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I I 11 Ill 11 I • I • I • 11 ' • M- - • • .y... $l, NO All, ttO R Ttown ofp.� P Andover 0 ��" ' 0% • ® P z h verass 4".3 LA OCIO ® L:AKa 9 coc NlMl WIC" V o U BOARD OF HEALTH IT LD PER Food/Kitchen Septic System THIS CERTIFIES THAT ......... BUILDING INSPECTOR has permission to erectj ' Foundation .......................... buildings on ... ........... . . .. .............. Rough 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TI Rough Service t . ... ... .... ............. Final BUI IN PECTOR GAS INSPECTOR Qccy2ancy Permit Required t® Occupy BuildanRough Display in a Conspicuous Place on the Premises — Do Not RemoveFinal No Lathing r Dry Wall Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. CBA WOODWORKS Estimate 90 Boston St North Andover, Ma 01F MA 01845 Date: 05/17/16 (978) 305-2547 cbawoodworks@fzmaiLcom Estimate# 0693-3 Salesperson Job Payment Terms 1/3 deposit 2/3 completion Brian Desmarais Bath Revised2 Item Description Line Total 1 Demo shower to studs and subfloor. Remove linen closet $15,500.00 for larger shower. Remove tile flooring, underlayment,wall fixtures, base molding,vanities. Plumb for new shower fixtures. Install fixtures,vanity sinks same location,toilet same location. Update electric for new vanity lighting,general recessed lighting,shower recessed light. Replace exhaust fan. Install tile flooring with underlayment,walk in shower with underlayment,wall substrate,shower floor membrane. Install vanity cabinets,wood base molding, misc fixtures, medicine cabinet. Reverse swing of bath entry door. Remove wallpaper. Paint walls,trim,ceiling. Contract shower doors and installation. Included allowance of$1900.Standard height(not to ceiling) Contract/coordinate all trades, permit,disposal. Total $15,500.00 Quote prepared by: Brian Beasley This is a goutation on the goods named,subject tos noted below: To accept this quotation,sign here and return: �=V-at!�-- Thank you for your Buisness! NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date The Commonwealth of Massachrisetts Deparbilent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 kip ►VWN:nlass govIdlia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electrieians/Plumbers Applicant Information Please Print Leib Name 03usiness/organizadon/Individual): Address: 6t0 005 Ci /State/Zi : .�/vr�l A Phone#: 60 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 4. Q I am a general contractor and I 6. Q New construction mployees(full and/or part-time).' have hired the sub-contractors listed on the attached sheet. 7. Q Remodeling 2. I am a sole proprietor orpartner- These sub-contractors have ship and have no employees 8. ❑Demolition workiug for mein any capacity, employees and have workers' 9 Q Building addition [No workers' comp.insurance comp.insurance.$ 5. We are a corporation and its 10.[:]Electrical repairs or additions required.] officers have exercised their 11.3 Plumbing repairs or additions 3.Q I am a homeowner doing all work right of exemption per MGL myself.[No workers comp. 1213 Roofrepairs insurance re c. 152,§1(4),and we have no required.] t employees.[No workers' 1311 Other comp.insurance required.] *Any applicant that checks box#1 trust 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 bine outside contractors must submit a new 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 ant an employer that is providing?.wokers'compensation insurance for n:y employees. Betow is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address' I o 6 e)PLrr AT-AVn —City/State/Zip: .40-1VIM16-1 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Sia e Date Phone# a 7 P Oj tial use only. Do not sprite in this area,to be completed by city or toitni official City or Town: PermitiLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ContactPerson: Phone#: Board of BuHdings peg.-jations ,i �se;tsiYtictSc+n 5u�creisor � -cense: CS-107038 BRIAN BEASLEYi 68 RUSSELL STREET North Andover WA 01848 ` Pxoiration 03129/2017 Commissioner ..>, '`1�e�rrn;j;arru«rilf�nfC't�z;;rrc�rt�ef/.i _—Office of Consumer Affairs&Business Reguload - � AOME IMPROVEMENT CONTRACTOR � Aj2egistrafion_ 181826 Type:. Expiration –&5f2017 DBA CBA WOODS BRIAN BEASLEY 90 BOSTON ST 4 � � NORTH ANDOVER,MA 01845 Undersecretary ut5/-x vvooaworKS 90 Boston St.No. Andover, MA 01845 Tel : 978-305-2547 Fax: 978-208-8333 Email:cbawoodworks@gmaii.com www.cbawoodworks.com 01-0 Ak �3 ,5k P 9OBoston St. North Andover, MA 01845 Tel: 978-305-2547 Fax: 978-208-8333 Email: cbawoodworks@cbawoodworks.com AL> ® CERTIFICATE OF LIABILITY INSURANCE DA6/l/20166 DD/Y 6/1/ THIS CERTIFICATE IS ISSUED AS A MAT TiE rid OF! P.GM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_THIS CERTIFICATE DOES NOT AFFWMATMELY OR NEGAW4ELY GR ALTM T 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 me terms alto conantons oT the policy,certain policies may require an enuorsement, A Statement on anis ceruncate noes no,comer nunus to the certificate holder in lieu of such endorsement(s). PRODUCER CON NAME, Paul J. MacDonald CPCU, CIC MTM Insurance Associates PHONE978)681-5700 FAX (g76 681-5777 LAIC,No): ) 1320 Osgood Street ADDR certificates@mtminsure.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC A North Andover MA 01845 INSURERA:Preferred Mutual Ins Co 15024 INSURFn Brian Beasley dba CBA Woodworks INSURER C: 90 BOSTON ST INSURER D: INSURER E: North Andover MA ola45 (INSURER F: 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE n i 04c"��C BY T-tE v^,.,,��:;= DEcSCoISED HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE WVD POLICY NUMBER MMIDD(YYYF MNW/YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A CLAIMS-MADE $❑OCCUR DAMAGE TO RENTED PREMISES a occurrence $ 50,000 BOP0100715042 11/1/2015 11/1/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 S POLICY E PSETT F-1.LOC PRODUCTS-COMPlOPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS $ Per accident $ UMBRELLA L1AB OCCUR EACH OCCURRENCE $ EXCE7LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N/A EL.EACH ACCIDENT $ '.. Mandatory in N (f yes,describe under EL.DISEASE-EA EMPLOY $ I DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 /�� ���// P MacDonald CPCU, CIC Jr9w, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgmenn