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HomeMy WebLinkAboutBuilding Permit # 11/15/2016 00RTF1 0 BUILDING PERMIT 7 0 TOWN OF NORTH ANDOVER I- I APPLICATION FOR PLAN EXAMINATION- Permit NO. Date Received Avec 0, Date Issued: CHU IMPORTAI LOCATION_���� Print el PROPERTY OWNERfLr-1 %A I w, Print MAP PARCEL: ZONING DISTRICT: Historic District yes no NO: 0 Machine Shop Village yeses no �1 L loll" TYPE OF IMPROVEMENT PROPOSED USE Fe`sidential Ind Residential E] New Building 11 One family 0 Addition E]Two or more family Industrial Alteration No. of units: El Commercial :]2,:e ai r,,irffplace�ment 0 Assessory Bldg 0 Others: ri 0 e�pmo n D Other 0 Septic [] Well D Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer C4, X. pr -V� Aei �<Z # Identification Please Type or Print Clearly) ()C r�042­e Lo (LE-L O Phone- WNER: Name: Address: CONTRACTOR Name: Phi ie: lit 17 al`� 4f I'K Address: 111%, Vto J0 Supervisor's Construction License: Exp, Date'. Exp, Da Home Improvement License: te: 5 ARCH ITECT/ENGINEER /)o Phone: Address:- Reg. No. FEE SCHEDULE:BULDING PERMIT. MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$126.00 PER S.F. v FEE: ",2 Total Project Cost: $-Z�i� heck No.: Receipt No.: a, I C NOTE: Persons contracting with unregistered contractors do not have access to the guarqntyfilnd Signature of Agent/Owner_ Signature of contractor .......... ............................. ........................... .......... .................................................. * NORTH 'Town o #9 -Andover 0 No. CdA 11 IA ver, Mass, OATED li BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ... .... .... .......S.C.41 BUILDING INSPECTOR O.N.e................... has permission to erect ...........I'll,........... buildi on ....So...... ..... Foundation _111.0116— — Rough to be occupied as ..... ...... ......eip-t#.... ... Chimney provided that the person accepting this permit shall in every respect conform to the terms o/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 CONSTRUCTI S AFT!� Rough P Service ......... ... ...... .....( . ......... ................ Final BUILDING INSPECTOR GAS INSPECTOR Qccy2ancy Permit Required to OccupE BuMog 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. 24** 3 " i 184 - I l , 2 �t _O- WELUVVOR 0 - IN b Er in N tO t ;- -77"' 23 33 1,135" 51 CO i8Ds—Sal 10 08 2AUCS3 7B n I F .; * 12" 85 All dimensions_size designations This is an original design and must Designed: 1 11 10/20 16 , given are subject to verification on ; not be released or copied unless Printed: 11/14/2016 Jo b site and adjustment to ft job _ tapplicable fee has been paid or job j conditions. �J order placed. z g 1 Schoene Bathroom Final ,All Dracvin,�#: 1 �No Scale. ' f-bbinetry Bv Design Proposal October 1 i, 2016 Carl and Kathy Scheone 50 TUI-dc Ln North Andover, MA 0l 843 {9'S) 688-1898 We are pleased to quote you on remodeling your bathroom. All -work is fuliy insured and all trash createel by Cabinetry By Design will be removed bv Cabinetry 1^v Design. Second floor'/ Bathroom and closet. Remove existing vanity, shower, and shower walls to ceiling, Strip floor to sub floor. Repair floor as =seeded. Prepare floor for tile. Insulate, blue board patch and plaster room as needed, Vent exhaust fan.to exterior, Dura- Rock, shower arca for tile. Bloc;,walls for grab bats and accessories. Install vanity and accessories. All work- as code, 1 ' ' 1 1: Disconnect existing ti-tures remove acid cap. We have carried a $2,673.52 fixture alloy'ance (Saler Plumbinco bid;L's2210838).. Install all ftxtwes rough and finish. I`uvork drains to toilets as needed to bring LIP to code. All work as per code. w Electrical: