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HomeMy WebLinkAboutBuilding Permit #305-13 - 87 CHESTNUT STREET 10/15/2012 r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 0 M ORTANT: Applicant must complete all items on this page LOCATION ll �1�-�� ✓�� J Prin i/ PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO- _PARCEL: .( S ZONING DISTRICT: Historic.District yes- Machine Shop Village yes n j TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑A dition ❑Two or more family ❑ Industrial Pllteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District= El Water/Sewer . DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) ,�f- OWNER: Name: �aiv�r.� ��"�T/� Phone: �f6 � Address: 57 t CONTRACTOR Name: l f�.�/� U�Y Phone: Address: �O_ /I/�f/S�� s �J. �c%C7�G!5 �%v Exp. Date: laV1 l Supervisor's Construction License: Home Im Provement License: �5 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: $ 1j FEE: $ Check No.: O"� Receipt No.: NOTE: Persons contracting with unregistered contractors do not havAto ranu tSIg.nature of Agent/Ovvner Signature R contrPlans Submitted ❑ Plans Waived ❑ Certified Plot Planans ❑ 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 o 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) ❑ 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 ❑ 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: Doc.Building Permit Revised 2012 Location C No. 3U 13 Date TOWN OF NORTH ANDOVER Dj e 4e Certificate of Occupancy $ Building/Frame Permit Fee $_&A4*)Foundation Permit Fee $ . Other Permit Fee $ TOTAL $/G,G.C%01- Check# fov.3 25832 ilding Inspector NORTH own o .... ndover 0 .... .No. � Z o - h ver, Mass, c oc"Ic"t wic" �d ORATED J**' y S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ...... .. .o. ......................................................i......................... BUILDING INSPECTOR j7 Foundation has permission to erect .......................... buildings on ... ... .................................................................... Rough // ..:�. ..:..........................................:. to be occupied as ............ F�I�.�C:�..�.�G. .(.��1 .....�...... � �.,� .... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION §TARTS Rough Service ............... ..... G��:+�'a ��a.,.�......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. SEE REVERSE SIDE • CjLwa , • PROPOSAL Don &Laura Smith 87 Chestnut Street North Andover, MA 01845 (C) 508-523-7838 (H) 978-682-6193 (W) 978-983-3570 lsmithno1 @aol.com October 12, 2012 Decking and Railing Replacement Work to be completed includes: • Building Permit $ 200.00 • Removal of existing decking and railings. Install new pressure treated rail posts. Install new Kleer Golden\Teak Decking. Install new TimberTech Radiance Rail System. Install new PVC lattice and PVC trim around deck. LABOR $ 4,700.00 MATERIAL $ 8,500.00 • Removal of all debris. 400.00 TOTAL LABOR AND MATERIAL $ 13,800.00 NOTE: This quote does not include any labor and materials for any Work that might be needed to the framing of the deck. Terms: $4,600.00 upon signing of contract(not to exceed 113 of total contract price) $ Work to begin on 0 0?C91O� $9,200.00 when job complete Job to be completed o / / / Submitted by: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-31.15 (H)978-704-1.165 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 021.08 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 f V 1;2-/J Homeowners Signature v Date Z � Contractors Signature ! Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-072173 =�! CHRISTOPHER FJtIVET'- 207 WINTER ST N ANDOVER MA 018 + �.•�.. moi . " "' Expiration Commissioner 06/02/2014 i Office of Consumer 4ffairs'&S siness Regulate:+ h HOME '1FROVEMENTCONTRACTOR A - tZegistrarion: yz.139962 Type: { Expiration: .68/k`13. Individual 11 '> # R TOPHER r .RIVET, rr CHRISTOPHER RIVETS--r_ 207 WINTER ST { MANDOVER,MA 01845 ! Undersecretary` The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,ALL 02111 www mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: FAoun employer?Check the appropriate box: a em to er with4. F, � roject(required):P Y ❑ I am a general contractor and Ioyees(full and/or part-time). have hired the sub-contractorsw construction. am a sole proprietor or partner- listed on the attached sheet.1 odeling ship and have no employees These sub-contractors have working for me in any capacity. workers'comp,insurance. olition [No workers'comp.insurance 5. ❑ We are a corpozation and its ding addition required.] officers have exercised their 10 Eltrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL . lumbin re airs or m g p additions myself. [No workers comp. c. 152,§1(4),and we have no required.]t 12.E]Roof repairs insurance re ] employees.mployees.[No workers' comp.insurance required.] 13.❑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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:� � (j/010 `. _ � �//=_ Expiration Date: Job Site Address:_ City/State/Zi : 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 of up to$250.00 a day against the violand a foie violator. Be advised that a copy of this statement may be forwarded to the O Investigations of the DIA for insurance coverage verification. ffice a I do hereby certify unde he ains and p alties ofperju that the information ry provided above * true nd correct. . Date: 4` Phone Official use only. Do not write in this area,to be completed by city or town official. City or Town: Per # Issuing Authority(circle one): I.Board of health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC Ri®" CERTIFICATE OF LIABILITY INSURANCE OP ID NEMA DATE(MM/OD/YYYY) 41,,� 1 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 UUNIAkol Macdonald & Pangione Insurance PHONE LX P.O. Box 428 (A/C,No,Ext): (AIC,No): 104 Main Street ADDRESS: North Andover MA 01845 CPR ID I: CHRIS-5 Phone:978-688-6921 Fax:978-688-5350 INSURER(S)AFFORDING COVERAGE NAZCA 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: 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 44AY 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. UUU UB(LTR TYPE OF INSURANCE I INSR I WVD; POLICY NUMBER I(MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY I I EACH OCCURRENCE I S 1,000,000 A XX I COMMERCIAL GENERAL LIABILITY CPP 0180 57 01 05 09/26/11 09/26f1I PREMISES(Eaoccurrence) S 100,000 CLAIMS-MADE X1 OCCUR (MED EXP(Any one person) IS5,000 PERSONAL&ADV INJURY I S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 5 2,00 0,00 0 X ! POLICY JECT I ; LOC I i i I I$ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT { j j ANY AUTO I ( (Ea accident) 115 i BODILY INJURY(Per person) I S ! ALL OWNED AUTOS i I + i BODILY INJURY(Per accident) S SCHEDULED AUTOS E ! t �PROPERTY DAMAGE HIREDAUTOS ( i I 1 (Per accident) I S I�NON-OWNED AUTOS i III ) 1 S I € S II I UMBRELLA LIAB I OCCUR I I EACH OCCURRENCE I S I� EXCESS LIAB� AGGREGATE 5 i f CLAIMS-MADE i DEDUCTIBLE S RETENTION S i ! ± I$ 4 WORKERS COMPENSATION ; WC TATU- OTH- 1 AND EMPLOYERS'LIABILITY IN I ' TORYLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVY I NOFFICERIMEMBER EXCLUDED? /A I E.L.EACH ACCIDENT j 5 j(Mandatory in NH) If yes.describe under j E.L.DISEASE-EA EMPLOYEES � � � f i DESCRIPTION OF OPERATIONS below j I E.L.DISEASE-POLICY LIMIT 15 l ► DESCRIPTION OF OPERATIONS I LOCATIONS I 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(2009109) The ACORD name and logo are registered marks of ACORD