HomeMy WebLinkAboutBuilding Permit #531-2017 - 60 ROSEMONT DRIVE 11/17/2016�l�wsCAN�EO r/ �.
41�lyd ✓ �e pORTh
(,/ BUILDING PERMIT s� 6•'*`D" `'��`
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION -
Permit NO:-331,9-09Date Received
w
Date Issued: /1-17 -i-&
IMPORTANT: Applicant must
LOCATION (0 U KoSetnon+ 1JrkVe . N1
nt
PROPERTY OWNER
Print
MAP NO: '11k PARCEL:9O ZONING DISTR
all items on this
ye/ t-
VFEA
Historic District yes no
Machine Shop Village yes/,- no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
126ne family
❑ Addition
❑ Two or more family
❑ Industrial
pd`eration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
_I ric I o 611 ru
OWNER: Name:
Address:
.1 VAI a V I Ct-, no En,: q�v.r h od„
yu.tu shower and Iree-s+e.hd'- Y)a +bh ,Vt�-
[1d �D O r u D a rGt�(e rLh �� Q� ► n Q I iQ �'1 1 tact .
Identification Please Type or Print Clearly)
A. L, a 'Orrw '% 9Z.Yl d kk v cu Km r/on nlu Phone: ql l - I;a o -
CONTRACTOR Name:
Address:
Supervisor's Construction License: Exp. Date: 4 171 69
Home Improvement License: i w 3�O Exp. Date: 1Z O�
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: c5 R. 4 B 5 .(03 FEE: $____ t/
Check No.: 5`17 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have aec<ss t e guar my fund
Signature of Agent/Owner . ignature of contractor,
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR. PLAN EXAMINATION
Permit No#: Date Received
Date Issued:
MORTANT: Applicant must complete all items on this page
PROPOSED USE
Residential
Non- Residential
El New Building
V
El Addition
�T.
0 Industrial
0 Alteration
No. of units:
Pn
El Repair, replacement
0 Assessory Bldg
0 Others:
T ly,
P
[I Other
nnt
RfilbtumA
0a r.
V -,V t4/ao, P -
no
'MAP PARCEL'ZQN, STR
_qpr
no
Md8hih.e gh� ag,��
pp -
_ y,�
no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
0 One family
El Addition
11 Two or more family
0 Industrial
0 Alteration
No. of units:
El Commercial
El Repair, replacement
0 Assessory Bldg
0 Others:
0 Demolition
[I Other
-
El- Flood Ia'- i n- Q Wetlands;
-L- G--t-
0a r.
V -,V t4/ao, P -
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Type or Print Clearly'
nenWROMWIM
Address:
Phone:
6
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.
i Total Project Cost: $ FEE: $
Check No.: Receipt No,- -
NOTE: Persons contracting with unregistered contractors do not have. access to the guaranty fund
her Sianaturo* of con-frattor".-',
r
Plans'Sub.initted Plans Waived El Certified Plot Plan ❑ 1 Stamped Plans ❑
TYPF'bF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swlunn;ng 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 - U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On
Signature.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
t
Conservation Decision:
Comm
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
L ocatea Jt54 Usgooa Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureldate
y
COMMENT
F
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 lies No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$10041000 fine
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
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)
o 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
/�4
Location 0 '`1?-61(er-ACn A '2
No. _'S — .-)n I'%
i
Date
{
TOWN OF NORTH ANDOVER
Certificate of Occupancy $— ,—.-;
Building/Frame Permit Fee $ 4,44
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # -7-<--7 f
v Building Inspector
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 38,485.00
m
$ -
$
461.82
Plumbing Fee
$
57.73
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
57.73
Total fees collected
$
677.28
60 Rosemont Drive
531-2017 on 11/17/2016
master bath remodel
Oo oa y =
D
Ch<_ cu -0 N
D O CD 0.0CD 00
CL
•* rt Q
Z
C Q cn CD o.
CD 0 to O
N —• CD CD 2
-1
RL
o
CD O
CD cD
O N O C `D����
CD Z a -.i
CL r- m S. Q < to
sl1 sv = m � `a * — 3 +17
�O It V�� CD Q0'V,
_• -�
�� y
C/) Z0 CD
O X D (D v, a
v 00 CD �� o omar.L= U)
CD� o fi• �m (D CD
�' E
C: U)
Ern z �
CD h `c y
CD0z� �O
W O Do
�D
z
> RL
�•0 cn Qc
GQ CD zin
_ CD
cD
rt
cn oo 0 CD
-a Z c: m
�Dn U+�
C7 .O� —.0 �
0 _
O
asCD ��
DQ .1
CD
.:.
aoloodsul 6uping
��; . w
$ lviol
$ aad Iivaaad a9yl0
$ aad 1pied uoijepunod
�$ aaj Iivaaad auaeaj/6uipjin8
$ Aouedn000 jo alaolpliao
a3AOaNb HIHON =10 NMOI
9 /o -e_ L / _ �/ eIed
L5`1, e # moego
L 1 oi:5- --/ct.5 'ON
O t) uoi}eool
F/
r�
•
< 00-0— 3 -i
Or
O = ti=��� U
v �0 CD
y• o CL 0
�=-a N -�
C — o v,
CD SU C/) m
�• C, CCD '0 .
