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Home My WebLink AboutBuilding Permit #413-11 - 60 JOHNSON CIRCLE 11/15/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: J— / Date Received Date Issued: U IMPORTANT:Applicant must complete all items on this page LOCATION -40 A/V-5_Q/ r P ' PROPERTY OWNER p Q_,V 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 ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other `Septic ❑W611 �D;Flaodplain 'D Wdtlands �'❑ UVatershedDistnct Nater/Seover ; DESCRIPT19N OF WORK TO BE PERFORMED: -Oc Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: rn -e 5 Phone: Address: 2 V, f VAJ Supervisor's Construction License: 7 d"1 9 � Exp. Date: Home Improvement License: o� (�7 D Exp. Date: $ d/ II . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL;STIMA TED COST BASED ON$125.00 PER S.F. Total Project Cost: $ W3 012 oo a0061 �� FEE: $ b t --- Check No.: Receipt NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signafure_of Agent/Owner Signature of contracfo4 .- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBody Art ❑ 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature r 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 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.$10041000 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. 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks a 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 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 2008mi Date.. NORT/y OE Sao ,^.,410 or TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION h �9SSACHUSEtt � f This certifies that has permission for gas installation ........ te- . . . ' . . . . . . . . in the buildings of . /c,. . . . . . . . . . . . . . . . . . . . . . . at .l'.o. -f North Andover, Mass.� Fee a . . Lic. No d._'.d. . �� , . . . . . . . . . . ' GAS INSPECT6A G Check#7 7 Z,—? 7 12 8 Location//d r No. — Date NORTM TOWN OF NORTH ANDOVER O F � w ° Certificate of Occupancy $ _ Building/Frame Permit Fee $ s aMU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f / r Check # ! / 23657 Building Inspector ORTH ToVM of 0 Andover No. ^= o dover, IViass., LAKE It. COCKICMEWICK ADRATED PPS\ BOARD OF HEALTH Food/Kitchen PERM IT D Septic System • BUILDING INSPECTOR minTHIS CERTIFIES THAT Foundation .......... .......... ..... ..........'t'.........JU ................ has permission to erect... buildings on ...�/ .......J.ftj).AAJd.A........C..-A..•.•••.•••.•...••• Rough to be occupied 8S.... Chimney al �. . ....... ................... .... provided that the pens n accepting this permit shall in 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 ONTHS ELECTRICAL INSPECTOR TS UNLESS CONSTRU Rough ry Service .. ................................. ............................ BUILD INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR Rough 1 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. , IRC Registration Lookup Page I of I The Official Website of the Office of Consumer Aflairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regutation Home>Consumer>Home Improvement Contract-419> .................................................... ............. ...................... .............. ................ Home Improvement Contractor Registration Lookup The list is current as of Friday,November 12, 2010. You can search/filter the registration list by any of the criteria below. RELATED LINKS Search by Registration Number 126909 110111C Improvement ContractorracturRegisfration Home Search Registration Numbed Search by Registrant Name 1 Search by City Zip Code Search Registrants Click onthe registration number to view complaint history.You can also view arbitration and Quanajilv Fund histon.. Search Results REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS NAME INDIVIDUAL NUMBER DATE WALSH GENERAL WALSH,JAMES 126909 15 MARLYN RD 8/5/2012 Current CONST BILLERICA,MA 01821 @ 2010 Commonwealth of Massachusetts C) C14 Co c: .6N N - Co U Co .0 0 > (D LU L4 C c: 0) 0 0) 4z c1q U C14 OD X co a 0 W () cc,:) C) �r C .. Ir 0 (.5 C: 0) -0 >- CO j (0 LU UJ Cc) http://db.state.ma.us/homeimprovement/licenseelist.asp 11/15/2010 Proposal PAGE OF iSMARL YNRD al�'7A 11. iy �° �.1%, LIC# 072199 Billerica REG#126909 71 Jim Free Estimates RESIDENTIAL-COMMERCIAL 978-361-5697 PROPOSAL SUBMITTED TO ELEPHONE DATE RICH 978-946-9464 10128/2010 STREET IOB NAME 60 JOHNSON CIR SAME CITY,STATE AND ZIP CODE JOB LOCATION NORTHANDOVER MA. SAME ARCHITECT ATE OF