HomeMy WebLinkAboutBuilding Permit #277 - 8 ROCK ROAD 10/15/2007 OORTFf
BUILDING PERMIT °f�t�ao
TOWN OF NORTH ANDOVER 32
APPLICATION FOR PLAN EXAMINATION
a �
Permit N0: % Date Received
A
r^ SACHUS
Date Issued: U ��
IMPORTANT:Applicant must complete all items on this page
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TIONETfiPRDRRER
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
peptic :k 11�e11 _, i ;� loomr4ifi Wetlands z ,, _ 1Naterst►Bd D�strrpt ,
.E` s
st-"J'�i -^`. ''
DESCRIPTION OF WORK TO BE PREFORMED:
c,t.c�c
Identification Please Type or Print Clearly)
OWNER: Name: p/}.w. w. Phone:
Address: 1� T?Ork ?J
.,4
�C\Y�T�Vil't�la\�-1Ya111G .sltl��G rae.. " 4-a t rT.,r .•r.•
r. r r� 1 {7m ' +� x,t}i sz-x''a nr '^z 2'�•k. �" >� r M,"". .r y. r X.
L K%nyGf V 4 a tY ? y k� kw a
Addressl . —f cry R
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1lrii,Prover��erll�i�ense � ;....x
ARCHITECT/ENGINEER CN---k- 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: $ �r4 o FEE: $ �)g4—
Check No.: AIP2 Receipt No.: 0
NOTE: Persons contracting w'th ung gisteged contractors do not have access to the
:�grntyfund
S�gnature5of Agen#%Owner - � _ �mireo#contractor s �
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
Privatese tic tank etc
� p � Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
I
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Con nection/S iq nature & Date Drivewa ermit
Located at 384 Osgood Street
� : .
FIRE
.DEPARTMENT Temp Dumpser onsite yes
t]D
Located at 124Main'Street,: _--.
i
-xFare Departrnent signaturel7ate
E � t
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)
ori '
❑ Notified for pickup - Date
i
Doc.Building Permit Revised 2007
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
o Floor Plan Or Proposed Interior Work
o 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
o 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 j
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
z
Location OQ
No. Date
HORTN TOWN OF NORTH ANDOVER
FAwo9
+ Certificate of Occupancy $
�'�s'•"°'''<�
Building/Frame/Frame Permit Fee $
s�cNust 9
Foundation Permit Fee $
r
Other Permit Fee $
TOTAL $ —
Check #
206 (, 11
Building Inspector
` NpRTH '9
o of : Andover
0
No. Z.7_ _ - = r _
o -= = o ` over, Mass., to
�.
COC HIC HE WICK V
ADRATE D PPS` ��
'9S BOARD OF HEALTH
Food/Kitchen
PER IT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT....... ...WOW. S�!/'�.
..................................................... . Foundation
............................... buildin on
has permission to erect. ...... ......5...... a`..r.........�....................::..... � Rough
to be occupied as.... ii r�lr�►............ ........... ��! ... .�h......................................................... Chimney
e
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
�li • Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTR NP TS Rough
Service
BUILDING INSPECTOR Final
Occupancy Permit Required t0 Occu'PY 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.
1L__SEE REVERSE SIDE Smoke Det.
•
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�ife '�a�reereo.w.vwll�(o�.��awae�+a+taAs ,!
BOARD OF SUILOINO REOPLAT ONS i
License: CONSTRUCTION SUPER.JPOR
Number.,$ 073424
E:phi: 2/0812008 Tr.no. 17840 <
.. Resttfcledc:�o` . .
JEFF A SCHULTZ
PO BOX 855 t;
NDOLETON, MA Ot6tp�_I" C
Conw�tbslsnu J
'� ,,il� �Jlri 700 ��O�✓{'tL7//fKyMfiR(i 1.,`'1
lord of anl�dist ReBstttloa swd SpsdaNt �"��,',�'
HOME IMPpOVEMENT CONTRACTOR ?
( R4pislralioil: 112278
��d X117/2009 Tr8' 127175
• -.fit ':.. �
6 6 CARPENTRY-•:'•••r r --r
"-JEFFREY SCHUlT2
%FOREBT ST. ,z .Z....Gt....`
I*ETON,MA 01949 Adminiitot
"L
to
Z68805L8L6 9950 • •L00Z/91T/0t
I 1ne uommonweattn ofIvlassacnusetts
Department of Industria!Accidents
Office of Investigations
600 Washington Street
Boston, SIA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): e. C
Address: �a ,-< C,-1;:5—
City/State/Zip: Phone #: (�i 7 7 S 7 �,V
Are you employer? Check the appropriate box: Type of project(required):
1. J,1 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.El am a sole proprietor or partner- listed on the attached sheet. E] 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.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §](4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers'
3
comp. insurance required.] 1 .❑ Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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: �z J C /U
Policy #or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/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 for insurance coverage verification.
