HomeMy WebLinkAboutBuilding Permit # 1/3/2017 1 g`�ytiav s6�k® BUILDING PERMITazg „ o TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINA IO Permit NO: Date Received q0 A1Tfo �s$aer+us�s Date Issued: I C°i} IMPORTANT:Applicant must complete all items on this page / C 1 r r .!',-•!"'N-- .m ie.+e.. _..;�,...w R.f.,/C., .,. , , 2X�X i. J..+ r.la� / TYPE OF IMPROVEMENT PROPOSED USE Res dentia) Non- Residential ❑ New Building One family [],Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other A� Identification Please Type or Print Clearly) OWNER- Name: Phone: Address: / if ............. ... ....... �2" C/ � � L / g.{af,, f yG�n l l G ARCH ITECTIENGI NEER Phone: Address: Reg. No. FEESCHEDULE.SULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$12500 PER S.F. Total Project Cost: $ v FEE: $ Check No.: Receipt No.: 2-i � NOTE: Personas contracting with unregistered contractors do not have access to the guaranty,fund e Slgnatu e of : ert �� � at re c rtlr for & .'Town of z :. T ndover , 0 y` To N o. ft / Aw7 CO �.K. h ver, Mass, COCHICHewicM 4ATEU C2 BOARD OF HEALTH PERMIT,,T LD Food/Kitchen Septic System THIS CERTIFIES THAT SVPIANW„ ..... BUILDING INSPECTOR has permission to erect.......................... buildings on .....&....... .0 ....S..r........... Foundation p .. .. .. ........ ...... F/ot& . ... Phro .. Rough t0 be oCcu ied 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 C® STRUCA� ,AR Rough Service ... ,+� ..BUILDING.INSPECTORFinal GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 15,900.00 m _ $ 190.80 Plumbing Fee $ 23,85 Gas Fee 100 comm. $ 1p0.Op Electrical Fee $ 23.85 Total fees collected $ 338.5p i 6 Allen Court 684-2017 on 1/3/2017 first floor bath i i P X b 1 Board of Building Regulations and Scarto:5.11s c% strut-dmu Supen-bior := _.cense:CS-107038 BRIAN BEASLEY; 68 RUSSELL S MET : f North Asda-er NFA 018 s r s r _ #. � Expiration fl3 ZVM17 Commissioner . i i 0 �fe�cattsuasltnFnfUE o��=���r.;;rri�it'r!l OfTice of CaosnmtrAffi'rrx&Bnsine�Itegnf�Eiii.�'t_:, = ME IMPROVEMENT CONITRACT(jR #tegistrador °.781826 Type: F Expion: tk17:. DBA CBA WOODS BRIAN BEASLEY 90 BOSTON ST NORTH ANDOVER,MA O1845 ilndersecnelary CBA WOODWORKS Estimate 90 Boston St North Andover, Ma 018MA 01845 (978) 305-2547 Date: 08/20/16 cbawoodworks2p,mail corn Estimate# 0763 Salesperson Job Payment Terms 1/3 deposit 2/3 completion 1Brian Fran Bath Item Description Line Total I Bath Remove vanity and toilet for reinstallation. $17,500.00 Demo tub&shower to studs,flooring to subfloor. Demo wall tile and sheetrock at toilet area to studs. Modify plumbing for new tub&shower fixtures. Install toilet and sink same locaton with new water line shutoff valves. Install tub&shower fixtures. Install new Runtel electric heat,shower light w/separate switch. Install the floor,shower surround and toilet wall the with cement board underlayment/substrate. Contract frameless shower doors and install,Allowance of- "$a'600- Install vanity, misc fixtures, new closet doors. Install new wood base molding, door&window trim. install window W/new exterior trim. Cost of window excluded. Paint walls, ceiling&closet. Stain doors&trim to match existing in hallway. Contract/coordinate all trades, permits, disposal. Excludes purchase of tiles, plumbing fixtures, vanity top, Total $17,500.00' Quote prepared by: Brian Beasley This is a qoutation on the goods named, subject to the onditions noted below. To accept this quotation, sign here and return: Thank you for your Buisness! The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a I Congress Sheet,Suite 100 Boston,MA 02114-2017 s www.mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Le6bly Natile (Business/Organization/Itidividttal): nC:,e-e51" Address: �( ,) Ovo�rn bP. City/State/Zip:Mo o 1 �+�Phone#: q.),p Are you all employer?Clieck the appropriate hox: Type of project(required): 1. I am a employer with 4. 1 am a general contractor and 1 ployees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ` ship and have no employees These sub-contractors have g, Demolition workingfor me in an capacity. employees and have workers' Y p t3 9. C1 Building addition [No workers' comp.insurance comp. insurance., required.] 5. C] We are a corporation and its 10.C3 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their I LCJ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2.C]Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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 ani an ernployer that is providing uvrkers'compensation insurance far lily eanployees. Belmp is the policy and job site information. Insurance Company Name: _ Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/"Gip: 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. Signature: Date: iA1Ite11tQ Phone#: A 7—3 U i — A►5 44 Official use only. Do not write in this area,to be 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 S.Plumbing Inspector 6.(utter Contact Person: Phone#: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swilnniing Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF w U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COM ENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature& Date Driveway,,Permit Located at 384 Osgood Street AR iU }.. 1iV 11nh7Y zl!...y....Y.. /' -! r /'r„ / ✓. 9C"J9, _� ,i'/ -/f'./ .N44� h 5 r, r r s r r ri r , AcaCERTIFICATE OF LIABILITY INSURANCE °A�E`MM'°°'YYYY' �.....� 12/30/2016 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 endorsement(s). PRODUCER COOINTACT Victoria Lowes, CISR _ MTM Insurance Associates PAHONe (978)681-5700 J FNo Ext), AAk No]: (978)681-5777 1320 Osgood StreetE-MAIL ADDRESS:vickiel@mtminsure.com INSURERS)AFFORDING COVERAGE NAIC# North Andover MA 01895 INSURER A.-Preferred Mutual Ins Co 15024 INSURED INSURER B: Brian Beasley dba CBA Woodworks INSURER C 90 BOSTON ST INSURER o INSURER E: _ North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER.-16-17 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. ILTR TYPE OF INSURANCE IN n SUER POLICY NUMBER MM ODnYYY MMID�fYYYY LIMITS X COMMERCIAL GENERAL LIABILITY 500 000 EACH OCCURRENCE $ , DAMAGE TO RENTE€J A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 50,000 BOP0100715042 11/1/2016 11/1/2017 MED EXP(Any one person)� $ 10,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY PRO- 1-1 JFCT L_i GOC PRODUCTS-COMPIOP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident W ANY AUTO BODILY INJURY{Per person) $ ALL OWNEC3SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA ....... (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,desc ibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. Paul Hutchins 120 Main aS t. AUTHORIZED REPRESENTATIVE N Andover, MA 01845 P MacDonald CPCU, CIC ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS 025 rgrrlam i