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HomeMy WebLinkAboutBuilding Permit #452 - 104 MARTIN AVENUE 2/24/2009 S BUILDING PERMIT of"°oT"�ti TOWN OF NORTH ANDOVER 3� 4 -*' ., �0 APPLICATION FOR PLAN EXAMINATION 4 0 ON" Permit NO: Date Received ,/ 7q�DR."rED SSACHU5�� Date Issued: IMPORTANT: Applicant must complete all items on this page /f LOCATION P�n'nt PROPERTY OWNERI/ . /,d' /s�`C. Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no { Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial `> epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: /,Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ���/� �✓ �c� CONTRACTOR 'Name: --� /� �' l Phone: )7- t 3 J f Address: ,� 1 �t✓! Supervisor's Construction License: , , % Exp. Date:- � � ��/ Home Improvement License: b Exp. Date: � F ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ����`� FEE: $ 9�__ Check No.: Receipt Receipt No.: 01 'T— NOTE: Persons contracting with unregistered contractors do not have access to the uaranty f n Signature of Agent/Owner Signature of contractoz/44 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation.Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS d. {i 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Ternp Dumpster on site ,.yes no Located at 124 Main Stree# Fite Departmentsignature/date COMMENTS Dimension ,1 Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location No. Date c2e` U c NORTq TOWN OF NORTH ANDOVER � 001 9 ' Certificate of Occupancy $ sACMus�� Building/Frame Permit Fee $ Foundation Permit Fee $ } Other Permit Fee $ TOTAL $ Check # /o 21 867 Building Inspector ;- Massachusetts- Department of Public Safety Board of Building Regulations anti Standards Construction Supervisor License License: CS 72173 _. m Restricted to: 00 CHRISTOPHER F RIVET 207 WINTER ST' N ANDOVER, MA 01845, Expiration: 612/2010 y('umnd��ioncr g Tr#: 25403 Board of Build�pg Rtgulations and Standards !:, HOME,IMPR01fEMENTCONTRACiOR Registration:,.139962 s Uprr. m 9/$/2009 Tuft-132286iiw, . sr,� IndiAduni - '•CHRISTOPHERF RIVET CHRISTOPHER RIVET 207-*NTER ST N ANDOVER;MA 013a Adanimstralor 117et owruction First Floor Bathroom Proposal Paul&Lisa Hunter 104 Martin Ave North Andover,MA 01845 978-689-0678 paulhunter@ps-net February 2,2009 Work to be completed includes: • Demo bathroom. $ 600.00 • Install DenseSheild the backer $ 250.00 • Hang blueboard and plaster.. $ 1300.00 • Tile Tub walls- $ 800.00 • Install DenseSheild tile backer on floor. $ 225.00 • Install floor tile $ 600.00 • Grout and seal tile., $ 150.00 • Install new baseboard. $ 50-00 • Install new trim on window&doors, $ 200-00 • Install Curved shower rod. $ 50.00 • 20 Yard dumpster $ 475.00 • Electrical $ 975.00 • Plumbing $2000-00 • Building Permit $ 200.00 Total Labor and Materials $7,875.00, Terms: NOTE:This quote does not include any plumbing $2,600.00 to start fixtures,vanity,tile,grout,mortar or,mastic. $2,600.00 due after plaster $2,575.00 when complete Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-704-1165 North Andover,MA 01845 ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified Pa-ments will be made as outlined above, Date Dates;�A2/'Q Signature NORTH 1 T0 Of : Andover OM 1 �•`', No. y4r - C,o o �` dover, Mass.• • O COC MIC ME WICK �� AORATED /Pa,`�5 `S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System � L BUILDING INSPECTOR THIS CERTIFIES THAT /1 , � ... .............................. ......... -Foundation oun ation has permission to erect................... ................... buildin son .... (&4 ... .... .................A111WW.0. Rough t0 be OCCUpled as......... .ft *0. �.. .. Chimney . . ..................................................... provided that the person accepting tasopoermit shall in every respect conform to the terms of the application on file in Final 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 CONSTR111C Rough ...................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ACORD. CERTIFICATE OF LIABILITY INSURANCE ATE 11 7/2008 11/17/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonald &Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURERA: PREFERRED MUTUAL INS CO 15024 207 Winter St. INSURER B: N Andover,MA 01845 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' POLICY EFFECTIVE POLICY EXPIRATION LTR INSRDDTYPEOFINSURANCE POLICY NUMBER DTE MIDDIYY) DATE(MMIDDMI LIMITS A GENERAL LIABILITY CPP 0150 57 0105 09/26/08 09/26/09 EACH OCCURRENCE $ 1,000,000 DAMAGE TO REED COMMERCIAL GENERAL LIABILITY PREMISES Ea Moccuence $ 100,000 CLAIMS MADE ®OCCUR MED EXP(Any one person) $ 5,000 _ — PERSONAL&ADV INJURY $ 1 OOO OOO GENERAL AGGREGATE S 2,000,000 GENt.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 1,000,000 X POLICY PROT LOC AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS � (Perpe ) $ tson HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S i OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCRY STALIMTU-IT oER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS betmu E.L DISEASE-POUCY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN- 120 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR No Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Gess' +1� ACORD 25(2001/08) ©ACORD CORPORATION 1988 ems, -AMC wlnnN/nWV68"n OJ massacnUse IS DPpw*xqd ofIndustridAeddents Office of Invesdgadons 600 Washingtam S&eet Boston,MA 02111 www MWS_9ov/diel Workers' Compensation Insurance Affidavit: BmMers/Contractors/E1ectricians/Piambers Applicant Information //,p Please Print Legibly Nmne(Businesstorganization/tndMdual): ef'I'�I-5 Address: city/State/Zip:/Va- AN otlwK,, A eay,Phone,.