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HomeMy WebLinkAboutBuilding Permit #648 - 29 SECOND STREET 3/12/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: `'1 Date Received Date Issued:===g-2, 'I% I IMPORTANT: Applicant must complete all items on this page LOCATION aS 6CCo C -Tv- e � �( ` Print? PROPERTY OWNER 7 I A Unit # Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes o 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial lffAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ez� rY �"� 8`,'+s�Cf .`�} f•`f £` t Septic ®Well.' r{ '` yY a .-1�'�l..eFt `.RSN+ta`��k't ��� 0 oocl lam , �® Wetland_ ,�� �, rtT .. tii:. � .�.. � Watershed "s�ri�c`tt ,��Water/Sewers*� =� -• .- t�-: a.04 DESCRIPTION OF WORK TO BE PERFORMED: 77) -s fi i�� L� s t—. -eG.> l 4 s s Please Tyre or Print Clearly) Address: 02 G1 �� (f , d 7 e C - CONTRACTOR Name: l (, �e 1 Phone: Address: J e S( S I 73 Supervisor's Construction License:- �J �33 5 Exp. Date: z L� Home Improvement License: f b Exp. Date: �/z 5 I ° 1 Z— ARCH ITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ `oZg1 0 O .ay FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have =griatureof_'Aent/©inrner Signture. ofcorit�acatcocess g ag Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑Swimming Tanning/MassageBody Art ❑ 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS ,y Reviewed on Signature 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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.$10041000 fine Doc:.Building Permit Revised 2011 June/mi 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 ❑ 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) ❑ 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 o 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 CIerks 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: Doe.Building Permit Revised 2008mi Location No. Date It TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check #—kV--D—k 25089 Building Inspector DATE(MM/DD/YY) ACORD rM CERTIFICATE OF LIABILITY INSURANCE 07/19/11 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 endorsements . PRODUCER COMPANIES AFFORDING COVERAGE COMPANY AMGUARD PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE COMBPANY ROCHESTER, NY 14620 INSURED DAVID REITANO COMPANY C DAVID REITANO BUILD & REMODEL 56 PLEASANT STREET METHUEN, MA 01844 FMD 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. 0 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ CLAIMS MADE OCCUR PERSONAL &ADV INJURY $ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ 171 OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY DAWC226669 06/11/11 06/11/12 ATU- X WC S LIMIT orH- EL EACH ACCIDENT $ 100,000.00 THE PROPRIETOR/ INCL PARTNERSIEXECUTIVE OFFICERS ARE: EXCL EL DISEASE -POLICY LIMIT $ 500,000.00 EL DISEASE - EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE r -- F cd i -t ,1 o O A a o G 0 W a C, W v O a A x w � C o z oto � cA v o cn ,1 o as c C, c ` O_ N C c O coa t� t : : •d'O Qc W R O o G- N .y� { 0 YA, �j m o Cn CD oCa LUCAa o `o as c �p c;r CD a C� o m 3CA • N V J CA cm C2� • Ls CD y m O tD w CD 0 : aV L.:m y =CD ' ti v; -CO2 Cf O 'Qv W ® � ams ' 0 0� kayo. v•�Z O c CL Fr O Co CD c •C i tD 0 O W 'm' Z C� O ::ui c +' � •N tZ� � c O oc E 05LLJ b- C3 cm •v, eon • LID too .0 !EC Q O CLOt» a m ' o _ .3 ` N = = � H 2 o..=.., 11 2 O O C O v Z CD O. O y o c O cm I O � O CD O .O CO m .a) m O CD = CL) CD L O d ca � ora .�.� O = C O O v J .0 CD ca ts C CD 0 CL C- y O C C C cc CL 0 CO)LLI LLI U) W W 19 W U) ACORD- CERTIFICATE OF LIABILITY INSURANCE ATE D12/0512011' MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Paychex Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 150 Sawgrass Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rochester, NY 14620 DABP201902 12/01/2011 INSURERS AFFORDING COVERAGE INSURED INSURERA: AmGUARD Insurance Company David Reitano dba David Reitano Remodeling and --- �— Building INSURER B: ----- -- -- 56 Pleasant Street INSURER C: Methuen, MA 01844 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. jj INSR • Tr TYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTWE POLICY EXPIRATION LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 A Ij-_--' COMMERCIAL GENERAL LIABILITY DABP201902 12/01/2011 12/01/2012 FIRE DAMAGE (Any one fire) $ 50,000 I X CLAIMS MADE a OCCUR 1 MED EXP (Any one person) $ i 5,000 PERSONAL & ADV INJURY $ Included _ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X__1 POLICY PRO. LOC—...