CD -O
cn N �
D
p
cOi —i
su
O
rts CD CDZ
CD N A Ca z EL -
CL m
'� 0
<cc
mS2
c�WNO CD O
�N �-h CZo
CD
�INn ZCl) � U)o � � :W'
C? a cC
c O Er �' Z v Co
rt = CD vi
CD
CD
O - 0
_ CD ._. Zfu
FL, CD >2
ON ., .�►
CO CD r.O
O CD
CD
rt
• C
Z C
cD
r- z -h
_
oCD
G): CD
nsu
ID
o �!
CD --I
O :u o
CL
O
W
J
LA
N
W
T
3
O
rD
a
. G'
O
O
O
O
O
O
rD
O
A-
rDrD —
rD
S
_
00
_S
q
7
n•
Q
S
f02
0
z
O
N
5
v
O
N
*
O
�n
n
O
.n
r
W
rD
rD
n
C
C
3
3
m
W
D
H
W
O
my
z
Z
V
r
G1
G)
0
�
n
N
m
y
tZi+
M
rn
-Ai
_
700
700
700
r
J
s
,qm
Westminster Woodworks
8 Westminster Road
Merrimac, MA 01860
drescherd@comcast.net
978-912-1945
H.I.C. Reg. #177436
Expiration - 12/09/17
Constr. Super. Lic. #095003
Expiration - 04/21/18
Bill To
Angiras and Nancy Koorapaty
60 Rosemont Drive
North Andover, MA 01845
Terms
20% at acceptance, 60% at start, 20% at completion
Description
Quantity
Demo - remove existing plumbing
$2,900.00
fixtures, cabinetry, one interior wall and
1.00
existing flooring.
$2,700.00
Prep - prepare wall and floor surfaces for
$4,960.00
step-in shower, floor tile, free-standing
1.00
tub, shower base and shower tile.
$800.00
Plumbing - fixtures (free standing tub,
$1,300.00
shower head, valve and body spray, floor-
$830.00
mounted tub filler, toilet, 2 sinks and
1.00
faucets).
Plumbing - labor (cost to rework for and
install fixtures).
1.00
Electric - wire for and install 4 recessed
fixtures, 2 interconnected fan/light/vents, 2
vanity lights and other outlets and
1.00
switching as needed.
Floor tile
150.00
Shower tile - includes wall tile, shower
floor tile and granite (or other stone)
thresholds. Niche, shelves and seat
1.00
included as well.
Cabinets - provide, per plan, Diamond
brand cabinetry.
1.00
Cabinets - labor
1.00
Granite - countertop for vanity.
1.00
Bath hardware - provide and install towel
bars, rings, hooks, etc.
I.00
Carpentry - provide and install baseboard,
1.00
crown and other trim.
Ship To
Esh"l ate
Number E201
Date 5/10/2016
Project
Master Bath remodel
Price Tax Amount
$1,800.00 $1,800.00
$2,200.00 $2,200.00
$7,500.00
$7,500.00
$2,900.00
$2,900.00
$3,040.00
$3,040.00
$18.00
$2,700.00
$4,960.00
$4,960.00
$4,730.00
$4,730.00
$800.00
$800.00
$1,300.00
$1,300.00
$830.00
$830.00
$1,060.00
$1,060.00
Westminster Woodworks
8 Westminster Road
Merrimac, MA 01860
drescherd@comcast.net
978-912-1945
H.I.C. Reg. #177436
Expiration - 12/09/17
Constr. Super. Lic. 4095003
Expiration - 04/21/18
Bill To
Angiras and Nancy Koorapaty
60 Rosemont Drive
North Andover, MA 01845
Ship To
Estimate
Number E201
Date 5/10/2016
Terms Project
20% at acceptance, 60% at start, 20% at completion Master Bath remodel
Description Quantity Price Taxl Amount
Shower enclosure - measure for, provide 1.00 $2,600.00
and install custom glass shower enclosure. $2,600.00
Paint 1.00 $1,200.00 $1,200.00
Permit and disposal 1.00 $420.00 $420.00
Signed with da
Signed with date:
l/
r76q�
(4 53
Amount Paid $0.00 Discount $0.00
Amount Due $38,485.63 Shipping Cost $150.00
Sub Total $38,190.00
Sales Tax 6.25% on $4,730.00 $295.63
Total $38,485.63
8 L
OO
oN o
II
O �
N
v� L7
Vi
U •r,
qa
z 0
3
0
ti0
q
ova
0�
R
U U fl+
'!
