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HomeMy WebLinkAboutBuilding Permit # 4/7/2016 f %AORTH —� BUILDINGPERMIT `' 0`�t�e4 °��° a O 0 TOWN OF NORTH ANDOVER h7�0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received q V �s9sS ATeR ns�q,(h Date Issued: ACHu IMPORTANT: Applicant must complete all items on this page .,� LOCATION ��" ` : / PROPERTY OWNER Print MAP NO:' ' PARCEL: „ZONING DISTRICT: Historic District yes no Machine Shop Village yes no w TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Q New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ommercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: emolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer -1) V I L14E 'Lill IAtre 11 A 11ADILT CLA.6i (' Lie ° f Identification Please Type or Print Clearly) OWNER: Name: �® Q S Phone: Address: r CONTRACTOR Name: Phone: ) Address: 102 -� I A l 1 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: $ /5�q FEE: $ Check No.: / Receipt No.: -3 C'--2/ NOTE: Persons contracting with unregistered co tractors do not have ace the g a.ty fu Signature of Agent/Owner ignature of contractG� NORT1i E � Amp% dover town of ® ® - z , C% / : ,.�. h , ver, ass, coC MICNEWICK x,95 RATED Jk'p � U BOARD OF HEALTH Food/Kitchen Septic System P �E IT ...THIS CERTIFIES THAT ... ... � BUILDING INSPECTOR L..... .......... ... ................. ....... ...... ......... ................ ........ . . ���� Foundation has permission to erect . .................. .. buildin s on ... .... .............. ............. .................. Rough to be occupied as .... . . . ... . ... .............. .....N... .... .. ...... .............. ... Chimney provided that the person accepting this permit shall in every res 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMITIMONTHS ELECTRICAL INSPECTOR UNLESS T TIO ARTS Rough Service .....................��.. ..��— —............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. CONTRACT ROBERT BOHONDONEY CONSTRUCTION CO. 12 HALL STREET METHUEN,MA 01844 978-685-0970(office)/978-685-8262 (fax) Fully Insured Construction Supervisor License#979 Exp 4/21/2018 Home Improvement Contractor#114238 Exp 8/16/2017 bohondoneyconstructigt1pyahocn in Customer Name: Scott Management Property Address: North Andover(Dawg City) Contract Type: Interior Demolition Date: April 6, 2016 Scope of Services: Interior Demolition 1. Provide demolition building permit(building and plumbing)and necessary inspections. 2. Provide demolition labor for removal of all fixtures and existing furniture in unit. 3. Provide removal of freestanding columns. 4. Provide demolition of 2 interior room walls and walls located at the mani/pedi area as specified. 5. Plumbing—provide removal of 5 hand sinks, 2-80 gallor:electric water heaters,jack hammer around 2"pipe in slab and cap, and remove 2 wash boxes in pedi area and 1 laundy box in utility room and cap. 6. Repair concrete floor at pedi station. 7. Supply and install ceiling tiles to match existing in locations of demolition. 8. Repair walls as necessary—mud,tape . 9. Provide job site clean-up and safe work zone. 10. Dispose of debris from site. Payment Terms: Deposit to start project$5,300.00, Progress payment$5,300.00 and remaining contract balance of$5,275.00. TOTAL CONTRACT AMOUNT: $15,875.00 CUSTOMER SIGNATURE: DATE: L G / / DATE: CONTRACTOR SIGNATURE: L Page 1 of 1 The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Avolicant Information Please Print Le ibl Name(Business/OrguJnizaation/Individual): Address:/a City/State/Zip: �kf �ir l�lr`'Y U 2/ Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.641in a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[:]Building addition 4.[]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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 hire outside contractors must submit a now affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the 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 I ant alt employer tliat isproviding ivor/rers'eonipeitsation insurance for itiy employees. Below is the policy and job site information. insurance Company Nam ( Policy#or Self-ins.Lie.#:• [ Expiration Date: Job Site Address: � City/State/Zip: ' - Attach a copy of the workers'comp nsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby cert1 ender the paZd pen It' of etquty that the information provided above Is true and correct. Signature: Date: l ' Phone# Official use only. Do not write ill this area,to be completed by city of town official City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/3/ fry 11/3/15 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(ies) 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 endorsement(s). PRODUCER CONTACT NAME: Bates Insurance Agency Inc. PHONE(AICNa (7$1) 396-4985 FAx No: (781) 395-9454 92 High Street, Suite Bl -MAIL ADDRESS: Andrea@Bates Ins.com Medford, MA 02155 INSURE S AFFORDING COVERAGE NAIC# INSURER A:RCA-Es sex Iris Co INSURED INSURER B:A.I.M. Mutual Ins. Co. Robert Bohondoney INSURER C: Bohondoney Construction INSURER D: 12 Hall St INSURER E: Methuen, MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POUCY EXP LTR TYPEOFINSURANCE I SR WVD POLICY NUMBER M/DDIY NM/DDIYW LIMITS A GENERALLIABIUTY 2CV1242 2/3/16 2/3/17 EACH OCCURRENCE $ 1,000,000 }[ COMMERCIAL GENE RALLIABWTY DAMMISEAGETORENTETD $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AG GR EGATE L IMI T APP LIE S PE R PRODUCTS-OOMP/OPAGG $ 1,000,000 POLICY ,PERCO-- LOC $ AUTOMOBILE LIABILITY CON [NED�SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS e UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION AWC40070243322015 8/9/15 8/9/16 WC 1 TORY LIMIT OTR- FR AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICERMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If YYes describe under DE, RIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 1,000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 1101,Additional Remarks Schedule,if more space is required) 550 Turnpike Street North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Inspectional Services AUTHORED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts Department of Public Safety Board of Building Reguiations and Standards License: CS-000979 ROBERT A BOHONDONEY 12 HALL ST METHUEN MA 01844 �oIt,on ommission`_r 04/2112018 Ortice ol(onsunter HOME IMP(�OV1 MEN Is& Registration; ENT CONTRACTOR 91,141tiol, -:!:!-7 Explrationr 114238 ©116/2017 Type: ROBERT BOHONDON[YDSA CONST CO 20��R SBOHONDONEI' METHUEN,MA 01844 tputerseCretnry i