HomeMy WebLinkAboutBuilding Permit #132-12 - 90 SPRING HILL ROAD 8/15/2011 I
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO. / Z� 2�,
Date Received �/! �!
Date Issued:
IMPORTANT:Applicant must complete all items on this page
I
LOCATION 1/7 G�
Print
PROPERTY OWNS r---
Unit#
Print
MAP NO: &ARCEL- ONING DISTRICT: Historic District yes
Machine Shop Village ye no
100 year-old structure ye no
TYPEOOF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 0 One family
0 Addition 0 Two or more family ❑ Industrial
0 Alteration No. of units: 0 Commercial
0 Repair, replacement 0 Assessory Bldg 0 Others:
❑ Demolition ❑ Other
�Well
❑'Se tie - . ._
p 0 Floodplain O_Wetlands 0 Watershe&District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identificatio Pleayf,
ype or Print Clearly)
OWNER: Name: Y Phone:
Address:
CONTRACTOR Name: f1 o Phone: lok3 /y2.�
Address: �(1r 0303
Supervisor's Construction License: /O S Exp. Date: /3
Home Improvement License: 7—?_O 2-22-- Exp. Date: ��-�� /2--,
ARCHITECT/ENGINEER Phone:
Address:
Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $
FEE: $_
Check No.:A2(9_ ��
Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guar fun
:_ignature of_Agent/Owner
Signature_d- contractor',
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 ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH' Reviewed on Signature
Z:)
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:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.: k
I
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
i
- 1
❑ Notified for pickup - Date
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 j
❑ 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: Doc.Building Permit Revised 2008mi
— — — -
Location
No. Z" Z- Date �
�I
MORTh TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
}} TOTAL $
Check #
24 L;riS
. -y2---Q-
Building Inspector
NORTH
Town of __ Andover .. .
0
No.
o , dover, Mass.,
o E �.
COCHICHEWICK
%S RAP'? C5
TED
U BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT......4poo.................�5�►.�!........................................................................................................ Foundation
has permission to erect........................................ buildings on ..Q.().....5 .. ► .I. ,..r ................................. Rough
to be occupied as.........MK .....46A+..
Chimney
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
Final
I q a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTS KRTS Rough
............. ...... .... .................................................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy 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.
SEE REVERSE SIDE Smoke Det.
R. U . Handy
14 N. Shore rd, Derry, NH, 03038
Tel: X603)818-1923
R U HANDY CO 5/16/11
Ross Urquhart
603=818-1-923
ruhandyco@yahoo.com Pg 1 of 2
Valerie&-Bob Reading
90 Spring Hill Rd
No. Andover-Ma
1-978-689-7718
vrreadin a),,comcast.net
Job description; Bathroom Remodel:
We propose to remodel master bedroom bath
Demo; Remove existing tile flooring, remove existing closet walls to allow a new over
sized custom shower stall. Remove existing vanities, sinks, toilet and shower stall.
Remove drywall surfaces behind vanity and toilet areas. This will allow new electrical
and plumbing to be preformed. Cut open floor for relocation of toilet, an again for the
shower drain.
Electrical; Remove and relocate switches and outlets as necessary.Install new exhaust
fan and new recess lighting. Install new wall mount lighting in three (3) locations also run
a new GFI supply to this bathroom.
#Note: Wall mounts supplied by owner.
Plumbing: Relocate the toilet to a spot approximately 3', to the left. A location that is
closer to the outside wall. Add new water supply to it and to new dual sinks, and a new
drain system. Also new supply's to the oversize shower. This stall will have three (3)
showerheads and three (3)valves. Repositions drain system to center of new stall.
#Note: Valves, faucets and shower-heads supplied by owner.
Pg2of2
Carpentry: Cut open floor for access of plumbing work. Frame an area for new shower
base. Frame a bench to the left side or end of this stall. Add 1/2" ac plywood to floor
for the insulation. Apply '/Z"-hardy board to shower walls for the also on the shower walls
a layer of poly plastic for a moisture barrier. Apply 1/Z" blue board to demoed walls and
ceiling, then apply a finished coat of plaster with a smooth finish to walls. On the ceiling
match the ceiling on the other side as close as possible.
Finish: Install double vanity, linen closet unit, accessories, towel-bar, paper holder,
hooks or rings and mirrors. 3 1/z' baseboards. apply primer, one coat to entire room.
Note; Vanity base, Sinks,Linen closet unit and accessories supplied by owner.
Clean up all construction material generated by R U Handy, Electrical and plumbing
contractors cleaned and hauled away by R U Handy Co.
