Loading...
HomeMy WebLinkAboutBuilding Permit # 6/4/2015 `.►ORTy BUILDING PERMIT ( TOWN OF NORTH ANDOVER +�2.y ;,r. IV =a APPLICATION FOR PLAN EXAMINATION - n0# Permit No#: Date Received �,q °RATEo„PP�cy SSgcHuse Date Issued: IMPORTANT:Applicant must complete all items on this page .:/ I l / ll / y / .! y l'F' f /k tf � '"f f/ /r ,✓ r r / J'y f ,t*/ ,,; rl' sr / frf yr 9/✓ /rr rx :.r.� t�v ..,,rr JI' �x y">3'.�G f' r v`i t r r�'rr c} r r .xr r v r s✓ r � / r j ttr� ✓ f`f,{ Ix.&,rr x' :-r r t! �r -r ✓r✓ ,xr✓.„/ � t r tlrt r y 'r: x/ s /'r'r f j �� �;�✓ r ,r*;:r /r f.”v � rt'x ct�_ ,v�i >7.'�rxl�?r x l.r s ra .r t:rr t. t 1 .r/ r F �.�:air�t%I�,.r9k.,/frfF�;�-.,::/I,✓r f..nr r ,,r.f5� j/ � rr!' r rF9�' rt f ✓ r r I Y✓ -',rr rt r „= f �^�.�.;f ,�f 7� rr s � iar rry�l ;x, x ,� tU r rr r ✓ :'l � / G ✓ a :� t s r/ �f'"' ;.r. k 1fr.�`,/` � � S r� fr ti: �r tkry�r�.71 rr���rw"�Gf rrJ r r 5 / 1 ,y ✓ r / _� r r x r �'' ���Fv, ."., `__.. " r2{,fr` F„n�.. .fir r✓ 4 � ✓a�-�y � ..r.' �'" r` ��,,rrr / f 'fIx � x. �v✓�f fry xsl r.✓:rr/v+' / rl r� `;.. 1 Wr,f�� „''rr'rr.' ,"' s x,1.1 �,' Z _l� ''sr""i�! :r✓r x sf rP��"zv :.r"�'JtG✓ r- ,.r,;� f r r Fy'.�r� r ' �s�,�1�rf� < �� -r �� �� �� %��fx � � .�/ f ./ ���r/�r P,nnt�f ✓ r X100 Year Structure - 'es n j�fr�f;.,/�t `= N�'. �� ✓r r` rrxr ��t�-�1�m ,.vrcl"�,� xr�t rffr�,'../�'",�>r v / �, r ff"� 'r,f=: ,r rrJ„r s r Y f �„v ,MA;,�rrr ��rr �x7 I'ARC�EL��� �� ,;r� 20NING DISTRICT ✓rr�✓ Hts#d�tc Districtf ,t°f ,;yes j rf f f f J xs aT Jrr= is /w d t r r - r ,11G fr , �' xrfr,✓r / Machrne Shop Village yes r. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Meration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg 11 Others: El Demolition ❑ Other Sept�ct ❑Well ❑ Floodplain ❑Wetlantls ❑ Watershed Distract ✓ f .: x/ ✓ r 'y DESCRIPTION OF WORK TO BE PERFORMED: r � i Identification- lease Type or Print Clearly OWNER: Name: .�s���C� i, Phone: Address: '�� � r f� ( 1 r 11 / r ✓ G (� r < r / r sf:�rrrr✓`� f n� r / / r / r r r f t � / f r / r / r r r Ardd ress r ,�1 ' ✓ r�a�,✓ - �' ✓, � ��. �C �/ ��✓�” y � x�/�! � `jd rl� rffJr � t r t.x'r f ./f /r rv`rGr`' G;-/f/ rt rr ,+ r,r`rlr5'rr v / ✓/ '`r'11r r � r/,,, v /r r ,rt rr✓fr"� r r r cr r x ✓ r c r /. Sup"er'uisorss�Constructionr� ricense,� ��`�'t�`nrn; �f �. /� „ ' t r Expr�✓.Date ,r �/� ���f� `= r! ✓ /r r r /`/ r / J-sr '/ r .`r/ i r r" fr r /r J1 / l 7 f I i` "= r Jr✓ I r t ✓. t ✓r L / sr/ f fr r / y' f l /f / ”" / x � 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: $ FEE: $ �0 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he guaran and P Signature of Agent/Owner Signature of contract ttORTH Town of Andover Z h o �'eI' SSS' y COCNIc"IWICK 04A,rE 0 PP��.(5 u BOARD OF HEALTH Food/Kitchen PERml i T LD Septic System 0 THIS CERTIFIES THAT . .. .... .t .. #too BUILDING INSPECTOR .... has permission to erect .......................... buildings on ........ 6 . Foundation Rough to be occupied as ....... ... AL ........ .............................................................. Chimney provided that the person ?cep ing this permi 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRESI 6 N ELECTRICAL INSPECTOR LESS CONSTRUCT Rough Service ............. . ...... .... ......"......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. efutoi, Jqh,,td eomhuction Janice Piasecki 77 Bridges Lane North Andover,MA 01845 (H) 978-686-1442 November 1, 2014 Full Bathroom Remodel Work to be included includes: • Acquire Building Permit • Remove existing toilet and vanity top. • Demo of existing tub and floor. • Install new tub with tile walls. • Install custom tub door. • Complete all required plumbing. • Complete any electrical.. • Install new tile floor. • Install new Panisonic vent unit. • Install new baseboard heat cover and baseboard. • Install new granite vanity tops,undermount sinks and faucets. • Install new toilet paper holder,towel bars. • Removal of all debris. • Paint bathroom. TOTAL LABOR AND MATERIAL $ 16,640.00 Terms: $5,500.00 upon signing of contract(not to exceed 1/3 of contract price) $ 11,140.00 