The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #404-15 - 9 COBBLESTONE CIRCLE 10/29/2014 NORTH q BUILDING PERMIT 3�°e4t`lo °•e"°� TOWN OF NORTH ANDOVER #- : o '-APPLICATION FOR PLAN EXAMINATION t eq C� o Permit N0. � Date Received 9a Are u Date Issued: LRL-4 �9SSACHUS t I O TANT:Applicant must complete all items on this page LOCATION ( A PROPERTY OWNER "� `- 1 N�/ Print MAP NO:Ob PARCEL: v/SZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building k(One family ❑Addition ❑ Two or more family ❑ Industrial 'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: LdapeollPhone: Z. Address: - CONTRACTOR Name: /y q Phone: 6/ T Address: Supervisor's Construction License: Exp. Date: 91131-2,216 Home Improvement License: Exp. Date: O/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING 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.: ' c NOTE: Persons c tact g IVregister contractors do not haveQ09s 164heIguaranty fund ignature of Agent/Owner � _gnature of contractor n./ •sn s. d t%0RTy BUILDING PERMIT o* t,Eo ,baa TOWN OF NORTH ANDOVER 3? y ''`- �0 APPLICATION FOR PLAN EXAMINATION yy q ca Permit No#: Date Received �9ssgc««« ►+u5��y Date Issued: IMPORTANT: Applicant must complete all items on this page 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 ❑ Septic El Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: ' Address: Supervisor's Construction License: 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 Signature of Agent/Owner _T �� Signature of contractor Location No. Date D • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � G U fl / t; Building Inspector J C - b Plans Submitted ❑ Plans Waived F1. Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools El Art ❑ 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 Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r i 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 Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS* s 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 I NOTES and DATA— (For department use) �I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i i it 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 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 o 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 i 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) o 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 stampthe decision from the Board of Appeals PP 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 s Doc:Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 203000.00 m $ - $ 240.00 Plumbing IFee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical ree $ 30.00 Total fees collected $ 400.00 9 Cobblestone Circle 404-15 oft 10/29/2014 Master Bath Remodel and Walk in Closet I I i I i i CT-29-2014 WED 10; 16 AM P, 001 I I ® DATE(MM/60A- Y) CERTIFICATE OF LIABILITY INSURANCE 10/29/2014 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(les)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 andorsemen s. PRODUCER ZONTOT William a. Tarpey Tarpey Insurance GYOt1p PHONE (781)246-2677 F I181122a-0973 A/C No 442 Water Street AD AIL bill@ tarpeyinsurance.aom PO BOX 567 INSURERS)AFFORDING COVERAGE NA1C tt Wakefield NA 01880-4667 INSURERA:Norfolk & Dedham Groa INSURED INSURER 8: in Realty Trust INSURER C: 22 Wicker Lane INSURER D! IN RE: Wakefield MA 01880 INSURER F. COVERAGES CERTIFICATE NUMSER:2014-2015 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 BEI 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 POLJCYNUMSER POLICY POLICY 922D XP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence 5 .50,000 A CLAIMS-MADE a OCCUR RDPOI0344 9/29/2014 /29/2013 MED EXP(An one person) $ 5,000 PERSONALSAOVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMfr APPLIES PER PRODUCTS-COMP/OP AGG 5 2,000,000, POLICY T& LOC $ IN AUTOMOBILE LIABILITY EOMaB.d.D=SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) S . ALL OWNED SCHEDULED BODILY INJURY(Per accident) S PROPERTYAMA HIRED AUTOS AUTOS NON-OWNED P 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCE55 LIAR HCLAIMS4Y1ADE AGGREGATE $ DED RETENTION$ $ W WORKERS COMPENSATION STATU- ER AND EMPLOYERS'LIAuiLITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT 5 OFMCER/MEMBER EXCLUDED? (Mandatory in NMI E.L.DISEASE-EA EMPLOYE 5 If yyes Glescrilxa under DESCRIPTION OF OPERATIONS WIQW E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Sehadule,if more space Is required) General COntraCtCr- CERTIFICATE HOLDER CANCELLATION (978) 6889542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of North Andover North Andover, MA 01845 AUTHORIZED