HomeMy WebLinkAboutBuilding Permit # 6/9/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION .`: 'Print PROPERTY OWNER Print 100 Year,Old Structure yes n MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o' Machine 11 Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family 11 Industrial ❑Ateration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: � 7 dentification Please T pe or Print Clearly) OWNER: Name: 0 Phone: ar - Address: /=' J0110& t CONTRACTOR 'Name � �`° Phone: < Address ��A-'� l > w � Sup ervisor's Construction License: Exp. Date: e< _ Home Improvement License` Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ —?. 0S) FEE: $ 6w// Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to guarantyfu Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ µ Stamped Plans ❑ F.. ItORTH "I d _E. :...1,. . 1 u T ®116 16 is a� .Z.. - 77�.. )r ®®�� 11 � v� yc�.SSy Ir O LAKE 1, COCKIC K.WICK AORATeO � U BOARD OF HEALTH PF= RMIT �1 � LD Food/Kitchen Septic System • THIS CERTIFIES THAT 4 ®0i^�� BUILDING INSPECTOR ..... 4................................................ ® ............... .. ........................... L Lim Foundation has permission to erect .......................... buildings on . . .. ... ...................................... • �� � Rough to be occupied as ..... ....... .. .... .... �... ........ ..... ,..IQoth � ...S...� ........ .. �. Chimney ' e provided that the person accepting this permit shall in eve aspect conform t 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 E I I MON S ELECTRICAL INSPECTOR LESS C N S FITS Rough Service .G„oma .�:.�'�` ......... ....... ..... ................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Puzldzn¢ 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. ew-h4i6 9&wt eon6twxtian, Bill&Marie O'Mara 100 Johnnycake Street North Andover, MA 01845 (H) 978-289-2403 marieomara@comcast.net June 1, 2015 Decking and Railing Replacement Work to be included includes: • Acquire Building Permit. • Demo of all existing Decking, Railings,Trim, and Lattice • Remove existing stair stringers. • Jackhammer out concrete first step. • Install new Stair Stringers. • Install new PVC Lattice and Trim around Deck. • Install Azek XLM Grey Composite Decking. • Install New White Radiance Rail System. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 17,550.00 Note: Any Framing that is needed to be.replaced is additional. Terms: $5,850.00 upon signing of contract(not to exceed 113 of contract price) $11,700.00 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 i I Homeowner Signature k e-- 6 Date d -, &/ Contractor Signature -5 � �� The Cofntnonwealth of Massachusetts Depa•tinent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 mvap.nzass goy/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print lLe2ibl 4,/ee Name(Business/Organization/Individual):�_� , ,/�t � Address: Ci /State/Zip: f 1, �.-i. %'% y: < 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. ❑New construction _employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. ? ['Remodeling ship and have no employees These sub-contractors have 3. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance j• ❑ We are a corporation and its required.] officers have exercised their . ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I1.❑Plumbing repairs or additions myself[No workers'comp. e.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 1;1-1 Other comp.insurance required.] Any applicant that checks box-"I 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 providing lvorkers'compensation insurance for my employees. Beloly is the policy and job site nzforrnation. nsurance Company Name: .� �/�(L :� 'olicy+;or Self-ins.Lic.- �� U,/90 t `7 0/0 Expiration Date: ob Site Address: City/State/Zip: /J,3• kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to S 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 fonvarded to the Office of avestigations of the DIA for insurance coverage verification. cdo hereby cert fy wider hepairns andp �ialties ofperjrcry that the information pl ovided abo7�rstie tid correct. vc � i trnature: i Date: hone i Official use only. Do not sprite in this area,to be completed b-y city or tolvn official. City or Town: PermitiLicense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityirown CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone:u.- OP ID:SHHE YY)CERTIFICATELIABILITY INSURANCE 09130//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(les) must be endorsed. If SUBROGATION 1S 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 PHONE FAX P.O.Box 428 Fax:978-688-5350 WC No.Eat): I A/c.No): 104 Main Street E-MAIL North Andover,MA 01845 ADDRESS: Michael Pangione CUSTOMER to it:CHRIS-5 _ INSURERS AFFORDING COVERAGE NAIC 9 INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. North Andover, MA 01845 INSURER B: INSURER C: INSURER D: _ _INSURER E: I 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. (NSR I ;ADDL SUER: EFF POLICY EXP LTR i TYPE OF INSURANCE I 1 POLICY NUMBER MMIDDYIYYYY I MMIODIYYYY I LIMITS GENERAL LIABILITY j (EACH OCCURRENCE S 1,000,000 A I X COMMERCIAL GENERAL LIABILITY ;CPP 0180 57 01 05 09/26/13 09/26! I D� RENTED I I �i PREMISES(Ea occurrence) I S 100,000 CLAIfv1S-MADEVI OCCUR i I MED EXP(Any one person) I S 5,000 i- -. -- PERSONAL&ADV INJURY FS-1,000,000 r -- _ GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIESPERi : PRODUCTS-COMP/OP AGG I S 2,000,000 X I POLICY FI PRO- i { LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i (Ea accident) (S ANY AUTO BODILY INJURY(Per person) i S I ALL OWNED AUTOS BODILY INJURY(Per accident)! S SCHEDULED AUTOS j PROPERTY DAMAGE I HIRED AUTOSI S j (Per accident) NON-OWNED AUTOS g S ! UMBRELLA UAB j j I OCCUR I I i EACH OCCURRENCE I S i EXCESS LIAB I ( S CLAIMS-MADE AGGREGATE DEDUCTIBLE IS I RETENTION S ! S WORKERS COMPENSATION WCSTATU- iOTHI AND EMPLOYERS'LIABILITY YIN _ I TORY L M TS I T ANY PROPRIETORIPARTNER/EXECUTIVE i E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? NIA; (M If andatory in NH) yes,describe under E.L.DISEASE-EA EtvIPLOYEE' S i l I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S I I i 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 01845 AUTHORIZED REPRESENTA IV / Michael Pangion Y"'o I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 1 MassachUse is-Department of PuNSafety Board o/BuHdH ng RegukiVsans and Standards ¢dfid°i&ructiml superli"oc 1- License: CS-072973 CHRISTOPHER IF-RIVET 207 WINTER ST NANDOVERMA 01845 Expirabon Cor'✓missioner 06/02/2016 Office of Constfter Affa,rs&Business Regulation m. OME IMPROVEMENT CONTRACTOR I registration: 139962 Type: . Expiration: 9/8/2015 Individual CHRISTOPHER F.RIVET ; CHRISTOPHER RIVET 207 WINTER ST. N.ANDOVER,MA 01845 Undersecretnrc