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HomeMy WebLinkAboutBuilding Permit #237-12 - 95 CAMPBELL ROAD 9/19/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 933�- —(L- Date Received Date Issued: -1 t� 11 IMPORTANT:Applicant must complete all items on this page LOCATION9,5:�&)j&22 -4fAo �jj E^ : Print PROPERTY OWNER4VI;5bi g_ e_ ,eLe__ Unit# Print MAP NO-.10(p PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New BuildingOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑'Sep c b, Well'f Floodplain, D Wetlands, ❑' Watershed Distract ❑:.Water/Sewer _ _ _ D C TION OF TO J3E PERFORMED: r tG� e da e 41dentificati n Please Type o Print Clearly) OWNER: Name: �'`)� ,�yJej /�iiJ'�` / ,tI Phone: 493 ��2 Address: &)5 114lJ Ke )VaLA �llCh�O A5� 418 CONTRACTOR Name: Phone: 192 e,69 e4N/' Address: ,�J �ylS�r e��,Q r t pj wle ce /)�P.+3 Supervisor's Construction License: Exp. Date: Home Improvement License: )_3 V<� Exp. Date: l2 SII ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_//J 9� ©� FEE: $ A/y ."— Check No.: / 3 5-3 Receipt No.: 0 NOTE: Persons contracting with unregistered contractors do not have access to th uaran f nd Signature of Agent/©,wner ;• . g _ . —.. Si nature of contractor' _ r Location ,3 No. �3 Date �l NORTIy TOWN OF NORTH ANDOVER- 9 Certificate of Occupancy $ s�CMusEt� Building/Frame Permit Fee $ I { Foundation Permit Fee $ Other Permit Fee $ a TOTAL $ Check # .7 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 11Tanning/Massage/Body Art El Swimming Pools El 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 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.: 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 i Ll Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi R-_ J j 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 ❑ 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 ❑ 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 NORT#q Town of _ Andover .. 0 ""V......... %In * _ o , dover, Mass., ' I • O •- LAKE COCMICKEWICK DRATED 9Y .7 U BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR �� THIS CERTIFIES THAT.................... .{.. .............. ................................................................................................ Foundation has permission to erect........................................ buildin on ..... ........cfto�.e.&tAL ..... ............. .., Rough to be occupied as.0 A.........F(40w—............ .. .W+4.. �•............ 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CO S TRU U � �0 S . TS Rough .......... ........ ........................................................................ ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. - - a f 1 �� XIS t fl 5 XIS �T )IR JI)I ) A) ' f lis I e d ! UAA n -,ji i , � I - .! ... ; X15 IID - x � The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsXlectricians/Plumbers _Applicant Information Please Print Legibly Na1118(Business/Organization/Individual): (_.. , P S Address: 1r City/State/Zip: ' "C.,i': , 0. b�d 3 Phone#:_ C,)-�� ��� Q Are ou an employer?Check the appropriate box: _ 1.WI am a employer with 1 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheaet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demblition working for me in any capacity. workers'comp,insurance. [No workers' comp.insurance S. ❑ We are a corporation and its 9. Building addition 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 insurance required.]i employees. 12.❑Roof repairs [No workers' comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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-_a4[1, *4,(,. %_1Y1 Policy#or Self-ins.Lic.#:�} ���� � A Expiration Date: f Job Site Address: y� �1 �. City/State/Zip; r t �� L ♦/�' 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 under the ain andpenalties o P fperjury that the information provided ove . true and correct. Signature-/ ���� •• Date: . Phone#:11 . 