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HomeMy WebLinkAboutBuilding Permit # 3/8/2016 ........... TOWN OF NORTH ANDOVER RT II APPLICATION FOR PLAN EXAMINATION 40 Permit NO Date Received Date Issued: IMPORTANT: A licant must coLn plete all items on this LOCATION 91, t PROPERTY OWNER L Print IJ MAP NO.:C 2, PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential IJ New Building F1 One family 1-1 Addition PoTwo or more family L1 Industrial X'Alteration No. of units: [i Repair,replacement F1 Assessory Bldg El Commercial F.1 Demolition U Moving(relocation) I❑I Other I-I Others: 0 Foundation only DESC7TIOT OFA ORK TO E PREFORMED < Identification Please Type or Print Clearly) OWNER: Name: Phone: - �1114"' A, )d �v v-, Address: °i ° CAA- bf')J'aa ." 'i� /I (,o tf?")-- 3a CONTRACTOR Name: "X110 hVIE'An'1-r Phone: Address: 10 oonAej k \ r� Supervisor's Construction License:—L��"--- c'1'qC11L3172 Exp. Date: rA?)0 k-1 Home Improvement License:—I. I 'Q(e Exp. Date: (c ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLD/NG PERMIT. $]ZOO PER$1000.00 OF THE TOTAL ESTIMATED COSTF. J'ASON$125.00PERS. Total Project Cost :$ —xl2.00=FEE:$ TIT Check No.: Receipt No.: Page I of 4 t10RT11 Town ofndover No. o L,KE h ver, Mass, COCNICKl WICK �,95 RATED P'Pa�,�g5 U BOARD OF HEALTH OF PER I I- -F Food/Kitchen .. Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ..... . ............. ......® ..... ................................... has permission to erect .......... buildings on . Foundation ..... ..... aT1 ..... ...... Rough to be occupied as .....64T ..... ...............K'M ! ,,,,,,... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 ;;0*010 UNLESS CONSTRUCTI T S Rough Service ............... .. ... .... ... ....... .......... .. ...................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art r] Swimming Pools Li Public Sewer ❑ Tobacco Sales D Food Packaging/Sales L1 Well ❑ Permanent Dumpster on Site F1 Private(septic tank, etc. L1 Electric Meter location to project NOTE: Persons contracting with unregistered contractors(Io not have access to the gu ra ty 11 Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived Ll Certified Plot Plan tamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT El 11 []Water Shed Special Permit L1 Site Plan Special Permit 11 Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION 11 ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH F1 11 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 Temp Dumpster on site yes—no— Fire Department signature/date 10 Itrichetts Mill RoaLl Duk Plus' 1Iamh.[c60 y1I -507 (�:(GO.i)529-'ill? I':(603)329.7036 C O N S T R U C T I O N dubC1111.is.ccmi ACCEPTANCE/PROPOSAL LETTER February 4, 2016 Client Name: Denise Goldberg Job Location: 18 Alcott Way North Andover,MA 01845-5818 Telephone Number: Home: (978)686-8747 Cellular:(978)604-0683 Business: (978)899-2695 E-mail:denise.goldberg@gmail.com Job Description: Remodel of Master Bathroom and Kitchen w/Flouse Painting. Dear Ms. Goldberg. We propose hereby to furnish labor and materials in accordance with specifications(as discussed and illustrated in the Xactimate Estimate document dated 01/27/2016),for the scope of work as follows: Master bathroom work: I. Remove and dispose of existing shower,Jacuzzi tub and tile flooring. Demo out wall between old shower and toilet. Partial tear out of subfloor to allow access to reconfigure plumbing drains &supple from shower being eliminated. 2. Supply and install new Fiberglass shower base at location of old Jacuzzi. 3. Supply and install new tile surround at shower with recess shelf.Note:Material allowance for new the surround is$4.501vf and new file floor.Note:Materiel allowance for new4. Supply and install new tile underlayment floor is$4.511/sf. 5. Supply and install new toilet w/standard 12"offset.Note:Material allowance for new Toilet is $330.00. head assemble.Note:Material allowance for new6. Supple and install new valve and shower Valve and bead assentbly is$180.00. anel assembly.Note:Material allowance for new 7. Supply and install new shower door and p Shower Door assembly is$800.00. 