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HomeMy WebLinkAboutBuilding Permit #526 - 92 FRENCH FARM ROAD 1/10/2012TOWN OF NORTH ANDOVER %© APPLICATION FOR PLAN EXAMINATION Permit NO: �`'� Date Received P Date Issued: IMPORTANT: ADDlicant must complete all items on this age LOCATION Print PROPERTY OWNER 1K Print MAP NO: .�PARCEL: 0 0 ZONING DISTRICT: Historic District yesne Machine Shop Village yes(no 100 year-old structure yesno DESCRIPTION OF WORK TO BE PERFORMED: (Identification Pleas Type or Print Clearly) OWNER: Name: �? _ Address: _1"2 e ,e - CONTRACTOR Name: ✓• ' � s Address: Supervisor's Construction License: Home Improvement License: %u�7� ARCHITECT/ENGINEER -- ir 7 L V i 42 t �- Phone: �' - 3 (� t► - 4 e M! ,� e V Exp. Date: % Z - 'l - -2'o 1 Exp. Date: ;!r/ 7- 5/ 7,; 1 Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIj� $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �4j k - Check No.:J Receipt No.: NOTE: Persons con ratting with unregistered contractors do not have access to rn Location No. Date TOWN OF NORTH ANDOVER rik Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24 9 9 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinunmg 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 ` PLANNING & DEVELOPMENT COMMENTS CONSERVATION HEALTH COMMENTS I. DATE REJECTED ❑R DATE APPROVED Reviewed on Signature Reviewed on Signature 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 Main Street Fire Department signature/date 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 2011 June/mi 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 o 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) o 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: Doe.Building Permit Revised 2008mi h z rA . c o m c o � � h c L C C O V V :gyp, c ma C =45 O L d O w V CD O O. 0 CD `NG p� ocm c V N �C CD z3 N � CO C C m •O R � N W CC m co 0 CLCD L N m _,,, O C O Q dC.0 v yZ A O C L O m yC. . C = m 4- 30 O. N pN CD .S WC O=..*c li. � m w C +� F. •H EL :5 Z O C Ir- .E c , 0 Q, COD a m � O 'fl _ w M o h o F- s 0a�m .fti a y Z O a N C O A O Q CM m O cm C �C N CP L r 0 Z O J F. O w P-4 NO 6 O O O O O v Z � CL O y 0 C O CM C.�.■ ca p 'C O y O O ■E m m 0 CD CL 3.0 � � L O O Q a- cMQ co c .a cc CA ts V y C C . C COD o w v cn 0 A 0 .r co o w o w v0U) G,.. U a u. o a o as a w x o W .0 o w ca f0 o R; w" w . CA L cn .� Q v o V) rA . c o m c o � � h c L C C O V V :gyp, c ma C =45 O L d O w V CD O O. 0 CD `NG p� ocm c V N �C CD z3 N � CO C C m •O R � N W CC m co 0 CLCD L N m _,,, O C O Q dC.0 v yZ A O C L O m yC. . C = m 4- 30 O. N pN CD .S WC O=..*c li. � m w C +� F. •H EL :5 Z O C Ir- .E c , 0 Q, COD a m � O 'fl _ w M o h o F- s 0a�m .fti a y Z O a N C O A O Q CM m O cm C �C N CP L r 0 Z O J F. O w P-4 NO 6 O O O O O v Z � CL O y 0 C O CM C.�.■ ca p 'C O y O O ■E m m 0 CD CL 3.0 � � L O O Q a- cMQ co c .a cc CA ts V y C C . C COD ACORD. CERTIFICATE OF LIABILITY INSURANCE °itio5/201 ' PRODUCER Paychex Agency Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 150 Sawgrass Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE Rochester, NY 14620 INSURED David Reitano dba David Reitano Remodeling and Building 56 Pleasant Street INSURER A: AmGUARD Insurance Company _ v INSURER B: -_ — -- INSURER C: L__' COMMERCIAL GENERAL LIABILITY IEGEN1 Methuen, MA 01844 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS 1DATE [MMQDfYY1 DATE IMMIDDfYYI GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 A L__' COMMERCIAL GENERAL LIABILITY IEGEN1 DABP201902 12/01/2011 12/01/2012 FIRE DAMAGE (Any one fire) $ 50,000 CLAIMS MADE a OCCUR I MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ Included GENERALAGGREGATE $ 2,000,000 GREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 – — ICY PRO- LOC ' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E I ANY AUTO (Ea accident) _ ALL OWNED AUTOS - BODILY INJURY $ SCHEDULED AUTOS (Per person) BODILY INJURY $ (Per accident) . HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EA ACC ANYAUTO THAN _$ OTHER -- — AUTO ONLY: AGG E EXCESS LIABILITY EACH OCCURRENCE S OCCUR El CLAIMS MADE _ AGGREGATE I $ $ I DEDUCTIBLE $ RETENTION E STATU- i �OTH•I ! WORKERS COMPENSATION AND O EMPLOYERS' LIABILITY E.L. EACH ACCIDENT E E.L. DISEASE - EAEMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ ! OTHER I DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Lowe's Companies Inc. and any and all subsidiaries are named as additional insured as respects to General