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HomeMy WebLinkAboutBuilding Permit #638-12 - 85 JOHNSON STREET 3/6/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: - J2,— Date Received Date Issued: S& -IL, IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER DIg O(t i;,;, C F- K R ot� Unit # --- Print MAP NO: �PARCEL:�� ONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE 1,-T�%t{ tv wAA 4 f g- V y Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 4ept ®Well EO Flood* t®Wetlands ®Wa rshed Dim s r,�if'r eft DESCRIPTION OF WORK TO BE PERFORMED: CSM �' �'on R" 0 VA -211 -70 -Ju OWNER: N [cation Please Type or Print Clearly) /� 17— 6-;P-Rgo $3 r i i Address: Z ©,4f�oP ST- do - A`t-I -Dyy-F & mA of eV 5r CONTRACTOR Name: Rd Y'S E -RT- 1 -AP G-F—V1 _i`% Phone: -�5-09 �/�/ 3!6 r2 - Address: 16'7 :::�?T m 1,-T�%t{ tv wAA 4 f g- V y Supervisor's Construction License: l 0 0 t� / 9 Exp. Date: //3 Home Improvement License:. l / ) q 7 CJ Exp. Date: / / 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BAS�EDjON $925.00 PER S.F. Total Project Cost: 3 Od FEE: $_ Check No.: �6 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund lana ture of�contractor� Plans Submitted V/ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSA Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent )[)umpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED El DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comme Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 Doc:.Building Permit Revised 2011 June/mi 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/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 a Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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: Doc.Building Permit Revised 2008mi Locationg-5- -_ I --v 0/jW&--/t No.- 'j�� Date -c Check# I& � 25072 TOWN OF NORTH AN90VER Certificate of Occupancy $f, Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $— TOTAL $ )�2��� Building Inspector O FM4 A v � O O�� O O a U a � ?� z w A o a ro G U Cd w a o°G co w a W a°' U) . w b o pG u. �. rA z cn o o cn c � o = y � C �c O 1� R A V v d'O ol C c �� m c 114r �� Q E Q O Yd y' m { u W a; m -M Y = o 1, Ju wO C. '+ u Q ! �! r N „ E — o c � me CIO C. (A A O N � 3 'a mo N O mo CL C-3 16 - co O O .00 o'oac N CL = m O O 0 v y � c O Q CL CD. H -..m c �.:. = m C+" p N y m y0.. ~ ui WLL- r.. •yN CLC- . t A c_ _ �... •N L3 .o Q im '.0 cm c ti C. O- O-0 �- m :$ C.* m O z s 0 �O W P y.= 4-1 v W W z La � m (Do 00 ` Lo� '- J Page 1 of 2 795 Dale Street North Andover, MA 01845 (978) 686-3607 HIC # 111990 FID # 26-0816298 www. LangevinBu ilding.com Proposal Dan & Liz Gerron 85 Johnson St. North Andover, MA 01845 We hereby submit specifications and estimates for: Master Bath Remodel • All necessary permits • All demolition, cleanup and trash removal • All piping and installation including a copper pan in shower • Electric radiant heat in the floor with programmable thermostat • New fanlight unit in the shower ducted outside • Install new vanity lighting supplied by you • Prepare entire floor and shower walls for tile using Durock • New plaster ceiling in shower and all plaster repairs as needed • Fabricate and install two cherry vanities with raised panel doors and two granite tops as selected by you • All new wooden mop boards to match original • 3' high cherry matchboard paneling in soak tub alcove • Install tile on floor, shower floor and shower walls • Paint all wall surfaces and trim • Install two vanity mirrors provided by you • Our price quote excludes the cost of tile, light fixtures, mirrors and plumbing fixtures We propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of. $20,300 Payment to be made as follows: $7,000 at the start of job, $11,000 when Durock is installed, $2,300 upon completion. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home .Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727- 3200 or 1-800-223-0933. You may cancel this agreement within three working days following the signing of this agreement. Authorized Date Signature % j L - g Note: This proposal may be withdra4 by us if not accepted within 30 days. Acceptance of Proposal — The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Page 2 of 2 Do not sign this contract if there are any blank spaces. Date of Acceptance 5 b �2— Signatur Signature_ c4U � iuJ.l � a c logCL w O CO '� J, r cts d � O ' O® O J U,) q d 0 J 0 9 F Ns,' N d i e F Z Aa H� r h PQ d ® ca .3 zoW b0 cc - as o � C Z wc rnoO Ea .- ! ;: � gasw kn S L ♦� G r V ,.-r C 1 E> O c m vF, g a O 1, i z��11 t� o y i ., > V ` -nom Q •OA •C. O r N O. (1) V` �. w as R Q Z r. O �w Z a ! csww w G t W w > „ i y a 0 V a C m m p Z 0 Q y„0 .. Ir�Z . to'_ c4U � iuJ.l � a c GJ w O CO '� J, r cts d � O ' O® U,) Ns,' m tea= Aa H� r M PQ d ® ca b The Commonwealth ofMassacliusetts - Department or[ dustriat ,,4ccidents Office oflnva gations 600 Washington Street Boston, J A 02.71.7 www massgov/dia Workers' Compensation Insurance.A,ffidavit: Builders/Contractors/Electricians/Plumbers s 1GOAG A A AML 1.JC Jt)j Name (Business/Organintion&dMduat)D �J 19d•,D _C Address: —77-') �,F 5 City/State/Zip: A) N-bvVF-p, Phone#: c%-7 3,o7 Are you an employer? Check the appropriate box; I . ❑ I am a employer with �P aY 4- I am a ❑ general contractor and I Type of project (required): employees (full andlorpart time).# 2.[1I am a sole have hired the sub -contractors listed on the attached 6• ❑ New construction pmprietororpartner- sheet 7. ❑ Remodeling ship and have no employees These sub -contractors have 9. 0 Demolition working for me iu any capacity. [No workers' comp. insurance employees and have wodcers' comp. insurance- 9- ❑ Building addition required.] 3. ❑ I am a homeowner doing all work 5- ❑ We are a corporation and its officers have exercised their 10 -El Electrical repairs or additions myself. [No workers' comp. right of exemption per MGL 11.(] Plumbing repairs or additions insurance required.] t c. 152, 91(4), and we have no 12. ❑ hoof repairs employees. [No woricers 13_n Other COMP. insurance reauired_1 TAny applicant that checks box gl must also fin out the section below showing their workers' compensation policy information. 1 t Homeowners who submit this affidavit indicating they are doing all work and t>ien hire outside contractors m tContractors that check this box must aust submit new affidavit indicating soeh. attached =additional additional sheet shbmia owing the name of thcsub-contractors and state bmi to or not those entities have employees. Ifthe svb-contractors have employees, they must provide their workers' w°rP- policy of number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #- Expiration Date: Job Site Address: CitylState/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage asrequired under Section 25A ofMGL 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 farm of up to $250.00 a day against of a STOP WORK ORDER and a fine the violater. Be advised that a cc) of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa ns and penalties ofpelury that file information provided above is true and correct ,.3 Official use only- Do not write in this area, to be completed by city or town off,- at City or Town- Permid/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical "Spector S. Plumbing inspector Contact Person-. Phone #-