnpn nnmo nnel Inn^ nro ronieforort mnrka ^f Arnon i Massachusetts - Department of Public Safety Board of 8WIding Regulations and Standards Construction Supers k4wr License: CS -065246 } SCOTT A BERUBK 771 SALEM STk'J' GROVELAND WA 011!f � 14. Expiration Commissioner 12/16/2015 j r=fit� t�c�rrrrrc>sn„fi�{lJ� nJ-'' l�r�.;rrr�rid.t`l; . . office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR is#ration: 119555 Type: -p-S7/26/2015 DBA BERU.BE CONSTRUCTION SCOTT BERUBE 771 SALEM ST GROVELAND, MA 01834 Undersecretary t �W