8. Remove existing door and modify trim. Supply and install new"Barn Style" interior surface mount by-pass door.Note:Material allowance for new "Barn-Style door"is$190.00. 9. Remove existing sink, countertop and cabinet hardware. 10. Supply and install new granite countertop w/4"back-splash at existing vanity.Note:Material allowance for new granite vanity top is$26.00/sf ] I. Supply and install new under mount vanity sink.Note:Material allowance for new sink is $140.00. 12. Supply and install new bathroom faucet.Note:Material allowance for new bathroont faucet is $150.0/1. 13. Supply and install new vanity cabinet hardware.Note material allowance per fixture is$5.00 ea ►v/5 total at$25.00. Kitchen: I. Remove existing countertops, sink, faucet and garbage disposal as well as existing cabinet hardware. Customer's Initials_— 1 11) liridxllt A11!1 Road Dus"" ube IIan7p�R tel MI 03811t l i Gl l-i, '1i) 511- C () N STR U C T 1 0 1vI 1 Ihn;;; Ji.�lxl,lu..cum CI].elomers.shall be and arc responsible for all costs oI'CullCC(ion,including re:uunable attorney's Dees, arising from any breech ol'this agreement or failure to pal any amount due and owing. ('h:urges to file abuse specilica(ions n ill be accepted only if a%I ritten request is made. We shill then complete a"Change Order" to supph'Noll scilh the additional charges or credits. No work can be changed, altered,or cancelled Without all authorized"('hangs Order". IaNntenl of"Chane Order" is as follows: Full payment of change order is due at custonur signing prior In Churl of,11 ork. ACCEPTANCE: the price(s),specifications and Conditions aboNc arc satisfactory and are hereby accepted. You are hereby authorized to proceed t%ill]the wort:as specified. 1/NNc agree to make payment as detailed ab(INC. M)/Our(the customer's signature below constitutes full agreement. 2..01 Denise Goldb_rgy Date February 4,2016 Paul E. Saint-C1'l. Date i i I'LE.ASE, INITIAL,ria, iio, TOM OF E,ACII PACE,BEFORE SIGNING Customer's Initials . i S l n j � r .�� � � �` 6` � � � :' ��. .. i fi I � � « -`� �, `` '_"? t i � � � � � � i ��° � L� �. � w�� _.._ � �--- �,. �j�N `•�. .`A �____ ,�,j r� ,, �U ���� 4� S`� �Y _ 1_=�_ _ v �� The Commonwealth of Massachusetts F Department ofludustrialAceldlents M _ r 1 Congress Street,Sztite 100 d02114 2017 _ - Boston,MA www.mass.gov/dza ODM 54'V` ](+oil encs'CompensationInsuranedA.ffidavit:Builder/Contxactoxs/Electxicians/Plumbexs. TO BE FILED WITH THE PERMTTXNG�UTHORT> '• Blease Print Le. A ''li.cantLnform-ation C� Nalxle(Business/0ig*zation/7'ndividual): Address: I Q �I City/State/Zip: ' '` xo rlatebox: Type of�project(tequi�ed), A re you an employer. Checkthe app p 6— em to ees £sill and/or part time).` 7, p N6*.�c6nstr6dtion a employer with. p y ( Jili" 2 Q I am a sole proprietor or partnership and have no employees working for me in 8� emodeg any capacity.[Noworkers'comp.insurance'equired.] 9• ❑Demolition. 3,Q I am a homeowner doing all work myself.[No workers'comp.insurance required]t 10 El Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 11.E]Electrical repaiz's or additions ensure that all contractors either have workers'compensation insurance or are sole1 proprietors Withno employees. 12 'Ptum-bing repairs'or additions 5.�X am a general contractor and T have hued the sub-contractors listed onthe attached sheet. 13 Roof repaixs These sub-contractors have employees and have workers'comp.insurance t 14.0 Other 6.Q we area corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'yvehave A6 employees:[No workers'comp.insurance required.] xA ny applicant that checks box#1 must also fdl out the section below showing their workers'compensaflonpolicyenformation: i 13omeowners who submit+ties affidavit indicating they are doing all work, hize outside contractors must submit a new affidavit indicating such. tContractors that check flus box must attache comp.additional sheet showing the name o£thesub-contractors and state whether of not(hose entities have employees. If the sub eon.1 . .rs have employees,they must provide their workers'comp.policy number. -workers'compensation insurance for my employees. Below is the policy and)oh site X am an employer treat is providing information. , Insurance Company Nam0-_AC_a Expiration l)Ooz Policy#or Self ins.Lic.