I do hereby ce d penalties o erJurY th_.at the information
provided above is true and correct.
Signature:
/ Date: 02 U -7
Phone#: � �U L1 I
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#:
Page 1 of 1
Smith, Pamela(Dir.)
Subject: FW:Agent Letter.doc
J&S Carpentry
P.O.Box 655
Middleton,MA 01949
(978) 750-9741 Fax:(978) 750-8892
Mass Construction Supervisor License#CS 073424 - HIC License#112278
October 4, 2007
Letter of Agent
To Whom It May Concern:
I hereby authorize J&S Carpentry and Construction, Inc., represented by Jeffrey Schultz, to act as our agent and to
make application for a building and related permits.
Address:
dd ess.
8 Rock Road
North Andover, Mass
pa4n&'�
Signed: Date
10/4/2007
Y,0
-7........ . .........
P RO D I UC.E.R . ........ ........... CERTIFICATE IS ISSUED AS A MATTER AP INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
B R MCCARTHY INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
10 CENTENNIAL DRIVE ALTER THE COVERAGE AFFORDED.BYTHE POLICIES BELOW.
PEABODY MA 01960 COMPANIES AFFORDING COVER.AGE
COMPANY
2777W A AMERICAN ZURICH INSURANCE COMPANY
INSURED
COMPANY
J & S CARPENTRY AND B
CONSTRUCTION INC COMPANY
PO BOX 655-
MIDDLETON MA 01949 C
COMPANY
D
............
...........
RAG S.. .... ..........
:-CO-
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BE •
EN ISS•
UED TO.T.H-E.INSURED NA.:.:
MEDABOVE 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.
CO POLICY EFFECTIVE POLICY EXPIRATION
TO TYPEOFINSURANCE POLICY NUMBER DATE(MIUKDD\YY) DATE(MRADDXYY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $
CLAIMS
MADE F OCCUR. PERSONAL&ADV.INJURY
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) $
f I
MED.EXPENSE(Any one person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE
ANY AUTO LIMIT $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per Person) $
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per Accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
P AGGREGATE $
EXCESS LIABILITY
EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND ......
' LIABILITY STATUTORYLIMITS IT
A EMPLOYERS (UB-043OL60-1-07) 03-19-07 03-19-08
THE PROPRIET EACH ACCIDENT $ 1 nn,nnn
PARTNERS/EXECUTIVE INCL DISEASE—POLICY LIMIT Is
OFFICERS ARE: EXCL DISEASE—EACH EMPLOYEE9nn., f)nr)
OTHER
Is 100,000
LI
DESCRIPTION OF OPERATIONSILOCATIONSIJVEHICLES/RESrRICTIONStSPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
VIM—
lROM NOW
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
JEFF SCHULTZ LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
22 FOREST STREET
MIDDLETON MA 01949 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
J&S
Residential 04RPEN`V'W� Commercial
AND CONSTRUCTION, INC.
8. Entire Agreement—Except as otherwise stated expressly herein,this Agreement
constitutes the entire agreement among the parties hereto. This agreement
supersedes any prior agreement or understanding and may not be modified or
amended in any manner other than as set forth herein.
9. Miscellaneous-The covenants and agreements contained within this Agreement
shall,be the joi�t,arid several obligations of all parties, and shall be binding upon,
the successors and'assigns-of all parties.
10. Governing Law—This agreement and all rights of the parties hereunder shall be
governed by the laws of the Commonwealth of Massachusetts.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and
year first written.
rN
Witness , Owner
Witness , Owner
Witness JeffrlyW Sdbultz, President
J&S Carpentry and Construction, Inc.
P.D. Box 655 -Middleton,MA 01949 • 978-750-9741 • Fax 978-750-8892 • Toll Free 1-888-853-5339 • www.js-carpentry.com
10/12/2007 09:04 9787508892 J&S CARPENTRY & CONU PAGE 02
&(
Residential i4RPEN§%* Commercial 0
AND CONSTRUCTION,INC.
C0NNS_nLL( QN CON'Y;B&a
AGREEMENT entered into this 27 day of September 2007,by and between
Pam and Lee Smith of 8 Rock Road,North Andover,Massachusetts, hereinafter called
the"Owners"and J&S Carpentry and Construction of Middleton,Massachusetts,
hereinafter called the"Comractor".
