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HomeMy WebLinkAboutBuilding Permit # 7/30/2015 %AORTH BUILDING PERMIT 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �sSAC Date Issued: US "IMPORTANT: Applicant must complete all items on this page LOCATION lI81ck-) w , Si- I i Pri PROPERTY OWNER h I Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no 10 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential F-1 New Building One family [I Addition [I Two or more family 11 Industrial Xq\Iteration No. of units: 11 Commercial [I Repair, replacement [I Assessory Bldg 11 Others: Demolition [I Other er/ ewers�/,/, ��l x.r , .,f�� , ��, f�� 1����rf��/,j'� r,�,����1���� ���1����� DESCRIPTION OF WORK TO BE PERFORMED: V e, ro dT Co&q17Fu6-,t Cxz-n-e)t,)c1 Q�,�r --c— i-oATI Identification- Please Type or Print Clearly OWNER: Name: Pho n e: 137f Address: Contractor Name: Jvke ' �, fi?,rcPhone: 106�z Email: RWRPC- R6K)-T (i;;) Jle,e-li 6dl A)Er Address: ,:2 N 016ck- Dr, Wclur-li M A Supervisor's Construction License: —Exp. Date: C /Ac 6 Home Improvement License:— Exp. Date: 13 r ' / 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: $ 06- FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund -6 c Flans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped !Tans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionisignature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp..Dumpster on site. yes no: Located of 124,Main Street Fir6Departrvient sic rAature/date COMMENTS FORTH Town t E. ...'.�.ofndover ® `�' 0% ® h ver, Mass U o2U o LAKE COCKICKI'WICK v AERATE O NP�,`'�� S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT fes. � .......................................... BUILDING INSPECTOR ............Uo'v ........................................... . . has permission to erect ... buildings on ...�i.',... . ,Q � Q Foundation ................... ........ f.. .. �` .... ..... Rough to be occupied as . . . ! .......... ....... Y.............. .......... . . �.� �?T...1rI. .......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the app cation 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 3w LESS CONSTRUCTION,r '_ Rough Service e ........................................... . ............................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occupy Buildinga Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final N'o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. RENE' L. PERONT CUSTOM CARPENTRY 2 Rag Rock Dr. Woburn, MA 01801 REMODELING CONTRACT This contract between Mr. John Lahoud 114 Middlesex St.North Andover, MA and Rene'L. Peront(contractor)for labor and materials described below,is agreed to by the undersigned parties. Remove the existing front porch and replace it with a canopy over the front door and stairs and a platform.Contractor agrees to remove all debris and supply all materials and labor to complete the project. The building permit will be obtained by the contractor and is part of the total cost. The project will begin on or about Aug. 3`d and is expected to end on or about Aug. 3 V. The total cost of the project will be $25,000.00 Payment will be scheduled as follows: 1/3 due upon signing of contract 1/3 due upon 50%completion remainder upon satisfactory completion Rene L. Peront 2 Rag Rock Dr. Woburn,MA 01801 CSL CS-095381 HIC 151906 Contractor or subcontractor inquiries should be directed to: OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION TEN PARK PLAZA,SUITE 5170 BOSTON,MA 02116 PHONE(617)973-8700 I hereby agree to all terms and conditions of this contract and acknowledge the homeowners right to cancel this contract within three days of the agreement. HOMEOWNER DATE 071a&A5- CONTRACTOR ACONTRACTOR r DATE i it j!( � -- __ -• - � = 1_- _-'- � i. _ t _ 1 All ZZ 4 t y i f"" 1 K � ,rte I .t�� � r- °• } � f 1 I North Andover MIMAP July 30, 2015 s� f +II,. !dileI� I Y� Gid' i °sv 'Uri "''"� �'•, �`''4�r�;�f���, ���, 0 MVPC Bo Interstates Horizontal Datum:MA S(ateplane Coordinate System,Datum NAD83, Meters Data Sources:The data for(his map was produced by Merrimack —SR 14O1111 Valley Planning Commission(MVPC)using data provided by the Town of Roads �f,t`to 9MO North Andover.Additional data provided by the Executive Office of 6a Easements } $e *a p Environmental Affairs/MassGIS.The information depicted on this map is Parcels ' _ L for planning purposes only.It may not be adequate for legal boundary 6 -- 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER M MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY '.. OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT IF°o A ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �s�AC14U 1"=45 ft The Commonwealth ofMa_ssachusetts Department oflndustrialAccidents T F tl 1 Congress Street, Suite 100 s Boston,MA 02114-2017 .. www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERIVIITTING AUTRORITY- Applicant Information 1 Please Print Legib Name (Business/Organization/Individual): �•ptc hU iYl ��� dam `' Address: I (57 e _ 1 City/State/Zip: bf)f- )�fi Phone#: 32 Are you an employer?Check the appropriate box: Type of project )required): 1.❑I am a employer with employees(full and/or part-time).* 7. New construction 2. am a sole proprietor or partnership and have no employees working for me in 8. F]Remodeling ny capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 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.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insruance.t 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.[]Other 152,§1(4),and we have no,employees.rNo workers'comp.insurance required.] *Any applicant that checks box 41 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 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 have employees,lhey must provide their workers'comp.policy number. I am an employer that ispi'aviding workers'compensation insurance for nzy employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lia#: Expiration Date: Job Site Address: 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 WORD 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. Ido hereby certunder thepain an en ties ofpeijur that the informationprovided above is true and correct. r t � Signature: Date:-� Phone# `� �d® 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 Contact Person: Phone#: ® DATE(MM/DD/YYYY) A`C� 7/22/15 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(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statDment on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: W. Gochis Insurance Agency Inc PHONE (781 272-8306 FAx No; (781) 272-1362 113 Cambridge Street aDEss: ochisl@verizon.net Burlington, MA 01803 INSURENS)AFFORDING COVERAGE NAIC# INSURER A:Commerce Ins. Co. INSURED INSURER B: Rene's Custom Carpentry INSURERC: Rene Peront INSURER D: 2 Rag Rock Rd. INSURER E: Woburn, MA 01801 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 ADDL SUBR POUCY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/Y MM/DD/YYYY A GENERAL LIABILITY BCYQDS 7/6/15 7/6/16 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGETORENume ED $ 100,000 CLAIMS-MADE F-I OCCUR MED EXP(Ary one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 11 000 1 000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PROJE C LOC $ COMBINED AUTOMOBILE LIABILITY idSINGLE LIMfT accident) $ BODILY INJURY(Per parson) $ ANYAUTO ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS (Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIP CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATLI IR OTH- CRYAND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCT DENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yyes,describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is reguired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER MA ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING INSPECTOR 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE BLDG 20 STE 2035 NO ANDOVER MA 01845 ©�1988.2010 CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: p���1/��QJCX,ClI,UJB Office of ConsumerA,ffairs& CIJ Business Regulation ;� OME IMPROVEMENT CONTRACTOR egistration: 15.1906 -� PExpiration: 7/13/2046 . Type:DBA RENE'L PERONT on: CARPENTRY RENE' PERONT 2 RAG ROCK DR WOBURN, MA 01801 Undersecretary 9 Massachusetts -.Dep..rtment of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-095381 K In Rene L Peront 2 Rag Rock Drive; Woburn MA 01881 ;> rAw;.> � 1 Expiration Commissioner' 04/01/2016