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HomeMy WebLinkAboutBuilding Permit #310-15 - 107 COVENTRY LANE 9/25/2014 NORTf1 BUILDING PERMIT 0 .1,.e6 D ,° TOWN OF NORTH ANDOVER h �0 APPLICATION FOR PLAN EXAMINATION Permit No#: L 0 ( Date Received �gSSACHV Date Issued: Vfl 14 . IMPO ANT: Applicant must complete all items on this page LOCATION ICJ`7 C Q V F yl T✓��1 V (J Print PROPERTY OWNER C&K C G C',-, a /1 Print 100 Year Structure yes MAP d PARCEL: ZONING DISTRICT: Historic District yes ( no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building imine family ❑Addition ❑Two or more family ❑ Industrial Ct7,�Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (3Cf+ an 0!% P e.'n n u a J co R na ' I2 u-fh r o a vh `)oL h 11- 7 TU cc 4-A f u L) e ,/ C-e t 19 Q r)cl r 4 �cA of r e a �4 fl a ,t2c�eA yko� c p, Identification- Please Type or Print Clearly ' OWNER: Name: Phone: Address: Contractor Name: Le►,c% ,. Phone: X17 S- Address: le e � a-a rMCJ `-� Supervisor's Construction License: 0 &,5-J Exp. Date: � -7 - � Home Improvement License: �G 3 Z Exp. Date: y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /,o, (,o FEE: $ Check No.: IU , Receipt No.: NOTE: Persons contracts g with unregistered contractors do not have access to the guaranty f d Signature cto of Agent/Owner Signature of contra 1 E ^'� 1 Location No. Date i • TOWN OF NORTH ANDOVER Certificate of Occupancy `$ Building/Frame Permit Fee $ I F Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ 1 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature I COMMENTS n+ i K HEALTH Reviewed on Signature COMMENTS i 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 - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i Dimension 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) I i I I ❑ Notified for pickup Call Email ` Date Time Contact Name uDoc.Building Permit Revised 2014 �I 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract ❑ Floor Plan Or Proposed Interior Work j ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks j ❑ 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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:Building Permit Revised 2014 The Commonweaft offfffmchuseft *.� Office ofbVesfig'aflofiff 00 Washiniton 'reef Rostov,HA 02111 workexco'Compowationbsurance. 'c& :Sader IC0,:tradorc$W-ecWczansj�l*�erg ica� 7 orc�aa zoo Please..Prc;intL-gdbZy Name(Bsix3essfdxgaaionllnclvzdi�al}:^ 2 V ES VU ✓Vt (�ri Vl �.QC' Address: IS e.wc EJ, CafStatef ` :: P► f� �, Si°• Pz 14- phane g:^ �1 C 7. 2 Axe you an OM-Ploper?CAeektfa6 approprzata box: Type oz'project(xe%m-red): �, [I I am a general acoox and contr �.� lam a exia�lopexwatb.�� 6. EJ-qew c6nstxizctzon. o z7landlox axe time}T havenodthe sub-contractors p tyees( t 7. remodeling 2, ,PKl am a ss�lepropxzetax orlraxtnex iistedonthe atrac�.edsheef sulx shiand`kavexio•em�loyees These contractaxshave 8. ps �[�]emolitzon. working foxme in.any capacity. workerscoma,insurance, ' 91 Building addition [No woAM&c0mm.;4m8ace 5. ❑We axe a corp oragon and its 10.0 Electxzcalxepairs or additions xecJuixed.] of"zcershave exercisedfheix �exon ti night of exemption lt�SGB 11.�j.p'lummagxepairs or additions 3.� �am.a ho�ieawnex doing all work � mysa .UTO W9rkers'comp. c,152,§I(4),and weRaw-- o I2,Q Rio au palm hmrantcarecpzir q employees.[Noworkexs' 13.0©tbex coma.insmancereguired] � rapplicariaicbecksbox �mus�aisollauithese�fionheld�showiagtheirworkers'compensatiogpolioginformation. i orneovrners who su�mitfhis af�tdaviindicatingley 2ze dping atlworl£andtheniiire outside contractors mnsnbm anew afddagiindicaang sucb, xCon�racforsih�cheektb3s boxmusEat#ached ar�additionai s3ieeEshcv�ingthename o��he sul�-coutracfors andtftei�•workers°camp.polzcyiuformatzon. I i rm an exny��y��trtaX r���avzc�%tzg tt�n��er�'corrape�a�atior�iri��ar�ce fog�r��er�ro�ees�. Below i���ie�aZacy te�trX job,��e ire,fv�mutio�t 7nsmance CampanyName, 6— c.0 cit k p w C �j 3 3 Gf Ex ixatzonDate a- s Policy oxe7 Ins. c.#: lob Site Addxesis:�0:7 C ay�Yl� r ��-=4 R CWState,/.j.P: .�.ttacb,a copy'of#�tewo�kM'conn ensavon omq Reclara-don[page sho r Me polzvYnumber axici e. zra 0 at . �covexa e as xe `ecxunderSection.25.A ofMGL o.x52 cantleadto tbeimposition o£eximinal�enaZtzes of a failure to sect g . � , :rte�to$X,500.00 and(ox flne�y'eax Nprfsoinneut,as well chgpenaltzes in tae form.of 3TOP�V ORS ORDER,and a fine ofvp to$250.OD a,day agdnsttf 0 V-10Zatoz: Be advised•hat a copy'of tbis stafementmay'be i"oxwardeclto the 0fr"zce flz Xtive.stigaRons off o I)TA fox insurance coverage verification, AoIiarebycertfyuricter AW.&inSurrcX,verr�Xti oJper�rr 'trarc�zrteir2 o r�rctio ppovi ecXtrXiove% z zceant co�z�eet S` afore: Date: �'iione#: Qffmzal use a.gry, .Do not mite in Als area,to ire cowlefod ry city orlom off oW City or Town: �'ez�azttLzcense# 1'8swing.An-thorffY(circle 631e); 1.$aaxd o ealtb 2`.SuzzdzngDepartnient 3e 0419COM Clerk .Blectxzoal ns eetox .Numbbig inspector 6 Other bfOrmation and Instructions r Massachusef#s Generalfaws chapter 152xeq*es allemployexstopxovideworlZexs'compensatiorEforfheixemployees. r, Parsaait tothisstatute,anev, royeeisdefinedas``,.,evex pexsaraiifhesexviceofanofhexunderany contract ekf&o; • express orimqRA Dial or wxitiert:' .Artc era�raye��ls de£ned as"an individua axinexs . t�.� I,p hfp,assocxafzon,corporation or othexlegal entity,ox anytwa oxxnoxe ofthe i oxegoA�engaged in a joint enterprise,and kaludiagtho legal xepresentatives ofa•deceased elnPIQye,.or the xeeezve'r oriiisfee of an dz'�rzclua� ra exship,as oczation ox otbexlegal entity,employing empXoyees. owevex;lac ownerofadwel&ghousebavivgnatMDxetbaAfh eeapartmentsaadwhoxeszdesterezn,oxfheoccupaotoftlte dwellinghouse ofanother who employ$pexsonsto do maintenance,comtractionorrepaixwo&onsuc dwellxnghouse � or on.thegxounds oxbuilding appuxienanttberefo.sb.allzioEbecause o�such,employ�nentbe dee�nedfc be an employez:" F MGL chapter 152,§25C(6)also states that"every state or to cal ycensing agency shall wiflthold the issuaxtc ox renewal 09a lieense or permit to operate a business or to constrttet hrdldiugs in the eommonwealtlx forarty applicant who has n, produced.acceptable evidence of complfanee witlx the xnsrtran.ce coverage required;' Additionally,Ma chapter 152,§25C(7)states'We eommonwealfhnox any ofits political subdzvhons shall enter into any confract fox the performance ofpublic workumfiz acceptable evidence of compliance with,fhe insurance r6gakezxtenf8 oftbis cbaptexhave beextpresentedta the cuntxacfingaufhozity;" App.acanb J'lease ouG the workers'comp ensaizon affidavit completely,by checking the boxes that apply to yot�x sitaaon and,if iiecessax ,supplysub-confxactox(s nauze(s�,addresses andplzorcuumbex(s)along wzth.fheixcerecate(s)of insurance" Limited f bEty Companies(LLCM orLim&dLiabftrParfaDrsbips(W) emplDyees otliexthWtbe xnexnbers ox Partners,are notxequixecl to carry workers'compensation insaxance. li an luG ox LLP does have )mployees,aP,olicyi9xeq*ed. Beadvkcdthat-aafdavitmaybambmittedfofbel7eparfinentof lnrlustrzal Accidentfax confirmation of insurance covexage. Aho be sure to sign,and date the afdavi. The affidavitshould. bexetamdfathecity ortown thatb�application fox Ifiopemitorlceaseisbeingxe esed,xotheL arment of 7ndttstkzal ACQfde,nfs- Sbouldyouhave any guest[onsxegarding the,law orifyora at'exagaixedto obtain,a*crkexs' eompensa�.anpolicy,please call theDopartm en-t at fhenatnbor listed be-low: �eIE~insuxed oompanies should ender flxeir • self hmrallce license number on the appropriate line. t City or TOM 0MCIals . J?leasebe sure fhatf$e affidavit is complete andpxinted legibly. Tho DeparEm enthas provided a space atfbe hotcom oxfhe cit"ZclayztfoxyoutD�Iloufzo.tbe eventtlze O�ca ox�,vestjgafzonshastD conta�ctyotxxegardingfJieaplilzcanfe .?'lease be suxo to z�llznthepermif/licehsenumbexwhieh wiilbe used as a xeiexencenumber, In addition,art applicant thatrnustsubmitntulfiplepezmzf/lice eappRoations.iaany givenyear,need onlysubmit one,afftdavitjudicafin c- 6g, policyxnfOnMaVonOfnecessaxy)analundex"J'ab,Site.Address"thaap�plfcantshouldwxzte"alflocadowxn. g(cityax appt0vRe 'A copy o the affidavit fhathas been ofCtcially stamped oxmaxked by;Phe city or towu.may be�xovided to the applleantaspr90fthataVandaff[davitssonffle�COrf ft epexnucsorRoffines. Anew affidavitmistbe.Modbuieach year.More,ahoma Omer orcz&enis obtah g alicense 06MAnotxelatedto anybudn,ess ox commexcM Venture (x.e,acloglie enseorpermittobum.leaveseta)said personisNOT xequire