HomeMy WebLinkAboutBuilding Permit # 6/10/2016 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: -Op
Date Received
Date Issued:,a
L IMPORTANT:Applicant must complete all items on this-page
.~. `
,//-z Print 100 Year Structure yes 0
MAP _---PARCEL:+_^ ZONING DISTRICT: 's no .
Machine Shop Village yes no
[]New Building
0 Addition o Two or more family Ll Industrial
No.of units: 0 Commercial
0 Repair,replacement 0 Assessory Bldg 0 Others:
[I Demolition D Other
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
Address: MAYR),41,3
Supervisor's Construction License: ul _Exp. Date: ";t_
[Horne Improvement License: C) ----,Exp. Date:_aA
ARCH ITECT/ENGI NEER Phone:
Address: Reg.No.
Total Project Cost:$ -FEE:$ 44
Receipt No.:
NOTE: Persons contracting with unregistered 6qnAractors do not have acce totheguarantyfund
MV
An
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IF-in
-town Andover
No.
129q-- ?A(�
h ver, Mass,
ED
AW& BOARD OF HEALTH
Food/Kitchen
PER I IF ILD Septic System
%A A BUILDING INSPECTOR
THIS CERTIFIES THAT..................01!6.....4......� .....4..... .....b A..... 'Y- -1...............I....
has permission to erect... Foundation
....
.....................buildings on...36..........
A Rough
to be occupied as.......... 4%)4A...........M. 44A.............. .... 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 TIO Rough
Service
Final
WA=Bi'6111 eIN6 4PiECTOR
GAS INSPECTOR
Occupancy Perydt Required to Occupy Buildirt Rough
Display in a Conspicuous Place on the Premises-Do Not Remove Fin.]
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
I'lbEEl:9 I ROBERT LA NEVI
Building&Remodeling,LLC
795 Dale Street North Andover,MA 01845(978)686-3607
HIC#111990 FID#26-0816298
www.LangevinBuilding.corn
Job Description
Allison and Nathan Ray
35 Marion Drive
North Andover,MA,01845
Bathroom Remodel
L All necessary permits
2.Demo walls,floor ceiling,and fixtures
3.Move the doorway closer to the hall and install a new door
4.Rough and finish plumbing:install fiberglas tub and 3 piece wall kit,new toilet,2
sinks with faucets,and shower valve
5.Rough and finish electrical:install new GFCI outlet,ceiling light/fan combo vented to
outside,2 vanity lights,and switching
6.R-15 insulation on outside wall
7.Blueboard and skimcoat plaster on walls and ceiling
8.Shop built 5 ft vanity with granite top(a remnant piece from Napolitano Marble and
Granite),and a floor to ceiling storage cabinet
9.Durock floor prep
10.New baseboard heat cover
11.New door and window trim and new baseboards,all to match existing
12.All cleanup and trash removal
Items not included in the price quote:finish bath fixtures,electrical fixtures
Signed Date
Signed Date
'H;1,1 E7 T L A IST G E I N
i1t1\114", -�U'121_0 Jb_�41
i§Building 8,Remodeling
Homeowner Inforniation Contractor Information
Name company Name
_f 3L�)�U24ZT).AP)6'JF_V)§j 6A-,))c-
Street Address(do not use a Post Office Box address) Contractor/Salesperson/0—Name
Cittyl�ranwn Stato Zip Code g-- Business Address(must include a street address)
Daytime Phone Evening Phone Cfty/T_ownState Zip Code
CIO 3 1963,6 17
............
Mailing Address{h different from above)
Business Phone FcdcnEmployer ED or S.S.Number
iqm-d-
The Contractor agrees to do die following work for the Homeowner:
(Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.)
Ste- ,97—J-T' C Ze,,6 D 5 C rR 1 P-/7&-aj
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and will be secured by the contractor as the horneowners agent: be adhered to unless circumstances beyond the contractor's control wise
(Owners who secure their own permits wills be
excluded from the Guaranty Fund provisions of late when contractor will begin contracted work.
MGL chapter 142A.) I Iate when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Commotaragrees to perform the work,furnish the material and labor specified above for the tinalsurn of:I J/,
Payments will be made according to the following schedule:
-J� _6 77 aT-
rac trto
c.d 1/3 ofthetmal contract price_Qr the costofspecial order items,whichever is greater)
$ -7-K
or upon completion of R4A-_�� --YQJ a J
letion of
�_'4on completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following materialloquipment must be special to be paid for
ordered before the contracted woric begins in order
to meet the completion schedule,(**) to be paid for
NOTES:(4)Including all finance charges("*)Law requires that any deposit or down-payment required by the contractor before work begins may
not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express Warranty-is an express warranty beim,oro ideal by the contrachu� T^to Yea Wl terms of the warranty must be attached to the,_epM�Ict)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for
r4aterials and]aUor under this agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices
carefully before signing this contract.
