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HomeMy WebLinkAboutBuilding Permit # 11/17/2016 BUILDING +. TOWN OF NORTH ANDOVER APPLICATION FOR LAN EXAMINATION � - Permit 4 Date Received 41 Argo ACF9kD�� Date Issued: Ju 167 _ --- --IMPORTANT: leant must co lete all items on this o �WN N �,�� � ' TYPE OF IMPROVEMENT PROPOSED USE Residential_ ion- esidential [-:I New Building F6,One frail I:I Addition [-i Two or more family I Industrial I_:1 Alteration No. of units: C:1 Commercial � i Repair, replacement C-1 Assessory Bldg F] Others: 11 Demolition J1Other F 1� i I � i^ shad/ l rl > ' 7o Le Identification Reese`Pylae or Print hearty) OWNER.-: me: " %t Phrens: Address- , r Up $O,r 41, ARCH ITE T/E I I NEER Phone: Address: Reg. No. FEE SCHEDULE., UL IN PERMIT.$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project t: �..� ii:rI FEE: Check No.: Receipt CITE: Persons contracting fly rarrr tend contractors do not haame access rant raarraraz bra Igttr rtwrar � Si nature, D contra °I Agent rv. 'Town tj®RTH F ®ver 0 No. T O _ lAKE h ver, Mass, 1 - 17 AWL COC HIC HE wf4M 1' 7,95 R47E D e` ,�•(� U BOARD OF HEALTH Food/Kitchen PERM �IT T LD Septic System mak THIS CERTIFIES THAT .. 0.....4,............ BUILDING INSPECTOR ..., .. ..... .... ..................................I.. qi# has permission to erect .......................... buildings on .......t...I S.....50.NPA...,..,..... ... Foundation �. .�� i� .,..... Rough tobe occupied as .......... ...,.,. ...I..... ....�..................................................... 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT .: STARTS Rough f/!`' Service ........f l ....�..... BUILDING.INSPECTOR. Final GAS INSPECTOR ®ecu seatPermit Required to ®ccu Ruildiaa Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. AMERICANrto PROJECT NAME WOOD COUNCIL Mry v.��lvvc o r �__— _ ---- -------------- I ik r� 4 i i i 4 i - 1 l 1 i i q,. i � Residential &Commercial PO Box 3216 Wakefield Ma. Supervisor's Lic.#025603 MA Home Improvement#181312 E-Mail scolella2@comcast.net Cell#781-258-6854 11/3/2016 Linda O'Hara 855 Salem St North Andover, MA Contract Remove existing vanity, toilet, and shower unit in existing 2nd floor master bath. Replace with new vanity,toilet, and shower unit picked out by homeowner. Home owner to purchase, and provide, all fixtures and tile floor product Patch floor and install ceramic the on floor. Plumbing cost to change shutoffs and reconnect new fixtures included, as well as cost to install dedicated GFI receptacle File permit with town as well Total $19,000.00 Contractor Signature A14 _ pate Property Owner Signature A,.- °w ° „. Date i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit LZ Please Print Name: �' t� �' +/ v Le Location: C' � Ir- �( � — L� f�U Pho e (� am a homeowner performing all work myself. am a sole proprietor and have no one working in any capacity EI am an employer providing workers'compensation for my employees working on this job. Company name: Address city: Phone#: Insurance Co. PolicV# Company name: Address City: Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGI.152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 andlor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the rns and penalties of p that h nformation provided above is true and correct, Signature 4XDate Print name , �� L� r`[✓7 Phone Official use only do not write in this area to be completed by city or town official' Building Dept []Check if immediate response Is required Building Dept p Licensing Board E] Selectman's Once Contact person: Phone tl; Health Department Other p FORM WORKMAN'S COMPENSATION rom:Chase & Lunt Insurance 978 465 6204 71/17/2016 13:56 #313 P.001/002 WESTM-1 OP ID:AC cern° CERTIFICATE OF LIABILITY INSURANCE D1111A/2016 11li712016 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(les)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 endorsements. ACT PRODUCER NAME' Select Business Unit Chase 8 Lunt LLC PHONE978.462.4434 AIc No);978465-6204 65 Parker Street c IL Ext Newburyport,MA 010£0 DRESS: Select Business Unit INSURERS AFFORDING COVERAGE NAICN INSURER A:Merchants Insurance Group INSURED Westminster Woodworks INSURER B: David Drescher INSURER C: 8 Westminster Road Merrimac, MA 01860 INSURER D INSURER F: (NSURE 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. TYPE OF INSURANCE POLICY NUMBER PMl�DlYYYY MMIDD LJ EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 300,00 BOPloegsss o4i0sr2016 0aroel2017 300 00 A X COMMERCIAL GENERAL LIABILITY PREMISES Ea currents $ CLAIMS-MADE �OCCUR MEQ EXP An one person] $ _ 15,00 X Business Owners PERSONAL S ADV INJURY S GENERAL AGGREGATE $ 600,00 GEN`L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 600,00 X PDLICY PHO-A41T -1 LOC $ AUTOMOBILE LIABILITY Ea as dCOMBINen SIN LEGFE LIMIT BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED 80DILY INJURY(Per accident) $ AUTO5 AUTOS PROPERTY DA AOE NOWOWNEQ PERACCIDENT $ HIREDAUTO5 AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S $ DEQ I I RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YNIA E.L EACH ACCIDENT S OFOCERIMEMBEREXCLUDED9 El (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under E.L.DISEASE-POLICY LIMIT $ DESdR PTtflN OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more apace la required) v1A FAx 978-688-9542 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Attn Donald Belanger AUTHORIZED REPRESENTATIVE 120 Main Streeet North Andover, MA 01845 �+•� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010!05) The ACORD name and logo are registered marks of ACORD : V jL� ryyiG79L4'IGIUCC[��I - l..ntTice of Cvnsat°er,L"iairs& cress ~ DtV't .IMPRDVMI�rt C013Z4s,T� .::TYFB - e9ssfration: '181312 DGA . xg4ra4►on 31t6►2©A COLELt A HOME MAthTNAI�CF STEp4'EN .COLELLk w A HyLL1S AVE. tJndcrsecretary" ' WAKEFIELD MA()188t} Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-025603 Construction Supervisor STEPHEN F COLELLA r_ 4 HIL.LI,% E WAKEFJ� J MA 078 { Expiration; Commissioner 10102/2017