Note: Tile by others. ko
Glass wall and glass door by others. v (1041
Labor and Material for the sum of$14;800.00 U w
Start1/3 OOO , 7
Midpoint 1/3
Finish 1/3
Accepted by; Approved by;;At
Bate; !t /)1 �T
111 1
Thank you,
Ross Urquhart
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Cont>ractors/1Clectricians/Plumbers
Applicant Information / Please Print Le 'b
110qName(Business/Organization/Individual): V� b co
Address: 0��'vl �120►^'� �C o �
City/State/Zip: e td- O o 3 P, Phone#.(&10 3 B 16J f z 3 -- Cel/
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. [LKam a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.EJI am a sole proprietor or partner- listed on the attached sheet.t 7. remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for mein any capacit5workers' comp.insurance.
9. E]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.El Plumbing repairs or additions
myself. [N o workers'comp. c. 152,§1(4),and we have no
Y p 12.❑Roof repairs
insurance required.]t employees.No workers'
comp.insurance required.] 13.
comp.
*.Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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.
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.�Liic.#: Expiration Date:
Job Site Address: /o �j2rNS G'�t l l ap City/State/Zip: N fav t/L°yL
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.
X do hereby certify under t e p ins andpenaldes of
perjury that the information provided above is true and correct.
Si ature: Date: pl_/p
Phone#:
F only. Do not write in this area,to be completed by city or town official.
n: Permit/License#
use
(circle one):
Health 2.Building Department 3.City/Town Clerk 4.EIectricalInspector 5.Plumbing Inspector
soiv Phone#:
11"
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ConstBuildin" Re"Id- nt ot-ptrhlic'Satct,
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License: CS 105148 uPervrsor Licensetr7dar'd.�
ROSS UR
14 QUHgRT
DERR R NH oHORE ROAD ,.. ._..
3038 - ,7
c �nmJ...�lner• ,
Expiration;
8/18/20
105148
_ Board of Building�,�
gRegu/alio y ads
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_— HOME IMPROVEMENT and Stana` ds
Registration- CONTRACTOR
Expiration: 151021
5/11/2010
TYpe: DBA 7 280222
R. U HANDY CO.
ROSS URQUHAR7
14 NO
i' RTH SHORE RD.
DERRY,NH 03038
Administrator
08/15/2011 10:05 FAX 978 649 6064 BITHER INSURANCE 0 002
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CERTIFICATE OF LIABILITY INSURANCE DATE( 4m/bDNV)
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PRODUCER THIS CERTIFICATE 18 ISSUED AS A MATTER OF' IMPORMATIO
A.I.I In»urance Brokerage of NCA. , Yric ONLY AND CONFERS NO A1QHTS LIPQN THrz C-ERiTIFJCATE
183 David Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND O
Douglas MA 01516 ALTER THEFO O TH P c►' O
INSURERS AFFORDaNO COVURACE MAIC#
INSURED INSURER Aftrjaat�c canualty %yIw==ce ass4c
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08/15/2011 10:05 FAX 978 649 6064 BITHER INSURANCE 0 003
-_' CERTIFICATE OF LIABILITY INSURANCE =J1MW01WVDD"YY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIti
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY'AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE GOES NOT CONSTIT11TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: ff the Certificate holder Is an ADDRIONAL INSURED,the PolicAies)must be endorsed. W SUBROGATION IS WAIVED,subject to
the terms and conditions or the Policy,c1tr1ain pollcles may require an endorsement- A statement an this eertirle
Certificatea does not confer rights to lite
holder in lieu of such andomemnt a.
PRODUCER LEWIS P EITHER INSURANCE AGENCY IN comcr
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TYNGSBORO, MA 01879 PHONE 7' s s- - a
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DERRY NH 03038 ERER
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:
COVERAGES CERTIFICATE NUMBER.: 10879484 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 CONTRACTOR OTHER DOCUMENT W(TH RESPECT TO.WHICH THIS
CERTIFICATE MAY Be ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIfE.TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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IE WORKRS COMPENSATTON POLICY DOES NOT PROVIDE COVERAGE FOR ROSS UROUART
Aers Compensation Inaurance:Part One of the policy applies only to the Workem Compensation Law of the State of MA-
TT I AT Ht7 D
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—BELWIO
OB&VALERIE READING SHOULD ANY OF THtE ABOVE D"C"ED POUCIEB W CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
7 SPRING HILL ROAD ACCORDANCE WITH THE PoucvpROVt$iONJS.
ORTH ANDOVER MA 01845
AUTNORRED REFRb9EMATR/E
fRD 25 2010/05 0 1988.2010 ACORD CORPORATION. All rights reserved.
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