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L ?fio:� "�a F: „g^ r�`'r': .;� #�,#, �.y,�•. T "�.�`� ;" . .�". .x �tF; �a7 3 � s.,�4�s�t��T, �`f�_Si, .,�j+ r�.`�.. �t-,s � t.a 'f a .��,z -2 p C §a�'. � .R F r w Lh PROPOSED USE • - •n- Residential N e - •- - • • b! • - family ■ � •• • 11 • • more ■ Industrial L Alteration • of ■ Commercial 0 Repair, replacement 11 Assessory Bldg [I Others: ■ Demolition ■ Other �'yii'#3�:*:lea..-.� ;�"�-Sa ani..rt'�:`� s) .;,�.-r*�a�-g i.�•,� •� .�'c<mYg�_ss�X�,�.r ;� 1� � �^ `` „a�:>•d5ai�i_s��*'%x�'� ;� �; �• ;t�.- ,y: („ �,���#a '�' '.f..t� L ;`.;w t+�: �t��� t��"7� �7 :.�{`,�+'�,5'.'%,+-��.'sa-•S,C >-�'-•;l,`���~x. .�.+�Sn€ ,., jitts�'•i1`" r�'�3"',�t`�^`�:�„>t, f �w n���j,>� `*" �?:�j }•Q�i..�y`t �i�:.we bM�,�jK�a�;n"�art ,�� �,�. 'F-.����.•'�.,�I*i`�:` `+;d't" 3'h.�- �. 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'r" �k' ..;§,. .�:+�° ,T • ,�`S`r.:�, ��,:=S4 fi 1-.•;�� -t,. �.�5f F,.'� . -„`t-s .t#. a:�:,. .» �.ci..+a�i fiw w��,'at�' .r,,�er�•'°Ya'€-:.. aT t`. �..�, .��;:., �c,� s�,±.�^a�, w�,'rt{ �a � ±.� �r.. �,� 'Yk�€a�' '� � ,�:' >�,� q?d,�'w c4-v`�kk.�'�,•`�� ��,r-.. {�tY •�fY t"�.'E����,� �.._�''4 �ys°3 '� a�� .�A e,;_� ��, .=.ah �F���'`•'� �_"'S��`£ �z.:'. + .';:'.te - r t a �-,� .t.2>"�, ,w -�•+Ydo r:Ay v�.�.aSM,�';.+.� ,:t�a����` *ka�,n�;�.L,.A''A.3r.��� '^€'�1 � � 't,A£x� ^,*' 1ta' �°n� �r^*2g'>��y ��� iy ,��e7�`�3 3�� ?�S� -C-�..:•*.ti ,.-� ?m h "4.�°' .�f>�•�.,.�a':��'t 1�war4S`�, <? ..4t r�a9��i.,._`��• ,% BUILDING PERMIT NORTy w. 6 TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �,y'°°R,TEo SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page r - LOCATION Print PROPERTY OWNER -Print 100 Year Structure yes no MAP 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 Septi-c b"0 [I �0 Flgodpl'AJ OW 6 lantls, 0 Irate sr he'd4'Pist ipt ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: . Address: i Supervisor's Construction`License r: -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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund . . . - l Plans Submitted ❑P Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL <_ Public Sewer ❑ Tanuing/MassageBody Art ❑ Swhnming 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature I COMMENTS C III I ri ` 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 uD rnpste on si efi es no OC-9 ted'at 1r'2=�M_aivnCpt��gW� ''�' rFir .,X—F' ti.-�signature t a +R!r, }x.`,•''.Z L;,titp r.. .' �r�=� 's a � ++ F `-�,ra @,+.;.�, w. � ,:nr �" f`sa .�+�: :[+K. lyhe� «ir�a e :. +'r s �' K acs ,.<,... _.,• F a,.� � '' � __� `t° �'�; r, v� iC®MJME_TtspwR I � Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Deter location, wast 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) j i i I s ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 OTE: 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) Engineering Affidavits for Engineered products OTE: 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) 4. Copy of Contract 2012 IECC Energy code 4� Engineering Affidavits for Engineered products j 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 Doc:Building Permit Revised 2014 I Location No. , . '_ 7,01� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ° >> Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check'# 30487 f Building Inspector 777 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $� 1167„37/5.00 m $ - $ 196.50 Plumbing Fee $ 24.56 Gas Fee 100 comm. $ 110;©i,D Electrical Fee $ 24.56 Total fees collected $ 345.63 767 Johnson Street 1291-2016 on 6/10/2016 Basement I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 16X5.00 m $ - $ 196.50 Plumbing Fee $ 24.56 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 24.56 Total fees collected $ 345.63 767 Johnson Street 1291-2016 on 6/10/2016 Bath Remodel tAORTFi Town �� : _ : ., LAndover No. �i o zT2,a C h ver, Mass O > > COC KIC Kl WICK �'►• tl BOARD OF HEALTH Food/Kitchen PERM T LU Septic System THIS CERTIFIES THAT 1S i4 ,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ...................... .... . ....