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HomeMy WebLinkAboutBuilding Permit #639-2016 - 19 PHILLIPS COMMON 11/23/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: I Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LO'CATI ON k, PRO_ PERTY OWNER = tint 100 Year St MAFPARC:ELZY ,ZONING QI$TRI`CT ;Historic D Y0 O' �`eO ,6*6NO\ OL °i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 0 -Demolition ❑ Other ❑Septic �.V\lell ❑Floodplain Wetlands ❑z Watershed=Dist ict Q_Water`/Sew:er - - DESCRIPTION OF WORK TO BE PERFORMED: 0 Identification - Please Type or Print Clearly OWNER: Name: _ /�f �,,�Z Phone: ��9 j77— Address: Contractor Nam,/_ Phone:__�3/ l_ ,Address: � © _ /. _n' a Supervisor's Construction,License _� ©�c%i _Exp., !Date: Home;Improvement License:43 --Exa: Date= ARCH ITECT/ENGINEE 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: $ fa® 0- `J FEE: $ I?zl Check No.: Zupg Receipt No.: 11 NOTE: Persons contracting with unregistered contractors do not have access to the Tuaran&_fi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plar 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 COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH CC+MMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/signature $ Date Driveway Permit DPW Town Engineer: Signature: - -Located3 84 Osgood Street 111111117- = Te pD - - m _ ,� urnpster n>4s - o ite a Locate � d'at 12� Main;Street yes, K FieDe a..rmen.srgnaturedrate_ _ s C'OMMEN "S �. � 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 MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NU I tJ and UA I A - (For department use ❑ Notified for pickup Call Emai Date Time Contact Name Doc.Building Permit Revised 2014 17. 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 o 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 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 Doe: Building Permit Revised 2014 Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL Check # Building Inspector 2,9-72- 0-- N f� Eq_* 0 ENO O y.r O CL CL L C � Q y � E a L y SNOOP a: . 0 0 v � a) to i m :,vamp�>� r- 0 O = N > U) e 'a 0 O C t U Q to EoL- O z �U� LI) O O � .y 3 .> F- Q o, 0 a) t o c c CL a> � W O +O+t �m _ = O O LL •� c N C .= ,O O LU E =_ • U aL� o�_.� ,LO. N n m >y U) � O = .c $ MOV a) a N N to O a� d m L- 0 0 as O N O t 4- 0 z 0 Q J 0 0 LUCOZ CDZ m CO C LLI Z x O LLJ U W. C- Z I., v v C - .N 'I w N Cj E ti O 0 Z ^N 0 ED ^I+ O 'r_ W Q N .E m m CL ~_ 0 �, d 0 0 CL Q CF) Q O v J � �C 0 � Z � O U i' _y D a LLI U. O o oQ m N U y++ Y O LL cu N 0 N O_ N 0 z z co m C O c0 7 LL 3 0 K T N :E U — LL ® z z m J G h.0 7 K LL a z U W Lh0 O U i N C LL O w of ? �, j K LL a- W Q W c o i m O z v N v Y O N 0 ENO O y.r O CL CL L C � Q y � E a L y SNOOP a: . 0 0 v � a) to i m :,vamp�>� r- 0 O = N > U) e 'a 0 O C t U Q to EoL- O z �U� LI) O O � .y 3 .> F- Q o, 0 a) t o c c CL a> � W O +O+t �m _ = O O LL •� c N C .= ,O O LU E =_ • U aL� o�_.� ,LO. N n m >y U) � O = .c $ MOV a) a N N to O a� d m L- 0 0 as O N O t 4- 0 z 0 Q J 0 0 LUCOZ CDZ m CO C LLI Z x O LLJ U W. C- Z I., v v C - .N 'I w N Cj E ti O 0 Z ^N 0 ED ^I+ O 'r_ W Q N .E m m CL ~_ 0 �, d 0 0 CL Q CF) Q O v J � �C 0 � Z � O U i' _y D gyp, r PROPOSAL # 3 Mike Sady 19 Phillips Common North Andover, MA 01845 msadykcomcast.net (H) 978-687-4455 (C) 617-840-5559 - November 23, 2015 Bathroom Remodel Work to be included includes: • Acquire Building Permit • Removal of existing tub, toilet, vanity, tile floor. • Complete all required plumbing. • Complete all electrical. • Install new vanity. • Bump out closet to allow for 36 x 60 shower. (36 x 48 Cast Iron Base w/ 12 in. bench) • Re -hang existing closet door. (new door additional $185.00) • Install DenseShield Tile board on shower walls. • Install tile on shower walls. • Plaster patch where needed. • Install DenseShield tile board on floor. • Install new tile floor. • Install new baseboard. • Install new toilet paper holder, towel bars. • Removal of all debris. TOTAL LABOR AND MATERIAL $10,750.00 Note: This quote does not include any plumbing fixtures, vanity, tiles, grout, granite, or painting. Custom Enclosure would be an additional $ 1,900.00 Additional plumbing required to change shower drain to 2 inch will be extra. Terms: $ 3,380.00 upon signing of contract (not to exceed 1/3 of contract price) $ 7,170.00 when job complete Submitted By: Chris Rivet MA Lic #CS072173 HIC 4139962 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 anA-whereby accepted. You are authorized to do the work as specified. Payments will be ad as outlined above. Date 1 Homeowner Signature n, Date �� .:c' 3 4olitractor 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 =act, eowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract a contract r may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive te of Co sumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provideass US setts Genyral" aws, Chapter 142A. Homeowner's Signature X \ ) Contractor's Signature NOTICE: The signatures the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractA omeowner 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 duplicate 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 OP ID: OUJA ,44Co,Ro CERTIFICATE OF LIABILITY INSURANCE D09121ATE /20'15Y) 09/21/2015 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). PRODUCER Phone: 978-688-6921 Macdonald & Pangione Insurance Fax: 978-688-5350 P.O. BOX 428 NAME: CONTACT Jane Ouellette PHONE 978-688-6921 FAX _(AIC No Ext): (A/C No): 978-688-5350 104 Main Street North Andover, MA 01845 Michael Pangione E-MAIL ane m ins.net ADDRESS:) p PRODUCER CUSTOMER ID #:CHRIS -5 INSURER(S) AFFORDING COVERAGE NAIC # I EACH OCCURRENCE S 1,000,000 INSURED Christopher Rivet INSURER A: Preferred Mutual Ins Co 115024 207 Winter St. North Andover, MA 01845 INSURER B - _PERSONAL GENERAL AGGREGATE 5 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO- ( LOC X I POLICY 17 JECT INSURER C INSURER D: INSURER E: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS AUTOS INSURER F: i 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. IPOLICY LTR TYPE OF INSURANCE IN DDLI W I POLICY NUMBER EFF MM DD/YYYY PLICY EXP MM/DD/Y YY I LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY ( ;CLAIMS -MADE OCCUR , BOP 0100719749 { 109/26/2015 09/26/2016DAMAGE I EACH OCCURRENCE S 1,000,000 TO RENTED l PREMISES Ea occurrence $ 100,00 I` MED EXP (Any one person) $ 5,000 & ADV INJURY S 1,000,000 _PERSONAL GENERAL AGGREGATE 5 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO- ( LOC X I POLICY 17 JECT PRODUCTS - COMP/OP AGG S 2,000,000 I S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS AUTOS i i COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident)$ 1 lNON-OWNED I j$ UMBRELLA LIAB EXCESS LIAB III (� OCCURI I CLAIMS -MADE I I I ( EACH OCCURRENCE $ AGGREGATE I$ ^I DEDUCTIBLE RETENTION $ I I $ WORKERS COMPENSATION{ AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I I WC STATU- I OTH-� TORY LIMITS I I ER E.L. EACH ACCIDENT $ 1 E.L. DISEASE - EA EMPLOYEEI $ I E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Town of North Andover 1600 Osgood St No Andover, MA 01845 ACORD 25 (2009/09) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U lyi5t1-ZUU9 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/lndividual):. Address: c L; //K/7 %... L4 0 –_44zck- Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts 1. ❑ I am a y emp to er•with Department ofYndustrial Accidents 1'%td Office ofInvestigations have hired the sub -contractors listed. on the attached sheet 600 Washington Street r Boston, MA 02111 www.massgov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/lndividual):. Address: c L; //K/7 %... L4 0 –_44zck- Are you an employer? Check the appropriate box: Type•of project (required): 1. ❑ I am a y emp to er•with 4. E]I am a general contractor and I 6. E] New construction AmPloyees (full and/or part-time).* have hired the sub -contractors listed. on the attached sheet 7:. ❑ Remodeling 2. I am a sole proprietor or partner- ship and have no employees These sub -contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers comp. insurance required.] ir,cnran�g,# - comp. 5. ❑ 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 ❑ g P myself. [No workers' comp. right of exemption per MGL 12.[] Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.0 Other employees. [No workers' comp. insurance reauired.l *Any applicant that checks box #1 must also flit out the section below showing their worker' compensation policy information. t Homeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box mast 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company �� IlA -e— Policy Policy 4 or Self -ins. Lie. #: /Ybe O./ %-0 �� ®1` Expiration Date: 5)1dK111K Job Site Address:�%r�i�/ < �^^ ®� City/State/Zip: Gy�'ib 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 u p 'ns ,penalties of perjury that the information provideedd ab ve iss e and correct Official use only. Do not write in this area, to be completed by city or town oflicial 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 #: Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -072173 CEMISTOPIIER FIt1YET r ` 207 WINTER ST N AAI+ DOVER MA 0141 " Expiration Commissioner 0610212016 Office of•ConsO�Mcr_lffa rs & BusinessRe0 on 2 — � � • ME IMPROVEMENT CONTRACTOR -_ registration: 139962 Tr?a xpiraflo.n: 9/8/2015 Individual CHRISTOPHER F_ RIVET i CHRISTOPHER RIVET 207 WINTER ST. N. ANDOVER, MA 01845 Undcrsccretar :