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HomeMy WebLinkAboutBuilding Permit #492-13 - 71 PADDOCK LANE 1/2/2013Permit NO: 'M//— Date M/, Date Iss BUILDING PERMIT TOWN OF NORTH ANDOVER o? '.•, °�, APPLICATION FOR PLAN EXAMINATION ^O bb A w 7' Date Received 7a4�0AAro 4� 1;11 IMPORTANT: Applicant must complete all items on this LOCATION Oel ! . dlV�r Print PROPERTY OWNER JO/ A/ iT( � 1<-/y Print MAP NO: APARCEL: ZONING DISTRICT: Historic District yes Machine Shoo Village ves nn TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Iteratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) q OWNER: Name: -J0/gw Phone: Address: %/ /12,0 ate' ��1�✓� CONTRACTOR Name:_ �_ l lS ,A& �/7 /, /, 6KT' Phone: Address: v927 4lxltiT le 5-/ - /J10, Supervisor's Construction License: O?02/ %'-? Exp. Date: Home Improvement License: a Date: '71 KXI. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATEDBASED ON $125.00 PER S.F. Total Project Cost: $ -7 1,4? -5 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaran fund 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 COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: IV Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS yes, t_ocatea %4 usgooa Street no 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 2008 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 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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li 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 ❑ 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 Li 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location Z No. Date / Check #&6 Z TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $Yk Foundation Permit Fee $ Other Permit Fee $ '+ TOTAL $ d 26063 Building Inspector m m m m y m CO) m v C � Cl) 0 10 p CD n Z y rmloh CD o a - `0 -v o 0 vCD CDo CL. cr CD CD o CD CL o N• cam- C � � v 0 0 o o CD O CD r2 0 Z m cn 0 V/ C m X in z (7) cn Oh 5 CD N O 7 O� O 0.W cm CD 0 N 0 U) vsCD 3 0 '� w 5 _ y = < CSD y N 4 CD, C O C 0 CL m O S-ra- y N1 � '17 Q 0 STI W CCD) cN � y . O --qCD CD 2 � N O y O O ,r S CD S y O � O < to O y -CD CD o 0h �c CD y to S = o Q Q v, < CD O CD y <D C � Q 00 �C W COD r y � o �o c� o� O =r =r c 0 y o h a CD CD -0 @� � _rt G1 O CL , K 3 y 0 O (D rD NW - N - C ( T A O c =P T v N (D ;)a O v=o =T T :3O 0) � OCa S -n 5 � .� S 7 ;;oT O S O _ d p' N (D 'O n T O O CL n mD D rn -zi (A (A n 70 a n r LA M 0 W (A m 0 z M m m p 3 O O = W PROPOSAL John & Patti Fouhy 71 Paddock Lane North Andover, MA 01845 (C)978-973-0610 (H) 978-687-9937 fouhy@comcast.net December 28, 2012 Bathroom Remodel Work to be completed includes: • Acquire building permit • Demo of existing floor. Removal of existing toilet, tub and vanity. • Complete all plumbing required. (additional costs to move piping to allow for recessed med. Cab) • Complete all electrical, new switches and plugs.(need to discuss lighting) • Install vanity and tub. • Install tile on tub walls and ceiling. • Install new tile floor. • Install new baseboard heat cover. • Install new baseboard. • Install DenseSheild tile board on floor. • Replaster in where needed. • Install new towel bars etc. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 7,125.00 Note: This quote does not include any plumbing fixtures, vanity, tile, Grout or granite, or Paint.( my guy would be $750 to paint) Terms: $ 2,375.00 upon signing of contract ( not to exceed 1/3 of total contract price) $ Work to begin on ' / -? $ 4,750.00 when job complete Job to be completed on I .S-//-7 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 I THER ARE ANY BLANK SPACES! Date _/ //' Homeowners Si ature 9 Massachusetts - Department of Public Sa€ety Board of Building Regulations and Standards Construction Supers icor -cense: CS -072173 CHRISTOPHER F -RIVET M 207 WINTER ST N ANDOVER MA 0184 ' Expiration Commissioner 06/02/2014 ✓ize �o��vmomu o�..nnxaruc%elta Office of Consumer Affairs & Buusincss Regulatir•:: HOME '. SNROVEMENT CONTRACTOR Registration: 139962 Type: -' >-xpiration: 9/8/2013 Individual :. ,Hid TOPHER F. RIVET CHRISTOPHER RIVET 2G' WINTER ST. N. ,;NDOVER, MA 01845 Undersecretary 0 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MM 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsAFIectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ZW,4�7/5 Address: a © % _ /j/+JTS'�� 5' % City/State/Zip: //0 - v,S2 �,�' o IAT Phone 4:_ .-e Are you an employer? Check the appropriate opriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ryemployees (full and/or part-time).* 2. I am a sole proprietor or have hired the sub -contractors listed partner- on the attached shget. ship and have no employees These sub -contractors have working for me in any capacity, workers' comp. insurance. [No workers' comp. insurance 5. ❑ We ai•e a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their 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.] *Any applicant that checks box #1 must also fill out the section below sho , th Type of project (required): 6. ❑ New construction 7. 'Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other Homeowners who submit this affidavit indicating they are doing all work and then hire rkers outside contractors must submi t 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_/X�d'� 1 t Policy # or Self -ins. Lic. #: c1/ 'Q `'� �/ O S' Expiration Date: Job Site Address:_ �� �Q�J©��%� ,CtiS l City/State/Zip._Q 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 coverage verification. Ido hereby certify der he pains a d p alties ofperjury that the information provided abo a is true and correct. Si nature: Date: / v� /-� Phone #: Official use only. Do not :ell,,sompleted by city or town official. City or Town: Permit/License # Issuing Authority (circle o I. Board of Health 2. Builty/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone #: OP ID: SHHE CERTIFICATE OF LIABILITY INSURANCE DAT10/121YYYY) 110/12/12 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 978-688-6921 Macdonald & Pangione Insurance 9786885350 - P.O. Box 428 - CONTACT NAME: PHONE FAX JA/C, No Ext): AIC No): E-MAIL ADDRESS: 104 Main Street North Andover, MA 01845 Michael Pangione PRODUCER CHRIS -5 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # _ INSURED Christopher Rivet INSURERA: Preferred Mutual Ins Co 15024 207 Winter St. INSURER B: North Andover, MA 01845 INSURER C INSURER D INSURER E: INSURER F : COMBINED SINGLE LIMIT $ (Ea accident) 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 TYPE OF INSURANCE LTR ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X7. COMMERCIAL GENERAL LIABILITY F -- �J CLAIMS -MADE ` X OCCUR j CPP 0180 57 01 05 I 09/26/12 09/26/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS i COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ $ UMBRELLA LIAB OCCUR EXCESS LIAB HCLAIMS-MADE DEDUCTIBLE RETENTION $ _ EACH OCCURRENCE $ AGGREGATE $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS / 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 REPRESENTATIVE Michael Pangione © 1988-2009 ACORD CORPORATION. All rights reserved ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD