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HomeMy WebLinkAboutBuilding Permit #327-16 - 222 BRIDGES LANE 9/24/2015 BUILDING PERMIT o�itNORTl1 q 6�64,- TOWN OF NORTH ANDOVER io APPLICATION FOR PLAN EXAMINATION h Permit No#: �o Date Received °oR„rE0 AC US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION oZe22 '6RWQ6-fS Print PROPERTY OWNER MI c ;� �> ►0 6 -:'-eN.N�F w' R� Print 100 Year Structure yesno MAP _PARCEL:—�ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building .ane family El Addition ❑ Two or more family ❑ Industrial eration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: -U.66molition ❑ Other 1? Septic ❑Well El Floodplain El Wetlands El Watershed District 0 ter/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��`T� ��f�l7�.i- — 7�rRC9- csPC-2�4fl� 1 �5�L-t4�'i o o•� — {� �-- t N*-4 ehi&A-1 rv6 y Identification- Please Type or Print Clearly OWNER: Name: M )CM.0-,$'JO SQ W1F A tr ft RD Phone: Address: �a.� $(�1 L>��5 L,,�-N /J �-P•J D- Contractor Name: fQ Phone: `��$ 6' G'3do 7 Email: V1N 1BVt1-r ,1►J6 r9 6 I4— C�m Address: :5T- Nom- kob ovierZ Supervisor's Construction License: �� � Exp. Date: � �`/�/,f, Home Improvement License: � � ( �f � � Exp. Date: ARCHITECT/ENGINEER Phone: Address: — Reg. No. FEE SCHEDULE:BULDING PEq RMIIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ �� �� FEE: $ �/ I Check No.: 15? Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location .�` S "e-- No. " 2-o(�a Date ti . • TOWN OF NORTH ANDOVEp9 ID) . a ® Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 7 Check#")/J& r r -� Building Inspector 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 e Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: + LFocIRaEtedDa"EYt=P12A4RM�T�aMine 5 .T __4_ r ,.__ o�ca�e .-_..$ 4 ` w.- u Esito n treet Fire Depart, rrient signature/date; - COMMENTS. 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) ® Notified foricku Call p p Email i Date Time Contact Name Doc.Building Pennit 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 .4.. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work � p Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4.. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance orspecial 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 NORTHTq own of 711, ndover 0 . , No. �� _ a * t _ h ver, Mass, COCMICHEWICK ��• S ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ ��` / �:ryLo ............................ . BUILDING INSPECTOR • ` JR�',�. r has permission to erect .......................... buildings on .... ..... . .� S........�i/.1of................... Foundation Rough Chimne to be occupied as ............ .....r: �C�r�.< ...� y .. . .. ..... .................................................. 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 STARTS Rough Service ...... .............. ........... ...... ..... ::---::.,..� ............... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. i t ROBERT LANGEVIN ® ® ■ Building& Remodeling, LLC Homeowner Information Contractor Information Name Company Name Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name Bc City/Town State Zip Code _ Business Address(must include a street address) y� c� i LI� 7�� � �� �•- N�cs1F�e2 �� o r�y5 0� Daytime Phone. Rvening Phone City/Town State Zip Code y Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number ,g ; Home Improvement Contractor Reg Number Expiration date V Lam! Q Law requires that most home improvement contractors have n valid registration number / / I Q 17 /V"0 /f1 rn / ( r Y The Contractor agrees to do the following work for the Homeowner: �' �` "' Describe in detail the work to completed,specifying the � t.y t•�t .L .. ( p type,brand,and grade of materials to be used,use additional sheets if necessary.) r j-3 R cmoL),F-1--— G = w) r`l► Z-4-mo o %j- ii., /JF— JYi0kD1PJ6-- 60-4-44 f'r4r�£1-�u�— �NsTArA�t_ o?J —; �400R ri.,E, /3,tOMi8ItJ6 O e F-1 A T U:ZF-s 416-6—, ��„ A ! Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of ate when contractor will begin contracted work. MGL chapter 142A.) Ajo ate when contracted work will be substantially completed. Total Contract Price and Payment Schedule �j o n. The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of. Payments will be made according to the following schedule: � - ice or the cost of special order items,whichever is greater) .2 E" F 4 o Q 't" O rU+ .LV". N GaET El V L ❑ ❑ A CY O U 'p O p Q o Sep 11 15 02:04p Langevin 9786863607 p.2 Mmlifyyyy ACOMEX CERTIFICATE OF LIABILITY INSURANCE Qc{` S,. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE . 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(les) must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). NT PRODUCER NAMEACT Erik Hays Hays Insurance Agency Inc. PHONE (978)686-3162 AIC Ne; (976�89�425 36 Hawthorne Ave. oDDRESS: haysinsurance(a`COmcasLrtel INSURERS AFFORDING COVERAGE NAIL R Methuen Ma. 01844 INSURER A: Norfolk&Dedham Mutual Fire Insurance Company INSURED INSURER B Robert Djangevin INSURER C: 795 Dale St. INSURER D: INSURER E North Andover Ma 01845 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. INSRj AODL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM)DDJYYYY MINDDIYYYY COMMERCIAL GENERAL LIABILITY. EACH OCCURRENCE S 1,000,000• DAMAGE TO REN I 00. CLAIMS-MADE OCCUR PREMISES Ea oaurrenca 100,0 S . MED EXP An one person) $ 5,000• A R0514357A 1012512014 10125/2015 PERSONAL&ADV INJURY $ 2.000,000. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000. �I pR0- PRODUCTS-COMPIOPAGG E 2.000,000• i_ ?OLICY JECT LOC S t OTHER: COMBIacclNEOSINGLELIMIT S AUTOMOBILE LIABILITY Ea denl 1 ANY AUTO I BODILY INJURY(Per person) S ^�ALLOWNED �—SCHEDULED 'I '-BODILY INJURY(Par eccident) S 1 AUTOS AUTOS PROPERTY DAMAGE �i NON-OWNED Per accident S HIRED AUTOS I AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE S i EXCESS LIAB CLAIMS-MADE , I AGGREGATE S T I DEC RETENTION S PER OTH- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPAR•HER'EXECUTIVE E.L.EACH ACCIDENT S OFF CER'MEMBER EXCLUDED? ❑ N I A .(Mandatory In NH) EL.OLSEASE-EA EMPLOYE $ i II yes.describe undo' E.L.DISEASE-POLICY LIMIT S 1 DESCRIPTION OF OPERATIONS baOw DESCRIPTION OF OPERATIONS:LOCATIONS i VEHICLES (ACORD 161,AddMonai Remarks Schedule,may be attached if more space Is required) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. North Andover Building Department 160C Osgood St. AUTHORIZED PRESEFL7ATIVE Builcing 20 Suite 2035 North Andover Ma 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _ _aOftice of Consumer Affairs&Business Regulation + < r}OME IMPROVEMENT CONTRACTOR C= tegistration: j11990 Type: - a�= Expiration:=-__2/11/2017: LLC . ROBERT LANGEVIN BLDG&REMOLDING LLC. ROBERT LANGEVIN. - 795 DALE ST g � � N ANDOVER,MA 01845 Undersecretary 1 Massachusetts -Department or Public Safety Board of Building Regulations and Standards Construction Super icor License: CS-002685 ROBERT M LANGIVIN 795 DALE ST N ANDOVER MX 01845 Expli ration Commissioners 02/24/2016