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HomeMy WebLinkAboutBuilding Permit # 6/25/2015 BUILDING PERMIT G �o A OF�TI.ED TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: � s �' Date Received �SSgcHus��c Date Issued: t(� IMPORTANT:Applicant must complete all items on this page LOCATION �d 'S cJ�•R L� P/L Print PROPERTY OWNER LrV 6, L. ! 6,AJ Print 100 Year Structure yesJno MAP PARCEL: ZONING DISTRICT: Historic District ye Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Eiu ❑,Se otic' D Well`y , ` t ❑ Flootlplain ❑Wetlands ,f ❑ Watershed District ✓T 1 k yr,`'" f r -`N' r. m"�,�i.^ t l�s���, Y .O,,Water/,Sewer u,>. ,• �, �� �t�r� , ,� �� � �' � � ����� � � ���� � r �.r l/' 4 7 Yr ;"& r .^'f; :^- � oma.✓; .it-x�Fw� ?h ,1 ,�. .H.usr'�r ,,.,r-x,r DESCRIPTION OF WORK TO BE PERFORMED: S' CSL,, Identification- Please Type or Print Clearly OWNER: Name: CA-F L_I'K) ,'y,1sr 6,M�) Phone: Address: 3 S Contractor Name: 44YtO f--L4AC--? Phone: 17 G 9 S— `7O e Email: f? i G /O;L e- , Address: e )3 ✓<, )9t-2 taw-7c4Liv yam-, Vt4 vim, e Supervisor's Construction License: To.')/° Exp. Date: Home Improvement License: > Q9 Cd-b Exp. Date: of / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST/ EBASSED ON$125.00 PER S.F. Total Project Cost: $ ) 3 G i v FEE: $ / 6/• Check No.: :Z— Receipt No.: NOTE: Persons contracting with unregistered c ntr ors o t havo the guar" unci �aORTH fown of 2 -c ? E......11. Andover . • i( ZTh �c 26 ?�1 T O LAKE ver! Mass, ' COCNICNE WICK A04ATeD S U PBOARD OF HEALTH ER Food/Kitchen Lu Septic'ISystem T THIS CERTIFIES THAT ............ ... ® ®.. . .'.,... BUILDING INSPECTOR Foundation has permission to erectRellsi .................... buildings on ................ .. /�!►„ �........ ........ Rough, to be occupied as ........ G4r . .... .6Jim T...� � ... . 5�. Ch mn'' 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 PERMITE 1 OTS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough!, ..................... .. .................. Final .� Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough li is lay in a Conspicuous Place on the Premises — Do Not Remove Final ' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT ntil Inspected and Approved y the Building Inspector. Burner Street)No. Smoke Det. RICHARD FLUET 02 BRIDLE PATH LANERACTING, INC PROPOSAL METHUEN,MA 01844 I� f�i Date Estimate# 5/18/2015 508 Name/Address CAITLIN GILLIGAN 75 SURREY DR. N.ANDOVER MA.01845 Description FIRST FLOOR BATHROOM;REMOVE EXISTING FIXTURES AND WALLPAPER.FRAME FOR NEW SHOWER.MODIFY EXISTING CLOSET AND ADD NEW DOOR FOR CLOSET.SHEETROCK AS NEEDED.PRIME ONE COAT AND PAINT WITH TWO COATS OF BEN MOORE.RETRIM WINDOW AND DOOR IN BATHROOM.INSTALL ALL NEW BATH FIXTURES AS DESCRIBED IN QUOTE FROM PEABODY SUPPY.FLOORING AND SUBFLOORING BY OTHERS.PLUMBING AND ELECTRICAL AS PER ATTACHED QUOTES.PERMIT AND TRASH REMOVAL IS INCLUDED IN PROPOSAL. FIXTURE ALLOWANCE AS PER PEABODY QUOTE DATED 5/9/15.$4306.01.PLEASE NOTE;TAX NEEDS TO BE ADDED TO QUOTE. PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$85.00/HR/MAN. MA.LIC.#50710 HIC.# 106620 FINANCE CHARGE OF 1 & 1/2%PER MONTH FOR UNPAID BALANCES. 1/3 WITH ACCEPTANCE, 1/3 WITH ROUGH INSPECTIONS,BALANCE UPON COMPLETION OF INSPECTIONS. Total $13,690.00 Signature Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@verizon.net The Commonwealth of Massachusetts Department of IndlustrialAccidents r 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia �+m sas Workers' Compensation Insurance Affidavit:Builders/Contractors/Electxicians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORXT Y. ,lease Print Legibly A �licant Information Name(Business/Organization/Individual): Address: �— V j,t� L(j �}"`Z �--A.1 ' L�T�I�+) ✓h ✓✓�-- Phone#: City/State/Zip: r" Are you an employer?Checic the appropriate box: Type of project(required): m a employer with Ae,uP (full frill and/or parttime).* ❑ 7. Now'donstruction ayees 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Q Remo deliing any capacity.[No workers'comp.insurance required] 9, ❑Demolition 3.E]I am a homeowner doing all work myself,.