HomeMy WebLinkAboutBuilding Permit # 11/29/2016 OF NORTH qH
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
-yam �o
-2-o1 Date Received f'- ?q-�1 6J �s4 •� e`ag
Permit No# .S y 7 �SSaCHUSE`
Date Issued: B
IiVIPORTANT Applicant must complete all items on this page
LOCATION Co 4r�--i-s Izy
Pnnt �
PROPERTY OWNER f3I�uc F- T �f I' A
Pnnf 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Rntial Non-Residential
eside
❑New Building C One family ❑industrial
E Addition ❑Two or more family
No.of units: ❑Commercial
aeration
❑Repair,replacement G Assessory Bldg ❑ Others:
G i
El Demolition Other
la = �
DESCRIPTION OF WORK TO BE PERFORMED:
k
Identification-Please Type or Print Clearly ✓l _ l f_Q CI®3
Phone:
OWNER: Name:
Address: C c 7l
Contractor Name: � f� VI *,JPhone. ��
Email � }tJC f� r3t�t��INr� t4 Cry1r� c�,r� S�C3 X63 ?63y
Address: s-�
Supervisor's Construction License: Exp. Date: j I
Home Improvement License: l 1 g Exp. Date: >l 1 7
ARCHITECT/ENGINEER
-_�- Phone:
Address: —� Reg.No.
FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$725.00 PER S.F.
Total Project Cost:$ U FEE:$—/q/ -�
Check No.: �J Receipt No.: 3t a 6-
NOTE- Persons contracting w' unregistered contract o do not have access to the guarantyfund
Town of . Al. dover
No.
h $ ver,Mass, 11 ' A. /'k 0
pDRATEDr^QP �y
s �
U BOARD OF HEALTH
Food/Kitchen
PERMIT T ILD Septic System
THIS CERTIFIES THAT.......�►.O..Q.....t..�. .�G. �/► i .. ....... BUILDING INSPECTOR
has permission to erect.... .buildings on...�.3.� 1r..A. .� �... .... ,,,• Foundation
Rough
to be occupied as..... .....79r...... .. .... Chimney
provided that the person accepting this permit shall in every respect conform to the erms 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 G MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT TART Rough
Service
...... ...... .. .. ...................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reauired to Uccupy Buitdina 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 bet.
5Zucf- iAw�r�tm �
795 Dale Street
North Andover,MA 01845
V
2:ll BERT LANGEVIN
MEN Building&Remodeling,LLC
795 Dale Street North Andover,MA 01845(978)686-3667
HIC#111990 FID#26-0816298
www.LangevinBuilding.conn
Job Description
Deanna and Bruce Pomfret
136 Coventry
North Andover,Ma,01845
Total bathroom remodel:
1. All necessary permits
2. Floor protection for the duration of the job
3. Complete demo down to framing and subfloor
4. Electrical:new ceiling lite/fan combo vented to outside, outlet and switching to
remain in place,installation only of new light fixtures
5. Plumbing:installation only of 5'fiberglas tub,shower valve,toilet,sink and
faucet.All remaining in the same location
6. Upgrade insulation:ceiling to R30 and exterior wall to R15
7. VY'durock the backer on tub walls to 6'high and blueboard with skimcoat plaster
on ceiling and all other wall surfaces
8. Shop built vanity the same size as the existing one in walnut with a granite top to
be selected from remnants at Napolitano Marble and Granite of Lawrence
9. Duroek floor prep and installation only of floor the
10.Installation only of wall tile in tub area(one recessed alcove included)
11.New baseboard,window,and doorway molding
12.New closet shelving to your specs
13.All cleanup and trash removal
Owner signature Date 2
Contractor signature Date 1 2 3 j
(01
~ Building&Remodeling '
Homeowner Information Contractor Information
Name Company Name Street Address(do notuse a Post Office Box address) Contractor/Salesperson/Owner Name
Chytrown State Zip Code Business Address(must include a street address)
Daytime Phone. Evening Phone City/Town State Zip Code
63407 0 1(5— 9
Mailing Address(it different from above) Business Phone Federal Employer D or S.S.Number
nomeimpmvemw Camtmmor Rd@.Num6er H'ePiraiao dale
L��d�that meet home
regiuu•atiorrnumbsrave 7
The Contractor agrees to do the 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 ifnmessarv.)
