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HomeMy WebLinkAboutBuilding Permit #761-2016 - 158 DALE STREET 12/28/2015 thOR fi BUILDING PERMITD"F O�4gl.fi .6 q�O TOWN OF NORTH ANDOVER �a � " APPLICATION FOR PLAN EXAMINATION _ 7D Permit No#: 4� �✓/ -J`� Date Received AC us Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ls- :r 0�e M PROPERTY OWNER /`/=�/��/ i�a,4�/ �7 Print 100 Year Structure yes no MAP 037 PARCEL: / ZONING DISTRICT: Historic District yes Machine Shop Village yes I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial 'L�-dteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic alNell prFloodplaien4Wetl`ands. ❑ VVatershed�Dstnct DESCRIPTION OF WORK TO BE PERFORMED: �,Identification- le Type or Print Clearly OWNER: Name: /C/7�11//t-� `> e�iSLG�Q Phone: Address: Contractor Name:L_/�i��S v j Phone: Email: ew, _ llr Address: A,07 S71, Supervisor's Construction License: Ola/7 -7 Exp. Date: ,� Home Improvement License: �� 02 Exp. Date: 7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ O q 0, 'D `J FEE: $ /O '_ o e , ' Check No.: � Receipt No.: a.y 9'5 7 NOTE: Persons contracting with unregistered contractors do not have access to h gua, fund t /6-(:5 bnxe j4aA Location /- ' No. �t� 2>)i Date g 5 F..- �s . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ .e. Building/Frame Permit Fee ��-� Foundation Permit Fee $ Other Permit Fee $ TOTAL $_i_ E= Check#c?, t J y !Building Inspector i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans P ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swnnming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM k I l PLANNING DEVELOPMENT Reviewed On Signature_ I COMMENTS CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature 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 D7PW Town Engineer: Signature: Located 384 Osgood Street FIREiDEP,AR� IMENTP Tem(� Qum ster on r ` sr' ;i �- Located�af�12'4�MaintStteet• • • ` r •� -' • r •. r . - ; = - �.�... _--_ ..�.�.� __ •t Fire De" s ( ��IIII�'fl�l�l, ,gnatur4e/d e 1 .� COMMENTS. { Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Motor 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.$1oo-$1000 fine NOTES and DATA— (dor department used EI Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Permit Revised 2014 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 a. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4� Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products g 9 g OTE: 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 � NORTH Town ofndover O No. I, - Z e bre ?� y - h C hn �:�� � � ver, Mass, / coc NIc"IMCK 1' S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ........... JCAA t4......................." BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ....... ..... .... .... .. ... ...... ...... Rough to be occupied as ........ ... 1►:.X• ... ... �.4C . ........ ......................... 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 CONSTRUCTION VARTS Rough Service ..................I..... 1�1./.:L: r......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. " efi00%i6 jqiad tuwiian Kevin McLellan 158 Dale Street North Andover, MA 01845 kbm@sloan.mit.edu (C) 617-510-3497 (H) 978-688-5007 1 December 28, 2015 2nd Floor Bathroom Remodel Work to be included includes: • Acquire Building Permit • Demo of bathroom. • Complete all required plumbing. • Install new Panisonic light/vent unit. • Complete all electrical. • Install Electric radiant heat in floor. • Install 36 x 48 Cl Shower base. • Install DenseShield Tile board on shower walls. • Install tile for shower. • Install two grab bars. • Install electric floor heat.. • Install new tile floor. • Install new toilet paper holder,towel bars. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 9,000.00 Terms: $3,000.00 upon signing of contract(not to exceed 1/3 of contract price) $3,000.00 after plaster complete $3,000.00 when complete Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-794-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel: 617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as outlined above. Date Homeowner Signature , Date* 2 ZContractor Signature '� Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required submit to such arbitration as provided in Massachusetts General Laws,Chapter 142A. Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL Chapter 142A)and other consumer protection laws(i.e. MGL Chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in delicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law",contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or(888)283-3757 The Commonwealth of Massachusetts Department of IndustrialAccidents Office ofInvextigadons i - 600 Washington Street Boston,MA 02111 -www.massgov/dia Workers' Compensation Insurance Affidavit:Bidlders/Contractors/Electrscians/Plumbers Aunlicant Information Please Print Lealbly Name(Business/OrganizatiorAndividual): Address: 49"0% City/State/Zip:/Ur. A4.0/geK Phone#: 0<"0;7_CP�" Are you an employer?Check the appropriate box: Type'of project(required): 1.❑ I am a employer-with 4. ❑ I am a general contractor and I 6. ❑New construction �Ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed.on the attached sheet 7.. 0 Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers'comp.insurance comp. insurance.x - required.] S. [] We are a corporation and its 10.❑Electrical repairs or additions 3.[] I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑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 wotkers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and Eben hie outside contractors must submit a new affidavit indicating such. tContract ors 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 am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: � ��>_1 ;-� ��! �,l/✓rc, Policy#or Self--ins.Lia#: 1206'!�7 C%" /,�7 2�� Expiration Date: ,,// ��r Job Site Address: %�g �r4 "/5 S� City/State/Zip:/VD rude✓�2y�f� 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 io 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. Ido hereby certify u p 'ns penalties of perjury that the information provided ab ve is 4rue and come S' e• 6 �.�� Date: Owl n ;gw//S .�' Phone#: X � 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID: OUJA CERTIFICATE OF LIABILITY INSURANCE 7OT9/21/2015 E(MM/ Y) 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:978-688-6921 NAME: Jane Ouellette Macdonald&Pangione Insurance Fax:978-688-5350 PHONE 978_688-6921 FAX P.O.BOX 428 _(AIC No,Ext): (Arc No): 978-688-5350 104 Main Street EMAIL nl In North Andover,MA 01845 ADDRESS:)ane @ p s.net PRODUCER CHRIS-5 Michael Pangione CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE_ NAIC# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. North Andover, MA 01845 INSURER B INSURER C: INSURER D: _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. ILTR NSR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER i MM/DD/YYYY I MM ODfYYYY LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 A j X COMMERCIAL GENERAL LIABILITY BOP 0100719749 ( 09/26/2015 09/26/2016 DAMAG T RENTED fi � PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X C OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 i j f I GENERAL AGGREGATE S 2,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 2,000,000 X 1POLICY 7, PRO- LOC $ i 1 JECT AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT I (Ea accident) $ ANY AUTO i BODILY INJURY(Per person) ,$ ALL OWNED AUTOS BODILY INJURY(Per accident))$ SCHEDULED AUTOS ! PROPERTY DAMAGE 1 HIRED AUTOS I (Peraccidenq 1 NON-OWNEDAUTOS j $ IIf ,$ j UMBRELLA LIAB I OCCUR ( I EACH OCCURRENCE $ _) EXCESS LIAB I CLAIMS-MADE I I j AGGREGATE $ DEDUCTIBLE RETENTION $ I N $ WORKERS COMPENSATION I OT _ AND EMPLOYERS'LIABILITY YIN j f TORY L M TS ( R ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ ELEACH $ OFFICER/MEMBER EXCLUDED? NIA i (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below f E.L.DISEASE-POLICY LIMIT (S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St No Andover, MA 01845 AUTHORIZED REPRESENTATIVE I 46z z ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety r Board of Building Regulations anei Standards Construction Siipervisor License: CS472173 CMMTOPBERF ,-RIVET 207 WINTER ST. 1 N ANDOVEk Xk 01b45 Expiration Commissioner 0610212816 'J�P�nnt Dtnntten�/Jt n/^l�[(�JJnc�nJel�J -Office of Consumer Affairs&Business Regulation �atfOMEIMPROVEMENT CONTRACTOR Registration: 139962 Type: Expiration: 9/8/2017 Individual CHRISTOPHER F.RIVET - CHRISTOPHER RIVET 207 WINTER ST.N.ANDOVER,MA 01845 Undersecretary