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HomeMy WebLinkAboutBuilding Permit # 7/28/2015 FORTH BUILDING PERMIT 0 4. TOWN OF NORTH ANDOVER to APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ATED sS�cHUS Date Issued: ' IMPORTANT: Applicant must complete all items on this page ,� i, LOCATION r �) 1 q qNq6/ / W ,UL Print PROPERTY OWNER 071 00 9J 5 Print 100 Year Structure yes no MAP PARCEL: 2, ZONING DISTRICT: Historic District ye no 10 Machine Shop Village y yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial X!Repair, replacement 0 Assessory Bldg El Others: El Demolition El Other W/ voy xg, ,�/NXL,H DESCRIPTION OF WORK TO BE PERFORMED: k t x) L C,(946-J t J/( fa 0 CA-t Identification- Please Type or Print Clearly OWNER: Name: 1�a06 tc-s 5;ct/,n)o Phone: Address: k2 Contractor Name: v4yo PLUS` -7 G hone: e1 10 Email: 12 P;(— /0). 0- uc-yl KA22 Address: /p�- 1-3/7 e I.7 La Supervisor's Construction License: (:0 f 0 Exp. Date: Home Improvement License: Exp. Date: `�// 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.' rs 0 Check No.: ;R e e c o.: - r, NOTE: Persons contracting with unregistered contracto0 not have a cess- o uar tyfiund t%ORT'I Town a E ..•h' Over ® " No. 2h ffi C' - •A h ver, Mass, T O L KE 1 COCMIC MI WICKN'_ A°Ramo PPa,`�65 S lJ BOARD OF HEALTH PERMIT D Food/Kitchen Septic System ze THIS CERTIFIES THAT 2rw. ,,; �,,,,,, BUILDING INSPECTOR has permission to erect .. g � �Ih` Foundation ........................ buildings ... .. ........................ .................... ........�.......... ® .....................................I........................ Rough to be occupied as ......... ...1 .�.....r�,�. 0 �. Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTI S RTS Rough Service .............. ..... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Ruildin Rough Islay 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. RICHARD FLUET CONTRACTING,INC 102 BRIDLE PATH LANE PROPOSAL METHUEN,MA 01844 Date Estimate# 6/29/2015 523 Name/Address BROOKSSCHOOL 1160 GREAT POND RD. N.ANDOVER,MA.01845 BLAKE NORTH Description KITCHEN;REMOVE EXISTING KITCHEN,RELOCATE STOVE AND FRIDGE AS PER PLAN.INSTALL MICRO WAVE,ADD POWER AND VENT OUT TO EXTERIOR,REPLACE DRYWALL AS NEEDED,UPGRADE OUTLETS AS NEEDED,INSTALL TWO PENDANTS WITH ONE SWITCH PLUS THREE RECESSED CANS IN KITCHEN AREA,REPLACE FIXTURE ABOVE TABLE.INSTAILL 6 RECESSED LIGHTS(3&3) IN LIVING ROOM WITH 3 WAY SWITCHESYLUMBER WILL INSTALL NEW SINGLE BOWL SINK AND CONNECT DISHWASHER,INSTALL NEW CABINETS,PAINT ALL DISTURBED AREAS AS NEEDED WITH TWO COATS OF BEN MOORE.REPAIR FLOOR AS NEEDED.SUPPLY PERMIT AND TRASH REMOVAL. BROOKS WILL SUPPLY FLOORING MATERIALS,PENDANTS,FIXTURE ABOVE TABLE AND APPLIANCES. 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. PAYMENTS;PROGRESS AS WORK PRECEEDS. Total , 80.00 Signature'74. ��/4�� Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@verizon.net Richard Fluet Contracting Inc. 102 Bridle Path Lane Methuen, MA 01844, Tel/Fax (978) 685-7010 .A v )W1 Q� 13 1-71 L T I The Commonwealth of Massachusetts R . F Department oflndustrialAccidents wa. a 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.rnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le0bly Name (Business/Organization/fndividual) 7 .Addl:ess: City/State/Zip: 4Phone#: 17S_ G Y S^7 0l() Are you an employer?Check the appropriate box: 'Type of project(required): 1. I am a employer with 3: employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. El Remo delhig any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. F1 Demolition 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12,[]Plumbing repairs or additions i 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workerscomp,insurance.