^-1... . ..... .................. has permission to erect .. ..... buildings on .J(P]. �;�,� Foundation ........ .... . ....O.... Q...... .�.................... s , Rough tobe occupied as ........... ............. ...... .� .�1........................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONST ON SRough j5. '__ Service . .. .. .. ... .. . . ..... .. ....... ........... Fina BUIL IN ECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. CBA WOODWORKS Estimate 90 Boston St North Andover, Ma 01E MA 01845 (978)305-2547 Date: 04/12/16 cbawoodworkst@email.com Estimate# 0726 Salesperson Job Payment Terms 1/3 deposit : 2/3 completion Brian Kathy Belton Bath Item Description Line Total $0.00 1-Bath Demo bath down to studs and concrete floor. 14,400.00 Frame&prep for widened walk in shower. Install tile floor&walk in shower floor&walls with curb. Electric-Replace vanity light, exhaust fan.Add new shower recessed light. Plumbing- Modify plumbing for widened shower, new vanity&toilet(same location ). Install all fixtures. Plaster walls&ceiling smooth finish. Install wood base molding&door trim,vanity,misc. wall fixtures,mirror etc. Paint walls, ceiling,trim. Contract installed glass shower doors. -Allowance$1300.00 (included ) i 2-Bar Sink Remove, modify&reinstall existing base cabinet for 1,200.00 bar sink. Run water lines,drain,vent for sink. Install fixtures. Patch wall as needed. 3-Upstairs Toilet Patch subfloor, replace tiles, resecure toilet as needed 775.00 if determined there is damage. Includes contract/coordinate all trades,disposal, permits. Excludes purchase plumbing fixtures,tile,vanity etc. Total $16,375.00 Quote prepared by: Brian Beasley This is a qoutation on the goods named,subject totco s nobt ow: To accept this quotation,sign here and return: d . Thank you for your Buisness! T LSHyyooa_worKs 90 Boston St.No.Andover,MA 01845 Tel: 978-305-2547 Fax: 978-208-8333 �j Email:cbawoodworks@gmail.com www.cbawoodworks.com � u 31, f } gam,, a-R 00 1 90 Boston St. North Andover,MA 01845 Tel:978-305-2547 Fax:978-208-8333 Email:cbawoodworks@cbawoodworks.com NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FOM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: i a6 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date o,Q e D f I iqS �v t SS V�2m jz 64RY 4 nee- ZIN1=11E t:DA tn'tltf�Elitgt O,jiYRtsSOCUMOS Dqwftad of Indushial Aoidents Offee oflnvm*adons ' 600 Washington&red Boston,MA 02111 www nm govldia Workers'Compensation Durance Affidavit:Bw7ders/Contractorsmectricimdplumbers Ands-ant:Information Please Print L Name 011;ur� � cc��c-� I L34- VjQ0 vvn�c5 Address: 60 ci /State/Z• : �t/Jr hone#: Are you an employer?Check the appropriate box: - I.❑ I ain a with 4. ❑ I am a general contractor and I - Type of project(required): loyees OUR anchor art-rums).* issue hired the sub-coatractms 6. 0 New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. 13 Remodeling ship and have no employees Ilsese sub-contractors have S. ❑Demolition working for use in anycepcity• employees and have workers' �stuatscet 9. ❑13nildiug addition [No wogs' cow isssuuance �P- required•] 5. [3 We are a corporation and its 10.0 Ekctriral repairs oradditions 3.