dtocompletethlT af€idavi The Office bfl'nvesggatioms would Ma to ffiM c you in advance fox youx ccopexaffon and ohQuld you pave any gixesfions, please do uo L hesitate to give us a call. Tha Depat-t monf s address,telephone and fax number. C4? Qax Qa l?v.: e t?pa e t Qf'I-QCTU*IaI AcrIace-f. Of Roe dICAVeAkAma BQSfQn, Ma Revised5 26451 � LEVIS-1 OP ID: KM ACOR>D" _DATE CERTIFICATE OF LIABILITY INSURANCE 04107/14 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(ies) 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). CONTACT PRODUCER Phone: 978 688 8829 NAME: Michaud,Rowe And Ruscak Ins. Fax: 978 557 2130 PHONE FAX P.O.Box 188 A/C No Ext): AIC No): North Andover, MA 01845 E-MAIL Lawrence R.Michaud,CIC ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Preferred Mutual Insurance Co. 15024 INSURED Levis Companies Inc. INSURER B:Safety Insurance Company 12808 Joseph Levis INSURER C:Guard Insurance Group 154 Pleasant Street North Andover, MA 01845 INSURER 0: INSURER E: INSURER F 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP0160589059 10/26/13 10/26/14 DAMA E TO RENTED 100 000 PREMISES Ea occurrence $ CLAIMS-MADE AI OCCUR MED EXP(Any one person) $ EXC PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG• $ 1,000,000 7X POLICY PFc RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,000 Ea accident B ANY AUTO 821254 01/01/14 01/01115 BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONX WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N LEWC538379 02/27/14 02/27/15 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION NORTH13 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. 384 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD PROPOSAL 1041040 LEVIS COMPANIES, INC. r : ,• - . General Contracting Residential:& Commercial 160 Pleasant Street North Andover, MA' 01845 978-687=2783, FAX 978-687-3042 PHONE DATE TO: Janet Cowan 9/19/2014 JOB NAME/LOCATION 107 Coventry Lane North Andover MA 02845 .107 Coventry .Lane N. Andover Bath Update-: JOB NUMBER_ JOB PHONE 10.40 We hereby submit specifications and estimates for: Replace existing bathroom vanity, toilet and tub. - Install new ceramic tile floor and tub area. Replace existing wall light, ceiling light, and 'ceiling. exhuast fan. .'. Homeowner to supply all ceramic tile. We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Ten Thousand Six Hundred and 00/100 Dollars dollars($ 10,600.00 Payment to be made as follows: $5,000 due now and balance due upon completion All material is guaranteed to be as ed.All work to be completed in a professional 9 specified. P P ss onal manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our N e:This prop a may be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within 10 days. Acceptance Of Proposal—The above prices,specifications and con• ditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature Date of Acceptance: 9�/9 /ZO � Signature LIZ PRODUCT 131286 USE WRH 771C ENVELOPE Deluxe For Business 1-800-225-6380 or www.nebs.com rA4RINTM IN U.S.A. A _ ! Massachusetts-iopartmcnt of Public Safety Board of Building Regulations and Standards Crmtructir.n 4slse;►h!,T License:CS-030651 -, JOSEPH GIE'VIS: 154 Pleasant St. North Andover MA 01845 1', ,110 Expirction Conanissioner 01/07/2016 -72, :.,tiro i✓r ul/,S "��u.xtcfu rll� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR `,,Registration: 103772 Type: y Expiration: 7/9/2016 Individuai JOSEPH G.LEVIS JOSEPH LEVIS 154 PLEASANT STREET NORTH ANDOVER,MA 01845 [Indersecretan II NORTH Town of s .T ndover O `1. � ��,• •t No. > h ver, Mass, 14 tocN�cHtw�cK �1' x.45 R�rEo �4P��5 U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System pmCTHIS CERTIFIES THAT BUILDING INSPECTOR //�� .. .. Foundation has permission to erect .......................... buildings on ...�..V......... ! !!:4. . ........111FIC010111110F Rough to be occupied a � ...... ... ..�*. ..... ...... ..... ... .... ........ ....... ...Cam.&..... Chimney provided that the person accep Ing 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"NTHA ELECTRICAL INSPECTOR UNLESS CONSTRUCUMSTARTS Rough Service .................. ....... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Promises - 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.