Disconnect existing and rough bath as per plan and code. Sapp)_) aild install on:Panasonic fan liollt cenirally located_ (2 in bathroom ') in closet) recessed lights locations to be detennined and install (1)wall fixture - supplied by homeol ner above vanity. Switches and otitlets as need. All v,orl, as per code tying into existing? Iff ice. �.'anatK,Closet caIsietyv and Granite:We have carried a `45,900,00 unity allowance for s.anity and bo:1 storage cabinets. o«net to select. Supply and install mid-price point granite cottntef top ;� v n as Per plan complete N ith any standard edge and 4" Nack- splash owner to select. Fide: - -_� Tile 11001'usin-OWDer SUPplied file and grout. Amount needed is 40 sq ft. Tile shower walls to ceiling Luing oil ner supplied tile- and grout, Amount needed i -3' scl ft. Ii;sta Proposal coi4 meed ne.' looJ�' Cabim?ttyy�qy-Desip?— _56 A'P umon? Si-�D��nI'i s, _��� (11 a2�— I� c�) .�'�-0002 Cow 7 netry By Design (Proposal corafinned) Nothina other that stated above is included. No shower doors. tile, Qrortt, accessories or paint inc-Nde d in quole. Total Cast: S25s766A Op i€n–Remove adjacent bathroom floor.. prep and install own,—,r sttppiied the (standard sq pattern) $1.800.00 Terms: 30% domvn, 30% upon starting, 30'1/. at encs of eek 7 10% upon completion per bathroofn O��n.er Date QsV r Date Jim izillips, esident Date HfC License V15283 Selections.' Wood: B,.hy� Door: G� ie Color: Sabi Counteiiop: Granite doe: Standard Hard, are: TBD Schcoi� e 10-/24!'20-16 r l C..�Ibinefiy.�v Desigi7—,56't'1'tttnom Si— 1 onvers. AIA 01923 -- (9 c5'j r"'-00012 The Corrtnroniflealth of Massachusetts g Department of In(hsstrialAccidentsr � Office of Investigations 1 Congress Street, .Shite 100 Boston,MA 02114-2017 ivrtv)f.Mass.gov/dia Wormers' Compensation hisurance Affidavit: Builders/Contractors/Electricians/Plumbers Angliellyt Int rrn tion Please Print Legibly Manic (Business/Orgunicationdiidividiial) . dJ )e" J Address: : ;)� 0,4 vt4,,— Citv/State/Zip:_J-,.:,1vk,S. 1c1 Phone#: Are on an employer? Check the appropriate box: Type of project(required): 1, 1'am a employer with 3 4. ® I am a general contractor and I 6, 0 New construction employees (full and/or part-time).* have lured the sub-contractors 2.El I am a sole proprietor or partner- lasted on the attached sheet. 7. bleniodeling ship and have no employees These sub-contractors have g, ®Demolition workingfor me in any capacity. employees and have workers' p h'• 9, ❑Building addition [No workers' comp. insurance camp. insurance) required.] 5. ® We are a corporation and its 10.®Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c, 152, §1(4),and we have no employees. [No workers' 13.[:]Other comp. insurance required.] *Any applicant that checks box 111 must also fill out the section below showing their workers'compoasation policy information. t Homeowners who submit 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 have employees,they must provide their avorkers'comp.policy number. I am an employer that is provi(lingr workers'compensation insurance for my employees. Below is the policy and Joh site information. Insurance Company Name: Policy#or Self ins. Lic, #: 110 Expiration Date: Jab Site Address: City/State/Zip " ° 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 pewilties 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$250,00 a day against the violator. Be advised that a copy of this statement rrtay be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify,iln(ler thepains(in dpelt alties of perjury that the information provided above"by true and correct. /16 &g-nature: i "a . Date: j t t h n #• ''—. 