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HomeMy WebLinkAboutBuilding Permit #594-12 - 60 MOODY STREET 2/8/2012 NORTH BUILDING PERMIT o* t,�o ,bgtio TOWN OF NORTH ANDOVER cr - °Z., APPLICATION FOR PLAN EXAMINATION Permit NO: 7 r/ Date Received A�"Arap I•PP�.�S n SSACHUS� Date Issued: �X �2 IMPORTANT: Applicant must complete all items on this page LOCATION, fKrmt /� Print PROPERTY OWNER A!!2&-'14 4 j"D U Print. MAP 210 r PARCEL: /O ZONING DISTRICT:_I-1 storic"District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial " eratio No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: Identificatii Please Type or Print Clearly) OWNER: Name:_ r' Phone: Address: 4),M • ;2- -75-/. I�O.. �/►/Dov�r ///,1 CONTRACTOR Nam-e; M/.5 G' Phone. Address:,, Ii. 77a .:5-1 Su:perAsor's Construction,License: , c f Exp. Date: ' Home Improvement License; / �, tSv Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� . DD FEE: $ a 00 Check No.: Receipt No.: o�,�d/ 7 NOTE: Persons contracting with unregistered contractors do not have access to thr gjdarantyfund Signature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT 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 =_C.Qnservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - TempDempster on.site. yes no :Located 91:124 Main-Street :Fire Department.esignature/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 for pickup - Date Doc.Building Permit Revised 2010 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a 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 o Copy Of Contract o 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 a 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 ❑ 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 2008 Location 4�a 1,4� S�� No - " 2 Date 2- • ' TOWN OF NORTH ANDOVER • vv'v VD Irfq ` � e • -� Certificate of Occupancy $ g Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# /�dj ' 25017 Build ng/lnspector NORTH TO" Of _ Andover . . No. ��'/-P }, o W '� dover, Mass. Z� / '2-- LAKE ' ' COC'Hill HEWICK V �oRATE D P'p -`� �l BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT................��. Cif.. .. .... !' ................................................................................................... Foundation has permission to erect........................................ buildings on ... .©... �aC?. -'.. ................................... Rough to be occupied as Chimney �ld f /fl'd� j hi ney provided that the person accepting this permit shall in every4ect conform to the terms of the application on file in Final 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 CONSTRUCTIO ARTS ' Rough .�"----9 .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. i i ;Massachusetts-)epartment of Puhlic Saftty Board'of Building Re,uiatiti'iiti and Sb dut�iis Foristructiort•Supervisor License ' ` License:_ CS 72173 Rest;icted to: 00 4 CHRISTOPHER F RIVET 207 WINTER ST N ANDOVER,'MA 01845 Expiration '6!212012 C'nnnuis�ioncr Tr#: 27092 4 Office of Consumer Affairs&B-sines�atiou. } . HOME-04PROVEMENTCONTRACTOR Registration_ -139962 Type= Ft xpiration: -9!8!2013 Individual TOPHER', RIVETx CIiRISTOPHER RIVET', 20 WINTER ST NANNDOVER,MA 01845,,-k-.,!-" Undersecretary i aa4-'6 i Family Room Proposal Dave Gove 60 Moody Street North Andover,MA 01845 (C)978-973-7103 (H)978-794-0705 davidgove@comcast.net February 3,2012 Work completed includes: • Building Permit $ 300.00 • Hang blueboard and plaster. $2,000.00 • Install new baseboard heat $2,000.00 • New 3 '/i casing,New 4'/4 sq.base w/ 1 1/8 cap. $ 1,450.00 • Electrical(All new wiring,lighting and switching) $3,800.00 • Install new 2 '/4 red oak flooring. Sand and finish. $3,300.00 • Install 90 ft.of 3 5/8 crown moulding. $ 1,100.00 • Install new Smooth Star Fiberglass 6 panel Ext.Door. $ 880.00 • Bump out front wall. $5,000.00 Total Labor and Materials $19,830.00 Terms: $6,600.00 upon signing of contract(not to exceed 1/3 of total contract rice) $6,600.00 due after plaster complete Work to begin on 71/A $6,630.00 when job complete Job to be completed on o? ,'.L Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (II)978-704-1165 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.Payments will be made as outlined above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES! Date ` 1 Homeowners Signature Date Contractors Signature a4i i Ci • ecwlwa•� i Family Room Proposal Dave Gove 60 Moody Street North Andover,MA 01845 (C)978-973-7103 (H)978-794-0705 davidgove@comcast.net February 3,2012 Work completed includes: • Building Permit $ 300.00 • Hang blueboard and plaster. $2,000.00 • Install new baseboard heat $2,000.00 • New 3 '/2 casing,New 4 '/a sq.base w/ 1 1/8 cap. $ 1,450.00 • Electrical(All new wiring,lighting and switching) $3,800.00 • Install new 2 '/<red oak flooring.Sand and finish. $3,300.00 • Install 90 ft.of 