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HomeMy WebLinkAboutBuilding Permit #615-15 - 60 MOODY STREET 1/20/2015BUILDING PERMIT TOWN OF NORTH ANDOVER o ✓�j APPLICATION FOR PLAN EXAMINATION Permit No#: 1� l Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION // y J ._ Print PROPERTY OWNERXooz,-z Print 100 Year Structure yes MAP.D. . i PARCEL:. ZONING DISTRICT: Historic District yes `Machine Shop Village yes �.. ,6t -.moo o p * ` h \7,a QDRATED I1Pai'��/ n n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: El ❑ Other -Demolition ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: y- Please Type or Print Clearly OWNER: Name: Address: Q /��°+� Contractor Nameti//X/-5- 00 /1Phone: Address: l Supervisor's Construction License: 0 -ZA-17 _Exp. Date: Home Improvement License: /�c�� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE., BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ r� `� FEE: $ '240 Check No.: `I �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty find re of Agent/Owner Signature of 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 - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION COMMENTS ~ HEALTH .Q COMMENTS Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition N y Planning Board Decision: Conservation Decision:_ Comments Com Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: uocatea :5t54 us ooa 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NU I tJ ana UA I A — wor department use ❑ Notified for pickup Call Emai Date Time Contact Name Doc.Building Permit Revised 2014 M. 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 a 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/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 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 o 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 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 Location too No. Date Check # J 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 Calculation Construction Cost 20,000.00 m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 60 Moody Street 615-15 on 1/20/15 Finish 2 Rooms in Basement for Storage O O z 0 CD N O O co 0o CD to c N O E N U) CD 00-9_ O C a y N c v (D n CD 0 m v m C =r= � N —I N O N ,�,�, rD TI O O .•a. 0 m -" v'a) ,� cn WN0 CD co = O N O CD " O cv CL N o W � .� s �� CD -0 N• ^" 0,_ �, o O " . Cr -&rte D C N 9 Q' = 0 a S. rL 0:9 O CL < N O ��)�� a 4 CDN r-0 CD N rt su� A O 7 0 O to : 0 =r CD N CD U)C ND -C ON 0 v_ CD tjvk 030 03 o 0 V7 N W T ;o T N 7p T .Z7 T A x T N T 0 Co C � S N j DJ C N C NL L c N 0 C C N O ((D 3 n z y N C CID 010 ;z z '0 S 7 S Q ay ;v - .o L cn n —� O �_ �'' O M O x rr O ui Y vn CD cp CD o mm m CL Z3 CCn S T CD r W CD O C m C C CD y. e� Q5. CD O N O b (M CD Cl) v v NCD o W m z �' z z O ;a z c� v CD V V y z y cn < 0 CD O o O O z 0 CD N O O co 0o CD to c N O E N U) CD 00-9_ O C a y N c v (D n CD 0 m v m C =r= � N —I N O N ,�,�, rD TI O O .•a. 0 m -" v'a) ,� cn WN0 CD co = O N O CD " O cv CL N o W � .� s �� CD -0 N• ^" 0,_ �, o O " . Cr -&rte D C N 9 Q' = 0 a S. rL 0:9 O CL < N O ��)�� a 4 CDN r-0 CD N rt su� A O 7 0 O to : 0 =r CD N CD U)C ND -C ON 0 v_ CD tjvk 030 03 o 0 V7 N W T ;o T N 7p T .Z7 T A x T N T 0 Co (D S N j DJ C N C NL L c N C C 'O O ((D 3 \ N — n S S 7 S Q n z N CD (D O rr O M A Y mm S T r W (D 7 m C C O y v v W m z n z z v V V y C) cn (— O A N N H m y m O m m m z 0 0 0 _ O g e 1fff Massachusetts - Department of Public Safety 4 Board of Building Regulations and Standards Construction Supen-isor License: CS-072173 CHRISTOPHER F-RIVET 207 WINTER ST N ANDOVER Mfi 01845 'F Expiration Commissioner 06/02/2016 Office of Consumer Affairs & Business iteboieition ME IMPROVEMENT CONTRACTOR egistration: 139962 Type: Expiration: 91W015 Individual CHRISTOPHER F. RIVET CHRISTOPHER RIVET 207 WINTER ST. N. ANDOVER, MA 01845 Undersecretan OP ID: SHHE A�CERTIFICATE OF LIABILITY INSURANCE DATER"' 09/30D/YYYY) 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). PRODUCER Phone: 978-688-6921 Macdonald &Pangione Insurance Fax: 978-688-5350 P.O. Box 428 104 Main Street North Andover, MA 01845 Michael Pangione CONTACT