HomeMy WebLinkAboutBuilding Permit #706-2017 - 716 FOREST STREET 1/11/2017Wt�
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 70 & 617 Date Received
O �TtED t6 �
5.1.2 h.;_•. -
D - `
�o-.
7q DR'STED 1•PR�
SSACHU
Date Issued: -
EVRORTANT Applicant must complete all items on this page 4
ti f
LOCATION •''"_�%�,�-Fa_Ri✓Sr ,t 1 r_..�_.. f , ;,_
F'ROPER�T1Y'®ilVNER1
Pnnt�1,!'1t3YeaR; Et ctu ex ►yeS' Ch
MAP - `=PARCEL=� ZONING DISTRICT��Htsrtc _®istnct?
f m
Maciiine.Shop Village yes ,,
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Y10ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Aepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
- Septic, 1/Vell
q lands Floodplain M Wet
UVaterslied ®►sf�icf
Il- iter/Sewery
DESCRIPTION U(= WUNK ! U est FJ=M1-vK1v11=y:
8A -'N- �/� fl�s'to9 /ti/�LLt/J(r�I� x) � 4, 4404 -!� .59,: 4lz- 9z �v�
I/AnJ(TY ►.J � Gam./" !� i ,�Upftl� n.�r�/ S ��fL71�-D�' 1L , /�l LL �/ X y l�f/L� S
/ t�P�Qok'i T� SA M12- L6 G4
Identification - Please Type or Print Clearly
OWNER: Name: s7Ey6 ,r Y Phone: Z / - t` ,O - i/S-9
Address 7/ rOtZF 5 i 5T NO. /1n.1 uoI/F R— � /"VI
/v1l.
G�t/l Tl� Phone:, 7c�1- 3. jt � - �� ` . .r
Contactor Narrie:_. - _
..Address:,: _ _ _ --- - - - - -- - - - •- - _
....... ...
Supervisors Construction Liccns� _�. _ _ _� .p,
vyHomP, jTMIprovement Licensea �S/ 7� Exp � _
s—
ARCH ITECT/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.
i _,Total Project Cost: $_yt' '�'� FEE: $ V60
Check No.: Receipt No.
NOTE: Persons contracting witli unregistered contractors do not have: access to the guaranty fund
Location -7/& 4�'-O is s T S
No. -70 to
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # y?
7
/building Inspector
f
Plans Submitted ❑
Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
-TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBody 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 Reviewed On
COMMENTS
Signature
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on
nature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
F' Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT"- Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signatureldate
Located 384 Osgood Street
no
-imension
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
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$1DD-$1000 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 G.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)
❑ 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 Uf Contract
tr act
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
10TE: 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 Appel
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: Building Permit Revised 2014
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 81400.00
m
$ -
$
100.80
Plumbing Fee
$
12.60
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
12.60
Total fees collected
$
226.00
716 Forest Street
Bath Remodel
706-2017 on 1/10/2017
I
C
W
T
:OT
z
-v
x
T
Zu
rn�
T
n
X
T
V7
T
3
1-C
•
0
m
(D
O
z
CO)
a
55
m
j
Cl)
nz
N
G
N
O
N
0
"6
—�
z
(
((D
t7o
Cl)
m
3
�
v
—
(D
S
f1
z
CD
7
S
O_
n
\
n
n
0 o -a rt —I
o
cn <,cr a N
C �D, CD n m
n
0 rt Q-
O cn
N
O N _rt
h =p cn
�� o
CD CD 2
CLO D
3 G n
CQ Q- O : � �
N
o a
' ° C9
� rt f
rt
CD -a •�
�o�:s F
:0 <
2 �
o0U)
�, cn
z CD
° 0Cr
D`D�' a
�-
0 CL
o —
< CD �'1�0
�CU<��CD Mp
CL
Wm v
�n
CD0
N rt
cD O
o =�
rt 0
CDCD
A
`° OCCD�
0 N
o�
�C
DCD
m -a
o' 0
a)
a1 O
C .
V1
Ln
W
T
:OT
V1
x
T
Zu
T
n
X
T
V7
T
3
1-C
O
(D
O
O
j
N
G
N
N
"6
Q
(
((D
m
3
�
(D
—
(D
S
f1
S
S
7
S
O_
n
\
0
O
< C
(D
O
rr
r-
r
S
T
m
W
3'
C
C
W
C
O
H
W
>
n
z
N
G1
O
LAm
m
O
D
=
-Zi
00
0
0
z
0
co
coo*
N
O
amm
1
J
m
c
c�
A �` CERTIFICATE OF LIABILITY INSURANCE
F�ATE (Mm,21YYY)
01/09/2017
THIS CERTIFICATE IS ISSUED 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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Phone: 978-346.8761 Fax: 978-346-9620
JOURNEAY INSURANCE AGENCY INC
8 WEST MAIN STREET
MERRIMAC MA 01860
CONTACT Journeay Insurance Agency Inc
NAME
ao"N Ext: 978-346-8761 ac No: 978-346-9620
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER : Liberty Mutual Insurance 24198
INSURED
GREEN STAR CONSTRUCTION, LLC
INSURER a The Travelers Insurance Company
INSURER
CIO MICHAEL CURTIN
7 FOREST STREET
MERRIMAC MA 01860
INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 12275 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADD'L
INSR
SUBR
YWD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
(MMIDD/YYYY)
LIMITS
A
GENERAL LIABILITY
BKS(17)56339670
10/30/16
10/30/17
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE IXI OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurence) $ 300,000
MED. EXP (Any one person) $ 15,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
$
POLICY JECPRO-
T LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO
ALL OWNED AUTOS
AUTOS
HIRED AUTOS NON -OWNED
AUTOS
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(per accident)
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE $
EXCESS LIAR
CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE YIN
OFFIC(Mandatoryin NH) EXCLUDED? I T
(Mandatory in NH) —��J
N / A
6KUB4838P52-8-16
11/03/16
11/03/17
WCSTATU-OTH
TORY LIMITS
ER $
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE -EA EMPLOYEE $ 100,000
It yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Executive Officer, Michael Curtin, has elected to be excluded from coverage.
%.r_r%r Iri%oA I r_ rIUL.UCK GANGELLATIUN
Town of North Andover
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town Hall
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
North Andover, Ma.
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
\l /^/
Attention: Paul Hutchins Fax: 978-688-9542
Derek Journeay
M%.vrcU AD tcu 1u/uo) W 1V1Jt5-ZU9U AUUKU cUKF'UKATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
GREEN STAR
CONSTRUCTION, LLC
Mike Curtin Lic. # CS089677
7Forest St. 1HC # 154178
Merrimac, MA 01860
mi.curtinAcomcast.net
Proposal and Contract
--C-trent:
Steve &Judy Roy
716 Forest St.
North Andover, MA 01845
Job Location:
716 Forest St.
North Andover, MA 01845
Proposed work:
This proposal is to complete the currently gutted bathroom off the master bedroom. Work
to be done will include the following:
1) A permit will be taken for this job. Please note the cost of the permit will be added
on.
2) The area being worked on will be isolated with plastic sheeting as needed.
3) The wall studs will be trimmed or built out to form a level plane in preparation for
sheet rock and the -being installed.
4) Blocking will be installed inside the walls for mounting towel .bars or safety grab
bars.
5) Sheetrock and cement board will be installed on the walls and ceiling and finished
smooth. This will include a section of wall in the bedroom that was opened up for
the pocket door.
6) The existing plywood will be removed. The floor joists will be trimmed or built up to
form a -level plane. New 3/ inch plywood will be installed.
7) A new vanity will be installed.
8) A new medicine cabinet or mirror will be installed.
9) Please note this proposal does not include any cost associated with plumbing,
electrical, painting, tiling, or finish carpentry. It also does not include the cost of any
of the plumbing fixtures.
10) This contractor will coordinate all work between subs.
Additional Notes:
All work will be done in a clean, courteous, and professional manner. Any refuse produced
during the project will be removed and disposed of and the work site will be left broom
clean.
It is possible that conditions may arise that will require additional unforeseen work. Any
extra unforeseen work will be billed on a time and materials basis and will be discussed
with and approved by the homeowner prior to work proceeding. If additional work is
-necessary labor will be billed -at $40:00 -per -hour -and materials -will be at -cost.
Job pricing and terms: We propose to supply labor and materials in accordance with
the specifications listed above for $3,900.00 payable as follows:
$1,800.00 payable at the start of work.
$2,100:00 -payable at job -completion.
Accepted: The .price, specifications, and conditions listed above are satisfactory and are
hereby accepted. Green Star Construction is authorized to do the work.
F
Mike Curtin, Green Star owner
Note: This proposal may be withdrawn if not accepted within 30 days.
Addendum:
�� I I I,
i� j ! i I c �
coo
►
I
�
I
F Xr
,
G MSFT �
i
1
VI i
�.
I
I
,
,
1
I I I ►
,
I
'I
I
�
;
1
I I '
—T-- --�'— i f—r—�—i— i i I # I f f i .—T•—I—T r I
I
I
I
1 ,
I I
I
I !
1 ;
1 1
'
1 I
I I
_
I
I 1
1
I I
,
I I
r I
f
,
V
I
t
I I
1
_
I
I I I
I I
I I
I
'
a
w G)
q 0 \ \
a § > z
ƒ \ \.
/ \ / f
\ o
/ _0
OD ®\
/jIT !://
` /R1\/
�
dR
1
)oo
.
�
&mm
a
$1j
§m
q
\/o
�Q0
j
2q0
a,-
E/
�C/)
®
co
_&
E
§�(M
w
0
�
§
f
k2
-
§ \
§ -0
\C,
2a'
..,CLw
GO
,�£
CL
®
.�.
. . .J
The Commonwealth Of .Massachusetts
Department of-ndustrpiaTAceldefats
e 100
Y 1 Cong�'ess street.,,5`ult
Boston, MA. 02114-2017
o�M s'ti
wrww mass gov/dia
Mectri
-Workers' CompensaiionhsurMC6 Affidavizt: BuildexslCi�Y.
czansl'lunnbers.
