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HomeMy WebLinkAboutBuilding Permit #333-12 - 67 FOSTER STREET 10/17/2011 I i BUILDING PERMIT ofr10RTF/11 TOWN OF NORTH ANDOVER o m APPLICATION FOR PLAN EXAMINATION Permit NO: �' Z�. Date Received � q,TEo gSSACHU`+�� Date Issued: ZO IMP TANT: Applicant'must complete all items on this page 16 4 k TIGIS .v.rl—r,� ta'".' t T' - `'°'�s' ':. a�` 'S 3a �,t- e'',`^•,dT,.t�r'" G a�. T �. a- �, t� s,,,ry PROPERTY OW�NE#2 � � ` �� :�.;� �.`"� /IAP 2�1�� PA GEL ZONl 1G DIST CT � OT1CW1str1C1� °per..-+,1 Y'+fi.; hF :� whine Sho illa eso . 9�_a, .. �� . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family.,,/Addition Two or more family Industrial Alteration No. of units: Commercial j Repair, replacement Assessory Bldg Others: i Demolition Other '� a-s. u P =ts �; � �x", w #.- t �„�„ v v -�,�^" rs` 3 �-�' sSeptic = Weil e * Nil floodplain V1�etlanis y�Eatershe�I'Distrct , Y nM' , esq�x- - '+�: .,-�t'3. WesterISeaNer `m�:n�:. , �." yv' .L.,tea k. z._ e. .Ns;' r< 'F .,.. :"' 7 DESCRIPTION OF WORK TO BE PREFORMED: 17,1 Identification ease Type or Print Clearly) �SO OWNER: Name: �� 16z,119-7- Phone: Address: c�q�§'sy.F � t § - 5„c""w.0 "'r, " -, ix C�T�I 'RAGft 1Varne ' ° Plo� r✓ ,' � SOT' x^-§ .:+ thMrb h ....s.3. j � +�r,as ' "r^k n._ 7 x ti. ^�, Address Yra nx - wry _..# �vt xia �.' ''C� ,. uper�vsorsConstruct�on Licerse .� Expate ° xw���t,.'�' t- ,�..�,n F,t "gam -c a•,�6',7 k's+c" >x3..� �' -s.�-, r ''�'z�ar a �..� .. � 9 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: $ . 3'�g 01900 , 00 FEE: $ Check No.: / y Receipt No.: y �' NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty.f d Signature of' t/Owner = Signature of contractor .r - Location /r . S4. -r r' No ? Date-29 4 MORT� TOWN OF NORTH ANDOVER f ,h O t h 9 Certificate of Occupancy $ 'ss�cMust`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 't Check # Building Inspector 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 i COMMENTS � I i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street '�s .';; t y* ,' �.�y`s 'k - t .F - :Locatec��et'�24 MamS#reet � � � � � � ���� � �� � �Y� � � �� � , ;Etre Depairtmeh.usignatu I w COMMENT`S - - _ 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 El Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li 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/Crossectlon/Elevation Plan Of Proposed Work With Sprinkler Plan And I 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 Pian ❑ 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 I Doc:Building Permit Revised 2008 WORTH TO" of 0 ..........111111" .. ' o o , dover, Mass., 10 * 1`4 LAKE � b! COCMICHEWICK TED `s U BOARD OF HEALTH PERM . IT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT............. 4C .. ............:...............`..V ................................................................................... Foundation has permission to erect.... .................... buildings on ..........�. ......... j .....�''�.................. Rough to be occupied as . k _ ......................................... Chimney provided that the person accepting this permit shall in every respect 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 NI01eT -IS ELECTRICAL INSPECTOR UNLESS COg ad SUOTS Rough ; . ...................... ........ ... ........... 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 SLIDE Smoke Det. too # 0 1 PROPOSAL#2 Matt& Pam Rivet 67 Foster Street North Andover, MA 01845 (H) 978-258-2580 October 16, 2011 Master Bathroom Completion. Work to be completed includes: Completion of interior of 16 ft. x 18 ft. addition. First floor to be family room. Second floor to be master bath. i I i I TOTAL LABOR AND MATERIAL $30,000.00 i I Terms: $10,000.00 upon signing of contract(not to exceed 113 of total contract price) $10,000.00 due after plastering Work to begin on $10,000.00 when job complete Job to be completed on Submitted by: Chris Rivet MA Lic#CS072173 RIC#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! Date /v J ( Homeowner s Signature CA, Date Contractors Signature i 100 ♦ 'JI♦ "et CmAwa♦ PROPOSAL#2 Matt&Pam Rivet 67 Foster Street North Andover,MA 01845 (H)978-258-2580 i October 16, 2011 Master Bathroom Completion. Work to be completed includes: Completion of interior of 16 ft.x 18 ft. addition. First floor to be family room. Second floor to be master bath. i i T'OT'AL LABOR AND MATERIAL $30,000.00 Terms: $10,000.00 upon signing of