1711 " i )' Official use only. Da not write in this area,to he completed by city or torvrt official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector a.Plumbing Inspector 6.tither Contact Person: Phone#: L,aS /2016 10:17 FAX 978 532 2217 CROSS INSURANCE IN01 Q CERTIFICATE OF LIABILITY INSURANCE DA `Y DATE F11/1a/2016 RTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORfZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tha certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION 18 WAIVED,subject to the terms and conditions of the policy.Certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder In lieu of such endorsement(s). PRODUCER NAM . ACT c�uzeri Goldman. cross Insurance-Peabody PHONE (879)532-5445 AIG Na: [9�a)582�22�7 139 Lynnfield stra§t E-MAILAbORE :lgraldmar>�dcrnal>30gOncy•corn INSURER$ AFFORDING,COVERAGE NAIL R Peabody MA 01960 INSURERA:Main Streat Arkarica Assur. Co 29939 INSURVI) 1N5ORERO;NGM Insurance CO 14788 Cabinetry by Design. Inc. ENsuRERGffleago Ins Co 56 N PVTWM ST INSURERD3 INSURER 0: DANVERS - DANVERS MA 01923-2058 INSURERF= COVERAGES CERTIFICATE NUMBER:CL16111491615 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PQLICIES OF INSURANCE.LISTED BELOW HAVE BEEN ISSUEQ 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. LTR TYPE OF INSURANCE b �R POLICY NUMBER MMIG�Y EFF MM/�0 EXP LIMITS X GOMMI11RGIAL GUNRRAL LIA6ILITY EACH OCCURRENCE g 1,GOD,000 A CLAIMS-MADE �OCCUR PR_AEMI$GE TO N E g 50fl,000 EPT3936B 3/1/2016 3/1/2017 MED EXP(Any one person) 6 10,000 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE S 2,000,000 JEST D LOC PRODUCTS-COMPIOP AGG $ '2,000,000 POI[CY El OTHER Employment PrecIN95 00111ty z 10,004 AUTOM015ILF LIAHILITY COMBIMIINED SIN LE Lg � Q00 000 Go accident r B ANYAUTO BODILYINJURY(Par person) S AVTOS CO X AUTOSULEO kl9854944 1/29/2016 1/29/2017 BODILY INJURY(Per ecclawl) S NON-OWNED PROPERTY DAMAGE 5 X HIRED AUTO5 X AUTOS Fpr accident PIP-Sonia 3 8,000 UMnRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIARCLAIMS-MADE AGGREGATE 6 OED RETENTtON$ 3 WORKERS COMPENSATION pT T T ERH _ AND EMPLOYERS'LIABILITY ANY PR0PRJETOR1PARTNER/EXOCUTIVE Y_1� CN NIA A E.L.F.ACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? T4WC32297HH 1t7/11/2016 1V/11/2017 (MangatorY In NH] E.L.DISFASM-EA EMPLOYEE,5 500,000 II ee,describe under DESCRIPTION of OPrRATIONS below E.L.DISEASE-POLICY LIMIT 3 500 0 DO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101•AddlUonal ROMAVRe 30hOdU10,may bn a[raahad If inero space Ir rogefrud) CERTIFICATE BOLDER CANCELLATION (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 139 CANCELLED BEFORE T©wrm Of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St~ ACCOROANCE WITH THE POLICY PROVISIONS. North Andover, MA AUTHORIZED REPRESENTATIVE w p Lauren Goldman/MDlu.►dl —� 01988-2014 ACORD CORPORATION. All rights resarved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS026(201401) 'DR uIt's t 1 i �3A�IES, kr 9Et001C sT T'eWK5$URY,MA 61876-W E Y �5 D054•ip•2pEY ReY 071S2LOS ':.� i' u Massachusetts -Department of Public Safety Board of Building Regulations and Standards vfiTi�tiruC&— `obngjrteif7' License- CS-081143 `NC 1 BROOK ST TEWKSBURY N; 0 r .rf 1 954.• .'i',5 � Expiration Commissioner 06/1612817 off€ce of Consumer Affa€re,&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only 1 E; Type. Corporation before the expiration date. If found return to: �,,, Registration Expiration Office of Consumer Affairs and Business Regulation ' 101(32!2018 10 Park Plaza-Suite 6170 = 152838 Boston,MA 02116 Cabinetry By[]esigrt'apc Richard Brown 56 North Putnam St Danvers,MA 01923' Undersecretary Not valid without signature