Witnessed,that the Owners and the Contractor,for the consideration hereinafter named,
agree as follows:
1. Scope of Work—The Contractor shall fiunish all of the materials and perform all
of the work necessary for the following job: Master bath renovation.
a. Remove all bath fixtures.
b. Gut interior of bath to wall studs.
c. Insulate wall as required.
d. Install moisture resistant green board to walls.
e. Open wall and reframe master bedroom closet to facilitate 32 inch x 60
inch tub.
f. Remove closet to allow 60 inch vanity.
g. Frame left over space by vanity for linen closet.
h. Frame for new shower 36 inch x 48 inch.
i. Install new fan light.
j. Prep floor with Hardi backer board for tile.
k. Install the standard pattern.
1. Plumb all fixtures
m. Electrical to code. Three GFI outlets for vanity. Center outlet to be
double. Wire Vanity light,Wine fan/light. Disconnect and terminate
master bedroom closet light.
n. Replace bathroom entrance door with a pocket door. Door will be 2.4 x
6.8 sax panels.
o. Customer supplies all fixtures, fights,tile,grout, valves,etc.
p. .All work is guaranteed for a period of two(2)years.
2. Time of Compktion—The work to be performed under this Agreement shall be
commenced on or about October 10,2007 once city permit has been issued and
shall be completed within a reasonable time,weather permitting.
P.O. Box 655 • Middleton,MA 01949 • 978-750.9741 • Fax 978.750.8892 • 1b11 Free 1-888-853.5339 • www.js-carpentry.com
10/12/2007 09:04 9787508892 J&S CARPENTRY & CONU PAGE 03
Residential c4�p�N§0 Commercial
AND CONSTRUCTION,INC.
3. Contract Sum-The Owners sbail pay to the Contractor for the performance of
this Agreement,the sum of Nineteen Thousand Eight hundred 00/100 Dollars,
($19,800.00). Deposit of$3,000 on contract signing. Further payments due on
request of the contractor. They will be at the start of job,and as the job
progresses. The Owners are responsible for paying any amounts due for plana,
drawings,architectural work,permits,and any other related fees.
4. Impossibility of Performance-In the event that any contingencies beyond the
control of the Contractor, now unforeseen, including but not limited to Acts of
God,shall arise which shall render temporarily impossible the performance of this
Agreement by the Contractor,the performance hereof shall be suspended
temporality until such impossibility is removed;and if such impossibility of
performance shall excuse performance by the Contractor and shall discharge both
parties from all obligations under this Agreement.
5. "Or Equal'Clause-Whenever any item in this Agreement,defined by
describing a proprietary product or by using the name of a manufacturer or
vendor,the terms term"or-equal",if not inserted,shall be implied. The specific
article, material,or equipment mentioned shall be understood as indicating the
type, function,standard of design,efficiency,and quality desired, and shalt not be
construed in such a manner as to exclude manufacturers'products of comparable
quality,design, and efficiency.
b. Extra Work or Cbansges-No extra work or changes shall be done except upon a
written order signed by the Owners and the Contractor. Such order shalt state the
cost of such work and that time allowance for same,if any.
7. Secdewnt of Disputes-If payments are not made by the Owners and received
by the Contractor by the due date set forth in this Agreement,the Contractor shall
charge interest on the balance overdue at an annual interest rate of twelve percent
(12%). In addition if said payments are not paid when they become due,the
Owners agree to pay all costs and expenses of collection, including reasonable
attorneys' fees.
P0.Box 665 • Middleton,MA 01949 • 978-750.9741 - Fax 978.750.8892 • 7b11 Free 1.888.853-5339 - wwwJs-carpentMeoioo
10/12/2007 09:04 9787508892 J&S CARPENTRY & CONU PAGE 04
& wwwws���
Residential qt10' Commercial
0
AND CONSTRUCTION,INC.
8. Entire Agreement—Except as otherwise stated expressly herein,this Agreement
constitutes the entire agreement among the parties hereto. This agreement
supersedes any prior agreement or understanding and may not be modified or
amended in any manner other than as set forth herein.
9. Mbeftneeus—The covenants and agreements contained within this Agreement
shall be the joint and several obligations of all parties,and shall be binding upon
the successors and assigns of all parties.
10. Governing IAvr—This agreement and all rights of the parties hereunder shall be
governed by the laws of the Commonwealth of Massachusetts.
IN WITNESS WHEREOF,the parties hereto have executed this Agreement the day and
year first written.
Witness >Owner
Witness ,Owner
A t
q•olCj �O
Witness Je N Q ltz,President
1&S Carpentry and Construction,Inc.
P.O. Box 655 • Middleton,MA 01949 - 978-750.9741 # Fax 978.750-8892 • ToU Free 1-888-853.5339 • wwwJs-earpentry.mm
