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Home My WebLink AboutBuilding Permit # 3/18/2016 TOWN OFN o . APPLICATION FOR � INpermit NO: ceiv d7r�� F �� aacw°rcpmanc«Yn ` Date Issued: > HU rMIP lete all item TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 6ne family 0 Addition ❑Two or more family ❑ Industrial [ Altertien No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑Other NNIENEEM Orb AI&WhOW-cA r� cr P6<re� r ► elan r a t 1'r��+„ ` ®Q1"±Tr� 1 r t�J'!'� ✓ . )Identification Please Type or Print Clearly) OWNER: Name: � �c� ., ..I�.._.. w,l �,..� �..� ��-.I ._ r( Phone: Address: ARCH ITT/ tV I E Rhone: Address: Reg. No. FEE SCHEDULE.BULDIN PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project t: 19,\�,'��/�' FEE. Check No.: IITI< Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar'anty,fund NORTH _t ownndover .. ® �` to O Z c verass lt., 24 ve 7 ® COCHIC EWICN V� RATE D U BOARD OF HEALTH E R1 A L D Food/Kitchen Septic System GIS t THIS CERTIFIES THAT .......... .�. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .,,....... ..... 110W....... ........... . .. ............ Rough to be occupied as ..... ...bbAVb.#1A. .... . .... . .. .. . ,,. . ...............................................................'. Chimney provided that the person accepting 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 EXPIRESI MONTHS T' S ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS S T Rough Service —.................. Final LDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall.ToBe one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 6 A WOODWORKS . . _ sti Boston St North Andover,fila MA 0 ..845. (978}305-ZS�IT Date: 03/07/10 cbawoodworks@040il.com ;Estimate# 0703<. %Sales erson lob Payment-Terms 1/3 deposit 2/3 Brian Thannikal Bath.Revised! Completion ,Item [3escri tion tine Total $0.00 1-Main Bath Remove:and:dis ose of van!V,mirror;van _ ii lit,tile floor. 1285t100 &:underla menti tub,tun surround and affected plaster wall: Build:wall for dpog in tub..Install cernent board.undeda #Hent for-Poor and shower.Wall surround,_ Install the floor:and:shower/tub surround.Install new wood basemolding,vanity;counter;-mise:fixtures,framed mirror, door hardware. Wire.for and install 2.vari light pendants,verfitci receptacle.replace switches... Install:toilet,vanity sink&faucet with new shutoff valves.Plumb for and install.new shower/tub fixtures (.existing.layout) Paint walls trim,doors,ceilin . Included glassshower door allowance $1;300 Includes contract all trades and trash disjxosai. Total Quote prepared by Brian Beasley This is a goutation on the goods named,subject to the ca dittons noted below.. To accept this quotation,s►Rn here and return: ci.2900NG an, jb Oh: lubm VVOOOWOFKS 90 Boston St.No.Andover,MA 01845 Tel : 978-305-2547 Fax: 978-208-8333 Email: cbawoodworks@gmail.com �� www.cbawoodworks.com Fie— I b IV, t� � 1 orv,P M Tp to \ Of' f I ! NAV,) fir= 90 Boston St. North Andover, MA 01845 Tel: 978-305-2547 Fax: 978-208-8333 Email :cbawoodworks@cbawoodworks.com The Commonwealth of Massachnsetis Departhnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wipwanass govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant In PIease Print LeWbly Name(Business/Organizadon/lndividual): ( (��)i��j� n�� n �� Jl `7 C Address: q0 City/State/Zip: A4+oozj Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 ., ployees(full and/or part-time).* have hired the sub-contractors D New construction �m 2.E3 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, C3 Demolition warkiA for me in an capacity. employees and have workers' 1; y Aa ty• # 9. �}Building addition [No workers' comp.insurance comp.insurance. required.) 5. We are a corporation and its 1013 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any 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 are doing all work and then!tire outside contractors must submit a new affidavit indicating such. tContmctors that check this box must attached an additional sheet showing tie name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ata int etttployer that is providing workers'compensation insttrattce for my employees. Below is the policy anti job site Information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: AA 1�y m City]State/Zip:Aleri-hA,,,bav-vL�✓Y�fj—�l$�i��' 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 c��elriify under the pains and enalties of perjury that the information provided above is trite and correct. Signature; Date: 0310,) l 10--- Phone# (DPhone# O,/,iidal use only. Do not write in this area,to be 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 Inspector 6.Other Contact Person: Phone#: ® OATS~(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/10/2016 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[tau of such Andorsaman s). PRODUCER CDMNrE- CT Paul J. Ma oonald CPCV, C=C N MTM InBurance Associatos PRCNEo , (978)681-5700 FAX No:(978)681-5777 1320 Osgood Street ADORE .C.ertificateB@mtmineure,acm INSURERS AFFORDING COVERAGE MAIC 9 North Andover MA 07.845 INSURERA:Ereferrad Mutual Ina Co 15024 INSURED INSURER B: Brian Seasloy dba CHA Woodworks INSURER 0: 90 BOSTON ST INSURER D: (SURER E; North Andover M& 01645 1 INSURER F: COVERAGES - COVERAGES CERTIFICATE NUMBER-15-16 Master 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 WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDI=D 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION$OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LNSR T TYPE OFINSURANCE ADDL uBR POLICYEFF POLICY X POLICY NUMBER MMfDD MPNO, ILIMITS $ COIAMrIzCIAI.GRNRRALLIABILITY EACH OCCURRENCE $ 500,000 -17TMAGE TO RENTED A CLAIM$-MADE F% OCCUR occ soca $ 50,000 BOPDIO0715042 11/1/2015 11/1/2016 MED EXP(Anyoneperson) $ 10,000 PERSONAL$ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 11000,000 X POLICY 0 JECT F71 LOC PRODUCTS-CQhIPlOP AGG $ 1,000,000 OTHER; $ AUTOMOBILE LIABILITY M13INED SINGLE LIMIT $ ANYAUTO BODILY INJURY(Perpersan) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUT05 AUTOS HIRED AUTOS NON-OMEO r OPERYYDAMAGE AMA E $ S UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LtAB HOLAIN03-MADE AGGREGATE $ DED RETENTION& S WORKERS C0MPEN5AT10N AND EMPLOYERS'LIA6ILITY YIN STATUTE I I ERTH ANY PRQPRIETORtPARTNERlEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEM5FR EY,CLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE 5 If yes.describe under DESCRIPTION OF OPERATIONS bel" E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 109,Additional Remarka Schedule,may be adached if more space is Mquired) This certifi !aLte of ;insurance represents covarago Currently in effect and may or may not he in aomplianae with arty wri.ttQn contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIKATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVIS1oNs. 1600 Osgood Street Building 20, Suit® 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 P MacDonald CPCU, CTC 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS020 f9ouoii Board of Building Iz,,eguiations and ;cense,GS407038 BRIAN BEASLEY= �--- 68 RUSSELL STREET z North Andover MA 01845 r CXpIfation Commissioner 03129!2017 i f License or registration valid for individul use only before the expiration date: If found return to: Office of Consumer Affairs and gusiness'Begulation 10.Park Plaza-Suite 5170 Boston,MA 02116 Not valid wit out signature Office of Consumer Affairs&Business Reguhtii u "RMVRA 9ME IMPROVEMENT CONTRACTOR _ ��Registration: 181826 Type: Expiration: 5/5/2017- DBA CBA WOODS BRIAN BEASLEY 90 BOSTON ST NORTH ANDOVER,MA 01845 Undersecretary