NAME: PHONE FAX (A/C. No. Ext): EMAIL ADDRESS: PRODUCER CHRIS -5 CUSTOMER ID #: _ INSURER(S) AFFORDING COVERAGE NAIC # 09/26/13 INSURED Christopher Rivet 207 Winter St. INSURER A: Preferred Mutual Ins Co 115024 DAMAGE T RENTED ! PREMISES Ea occurrence + S 100,000 North Andover, MA 01845 INSURER B: �GENERALAGGREGATE (S 2,000,000 PRODUCTS - COMPIOP AGG S 2,000,000 INSURER C : i INSURER D: 1 AUTOMOBILE _ L ' INSURER E: i ! INSURER F: I I I 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. INSR LTR I TYPE OF INSURANCE IADDL SU D POLICY NUMBER PO MMUCY EFF IDD/YYYY POLICY EXP I MM/DD/YYYY ' LIMITS I GENERAL LIABILITY A I X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY { PRO- I` LOCis i 1 I ` i iCPP 0180 57 01 05 09/26/13 091261 % 1 EACH OCCURRENCE I S 1,000,000 DAMAGE T RENTED ! PREMISES Ea occurrence + S 100,000 j MED EXP (Any one person) j S 5,000 PERSONAL & ADV INJURY 1 S 1,000,000 �GENERALAGGREGATE (S 2,000,000 PRODUCTS - COMPIOP AGG S 2,000,000 i AUTOMOBILE _ L ' LIABILITY ANY AUTO I ALL OWNED AUTOS SCHEDULED AUTOS 1 HIREDAUTOS NON -OWNED AUTOS i ! I ' i I I I f I ( i I COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) S BODILY INJURY (Per accident) I S PROPERTY DAMAGE (Per accident) S I S i_ 1S I _ UMBRELLA UASOCCUR � I EXCESS UAB1 I CLAIMS -MADE, I 1 ; i I 1 I I I I j EACH OCCURRENCE I S i-- AGGREGATE 1 S __ DEDUCTIBLE RETENTION S j I $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 1I , j i I WC STATU- I TORY ATIT I ER E.L. EACH ACCIDENT I S E.L. DISEASE - EA EMPLOYEEI S E.L. DISEASE -POLICY LIMIT I S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 REPRESI Michael Pangio ©1988-2009 ACORD CORPORATION_ All rinhtc rPsanrurl At,umu Za (LUUUIUa) The ACORD name and logo are registered marks of ACORD The Comnionivealth ofMassachusetts Department of Industrial Accidents Office of Investigations UT 600 Washington Street Boston,lVIA 02111 zpipip.nzass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information please ]Print Leeibl Name (Business/Organization/Individual):�-J" 64/'1 Address: 0 -;7 X. City/State/Zip:,/U—,, .i -i f % %f r ; k' y Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 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 t ship and have no employees These sub -contractors have working for mein any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3 . ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box K 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.. am an employer that is providingivorkers' compensation insurance forYuji employees. Below is thepolicy azzd job site aformation. assurance Company Name:.�,�!!Fi�c`�ffi/'`i% 'olicy A or Self -ins. Lic.t%G ^'/" <i l L% i Expiration Date: ob Site Address: J ���y City/State/Zip: kt tach a copy of the workers' compensation policy declaration page (sho Mng 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 irne 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 f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certI J�a der I pains and p aloes of perjzzry that the information provided above is trt and correct. denature: : /�' U Date: %/ �' Q/ / hone Official use only. Do not write iiz this area, to be completed by city or town official. Cit}, or Town: Permit/License r Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone =: PROPOSAL Dave Gove 60 Moody Street North Andover, MA 01845 (C)978-973-7103 (H) 978-794-0705 davidgove@comcast.net January 20, 2015 Finish off two rooms in basement for storage rooms. Finish room for washer & dryer. Re -locate heating piping. Re -wire for new lighting. TOTAL PROJECT COST $ 20,000.00 Terms: $ 6000.00 upon signing of contract (not to exceed 1/3 of contract price) $ 14,000.00 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 satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will made as outlined above. Date 2Z (Homeowner Signature Date's �� 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 shallbe required to s mit to such arbitration as provided in Massachusetts General Laws, Chapter 142A. Homeowner's Signature lo<ntractorl'sSignature 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