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Home My WebLink AboutBuilding Permit #378 - 59 SANDRA LANE 11/16/2009 TOWN OF NORTH ANDOVER 1 - APPLICATION FOR PLAN EXAMINATION Permit NO: O Date Received Date Issued: 'D IMPORTANT:Applicant must complete all items on this page LOCATION -S'� fi�bR-N L NJ E Print PROPERTY OWNERR�• �O ��1-,�, � Print MAP NO: PARCEL:- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne famil Addition Two or more family Industrial terati No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Gv 'tzw�) 70 r t�6 Identification Please Type or Print Clearly) OWNER: Name: Cil&R9PTN4b Phone: Address: CONTRACTOR Name: �0 - Phone: (03- .x Address: (5365-1 P � - (5365-( Supervisor's Construction License: ��3f Exp.. Date: �-Lo-2�( l a Home ImprovementLicense: `22-2 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: $ q b�� FEE: $ Check No.: al 3-3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t e guaranty fun signature of Agent/Owner Signature of contractor 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 i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS S 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 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 2008 Building Department . The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application L3 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 PP Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses i Li 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 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: Doc.Building Permit Revised 2008 tAORTH Tovm of 4Andover' . No. 3 O dover, Mass., T O - LAKE COCMICMEWICK V AERATED PPS\ BOARD OF HEALTH PERMIT T D Food/Ki'tchen' Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 1. ........ .... A. ............... .... L .......If... ......................................................... Foundation has permission to erect........................................ buildings on ...5!........ ........................................... Rough A to be occupied as...........A.!, ........0.4.................. .1.....,................................ ........................... Chimney provided that the person accepting this permit shall m 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUN STARTS Rough t ....................................................................................... Service BUILDING INSPECTOR 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 SIDE Smoke Det. �". ,Massachusetts - Ue ►� Board ol• I rr-t►nenC of Public Satet� Building Re�ulatiorrs and Stand.0 zls Construction Super�.isor License License: Cs 40731 Restricted to: 00 JOSEPH DEREK 95A BELKNAp RD HUDSON, NH 03051 cam_ • ('nn�ni�.tii=mc,r Expiration: 3/10/2011 Tr#: 13020 c� l;a� •ot�or�A�P�'i� �or�a,s��P�ff��i''B� • , HOME IMPROVEMENT CONTRACTOR Registration: 122209 j Expiration 8/2/2010 Tr# 0 1 , '-•Type•.oBAn �, � �t +a J •{k, I i J. DEREK BUILDING&`REMODELING JOSEPH DEREK JR f 95A BELKNAP RDS HUDSON, NH 03051 y Adminishator I Imo—-- f The Commonwealth of Massachusetts Department of Industrial Accidents 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/Organization/Individual):Joseph Derek, Jr. Dba J Derek Building & Remodeling Address: 115 A Belknap Road City/State/Zip: Hudson, NH 03051 Phone #: 603-880-0811 Are you an employer?Check the appropriate box: Type of project(required): LN I am a employer with 1 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. EJ 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 workingfor me in an capacity. employees and have workers' Y p tY• 9. E]Building addition [No workers' comp.insurance comp.insurance.+ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself ' right of exemption per MGL Y �o workerscomp. 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy#or Self-ins.Lic.#: 1P JUB b32Kg0g1-0q Expiration Date: q/15/2010 Giarratano — 5q Sandra Lane N. Andover, MA 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 the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Si ature: �e4o�_' 4A Date: I/q/200q Phone#: 03-880-0811 (0) b -234-1203 (G) Oficial 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#: V®AC AWbkr TRAVELEM WORKERS COMPENSATION AND f EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: {7PJUB-832K909-7-09) RENEWAL OF (7PJUB-832K909-7-08) INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA NCCI CO CODE: 13579 1. INSURED: PRODUCER: DEREK, JOSEPH JR . DBA FOY INSURANCE GROUP LLC J. DEREK BUILDING & REMODELING 3.50 MAIN ST 95-A BELKNAP ROAD NASHUA NH 03060 HUDSON NH 03051 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedules) attached. 2. The policy period Is from '09-1'5-09 to o9=15-1012:01 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 state(s) 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: Bodily Injury by Accident: $ 100000 Each Accident ,.�. Bodily Injury by Disease: $ 500000 Policy Limit �.,. Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A 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: 08-26-09 LM ST ASSIGN: MA OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: FOY INSURANCE GROUP LLC 29LKJ 002011 J. Derek Building & Remodeling 95A Belknap Road-Hudson NH- 03051 603-880-0877 Office - 603-234-1203 Cell -jDerekBuilding@aol.com PROPOSAL Mike Giarratano 59 Sandra Lane,N.Andover,MA 978-764-2631 Date: 5 November 2009 Project Location: Giarratano Residence 59 Sandra Lane,N.Andover,MA Description of Work: Bathroom Remodel Plans&Permits • J.Derek Building&Remodeling shall be responsible for obtaining all permits necessary to complete the project as outlined in this proposal Site Preparation • Prep work area with drop cloths,dust barriers and fans as needed • Disconnect,remove and cap shower lines • Remove shower • Disconnect and remove toilet • Disconnect and remove sink • Remove lavatory • Remove vanity base cabinet • Remove interior door • Remove existing light fixtures • Complete gutting of existing bath down to studs-including floor,ceiling and removal of sub-floor for placement of insulation • Remove studs for pocket door on one side of wall • Remove ceramic tile floor • Remove underlayment • Open floor to rework plumbing for toilet • Remove all demolition debris from site r Floor Framing • Close up bathroom floor after reworking of plumbing for toilet Wall Framing • Rework wall framing as needed Insulation • Sound-proof floor of bath by filling cavities between floor joists with un-faced insulation Interior Walls • Installation of 1/2"blueboard with skim coat plaster • Install 1/a"ceramic tile backer board • Apply a rubberized waterproofing coating over entire wall of shower • Installation of owner-provided tile and grout for walls • Note: Estimate does not reflect marble tile or epoxy grout application Ceiling Covering • Installation of 1/z"blueboard and skim coat plaster for smooth ceiling Millwork&Trim • Install cabinet over toilet • Install 60"vanity cabinet in bath • Countertop with integrated sink is to be installed by others • Installation of 3-1/2"colonial baseboard • Installation of metal reinforced sliding door pocket with casings and hardware • Installation of 1-3/8"thick colonial door unit with solid raised panels and brass privacy hardware • Installation of new 2-1/2"casing for window trim Specialties • Installation of homeowner-provided bathroom accessories • Installation of homeowner-provided mirrors on wall above vanities • Connect new bath exhaust vent into existing vent of adjacent bathroom • Shower enclosure to be installed by others Floor Covering • Layout and install electric radiant heat flooring • Install owner-provided ceramic tile floor in bathroom area • Note: Estimate does not reflect marble tile or epoxy grout application i Painting • Paint smooth ceilings and walls using roller-prime and two coats • Homeowner to stain wood trim and door • J.Derek Building&Remodeling will apply polyurethane on trim and pocket door Plumbing • Re-rough and install plumbing for shower • Rework plumbing and connect two (2) sinks • Install new toilet • Note: All plumbing fixtures are to be provided by homeowner • Plurrlrinn Allo wanc e: $1,700.00 Electrical • Install two (2)GFIC outlets to left and right of vanity • Rough and install two (2)light fixtures over vanity • Rework three (3) switches by pocket door • Install homeowner-provided exhaust fan for bathroom • Install homeowner-provided heat cable for radiant floor • Install homeowner-provided heated towel bar • E<lec.tric£l.Allowanc:e: $800.00 material MTor Clean Up • J.Derek Building&Remodeling shall be responsible for the clean up and removal of all construction-related debris NOTES: • All items provided on site by homeowner are the responsibility of the homeowner and are assumed to be correct and defect free at the time of installation. Items found to be defective or missing components during the time of installation resulting in rescheduling of work will be subject to compensation fees. • Dedicated allowances found in this proposal reflect a budgeted amount to those areas and will be subject to change based on actual cost. Total Project Cost: $15,950.00 I i Payment Schedule: I Payment#1 -Upon signing of proposal $ 800.00 j Payment#2 -Upon start of project $ 7,177.50 Payment#3 -Upon completion of rough-in $ 6,380.00 Payment#3-Upon completion of project $ 1.592.50 TOTAL COST OF PROJECT: $15,950.00 I Contractor's Signatur . Date: Acceptance of propo 1: he above price,specifications and conditions are satisfactory and are hereby accepted. You are authorize e work as specified. Payment will be made as outlined above. q Owner's Signature: Date: 3/0 I Home Improvement Contractor -Commonwealth of Massachusetts#122209 I i I i Ile Iz. 2g" Wat rift R t� �o�tT Re-vtS j�Z f UAL 17oCKcf wqq cwsg'r Do%iR5 .�acaR uSt N ts ejzt5,vl n!G,. CLosr-�f' F04k AP5 i M. a _3..-D r 3CIA " IfALL ,ro JAN w TU) Daµ LA ljL�j ks 41,00 I(na°/2tt Location No. 3ao Date ` 0 TOWN OF NORTH ANDOVER + i Certificate of Occupancy $ + 3 CHUS t�' BuildinglFrame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2262 _ 3 Building Inspector