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HomeMy WebLinkAboutBuilding Permit #1294-2016 - 35 MARIAN DRIVE 6/10/2016 _ L O1 NORTM q LF' BUILDING PERMIT Cg LED 'Y\ TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXAMINATION '� _��jj�� Permit No#• �i eU4 Date Received "�R,,r �SSHCHLIS �� Date IMPORTANT:Applicant must complete all items on this page LOCATION 3< M&f n Print PROPERTY OWNER NA—)17MN' Print. loo Year structure yes o MAP PARCEL: 3 ZONING DISTRICT: Historic District yes no ti Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building .a OTTe-family ❑Addition El Two or more family 0 Industrial t eration No. of units: [ICommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition --p-Other ©4Sept�c°° "tWell` MIA-11619,01 +Fl.00dlaraWetlan s ~ �` ❑'Water�s.iedDstnct n'WLWatrsSewer DESCRIPTION OF WORK TO BE PERFORMED: rt 9CTy RFs c�P�r "I ►+"Sr'.AA y�T' av-ri�N ► r�'1,r4-s-T��e, `Het j'►l,. V.�A->� n-,-r, � 9-Y Identification- Please Type or Print Clearly OWNER: Nam e:/y141` *J �i sO N �RI ° Phone Address: Contractor Name: J A4V'I 8',J Phone: 9- 4� 0 e ­360 _7 Email L�}N6:e-01 � AD N36:_ c�i►1,r97�.� �'"� x Address: q<_ 7A-)jE :S-L A-PDQVC- Supe.rvisor'sConstruction License: G Exp:, Date:.. . Home Improvement. License: I 130 Exp. Date: ARCHITECT/ENGINEER �� Phone: �— Re No. Address: g FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ /` z" Check No.: 1 q� Receipt No.: �©�'y NOTE: Persons contracting with unregistered actors do not have acce to the guaranty fund h 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 4, Building Permit Application 4. Workers Comp Affidavit 4, Photo Copy Of H.I.C. And/Or C.S.L. Licenses � Copy of Contract 4� Floor Plan Or Proposed Interior Work 4. 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 46 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 aCertified 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 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 J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL t Public Sewer ❑ Taming/Massage/Body Art ❑ Swianniug Pools ❑ Well ❑ Tobacco Sales 11 Food Packaging/Sales El (septic tank,etc. ❑ Pennanent Dumpster on Site ❑ i I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING DEVELOPMENT Reviewed On Signature_ i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer ConnectioniSignature& Date Driveway Permit DPW Town Engineer: Signature: FIREt p prn y "Located 384 Osgood StreetDEPoste Located at 1►24 Main Street partMe. Si.g ature/date �u: y , r' 4P4a_ r , 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 i NOTES and DATA-- For department use) i ❑ Notified for pickup Call Email Date Time Contact Name €_ Doc.Building Permit Revised 2014 i r i Location " / I'A21 Q— No. t-- }o r Date (0 !(� • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ � Other Permit Fee $ TOTAL $ Check# 3 0490 Building Inspector t` Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 11 ,500.00 m $ - $ 138.00 Plumbing Fee $ 17.25 Gas Fee 100 comm. '$ 10a,,00 Electrical Fee $ 17.25 Total fees collected $ 272.50 35 Marian Drive 1294-2016 on 6/10/16 Bath Remodel t10RTH E � Town of �� Andover O No. z h ver Mass C OC MICHe WICK y1' �as RATED U BOARD OF HEALTH Food/Kitchen P E T D Septic System THIS CERTIFIES THATRq.. ! "�.... .. . �. .. 04...... ,,, ,,,, BUILDING INSPECTOR ..... .... .... ... .................... Foundation has permission to erect buildings on ... .......................... ............ ........ �...... .. .. ....... .................................... Rough to be occupied as ............ ...... ��M[!:.`........... "��.�.........:. 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 CONSTM"X�b Rough Service . ..eSPECTOR ........ final IL ING 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. Poa ROBERT LANGEVIN ®® Building& Remodeling, LLC 795 Dale Street North Andover,MA 01845 (978)686-3607 HIC#111990 FID#26-0816298 www.LangevinBuilding.com Job Description Allison and Nathan Ray 35 Marion Drive North Andover, MA, 01845 Bathroom Remodel !. All necessary permits 2.Demo walls, floor ceiling, and fixtures 3. Move the doorway closer to the hall and install a new door 4. Rough and finish plumbing: install fiberglas tub and 3 piece wall kit, new toilet, 2 sinks with faucets, and shower valve 5. Rough and finish electrical: install new GFCI outlet, ceiling light/fan combo vented to outside, 2 vanity lights, and switching 6. R-15 insulation on outside wall 7. Blueboard and skimcoat plaster on walls and ceiling 8. Shop built 5 ft vanity with granite top (a remnant piece from Napolitano Marble and Granite), and a floor to ceiling srorage cabinet 9. Durock floor prep 10.New baseboard heat cover 11.New door and window trim and new baseboards, all to match existing 12. All cleanup and trash removal Items not included in the price quote: finish bath fixtures, electrical fixtures 1 Signed Date Signed Date (� ROBERT L 0 E`] EJ Building& Remodeling ' Homeowner Information Contractor Information Name Company Name Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 3'S ffi/W) lv DR)v€- 7175 :517- City/Town State Zip Code Business Address(must include a street address) AeR-R-) DO V Q� MA 001A NDr�jv AW.v�� 0 Daytime Phone Evening Phone City/Town State Zip Code �U3 Mailing Address(It different from above) r Business Phone Federal Employer ID or S.S.Number Home Improvement contractor Reg.Number7E*ra6o)n date Lav requires thot most home r improvement contractors have a valid registration number ' J IT®The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) 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 I Date when contractor will begin contracted work. MGL chapter 142Ae) Date when contracted work will be substantially completed. i Total Contract Price and Payment Schedule �0 The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of- Payments fPayments will be made according to the following schedule: l $�� 'ac ltm[o brtceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $. — !