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Home My WebLink AboutBuilding Permit #809 - 667 FOREST STREET 5/8/2012BUILDING PERMIT iL-E° 6�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Rz) Date Received �R Permit NO: • � p �• '];.--- 9S° ATE° CHUSSA�,( Date Issued: y - , v IMPORTANT: Applicant must complete all items on this page 4 � } r t z a.r - ' ,a r x r= •r'icY• .') y, '`+x. 7 ti '-st. a fL j � tis °� � i x, . �'^"'�""�ci�_�-�•.s'�n�yR f .x., PARCELZ®NINGl71STRICT '`" >-� ' .�.Histonc District �`;°yes `„ r b� w:'t't �.e MachineShop,Village"`tiYe` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [I Addition ❑ Alteration PILOne family El Two or more family No. of units: El Industrial ❑ Commercial K Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition Non-,�EO 'LI]AG e�t�ri� Well: r ❑ Other Flood` la n t{ Vlletlands r� . W_atfrshed District .1 RIPTION OF WORK -1 U tjt FKKt1-UK1V1tu: / ;�( IQO..,�..�_ •�Gi>_ •�iV�i�/�..s. �� 1/moi!'/l�lc �' G��li: // �i- a exk 115-7-1 144s -4;i7 ,11 f?ec✓ % iii , Tex</es OWNER: N Identification Please Type or Print Clearly) h one: - r. ' 9..v"':' +• '' f`.`..'ytt, , r v .•„ K t, i x �.7 ... ,� , , n x niJ� r §I t r,s• f t {.,: ,f x • f -i�, Zf t -.i � ..±t��i R� CONTRACTOR 'Name '4;C Phone ,a ,yr,p s41„�,,,,-- :,?•-,.e*Fa�,.,sy4�:. Via: �..j�„ .a"Py�a x`• t�`w3 ��dress " ) "ke ` ��y*.r•..°.:5�,;-} ]� . + . {,R �� k{r �`� .TJ '° • )f r^ (" us .y �f' ,#oft' �}3i h` -r � }�'+ 7i3 •x f p2T f r�, ' f_ `x.b�r` Exp�Date �Q r s M Supervisor s Construc`t, on Licensees qt lift r€{Fi` '>x $k x � € � �;_ �ar � Chi s • �'L i 7 / - '7{ f t :Home$a� mprovement License ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000°00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. 0 ��, Total Project Cost: $ (� FEE: $ Check No.: % Receipt No.: �2L_ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location (IZ4� 7- �r— Check # 4 25282 Date 6— _d�- - /t"x— TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED 11 DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS Reviewed on Sionature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Wafer & Sewer Connection/si nature &Date DrivewaV Permit DPW Town Engineer: Signature: 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 i Doe.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 a Engineering Affidavits for Engineered products 40TE: 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 V®TE: 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 IM OTE: 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 Doe: INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 05/08/2012 14:01 9786833147 PAGE 01/01 `CORD CERTIFIC ATE of LI ABILITY INSURANCE DATE(MHIDDvYYYY) THS CERTIFICATE IS 13SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AU HORrzED REPRESENTATIb'E OR PRODUCER, AND THE CERTIFICATE HOLDER. Ithe MPORTANT; ff the certificate holder IS an ADDITIONAL INSURED, the pollcy(ies) must be end teRns and catdtionS of the pofiCy, certain policies may require an endorsement. A atatemeltt on this ertiROG does 13 WAIVED, nfer subghts the certificate holder in lieu of such endoraemen tlai.PRODUCER M.P. Roberto Inaurance Agency _NAME: EVA 1060 Osgood Street PHONG 978 83-8073 North Andovor, MA 01845 E{"la N (s7e) 693-91Q7 aDORss; EVA@MPRna> nrnQTUe,,,�.,_..� INSURED MICHAEL GOODWIN MF GGODWIN 7 HOLT ROAD EPPING, NH 03042 COVERAGES-- INsuRERt•- �-' CERTIFICATE N UMBER: THIS IS TO CERTIF" THAT THE POLICIES OF INS11 URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REVISION NAMED ABOVE FOR THE POLICY PERIOD INDICATI_D, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. TREXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURaxrrr� UBR rvucv NUMBER A OENERALLIABIUTY �� rw RIP M(OpIY MMlD YYYY OMMERCIAL GF, NERALLIQBILITY �0714j 41 LIMTS 4/27/12 4/27/13 EACH OCCURRENCE CLAIMSAIADE � OCCUR DAMAGE TC 1) L I CERQ�y) ¢ 1. MED EXP ArD'0-pm - S PERSONAL, & ADV INJURY $ ;GPN' AGGREGATELIMITAPPLIE5PFR GENERAL AGGRF,Qq� $ LICY P10- LOC PRODUCTS-COMP/OPAGO $ OBILE LIABILI'YYAUTO C INED NCILE rr EdopcidardLOWNED SCIiL:DULED AUTOS BODIIYINJURY(Perperg0hlTOS HIREDAUTOS NON-OWNF.O AUTOS BODILY INJURY (Paradnnl) S