TOBTP�G AU7 tORmPncai'rint ]
Name) (Business[6iS8 aizgdonllnl4dividua�:
Address:
City/Slate zip: 1"'t U2 Ny — AM U l C Lev Phony #:
Aeyou an employer? Check6e appropriatabox:
am a empiayer with �employees (full and/or part me).
2,Q I am a sole proprietor or partnership andhaveno employees Working forme in
any caparity- [No -workers' comp. insurance requi[ed.]
3.] I am ahomeowmr doing alt work myself. [Noworkers' comp. insurance required.] t
4.[JI am ahomeowner andv,0 be hiring contractors to conduct all work onmy property- Iwfil
Ll e e k all ,oj]fracto=s eiiirer have workers' compensation fi=anee or are sole
proprietors withno emg%yetis.
5.� T am a general conuactvr �d II?ave hiredthe sub-conftactors listed the attached sheet
These sub -contractors have employees andhaveworkers' comp. insurance.
6. ❑ We are a corporation. and its, officevj"ve exeroisedtbeir right of exemption per MC,Z G.
d' have no empldyees_ jNo worker' comp. issuance required.]
3rd ' 4a- —
Type of project (rcgnh'e(1)
`I. ❑ NL'9T'd6nstrd6iion
g. [�ekemodelisig
9. ❑ Demolition
10 ❑ Building addition
11.❑ E1ecicalepaizs or additions
1.2.K Plam=bingrepairs or additions
13'.�Roofrepairs
14.E] other
152, vk.N, an we
*A apjg - that chem bbiA must also f>7I out the rectos below showiag
their workers' compensafionpoficyurforrnatiom•
Homeowners who submit this affidavit indicating they are doing'U work andthen hire outside contractors must sabmft anew affidavit indicating such
Contractors thatcheckthis1i...... attachedanadditionalsheetshowingthenameofthesub-contractorsandstatewhetherornotthose.c ieshave
ees,theymustproYidetheit workers'comp.policynumber.
employees. ifthe sub-coniraotors have employ
to er iliatisprovidingrvo keNs' compmsation inszarancefor my employees 13e1o7v f t�iepolicy utidjob site
X am an emp y
information. -r A U 15- L 0 /'iJS UA-AJ LL
Insurance Company
L
1
Policy # or Self ins. Li'c. #:
If �� — f3 � 1'—dS' Expiration
IfArw-1 /
lob Si-teAddxess_ —71&
FAV57- 3T , ISH AQ611a IM City/Staie-Mp:
Attach a copy' of the WQo Ckers' compensadon poficy declaration page (s owm ail e policy
numb abl' by a fine � to $1,500-00
date)-
Attach
to secure coverage as required uuderMGL c- x52, §
25A is a cximin P•
of Investigations and/or one-year imprisonment, as well as civil penalties i a the form of a STOP WORK ORDER and a fine ofu to $250.00 a
day against the violator. A copy of this statement stay be fbiwarded to the Office, gations of the DTA for insurance
uu Y GA a6S Y -------
I
v.,.—,....—..,I do ker•e-by cepti�
g,epaans andTmaltieff 0fpeYjct1y Haat the infor nation p ovzctea c�ar�ye !Y"' - G ".`>� "'..
A - n.+,-. ! X�Y/0—
Official rase only. Do not1wite ira t7sis area, to be eorrrpleted by city or'tuwn official
PermitlLicense
City or Town-
fss�g AuthoX ity (circle one): ' ectox
i. Board of ff ealth 2. Building D epartment 3. City/Town Clerk 4. Eleetxitcal Xnspector 5. Plnxabing Insp
6. Other
Phorate #:
Contact Person•
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 bite,
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 enferprise, and including the legal representatives of a deceased employer, or the
recaMFor. trastee 6f an individual, partnership, association or other legal entity, employing emplbyees. -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 b6 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
applicaAtwlid bras not produced acceptable evidence of Moapllance with the insurance coverage req�&ed."
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
Pleasb fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), addtess(es) and phonenumber(s) along with their certificate(s) of
hisumuce. Limited viability Companies (LLC) or Limited Liability Partnerships (LLP) viii no employees other than the
members or partners, are not requited 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 itina,r ce 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 b Bing requested, not the Department of
Industrial,Accidenis. should you have any questions regarding the law or if you ate required to obtain a-6rkers'
compensation, policy, please call the Department at the number listed below. Self-insured companies shouldenter 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 Iuvestigations has to contact you regarding the applicant.
Please be sure to fill in the p etmit/Rcema number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications i a any given year, need only submit one affidavit indicating current
Policy information (if necessary) and under `Job Site Addxess" the applicant should vaite •"all locations in (city or
town)." A copy of the aff davit that has been officially stamped or marked by the city or town may b e 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 notrelated to any business or commercial venture
(i.e. a dog license or permit to butts 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 MASSAFE
Fax # 617-•727-7749
Revised 02-23-15 wwwmass.gov/dia