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HomeMy WebLinkAboutBuilding Permit #436 - 41 COPLEY CIRCLE 1/8/2008 _ BUILDING PERMIT c?°b<NORT1j t0R #"ago TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � e Permit NO: Date Received ATE° Date Issued: /v/A' Q� �SSAc"USEt IMPORTANT:Applicant must complete all items on this page LOCATION t'L- C tr 1 Print PROPERTY OWNER C, f/_ J4 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resid Non- Residential New BuildingOne family Addition Two or more family Industrial Alterati No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Nv�a//me:40/34 rL 6 214� 7 /� C Phone: %--fid `-g7g 7) ) Address: "T� C O&Y C I AC L. CONTRACTOR Name: A or iH f��r 2v i L056 U C Phone: h f)-3 71 14 3 -_ Address: L...• i L 16. L� Z)9 d 0g-) —A A /� 0-3 Supervisor's Construction License: Exp. Date: Home Improvement License: 2 1 `T q Exp. Date: 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: $ t 3 , q0 FEE: $ Check No.: /l0 ( Receipt No.: 00 pi�f(ell NOTE: Persons contracting with unre iste ed contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location 60 /e /2 t/,— If !. ?�o2 No. Date NORTIy TOWN OF NORTH ANDOVEFk 3: ' OL • : ; Certificate of Occupancy $ Building/Frame Permit Fee $ swcNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2Di_ ,_ ,, Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED Q� CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 NOTES and DATA— For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 ,❑� Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 L3 Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy orH.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) o 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) o Copy of Contract ❑ Mass check Energy Compliance Report o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTH ToVM Of over o dover, Mass. ' COCMICMEWICK �� ADRATED P .(5 S ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System " BUILDING INSPECTOR THIS CERTIFIES THAT..... d .. � .. .. .. .. .....�..................... � ............................................ Foundation has permission to erect.. buildings /..........�.I.. e�M ....... Rough to be occupied as..... .M1. :. ................................................. Chimney provided that the per on accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final vo PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TR ARTS Rough ..... Service BUILDIN TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE S 1 D E Smoke Det. I IS I Lei. c, 603.791.4163 o BATH info@NortheastBathBuilders.com BUILDERS www.NortheastBathBuilders.com o bottom.bathroomrenovations quick and easy...for less than you'd expect! This is an estimate to remodel the existing full bath to include the following Full Bath • Remove and dispose of the toilet, vanity's, hot tub, flooring and closet flooring • Repair and replace any rotted sub flooring and framing • Build custom shower as shown in drawing • Move electrical plugs and lights for new configuration • Install all new valveing • Install new underlayment on floor • Patch walls with three coats of mud where necessary • Two coats Benjamin Moore paint on walls ceiling and trim • Install duraceramic flooring and new baseboard • Install all fixtures , furniture, and accessories • Price of shower door not included Total price $33,450 Estimated time 15 days Prices shown reflect permitting fees and the use of mass licensed plumber and electrician. We do work closely with the plumber and electrician to be sure the job does not get held up. Dora Elguezabel Date 1- 07- a ooK NEBB ���/ Date /..,I- f a o g Northeast Bath Builders,LLC. 13 Twilight Drive Nashua,NH 03062 Fax: 603.791.0015, � e r ��o stiff { i 00 C-D I 9 , : v A 6/-7 CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY,Bloomington,Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY,Bloomington,Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY,Scarborough,Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY,Winter Haven,Florida ❑ STATE FARM LLOYDS,Dallas,Texas insures the following policyholder for the coverages indicated below. Poluyholder Northeast Bath Builders LLC Address of policyholder 13 Twilight Drive Nashua Na 03062 Location of*paragons 13 Twilight Drive Nashua NH 03062 Description ofoparajons Contractors The policies listed below have!teen issued to the pokyholder for the policy periods shown.The insurance described in these policies is SMOd to ad the terms dons,and oorf WOM of those Pte•The limits of Nabky shown may have been reduced by arty paid claims. POLICY PERIOD LINTS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Ellkrfllas Dse : bots W begloning of Pdic]►period) 94-Sia-6825-2 Comprehensive BODILY INJURY AND -- - - -- - - - BusinessLgdxklr_ - _ - -08/30/2007 08/30/2000 PROPERTYDAMAGE This inwranoe includes ❑Products-Completed Operetions ❑Contractual Liability ❑Underground Ha= Coverage Each Oecurrenoe S1,000,000 ❑Personal 14" ❑Advertising hqury Gerrerol Amregate $2,000,000 ❑Explosion Haw Coverage ❑Collapse Hazard Coverage Products-Carrpleted $2,000,000 ❑ Operation Aggregate EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Elh�Dasa % ElWkWjon Ouse (Combined ShVle Llai!) ❑Umbrella Each Oow►rence $ ❑Other Aggregate $ Part I STATUTORY Part 2 BODILY INJURY 19785300 WorkeW Cornpensalion 05/21/2007 05/21/2008 and Employers Liabft Each Aet3dent $ Disease-Each Employee i Disease-Poky Limit S POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY ElMotlre Dass ; Dat! st"0!!! ng of poky 0 THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF NISURANCE AND NErTNER AFFUU"TiVELY NOR NEGATIVELY AMENDS.EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the desaibed policies are canceled before IN wWiretion date,State Farm will try to mail a written notice to the certificate holder 4 5 days before Name and Address of Certificate Holder cancellation. If however, we fall to mail such notice. no obligation or liability will be imposed on State Farm or its agents or representatives. Signature of AvOwdaed Reprsaentative Agent 01/02/2009 Tige Oats AgWa Code Stamp AFO Code F976 6S8-M 2.4 11-12 002 PrinMlA Irl U.SA V i L , a! L. U CO f C � W N O r �rn go O O N E I 00 i0 f ts7 J C-4 ' v 'n r!) L MF- ' tea c o NJ CFJ ^" C UU C fYrn C) C13 FU _ p W C13 0 p I N oCn . �a E00 -�- Q4�z WU_Q 0 Q'Q to w QUCID Q • ZU)r-Z g n All j�l'ii,l.i'a,l•jlli'3;ii..' d U a o Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: * r Registration: 158020 Board of Building Regulations and Standards Expiration: 11!28/2009 Tr# 261941 One Ashburton Place Rm 1301 Type: Ltd Liability Corporation Boston,Ma,02108 / NORTH EAST BATH BUILDERS,LLC. / SCOTT COMRIE 13 TWILIGHT DR. �„` h NASHUA,NH 03062 Administrator ot valid without signature ature North East Bath Builders, LLC (603) 791 -4163 13 Twilight Drive Home-Improvement Contract Nashua, NH 03060 This Sales Agreement is made between North East Bath Builders, LLC, (NEBB)and Purchaser: Name: Dora Elguezabel Mailing Address: _41 Copley Circle City: North Andover State: Ma Zip: 01845 Phones: Day: /__,o_ 879— ?<<7 Evening: Cell: NEBB agrees to furnish the following material and services at the stated price and on the following terms: Materials and Services: Price To remodel the existing full bath to include the attached $33,450 Terms: 40/30/30 40% deposit to get material ordered and be put on schedule 30%the day we start and 30% after completion Any alteration or deviation from the above specifications involving extra costs will be done only upon a written change order. The costs will become an extra charge over and above the estimate. This will include, but is not limited to, hidden damages that are uncovered during the course of the job and additional work required by local building inspectors. An interest charge of 1Y2% per month If payment of this order or any part thereof is referred (18% per year) is added to any amount to an attorney for collection, Purchaser agrees to pay unpaid after 3 days from due date. all reasonable attorney fees and costs of collection. All elements of this agreement are contingent upon strikes, accidents or delays beyond our control. The estimate does not include material price increases, or additional labor and materials which may be required should unforeseen problems arise after the work has started. Purchaser's Signature: I&aL Date: North East Bath Date of Builders, LLC (� ; 1 �� Acceptance: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 41 OAS I N.1, A'S % /j r;) ►� 1{ Address: tL i 14 City/State/Zip: AM Phone.#: Are you an employer?Check the appropriate box: 1.El I am a employer with ' Type of project(required): 4. El I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance SPW. msurance.t 9• [:1 Building.addition , required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.0 OtherffA7,W A C1 j U comp, insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeow=ners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Icontractors that check this box must attached an additional sheet all 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 isproviding 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 may be forwarded to the Office of Investigations of ' DIA ance coverage verification. Ido hereby cert' unde the a ns and penalties of perjury that the information provided above is true nd correct Si atur`e: t_ ✓ Date: 4 7 Phone#: [6.'Other ficial.use only. Do not write to this area,to be completed by city or town official ty or Town: Permit/License# uing Authority(circle one): Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector - ntact 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, §25CO)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-contractors)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 maybe 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 permitllicense 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 bum 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.#617-7274900 ext.40,6 or 1-877-MASSAFE ` Fax# 617-727-7749 Revised 11-.22-06 t www.mass-gov/dia OORTp TOWN OF NORTH ANDOVER ° '• OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 �,. �►+n� �ra� North Andover,Massachusetts 01845 ,ss'AC Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please DATE: C. JOB LOCATION: �� r c/off. Nuuwcx Street Address Map/Lot HOMEOWNER L0IZ A Lt- LU f 2,,16 LL Name Home Phone Work Phone PRESENT MAILING ADDRESS d. C L,6 V C' ii2 c City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Persou(s)who owns a parcel of land on which helshe resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner-certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 form Horaww m ExaW ion BOARD OF \PPE.'V_S 60-9511 CU.NCERV-vri 1N 6s8-9530 ITEALTH 688-9-540 PLANNING 688-9535 1 '