•moi
mA� y
TS
H C cd 0
r
N
CNS
Z
S
� \O
H
M
0
O
•O •0
•� Irl O
r•1
N O
'' The Commonwealth of.Massachusetts
{
Department ofIndustrialAceldents
I Congress Street, Suite 100
.Boston, MA 02114-2017
7 v� www mass.gov/dia
iNnkers' sation Insurance Affidavit: Builders/Contractors/Electritcians/P'lumbers•
Compen
TO BE FILED WITH TEE PERMITTING AUTi1ORTz"Y.
Name (Business/(jrgauization/Individuat)VVeb1rM1M1=4 "w wV.
Address:�5
city/State/Zip: e,Y r'' O (-S Phone #: Q i $ -0I (S ,1 14 5 _
�Ytt
Are you an employer? aeck6e approprlate box: Type of project Orecluired)
lt
1.❑ I am a employer with employees (full. and/or Part-time).' 7. ❑ N6vd6nstr-&iion
2 am a sole proprietor orpartnarshipandhavenoemployeesWorkingformein 8. elnode7ii7g
any capacity. [Noworkers' comp. insurance required.] 9, ❑ Demolition
3.E] I am ahomeowner doing all work myself No workers' comp. insurance required.] t 10 Fj Building addition
4.❑ I am a homeowner and will be hiring contractors to conduct all work on my properly. I will
ensure that all contractors eitherhave workers' compensation insurance or are sole
11.❑Electrical repair's or additions
proprietors withno employees. 12. g] -Plumbing repairs or additions
5.❑ I am a general contractor and 1 have hiredthe sub -contractors listed on the attached sheet 13. [] Roof repairs
These sub -contractors baud employees and have workers' comp. insurance.! 14 Other
6.F1 We are a corporation and its, officers have exercised their right of 'exemption per MGL c.
152, §1(4), andyve have no e_mpldyees. [No workers' comp. insurance required.]
*Any applicant that checks box*1 n ust also fill out the section below showing their workers' compensation policy mforrmation.
T Homeowners who submi.1 1 affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such
!Contractors that checkthis 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.
lam an employer that is providingworker's' compensation insurance for my employees. Below is the policy andjob site
information..
Insurance Company
Policy # or Self -ins. Lic. #:
ExpirationDOe:
Job Site Address: � Ir' P City/State/Zip: QO
Attach a copy of the workers' compepsatxon p olid'i declaration page (showing the policy number and expirati'.onate)-
Failure to secure coverage as requited under MGL o. 152, §25A is a criminal violation punishable by a fuie up to $/,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 ofthis statement may be forwarded to the Office of Investigations of the DTA for insurance
coverage verification.
I'do herahjLcertify under thepaka andpenalties ofperjary that the information provided above is true and correct
Official use only. Do not write in this area, to he completed by city or town off ciaL
City or Town:
permit./License #.
Issuing Authority (circle one):
1. Board of health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact
Phone
Information and Instriuctions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their eIhpldyees.
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' deified as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enferpri'se, and including the legal representatives of a deceased employer, or the
receiverfor trastee 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 dweEhig 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 Iocal 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 whd 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) a-adphone 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. 13e 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 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'
compensatiori 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 permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications ixr 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 ahome owner or citizen is obtaining alicense orpermit notrelated to any business or commercial ventuxe
(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-MA.SSAFE
Fax # 617-727-7749
Revised 02-23-15 wwwm.ass.gov/dia
g:00o:�
D
�<_
70U)
D--,Opz
nzmCt)
�
io m
Drn=70
o�om::E
o
o�%v0
�>
� O
cn
❑" ``
Izd
d
a
I °
70
M m
H
CD
❑ H
La
i
r«
~
O
UG
y
Ci3
SU)°
-4 r
0
co a
dI
O 'a
3
30-4
t
CD
7 (D 7
I
n �.m
(nb
'�^
ori
o
3
N J
i+�
I m
O
p7
❑
c�D4
o
J
c
w
o rn
3
t
3 �
�
s:
m o
o -s
M y
Q
❑
LJ
LJ
v 11
N�•
�!
w
Nom.
OS
a)
CL
n ao
N
1
a
g00°
SMS
0w
�� v�
Ci3
SU)°
-4 r
0
co a
nz�
3
30-4
��
m.
m We
I
n �.m
(nb
'�^
ori
o
3
,Omc
i+�
I m
cp
-n M
vi w La W
o
3
t
s:
m o
of t a. cc
A X
v 11
N�•
7 :/1
Nom.
� fD
0 0
CL
Go 3
N
1