contract(not to exceed 113 of total contract price) $10,000.00 due after plastering Work to begin on $10,000.00 when job complete ,lob to be completed on I 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! Date /[% / Homeowner s Signature Date Contractors Signature �® CERTIFICATE OF LIABILITY INSURANCE OP ID NEMA DATE(MM/DD/YYYY) 05/18/11 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 endorsement(s). PRODUCER Macdonald & Pangione Insurance NAMEPHON: FAX P.O. Box 428 ac,No Ext: (A/C,No): 104 Main Street ADDRESS: North Andover MA 01845 CUSTOMERID#: 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 iNSURERC: INSURER 0: 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 CONTRACTOR 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 TYPE OF INSURANCE INSR WVD POLICY NUMBER (MOLIC YYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1'0001000 1r r 00O 00_0 A X COMMERCIAL GENERAL LIA8ILITYCPP 0170 57 01 05 09/26/f f 09/26/1jt PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 j GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 X POLICY PRO LOC $ JECT j AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION )TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUT OFFICER/MEMBEREXCLUDED? /A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION I 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 /A No Andover MA 01845 �i / ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department-of Zradusti-ial AccUents Office o•f 1"nvesligations. 600 Washing Street Boston, AlA 02111 s&gov/din Workers' Compensation Insurance Affidavirt ADDlieant Information : Builders/Contractors/E lectricians/Plumhers PIease Print Leanbly Name(Bus,,=s oTanization/fndividual): Address: , U City/State/Zip:�1� Phone Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): . 2.Eemployees(fiill and/or part-time).* have hn d the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on tbLe shed she„Qt l 7. 2`Remodehug ship and have no employees These sub-contractors have worki8• E]Demolition ng for me.in any capacity. workers' comp•insurance. [No workers'comp.insurance, 5. ❑ We are a corporation is 9. ❑Building addition 3.❑ reed-] officers have exercised their 10•❑IIectrical .I am a homeowner doing all work right ��or additions m sel£ �of exemption Per MGL .1 l.[3 Plumbing Y [No workers'comp. c. 152,§1(4),and we have no repairs or additions ins►i-ance required.]t employers. [No workers' 12•❑Roof repairs " �omP•wrequired] 13.❑OtherInh �bo =! must aaw the e Homeowners who submit oris affidavit indicating w0&=' m,�;..-n fey ere dam€41work ani hire onmide eo�..ctar z(iasf, ... .�. ^tt +Coatmctnrs that cb�this bax meat alnwhed an additional sheet show* submit a new affidavit i:mdi Eng such. the name of tfie sub-cGnb�s and their workers' COIIjP•Po�Y information. am an employer that is providing workers'co�npensauon irrsya.�e for my mfor�on. employee& Below is the policy and,job site Insurance Company Name: �I L Policy#or Self-ins.Lic.#-_L g ff � 10/70 7 / n •s Expiration Date: Job Site Address; d Policy Attach a copy of the workers'�mpensatioa d P c3' aratian.Patine City/State/Zip: /Jot Failure to s (showing the policy number and expiration date).secure coverage as required under Section 25A of MGL c. 152 fine up to$I,500.00 and/or one-year imprisonment,as well as civil can lead to the imposition of criminal penalties a the form of a STOP WORK ORDER penalties�a�e of up to$250.00 a day against the violator. Be advised that a copy of�statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification I do herelry cerhff� P Pers o fPellw7'th¢P the informadon J"W ided above is true and correct Simiature: Phone#: Date-_- _/�_ __ �© � �" � --- rContact al use onlu Do not write in this area, to be completed bj,C47 or town o fftcial r Town: PermitUrense# Authority(circle one): rd of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector3.Plunibina er Insnector Person: Phone n Massachusetts-fiJepai tinerrt of Public �.11°CtN 4 t3tiard ofsRuiidri�.Rc��uia'tioii�.triiar���"rc15{ onsfruciion-SuLicen's'e""' ,`' } pervtsor Lic�rtse License:_ CS 72173 Rest;icted to: 00 CHRISTOPHER F RIVET `'t f 10 207 WINTER ST a N ANDOVER, MA 01845 ° F p Expiration: 6/212012, ('onun�siancr Tr#: 27092 Officeof Consum Affa Bdsiness egulation HOME IMPROVEMENT CONTRACTOR Registration:;x,139962 Type: Expiration: 48(2013 Individual RCTO -RIV-EPHER FT r { CHRISTOPHER RIVET, _ �t 207 WINTER ST. - � - N.ANDOVER,MA 01845.E Undersecretary