HomeMy WebLinkAboutBuilding Permit #400 - 66 PALOMINO DRIVE 11/20/2009 TOWN OF NORTH ANDOVER
[� APPLICATION FOR PLAN EXAMINATION
Permit NO: 7 Date Received
Date Issued: /rte
IMP TANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER t 1�4v �c til=es
Print
MAP NO-./'O-of CPARCEL:.A46 ZONING DISTRICT: Historic District yes n
Machine Shop Village yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building . One family
Addition �'`r� Two or more family Industrial
Alteratio I—l.*J, r 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:
Identificatio Please Type or Print Clearly)
OWNER: Name: Phone: 97B— ZPb-7s-V�
Address: Lo D AA ,,r6 b o-
o,-CONTRACTOR Name: q1 GbowjtU �;a V& Phone: -7F/- `{,Y . a 19
Address: Z I &A-12 0( 96 7
Supervisor's Construction License: ! Exp. Date:
Home Improvement License: � � 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: $ Cq G FEE: $ �
Check No.: Receipt No.: d-4)-4l
NOTE: Persons contract' "unreistered contractors do not have acce the g'qgrantyfund
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
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on . Signature
COMMENTS
ti
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 signatureldate
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.
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/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
r,
Location �•� �•`r7f►�Ny
No. Date
TOWN OF NORTH ANDOVER
0
i 7 ' Certificate of Occupancy $ ► '
Its tt� Building/Frame Permit Fee $
�►CMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2L6 �. ;,
Building Inspector
xkORTH
TONM of 4 ove r
o .
CO, z== dover, Mass.,ZZ� ' b
o �.
COC MIC MEWICK V
ADRATED
S BOARD OF HEALTH
PE .RMIT T D Food/Kitchen
Septic System
✓i / BUILDING INSPECTOR
THIS CERTIFIES THAT......� GI .cd ✓�
............................�,N.......................................... .................................................................. Foundation
has permission to erect......................................... buildings on ..�.r.�........... cN-d................................ Rough
...............
ie
tobe occupied as.............. Gw�- ............... ........................ ................................................................. Chimney
provided that the person 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 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU STARTS Rough
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.
N'lassachusetts - Department of Public SafetN
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 89566
Restricted to: 00 XcaffiL
THEODORE B GRAB
1029 HUMPHREY ST
SWAMPSCOTT, MA 01907 '
Expiration: 11/24/2011
(' nunissiuner Tr#: 10221
✓fze -�o7�nraneueaLC�i o��/�aaaczcfr....aelta
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registratioi1�,s140838
Expiration= 91/2$42011 Tr# 290650
Type's ,� 'f�vate Corporation
ADVANCED BASE(U1NTt*L1-$H1NG, INC.
THEODORE GRR,�
1029 HUMPHREY1� ��� --
SWAMPSCOTT, MA`Qfii907 Undersecretary
-- 50'1 - - -
I
k - ---- - 16'--- - - - -- - - ---- --- 34'1 ---- - - --- - - -- - - ------- ----- -=�
�- -4'4 13'4 - - 10'6 -- —5'11 —a
.42"bookcases
� a I
furnace&storage area children play area Cl
family room
i
-----------------------------------------------------------------------------------------------------------------------------
co = X tM'wall&pole enclosure
N N
V Move hot water heater - CO
- 3'g io T
- -- ---- — . .-- -- - - -�. - oy pantry
�EUP4
Household Pantry w/shelves bo
rt
sliding doors -
ZO
n utility closet
_V 2 -
�, - -- 15'10-- - __ 77 >'
--- - - - - 50'1 --- - - -- -
waste pipe enclosure w/clean-out
access LIVING AREA
1148 sq ft
The Commonwealth of Massachusetts
Department of Industrial Accidents
Dice of Investigations
600 Washington Street
Boston, M4-02111
www-massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Maine (Business/Organization/Individual): / r i�J)eyt
Address: /02 `� `7� 114-
City/State/Zip:
� 6,t, Phone#: I{1—,V
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.( 1 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 10.[3 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.]