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 homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of ! AcG /Date when contractor will begin contracted work
MGL chapter 142A.)
! -z ��Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule ,["� .� Q
The Contractor agrees to perform the work,furnish the material and labor speed above for the total sum o / :/ *)
Payments will be made according to the following schedule:
4T-. )
���i-�the total contract price or the cost of special order items,whichever is greater)
$ by / /_or upon completion of p�•�'�• � -
$ y _! upon completion of ---
upon completion of the contract(Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following matenallequipmem must be special be.paid for ._..
ordered before the contracted work begins in order
to meet the completion schedule.(*•) $ _to be paid for
NOTES:(")including all finance charges(**)Law requires that my deposit or down-payment required by the contractor before work begins may
not exceed the greater of(a)one-third of the total contract prim or(b)the actual cost of any special equipment or custom made material
which most be special ordered in advance to meet the completion schedule.
F'x ress w _ farm a mbeing d n o � e attached to the Marmon
Subcontractors-The contractor agrees to be solely responsible for completion of the worlc 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
materials and labor under this cement
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 bas been placed on the residence.Review the following cautions and notices
carefully before signing this contract
o Don't be pressured into signing the contract.Take time to read and My understand it.Ask questions if something is unclear.
m ce pa the contractor I;gg q valid ,e jmpzovemgOt Contractor Remjs. 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.
m 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
Bnow 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 1 ater than midnight of the
third business day following the signing of this agreement See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
Two identical copies of the centrad most be completed and signed.One copy should go to the ho or.The otheroutdye kept by rte con6actor.
Homeowner's Sign atu Contractor's Signature
11f Z3/7OL �/ azrl6
Date Date
DATE(MMIWIYYYYI
.4 CERTIFICATE OF LIABILITY INSURANCE 11/29/2.016
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 YHfi 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 cortiflcan,holder is an ADDITIONAL INSURED,the P011cy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,sub)aot to the terms and conditionS of the policy,certain policies may require an endomomenL A statement on
this certificate does not confer rights to the certificate holder in IN of such endorsement(s).
PRovDCEa ? Edward W Nays
PHONE B78 86-3162 PA% 978 688-4425
Hays Insurance Agency Ina Y( )6 --- � { )
EMAIL ha insurance Comcastnet
36 Hawthorne Ave. ADDRE$s Ys �
INSURER(sj AFFORDINGCOVERAGE NAICM
Methuen
Ma 01844INsuReaa:Norfolk&Dedham Mutual Fire Insurance Company
INSURED iryetlRERe:
Robert D Langevin INSURER D_
795 Dale St MSURERO; --,--
INSURER E: -
North Andover Me 01545 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IB TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PODGY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DE$CRIAEO HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSION$AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWMS-
INSRP IJGYEXP UNITS
TYPEOPINSURANCE lum IsOUCYNUMBERIMMIDDMYYY) man—)IMM
X COMMERVALOENERALUAMLITY TEACH OCCVRRENCE 3 1,ODOi000.
I PREMISE $ 100.000.
OIAi.Ma-N M 0 OCCUR a r
MED E%P(Any Oise Perm n) 5 6,000.
A R0514557A i 10/25/2018 102512017 PEft50NALSADv mJURY 3 2,000+000.
CeML AC-GREGATE UNIT APPLIES PER: I CENERALAGGREGATEIS
2,000,000.
POLICY❑JEC_ LDC PRODUCTS-COMP/OPAGG 13
S
OTHER: a INdant MIT
AUTONosruE—.' S
as ��
ANYAUTC ( BODILY tNJURY{PPr Par ) S
OWNED SCHEDULED SO LY.NJURY(Par ac IMI)!5
AUTOS ONLY AUTOS OPERTYDPMAG ig
HIRED NON-OWNED acddalit
AUTOS ONLY AUTOSONLY 5
UMBREUA UAB OCCUR EACHOCCURRENCE 3
a%CESSUAB CLAIMS-:.ACEI AGGREGATE S
5
OED I RETENTION
wOMRSOOMFENSAMN STA TE ER 1
ANDEMPLO`9A9'UABIUTY YIN
ANYPROMETORIPARTNERtEXECUTIVE ❑NIA 2.L.EACH ACCIDENT S
OF EMSER6`(CIVDED� E IEA.DISEASE- a—LOYE E
(MeOQaION In NHI
fy desofEA rmda- EI.DIBFJIBE-POLICY LIMIT t
DESCRIPTION OF O'ERATIDNS ealmv
I
DESCRIPTION OF OFERAYIONS/LOCATIONS I VEHICLES(ACORO 101,Addill—I Rmmadre SMOVIa,-V Pa 4RacPAa if more space Is 1,:Ru[+�dl
Carpentry
CERTIFICATE HOLDER CANCELLATION
SHOULD 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,
Ann:Building Inspector AerHORaEoa nr
120 Main St.
North Andover Me 01845
1988.2016 ACORD CORPORATION.All rights reserved.
ACORD 28(2016103) The ACORD name and logo are registered marks of ACORO
The Commonwealth of Massachusetts
Department of Industrial Accidents
a• J i Office of Investigations
600 Washington Street
Boston'MA 02111
�4f
wtvw.massgov/die
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information (� �37� Please PrinfLegibly
NaMe(Business/Organization/lndividual):RC.I�C+� j•.A 1-}6":yl 0 !&-11D6Y p
gr 1�C V0U_1rF-1 1 KjG-
Address:—79"';- DA-)-f
City/State/Zip: tom.}0 A-1-4N Phone#: 7
Are you as employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 4.❑I ata a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
�" listed on the attached sheet.t EJ Remodeling
2.tiq�
t am aole proprietor or partner-
ship and have no employees These sub-contractors have &. 0 ffemolition
working for me in any capacity. workers'camp.insurance. g. Building addition
[No workers'comp.insurance 5.El We are a corporation and its 10 12-ffjctrical repairs or additions
required.] officers have exercised their
3.0I am a homeowner doing all work right of exemption per MGL 11.�i Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.E]Roof repairs
insurance required.]t employees.[No workers' 13.0 Other
camp.insurance required.]
*Any applicant that checks bex#I..raise tilt 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 must submit anew affidavit indicating such.
`Contractors that check this box must attached an additional sheet showing the name of the sub-contractors add their workers'comp.Policy information.
I ant an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job 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 a.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 ofthis statement may be forwarded to the Office of
Investigations of the DIA for insurance"coverage verification.
I do hereby cert"'[r under I pains/annddpeenalt�ies ofpeijtuy that the infornmtton provide)d}ab�v�e is true ttd/coi'reci'
Siunature `_—p' ice•__ Date_!11! •---.�E ' G
Phone# -2 6 -360-7
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/Lieense#
Issuing Authority(circle one):
1.Board of Health 2,Building Department 3.Cltyffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
?lassachus tts,e._ -[
P-; en;of Pt O11C Safety
Board of Bwldrng Regulations and Standa,cl,
/cense:CS-002885
ROBERT M LANGEVIN
795 DALE STREET
NORTH ANDOVER MA 01845
0,11—ss 0,,e, 02/2472018 -
Office ofCoosamer Affairs&Business Regulation
-rOOME IMPROVEMENT CONTRACTOR
13 Xeglstrafion: .111990 TYPe-
WQxpitation: 2111/2017 LLC
ROBERT LANGEVIN BLDG&REMOLDING LLC,
ROBERT LANGEVIN'. -
795 DALE ST
N ANDOVER,MA 01845 --�' --
Undersecretary