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Home My WebLink AboutBuilding Permit # 9/15/2015 qp0 RYFI BUILDING PERMIT TOWN OF NORTH ANDOVER a P APPLICATION FOR PLAN EXAMINATION - ,-; - Date Received Permit No#' _ 9SSACHUSE4 Date Issued: )rIPORTAN'i':Applicant must complete all items on this age LOCATION a- Print PROPERTY OWNER la'--t 1 6!5-z, tF 24,z- L- rn ; i. n Print too Year structure yes MAP IPARCEL:_ ' ZONING DISTRICT: Historic District ye Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential E New Building ane family ❑Addition ❑Two or more family ❑Industrial eration No.of units: -i Commercial ❑Repair,replacement ❑Assessory Bldg ❑ Others: demolition ❑Other Se fic 1tUT`\ Ploadpla n`ti ❑Wetlan- \ lNaferhed }srCct O\ DESCRIPTION OF WORK TO BE PERFORMED: Identification-Please Type or Print Clearly OWNER: Name: �F Phone' ts? Address: ? t5 t �s ti- -K,DI Contractor Name: T � '$ ' Phone xf Email iB04 3 r,C r1 moi' C v Address: S FD -1° �5 i Supervisor's Construction License: 5 Exp. Date: �--/-- yf _ Home Improvement License: 1 k Exp. Date: ARCHITECT/ENGINEER �— Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ON$125.00 PER S.F. Total Project Cost:$ FEE:$ Check No.: -91, =` Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ire Sign i _ . . _r Q NOR7b{ Town of; Andover No. so h ver,Mass, � /S q R 1' q�RnrEO y'��J S U 4 BOARD OF HEALTH �PERMIT T ILD Food/Kitchen Septic System THIS CERTIFIES THAT........ ^ BUILDING INSPECTOR Foundation has permission to erect..........................buildings on....a. ., ...�� E`................... Rough to be occupied as............1 .�.�.r:r.?waIVI II/......... '.... /. C...:./................................................... 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 UNLESS CONSTRUCTION ��STARTS //f//jJ Rough "..! �+-... Service ....................,................ ................ ,\............... Final BUILDING INSPECTOR GASINSPECTOR Occupancy Permit Required to 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. P2 IV ROBERT LANGEVIN MEN Building&Remodeling,I-l_C Homeowner Information Contractor Infformation Zanie Company Name FIs, } ;i;:.�� Street Address(do not oseaPost Qffiee Box address) Contractor/Selespersonl0vm rName City/Tawn State Zip Code =Business Address(must include a street address) " fix. C-t ")� s7;_ _ >.— 4a Ic'is,g v, c!'xi,4 Daytime Phone. livening Phone City/Town State Zip Code Mailing Address(It different from above) Business Phone Federal Employer 1D or S.S.Number ome:mrro.anem co�naao.nes.rv�nsa err�reuoo sure r.,w�mauw.9 n„r most hove �ne.ud- r: i r The Contractor agrees to do the following work for the homeowner: (Desenb in detail the workto completed,specifying the type,brand,and grade of content als to be used,use additional shouti ifnecessary.) Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will andwill be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their owes permits will be _ ' / excluded from the Guaranty Fund provisions of !�,%j /'bate when contractor will begin contracted work MGL chapter 142A.) } ate when contracted work will be substantially completed_ Total Contract Price and Payment ScheduleThe Contractor agrees to perform the work,famish the material and labor specified above for the total sum of r{i, f�-'�- "� (") Payments will be made according to the following schedule: ice or the cost of special order items,whichever is greater) by or upon completion of P%.f?'t� $ hi- 1 -4, or upon completion of $ 17» _-=' upon completion ofthe contract.(Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment most be special $ topaid for ordered before the contracted work begins in order ' to meet the completion schedule.(**) $ 2 to e paid for NOTES:(*)Including all finance charges(*")Law requires that any deposit or down-payment required by the connector before work begins may not exceed the greater of(a)one-third of the total contract price or du the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. L^p I ss w tv-& ante br rev"ddb thetr t No 11 V.(ai12e ms of then t battached[ t5 —mmet) Subcontractors-The conhactm-agrees to be solely responsible for completion of the work described regardless of the actions of any third party/suUcontractor utilized Uy the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor oder this reement Contract Acceptance-Upon signing,this document becomes a binding contract under law_Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and nodus carefully before signing this contract. ® Don't be pressured into signing the contract Take time to read and hilly understand it.Ask questions if something is unclear. s Make sure the contractor has a valid Home Improvement Contmetor R""to""on.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvomeor Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. s Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a.copy of a"proof of insurance"document. IZnow your rights and responsibilities.Read the Important information on the reverse side ofthis form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it leas been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing ofthis agreement.See the attached notice of cancellation form for an explanation ofthis right. DO NOT SIGN THIS CONTRACT IF THERE ARE, ANY BLANK SPACESM Two identical copies ofthe conhacf moat be completed and signed.One copy should go to the honoe—r.The other copy should be kept by the conhactor. I-lomquper's Signature Contractor's S gnamrc jllui �T � i11j' �� i� t f Date # I Date - ty� The Commonwealth of Massachusetts Department oflndustrial Accidents jl Office oflnvestigations 600 Washington Street A Mlu ��., Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information 'O�� / pl�yPlleeaseePrintLesibly Name(Business/Organization/Individual):1`p t Beg-r� F-7 f Address:-79-5'- DA-) S" City/state/Zip: hV©y /q- T e-la"k M A Phone#: q�� 6 3?<0 7 Are you an employer?Check the appropriate box: Type of project(required): L❑lam a employer with 4_❑I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet.$ ?. ❑Remodeling am a sole proprietor or partner- . hip and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp_insurance. 9. ❑Building addition [No workers'comp.insurance 5.❑We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 13.❑Other comp.insurance required_] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicating they are doing an work and then hire outside comrsemrs must submit a new affidavit indicating such. tContmetors that check this box must attached m additional sheet showing the name of the sob-contractors add their workers'comp.polity information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name! Policy#or Self-ins.Lie.#: 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 trader Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance'coverage verification. I do hereby yy u the pat andpenallies ofperjury that the information provided above is true and correct Sig,so re / Date Phone#: �� Oficial 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person' Phone#: Sep 11 1502:04p Langevin 9786863607 p.2 eco be CERTIFICATE OF LIABILITY INSURANCE pql -f TE5 L5. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY CR 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 AODITIONAL INSURED,the Policy(les)..at be Endorsed, If SUBROGATION IS WAIVED,subject to Ure tames and conditions of the policy,certain Policies may require an endorsement A statement on this certificate does not confer lights to the certlFirate hDltler in IleU of such eed—monIII). coarncr PRooueER pry ME E kHays Hays Insurance Agency Inc °NE1(978)586-3162 pjc N,_ (976691.425 36 Havel—Ave. E.IL S. haysj..—CeQ,,-0 St.Ret INSURERS AFFORDING COVERAGE NNGR r-Aelhuen Me.01844 A.Nortdk&Dedham Mutual Fire lnsu rantz Company sVxEO )) NGURER e: Robert Dgangevm 795 Dale St. INSURER D: INSURERE North Andover Ma D1845 INSURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE PQUCIE5 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CCNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES CESOR18RD HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T�gR POLICY EFF LiCY P yMITs TYPE OFIHSVRANGE '� POLICY NUMREa MIDeM'Yy MFUDDrmY' T`I CO MMERCMLCENERALLIA111— 'CHOCCURR'ENCCEE a 1.000,001). _I^W}ASHXiOE❑OCC'J.i PPEMISE3 Ea um,nenm S t00,000- MED axP wn an aam S 5.000. A- ft0614357A 101252014 7012512015 PERSONAL a Acv lNUuxv s 2,OOD,1)1JO. LAGGREGAT=_LIMIT APPLIES PER: .24--Ser— 5 OHCYJPRODUCTS--.E.p AGG E 2,000,000.E�CT LOC S UTIER Mel'ED SMGLE LIV IT � LIwgILDY Ea acuEanl g --E. BOOBY INJUPY IPmpasm) 5 So LED BOD... INNareo RY 1 Pdmll S �.AUTOS O ATOS NED PROPE;SB D,V.wGE NON-0'NS HIREC AUTOS AUr05 MBRE_LA LNe FFf""""'1 OCCUR ELCH OCCURRENCE S j E%CEss uAe MSrMOE AGGREGATE E RETENRONSC S PER STwTIfTE N- ARDEMPLOYERS'HLIABRriY Yf N. TOR/FARTNER'E ❑' I. —H ACCIDENT 5 E eYSER EXCLuDMxCCUTIVE 'NIA R YY Hal EL.CISEASE EA EMPLOYE $ DEUCRIPT ON OF OPERAYIONG Lcew E DISEASE-POLICY LrMT S i vnONOPOPERAT.—LOCAnoas IME—Es ACORD r41,Addgonal Ralnarke SCM4ula,nay t>o aUACM1ed II morn(1µu(1Ic nRcin� CarFernry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. North Andover Building Department 1600 Osgood at THOROF3l PRESS PTIVE Buildrg20 Suite 2035 North Andover Ma 01845 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(20141(11) The ACORD name and logo are registered marks of ACORD Office ofConsumerAffain&Su sRegulation Reg IMPROVEM 990 ENT CONTRACTOR Type: Ezpnation: :2/1112017- LLC ROBERT LANGEVIN BLDG&REMOLDING LLC. - ROBERT LANGEVIN` 795 DALE ST N ANDOVER,MA 01545 ��. Undersecretary )��t ilAas—hus cs-D.pa, of?ubiic 3�-te-;1 0 Board CY S'llC:f n7 EP CS-002685 ROBERT M LANGEVIN 795 DALE ST _ N ANDOVER AM'01845 _.,..mr,ssicaev 0212412016