....y applIcant that checks„ox n. ...=aaav..11 out the section below showing their workers'compensation'
ompens - ati
.ton policy informon.
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 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
ity/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
g for insurance coverage verification.
I do hereb fs'u er the pains and penalties of perjury that the information provided above is true and correct
Si afore: Date: �' 2� G/
Phone#:
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 Vocal Iicensing 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 number(s)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 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'
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 permit/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 permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would Iike to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Deparhnent's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents:
Office of Investigations
600 Washington Street
Boston,MA 0.2111.
Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE
Fax# 617-72.7-7749
Revised 5-26-05 vr,w.mass,.gov/dia
Ted Grab — Interior Renovations
Advanced Basement Finishing
1029 Humphrey Street
Swampscott, Massachusetts 01907
781-430-0415
advancedbasementnyahoo.com
MA Home Improvement Contractors Registration# 140838—Exp 11/27/10
Construction Supervisor License#89566—Exp 11/24/10
Proposal To Renovate Basement
November 17,2009
HOME OWNER: Deborah & David Cohen
66 Palomino Dr.
North Aindover, Massach-usetts 01845
PROJECT DESCRIPTION
1. Areas to be created in unfinished basement
CONTRACTOR SHALL supply all new materials needed to _erect,
according to State and Local Building Codes, build all walls along walls
to create and finish areas as designated on scale drawing. The areas are
as follows.
➢ Family Room/Home Entertainment Area
➢ Children Play area
➢ Children Art Room
➢ Half Bathroom
➢ Common Area
➢ Utility/Furnace/Storage Room
➢ Snack Bar Cabinet
➢ Toy Pantry
➢ Household Pantry
r '
Sprinkler Room Closet
➢ Electrical closet
➢ Under stairs closet
➢ Closet for hot water heater
*****PLEASE SEE AREA CONFIGURATION SHEET*****
2. Ceiling and Soffit Preparation
❑ 1" x 3" spruce strapping shall be installed (as needed) on ceiling joist 16" on
center to support weight of new drywall ceiling.
3. Wall Structure
➢ Contractor shall make wall alterations as indicated (approximately, as
needed) on scale drawing. All wall structure shall be built according to state
& local building requirements.
5. Insulation & Wall Wrap
Ali exterior walls shall be insulated so that all living areas and spaces are
insulated according to code(as needed). The insulation value is R-13.
➢ To control moisture on partition walls that are directly adjacent to concrete
wall, contractor install typar type material on the back of partition walls
➢ Contractor will paint concrete wall with Drylok. This treatment shall only be
applicable to walls that are directly adjacent to partition walls.
6. Steps
➢ Contractor shall make alterations to steps (as needed) to allow for the proper
installation of carpeting.
7. Electrical Work
➢ A Massachusetts Licensed Master Electrician shall perform all electrical
work. This project shall include the following.
❑ Up to 22-6 inch recessed lights in living areas.
❑ Up to 4 dimmer switches to control all recessed lights.
❑ Light fixtures for all unfinished areas separately switched.
❑ Up to 2 cable/broadband wall connections.
❑ Up to 2 telephone wall connections.
i
t
❑ Electrical outlets through living area per code. These outlets are
controlled by a GFT (ground fault) breaker.
❑ 4 — six foot electric baseboard heat control 2 wall mounted
thermostats
❑ A separate and additional charge will be assessed in the event an
additional sub panel is required to accomplish this electrical work
properly.
❑ The cost of electrical breakers cannot be determined until the
electrician is on site. This cost will be allocated and billed when
electrician has completed his work.
8. Finished Walls. Ceilings & Soffits
➢ All walls, ceiling and soffit of finished areas shall be enclosed with Y2 inch
"blue board".
➢ All blue board shall be veneer plastered to a smooth finish on walls and
ceiling.
9. Doors
➢ All hinged doors shall be"6 PANEL"
➢ All Sliding Doors shall be"6 PANEL"
➢ All doors shall include standard hardware and doorknobs.
