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HomeMy WebLinkAboutBuilding Permit #581-15 - 198 LANCASTER ROAD 1/5/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �- Date Received Date Issued: �( IMPORTANT:Applicant must complete all items on this page f 0— Print.- PROPERTY rintPROPERTY OWNER Print 100 Year-old Structureyes no MAP NO` PARCEL: L ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial .PKAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well -. ~p Floodplain- n Wetlands ElWatershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Z4�e zk— /_00� A�o G"o-1— identification lease Type or Print Clearly) ` 3 OWNER: Name: J,®�SS �✓�l� Phone: ,zzF_d/��C� �S Address: CONTRACTOR Name:C ..---,Phone:. S;Y_40�. Address: QLl � X73 � � io Supervisor's Construction License: _ __ Exp. Date: Home Improvement License: / - ia. Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIMIIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ` ✓�� FEE: $ 42 Check No.: 0 I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t e g arantyfi d �Signatureof Agent/Qwner ��; R.. Sig� _ature�of cont�acfo_: Plans Submitted L_J Plans Waived ❑ Certified Plot Plan Stampe Plans ❑ " -: Plans Submitted ❑ Plans Waived ❑- Certified-Plot Plan ❑ ... Stamped Plans El TYPE_OF:-SEWERANGEDISEOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . _Swimming Pools ❑ Well ❑ ..Tobacco Sales 0 -Food Packaging/Sales ❑ Private:(septic tank,etc._ ❑': Permanent%tnpster.an-Site ❑ THE..FO.LLOWING SECTIONS FOROFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE.APPR:OVED PLANNING &.DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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 Con nectionisignature& Date Driveway Permit DPW TowA! Engineer: Signature: Located 384 Osgood Street FIREDEPARTII �°.`_Nt :-:Temp Dumps ter on site . yes no r •Located-at 124,Mair, Street- - 4; `Fire f-sigiiature/date 'Y COMMENTS -Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ -Total land area; sq. ft.: ELECTRICAL: IV1Aovement of.illlleter,l.ocatFo►a-, rriast-or service drop requires approval of -Electrical Inspector Yes No DANGER. ®NE LITERATURE: Yes No MGL-Chapter.166.Section 21A-F and G min.$100=$1000.fin.e NOTES and DATA— For department use ® Notified for pickup - Date I Doc.Building Permit Revised 2010 Building Department -The following i!34-list of the'.required,forms to be filled outt.for:the appropriatepermit to be obtained. Roofii,g, Siding, Interior Rehabilitation Permits u ' Building Permit Application._ ❑ Workers Comp Affidavit Li Photo Copy Of H.I:C. And/Or G.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�)i. ❑ 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 apw-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 . The Comnionivealth of Massachusetts Departinent of Industrial Accidents Office of Investigations UT 600 Washington,street Boston,M4 02111 ivwsp.mass.gov/rlia Workers' Compensation Insurance Alda-vit:Builders/Contractors/)E;lectricians/Plumbers Applicant Information Please Print Leo-ibly- Name (Business/Organization/Individual): Address: v 0 ff City/State/Zip: r'`'l Phone : 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 have hired asub-contractors6. ❑New construction employees(full and/or part-time).* hi d th 2.❑I am a sole proprietor or partner- listed on the attached sheet.1 ?• QRemodeling ship and have no employees These sub-contractors have S. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.j 13.0 Other Any applicant that checks box Q must also fill out the section below showing their workers'compensation policy information. Homeowners 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 must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. "ant an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site nformation. nsurance Company Name: . l 'olicy ii or Self-ins.Lic.r: !_ 3 Expiration Date: % 460V'� ob Site Address: /r l ��4�'1/��1 >S 2 ,/I>7 City/State/Zip: 0 kttach a copy of the workers compensation policy declaration page(shoeing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine -f up to$250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certifj�der lie pains and p alties of perjury that the information provided above 's tru and correct. "anature: �/f /��/ Date: - v t hone A: Official rise only. Do not write in this area,to be completed by city or tolvn official. City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone r: r1pRT11 Town of I ndover O ,: 0 o h ver, MaSS, COC NIC Nl WIC.K "�� 41,9 °RAreo S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .� IS "........ ..,.`.�!!�. .............................................. BUILDING INSPECTOR ........................ Foundation has permission to erect .......................... buildings on ..�-, ........Lm ....................... Rough to be occupied as ...a� ........ .�. �. ......... 1i.. .... ...... .... ....... ...........adom - A— .................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS. CONSTRUCTIONS R Rough Service .......................... ......... ................................... 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. OP ID:SHHE CERTIFICATE OF LIABILITY INSURANCE DATE09/30DnYYY) 09/30!13 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). ' CNTACT PRODUCER Phone:978-688-6921 NAME: Macdonald&Pangione Insurance Fax:978-688-5350 PHONE FAX P.O.Box 428 _(A/c No Ext): A/c No): 104 Main Street E-MAIL North Andover,MA 01845 ADDRESS: Michael Pangione CUSSTOMER ID n:CHRIS-5 INSURERS AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. -INSURER B North Andover, MA 01845 IN ' 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 I TYPE OF INSURANCE (ADD L SUBRI POLICY NUMBER POLICY EFF I POLICY EXP )) LIMITS MMIDD IMM/DD/YYYY 1 GENERAL LIABILITY i I I EACH OCCURRENCE Is 1,000,000 A X I COMMERCIAL GENERAL LIABILITY I CPP 0180 57 0105 09126/13 1 09/26/'ie PREMISES(Ea AMAGE TO RENTED T ence) S 100,000 CLAIMS-MADE X OCCUR iMED EXP(Any one person) S 5,000 i_._._. PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ( j PRODUCTS-COMP/OP AGG S 2,000,000 I7 POLICY PRO- LOC I ! S JECT I AUTOMOBILE LIABILITY I I I COMBINED SINGLE LIMIT S i I i I(Ea accident) ANY AUTO BODILY INJURY(Per person) I S ALL OWNED AUTOS ( I BODILY INJURY(Per accident) S I SCHEDULED AUTOS PROPERTY DAMAGE {HIRED AUTOS {�{ ! (Per accident) S �.t NON-OWNEDAUTOS 1 j I S S _ UMBRELLA LIAB _ OCCUR j EACH OCCURRENCE Is EXCESS LIAB CLAIMS-MADE I AGGREGATE 5 I IDEDUCTIBLE ` I Is RETENTION S 1 is WORKERS COMPENSATION I I ( WC STATU- I I OH-1 AND EMPLOYERS'LIABILITY Y/N TORY I ER ANY PROPRIETORIPARTNERIEXECUTIVEi E.L.EACH ACCIDENT I S OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) (E.L.DISEASE-EA EMPLOYEEI S If yes,describe under j DESCRIPTION OF OPERATIONS below i I E.L.DISEASE-POLICY LIMIT S � SII I ( I ( 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 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA 01845 AUTHORIZED REPRESENTA IV Michael Pang on I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD � a a ftmcaan Jim Pinho 198 Lancaster Road North Andover, MA 01845 (H) 978-687-6753 (C) 508-641-9339 jpinho@a,vendoralliance.com December 28, 2014 Bathroom Remodel Work to be included includes: • Acquire Building Permit • Removal of existing shower,toilet, vanity,tile floor. • Complete all required plumbing. • Install new Panisonic Light/vent unit. • Complete all electrical. • Install vanity. • Frame new wall for shower and install Cast Iron Base. Install DenseShield Tile board on shower walls. • Install tile for custom shower. • Install DenseShield tile board on floor. • Install new tile floor. • Install new baseboard heat cover and baseboard. + Install new toilet paper holder,towel bars. Removal of all debris. TOTAL LABOR AND MATERIAL $ 9,000.00 Note: This quote does not include an plumbing fixtures vani tiles rout granite, YP g � tY� � g � or paint. If current vent is not properly vented,we will need to address. Custom Shower Enclosure will be an additional$ 1,850.00. Terms: $3000.00 upon signing of contract(not to exceed 113 of contract price) $6,000.00 when job 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 sa4tis accepted. You are author* do the work as specified.Paymout, above. Date j Homeowner Signature Date �-� Contractor 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 to 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 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 I S Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervi-mr License: CS-072173 CHRISTOPHERF3RIV.ET 207 WINTER ST` "ii pl = N ANDOVER Mk 01845 , f� � Expiration Commissioner 06/02/2016 ;�k-1. 'Office of Consumer A''f-i"rs&Business Rcbnfiif on 7tME IMPROVEMENT CONTRACTOR l #egistration: 139962 Type y xpi ration: 9/8/2015 Individual CHRISTOPHER F.RIVET CHRISTOPHER RIVET 207 WINTER ST. N_ANDOVER,MA 01845 Undersecretary Location No. �� Date /X . - TOWN OF NORTH ANDOVER '-t o Certificate of Occupancy $ O ' r Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check#� lu Building Inspector '