#: +•_„ J �� r 1 4- City/State/Zip: ) rob Site Address: C O \C' Attach a copy of the s' kers, compelisation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25the f is aocf a S al OPviolation WORK ORDER and as fine ofUP to $250.00 a and/or one-year'imprisonment,as well as civil penalties in the form day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verific tion. X do her eli c tify under't/ paindpenatties ofperjury t/tat t/ie information provide alcove is true and correct. i Date: Si attire: Phone Official use only. Do not-write in this area,to be completed by city or town offieiat. permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityjTown Cleric. 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: ® ® 03-09-'16 10:07 FROM- 603-641-5062 T-101 P0001/0001 F-571 QO CERTIFICATE OF LIABILITY INSURANCE NSU®pNCE DATE(MM/DDNM) 3/9/2016 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT$ UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE 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(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and eonditlons 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 endorsement(s). PRODUCER NAME: Judith Goorge CIC,CPIA,CPIW FIAY/Cross Insurance PHONE (603)669-3218 FAx (A/C No Exil- (603)64b-4991 1100 Elm StreetE-MAIL j92Qrge@crQasagency.com INSURER($)AFFORDING COVERAGE NAIL B Manchester NH 03101 INSURERA:UniOn Insurance COMPanV 25844 INSURED INS RER B Acadia Ins Co. THOMAS A. DUBE CONSTRUCTION-PLUS INC. DBA, INSURER C: Dube Plus 6 Dirt Pro; Watertown village, LLC INSURERD: 1.0 BRICKETTS MILL ROAD SUITE C IN RPR 0; HAMPSTEAD NH 03841 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 All 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 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. ILR aR DY /�TTYPEOFINSURANCE POLICY NUMBER MM/ONYYMMONWY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 51OCCUR DAMAGE TO RENTff PREMISES EaoccuKnnca $ 250,000 X No GL Deductible CPA5028190-13 4/26/2015 4/26/2016 MED EXP(Any oneperson) S 51000 '... PERSONAL&AOVINJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIESPER: GENERALACCREGATE $ 2,000,000 POLICY a jE n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: M-Owner/Lessee/ContractorA S AUTOMOBILE LIABILITY aIF COMBINEeDISINGLE LIMIT $ 11 000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED CAA5028191-13 4/26/2015 4/26/2016 BODILY INJURY Peraoddenl) $ AUTOS AUTOS HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOSPer. Uninsuretlmoto(W propatty $ 25,000 X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,0001000 13 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1 000 000 '... DED RETENTIONS CUA5028192-13 4/26/2019 4/26/2016 $ '...... WORKERS COMPENSATION WPA5028193-13 X PER_UTS OTII, AND EMPLOYERS'LIABILITYI ER ANY PROPRIETORIPARE TNRIExECUTIVE YIN (3a.) 1A s DTE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? a NIA B (Mandatory In NH) Thomas Dube o5coludod 4/26/2015 4/26/2016 E.L.DISEASE-FA EMPLOYE $ 500 000 H nsc e,deribe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remark3 Schedule,may be attached If more space to required) Re: 18 Alaot Way in North Andover, MA. CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover, MA. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, HA 01045 AUTHORIZED REPRESENTATIVE J George CIC,CPIA,CPI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS025 munrn Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094372 " Construction Supervisor LORIANN J LANGAN 7 CREST ROAD KINGSTON NH 03848 ` { P ^^� Expiration: Commissioner 07/31/2017 16 vrrUJ � 1Rce of Consumer Affairs&Business Regulatit ?; f I 6ME IMPROVEMENT CONTRAC'17OR _1 Registration: 119623 Type: ' Expiration: 8/6/2017 Dube Construction- Plus, Inc. 5i�pplement Card LORIANN LANGAN 10 Bricketts Mill Road,Suite"C" Hampstead, NH 03841 Undersecretary - _--