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HomeMy WebLinkAboutBuilding Permit #563-14 - 410 GREAT POND ROAD 1/27/2014 TOWN OF NORTH ANDOVER PLICATION FOR PLAN EXAMINATION Permit NO: ✓ Date Received Date Issued: �� < IMPORTANT:Applicant must com, Dlete all items on this page LOCATION r..--Print PROPERTY OWNER %JN � IVA Prinf 100 Year Old Structure yes no MAP NO' ARCEL: ONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building Vbne family 0 Addition ❑Two or more family ❑ Industrial Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: N - u(4) QA) 0� -h Vv/ k4e,-em "+ 1-re.4 Identific TYA on Please e or int Clearly) _ OWNER: Name: OUN" A• .V, Phone: � 0' -7Z->S- Address: 7 Z->5 Address: LOC�� -f' /V Ove CONTRACTOR Name: i� '✓1 D)Q '-f ,01Z .� & hone: Address: (� C? _ _ o fL �(/� A' D) 4 Supervisor's Construction License- Qq 1 0 Exp. Date: /o Home Improvement License: l S 9 _ Exp. Date: L_0/�, 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. r� Total Project Cost: $ AS', 9 6 0 . 0b FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have aaess 4t ,, uar tyfu d Signature of Agent/Owner Signature of contrac ' y __. Plans Submitted L.� Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Building Department The foi,?wing is''a list of the required-forms to be filled out*for the appropriate-permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑` B,ailding 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 ❑ 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 apn•,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buil,ding permit Revised 2012 .-Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ ..Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-Chapter-466.Section 21A-F and G min.$100-$1000..fiine NOTES and DATA— (For department use El Notified for pickup - Date I Doc.Building Permit Revised 2010 -: Plans Submitted ❑ Plans Waived ❑ _Certified Plot Plan ❑ Stamped Plans ❑ .-TYPE-OF-SEWER-AGE-DI SP OSAL" Public Sewer Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ ToodPackaging/Sales ❑ Private(septic tank, etc.. Permanent Dempster 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 HEALTH Reviewed on Signature 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 Tow; Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM 'Nt - Temp Dumpster on site yes no Located-at 124 Main Street - Fire Departure►it signature/date COMMENTS 4 Location C(lb a 10,2MI, No. — Date • - TOWN OF NORTH ANDOVER * Certificate of Occupancy $ r � Building/Frame Permit Fee �.— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#...JC2 a Z 1 �' Building Inspector Enter construction cost for fee cal- North Andover Fee Cakulaf/on Construction Cost $ 25,460.00 m $ - $ 305.52 Plumbing Fee $ 38.19 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 38.19 Total fees collected $ 481.90 410 Great Pond Road 563-14 on 1/27/14 New Bathroom in Basement pORTfi ndover Town of _ No. wA347>_ iqMass,h ver 09 cocN� ewrcw �1 �Jd AOq�1TED HPa��S PERMIT T LD is V BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR .. �.. G .1 ........ . ............... ...................... THIS CERTIFIES THAT . ••••••• •• "" ...... ...... . . . . Foundation in son . .. ... ... ... .. ..... bund ............. � ........... .. Rough has permission to erect ..................... g !! •� .•,•.. Chimney ............................. to be occupied as ••••r•""•""" A, provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUC S S Rough Service .......... .. ....... ..... Final BUILDING INSPECTOR GAS.INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises - Do Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. SEE REVERSE SIDE !i Ex Co OW . AN C.DnVc�.c�e �v�T�R Pump L.A`v Sha�e1 Ll � C)- y � C W AL Z CLOSET 1 v ftbu �T ON �ma�� . JCfSfil CONC04e pau.,40�j W(/t/ DLJ TA-'V y C CLOSET �x 9 }�-b D V ) l 0.N ST l �11" AtteTr ►" W �LL S eN - The Commonwealth of Massachusetts Department ofIndustritrlAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizadon/Individual): U' Address: City/State/Zip: ._RJ /t/ one# 19 J_9 Are y u an employer?Check the appropriate box: Typo of project(required): L. am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/o art-Per- have hired the sub-contractors 2.❑ I am a soleproprietor orpa Listed on the attached sheet.I �• ❑Remodeling ship and'have no employees These sub-contractors have 8. Vemo lition workers' coin insurance.working forme in any capacity. p• 9. uilding addition [No workers' comp.insurance 5. ❑ We area corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all-work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.[i Other comp.insurance required.] "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 aie 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 i7tformatiorr: ,i-- top Insurance CompanyName:. v� ii — Policy#or S elf-ins.Lie.#: V "1 Expiration Date: L4 Ll Job Site Address: P—()4 o City/State/Zip: o A 4 .4; Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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 tho.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 maybe forwarded to the Office of Investigation f the DIA for insurance coverage verification. "do here cer if1'u der the • s and penalties of perjury that the information provided a ove Istrue and correct. Si atur Date: 3 1 Phone#: 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 Cleric 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - phnnaJY. r ell.Wpom�mwauuecrl fi o�C ac�zccael�a- t," Office of ConsumerAffairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e istration: 9 ,125545 Type: Office of Consumer Affairs and Business Regulation Expiration:-_1% (1016• Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 TAYLOR MADE T �` VICTOR TAYLOR lT•� dsj_ � r�/ 101 RESERVOIR ST CHERRY VALLEY,MA 01611!f Undersecretary Not valid without gnature t 1 Massachusetts-Department of Public Safety Board of Building i d ng Regulations and Standards _ Construction Supervisor License: CS-048019 tet.�..i.S ANDREW V TAYD6R 10 FIELDSTONE�VV N READING MA7018 , Expiration Commissioner 09/10/2015 TRAVELERST WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GNUS-5631 898-1 -1 3) RENEWAL OF (GKUB-5631898-1 -12) INSURER: THE TRAVELERS INDEMNITY COMPANY.OF AMERICA 1. NCCI CO CODE: 13439 INSURED: - PRODUCER: TAYLOR, ANDREW , LINNANE INSURANCE AGENCY 10 .FIELDSTONEiWAY. 280 MAIN .STREET NORTH READING MA 01864. NORTH READING MA 01864 Insured is AN INDIVIDUAL Other work places and identification numbers are shown In the schedule(s) attached. 2_ The policy period. is from 04-11 -13 to 04-11 -1 4 12:01 A.M. at the Insured's mailing address. 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 work in each state listed in item 3.A. The limits of our liability under Part Two are: o= Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: "..rCOVERAGE. REPLACED 'B.Y:ENDORSEMENT.WC 20 03 06A ti-- D. This policy includes these endorsements and schedules: SEE LISTING-OF:..ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-29-13 WC ST ASSIGN: MA OFFICE:. ORLANDO INDUS AFF 161 --:.."PRODUCER: LINNANE INSURANCE AGENCY 77TGX 000074 CVLIIWVUU/o[JU UQJOU4 � STATE AUTO® r4J. •Insurance Companies INSURED.COPY: BOP 2730624 00 COMM..ER.C—IALt GENERAL LIABILITY COVERAGE PART DECLARATIONS COMMERCIAL GENERAL LIABILITY COVERAGE LIMITS OF INSURANCE: " Each Occurrence Limit $1,000,000 Damage To Premises Rented To You Limit $300,000 Any One Premises Medical Expense Limit $5,000 Any One Person Personal Ani Advertising Injury Limit_._ _.... r.. .,... .. $1,000,000 Any One Person or Organization General Aggregate Limit $2,000,000 , Products ''Completed Operations Aggregate Limit $2,000,000 0 0 c • i" ... cNo AUDIT PERIOD::::{' 0 Annual a co DEDUCTIBLE LIABILITY SCHEDULE (See. CG 03 00 for complete details) o 0 Comage'`.i '" '•'' uu`�'+' Deductible Amount Basis 0 Property Damage Liability » $250 _ :, Per Occurrence' APPLICATION OF_DEDUCTIBLE- see endorsement CG 03 00 for any limitation on the application of this deductible. °�° Issue_Date�.:02/06/2013; :,"'10:11:04 AM BP 60 02 (01/08) Page 001 of :004 - I H I L err K 2ULINNUU/8230 001864 • STATE AUTO® r•®`V Insurance surance Companies INSURED COPY BOP 2730624 00 BUSINESSOWNERS POLICY COMMON DECLARATIONS NAMED INSURED AND MAILING ADDRESS: AGENT NAME AND ADDRESS: First Named Insured Is Specified To Be. LINNANE INS AGENCY INC ANDREW TAYLOR 280 MAIN ST STE 101 10 FIELDSTONE WAY N READING, MA 01864 NORTH READING, MA 01864 I POLICY PERIOD: AGENT TELEPHONE NUMBER, AGT. NO. From: 04/03/2013 To: 04/03/2014 (978) 664-2000 0078230 COVERAGE PROVIDED BY: A STATE AUTO INSURED SINCE: ' Patrons Mutual Insurance Company of Connecticut 2011 AUDITABLE POLICY: POLICY STATUS. AFTER-HOURS CLAIMS SERVICE: Yes Renewal - Standard 800-766-1853 or www.StateaUto.com The coverage and these declarations are effective 12:01 AM Standard Time on 04/03/2013 at the above mailing address. BUSINESS ENTITY TYPE: BILLING ACCOUNT NUMBER: BILLING QUESTIONS? Individual CB00582169 Call 800-444-9950 X5118 Direct Bill Insured 4-Pay BUSINESS DESCRIPTION: Carpentry - Residential Upon valid payment of premium when due, these renewal declarations continue your policy for the period indicated. In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the .insurance as stated in this policy. PREMIUM SUMMARY BY COVERAGE PARTS AND POLICIES This policy consists of the following coverage parts or policies for which a premium is indicated. This premium may be subject to adjustment. COVERAGE PARTS Businessowners Special Property Covera ges PREMIUMS Commercial General Liability Coverage Part $ 20.00 Buslnessowners Extra Coverage $573. 00 Commercial Inland Marine- See IM Declarations SM 50 00 $19.00 $78. 00 Terrorism (included in total below) $8.00 POLICY TOTAL AT INCEPTION $690.00 If terminated at your request, this policy is subject to a minimum retained premium of $350.00 These declarations together with the Common Policy Conditions and coverage form(s) and any endorsement(s) identified on these declarations and attached to your policy complete the above numbered policy.. Countersigned By (Date) (Authorized Representative) Issue Date 02/06/2013 10:11:04 AM BP 60 00 (01/08) Page 001 of 002 e Taylor Made Construction 10 Fieldstone Way, North Reading MA 01864 (508) 243-5254 To: Young and Jinah Park 410 Great Pond Rd. North Andover Ma. January 22, 2014 Proposal for new bathroom in existing basement area labor and material Disposal of construction related debris Framing: and general conditions to accommodate bath design. Install new Andersen 2032 on gable Plumbing: for toilet, lav,48"white fiberglass shower stall and work sink. Cut concrete _ floor, install pump chamber and replace concrete. (fixture budget: toilet, pedestal lav and faucet, shower valve, work sink and faucet $1,600.00 ) Electric: GFI protection, ceiling fan with timer vented, 7 lighting points, outlets to code. (fixture budget$800.00). Blueboard and plaster : Smooth walls and smooth ceilings where needed. Tile: Install white ceramic hexagons on bathroom floor. Brindle Bamboo in hall area, existing concrete in walk-in closet. Paint: 2 coats,walls, ceiling and trim. Interior Finish Trim: 2-2868 six panel smooth Masonite doors, 1-2668 lefthand 15 lite Fritz glass door. Walk in closet door existing. Stafford casings are 3 '/2"primed- finger ointed typical to existing. Baseboards are lx6 with 1 1/8"basecap. Emtek Old Town satin nickel doorknobs. Heat: existing Permits: to be determined Total: $25,460.00 plus permit fees i Payment terms; Receipt of permit $3,000.00 plus permit fee Install pump and rough plumbing inspection $5,000.00 Framing and rough electrical inspection $5,000.00 Blueboard and plaster $4,000.00 Doors, finish trim and paint $5,000.00 Flooring, fixture install completion $3,460.00 Total $25,460.00 plus permits Towel bars/bath hardware to be determined Acceptance of Proposal: Buyer Signature Date: /' Z3 /5L Contractor Signa Date: We propose hereby to furnish all labor,materials,accessories,equipment and supplies necessary as per the above requirements and specifications. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to cavy fire,tornado and other necessary insurance.