eci PROPERTY DAMA(;E .era idnl $ RELLALIAB OCCUR 5 MESS LIAB CLAIMS -MADE ]tDED EACH OCCURRENCE S R INVON $ 13 YWRKEM COMPENSATION AGGREC,ATE $ AND EMPLOYEATLIAIIILITY YIN VWC6015175012012 ANY PROPRfrTORIPAR.NERIPXECUTIVE 2/15/12 2/1$/13 WCSTATU• OTH- S OF9CERrMPM9ER EXCI-UDED? N / A YJJMIT.S !YIandnlory In NH) X] DESCRIPnON OF OPERATIONS I LOOaTIONS I VEMICLES (ARaeh ACORD 901, Atlm Zonal Ror�rles SchetlNa, IAmaro ppaep y,�q��) FAX 978-688-954.2 TOWN OF NORTH ANDOVER 1600 OSGOOD STREET BUXLDING 20 SUITS 2-36 NORTH ANDOVER MA 018,9.5 00.0 00.0 SHOULD ANY OF THE ABOVE DE80RIBE0 POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE CORD ZS (201 Ojos) lone: The ACORD name and logo are reglo Fax: (978) 688-9542 E -Mail: All rights reserved. m X m X CO) CO) mm C CCP _Z dH :9. CD ?=A CO) �: C ® v Z C2 CD �, Z CO) 01 IV Lot .0 �. ....0 ...a c T CD a C o -� m y -� O so : o c Z > > > CD. ' o OO 0 0. � C3 ... o 0 c y ') —1O H l7 CSD b _ �.vS,��/ C7 Z CO) R r c. a o CCD O 'O 06 CD s d C C/) CD CD Co �' C _• y ca =Imy y ate. Q C -)o W_ c CDCDJE CD CO) 0 CL (�• C y y .rt ^ CT � �' lJ mm m CD o °= CO) n CD O CD 0 `� o® V rte+ =r o 6. ao 00 Q o cCD Cn Z � 3 v S- -o 0 CL O CO)y CD to CD10 CD Z = ^► = o . a -o O: CD c o 0 C9 MA z O Inq 0 9 �N c ' 09 V P� °-G oc w O w O O to O ^ „z ' CL tz , .a o' n p CD z O Inq 0 9 �N c CD 09 0 130 Centre St. Danvers, Ma. 01923 Joe Palladino 667 Forest St. N. Andover, Ma. Project Description This estimate is for the following work. 2 bathroom remodels Hi Joe, Here is the estimate for the two bathroom remodels. If you have any questions please do not hesitate to give me a call or send me an e-mail. Scope of work; Hallway bath Estimate 978-423-8463 Obtain building permits from the town. Take out the toilet, sinks, cabinet, tub and flooring. Install a new tub, drain and single control shower valve. Put down Durarock tile underlayment on the floor and on the walls above the tub rim. Install a new exhaust fan and two 5" recess lights in the ceiling and vent the fan to the exterior of the house. Install an additional GFI receptacle above the countertop Install the new cabinets, sinks, countertop, faucets, mirrors, vanity lights and toilet. Total Signature mfgoodwincompany@gmail.com Page 1 Mass.CSL #081670 Mass. HIC #105029 5/1/2012 Total 130 Centre St. Danvers, Ma. 01923 Joe Palladino 667 Forest St. N. Andover, Ma. Project Description Estimate 978-423-8463 Install the new tiles and grout on the floor and on the walls above the tub up to the ceiling Install new pine baseboard along the floor. Prime and paint the walls and stain any new pine trim. Total estimate: $13,750.00 Masterbath Disconnect the fixtures. Rip out the shower and flooring. Install a new shower light and exhaust fan which will be vented to the exterior. A new single control shower valve will be installed in the shower area, a new shower base and a new drain. The shower will get Durarock tile underlayment on the walls. The rest of the bathroom floor will also get Durarock tile underlayment. The shower wall will be tiled and grouted as well as the bathroom floor. We will install the new glass shower door and walls. The new vanity, sink, faucet, toilet, mirror and vanity light will be installed. We will install new pine baseboard Total Signature mfgoodwincompany@gmail.com Page 2 Mass.CSL #081670 Mass. HIC #1 . 05029 5/1/2012 Total 130 Centre St. Danvers, Ma. 01923 Joe Palladino 667 Forest St. N. Andover, Ma. Project Description The walls and ceiling will be primed and painted and any new trim will be stained. Total estimate: $14,250.00 Details; All rubbish will be removed from the premises. The work will take approx 3-4 weeks for the work to be completed. Town permit fees are additional. Estimate 978-423-8463 All tile work is based on a single size porcelain/ceramic tile for each area,. Designs, patterns, marble, ect... will be an additional charge.I will help with the ordering and delivery. References are proudly given upon request. All products must be chosen and reviewed before a contract is finalized. The homeowners will provide the plumbing fixtures, cabinets, tiles, grout, surface mount lighting fixtures. M.F. Goodwin