#: S`©S7'e965- Are.you an employer?Check the appropriate bow Type of pJ 1.❑ I am a employer with 4. 0 I am a general contractoi and I fin andlor -tion; s have hived flee 6. Q New construction 2-2 I am a sole proprietor or on�- sheet 7: fRemo del'mg . and have no to These��have ship. employees 8. 0 Demolition - worldng for me in any capacity. employes and have wodwre .9. E B»iildmg•addition [No wodcers'comp.inssatance gip.msuisncx# reqnhvd.] - 5. We are a corporation and its ME Electrical repairs or additions officers have counise .fheir 3.❑ I am a homeowner doing all weak 11.E Pb mbmg repairs or additions mys [No ' riglit of Per MGL I2.E Roof repairs insurance .]t c.152,§1(4), and we have no - employeeL[No woakas' 13:E Other camp.insuraaux .] ..,may app&emit brat d=U box#1 must also fill out the section below showing weir worim,compmation Policy khru ation. t Homeowners who submit this affidavit indicating they are doing all work and flier hire outside contractors must submit anew affidavitindicatmg such. 1Conactors that cbeck this box must suachad m addidmd sheet showing the mmuc of fire subcoatractm and state whether or not those entities have employees. If the sub-co�heve employees,they must provide their workers'comp,policy number; I inn an employer that is providing workers'compensation ursunarrcefor my employees. Blow is the po&cy and job site fnformadom I mmuce Company Name:' �/.3 � u 1117QC Policy#or Self-ins.Lie.#: -�p/ O/�fl �� O j Expiration Date: W e o Job Site Address: City/State/Zip• 0l 4/lfOQw Ad 0/FY� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failuie.to secure coverage as reqdnduader Section 25A of MGL c. 152 can lead to the imposition of crimind penalties-of a fine up to$1,500.00 and/or one-year imprisommerd,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against tt violator: Be advised brat a copy-of this statrntent maybe forwarded to the Office of Investigations of the DIA for insurance coverage von. . I do hereby cer* P Pmddii ofP�drat the infora adon pr d abov tine correct Si e• Date• -� Phone'# Offwhd-use only. Do not write in this area,to be courlead by city ortam of wlaL City or Town:, Permitiiacen e# Issuing Authority(circle one): -1.Board of Health 2 Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General haws chapter 152 requires all employers to provide•workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or wriftem" r r. An employgr is defined as"an individual,par ship,association,corporation or other legal entity,or any two or more of the foregoing engaged in a jointenterprise,and including the legal representatives of a deceased employer,or& receiver or tnistee'of as individual,partnership,association-or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides dmvb,or the occupant of the dwelling-house of another who employs persons to do manitenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because bf such employment be deemed to be an employer." MGL chapter 152,§250(6)also states that-every state or local lung agency shall withhold the issuance 6r,. renewal of a license or permit to bperetfem business or to construct buildings ten the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL obapber 1ti2,§250(7)states"`Neithuer the commonwealth nor any of its political subdivisions shall enter no any contract for,the performance of public work untfi acceptable evidence of compliance with the insurance requirements of this chapter have been presentedio the contrasting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking.the boxes that apply to your situation and,if necessary,supply sub-coatiac6ar(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability►Companies(LLC)or Limited Liability Parmersbips(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Depart nibnt of Industrial Accidents for confirmation of insurance coverage: Also be sure to sip and dab the affnlaviL The affidavit should be tet urned to the city or town 69 the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the daw.or if you are required to obtain a workers'- compensation policy,please call_thee Department at the member listed below. Self-insured companies should enter their self-insuurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference mmnber. In addition,as applicant that must submit multiple permitllicense applications in aqy►given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"ail locations in (city or town)."A copy of the affidavit 69 has been-officially stamped or marked by do city or town may be provided,to the applicant as proof that a valid affidavit is on file for future permits.or licenses. A new affidavit must be filled out each year.Where a home owner or cidzzm is obtaining a license or pemnt not related10 any business or commercial.venture (Le.a dog license or permit to bum leaves etc.)said person is NOT requirid to complete this affidavit The Office of Investigations would lace to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give_uus.a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts D Varttnent of lndustrlal Accidents Qffioe of fnvesti pfions 6Q4 Washington Street Boston,lviA 02111 _ Tel.#617-727-40M ext.406 or 1-877 MASSAFE Fax#617-727-7749 Revised 11.22-06 wwu.mass.govfdia