3 5/8 crown moulding. $ 1,100.00 • Install new Smooth Star Fiberglass 6 panel Ext.Door. $ 880.00 • Bump out front wall. $5,000.00 Total Labor and Materials $19,830.00 Terms: $6,600.00 upon signing of contract(not to exceed 1/3 of total contr,act]price) $6,600.00 due after plaster complete Work to begin on /A, $6,630.00 when job complete Job to be completed on P / Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-704-1165 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.Payments will be made as outlined above. DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPACES! i Date W,— Homeowner s Signature i Date Contractors Signature I I The Commonwealth of Massachusevs Department of Industrial_accidents Office of rnpesligations ..600 Washington Street Boston, M4 02111 Workers' Compensation Insurance Affidavit: Builders/Contra ADDI1cant Information ctors/Electricians/Plumbers PIease Print Legibly Name(Business/Organiza6on/Individual):� l,L� U� Address: " €� �✓ Z`�i�� City/State/Zip:��e, Phone#: �:ro Are You an employer?Check the appropriate box: 1.❑ I am a employer with 4. 71 am a general contractor and I T ype of project(required): ,�employxs(full an part-time).* have hired the sub-contractors ❑New construction 2 �j I am a sole proprietor or partner_ listed on the ached sheet t 7. ❑'Remodeling ship and have no employees These sub-contractors have working for me in any capacitf. workers comp. ' 8• ❑Demolition [No workers' comp.insurance, 5. � P insurance. 9. Building ❑ We area corporation and its ❑ addition 3.❑ required.] officers have exercised their 10❑Electrical r I am a homeowner doing all work right of e �tiOIl x repairs or additions myself [No workers'comp. P MGL P c .11-0 Plumbing repairs or additions insura., ce required.] employees. [No workers,t . 10-�§1(4),and we have no 12. Roof repairs to P Y `-W,,,,nlic;.ut thr-cchecLs comp.insurance required.] 13.7 Other t box=1 mus!asi,ii cut fhe secem bei ow domeowners who submit this affidavit indicating,they az.acing ai.:vartti and.�..x work—',comp--w—d= Sx:c_;;��„•' �.--.,.; ' mm hire outside eonaacto o tfiast�gu y 'Contractors that chwk this box must attached an addition al shr_t showing submit a new affidavit indicating such. the same of the sub-contractats and their workcets'co I am an employer that is providing workers'compensation insures information. ante for my employees. Below is thePoficy and job sit.- Insurance iteInsurance Company Name: , Policy#or Self-ins.Lic. s Expiration Date: o� / - Job Site Address: 101 City/State/ z ,o, WAIn Attach a copy of the workers'compensation policy declaration aQe(showing Failure to secure coverage as required under Section,? of MGL cp 152 can le d t policy number and exprration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form oimposition STOP WORKRK ORDER and a a of up to$250.00 a day against the violator. Be advised that a co criminal Penalties of a fine Investigations of the DIA for insurance coverage verification. PY of statement may be forwarded to the Office of I do hereby certify e P P enalties of perjury thQt the information primed above ir e and correct Si�ature: � Date:-. Phone#: �ffzcial use only. Do not write in this area, to be completed ,c , bJ � or town official City or Town: Issuing PermitUcense#/Authority{circle one): i L Board of Healtb 2.Building Department 3. City/Town Clerk 4,Electrical Inspector 5,Plumbing 6. Other b Inspector Contact Per-son: Prone T; AC RORo V CERTIFICATE OF LIABILITY INSURANCE OP ID NEMA DATE 02/07/12 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 NAME: Macdonald & Pangione Insurance PHONE FA P.O. BOX 428 (AIC,No,Ext): (A/C,No): 104 Main Street ADDRESS: North Andover MA 01845 PRODDU tK CUSTER10#: CHRIS-5 Phone:978-688-6921 Fax:978-688-5350 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Preferred Mutual Ins Co 15024 Christopher Rivet INSURER B: 207 Winter St. North Andover MA 01845 INSURER C: INSURER D: INSURER E: 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. LTR If LICYI:XP TYPE OF INSURANCE 1 DDIJ WVD POLICY NUMBER Su R I(MM/DD/YYYY)POLIGIFEFF (MM/OD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP 0180 57 01 05 09/26/11 09/26/12 PREMISES((EEaa occurrence)nce) $100r000 CLAIMS-MADE "1 OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2 r 000 r 000 X �POLICY n JECT PRO- I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) I$ SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIABI OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC TATU- AND EMPLOYERS'LIABILITY Y/N ( TORY LIMITS ( ER-1 ANY PROPRIETORIPARTNERIEXECUTIV OFFICER/MEMBER EXCLUDED? E[:] /A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below 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. Town of North Andover AUTHORIZED REPRESENTATIVE Osgood St No Andover MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD