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HomeMy WebLinkAboutBuilding Permit # 4/5/2016 OORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION sp. oR q` Permit No##: it Date Received 0 Date Issued: M ORTA.NT: Applicant must complete all items on this page LOCATION y Print PROPERTY OWNER r4�1 t wv * � ! �=�� Print 100 Year Structure yes no MAP PARCEL: t ZONING DISTRICT: Historic District yes n� Machine Shop Village yes. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Xone family El Addition 11 Two or more family [I Industrial Alteration No. of units: ❑ Commercial El-Repair, replacement ❑Assessory Bldg ElOthers: ❑ Demolition ElOther ,.� „ ,a +'^m r zr,x<;f%F/z?dr .✓F`Y ,f,rrr r^ t "'.« r ` `.rr.9 7 .,rrj'X`x`rr � �,A xr 1 gri.,, e �� • a Vis*`10�0'd�l�n `���❑We�(artdS�� �w .,®�� er5.a ed�®IS�riCt��",^f�'�� s ESC I TION OF WORKUOE PE OR E Ide ation- Please Type or Print Clearly OWNER: Name: L. Phone: Address: Contractor Name: < e Phone: `� Email: ILA Address: r� Supervisor's Construction License: t' Exp. Date: i I Home Improvement License: Exp. Date: ARCH ITECT/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: $ 0, FEE: $ Check No.: � Receipt No.: b I NOTE: Persons contracting with unregistered c n I"actors do not have access o the u anty and i"- U �r r bi-. '� 1� r y r�� 'rr' . ✓';, c� L,z,, Lx/x ,3�yr+ ,'�� nx�', �ir F NORTH own o ® * s h ver, Mass o > > COC NICN2WICK ��S RATED r,Pa�,�S U BOARD OF HEALTH PERO [ L D Food/Kitchen Septic System THIS CERTIFIES THAT ................. BUILDING INSPECTOR .... . .... ..... . .. . . Foundation has permission to erect .......................... buildings on .... ... a.. .. !r.• •.••.•..••••••�......• p Rough .. . .....Q!.�Q. . to be occupied as .... .. .......... .. .. .. .. ....... .. . .. ... .. ............................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARS Rough Service ......................... ...... .. . . .. .. . ". ................ Final UILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. Trepanier Remodeling LLC HIC#122347 14 East Capitol Street Methuen, MA 01844 C #069815 Date Estimate# 1/3/2016 17 Name/Address Lisa Torbin Shaw 45 Woodberry Lane No.Andover,Ma Project Item Description Rate Qty Total 02.10 Demo Demo complete bath and have a dumpster on site: 2,500.00 2,500.00 Materials/Labor Rough frame,prepare tub area for shower install: 875.00 875.00 14 Plumbing Rough and finish of new shower with PVC pan,remove and replace toilet and sink,add under 3,612.00 3,612.00 cabinet heating:(Price includes toilet and shower valve) 16 Electrical&Li... Rough and finish of new bath light fan,GFI and new cabinet lighting: 1,440.00 1,440.00 17 Insulation Insulate exterior walls and fire-stop according to code: 275.00 275.00 Blueboard/Plaster Install blueboard on walls and ceiling,plaster walls,install tile backer board in shower and 2,385.00 2,385.00 waterproof walls,subflooring for tile floor: Finish work Install cabinets and finish trim and install pocket door for entrance to bathroom: 1,980.00 1,980.00 Tile Installation of shower tile walls,shower floor and main bath floor:(Approximately 140s/f) 2,875.00 2,875.00 01 Plans and Perm... Cost of permits: 325.00 325.00 Payment Schedule: Payment 1:Dumpster delivery and demo started: 6,000.00 Payment 2:Rough inspections done blueboard hung: 6,000.00 Final payment:Final inspection complete: 4,267.00 i We look forward to working with you! Total $16,267.00 Cx The Commonwealth of Massa.chusetts Department of IndlustrialAceldents 1 Congress Street,Suite 100 Boston,MA 02114-2 017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FTGED WITH THE PEIMT TING AUTHORITY. Applicant Information Please Print Legib Name (Business/Organization/Individual): � — 1t -Address: City/State/Zip: LVhone#: Are you an employer?Checktlie appropriate box: Type of project(required)' l.❑I am a employer with employees(full and/or part time).* 7. 0 New construction 2.[M I am a sole proprietor or partnership and have no employees working for me in 8. D(Remo deliiig ny capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.h Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 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. i Homeowners who subriiif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 fiave employees,'they must provide their workers'comp.policy number. I am an employer that is pravid6ig rvorlrers'compensation insurance for my employees.'Below is thepolicy and job site information. Insurance Company Name: Policy#or S elf-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declamation 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 WORK 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 DIA for insurance coverage verification. I do hereby cert' r dpenalties ofperjury that the information provided ab ve' true and correct. Si nature: Date: C Z✓ Phone#: Official 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#: A�1 0 DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 04/04/2016 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(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 Peter Lafond R.C.Lafond Insurance Agency,Inc. PHONE FAX 396 Andover Street ac No Ext): 978-686-3826 (A/C,No):978-682-0713 North Andover,MA 01845 ADDRESS: peter@rclafond.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: Safety Insurance Company 30,454 INSURED Trepanier Tile&Remodeling -INSURERB: 14 East Capital Street INSURER C Methuen,MA 01844 INSURER D INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR D WVD POLICY NUMBER MMIDDNYYY MMIDDNYYY LIMITS A COMMERCIAL GENERAL LIABILITY Y BMA0018173 10/27/2015 10/27/2016 EACHOCCURRENCE $ 1,000,000 GE TO RENTED CLAIMMADE M OCCUR SPREMISES Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY 1-1 PRO- ❑LOC PRODUCTS-COMP/OPAGG $ 1,000,000JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Peraccident)DAMAGE $ "RED AUTOS AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$U $ ER WORKERS COMPENSATION PER D AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACHACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Business usual to a small construction and remodeling contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD aau°issiww00 960Z1£Z10 '� uc�i}- dxq ` ,- [ bti-8t0° �1Sg��t I[ }aalS i }. 16juedaty M�aa°� :5 'cc s g68690'S� :asuaoil :uadna u0r;�rslsUOD ,O�i e n6a�6u!Pl. bfl PaeoB ue suoi} t 3essev 4 sp�epue}S P eda0 s}}asng }a}eS oilgnd 10 _ _ rJf e`t`Fu�yrrciatccc�e�cl7��r��C?/l�`�%2sccc/zc<acll�c. Office of Consumer Affairs'�C Et�''�nEss lYc r.Ic1H°i� HOME IMPROVEMENT"CONTRAGI'OR Registration:f 122347 DBA Expiration =312012016 TREPANIERTILE� RE(IIIODELIN4� ROBERT TREPANiEFkJR 14E CAPITOL ST. UndersecretsEr}', MI -fHUEN,MA 01844