REPRESENTATIVE William B. Tarpey ACORD 25(2010105) 01888-2010 ACORD CORPORATION. All rights reserved. INS025(2oloos).o1 The ACORD name and logo are registered marks of ACORD i i J.K.L. REALTY TRUST CONSTRUCTION AND CUSTOM HOMES 22 Wicker Lane, Wakefield,MA 01880 617.257.4408 Jeff Manning October 28,2014 9 Cobblestone Circle North Andover Ma 01845 I propose to modify the existing master bathroom and walk in closet as shown on the on the plan labeled EXISTING BATHROOM to conform to the plan labeled PROPOSED BATHROOM AND WALK IN CLOSET. All finishes to match the existing house. Cabinets and fixtures to be supplied by the owner All walk in closet shelving to be owner's responsibility.All file to be purchased by the owner. The contractor shall be responsible for the wall configurations, blueboard and plaster,electrical,plumbing, and file installation.This project shall be completed on a cost plus basis due to many of the materials having not been selected. It is estimated that the cost for this project should be$20,000.00 Payments shall be made as requested. i 4 ature of Home Owner GArontr Si ature o or i NORTH Town of s ndover 0 - - — - - - - h ti ver, Mass, IDLAKI — — - cocHIcMlW1CK meq. X1.95 R^reo P Pkv tl BOARD OF HEALTH Food/Kitchen PER Septic System THIS CERTIFIES THAT .....NE .............. BUILDING INSPECTOR ..... 4 . ........................................ . . .. �® Foundationhas permission to erect .......................... buildings on , .. C.0 .. ... .....:................... Rough to be occupied as ........... ......... t. : ` . . ............ ....... ... . . ........................... Chimney provided that the person accep ing 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 MONT tt�_ ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service ............. .. ate..................... Final BUILDING INSPECTOR 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 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, S450 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: 7,,s�,� N rG ' 6 r� (Location of Facility) i 4/icant e o —Z4o Date The Commonwealth of Massachusetts - Department of f udustrlgl Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information PIease Print Legibly NaIMe(Business/Organization/Individual): Address: �� 1oCm7e City/State/Zip:,!A47 A IV 01M Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction / [ mployees(fall and/or part-time).* have Hired the sub-contractors �( 2.H I am a sole proprietor or partner- listed on the attached sheet x �• �Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition I[No workers' comp.insurance 5. ElWe 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,§1(4),and we have no 12.❑Roofxepairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] xAny 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 a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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.Lie.#: 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ado hereby certrider a• and nahl'es of rjury that the information provided above is true and correct. Simature: Date: �� .9 Phone#: / Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing lhspector 6.Other - - - I Contact Person: Phone#: I i -.- vYie amrniwoacUeau�t.°fvv�aa�rscstttdeta4� eeof CGusumer Affairs&Business Ite u ME IMPROVEMENT CONTRACTOR i gistration x71734 : Type. piration 4X912Q4f>; DBA , - *, 3KL REALTY TRUST"'' t� 22012KER LANE _— ��r iCi;�11L0;MA 01,880 Undersecretary # Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor: License: CS-051701 RUM LUCL4$JR 22 WICKER IN s WAKEFIELD MA 01$80 yoll . ; ` .s �. Expiration Commissioner 09113/2016 I ' I 00 � N -�- ----- ----- --- -- --- � - - � 0 OVERVIEW I X6 04 i Go y , 9 p `CD ✓r _ ` ~ LID SB362132 B242132R //SB362132 11 130D 1113ODH I I 3'-2" 12'-9 1/2" f 15'-11 1/2" Proposed Layout for Bathroom & Closet scale 1/4" = 1'-0" _ - - - - - - - - - - - - - - - - - - - - - - - DRAWINGS PROVIDED BY: PROJECT DESCRIPTION: SHEET TITLE: SCALE: DATE: J.K.L.Realty Trust Jeff Manning Modified bathroom PROPOSED BATHROOM 22 Wicker Lane Wakefield Ma 01880 9 Cobblestone Circle AND WALK IN CLOSET 617-257-4408 North Andover Ma 01845 DATE JKLRealtytrust.Com CV 00 I r r CV O U')F7 O r � r ti LIVING AREA 'n 190 sq ft 121-21/21' 3'-2" EE 12'-9 1/2'1 15'-11 1/2" Scale 1/4" = 1'-0' DRAWINGS PROVIDED BY: PROJECT DESCRIPTION: SHEET TITLE: DESCRIPTION BY DATESCALE: DATE: J.K.L. Realty Trust Jeff Manning existing bathroom 22 Wicker Lane 9 Cobblestone Circle Wakefield,Ma 01880 north Andover Ma 01845 Existinq Bathroom 617-257-4408 DATE JKLRealtytrust.com