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HomeMy WebLinkAboutBuilding Permit # 4/6/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ° a Print PRQPERTY OWNER Year,Old Structure yes r, 100 es i MAP NO.� PARCEL' ZONING DISTRICT Historic District y I, Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial 11AI ration No. of units: 11 Commercial epair, replacement ElAssessory Bldg El Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: °"00^ entification Please Type or Print Clearly) , OWNER: Name: Phone; ' Address: I0 CONTRACT(OF2 Name: � / l✓ Phone: Address: upervisor's Construction License ' ; Ex Date p S = -- Horne Improvement License. EXp. Date: � - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDIMG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t reguaran fund Signature of Agent/Owner Signature of contracto 11o Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 11 ,I L F NORT#j Town of . � E :. ., Andover ® - �: C% 0 0 .._. h ver, Mass, CO41 CH100WICK �• A�RA"rED PIP��,tS S V BOARD OF HEALTH PERMIT T Food/Kitchen L D Septic System THIS CERTIFIES THAT ................. .... ........S, ,l .�•�c.®.•.:.. BUILDING INSPECTOR ....... ..................... ............. fto has permission to erect ......................... builA01dings on ..I. ,�. ., Foundation , Rough to be occupied as .....6*4k..... ....-IT.... . • ....................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 tINMONTHS ELECTRICAL INSPECTOR ® UNLESS CONSTRUTI S Rough Service ........ BUILDING INSPECTOR Final 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. ehwj eo-tw,,- toyuctiott PROPOSAL Jay& Kathryn Sherlock 107 Rocky Brook Road North Andover, MA 01845 (C) 978-390-6660 (H) 978-683-4615 December 28,, 2014 Bathroom Remodel Work to be included includes: • Acquire Building Permit • Removal of existing tub,toilet,vanity,tile floor. • Complete all required plumbing. • Install new Panisonic Light/vent unit. • Complete all electrical. • Install vanity. • Install new Kohler KI 184 Tub. • Install DenseShield Tile board on tub walls. • Install tile on shower walls. • Install DenseShield tile board on floor. • Install new tile floor. • Apply smooth coat plaster to ceiling. • Install new baseboard heat cover and baseboard. • Install new toilet paper holder,towel bars, • Removal of all debris. TOTAL LABOR AND MATERIAL $ 9,000.00 Note: This quote does not include any plumbing fixtures,vanity,tiles,grout, granite, or paint.If current vent is not properly vented,we will need to address. Custom Shower Enclosure will be an additional$ 1,850.00. Terms: $3000.00 upon signing of contract(not to exceed 113 of contract price) $6,000.00 when job complete Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-794-1165 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. Date Homeowner Signature -,- � is C - Date X— Contractor Signature_ Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the con mer h>bequired t submit to such arbitration as provided in Maspchusetts General Laws,Chapter 142A. loniSner's Signature Contracto s Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL Chapter 142A)and other consumer protection laws(i.e. MGL Chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law",contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or(888)283-3757 OP ID:SHHE CERTIFICATE OF LIABILITY INSURANCE 7109/30/1 YYY) 3 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 Phone: 978-688-6921 CONTACT NAME: Macdonald&Pangione Insurance Fax:978-688-5350 PHONE FAx P.O.Box 428 A/C No Ext): A/C No): 104 Main Street E-MAIL North Andover, MA 01845 ADDRESS: PRODUCER CHRIS-5 Michael Pangione CUSTOMER to#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 15024 207 Winter St. INSURER B North Andover, MA 01845 IN 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. INSR I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,600,660 DAMAGE TO RENTED A I, X COMMERCIAL GENERAL LIABILITY CPP 0180 57 01 05 09/26/13 09/26//S PREMISES Ea occurrence $ 100,000 I CLAIMS-MADE [AJ OCCUR MED EXP(Any one person) S 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY II PRO- n LOC ( S JECT i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO i (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ I BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ H NON-OWNED AUTOS $ I$ UMBRELLA LIAB OCCUR ! I EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE f C AGGREGATE S DEDUCTIBLE RETENTION $ I $ WORKERS COMPENSATION WC Y/N STATU- OTH- AND EMPLOYERS'LIABILITY I TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT 1 $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ I DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 01845 AUTHORIZED REPRESENTA IV Michael Pangion I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Deparanent of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 uqw _ 1v1vtv.1nrrss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I,e2ibly f" Na111e (Business/Organization/Individual): Address: Vie'0- City/State/Zip: City/State/Zip: L1 ; �' lr Phone 4. Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. F1New construction employees(full and/or part-time).* have hued the sub-contractors 2.❑�I am a sole proprietor or partner- listed on the attached sheet.t ? [�Remodeling ship and have no employees •i'hese sub-contractors have S. []Demolition working for mein any capacity. workers comp.insunince. 9. ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their I0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' Li.❑Other comp.insurance required.l Any applicant that checks box nl 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 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. ain an employer that is providingivorkers'cozzzpensatiotz insurancefor my employees. Belorp is the policy atzd jab site z formation. G nsurance Company Name: olicy A or Self-ins.Lic. _ �; ;'�, /' 0 f z% Expiration Date: ob Site Address: /J -,,<v '4�,� 10 4,i City/State/Zip: kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'allure to secure coverage as required tinder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a [ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certify 11. lie pains and p alties ofpethiry that the information provided �above is trite and correct. ienature: .lam /,�i1 Date: f v 'hone ft: Official use only. Do not write in this area,to be completed vy city or tome official. f City or Town: Permit/License E 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 r: 11 Massachusetts -Department of Pamlaiic Safety Board of Building Re Lda&ons and Standards Construction`mzui:P riisor Ucense CS-072173 ,A Y y CHRISTOPHER F RIVE' 207 WINTER STjoil N ANDOVER M4- 01845 F aur aficm (30fnfflissi'o`rner 06/02/2016 Win..Office of C la `rJ��r��ar,�rrrrerr�/�r f r l�rrr rrc�rr r'lA.. onsuoner Affairs&Business RegaNtion 1OME IMPROVEMENT CONTRACTOR ,egistration: 139962 Tyfae: i. f � xpiration: 9/8/2015 Individual CHRISTOPHER F.RIVET t CHRISTOPHER RIVET 207 WINTER ST. N.ANDOVER,MA 01845 Undersccretar t.