/ or upon completion of r-`/,�'� �� TT $_ r--yyJ��i3}}�--/ l=ernpen-eet�gletion of $�C'4fpon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractor's EINQ❑Yes(all terms of the warranty must be attached to the contractl Subcontractors-The contractor agrees to be solely responsible for compl�f the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. © Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. * Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. * Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. * Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. D®NOT SIGN THIS CONTRACT]IF THERE ARE ANYMANK SPAC ESIM Two identical copies of the contract must be completed and signed. One copy should go to Ute -owner. a other copy should be Icept by the contractor. Homeowner's Signature Con ctor's ignature U ;, lip � � ( r0/ Date Date 4N The Commonwealth of Massachusetts Department of Industrial Accidents �r i x IU 1. }l Office of Investigations • i it=A'J'e I'.. ton Street 600 Washington' ;lr•� g "MI j Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):'�C BK�l— L A r�C-F-V I O 34D6: Or Address: —7 9`!�_ D A4-f S-C— City/State/Zip: 00f,-TA Phone#: r'I 7 G res, 3 �©7 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 employees(full and/or part-time).* have hired the sub-contractors 2.1&am a sole proprietor or partner- listed on the attached sheet.t g ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.❑ 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.], employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 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 anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors arid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �� M✓��\ r �� 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 of the DIA for insurance I coverage verification. 1 do hereby c7�� pains and penalties of perjury that the information provides o e is t e and correct Signature: 6 — Date: / 6 Phone#• �/ ? c� fS 3 6 ©- 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#: A a 0 CERTIFICATE OF LIABILITY INSURANCE 24 ),;ooNYy THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER,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: H the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed if SUBROGATION IS WANED,subject to the terms and conditions of the policy,cartaln policies may require an endorsement. A statement on this certlflcate does not confer rights to the certificate holder in lieu of such andorsemerd(s). PRODUCER NAME: Edward W Hays Hays Insurance Agency Inc. PNDNE - (878)686.3162 FA (9781689-4425N ; (878J689.4435 36 Hawthorne Ave. auo . haysinsurance®Comoast.net INOURERS AFFORDINGCOVERAGE NAICM Methuen Ma 01844 VMURERA: Norfolk&Dedham Mutual Fire Insurance Company INSURED INSURPR 8 Roberto Langevin INSURERC: 795 Dale St INSURERD: 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 N AND CONDITIONS OF SUC H POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLI F POLICY EXP LIMn'S L TYPE OF INSURANCE a POLICY NUMBER Dn►YYY x COMMERCIALGENERALLIABILITY EACHOCCURRENCE CLAWS-MA E 1,000,000. El M5ES Eaoccur n S 100,000. DE 1_.l OCCUR MRO EXP(Any one AOW S 5,000. A R0514357A 10/25/2015 10/25/2016 PERSONAL&ADVINJURY s 2,000.00 0. GENERALAGORECATE S 2,000,000. GEN 1AGGREGATEUMITAPPUESPER 2,000,000. POLICY j�T f7 LOC PRODUCTS-COMP/OPAGG s O?HER: COMBINED SINGLE Un S AUTOMOBILELIABILI Y Ea 2edde ll BODILY INJURY(Por Person) S ANY AUTO ALL OWNED SCTHEEDULED BODILY INJURY(Per eamenl) S AUTOS NON-OWNED Pm aeeiC�DAMOS g HIRED AUTOS AUTOS $ UMBRELLALIAB ±JO:CCUR EACH OCCURRENCE $_ EXCESS UAB LAIMS-MADE AGGREGATE b S DEO I I RETENTIONSPER OTH. WORKERS COMPENSATION STATUTE I I CR AND EMPLOYERS'UABRJrY Y I N ANYPROPAIETORIPARTNERIEXECUTIVE Q NIA F.L.BACH ACCIDENT $ OFFICERIMBMB@REXCLUDED7 E.LOIBEA68•EAEMPLOYEE 5 IMandalory In NH) 9 YYes,deacrbe under E,L,DISEASE-'POLICY LIMIT S oESCRIPnON OF OPERATIONS bekav DESCRIPTION OF OPERATIONS i LOCATIONS I VENICLES(ACORD 101,Addleanal Remarks Schedule,may be etcechod Irmom spaco Is repulred) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE T%mEOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORM REPReseK -CM88-20114 ACORD CORPO ON. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registerad marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-002685 Construction Supervisor ROBERT M LANGEVIN 795 DALE STREET- # / NORTH ANDOVER MA 01845 Commissioner 02/24/2018 �y r�fe �t rz��z-r�aa�z�uerc�(�a�`nil�aiafir.�u�e((. Office of Consumer Affairs&Business Regulation f4OME IMPROVEMENT CONTRACTOR egistration 111990 Type: Expiration ?J11/2017- LLC f . ROBERT LANGEVIN BLOGf&REM OLDIiVG LLC. _ ROBERT LANGEVIN 795 DALE ST t N ANDOVER,MA 01845 4� � G; Undersecretary } GAS C� 3e tj _ O. �Z 7 3 i , 1 1 1 I 4 ! i I ^ 9 ` E I