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 mde as outlined above. Date / � Homeowner Signature `� � P Dater°' r; 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 consumer shall be required t ubmit to such arbitration as provided in Massachusetts General Laws,Chapter 142A. omeowner's Signature Contractor'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 The Cofnnionivealth of Massachusetts Departnient of Inditstrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 iPiViV.Hzass bov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print 1Leaiioly Name(Business/Organization/Individual): Address: (:`0- x. j /' 1 Ci /State/Zip: �L Z�: �%'.� pct' i' ,`i = < r'• r ;'! City/State _ ' / Phone�. _ Are you an employer?Check the appropriate box: Type of project(required): 1-❑ I am a employer with ='.. ❑ I am a general contractor and I 6. F1 New construction employees(fall and/or part-time).' have hued the sub-contractors 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. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required,] officers have exercised their . ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work light of exemption per MGL ILEIPlumbing repairs or additions myself [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required]t employees. [No workers- comp.insurance required.l 13 0 Other Any applicant that checks box rl must also fill out the section below showing their workers'compensation policy information. Homeowners Nvho 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. am an employer that is providingivorkers'compensation insurancefor fry employees. Beloip is the policy acrd job site nformation. nsurance Company Name: . 4el--;-f4 'olicy or Self-ins.tic. Expiration Date:.... % ob Site Address: ''. 01</d✓C ZEN City/State/Zip:-Aajn, v,ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'ailure to secure coverage as required tinder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ine 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. e10 hereby certtip ir�zder Ire pains anap aalties ofperjrrry that the information provided above is trite and correct. iQnature: i'�, %,f Date: hone, Official use only. Do not write in this area,to be completed by city or town official. f City or Town: Permit/License# issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person• Phone tk OP ID:SHHE CERTIFICATE OF LIABILITY INSURANCE DAT 09130D/YYYY) 09/30/13 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 Phone:978-688-6921 NAME: Macdonald&Pangione Insurance Fax:978-688-5350 PHONE FAX P.O.Box 428 _(A/c No Extl: 104 Main Street E-MAIL North Andover, MA 01845 ADDRESS: Michael Pangione cusTnMER ID#:CHRIS-5 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: 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 ADDL SUBRI I POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AM DAGE TO RENTED A X f COMMERCIAL GENER�AL LIABILITY j CPP 0180 57 01 05 09/26/13 09/26/1 ' PREMISES(Ea occurrenceL_ $ 100000 CLAIMS-MADE t I OCCUR MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO-JECTLOC S i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ dALL OWNED AUTOS I I BODILY INJURY(Per accident) S '.. SCHEDULED AUTOS PROPERTY DAMAGE S HIRED AUTOS (Per accident) NON-OWNED AUTOS S j S UMBRELLA LIAB ._ OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DEDUCTIBLE I S RETENTION S � $ WORKERS COMPENSATION TWC STATU-ORY LIMITS ICER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S I I DESCRIPTION OF OPERATIONS/LOCATIONS/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 -- Massachusetts - Department of Pm,ubfic Safety Board of Budding ReagmuWions and Standards Construction Supervisor License: CS-072173 CHRISTOPHER F. A 207 WINTER ST � N ANDOVER MA 0I' v V )I � h0. } � vA�,. Expiration Commissioner 06/02/2016 . (-1111' ((CrPlt/It(al/„fL'I ft��fl ll���i[-[C(.l6Ullt/llr lr✓Lp i t Office of Oonstsner Affairs&Bus'iness RM,!'f#tinn f -V IMPROVEMENT CONTRACTOR ration: 139962piratipn: 9/8/2015 Individual "> P CHRISTOPHER F.RIVET CHRISTOPHER RIVET 207 WINTER ST. — �” N.ANDOVER, MA 01845 Undersecretary'