❑ I am a hotacowner doing all work officers have exercised am 1 i.❑Phunbing repairs or additions myselL[No workers'comp• ofexempron per MOL 12.0 Roofrepsirs insurance •]t c.152,§1(4),and we have no emp .[140 worims 13.00fim comp. ] •Any applkM that�box di m nt dwra out the sem belaw showing theirwodrae eomp�emation Faheymfwmaim. t Homeowmas who submit dds uf6davit indite they we doing aU wok end thea Line autddecummoms mast submit new affidavit indicating so& tContiectors dot check dis box must attochcd an addidaael shed shumug the name ofew sub-eons end ante wheiber o nae rimae entities have employees. If the sub-ooutraecois'have uV%yee s.they must provide their tva dbm-ramp.palicy numbet Iam an employer that is proWding workers'compensation insurance for my employeeL Below is tltepo5ey and job site information. Insurance Company Name: Policy#or Self-ins.L.ic.#: Expiration Date: i i Job Site Address: R V?) '�lvig_/_ 1. Mirrl h Amb&9,eyA City/State 4: AAY aj `+6— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Faihre 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-years w well as civil penalties in the foma of a STDP 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 ftwarded to the Office of Investigations of tine DIA for insurance coverage verification. I do hereby earl fy under the pains and penalties of perjury that the information provided above is bwe and CM7VA Simian- �Fh,�o Date: Od--6t(1 a Phone# `? OfjCldd apse oj* Do not write in this arety to be congdoed by city or tower of wkL City or Town: Permitli ices # Issaurg Authority(tirade one).- 1- ne):1.Board of Heatih Z.BmIdJug DVwtmeRt 3 City/Town Clerk 4.Eleetrieal Isaspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACoO V CERTIFICATE OF LIABILITY INSURANCE DATE(MNWD/YYYY) `� 1 6/1/2016 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 terns and conditions of the policy,certain policies may requite an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CNEOAMCT Paul J. MacDonald CPCU, CIC MTM Insurance AssociatesPHONE (978)681-5700 No,.(978)681-5777 1320 Osgood Street ADDRESS:certificates@mtminsure.com INSURER AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:Preferred Mutual Ins Co 15024 INSURED INSURER B Brian Beasley dba CBA Woodworks INSURER C: 90 BOSTON ST INSURER D INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master 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 ADOL SUBR LTR TYPE OF INSURANCEINSO WVDPOLICY NUMBER MMIDWYYYF PONWDD1YEYY� LIMITS ! B COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A CLAWSMADE a OCCUR DAMAGE TO RENTED 50 000 PREMISES a occurrence $ r SOP0100715042 11/1/2015 11/1/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 B POLICY COT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ffg accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident H 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS,LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A EL.EACH ACCIDENT $ (Mandatory N K yes,describb e under E.L.DISEASE-EA EMPLOY $ DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of North Andover THE IXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 P MacDonald CPCU, CIC JQWy __ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r�manmi } ` Board ofBuilding \$ s d Via:/ds w / £im«mcA,Slpervi mr w\;cense:CS-10703 _ ] 71 ^ ® ) aRJb4N B ASL Y;-- . ] g RUSSELL SIMET-,&A- ) North AndoRrW* 01IA3 \ - Expiration ] mors_r 0�1 : �it ,s ��