9 &B Official use only. Do not Write in this area,to be completed by city or town offcial. 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#: l \ \. Y. .\ .. A" 0.1 � ' � s; � ��: ��� �.� �' ���. erg �• e `� Vol f ch4 kill NMM" 3 i An \ \ a toll un , � � \�`� gam ', � , •e: �. �\`� 3 ':. :.fi A O k \� # toil, hy all, Fps t. + Massachusetts- Department of Public Safety Board of Buildin- Re-ulations and Standards , Construction•Supervisor License License: CS 59757 i Restricted.to: W 0 DAVID J BRADY ,ice 31 CRESTWOOD CIR'I "` •ter* LAWRENCE, MA 01843:+. --G-- �y� Expiration: 1/28/2012 ('ummisvioocr' Tr#: 16810 ' � ✓lee 'C�ovnmwnuuea�,l� o�✓l�U.raat�tu�l6 4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration X134639 i Expiration 12/220/2011 Tr# 291415 4. Type, lndiwdu _ DAVID J.BRADY' - I t DAVID BRADY 31 CRESTWOOD"CIRCL LAWRENCE,MA 01843'_ '` Undersecretary s _ W MA LIC NUMBER CS059757 HIC# 134639 "ADDING VALUE TO YOUR HOME" CUSTOM INSTALLATIONS A DAVID BRADY CO 31 Crestwood Circle Lawrence, MA 978 490 8745 —P SPECIFICATION WORKSHEET/ CONTRACT CUSTOMER NAME CUSTOMER PHONE Christine&Mike Rice 978 683 6270 ADDRESS: ZIP CODE: 95 Campbell Hill Road 01845 CITY: STATE: North Andover Ma PROVISIONS: PLANS&PERMITS:ALL APPROPRIATE PERMITS SHALL BE THE RESPONSIBILTY OF Custom Installations,ALL WORK SHALL BE DONE IN ACCORDANCE WITH LOCAL AND STATE BUILDING CODE.A DETAILED SET OF BUILDING PLANS SHALL BE PROVIDED, PLANS SHALL CONSIST OF ELEVATION,CROSS SECTIONS,FLOOR PLANS,AND ANY OTHER DOCUMENTATION DEEMED NECESSARY BY BUILDING OFFICIAL TO OBTAIN PROPER BUILDING PERMITS.IF PLANS REQUIRE A CERTIFIED ENGINEERS STAMP,THIS COST WILL BE THE RESPONSIDILITY OF HOME OWNER.SUPPLY OF APPROPRIATE BUILDING PLANS SHALL BE REPONSIBILITY OF Home owner. OBTAINING PERMITS,AND PAYING PERMIT FEES SHALL BE RESPONSIBILITY OF Custom Installations.ABSOLUTELY NO WORK WILL BE DONE WITHOUT THE PROPER BUILDING PERMITS.THIS INCLUDES,BUT IS NOT LIMITED TO,ANY AND ALL DEMOLITION WORK,UNLESS APPROVED BY LOCAL BUILDING OFFICIAL. UNFORSEEN CIRCUMSTAMCE:GREAT CARE HAS BEEN TAKEN TO PROVIDE ACCURATE PRICING.HOWEVER,IN THE EVENT THAT"UNFORSEEN CIRCUMSTANCES"ARISE THAT ARE BEYOND THE CONTRACTOR'S CONTROL,ADDITIONAL COSTS MAY BE INCURRED BY HOME OWNER.IN THE EVEN OF"UNFORSEEN CIRCUMSTANCES-,A WRIMM ADDENDUM TO CONTRACT SHALL BE PROVIDED BY CONTRACTOR AND SIGNED BY ALL PARTTES BEFORE CONTINUING WITH THAT PARTICULAR ASPECT OF PROJECT. "UNFORSEEN CIRCUMSTANCES"CAN CONSIST OF,BUT NOT BE LIMITED TO,STRUCTURAL DEFECTS THAT ARE HIDDEN BY SHEATHING, CERTAIN GROUND CONDITIONS BENEATH GRADE. DEBRIS REMOVAL:ALL DEBRIS REMOVAL SHALL BE THE RESPONSIBILITY OF Custom Installations.IF CONTRACTOR IS RESPONSIBLE FOR DEBRIS REMOVAL,A DUMSPSTER OR SIMILAR SHALL BE PROVIDED.FURTHERMORE,JOB SITE WILL BE KEPT IN SAFE,PROFESSIONAL,AND WORKMAN-LIKE MANNER. CONSTRRUCTION PRACTICES:ALL WORK TO BE PERFORMED IN A PROFESSIONAL AND WORKMAN-LIKE MANNER AND BE DONE IN ACCORDANCE WITH ALL LOCAL AND STATE BUILDING CODES,AND TO CONFORM TO PLANS AND SPECIFICATIONS PROVIDED.ALL WORK TO BE DONE WITH GENERALLY ACCEPTED CONSTRUCTION PRACTICES. SCOPE OF PROJECT: 2nd Floor Bathroom Demo: Existing vanity and top Existing tile on walls and floor Existing plaster walls and ceiling down to framing v Existing skylight Existing door from bath to master bedroom Debris removal: All construction debris to be placed in a contractor provided container and hauled away Ca enter/ rp drywall: Furnish and install venting to exterior for fanlight combo Furnish and install materials required to block in door from bathroom to master bedroom. Furnish and install batt style fiberglass insulation within wall and ceiling cavities as needed. Furnish and install continuous vapor barrier as required. Furnish and install fire stopping @ all ceiling and floor penetrations Furnish and install %z"blue board at walls and ceiling disturbed by demo. Furnish and install skim coat plaster @ walls and ceiling areas(to be finished