[No workers'comp.insurance required]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.F]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.0 Plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.t Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),andwe have no employees.[No workers'comp.insurance required.] *Any applicant that check's box#1 must also fill out the section below showing their workers'compensation policy information: i homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new p affidavit indicating such. tContractors that check this box must attached an additional sheet=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. X am an employer that is providing rvorlcers'compensation insurance for my employees. Below is the policy and jots site information. Insurance Company Name: 0_ 30 Expiration Date: Policy#or Self-ins.Lic.#: Ci /y � /a � n � L)Job Site Address: S 0✓j I �Lr! ��/ City/State/Zip: N 1. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a filib up to$1,500.00 and/or one-year imprisonment,as well as civil penalties inP Of K ORDER and a of the for $250.0 2550 00 a day against the violator.A copy of tors statement may b forwarded o� d d to the office - surance ------- - -- X do hereby certify un ns a ti of per jury that the information provided above is la ue anr1 cor t pct — -- • � Date: � Si ature: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: OP ID: CH GATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/25!15 THIS CFRTIFICATB IS ISSUED A$ 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. IFS BRO©ATION 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). corlTA PRODUCER 978-975-1300 E: Se rave&Hall Insur.AssoC.IAC 978-975-7596 Puo N° arc N° 306 North Main St. EMAIL Andover,MA 01810ODRESS: Michael L,Segrave ROouG;RID a'FLU ET-1 INSURERS AFFORDING COVERAGE NAIL N INSURED Rlchard F1uetContracting Inc. INSURER A:Arbella Protection Ins.Co. 41360 102 Bridle Path Lane INsuRERe=Commerce Insurance Co. 34754 -111=1- Methuen,MA 01844 OSURER c HNRrR D R E= INSIj F REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS lb TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU INDICATED. NOTWITHSTANDING ANY RE=QUIREMENT, 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 8Y PAID CY AIXMPS. LIMITS ILTR TYPE OF INSURANCE POLICY NUMBER M /ODIYYYY DIYY DYY EACH OCCURRENCE S 1,000,00 GENERAL LIABILITY 100,00 A X COMMERCIAL GENERAL LIABILn 8500034727 06/12/15 06/12!16 PREM,Es�e occh �� s CLAIMS•MADE i - U OCCUR MED EXP An one pnraon $ 8,00 PERSONAL&ADV INJURY $ 1.000,00 GENERAL AGGREGATE $ 2,000.00 PRODUCTS-COMP/OP AGO $ 2,000,OC GEN AGGREGATE LIMIT APPLIES PER: $ X POLICY PRO- LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100,0( ALL OWNED AUTOS BODILY INJURY(Pareedd9m) $ 300,0( B X SCHEDULED AUTOS PROPERTY DAMAGE $ 100,0( X HIRED AUTOS XV1460 12101/14 12/01/15 (PerecAident) 8 X NON-OWNFDAUTOS $ IRETENTION MBRELLA LIAR OCCUR EACH OCCURRENCE $ XCESS LIAR CLAMS-MADE AGGREGATE $ S EDUCTIBLE $ S WC STA U- OTH- WORKERS COMPENSATION if AND EMPLOYERS'LIA9ILITY 03/31/16 03/31/16 E.L.EACH ACCIDENT $ 500,01 A ANY FICER/MEME3 R F�RTNER E ECUTIVE Y NIA 97 04340312 600 01 �Ul E,L.DISEASE-SA EMPLOYEE $ (Mandatory In NH) 600,01 IrKyees,describe under E.L.DISEASE-POLICY LIMIT 3 DESCRIPTION OF OPERATION cIm'i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schadule,If more space is requlrad) 'CERTIFICATE HOLDER CANCELLATION NORTHAN. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERI10F, NOTICE WILL BF_ DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Deparment 1600 Osgood St. AUTHORIT,ED REPRESENTATIVE North Andover,MA 01846 Michael L.Segreve D 1988-2009 ACORD CO ORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD r* Massachusetts - Department of Public Safety Board of'Buiiding Regulations and Standards - Colistruch ni super!"Psor ,License: CS-050710 a : is rrti RICHARD A FLU `I 102 BRIDLE PAU-I r ! METHUEN MA 8184 " A Expiration Commissioner 04/22/2017 ' cc. n. - C'%�e 1panz�nzalzcuealf�o�C�eac�uaeCf 1, Office of Consumer Affairs&Business Regulation ME lMPRWt MENT dONTRAVOR egistration: 106620 Type: xpiration: 7/242€34.x-. Private Corporatio, .;- 1 RICHARD FLUET CONTRALTI ( r INC. 4! Richard Fluet E, 102 Bridle Path Lane ': Methuen,MA 01844 Undersecretary -g. f yyf i 1 i+4 t• Y} 1i Ef. i i i I i".