Don't be pressured into signing the contract.Take time to read and fully understand it Ask questions if something is unclear-
IsLahe sure the contractor has a valid FIome Imorovoment Contractor Registration.The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration,You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof of insurance"document.
o Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of"business,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of tate
third business day following the signing of this agreement. See the attached notice ofGancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF,THE,RE ARE ANY BLANK SPACESM
Two identi.1 c.Pi..fth.u1mmtbe euipl�tedaul�igud. -na-
6:
Homeowner's Signature Confractor's 1p-mo
J
Date Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office oflnvestigations
600 Washington Street
Boston,MA OZIII
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information QQ��,p.�-�- Please Print Legibly
Name(Business/Organization/Individual):�.CJf-t�l
Address:—I9`�- DM-f S-7
City/State/Zip: t)O R-r'A .�-N Phone#: rI ? G 76'3 6'0 7
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4.❑I am a general contractor and I
6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.p am a sole proprietor or partner- listed on the attached sheet.t -74 Ig
r shi °p and have no employees These sub-contractors have 8. ❑Demolition
working for mein any capacity. workers'comp.insurance. 9
E]Building addition
[No workers'comp.insurance 5.❑We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs
insurance required.]t employees.[No workers' 131-1 Other
comp.insurance required.] --
*Any applicant that checks box gl 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 most submit anew affidavit indicating such.
*Contractors that check this box most attached an additional sheet showing the name of the sub-contractors add their workers'comp.policy infortnation.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name:_,_
Policy#or Self-ins.Lic.#: Expiration Date: _
Job Site Address: 3�— 106 D AIV M WIE City/State/Zip: l j _f}N 9A/'F—
Attach
A/'FAttach 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 maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
!do hereby cert' under he�s andpenalties ofperjuiy that the information provided aho�s an correct
Sienature •— Date_ cb/
Phone#: is 3 p
Official use only. Do not write in this area,to he 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
fi.Other
Contact Person: Phone#:
AC RQ® CERTIFICATE OF LIABILITY INSURANCE
le. --
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER,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; H the certificate holder is an ADDITIONAL INSURED,the policy(ios)must be endorsed 1f SUBROGATION IS WANED,subject to
the terms and condlllons DI H.Policy,certain Policies may require an endorsement.A statement on this certificate does not confer rights to the
Certificate holder in IIeU Of Stich endorsemerd(s.
PRO.UCER MemE: Edward W Hays
______......_.._._........_..__.,.___ STB 689.4425
Hays Insurance Agency Inc. PHONE EXp:(978)G86.3162 " N.: ( )
36 Hawthorne Ave. pop IL4E.; haysinsurance®cromcast.net
INSURERS 0.FFOROING COVERAGE _ _ _ N.C.Methuen Me 01844 —URMA;Norfolk&Dedham Mutual Fire Insurance Company
INSURE. —RPRe:
RobertD Langevin RBAJRERD:
795 Dale St INSURER.:
INSURERE: ..
North Andwer Me 01645 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 HE
IS SUBJECT TO ALL THE TERMS.
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,QMrTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
U64 POU F POUOY ENv UNITS
ILSR TYPE OP INSURANCE POuCYNUMBER M A
�( COMMERGIALGENERAL LIARWTY EACH OCCURRENCE
5 1,000.000.,,,,
CLAIM&MADE 11 OCCUR MISES Ea p.culRnrnl E 100A00.
MED E%P fAnY am p— S 5000.
A R0514357A 10/25/2015 10125l201G PERSONALAADVEIJURY 5 2.000.000.
GENTAGGREGATE—ITPPPLIESPER: GENERAL2.DDO,000,
A90REGATE 5
PCUDf❑PHI1:1 LOC PRODUCTS-COMPIOP AGG S 2,000.000.
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OTHeR COMSWE081N n
AUTOMO6ILELPIRIUTY Ea a.,ade I S
eODILY INJURY(Prr P—) 5
ANYAUTO
AUTOS OWNED u..OESULEO BODILY WJURY(Pcrppc W)S
OW
NON-0WNED Pm acC9 DAM §
HIRED-100 AUTOS P
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Ume0.ELLALIAB OCCUR EACHOCCURRENCE S
Ex...UAB CWM6MAOE AZGREOAV 5
S
OED PZMWIONS PEN OTH-
MRRERa COMPENSATION PATO
AND EMPLOYERS'U—& YIN
ANYPROPRIETOi.PARTNEwExECUTNE ❑NJA E.L.EACH ACCIDENT S
Im-d n rY III M RPACLU0E0T EL.018FA6E•EA EMPLOYEE$
(Mantld. In.4
It yes,R—.NndPr EG DISEASE=POLICY LIMIT 5
DESCRIPTON OF OPERATIONS below
DESCRN,nON OF OPERATIONS I LE.—ONS I VEXIC—(ACOAD 101.......nai R.mark.S..-A.maybe.. ..........Io rNI—)
Carpentry
CERTIFICATE HOLDER CANCELLATION
~�
SHOULDANYTTFTHEAre THE ECIBED TICS SBE CBE DELIVERED
IN
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTXOR3E0 REPRESEN
" 88.2014 ACORP CORPO ON.All Hghts reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
Massac,uset's De--1 ' i ,
'eni: SF- ,
Board o-1 Bujlamg Reauianons and Standards
-joense.CS-002685
s-
ROBERT M LANGEVIN
795 DALE STREET
NORTH ANDOVER MA 01846
02/24mle
Off—ofCo.sumer A ffa irs&B usi Rem Regulation
-MOME IMPROVEMENT CONTRACTOR
istmtion: 11199()
Type:
2/11/2017 LLC
ROBERT LANGEVIN BLDG&REMOLDING LLC.
ROBERT LANGEVIN
795 DALE ST
N ANDOVER,MA 01845