-- JFCT -_--�_ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) _ .. 1 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS — NON -OWNED AUTOS PROPERTY DAMAGE $ (Per acddent) GARAGE LIABILITY �1 ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN . EA ACC $ T AUTO ONLY: AGG S EXCESS LIABILITY I EACH OCCURRENCE $ _ AGGREGATE $ OCCUR 1! CLAIMS MADE _ $ --- $ DEDUCTIBLE $ RETENTION $ I WORKERS COMPENSATION AND WC STATU• : 1 Ep ! OTH- iEMPLOYERS' LIABILITY .......... .. ..... _.. .. ____ ___. E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE$ I ! E.L. DISEASE - POLICY LIMIT 1 $ - OTHER I I i DESCRIPTION OF OPERAT*NSILOCATIONSNEHICLESfEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Lowe's Companies Inc. and any and all subsidiaries are named as additional insured as respects to General Liability. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL f (' IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR A-.1 ,i2 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I AGUKU 25-5 (7197) 0 ACORD CORPORATION 1988 A ILL l..V/It�1Wfi IYGCKiIs VJ lrsswuswr►►w..w.• Department of Industrial Accidents - 15-1 r Office of Investigations s ° " 600 Washington Street Boston, MA 02111 www mass goV1&a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Nan1e (Business/Organization/Individual):. Address: lq v. _ e- f et , 0 �r d- ( 4'73-. �rI"(4 Phone #: 78'-� Are you an employer? Check the appropriate box: 1. [ 9 I am a employer with -3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.I required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comm insurance required] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t 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 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: -TO 16 It c - Policy # or Self -ins. Lic. #: L'% C 2 2 �? (Q �Q Expiration Date: Job Site Address: �a �t 2 -'2 e G ` _ ►' T o " "'? City/State/Zip: 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 ofjhe DIA for inpurance coverage verification. I do hereby ceVify)rirJ#r t1(e)fain andpenalties ofperjury that the information provided above is true and correct '2- 2-"?- 2-0 / Z - Phone #: Official use only. Do not write in this area, tP be completed by city or town officiaL City or Town: ' '" ' Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Build' De artment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other II -- --F 0.41.-;--..-. G-17 07'1: a On 111,31LI !L111it .: k_A_)IN I K,," i�.,' li (..)KS 56 Pleasant Street Methuen, MA 01844 Phone/Fax: 978-688-3944 Company Email: Dave@DavidReitanoRemodel.com Proposal Date: 2/21/2012 Submitted To: Mr. Ryan Nicolosi 29 2"1 Street N.Andover Mass. 01845 Home: 978-420-7044 Work: Mobile E-mail Job location — same Job Description: Bathroom Remodel We herby submit specifications and estimates for: Bathroom Located on second floor will have existing bath -tub remove to exspsose framimg.. All debris will be removed from job site. Plumbing will be updated including drain,overflow and valve. Outside wall will be insulated if needed. New Sterling fiberglass tub multi pc. Will be install in same location.. Walls disturbed dme locations.uring construction will be repaired and prepared for paint by Owner Above total price $2900.00 c ^q *Contractor is responsible for allowances mentioned, anything that exceeds these allowances - Homeowner is responsible for. *Homeowner is responsible for paint and stain *Please review this proposal carefully for any items which may be missing. Contractor is not responsible for items not mentioned here. *Please do not hesitate to contact us if you ha an questions. Thank you for considering us for this project - I David Reitano Workmanship Completely Guaranteed/Sullivan Insurance (Please sign and return one copy) 1. L Signature: Date: 2--Z '7- z � � 2 14 Signature: Date: ,W m sac humris -oep; ex G @u b s s y Board S saw ng gaa ons an Standarcis License: CS -023365 ' 2 . � <� •� DwVIODREffAP(o m ■tEAsAW SII METHUEN KA 01844 \ c_msQmE 1210412013 / `(4 �� §� &B�� ■� |■& � �». HOME mPRov C 1 nRACTOR ] � RegWraftn 712782 Type: * P »fes/ E mom �e2Private�� o \'Ell 6DEEANOREM )DEL&.BuL David Rebm .. S Pleasant St Methuen, 01844.\2.. Undersecretary