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HomeMy WebLinkAboutBuilding Permit #626-15 - 776 GREAT POND ROAD 1/29/2015BUILDING PERMIT 3r°. • •.. TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION b Permit NO: ^' Date Received ' n9 Date Issued: ANT: Applicant must complete all items on this LOCATION 6r f e_" . l Print PROPERTY OWNER f_Y,:. Print MAP NO: 2 10 PARCEL: ZONING DISTRICT:/- z Historic District yes or�j 0 X30 Machine Shoo Villaae ves tfm n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Vbne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial WRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 0 Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Identification Identification Please Type or Print Clearly) 0 - OWNER: Name: Sos,r, tom, tLer. Phone: q 1 a (Qb78- Address: I Z Gnect -Td-&A R d CONTRACTOR Name Phone: Address,. . l tc— f Ot a) 0c; D, Supervisor's" Construction License: Exp. Date: 11L HIm ome provement License. Exp: Date: /c73 J:,a D IS 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: $ 3 Check No.: Receipt No.: NOTE: Persons co c ang with unregistered contractors do not have access to the guaranty fund Signature of _ f contractor Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this pale LOCATlO`N; _ +Print —_--- MAP ___ PARCEL _ ZONING iDl$TRICT: __ `Historic )I -- -'- n e"y s a� *� es Jno yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family 11 Industrial ❑ Alteration No. of units: ❑.Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ . Others: ❑ Demolition ❑ Other = ❑Septic ❑Well _ ❑�Flgodplain p Wetlantls ❑ WatershedkDistrict _ DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: t Address: 19 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 Signature of Agent/Owner _ _ Signature of contractor_ t Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ dr _ .- Stamped Plans ❑ TyPF'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning 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 Reviewed On COMMENTS Signature CONSERVATION Reviewed on Sianature COMMENTS HEALTH Reviewed on Signature COMMENTS 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: t_ocatea Jb4 vsgooa Street ;IRE DEPARTMENTTemp iDumpsterron •site yes ._ no- Located -at 124iMahS,treet. _ --- _ - 'Fire ID.epartYmentgsignature/date Dimension Number of Stories: Total square feet of floor area, based 66 -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 use ❑ Notified for pickup Call Email Date Time Contact Name 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) ❑ 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: Building Permit Revised 2014 Location A -K N Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ FOundation Permit Fee Other Permit Fee TOTAL $ Check 28456 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 46,925.00 m � - $ 563.10 Plumbing Fee $ 70.39 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 70.39 Total fees collected $ 803.88 776 Great Pond Road 626-15 on 1/29/2015 Bath Remodel ON rA *- 7 O � � o 'Q eLa m �� 0 Q m c o E" as Q. 70 3o= �Cc V L m �M - Q J l y L - m c � L C O y N O O y — 'a -a O y O Q 7 E 'C VIIZ L O O n C M O O ma = o0 L C' d d � � � � y ++ m � O O d CL v m WO 70 +�-� O O u. y rn c y -O =-- EL it LU E tv O� a> _ o�c,o F- s moV E d t/1 t cn :'C O U) C m d d' am m O C O N as t 4- 0 Z O O O LU Z z m U) Cl)� ocp O W Z 0' LU li O x Z W J N O J Q a LU a a f - W a tAa Z Z LL Z za Im Z Z W 0 CCO ui Q 2 m J LL O E J pum N C a W O N ? 0 ][ N N N L Z C L t U L 4J a+ N Ow O O i C O E O v s O E 7 E LL (n LL KU LL W LL CC In I.L d' LL do y, (n (n *- 7 O � � o 'Q eLa m �� 0 Q m c o E" as Q. 70 3o= �Cc V L m �M - Q J l y L - m c � L C O y N O O y — 'a -a O y O Q 7 E 'C VIIZ L O O n C M O O ma = o0 L C' d d � � � � y ++ m � O O d CL v m WO 70 +�-� O O u. y rn c y -O =-- EL it LU E tv O� a> _ o�c,o F- s moV E d t/1 t cn :'C O U) C m d d' am m O C O N as t 4- 0 Z O O :v N _I E � O Z O D = o •� N Q •�mm O d o laO Q a C. Os = v cc J 10 CL 0 0 CLW V N to U) O LU Z z m U) Cl)� ocp O W Z V LU li x Z w0 N LU J :v N _I E � O Z O D = o •� N Q •�mm O d o laO Q a C. Os = v cc J 10 CL 0 0 CLW V N to U) Tee03monwealth ofMassachuseffsh- Department ofIndifshiglAccident _ office of Investigations 600 Washington Street Boston, MA 02111 www.mass:govldia 'workers' Compensationbsurance Affidavit: SuRdersfContrcactoxslElec icxanslPIrianbe .A,. �i[can� 1'nformat�on Please What Le b Name (Business/0rganizationlSn6vidual): Z� i' �e� �V Address: Phone #- � 1 <:� " 4 �- 5 - -? 7— Are you an employer? check the appropriate box: Are `1. 