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HomeMy WebLinkAboutBuilding Permit # 6/9/2016 TH BUILDING PERMIT 0 ,qK'V.OORD TOWN OF NORTH ANDOVER & APPLICATION FOR PLAN EXAMINATION 01 Permit No#: Date Received S$ CHUS Date Issued:O 0 IMPORTANT: Applicant must complete all items on this page LOCATION 12001 s r 1Oz- CZ 6.o 6A Print PROPERTY OWNER 13 12 DLA S C-14-0 JL,, 13 L& ;Z,0 Print 100 Year Structure I.Qes no MAP PARCEL: Nz'r ZONING DISTRICT: Historic District "Yes -rl 6 -1 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ri New Building 0 One family 0 Addition 11 Two or more family 11 Industrial El Alteration No. of units: El Commercial M,Kepair, replacement 0 Assessory Bldg 0 Others. Lemolition 0 Other DESCRIPTION OF WORK TO BE PERFORMED: :T--o LAI f Ing/bw S t2!E�Uo yj o ptlC,,- r 7 �'c E7 44 ,4 C)'t (k y 6-1-12 03, C 6 IJ LEW-7 Q Y-b— Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor ame: RU' CJMPID f-L W Phone: Email: ��a `''/TtftJ Address: /0 G& [ 7,t4 Exp. Date: Supervisor's Construction License: Home Improvement License: /0 —Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 F THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3 G FEE: $ Check No.: Receipt No.: NOTE: Persons contracting ivith unregistered contractors do not havejaccess totfie guaranty fund —'ritzb, n CLewnrrt tAORTH Town of Andover I C% h Very Massq Ora a 9 0 Ka COC NIG Haw]CN S � BOARD OF HEALTH Food/Kitchen PE �R� MIT T LD Septic System THIS CERTIFIES THAT .. ... .... . .. ...... .. .104 it .............................................................. ............ BUILDING INSPECTOR has permission to erectg ., Foundation .......................... buildings on . . .... � . .. . Rough to be occupied as ...40&. ... ... ...... ... Chimney provided that the person accepting this permit shall in eve spec c nf"or heer s e application inal 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS 10 Rough Service .. .. .. ... ......... ...... Final BUIL NSPE ®R GAS INSPECTOR Occupancy Permit Required to Occupy By Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspect . 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RICHARD FLUET CONTRACTING, INC 102 BRIDLE PATH LANE PROPOSAL METHUEN, MA 01844 Date Estimate# 5/24/2016 626 Game/Address BROOKSSCHOOL 1160 GREAT POND RD. N.ANDOVER,MA.01845 INFIRMARY Description 2ND.FLOOR BATHROOM;DIVIDE EXISTING BATHROOM TO MAKE ROOM FOR AN OFFICE.REMOVE AND CAP TWO SINKS,ONE SHOWER AND ONE TUB AS NECESSARY.DEMO AREA AS NEEDED.ADD WALL TO SEPARATE ROOM. PROVIDE ACCESS INTO OFFICE THROUGH EXISTING CLOSET.INSTALL NEW FAN IN EXISTING BATHROOM. SEPARATE LIGHTING.IN NEW OFFICE ADD LIGHTING,AND OUTLETS TO CODE.INSULATE EXTERIOR WALL,SHEETROCK ENTIRE OFFICE.INSTALL BASEBOARD AS NEEDED.PERMIT AND TRASH REMOVAL IS INCLUDED.$8525.00 FLOORING AND PAINTING BY OTHERS. PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$90.00/HR/MAN. MA.LIC.#50710 HIC.# 106620 FINANCE CHARGE OF 1 & 1/2%PER MONTH FOR UNPAID BALANCES. PAYMENT SCHEDULE;AS WORK PROGRESSES Tota $8,225.00 Signature Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@verizon.net RICHARD I~LUET CONTRACTING, INC 102 BRIDLE PATH LANE PROPOSAL METHUEN, MA 01844 --�-, ::Date Estimate# 3/30/2016 615 Name/Address BROOKSSCHOOL 1160 GREAT POND RD. N.ANDOVER,MA.01845 INFIRMARY Description SECOND FLOOR OFFICE;REMOVE THRLiE-:CLOSETS,BLOCK OFF TWO DOORWAYS,REWORK TRl'fvI AS NEEDED.PATN7 WALLS AND TRIM.$3500.00 SECOND FLOOR BATHROOM;RELOCATE ENTRANCE DOOR TO PROVIDE ACCESS FROM HALLWAY,BLOCK OFF OLD DOORWAY,INSTALL NEW FAN/LIGITT'UNIT AND VENT OUT,PLACE TRIM AS NEEDED.FAINT DISTURBED AREAS. $3260,00 PATCH WHERE RADIATORS HAVE.BEEN REMOVED$75.00/PAT'CH REPLACE,60 WINDOWS WPi'I I HARVEY lVtll-1-6 DOL/43LE HUNG CLASSIC VINYL REPLACEiIM NT WINDOWS VITT I ENERGY STAR RATED GLASS,AND 1,2 SCREENS,ADD OBSCURE GLASS LN BATI IROOMS AS NEEDED.$21,000.00 REPLACE TWO 13ASEML'NT'WINDOWS 1VIT1 GLASS,S700.00 T HA1 RVEY WHITE' HOPPER TYPE WITH SCREENS AND ENERGY STAR RAPED Total / $28.460.00 Signature _ ------------------ Phone ft Fax# E-mail C' 978-685-7010 978.685-7010 RFC IO2�q)verizon.net The Commonwealth of Massachusetts " Department oflndustrial"Accidents a d 1 Congress Street,,quite 100 Boston,MA 0.2114.2017 www.rnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH THE PERAWTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization&dividual): ���(�t6v l-Y-) G d 0177' .Address: /O J•- �✓l �� 0(1t.`'' ( i't-A Lti i City/State/Zip: 0-L C---(14, , 0('? ( '-/ Phone#: G1 7 a:(.L) 3 Are you an employer?Ch.ecktlie appropriate box: Type of project()Vequired): 1. Lama employer with 3 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• ❑Remodeling any capacity,[No workers'comp.insurance required.] El Demolition 3.F1I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 9. 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 []Building addition 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 acrd I have hired the sub-contractors listed on the attached sheet. ❑ t 13.[]Roof repairs These sub-contractors have employees and have workers'comp,insurance. 6.F]We are a corporation and its officers have exercised their right of exemption per MGL c, 14.❑Other 152,§1(4),and Nye have na employees.[No workers'comp,insurance requited.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who sn6mif'lhis 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 employee.. If the sub-contractors have employees,t1iey must pivvidd flirz workers'comp,policy number.' lairs an employer•tliat is pi•ovidiiig ivorlrers'compensation insurance for•my employees.',Below is the policy andjob site information. ,Q� ? Insurance Company Name: Policy#or Self-ins.Lic.#: 9 1 n I 3 '1 0 Expiration Date: 3 3 l Job Site Address: J / L a f9��` r )��r� �/� City/State/Zip: Al Attach a copy of the workers'compensation 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 WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 d hereby certify u err e pains and na o rperjury that the information provided above is true andcorrect. sign 0: Date: / Phone#: Official use only. Do not write in this area,to be completed by city or town official., City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:WC DATE(MM/DWW"f)a CERTIFICATELIABILITY INSURANCE 05/19/2016 THIS CERTIFICATE IS ISSUED A$ 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 pollcy(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). CONTACT PRODUCER NAME: 5egreve&Hall Insur.Assoc.Ine PHHONC- r' FAX 305 North Main St. Andover, MA 01810 ADDREBBI Michael L.Segreve PROPUCE14FLU ET-1 C STOMEIi ID N: INSURERS AFFORDING COVBRAOS. NAIC 0 INSURED Richard Fluet Contracting Inc. INBURERA;Arbella Protection Ins. Co. 41360 102 Bridle Path Lane INSURER 1,Commerce Insurance Co. 34754 Methuen, MA 01844 INSURER C INSURER D: INSURER E: INBURRR 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 ADDLISUOR TYPE OF INSURANCE POLICY NUMBER MM/D /YYOY YY MM/ DD/YYYY P POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENC6 $ 1,000,00( A X COMMERCIAL GENERAL LIABILITY 8500034727 06/1212015 06/122016 PR MI. Ea occurren0e $ 1100,0011 CLAIMS-MADE Fx] OCCUR MED EXP An one person) $ 6,00( 8500034727 06/12/2016 06/12/2017 PERSONAL&ADV INJURY $ 1,000,001 GENERALAGGREGATE $ 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG $ 2,000,00( MX POLICY 7 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE.LIMIT $ (Um ooddent) _ ANY AUTO BODILY INJURY(Per persan) $ 100,001 ALL OWNED AUTOS 130DILY INJURY(Per accldenl) $ 300,000 B X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS XV1460 12101/2015 12/01/2016 (PER ACCIDENT) $ 100,00( $ X NON-OWNED AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE S BXCE$$LIAR CLAIMS-MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ WC 0TH WORKERS COMNFNSATION T YLIMIT AND $ EMPLOYERS'LIABILITYY/N $00,001 A ANY PROP RIETOR/PARTNER/EXBCUTIVS NIA E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 4220061550 03/31/2016 03/31/2017 E.L.DISEASE-EA EMPLOYEE $ 500,001 (Mandatory in NH) If an describe under E.L.DISEASE-POLICY LIMIT $ 566,001 DES RIPTION OF OPERATIONS Below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach AcQRD 101,Additional Remar(a SehedUle,If more space Is required) CERTIFICATE HOLDER CANCELLATION NORTHAN SHOUT-b 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. Building Deparment 1600 Osgood St. AUTHORIZED REPRESENTATIVE North Andover, MA 01645 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/00) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs&Business Regulation TR' W OME IMPROVEMENT CONTRACTOR (''ww egistration: 106620 Type: - xpiration: 7/24/2016 Private Corporatio,, RICHARD FLUET CONTP^,CTING INC. Richard Flue( 102 Bridle Path Lane Methuen, MA 01844 Undersecretary Massachusetts -Department of Public Safety ; oat'd of Building Regulations and Standards License: CS-030710 RICHARD A FLUA'T 102 BRIDLE PATI L19�',� ��' MET RUEN MA 01844"! yfji ig Expiration Commissioner 04/22/2017