➢ All doors to be installed with casing similar to existing casing on the first
floor.
IO.Baseboard, Door/Window Casing
➢ Contractor will supply and install new baseboard, door/window casing for
all finished areas.
11.Cabinetry
All cabinetry shall be fabricated of paint grade cabinet grade plywood.
➢ Home entertainment center shall have an enclosed lower section, which
includes 6 doors. Dimensions are approximately 18 inches deep, 108 inches
wide and 30 inches high. Upper section shall be approx 12 inches deep and
shall house a 50 inch TV (supplied by home owner). Cabinet shall include
power outlet and cable outlet. Home owner shall have reasonable input as tot
the design.
➢ Staircase bookcase shall be approx 48 inches wide and shall be ceiling height.
➢ Children playroom bookcases shall be not greater than 15 inches deep
approx and approx 12 feet wide by 42 inches high.
➢ Contractor shall fabricate a 36" x 24 inches deep snack bar to house a small
refrigerator and shelves above. The small refrigerator shall be enclosed by 2
cabinet doors.
➢ This proposal does not include any 'promotional" TV's
12-Plumbing
➢ Contractor shall install and supplied macerator toilet and create new
pumping and draining system.
➢ Contractor shall create new water supply line for toilet.
➢ Contractor shall create proper drainage for new sink.
➢ Contractor shall create new hot and cold water supply line for sink.
➢ Contractor shall move hot water heater as indicated on scale drawing.
13.Fire Sprinklers
➢ Contractor will engage a licensed Fire Sprinkler Contractor to provide
the necessary fire protection tasks. These tasked will include changing all
sprinkler heads in newly finished areas and installing new heads as
needed. The contractor shall provide an estimate to the homeowner and
this sub - contractor shall be paid directly by the homeowner.
M.Materials Supplied by Contractor
➢ Contractor will supply and install all materials and fixtures. However the
fixture listed below shall be supplied by homeowner and installed by
contractor. e
❑ Bathroom sink and faucet,
❑ Bathroom Tiles,grout, marble threshold
15.Flooring
➢ Thos proposal allows for no flooring.
➢ Contractor shall install ceramic tiles supplied by homeowner for bathroom
floor.
I6.Painting
➢ This proposal allows for no painting.
17.Permits
➢ All permit fees shall be reimbursed to the contractor by the homeowner.
Homeowners acknowledge that 3 permits are required: Building, Plumbing
and Electrical.
18.Scale Drawing
➢ Scale drawing attach shall be construed as an integral part of the proposal
and agreement. All measurement are approximate and homeowners
acknowledge the changes may be required due to building codes and
obstacles in the unfinished basement.
19.Provisions
➢ Homeowner acknowledges the following and hereby agrees to abide by these
provisions:
1) Reasonable access must be made to the premises during working hours.
2) Working hours are from 7:30 AM through 5 PM on weekdays. Contractor
may request the option of working on Saturday with homeowner's approval.
Said approval shall not be unreasonably withheld.
3) The basement area is a construction site, therefore, children and pets should
not be allowed in this area.
4) All personal property must be removed from construction site and
contractor shall not be held responsible for this property.
S) Quite often, communications concerning the project and questions regarding
the project will be done via "E-Mail". Homeowner agrees to reply
immediately and acknowledges that these communications shall become a
part or a change to this agreement.
6) Homeowner authorizes the reasonable use of bathroom facilities.
Project Investment $ 23000.00
➢ Payment Due with Agreement $ 1000.00
➢ Payment Due when Project begins $ 7666.00 (33%)
➢ Payment Due when rough Electrical
Work is completed $ 7666.00 (33%)
➢ Balance upon completion
Commencement Date
Project shall begin on or about t 1�' �e'�'� � and shall be completed
on or about AIALAq 3 1 4 1 10. These dates are approximate.
�J
Accepted by:
l Date: F7- 01
Deborah Cohen
Accepted by•
Pate:
David Cohen
Acce
7ted by:
Date
Ted Gr —Inte for Renovations
Advanced Basenient Finishing