Co. will order and pay for the tiles which will be reimbursed by homeowner. Work will begin Approx May 8 2012 Total for both bathrooms: $28,000.00 Total Signature mfgoodwincompany@gmail.com Page 3 Mass.CSL #081670 Mass. HIC #105029 5/1/2012 Total 130 Centre St. Danvers, Ma. 01923 Joe Palladino 667 Forest St. N. Andover, Ma. Project Description Payment Schedule: A deposit of $ 9300.00 upon starting A payment of $ 9300.00 upon completion of tiling. The balance of $ 9400.00 upon sign -offs by inspectors. Contract acceptance: Contractor: ��,� ;fX,lill� DateA-112— Homeownerse�w,�� Date: Signature mfgoodwincompany@gmail.com Page 4 Mass.CSL #081670 Mass. HIC #105029 Estimate 978-423-8463 5/1/2012 Total Total $28,000.00 Office of Consumer Affairs & B smess Regulation { — ` HOME IMPROVEMENT CONTRACTOR'. Registration: --X105029 Type: Expiration: -7/1612.012 Individual MICCIAEL F. GOODWIN JR { Michael Goodwin J`r..__ 4 7 HOLT RD. EPPING, NH 03042 Undersecretary License or registration valid for individul use only ; before the expiration date. If found return to: , Office of Consumer Affairs and Business Regulation 4 10 Park Plaza - Suite 5170 Boston, MA 02116 t• '54a""Z. s Not valid without signature ias achusetts - Department Of Public Safctl Beard of Buiidin.- Regulations and Stan�,a:s rtl Construction -Su pervisor License License: CS 81670 t MICHAEL F GOODWIN ; 7 HOLT RD EPPING, NH 03042 Expiration: 8/8/2013 ('ununi"io el* Tr#: 2951 The Commonwealth ofMassachusetts Department oflndustriglAccidents Office of luvestigations 600 Washingtoxt. Street Boston, MA 02111 www.massgovIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers Applicant Information Please Print Le0ltly Name (Business/Organizationffndividual): A/ '4"/ a Address: Phone #: Are you an employer? Check the appropriate box: 1. ® I am a employer with _�2_ 4. ❑ I am a general contractor and I employees (full and/or pari -time).* have hired the sub -contractors 2. ❑ I am a sole proprietor orpartner- ship and'have no employees working forme in any capacity. [No workers' comp. insurance required.) 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.) i listed on the attached sheet. x These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp, insurance required.) Type of project (required): 6. ❑ New construction 7. W Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs -13.❑ Other 'Any applicant that checks box#1 must also fill outthe section bel6w showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they ale 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. J Insurance Company Name% 421'_111111 Policy # or self -ins. Lic. #:_ 11W6 4®/SI 7701,,;1- 0/;L- Expiration Date: ;1--,)3-13 Job Site Address: a' iae,57_1 67- City/State/Zip:, /. AO)aler W411 Attach a copy of the workers' compensation 13 olicy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 civilpenalties 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 Officeof Investigations of the DIA for insurance coverage verification. I do hereby cert under the pains andpenalties ofperjury that the information provided above is true and correct. - Sip -nature:/% Date: hone #: 7,75' �,�3- We52 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 "...everyperson in the service of another under any contract ofhire.,. 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 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 ofpublic 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 -contractors) name(s), address(es) and phone 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. Be advised that this affidavit maybe submitted to the Department of industrial Accidents fox 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 (ifnecessary) 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. Anew affidavit must be filled out each year. More a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit 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: Tho Gommonwoalth of yassachvsetts Department offhdusirlat .A,ocldents Moe off"08tigatlow. 60() Washington. Street Boston, MA, 02111 Te1, # 617-727-4900 ext. 406 or 1.-87TMASSAFF, Revised 5-26-05 `ay, # 617-727-7749 www.Mgss,gov A ,a