0 I am a general contractor and I I. R I am a employex with 4 _ employees (fulland/or paxE time). have hiredihesub-coniractoxs 2. [i I am a sole proprietor or partner meted on the attached sheet. These sub -contractors have ship and have, no employees working for me in any capacity. -workers' comp. insurance. 5• El We are a corporation audits (No workers' comp. ins�?r'�•Ge officers have exereisedtheir required.] 3.E1 X am a homeowner doing all Work right of exemption per MGL c. 152, §1(4), and we have no myself. [No workers comp. employees. V96 workers' insurance required-] t comp. insurance required.] Type of project (regidred): 6. [] New construction f q. modeling 8. ❑ Demolition 9. [] Building addition 10.[] Electdcalrepairs or additions 11.❑ Plumbingrepairs or additions 12.[] Roofrepairs 13.[] Other xAny applicant tirai checks box#1 mustalso frli outthe section bel6w sh0v&gtheir workers' compensationpolicy information. ;-Homeowners who submit this affidavit indicating the Are doing gwork and then Hire outside contractors must submit a new affidavit indicating such. r� + +,, c +har rheekthis boy must attached an addifiional sheet showing the name of the sub contractors and their workers' comp. policy information. I am an employerthat is providing workers, compensation insurance for my employees: Below is thepolicy and job site information. (� Insurance Company Name:. wA T Policy -0 or Self ins. Lic.I#: i Expiration Date; 2 I [9 City/State/Zip: Sob Site Address; i% � r e L.`� Attach a copy of the workers' compensaizortTolicydcclaration page (shoaling the policy number and expirationdate). Failure to secure coverage as required under Section 25A of MGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to $1,50 0.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a cagy of this statement may be forwarded to the Office o£ Investigations of the DIA for insurance coverage verification. - --ido hereby cert under the gins c citp � des of peirjury that Me in Vrmadon px ovrcieci aboy (xr true and correct phonic #: Official use only. Do not write in this area, to be completed by city or town official. bt5 City or Town: # IssuingAuthority (circle one): 3. City/TaWn Clerk 4. Elecirical�nspectox 5. PlumbingTnspecto I. Board of Health 2. BuildingDepartment x° 6. Other - Phone M. ACOR" CERTIFICATE OF LIABILITY INSURANCE �..�- DATE(MM/DD/YYYY) 1/28/2015 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 Fabri 6 Rourke Insurance Agency, Inc. 2 Central St., 1st Floor Georgetown MA 01833 CONTACT William Fabri NAME: PHONE . (978) 352-4990f aC No; (978)352-9991 E-MAIL s.wfabri@fabrirourkeins.com INSURERS AFFORDING COVERAGE NAIC is INSURER ANational Grange Mutual 14788 INSURED Jerrett and Son, LLC, DBA: Jerrett and Son, 17 Graf Road Newburyport MA 01950 INSURER B AMGuard 42390 INSURER C: INSURER 0: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER CL146345478 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. ILTR TYPE OF INSURANCE POLICY NUMBER MM/DDY/YEYYY MM/DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR KSM29584 6/1/2014 6/1/2015 DAMAGE ( RENTED PREMISES Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 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 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 500,000 BODILY INJURY (Per person) $ 20,000 A ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS 9584 6/27/2014 6/27/2015 BODILY INJURY (Per accident) $ 40 000 X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accidentI, $ PIP -Basic $ 8,000 x UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 AEXCESS RDED LIAB CLAIMS -MADE I X RETENTION$ 10,00() $ CUM29584 6/1/2014 /1/2015 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NTORY X WC STATU- I OTH- LIMITS E8 E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) NIA A C551629 /18/2015 /18/2016 E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Town of North Andover 1600 Osgood Street Building 20, Ste 2035 North Andover, MA 01845 ACORD 25 (2010105) INS095 r,2ninnni m I ILIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE liam Fabri/JFABRI ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Ar_npn nnmo and Innn aro rnnicfororl markt of ar:npn JERRETTAND SON LLC. "111111 vim. BUILDERS/GENERAL CONTRACTORS �S r CUSTOM CABINETRY & MILLWORK 17 GRAF RD I NEWBURYPORT, MA 01950 P. 978.462.3772 NAME/ADDRESS I Mrs Susan Worthen 776 Great Pond Rd North Andover, MA 01845 Proposal DATE Proposal # 1/18/2015 6-15 DESCRIPTION TOTAL We hereby propose to furnish the necessary materials and labor to perform the following work to your home at 776 Great Pond Rd North Andover, MA Remodel master bath as per plan by Applied Form and Space dated 9/24/2013 and replace four windows with the following; Price includes; Building permit Existing fixtures, tile shower, vanity, tile floor removed and disposed of properly. Supply and install window to replace existing casement window with a Marvin Desert Beige Clad Ultimate casement window with white hardware and screen. Move casement window to a new location to allow for a larger shower. Supply and install window to replace existing arch top with Marvin Desert Beige Clad Ultimate custom arch top Supply and install window to replace existing second floor office window with Marvin Desert Beige Clad Ultimate stationary unit with custom arch top to match existing. Supply and install window to replace existing office casement window with a Marvin Desert Beige Clad Ultimate casement window with white hardware and screen. All new siding shall be Primed Clear vertical Grain cedar. All interior casings to match existing. Frame ceiling, new larger shower with seat and niche on toilet side according to plan. Insulation, blue board and plaster. Plumbing labor to include relocating toilet directly across from present location, setting of shower valve, installation of all new fixtures. Electrical allowance to install new recessed lights and fantec exhaust fan, electric radiant heat with thermostat ($2400) TOTAL Je�tttaanndon horize ature I Cli nt signature It Page 1 JERRETT AND SON LLC. BUILDERS/GENERAL CONTRACTORS CUSTOM CABINETRY & MILLWORK 17 GRAF RD I NEWBURYPORT, MA 01950 P. 978.462.3772 NAME/ADDRESS Mrs Susan Worthen 776 Great Pond Rd North Andover, MA 01845 Proposal DATE Proposal # 1/18/2015 6-15 DESCRIPTION TOTAL Interior finish including fabricate, install and finish new vanity with beaded face frame and Baldwin ball tip hinges and knobs in brushed nickel finish,framed mirror according to plan. Labor to install owner supplied accessories. Backer board, shower pan, and tile installation on bath floor and new shower. Painting of complete bath including walls ceiling and trim. Tile, Counter tops, Plumbing and lighting fixtures, Grab bars and Towel bars to be supplied by owner and installed by us. Total cost for the above described work. 46,925.00 Payment as follows; $5,500.00 to order windows $10,000 when started $15,000 when bath framed, rough electrical and plumbing complete and inspected $ 6,500.00 when plaster complete and cabinetry installed $ 6,500.00 when tile complete $3,425.00 upon completion and final inspections Work will start once permit is issued and be complete within six weeks of starting Acceptance of contract: The above prices, specifications and conditions are satisfactory and are hereby accepted. Signature of this agreement constitutes a binding contract. You are authorized to do the work as specified. Payment will be determined as scope of work is defined A 1.5% monthly finance charge will be added to past due balances. All cost incurred in the collection of past due balances, finance charges associated to the above, and any legal fees resulting are the sole responsibility of the customer We carry workers compensation and full liability insurance and are a licensed and registered General Contractors with the state of Massachusetts. We are also lead certified and licensed. TOTAL $46,925.00 Jett and Son Auth ed Sig r `� 'q A Cli nt signature ` Page 2 �lf � V �/ V,// VV �V� V l/ �'✓ I�/C/Wti Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 154582 Type: Ltd Liability Corporation Expiration: 3/23/2015 Tr# 237843 JERRETT AND SON LLC ERNEST JERRETT JR. 164 MAIN ST WEST NEWBURY, MA 01985 Update Address and return card. Mark reason for change. Address [:] Renewal F-] Employment R Lost Card Vfze �oo�vr�za�rcuerutl�. a�U!/r'aaanr,�uaellcl . Office of Consumer Affairs & Business Regulation -ROME IMPROVEMENT CONTRACTOR 2egistration: 154582 Type: Expiration 3/23/2015:: Ltd Liability Corpc�-ati JERRETT AND SON LLC ERNEST JERRETT 17 GRAF RD NEWBURYPORT, MA 01950A ,r �— Undersecretary 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -055190 ERNEST G JERRETT JR 164 MAIN STREET 11 W NEWBURY Ml 019jj�` Expiration Commissioner` 11/089015 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature 02 0 a 9.242073 =ra 7a eaars IA Hillmtl WA S- a� UW.�F�a�s h HapvlA�Milm .. 1beRd� mllWi 16,w FNbN Fenn Fe.11o� Qae. - - PIrN WA b - !r i C Ej �' etN /ltlb Ne,ela. fp/ImtlN9 ® __- _____ nth Elz llNYl�mn."A T 7 _ NfavNNtlMyclaraYw� Vr�41tlt2� m1 77 N-b511P 5[pyeR®n Ma._ -511? N1Nw.Mbom<N � I�I� n m v 0 M6rym A3AJ [bon. w�.umum N O _ sMno�ar, b ® I u' I « �• I M• � 2Vanity Fevation vs-Iw 1Schematic Bath Plan 3 Wet Wall Elevation ]/I�1'd 4Toilet Wall Elevation yl�Sd c Window Elevation J ]/l�i'Q 02 0 a 9.242073 =ra 7a eaars IA