# 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c, 14.El Other 152,§1(4),and we have nQ employees.INo workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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 fiave employees,they must provide their workeis'comp.policy iuunber. I am an employer that is providing workers'compensation insurancefor my employees.'Below is the policy and jab site information. ,,//�� _ Insurance Company Name: rTo l9 GSL Policy#or Self-ins.Lie.#: y a 030`6 Expiration Date: J� 1 Job Site Address: 10 �i � ���� t�lT� City/State/Zip: 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un ins and enalties petymy that the information provided above is true and correct. Signature: Date: Phone#• C) /t� Official use only. Do not write in this area,to he completed by city or toren 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.PIumbing Inspector 6.Other Contact Person: Phone#: OP ID: CI CERTIFICATE OF LIABILITY INSURANCE DgT07128DlYYY10 071281'15 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 endorsement(s). PRODUCER 978-975.1300 ONTACT NAME: Segreve&Hall Insur.Assoc.IncFAX 878.975-7596 PMON o 305 North Main St. ac N Andover,MA 01910 E-MAIL Michael L.Segreve UCER FLUET-1 CUSTOMER 1O y: INSURERS)AFFORDING coVF_RAGP NAIC 0 INSURED Richard Fluet Contralcting Inc. INSURERA:Arbella Protection Ins.Co. 41360 102 Bridle Path Lane INSURERH:Commerce Insurance Co. 34754 Methuen,MA 01844 INSURER G, INSURER D: INSURERS; INSURER NSURERS- 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 CONTRACTOR 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. ILTR YYPEOFINSURANCE Pow0YNUMeeR DD MMDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCEDAMAG $ 1,000,0( A X COMMERCIAL GENERAL LIABILITY 8500034727 08/12115 06/12116 PREMISES lEa occurr6 m) 100,0( CLAIMS-MADE Xp OCCUR MED EXP Any one person) $ 5,0( PERSONAL&ADV INJURY S 1,000,0( GENERAL AGGREGATE $ 2,000,0( GRNT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,0( NX POLICY PRO-JECTLOC 3 AUTOMOBILE LIABILITY COMBINER SINGLE LIMIT b (Eq accident) ANY AUTO BODILY INJURY(Per person) $ 100,0( ALL OWNED AUTOS BODILY INJURY(Per eccldenQ $ 300,0( B X SCHEDULEDAUTOS PROPERTY DAMAGE X HIRED AUTOS XV1460 12/01/14 12/01/15 (Perecxdenl) $ 100,0( X NON-OWNED AUTOS $ 3 UMBRELLA LIAB OCCUR EACH OCCURRENCE 9 EXCESSLIA,B CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPONSATION WC 9TA7U- OTHL Y IMITS AND EMPLOYERS'LIABILITY03/31/16 03/31/16 E.L.EACH ACCIDENT $ 500,01 A• ANY OFFICER/MENBOEREXCLNERtE ECUTIVEY/❑NN N/A 9104340312 _ (Mandatory in NH) E.L.DISEASE-EAEMPLOY>rr S 500,01 n ea,c1mrlbe under EL,DISEASE-POLICY LIMIT S 500,0( DESCRIPTION OF OPERATIONS belw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach AGORD 101,Addltlontl Remarks Schedule,If more aPac6 Is required) CERTIFICATE HOLDER. CANCELLATION NORTHAN 8HOUI-0 ANY OF THE ABOVE DESCRIl3!'D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. Osgood St. AUTHORIZED REPRESENTATIVE North Andover, MA 01815 Michael L.Segreve - ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety • . Regulations and Standards Board of Build ._ unStiUCiiOn u � i,er"v iSii� License: CS-050710 - .P. RICHARD A F LUJOT - 102 BRIDLE PAITO _ METHUEN MA 0184 J +�1/� �rls��` Expiration Commissioner 04/22/2017 <?�lie�nrrayiza-�uoeu�f�i,o����uld�ccftu4ef� i License or registration y#0 l for individul use only Office of Consumer Affairs&Business Regulation Li � g y before the expiration date. IWund return to: ME IMPROV( I11EN7 ONTRAGTQR Office of Consumer Affairs and Business Regulation eglstratlon T06620 type: xp'ration 7/2¢t 018< Private Corporatiop 10 Park Plaza-Suite 5170 Boston.MA 02116 RICHARD FLUET CQ{;1TRACTalf71NC. Richard Fluet 102 Bridle Path Lane7 Methuen,MA 01844 Undersecretary Not valid with signatare