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HomeMy WebLinkAboutBuilding Permit #613-2017 - 50 CAMPBELL ROAD 12/6/2016TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building R'06ne family 0❑Addition 0 Two or more family El Industrial R'AReration No. of units: 0 Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition El Other osbptic PR ---Q t andsWatershedrid DESCRIPTION OF WQRK TO BE PERFORMED: 0 Identification - Please Type or Print Clearly' Phone: cP,�' OWNER: Name: 1-'V it10* te ARCHITECT/ENGINEER Address: Phone: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. f otall Project Cost: $_4, 7 CO, FEE: $ Check No.: Receipt No.: 3f 9 NOTE: Persons contracting with unregistered contractors do not have: access to the guaranty fund 5igratiae of er Signature of cohttabtor­­ Location No. (0 Check# 31300 Date IZ7 - 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee s Foundation Permit Fee Other Permit Fee TOTAL Building Inspector r Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TypF'OF SEWERAGE DISPOSAL Public Sewer .. ❑ i Tanning/Massage/Body Art ❑ Swimming Pools ~ ' ❑ Well ❑ Tobacco Sales ❑I . Food Packaging/Sales ❑ Private (septic tauk, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS > •7, 'HEALTH Reviewed on Signature 'COMMENTS r 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 Town Engineer: Signature: Located - 384 Osgood Street FIRE DEPARTMENT' -.Temp Dumpster on site yes ` no Located at 124 Main Street! s , Fire Department signature/date. 4 COMMENTS r' r limension 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 ®ANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine Doc.Building Pennit 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 o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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/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 40TE: 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 7 Enter construction cost for fee cal - North Andover Fee Cakulat%on Construction Cost 68,7550.00 m $ - $ 825.00 Plumbing Fee $ 103.13 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 103.13 Total fees collected $ 1,131.25 50 Campbell Road remodel 2 baths, 5 replacement windows 613-2017 on 12/6/2016 0 _ 0 I M< 0 H 0 r CD CD nMU • FF 0 z �' � 3 Imo C O 0 o CL 3 m VD o -• �. 03 C a rL -, n c0 O fi 7 J CD 010 ;% Z a 01 0 �� • CL rnID c � Im 7 a`J 0 y _ . CL O CO) to S. Z �- �. cn • Q m �� 3 .L 'aCL 0 Oco t i Z � ci co q < = F 0 CL 0 en CL CO) 4D a� CL n— w� _ CD Z 0 r 4 CD O CD CD .• vCL � �0-CN�aR 3 �CD � CO (D=r �• C , R - v p=Od cn 10 Z O O ry •� Cl) �. o o 0 O CD G�: Dm IV�— O a: � 0 CD �o CL do lA T w T N m T m T A .Zi T (n T 3 O O 3 ID O O O 5 s O O a) O O m °-' °1 � °-' w °-' � �* a 7C' ago 3 ago m ' S 3 S Q A \ Z < N 0 .C'' (D .t m V pn = N S Z!G1 m C C 3 jD 3 O 7v G 0N 7Do n z VG) r G) GI D O z m A N H N S m m O m m A_ 0 0 70 r �-4" Mark Halliday_% From: Mark Halliday [markhalliday1@comcast.net] Sent: Tuesday, November 29, 2016 1:45 PM To: 'Mark Halliday'; 'Hamboyan, Denis D - BOSTON MA'; 'Ellen M. Harrigan' Subject: RE: questions comments 11-26-16 meeting hi den and ellen nice job getting everything cleared out..very nice!! below is a recap of pricing so we are all on the same page.. i am ordering windows today.. will have you guys look at the acknowledgement when i get it from harveys so you can have final approval.. please let me know if there are any changes or i missed anything or if you have any questions at all thank you for the deposit , $10,000.00 #1127 PRICING RECAP add outlets.. 1 in mb corner and 1 in med room corner • 17,800.00 master bath • 19,500.00 guest bath • 12,750.00 windows - • 2950.00 crown molding • 3150.00 add 13 recessed ..mb=5, dens rm= 4, med rm= 4 includes 1 switch.. owners to supply lights and switches 1,000.(Io • 300.00 add outlets.. 1 in mb corner and 1 in med room corner • 3,500.00 remove 3 bedroom ceilings, board and plaster smooth • 3,000.00 replace casings with 3.5 in three rooms and just the one window in the spare bedroom.. includes '-abor 2000.00 and materials approx 1,000.00 • 3,400.00 painting 3 rooms inc ceilings, walls, trim, and one side(inside) of doors and no painting in closets 150.00 add back in lighted mirror with outlets.. may need extra line from basement • 1250,00 supply and install metal stair pulldown staircase in hallway next to guest bath door 1,000.(Io tile one wall in master bath.. as requested.. owners to supply tiles and grout $68,750.00 • baseboard heat TBD.. will get pricing to you as soon as plumber lets me know CIRETICAL PATH 1. finalize scope of work and pricing .. 2. order windows 3. supply all lighting fixtures and all plumbing fixtures on site for electrician and plumbers, 4. provide sample or picture of new window and door casing �� d� SAMPLE FLOW CHANT_ I 1st 2 weeks / • prep, disconnect as needed , and demo as per plans, and frame baths.. r • electrical and plumbing rough and inspections.. • owners confirm electrical locations Important 3rd and 4th • electrical and plumbing could run into this time frame a bit • confirm marble pieces set to go.. template, etc 2nd- 3rd week • frame for windows, • insulate board and plaster 5th • frame, and install windows and doors if they are ready.. • marble install Z TR •` The Commonwealth of Massachusetts _ _ Departi✓nentofIndustrpialAccidents ~ r 1 Congress Street, ,Suite 100 _Soston, MA o2114_2017 .p IOM '. Sy'ti r www mass.gov/dia WaTkers' Compensation Insurance Afdzdavita BnUders/ContractorsMiectricians/Plumbers. TO BE I+II ED WrM THE PERM'T15TTG AUTHORri' Sf Namo (Business/Oigatiizat on/Tndividual): 7-d ,/- Address: S^ Z 1— IC S7— City/State/Zip- T City/State/Zip: t t,*j11• /- / x4l-) Mot Phone #: Are You an employer? Checkthe appropriate box: 1. Q Tama employer with employees (full and/or par_ time).' 