smooth) Furnish and install new operating skylight with screen and trim(includes all roof flashing) Furnish and install 31/2"colonial style base trim within bath area Furnish and install 21/2"colonial casing at interior of bath entry door and around. skylight Install customer provided vanity cabinet and top Install customer provided medicine cabinet Install customer provided towel bars(2) Install customer provided toilet paper holder(1) Plumbing: All plumbing and fixtures to be provided by owner Electric: Furnish an d install 20 amp circuit for bathroom Provide wiring for customer provided light(1)@vanity Furnish and install fan/light combo within bathroom Furnish and install switches and GFCI outlet within bathroom Install customer provided light over medicine cabinet No panel upgrade allowed for Flooring: Furnish and install %"cement backer board within tub area and half way up wall area to accept wall tile. Furnish and install '/4"cement backer board @ floor area within bathroom to accept floor tile. F Furnish and install ceramic tile at walls and floor areas within bathroom(includes mortar and grout).Tile at walls to be approx.42 above floor,and to ceiling within tub area. Allowance for tile within this contract is$2100.00 Paint: Furnish and install primer/sealer(i coat)to walls,ceiling and trim within bathroom area. Furnish and install(2)coats flat paint at ceiling within bathroom Furnish and install(2)coats flat paint at walls within bathroom Furnish and install(2)coats semi-gloss paint @ trim within bathroom All paint to be Sherwin Williams or similar Permits: Provide electrical permit Provide building permit I i i / µ Fixtures: All fixtures to be provided by owner unless stated above MATERIALS:ALL MATERIALS WILL CONFORM TO LOCAL AND STATE BUILDING CODES AND WILL BE AS SPECIFIED IN DRAWINGS PROVIDED AND APPROVED BY LOCAL BUILDING OFFICIAL. RIGHT OF DISPUTE:IN THE EVENT OF DISPUTE BETWEEN HOMEOWNER AND CONTRACTOR,TERMS OF THIS SPEC.SHEET WILL TAKE PRECEDENT OVER ANY AND ALL OTHER FORMS OF DOCUMENTATION.THE CONTRACTOR AND HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMITR SUCH ARBITRATION AS PROVIDED IN MGL.c.142A. .....................................OWNER ....................................CONTRACTOR NOTICE:THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES ALTERNATE DISPUTE RESOLUTION INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SIGNED SEPARATELY BY THE PARTIES. PAYMENT TERMS: TERMS OF PAYMENT ARE AS FOLLOWS: Cost for work described above to be$11700.00 and paid in (3) installments. 1/3rd in advance $3900.00 1/3rd after rough electric $3900.00 1/3rd upon completion $3900.00 LEGAL:ALL HOME IMPROVEMENT CONTRACTORS AND SUB CONTRACTORS SHALL BE REGISTERED AS A HOME INPROVEMENT CONTRACTOR WITH THE STATE OF MASSACHUSETTS,ANY INQUIRIES ABOUT A CONTRACTOR OR SUB CONTRACTOR RELATING TO AREGISTRATION SHOULD BE DIRECTED TO: DIRECTOR HOME INPROVEMENT CONTRACTOR REGISTRATION PROGRAM, P.O.BOX 871,TAUNTON,MA 02780-0871 PHONE:(508)821-9375 HOMEOWNER HAS RIGHT TO CANCEL THIS CONTRACT WITHIN THREE BUSINESS DAYS OF SIGNING DATE WARRANTY OF ALL MATERIAL SHALL BE THE RESPONSIBILITY OF THAT MATERIAL MANUFACTURER AND NOT THE CONTRACTOE,THE CONTRACTOR WILL WARRANTY ALL INSTALLATION OF PRODUCT AND CONSTRUCTION PRACTICES FOR A PERIOD OF ONE(1)YEAR FROM THE DATE OF INSTALLATION.CONTRACTOR SHALL ALSO POSSESS AND PRODUCE IF REQUESTED A CURRENT MASSACHUSETTS CONSTRUCTION. SUPERVISORS LICENSE INQUIRIES MAY BE MADE BY CONTRACTING BOARD OF BUILDING REGULATIONS AND STANDARDS ONE ASHBURTON PLACE BOSTON,MA 02108 PHONE:(617)727-3200 EXT 607 ONLINE:www.mass.gov/bbrs/cslsearch.htm ACCEPTANCE OF TERMS:BY SIGNING BELOW,HOME OWNER AND CONTRACTOR AGREE TO SPECIFIACTAIONS AS LAID OUT WITHIN THIS SPEC.SHEET.ALSO,BY SIGING,THIS WILL BECOME A BINDING LEGAL CONTRACT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CUSTOMER SIGNATURE CONTARCTIOR SIGNATURE DAVID J. BRADY e. 1�e�...... ... X. DATED: 03/12/2011