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HomeMy WebLinkAboutBuilding Permit #412 - 87 CHESTNUT STREET 11/20/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO`� Permit NO: Date Received 1 v Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER r.-� Print lob Year Old Structure yes MAP NO�PARCELW5 ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family 11 Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well D Floodplain ❑Wetlands ❑ WatershedDistrict ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) erv7-611Y OWNER: Name: 40,tJA4e2 x^/117-! Phone: Address: Z2 / -T- CONTRACTOR i CONTRACTOR Name: Phone: Address: o�a� ,rlf C� Zi2�� Supervisor's Construction License: Exp. Date: 6X Home Improvement License: _ 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: $ o� J 0 b O, O FEE: $ "71� Check No.: <� Receipt No.: r'�-rf NOTE: Persons contracting with unregistered contractors do not have access tothe eglarannd Signature of Agent/Owne_ r- Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location G�f J Date 2.2 42 No. -/�- o - TOWN OF NORTH ANDOVER e ® Certificate of Occupancy $ Building/Frame Permit Fee 4� Foundation Permit Fee $ Other Permit Fee $ \ 0 TOTAL $ Check#&Y 25969 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM M DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ e COMMENTS I CONSERVATION Reviewed on Signature COMMENTS - - - HEALTH Reviewed on Signature COMMENTS 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 `FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Department-signature/date COMMENTS , Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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 i 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 Li Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract Li Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application L3 Certified Surveyed Plot Plan Li Workers Comp Affidavit o 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) Li Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application a Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a Mass check Energy Compliance Report o 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 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 87 Chestnut Street 412-13 on 11/20/2012 Bathroom Remodel NORTH Town of s E : ., ndover O _ y - No. t 4h " ver, Mass 20 �Z 4 of > > c0C"1C"lw.C/c 1_�' A�R�TEO I•P��.�y S u BOARD OF HEALTH �1.T LD Food/Kitchen PERM Septic System THIS CERTIFIES THAT 641*1 . ...LOA.�S„. .Asv BUILDING INSPECTOR has permission to erect .......................... bulldin on El..C%raf es ....................... Foundation ....................... ............ ........ Rough to be occupied as ......... ........... . ....................................................... 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 CONSTT T Rough Service ...... .... .............. .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 PROPOSAL Don&Laura Smith 87 Chestnut Street North Andover, MA 01845 (C) 508-523-7838 (H) 978-682-6193 (W) 978-983-3570 lsmithno I&aol.com September 30, 2012 Master Bathroom Remodel Work to be completed includes: • Building Permit $ 200.00 • Demo of existing bathroom. $ 1,200.00 • Complete all plumbing required. $ 3,000.00 estimate • Complete all new electrical, including new Panisonic Heat/Light/Vent, $ 1,250.00 switches and plugs,vanity lighting. • Hang new blueboard&plaster. $ 1,200.00 • Frame for new shower. $ 300.00 • Install vanity and 18 in. towel cabinet. $ 400.00 • Install new tile floor. $ 1,300.00 • Install new baseboard heat cover. $ 100.00 • Install new baseboard. $ 150.00 • Install DenseSheild tile board on floor. $ 300.00 • Install new tiled shower with trough drain. $ 4,900.00 • Install new towel bars etc. $ 125.00 • Removal of all debris. $ 400.00 TOTAL LABOR AND MATERIAL $ 14,825.00 Note: This quote does not include any plumbing fixtures,vanity,tile, Grout or granite. Shower door,Est. $1,500.00. Terms: $4,940.00 upon signing of contract(not to exceed 1/3 of total contract price,,) $4,940.00 when plaster complete Work to begin on // alS IA $4,945.00 when job complete Job to be completed 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 Homeowners Signature �aLel (.GZ Date // ao is Contractors Signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cimstruction Super%isor License: CS-072173 CHRISTOPHER F-RIVET. 