PLANS JOB TELEPHONE!1 We hereby submit specifications and estimates for IST FLOOR BATHROOMREMODEL L REMOVE ALL EXISTING FIXTURES INA FIRST FLOOR BATHROOM 2. THE REMOVAL OF THE EXISTING TILE FLOOR 3. THE INSTALLATION OF NEW 318S SUBFLOOR AND TILE TO THE ENTIRE FLOOR AREA(CUSTOMER TO CHOOSE WITHANALLOWANCE OF$3.50 PER SF.AT FITZZGERALD TILE) 4. THE INSTALLATION OF NEW 3M INCH COLONIAL BASE MOULDINGS. S. ALTER THE EXISTING WALL FRAMING TO ACCOMMODATE THE NEW LARGER SHOWER 6. THE INSTALLATION OFALL NEW PL UMBING FIXTURES 3'CORNER SHOWER,NEW VANITY AND NEW LAVATORY,(CUSTOMER TO CHOSEAND PURCHASE SHOWER,VANITY,LAVATORY, SINK TOP,FAUCETSAND A NEW SHOWER VALVE AND FINISH) 7. AU PL UMBING NECESSARY(NEW SHUT OFFS FOR THE LAVATORYAND VANITYAND ANY ALTERATIONS NECESSARY TO THE EXISTING SINKDRAIN). 8. THE INSTALLATION OFANY DRYWALL,COMPOUND AND PRIMER NECESSARY TO FILL IN AROUND THE NEWLY INSTALLED SHOWER UNIT. 9. THE INSTALLATION OF GROUND FAULT PLUG 10. CUT AND INSTALL ONE MATCHING FILLER TO THE NEW VANITY IL CUSTOMER WILL INSTALL OR REPLACE MIRROR OR MEDICINE CABINETAND PAINTAND FINISHANY UNSPECIFIED AREAS. 12. CLEAN-VPAND DISPOSAL OFALL DEBRIS 13. A FIVE YEAR PERSONAL GUARANTEE UPONALL WORK SPECIFIED IIIE PROPOSE hereby to furnish material and labor-complete in accordance with above specifications for the sum of: THREE THOUSAND SEVEN HUNDRED dollars(k3,700 Payment to be made as follows: A PAYMENT OF$200 UPON THE SIGHNING OF THE PROPOSAL.A PAYMENT OF$1,650APPROX ONE WEEK BEFORE THE START OF WORK A PAYMENT OF$1,000 UPON THE START OF WORK.PAYMENT OF$850 UPON THE COMPLETION OFALL WORK SPECIFIED AD or deviation from material is guaranteed to be as specified.All work to be Authorized completed in a workmanlike manner according to standard practices.Any alteration above specifications involving extra costs will be executed only upon Signature: written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our NUM This proposal may be withdrawn by os if not accepted control.Owner to carry firs,tornado and other necessary insurance.Our orkcers arc fully covered by Workman Compensation Insurance. within days. ACCEPTANCE OF PROPOSAL-The above prices,specifications and DO NOT SI THE-4 ARE ANY B K A S conditions are satisfactory and re hereby accepted.You aro authorized to do the work as specified.Payment will be made as outlined above Signatu fe of Acceptance: The Commonwealth of Massachusetts w Department oflndustrialAccidents �'� :'" Office of Investigations 600 Washington Street ° "f` Boston,MA 02111 M f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Lelzibly Name (Business/Organization/Individual): r/(/ A �S �'I �.Q� e r/rc Address: .5 M Cr Y c City/State/Zip: ,1/1.{' Y,'e ct IN 0t7>1 Phone#: 2 9-24, Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 2.[ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 1011 Electrical repairs or additions 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.] employees. [No workers' 13T]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 anew affidavit indicating such. #Contractors that check this box,nust attached an additional sheet showing the name of the sub-contractors acid 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 information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c r the pains and3 �lties ofP Jury that the information provided ab a is Prue and correct Si nature: `` Date: A � �� U Phone#: /' ' ��v y 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for 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 enterprise,and including the legal representatives of a deceased employer,or the receiver or 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 be 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 applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 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-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s)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 confinnation 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 being requested,not the Department of Industrial Accidents. 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 Please be sure that the affidavit is complete and 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 pen-nit/license number which will be used as a reference number. In 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 pen-nit 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street - Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.govldia