2.[_1 Tam a sole proprietororpartnershipandhavenoemployees wr`rli gforma in any capacity. [Noworkers' comp. insurance required.] 3. Q 1 am a homeowner doing all work myself [No workers' comp. insurance required] t 4.Q 1 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 withno employees. 5_ [� l a general contractor and 1 have hired the sub comp. listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance 6. Q We area corporation and its, offcers•have exercised their right of exemption per MGI. c. 152 § 1(4) and Ove have no employees. [No workers' comp. insurance required-] Type of project (required); 7. Q Neva'c6n&6dii0n S. Q Remodeak 9. ❑ Demolition 10 [] Building addition 11.❑Electrical repairs or additions l2,[] -Plumbing repairs or additions 13•. n Rbofrepairs 14.] Other *Any applicant that checks box #1 must also fill out thee a below showing en hue outside contrac contractors must submit anew affidavit indicating such. � Homeowners who submii•this ai'ficlavitindicatingthey fContracors that check flus Box must attacPe yin additional sh r ode then workers' pomp. policy n aumberand state whether or not (hose entities, have employees. If the sub -contractors have em Io ees, They must p .. . X am an employer tiiatisprovidingwarkers' compensation insurance for my employees BeZory is tliepo7icy arzdjo7� site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date, Z ZG City/State/Zip: �1 07xv� Job Site Address: Attach a copy of the workers' compensation policy declaration page (showiorg the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal -violation punishable by a ftlie up toof o $250.00 and/or one-year imprisonment, as well aspenalties orwarded to the e form of a P O K ORDER and of the DIA. for insurance 0 a day against the violator. A copy ofthis statement may be f coverage verification. —7—do Iiereby cert fy under thepains andpenaltces ofPerjury that tine information provided above is true and correct i� _ r,a+P• 17141/4 -r,- �37G Z PhF�Qfflc�lalase e only. Do not write in tins area, to be completed by city or to �vn official. permit/License # City or Town- Issuing Autho x ity (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone #: Contact Person: ACORDr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/06/2016 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(les) 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 grownson Insurance Agency 139 Albion St. lrncT Maureen Pollman corME PHONE 781 245-2292 F4't 781 245-3826 ADDRE mo brownsoninsurance.com P.O. Box 349 INSURER(Sl AFFORDING COVERAGE NAIC # Wakefield MA 01880 INSURER A: Hartford Underwriters Insurance Co. INSURED INSURER 6 INSURERC: T & M Finish Inc. INSURER D: 52 Lake Street SURER E: Wakefield MA 01880- COVERAGES CERTIFICATE NUMBER: 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 ­Qr, SUBR —,n POLICY NUMBER POLICY EFF POLICY EXPITR DIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-1OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED (Ea accurrenca�_ $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY D JET F-1 LOC GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ (Per acriclant) NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB N A WORKERS COMPENSATION 6S60UB-9F53696-9-16 03/02/201603/02/2017 X I PqTEARTLITF OTH- AND EMPLOYERS' LIABILITYFR ANY PROPRIETOR/PARTNER/EXECUTNE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION C E.L. DISEASE -POLICY LIMIT 500,000 Coverage under Workers' Compensation is excluded for Mark Halliday, President. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Carpentry operations. Hartford Underwriters Insurance Company will issue the Workers' Compensation Certificate. 12/06/16. Project: Denis Hamboyan, 50 Mcambell Rd., North Andover MA. (2) bathroom remodels. Town of North Andover Attn: Building Inspector 120 Main Street North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MA 01845- I AUTHORIZED REPRESENTATIVE 1.3 Fax: (978)688-9542 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD V 11.6 �PO%79//Y�,O//ZG!/6CGtGfZ P�C—//�GCYiJJCGGiLLlJC1 Office of Consumer Affairs & Business R4*6on ,7ME IMPROVEMENT CONTRACTORgistration: .,:184222 TYPe: xpiration: .1.2/18/2017 LLC ACTION BUILDERS;',LLM ,VNJIARK' HALLIDAY 4152 LAKE STREET. e i WAICEFIELD, MA 01880 Undersecretary a i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -103435 Construction Supervisor 0 MARK S HALLIDAY 52 LAKE ST Ir ! WAKEFIELD MAS 01880 ! a �0 Expiration: Commissioner 03/12/2017 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation fox 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 enferprt"se, and including the legal representatives of a deceased employer, or the receive.for 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 b6 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 applicaAtwhd has not produced -acceptable evidence of compliance with the insurance coverage xegi&ed." 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=contractors) name(s), address(es) and phone numbers) along with their certificates) 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 b eing requested, not the Department of IndustrialAccidents. 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 PIease be sure that the affidavit is complete anal 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. 7n 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-NIASSAFE Fax # 617-727.7749 Revised 02-23-15 www.mass.gov/dia