Liability. CE ACORD 25-S (7197) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE o ACORD CORPORATION 1988 CERTIFICATE OF LIABILITY INSURANCE DADD/YY) ACORD 07/11 9/119/11 rM 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(les) 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 endorsements . COMPANIES AFFORDING COVERAGE PRODUCER PAYCHEX INSURANCE AGENCY, INC. COMPANY AMGUARD 150 SAWGRASS DRIVE ROCHESTER, NY 14620 COMBPANY INSURED DAVID REITANO COMPANY C DAVID REITANO BUILD & REMODEL COMPANY D 56 PLEASANT STREET METHUEN, MA 01844 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. O LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERALLIABILITY GENERAL AGGREGATE $ - PRODUCTS - COMP/OP AGG $ COMMERCIAL GENERAL LIABILITY PERSONAL & ADV INJURY $ CLAIMS MADE OCCUR EACH OCCURRENCE $ OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY DAWC226669 06/11/11 06/11/12 TH- X To WCRSTATU- OFIR EL EACH ACCIDENT $ 100,000.00 EL DISEASE -POLICY LIMIT $ 500,000.00 THE PROPRIETOR/ INCL PARTNERStEXECUTIVE OFFICERS ARE: X] EXCL EL DISEASE - EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ^�w.r,r,A♦TC tJ/�I neo CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY 4\- III�"111 • 1 tti p J ` PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR w( LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE l - F - I �f (Massachusetts - Department of Public Safety W! Board of Building Regulations and Standards Construction Sul+er%l4,!{- I License: CS -023365 DAVID REITAI b 56 PLEASANTSTREET METHUEN 5IA 01844 = Expiration Commissioner 12/04/2013 �� ICS 0 OdS0If1Q� A sirs I �. SIdPSs egu a�on , HOME IMPROVEMENT CONTRACTOR Registration:. 108782 Type: Expiration: 8/25/2012 Private Corporatio D D REITANO REMODEL & BUILD David Reitano 56 Pleasant St ��Bc Methuen, MA 01844 Undersecretary k 1 4 y � . The Coi si wnwealth of Massachusetts Department of Industrial Accidents Office of Investigations = 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual) Address: 5 b `1' lei S,_ �- City/S i 14 Phone #: Are you an employer? Check the appropriate box: 1. I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] " These sub -contractors have employees and have workers' comp. insurance.: 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] oZ Type of project (required): 6. ❑ New construction 7. f Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. E] Electrical repairs or additions 11. E] Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is roviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: a / Rffck e Policy # or Self -ins. Lie. 4: � C oZ �.% Expiration Date: ,1 ho I . . n Job Site 1-t City/State/Zip: J 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 Athe DIA for inWrance coverage verification. I do hereby tertif j� ifftder tlllA ns and penalties of perjury that the information provided above is true and correct. ./p '076 / Phone #: 7 zK- 36 0 -� o? 0 Official arse only. Do not write in this area, to be completed by city or town official City or Town: /V. 4"" J, ✓e z Permit/License # Issuing Authority (circle one): 1. Board of Health V Building De artment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector "ILIA iti.° It.. t..lfi�1 31. tl int~' ll t i i4 56 Pleasant Street Methuen, MA 01844 Phone/Fax: 978-688-3944 Company Email: Dave@DavidReitanoRemodel.com Proposal Date: 11/21/2011 Submitted To: Mr. and Mrs. Robert Saindon 99 French Farm Road N. Andover Mass. Home: 978- 681-4218 Work: Mobile E-mail Job location - Job Description: Bathroom Remodel We herby submit specifications and estimates for: Bathroom Located on second floor will have 3 fixtures removed including fiber glass shower ... sink and toilet. All debris will be removed from job site. Electrical will be updated to meet Mass Code requirements including fan/light combination properly vented to the exterior, all necessary switches, GFI receptacle and wiring to accommodate wall lamp over medicine cabinte area. Plumbing will include new shower valve,water suppiles,..and shutoffs to all fixtures,.. Floor will be prepared for tile including plywood underlayment. Allowance outlined below. Walls in tub area will be fiberglass to compliment shower pan.. Walls disturbed during construction will be repaired and prepared for paint by contractor. Window and door trim will be salvaged ,new baseboard will be installed over new tile. Above total price $9800,00 �Ra � b s�- 0 02 i 1 ` e- ,n-, C4- -. V\,f e, -j x TQ) -R e-- v--,. u � �, (