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HomeMy WebLinkAboutBuilding Permit #1216-2016 - 417 JOHNSON STREET 5/19/2016 Mw NORTh BUILDING PERMIT TOWN OF NORTH ANDOVER � i APPLICATION FOR PLAN EXAMINATION Permit NO: �? �/ Date Received Date Issued: q((0 / �,SStCHUs ORTANT:A licant must com tete all items on this a e LOCATION JUyh sc Sr- Print PROPERTY OWNER oaz 2( -P, H v w A— Print MAP NO: PARCEL: �ZONING DISTRICT: Historic District yesnno 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 ❑Water/Sewer � n �V I 1,4rooji v�&tl " T s L rC4I'It �r,'Cr 4;e c— -e1rc{r,lrc� I c, ,'�..r CC, f.54-9 Identification Please Type or Print Clearly) OWNER: Name: +, 6L Howard Phone: -7 S (043 5 7C9CPC( Address: 412e.I o h VIS 24 S-Z-rcc�- O t f3 L+ CONTRACTOR Name: /! '>i-/-,3 C�-m<P hone: Address: P�� �. Vit. .�y��>��� n���r��� �,/,/-a- Supervisor's Construction License: Exp. Date: e 11kh-et) Home Improvement License: Exp. Date: I4GI , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / ,SGC FEE: $ ' Z' Check No.: l 1 Receipt No.: '-75v 0 NOTE: Persons contra ctirig with unrg pstered contractors do not have access to the guaranty fund Signature of Agent/Own Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL F Public Sewer ❑ Tanning/Massage/Body Art ❑ .r>MMIng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signafiure_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS c Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments C?';iservation Decision: Comments Water& Sewer Connection/s Driveway Permit .DPW Town Engineer: Signature: FIRE DEPA — Located u { t RTMENT Temp,Dumpster�on.. +site o d 384 Osgood Street y Located[a t-,124tMamtStreet ` " _ w Fire�Department signature /date COMMENTS: Dimension r: Number of Stories:_Total square feet of floor area, based< 15derior dimensions. Total land area, sq. ft.: ELECTRICAL; Movement of dieter location, mast or service dr6P Mquires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes N® s' MGL Chapter 166 section 21A—F and G min.$1oo-$1000 fine NOTES and DATA-- (For department use) ® Notified for pickup Call Email Date Time Contact Name_ Doc-Building Permit Revised 2014 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 Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit from the Board of In all cases if a variance or special permit was required t et ti° s recorded at the Registry of Deedsown Clerks office must stamp the . copy and proof of recording peals that the appeal period is over. The applicant must the g must be submitted with the building application Doc:Building Permit Revised 2014 ■ Location No. I� Date11� �tf • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1&7 Foundation Permit Fee $ 1_ Other Permit Fee $ _ TOTAL $ , Check# f� Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 13550.0..00 m $ - $ 162.00 Plumbing Fee $ 20.25 Gas Fee 100 comm. $ 100:.0:0. Electrical Fee $ 20.25 Total fees collected $ 302.50 417 Johnson Street 1216-2016 on 5/19/2016 bathroom remodel r � c1ORTM _ : w: : . . : �. .c . : ve' 0 ' . No. a _ G * T _ 0 � a - I I Z * h ver Mass ( 9 a T O LAME ' COCMICKEWICK 'ls,9s RATEo U BOARD OF HEALTH LD Food/Kitchen PERN11Septic System • THIS CERTIFIES THAT ....... ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ...................... ....... �.�.......... .. 8 u�- ... ..... ..... has permission to erect .......................... buildings on .. .0�.... �.5lQ.IIJ Foundation Rough to be occupied as .........bA. M.4% r f4wo.j.j............................................................ Chimney 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ............... ... . ../. ................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildink 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. Smoke Det. KBC CONSTRUCTION KEVIN COIRO (781) 367.5142 OR KBC-CONSTRUCTION@HOTMAIL.COM 407 PARK ST, NORTH READING MA. 01864 PROPOSAL SUBMITTED TO PHONE DATE Natalie Howard 978-685-7669 3/7/2016 417 Johnson St North Andover Ma 01845 Bathroom Remodel Demo: Remove plumbing and electrical fixtures and remove drywall down to studs. Framing: Repair minor framing issues and firestop. Insulation: Install R-15 insulation on exterior wall. Plumbing: Install new fixture stops on toilet and vanity;install tub with 1 shower valve 1 regular shower head. Fixtures to be supplied by homeowner. Electrical: Install new 20 amp circuit, 1 recessed light in shower, 1 bath fan/light combo, 1 vanity light, and 1 outlet at vanity. Fixtures to be supplied by homeowner. Plaster: Blueboard and plaster bathroom. Tile: Install cement board and tile in shower area and on floor in a basic pattern.Tile and grout to be supplied by homeowner. Trim: Install vanity, bath accessories,and trim as needed. Cabinets to be supplied by homeowner. Painting: Prime 1 coat and paint 2 coats walls trim and ceiling. KBC will supply all permits,and remove all trash. This is an estimate, and prices are subject to change due to unforeseen circumstances. License Numbers: MA CS 99247, MA HIC registration 168517 Contractor shall not be responsible for damage or delay resulting from act of God,civil disorders,strikes,fire,accidents,storms, delays or default by carriers or suppliers,inherent defects in subject premises,or any other case beyond its reasonable control. We propose to furnish labor and materials,complete in accordance with the above specifications for the sum of: TOTAL: $13,500.00 TERMS OF PAYMENT: 1/3 DOWN, 1/3 AFTER ROUGH INSPECTION, 1/3 UPON COMPLETION This proposal will be withdrawn by KBC if not accepted within 30 days. Date of Acceptance: 3 12— Acceptance ZAcceptance of proposal The above prices,specifications,and conditions, are hereby accepted. Customer Signatur ': Lag KBC is authorized to do the work as specified. Payment will be made as outlined by terms of payment. Authorized Signature: The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 ~`< Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information // Please Print Legitbly NaMC(Business/Organizationikdividual): /,t 13C (_Cjq S&C (r Chi _TCC Address: YC/:Z PC,.,( 0- City/State/Zip: 4/Uitti J'1��.-4, Phone#: 7��'�G)�s`� Are yo n employer?Checkthe appropriate box: Type of project(xequired): 1. 1 am a employer with =7� employees(full and/or part-time).* 7. Q New construction 2.[]I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition I❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑4.C]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12..[]Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ � t 13.�]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its,ofcers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.employees.[No workers'comp,insurance required.] rt; *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who subniif•this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors jhat 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-cor tractors fiavo employees,they must protide their worirers'comp.policy number.• f am an employer that is piovid6ig workers'compensation insurance for my employees.'Below is thepolicy and job site information. Insurance Company Name: X7 T 41 44�'�� c, I Policy#or Self-ins.Lie.#: V U/C ( U()(a 0 U Q U-0 l S/f- Expiration Date: ` •Z- �t so Job Site Address: ��7 �GI+�$��, �f_ City/State/Zip: ei f!'47 "-lGc' Gi /� 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 penalties of per jury that the information provided above is true and correct. signature: � � Date: G Phone#• !—3 G 7 _ S_ 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#: ACORO0 DATE(MM/DDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 04/26/2016 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 endorsement(s). PRODUCER CONTACT NAME: Nicole Orlanzo BYETTE INSURANCE AGENCY INC. P"�"N (978)851-6678 ]FAX No); E-MAIL ADDRESS: nicole@akfowledns.com 200 Park St. INSURER(S)AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: KBC CONSTRUCTION INC INSURER C: INSURER 0: 407 PARK STREET INSURER E: NORTH READING MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER: 47783 REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MM/DD MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DA AGE TO CLAIMS-MADE 1-1OCCUR PREM SES EaENTED occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY E]jE a LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOSAUTOSL $ Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ REXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ v $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? NIA NIA NIA VWC10060205712015A 12/22/2015 12/22/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached IF more space Is required) Workers'Compensation benefits Will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govBwd/workers-compensafionAnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St. AUTHORIZED REPRESENTATIVE North Andover MA 01845 C� Daniel M.Croey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACOOREP® CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY) 4/26/2016 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 endorsement(s). PRODUCER CONTACT NAME: A & K Fowler Insurance PHONE (978)664-0366 FAX A/ AIC No):(978)664-2209 200 Park St E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURERAMain Street America INSURED INSURER B: RBC Construction Inc. INSURER C: 407 Park St. INSURER D: INSURER E: North Reading MA 01864-2106 [INSURER F: COVERAGES CERTIFICATE NUMBER�L161711189 REVISION NUMBER: 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. tLTR TYPE OF INSURANCE ADDL B POLICY NUMBER MM/DDI EFF MPMIDO� LIMITS X COMMERCIAL GENERAL LIABILITY 1,000 EACH OCCURRENCE $ ,000 A CLAIMS MADE OCCUR DAMA E T RENTED 500 000 PREMISES Ea occurrence $ IPT2239M 12/17/2015 12/17/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED i BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccident $ $ UMBRELLAlJAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVEWorkers Compensation cert E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F—] NIA (Mandatory in NH) to follow separately. E.L.DISEASE-EA EMPLOYE $ It yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO / 1k ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onl4mi Massachusetts-Department of Public Safety Board of Building Regulations and Standards tit •._--�----�-- �-----=--- LIIII�LI U1L11111 JUIIGI YI\111 �� License: CS-099247 KEVIN B COIRO 407 PARK ST NORTH READING Expiration i Commissioner 08/18/2017 r - - - - ��e�aan��eo�ruucalff a�C/1�����ryc�u.�etl� Office of Consumer Affairs&Busidess Regulation ME IMPROVEMENT CONTRACTOR I egistration: 168517 Type: xpiration: 3/1/2017 Private Corpotatic f KBC CONSTRUCTION, INC. KEVIN COIRO ' I 407 PARK ST # 1 NORTH READING,MA 01864 Undersecretary ' i