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HomeMy WebLinkAboutBuilding Permit #653-2017 - 492 SALEM STREET 12/20/20161 n_�u�� BUILDING PERMIT 1iTOWN OF NORTH ANDOVER Permit No#: (.9 6 nate Issued: 1T APPLICATION FOR PLAN EXAMINATION ' JA 11 Date Received 6%V" �•CIED I6 �a^jrO` 9� 1 O o y * 1 y4 IMfT'ORTANT: Applicant must complete all items on this page LOCATION / / o� S�ee.4 ? Print PROPERTY OWNERd/� S5° Print 100 Year Structure _yes MAP PARCEL ZONING DISTRICT: Historic District s Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ,P Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other gil of ibWAI J ®I'Floodpplain� 1Ne lands I�71 W t hed D%pct ®1Natej/Sewers - �. OWNER: Name: Address: DESCRIPTION OF WORK TO BE PERFORMED: %fIs" Please Type or Print Clearly 1 Contractor Name: Phone: Email: efel&=O Address: o<a �l:��r '� .��' ��d 4_rjo6lee, , / Supervisor's Construction License: 107,21 % Exp. Date:- � p Home Improvement License:Exp. Date: ARCHITECT/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: $ c�'©" FEE: $Z 0 Check No.: �� Receipt No.: -3I :5S717i NOTE: Persons contracting with unregistered contractors do not have access to th,91guaran 1 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 OTE: 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/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 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit 4� 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 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.$10041000 fine NOTES and DATA, — (For der)artment use ® Notified for pickup Call Email Date Doc.Building Permit Revised 2014 Contact Name, No Location Date No. Check# Z2 01359 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 71980.00 m $ 95.76 Plumbing Fee $ 11.97 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 11.97 Total fees collected $ 219.70 492 Salem Street 653-2017 on 12/20/2016 replace shower in master bath Lw.l O U) 0 N CD CD CDO U) 0 O CD O CD P O Z m U) m < C 7 � O � --I -, O a N N= < <D -a Q 0 O Q n 3 � Z O N. CD rt o, O 3 C. 0 m =cAn o 0 c NCD cD 2 U3 CL 0 O n O W CCD CD CD �. 0O 3 f CD o=N cCD o, a - .=r - �q CDN C: U) = 0 3 Q O A) O CCD N Q o y n ju CL r � N � f 9 t• *** n CD .•r x CD CD 2) ow 03o CL_ rA Ln nMo� WT :v T N Z7 Z T ,17 T X 3 C/) c n O O O' (D O j O �' S O O Z fD D fD O p1 cn p1 C p1 C ' p1 ' C Z 'd O C) z UQ 3 m = t O• tD 'O'�' ( < C 7 � O � --I -, O a N N= < <D -a Q 0 O Q n 3 � Z O N. CD rt o, O 3 C. 0 m =cAn o 0 c NCD cD 2 U3 CL 0 O n O W CCD CD CD �. 0O 3 f CD o=N cCD o, a - .=r - �q CDN C: U) = 0 3 Q O A) O CCD N Q o y n ju CL r � N � f 9 t• *** n CD .•r x CD CD 2) ow 03o CL_ rA Ln N WT :v T N Z7 T ,17 T 3 - c O O O' (D O j O �' S O O fD O fD O p1 . c p1 C p1 C p1 C C 'd O UQ 3 = t CL tD 'O'�' ( n 3 Q n Z O O v N O O G ? m O W O D Z G G V Z y r O (A N H = m O m m n 0 0 0 x too * qia'a eowAma�an PROPOSAL Rev 1 Don Foss 492 Salem Street North Andover, MA 01845 (C)978-683-7300 (H) 978-682-3088 dbfraf@gmail.com October, 16, 2016 Install new custom shower in master bath. Acquire building permit. Remove existing shower. Cut out floor tile and build curb for shower. Frame for shower seat. Install granite for seat. Install new rough plumbing and copper pan. Fixtures from Peabody Supply on Quote # SO] 8371178 included. Instill tile board on walls. Install granite curb. All tile, motar, grout included. Tile floor and two shower walls. Install two niches. Grout walls and floor. Finish for plumbing. Disposal of debris. TOTAL LABOR AND MATERIALS $ 7,980.00 Note: This quote does not include glass enclosure. Terms: $ 2,660.00 upon signing of contract (not to exceed 1/3 of contract price) $ 5,320.00 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 satisfactory and are hereby accepted. You are authorized to do the work as . Payments will be made as o ined above. Date b I//6 Homeowner Signature Date % /eContractor 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 Regula' n the consumer all be required to7as provided i sachusetts General Laws, Ch r 1 A. Homeowner's Signature Contractor's eiegnature 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 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: c'slo 7 AZ,;oI.s 17,4 j'' Ir! City/State/Zip:/Uc, A4 ,019K Phone #: S"O Are you an employer? Check the appropriate box: 1. Q I am a employer -with ,employees (full and/or part-time).` 2.2r I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. Q I am a general contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.; 5.E] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' Como. insurance reauired.l 211 Type of project (required): 6. New construction 7.. eRemodeling 8. (❑ Demolition 9. ❑ Building addition 10.Q Electrical repairs or additions 1 LQ Plumbing repairs or additions 12.Q Roofrepairs 13.0 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. lContractors 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 thepolicy and job site information Insurance Company Policy # or Self -ins. Lic. #: lyQeo 0%i �'�-/ � � �� Expiration Date: Jk.1.117— JobSiteAddress: ��%� �,Si (_ ( City/State/Zip: /-% �%,, o ily,,-t4 0,4 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 DTA for insurance coverage verification. I do herebycertify u derp '�apenaliies ofperjury that the information provided abZ-1 . true and correct S e• f-- Date: /,-.;z . Phone #:X Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense # 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 #: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 11 V' ate. 600 Washington Street Boston, MA 021.11 -www.n=S gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: c'slo 7 AZ,;oI.s 17,4 j'' Ir! City/State/Zip:/Uc, A4 ,019K Phone #: S"O Are you an employer? Check the appropriate box: 1. Q I am a employer -with ,employees (full and/or part-time).` 2.2r I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. Q I am a general contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.; 5.E] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' Como. insurance reauired.l 211 Type of project (required): 6. New construction 7.. eRemodeling 8. (❑ Demolition 9. ❑ Building addition 10.Q Electrical repairs or additions 1 LQ Plumbing repairs or additions 12.Q Roofrepairs 13.0 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. lContractors 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 thepolicy and job site information Insurance Company Policy # or Self -ins. Lic. #: lyQeo 0%i �'�-/ � � �� Expiration Date: Jk.1.117— JobSiteAddress: ��%� �,Si (_ ( City/State/Zip: /-% �%,, o ily,,-t4 0,4 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 DTA for insurance coverage verification. I do herebycertify u derp '�apenaliies ofperjury that the information provided abZ-1 . true and correct S e• f-- Date: /,-.;z . Phone #:X Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense # 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 #: OP ID: GOGL '4� �' CERTIFICATE OF LIABILITY INSURANCE DATE /DD016 09/15/2016 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(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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Macdonald & Pangione Insurance Phone: 978-688-6921 104 Main Street Fax: 978.688-5350 North Andover, MA 01845E Michael Pangione CONTACT NAME; Kim Land PHONE .978-688-6921 AI No): 978-688-5350 -MAIL ADDRESS: KIM@mpins.net PRODUCER CUSTOMER 10**,CHRIS-5 INSURERS AFFORDING COVERAGE NAIC r# INSURED Christopher 207 Winter Stt.. North Andover, MA 01845 INSURER A: Preferred Mutual Ins CO 15024 INSURER B : .INSURER C : INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATF NIIMRFR- Qcvtclnkl nuleeQro. 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 TYPE OF INSURANCE DL UB POLICY NUMBER MMS Y EFF MWpD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR BOP 0100719749 09/2612016 09/26/2017pREMISEs Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO X LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ HIRED AUTOS $ NON -OWNED AUTOS $ UMBRELLA UAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A WC STATU- OTH- TO Y LIM TS R E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ E°E$C IPTION OF PE ATIONS /LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) vl�ence o� insurance Town of North Andover 1600 Osgood St No Andover, MA 01845 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -072173 Construction Supervisor CHRISTOPHER F RIVET t 207 WINTER ST -- N ANDOVER MA 01845 ` -Jzu^ C'A'— Expiration: Commissioner 06102/2018 — Office of Consumer Affairs & BusinessRegulation HOME IMPROVEMENT CONTRACTOR 6101 ' Registration: " 139962 Type: Expiration.- .9/8/2017 Individual CHRISTOPHER F. RIVET' CHRISTOPHER RIVET 207 WINTER ST. N. ANDOVER, MA 01845 - Undersecretary r-