207 WINTER ST N ANDOVER Mk- 018435 ;—::xPiratior%. Commissioner 0610212014 92.-P..... -acluzz Offiot Consumer Affairs&Business Reguhtici:; HOME 1FROVEMENT CONTRACTOR - Z' j R egist ration: 139962 Type: Expiration: 9/812013 Individual TOPHER F.RIVi T CHRISTOPHER RIVET 2C-.--WINTER ST. N.:-'NDOVER,MA 01845 Un'dersecretary' The Commonwealth ofMassachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 U4. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are Y ou an employer?Check the appropriate box: 1.❑ am a employer with 4. I a Type of project(required): ❑ m a general contractor and I employees 6• New cons (full and/or part-time). have hired the sub-contractors ❑ fiction 2. I am a sole proprietor or partner- listed on the attached sheet.# �• remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers' comp.insurance. [No workers' comp.insurance 5. ❑ We are a corporation and its 9 ❑Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of per exemption p p MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12. Roof repairs ins ❑ insurance required.]T employees.[No workers' p comp.insurance required.] 1311 Other Any applicant that checks box#1 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 anew affidavit indicating inrsuch. $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 information. isthepolicy and job site Insurance Company Name: �"•� � _z&�Ze (_ . Policy#or Self-ins.Lic.#: � t7rQ Q tJ �� Expiration Date: ��' Job Site Address:_ _<77 City/State/Zip:�o, 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 violator. Be advised that a copy of this statement may be forwarded to the Office f d a fine Investigations of the DIA for insurance coverage verification. I do hereby certify u er he pains andpenaldes ofperjury that the information provided abov is tru and correct. Signature- i1 Date: o{— Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:SHHE DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/12/12 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). CONTACT PRODUCER 978-688-6921 NAME: Macdonald&Pangione Insurance 978_688-5350 PHONE FAX P.O.Box 428 _(A/C.No.Ext): _ I(AIC No): 104 Main Street E-MAIL North Andover, MA 01845 ADDRESS: PRODUCER CHRIS-5 Michael Pangione CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. INSURER B: 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. II POLICY EXP LTR TYPE OF INSURANCE I INSRADDSU D POLICY NUMBER MM/DDYYYYOLICY MM/DD YYYY LIMITS GENERAL LIABILITY I I LEACH OCCURRENCE $ 1,000,000 ! I I DAMAGE TO RENTED A Xi ,COMMERCIAL GENERAL LIABILITY ICPP 0180 57 01 05 09/26/12 09/26/13 (PREMISES(Ea occurrence $ 100,000 CLAIMS-MADEu OCCUR ( I ,MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: } _ _ I PRODUCTS-COMP/OP AGG $ 2,000,000 X I POLICY PRO-JECTLOC i $ AUTOMOBILE LIABILITY I I ' i COMBINED SINGLE LIMIT' $I I (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1 All OWNED AUTOS I BODILY INJURY(Per accident) $ SCHEDULED AUTOS ' PROPERTY DAMAGE HIRED AUTOS i (Peraccidenq S IJOWOWNED AUTOS I $ i UMBRELLA LIAB s j OCCUR I EACH OCCURRENCE S EXCESS LIAB I I I 111 j_ I CLAIMS-MADE I � j AGGREGATE � $ i DEDUCTIBLE , I $ RETENTION $ I I $ I WORKERS COMPENSATIONI ! WC STATU- (`OTH- AND EMPLOYERS'LIABILITY Y/N ___ TORY LIMITS I I ER I _ ANY PROPRIETOR/PARTNER/EXECUTIVE i E.L.EACH ACCIDENT $ I OFFICER/MEMBER EXCLUDED? 111NIA1 I C (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ I If yes,describe under — I DESCRIPTION OF OPERATIONS below I , I E.L.DISEASE-POLICY LIMIT I $ 1 I I 1 i I I 1 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St No Andover, MA 01 845 AUTHORIZED REPRESENTATIVE Michael Pangione I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD