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HomeMy WebLinkAboutBuilding Permit #517 - 54 COVENTRY LANE 3/11/2008Permit NO: 5-1?— BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received NS Date Issued: • O ` IMPORTANT: Applicant must complete all items on this pate LOCATI ._ ]:i 11547171 `" Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no 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 DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) I OWNER: Name: e22e�—= Phone: Address: R IV CONTRACTOR Name: -7- '6u - oi: . t Phone: 4;7 P�- & Address:_ /-*11 16f ,Gt'�., Cr ft J`S-- Supervisor's Construction License '' S G Exp. Date:V4e 2 Home Improvement License: 7 Exp. Date: 7 L 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: $ Zs--;C� FEE: $ /V Z CheckNo.: W4 Receipt No.: 0? 0 qkS----- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund l A of Agent/Owner Signature of contractor^� !�" Location ?��UU� 4 No. 51 Date NORTH TOWN OF NORTH ANDOVER 66D '... Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f TOTAL $ Check # ` 209165 M 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 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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) L3 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 a� O b � I o fs. a cn o Lr. o C2 x U a P. Gd o c2 � fs. a' O E -4 o w y c%i c Pr o bo o g2 —Cj G Gr. w � CO 2 � (n � � cn W UD UJ z 6 v O 2 B" 04 .,.a LU 0 Y/ uj U) W W 19 W N c o m c • O L C N O C v C3 :ate ,C o N = :Ea o 'Q CD .: r • .COCD Z L) : ts CD :mC E CA A L �CD p : �ca vi 0 3 Z93 .• ) ca h o _W � m y m m Z O y... w .p cr. Cf C cmoa :mom Ci y O i • V O cm H CD _ m N m C CD C N 03 m H =CD CD ev m = W C O C_-. •H rte+ oc E CL=O C v, Z o m 3=.s g C#* Vi d = CO 0.5010 y •� CLq- 6 v O 2 B" 04 .,.a LU 0 Y/ uj U) W W 19 W N � Tango and Co., Inc. 7 Applegate Lane Reading, Massachusetts 01867 (781) 944-8100 2 2 c�C MEMBER December 10, 2007 Matt D'Agostino 54 Coventry Lane North Andover Ma 01845 DESCRIPTION OF WORK: Re: New Bathroom A. PLUMBING Phone 978-681-5617 1. Install new drains, vents, hot and cold water pipes where needed for the new fixtures. 2. Install all new valves, traps and supply lines for all of the fixtures, which will be installed. (fixtures not included) 3. Draw all permits that are needed, and have the plumbing inspected by the town inspector. 4. Dig up cement floor to install pipes. 5. Install new underground pipes. Install new water and vent pipes. 6. Cement floor when completed. B. ELECTRICAL 1. Install new wiring for a new ceiling light and fan, a wall light, a G.F.I. plug and all switches needed. 2. Draw all permits that are needed, and have the electrical inspected by the town inspector. C. CARPENTRY 1. Build new wall for the bathroom approx 6' x 12'. 2. Purchase and install a new door. 1 3. Insulate all of the outside walls 4. Blue board all of the walls and ceiling. 5. Install new wood casings and baseboards. 6. Install new casings for the doors and window. D. PLASTERING 1. Plaster all of the walls outside the tub area with a skim coat of plaster. 2. Plaster the ceiling with either a sand finish or a skim coat of plaster. E. TILE 1. Install a new tile floor only (tile cost not included). F. DISPOSAL 1. Disposal of all debris from the job. COMPLETE LABOR AND MATERIALS: $89475.00* Any work not listed in the categories above is not included in this price. Any additional work requested will be at an additional chargee * Not included — Fixtures and tile cost One -Year Guarantee on All Workmanship Tango & Co., Inc. will not be responsible for removal and/or reinstallation of any manufacturer's defective product. 2 A CORDDATE TM. CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 07/17/2007 PRODUCER Phone: (781)933-3100 Fax: (781)933-9048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SALEM FIVE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOYLE INSURANCE SERVICES, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 445 MAIN ST BOX 606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX OCCUR R0634719A WOBURN MA 01801 04/01/06 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Norfolk & Dedham Grp 1449 INSURER B: Norfolk & Dedham Grp 1449 TANGO AND CO., INC. C/O DOMINIC TANGO 7 APPLEGATE LANE INSURER C: American International Group AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOSBODILY NON -OWNED AUTOS READING MA 01867 INSURER D: 04/01/08 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'LTYPE INSR OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A 1 ITS AGENTS OR REPRESENTATIVES. GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX OCCUR R0634719A 04/01/07 04/01/06 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 50,000 PREMISES (Ea occurence) MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - 17 POLICY JECPROT LOC PRODUCTS-COMP/OP AGG. $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOSBODILY NON -OWNED AUTOS BA90730007 04/01/07 04/01/08 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ rX INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY OCCUR F-1 CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 6832461 04/01/07 04/01/08 TU WRY L'MITS OTHER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) Certificate # 11021 © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attention: AUTHORIZED REPRESENTATIVE /t`�� Gerard F Bo Jr ACORD 25 (2001/08) Certificate # 11021 © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) Certificate #11021 .'age 2 — Tango and Co., Inc. Contract Insurance & Liability Tango and Co., Inc. is fully licensed and insured with adequate insurance to cover damage due to negligence on the part of the contractor. The contractor warrants thatn he, hisemployees, all of his agents and subcontractors, etc. who are to work at this site are duly licensed in conformance with the laws of the Commonwealth of Massachusetts and this city or town. All home improvement contractors and- subcontractors shall be registered by the Director of Home Improvement Contractors. Any inquires about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301, Boston Ma. 02108 Permits Tango and Co., Inc. will be responsible for obtaining all permits as are required by Commonwealth of Massachusetts for the work to be performed under this cotract the Owners who secure their own construction -related permits or deal with unregistered contractors will be excluded from access to the guaranty fund. Arbitration The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in MGL c. 142A. Owner Date W_ Contractor IN —/% � � Date NOTICE. The signatures of t e parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate an alternative dispute resolution even where this section is not signed separately by the parties. rOPerty Lien Within the terms of this contract, Tango and Co., Inc. cannot place a lien on the owner's property as a result of non-payment for work performed. DO NOT SIGN THIS CONTRACT IF IT IS NOT COMPLETED IN FULL - - The owner has theright to cancel this contract within (3) business days after the signing date. - Owner Date Contractor Date Page 2 of 2 i ✓iie 'C�o�mmw�nu�e Board of Building Regulations and Standards lug HOME IMPROVEMENT CONTRACTOR Registration: 143682 Expiration: 7/21/2008 Type: Private Corporation DOMINIC TANGO CO, INC. DOM TANGO 545 MAIN ST G�C" READING, MA 01867 Deputy Administrator ft 071, BOARDC�arnirnoouueall/ o�✓�iaaaaciu.Qetla BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:, CS , 021455 Birthdate:: 06/0:_4,141--941 Expi.res 06/04/2008 Tr..no: 27838 Restrjded ..QO:..,.,..' ROBERT A SPINELLA. ,,;`. 15 APPLE GATE LN D- READING, MA 01867 Commissioner TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1�il1` �!i c 5w;»say A a :rte BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �SY Covehh�y Lan e Map Number Parcel Number /Vv✓n' 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RecIttired Provided Reqaired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 1 d 51/ 6ovehi hc Name ( Address for Service: i Signa re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: -7, License Number l s .�4 �P p<<�a-� L►� A ss 04 oma/ o8 Expiration Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ,q,1 Ao 4- ec) Zhe - Company NarnV Registration Number 7A/,�(,) $ „? J`r Address �9 9yy r/00_ Expiration Date ure Telephone T rn X Z O v rn SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: II __ hoVc� i� e -X i S h #q' !qi J Q/ y h n 0Y'l1 A& jQ ly o4 m q e /t c h-1 ca I /e O GAha� /QST /: Ae n6 S+k y C /y A SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to bebFFICIALUSE Completed by permit applicant ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, a / as Owner/Authorized Agent of subject property He by authorize ^%Q!7r and�O b;c to act on rbif, , i NAtters elative to work authorized by this building permit application. i�S,�.iature of Own Date SECTION 7h O NER/AUTHORjjIZED AGENT DECLARATION 1, 7 ;-& (,rki z_ 6-0 ,as Owner/Authorized Agent of subject property 61 Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Na e �,Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TITVMERS 1ST 2 ND 3 SPAN DINIENSIONS OF SILLS DM ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE