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HomeMy WebLinkAboutBuilding Permit # 10/7/2015 .................... t%0RTfj BUILDING PERMIT 0 7z. TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Perm 0 ArEo y 1I it No# Date Received CH Date Issued: 'IMPORTANT: Applicant must complete all items on this page NE TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building IV,6ne family �11 A dition Li Two or more family 11 Industrial Ilteration No. of units: 11 Commercial El Repair, replacement 0 Assessory Bldg El Others: 11 Demolition El Other DESCRIPTION OF OR BE PERFORMED: \00 d a: 6V( rS Identification- Please Type or Print Clearly OWNER: Name: ::Tr->in0%, P. "a v Phone: W8 bP,38q- Address: 114 6T. f(r((((, NO'N.,I Offill 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: $ j 06 FEE: $ Check No.: 15—e'IC/ Receipt No.: 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,Signature of Sign ur� 'qf a Trac —o, �, N®RTH 2 S`ETown of ®ver ® �-,• y �n ® 20 ( �-� - o h ver, Mass, la e iL COC KIC ML'W�CK �• ATIED .9S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .................C�6�1,�f ;1�,e',�o�'�, ,,,,,,,,,,,,,,,,,,,,,,,,, ,, BUILDING INSPECTOR ......... has permission to erect buildings on `�� "�G//� -x ....�.-/` Foundation Rough to be occupied as ��dUF./l .................................................. ................................................................................ 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 ERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIOFARTS Rough Service ............. .... ... ,.a,�..�..�........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz 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. North Andover MIMAP October 6, 2015 I Y I �4'lu Y 4 qq t p, ol, ii I��kli I NII V � �I h dl� e J i ®MVPC Bo Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, — Meters SR Data Sources:The data for This map was produced by Merrimack t4ORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads Ct C r 'qk wrth Andover.Additional data provided by the Executive Office of l"r Easements „t b4 **4 Qa Environmental Affairs1MassGIS.The information depicted on this map is Parcels 3 G for planning purposes only.It may not be adequate for legal boundary O .»— A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {tWIMMW7F THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY f f ^ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Jr ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �pSSHCHUs�j 1"=55ft ° AA// Rene L. Peront Custom Carpentry 2 Rag Rock Drive Woburn, MA 01801 REMODELING CONTRACT This contract between John Lahoud, 114 Middlesex Street, North Andover, MA and Rene L. Peront (contractor)for labor and materials described below is agreed to by the undersigned parties. Rebuild pre-existing 4-foot 6-inch by twelve-foot porch at back door of house. Deck to include two sets of stairs, one at each end. The building permit will be obtained by the contractor and is part of the total cost. The project will begin on October 5, 2015, and is expected to end on or about October 26, 2015. The total cost of the project will be $12,000. Payment will be scheduled as follows: '3 due upon signing of contract Y3 due upon 50%completion remainder upon satisfactory completion Rene L. Peront 2 Rag Rock Drive 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 1 hereby agree to all terms and conditions of this contract and acknowledge the homeowner's right to cancel this contract within three days of the agreement. HOMEOWNER DATE O / CONTRACTOR DATE O. 4/ The Commonwealth of Massachusetts Department oflndustrialAccidents _4 1 Congress Street,Suite 100 Boston,MA 02114-2017 .� www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name (Business/organization/Individual): e( Address: �cz HOCK �✓' City/State/Zip: LVo b 0 rn e9180Phone#: 33 9 7 ` /196 Ilk Are you an employer?Check the appropriate box: Type of project(Vequired)' 1.❑Ia aemployerwith • employees(full and/or part-time).* 7. E] ewconstruction 2.I IVa"`a sole proprietor or partnership and have no employees working for me in 8. emodellrig any capacity.[No workers comp.insurance required.] 9, ❑Demolition 3_❑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 ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub contractors have employees and have workers'comp.insurance.# 14.❑Other 6.❑We are a corporation and its offigers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submif this affIidavit 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 state whether or not those entities have employees. If the sub•confractors have employees,'tliey'must provide their workers'comp.policy number. -tam an employer that is pr'ovidhig workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 WORK ORDER and a fine of up to$250.00 a may be forwarded to the Office of Investigations of the DTA for insurance day against the violator.A copy of this statement coverage verification. I do hereby certify under the pains a alties off rJuly that the information provi1ded above is true and correct. Signature: Date' /D o6 o�ojJ� Phone#: a39 CO4 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 Per son: Phone#: ® DATE(MM/DD1YYYY) AC40R o CERTIFICATE OF LIABILITY INSURANCEF 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 statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER CONTACT NAME: W. Gochis Insurance Agency Inc PHONE 781 272-8306 FAX N (781) 272-1362 113 Cambridge StreetE-MAIL ADDRESS: ochisl@verizon.net Burlington, MA 01803 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Commerce Ins. Co. INSURED INSURER B: Rene's Custom Carpentry INSURER C: 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE JM ACOL WVD SUER POLICY NUMBER MM DDjA POLICY EXP LIMTS A GENERALLIABILITY BCYQDS 7/6/15 7/6/16 EACH OCCURRENCE $ 500,000 X COMdERCIALGENERAL LIABILITY DAMAGE TORENTED- $ 100,000 CLAIMS-MADE F-1 OCCUR MED EXP(Ary one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LI MIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1 OOO OOO POLICY PRO- ,ECT RO LOC $ AUTOMOBILE LIABILITY C MBINEDSINGLELIMIT a accidert $ ANYAUTO BODILY INJURY(Per person) $ ALL 0 WNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED P eOr PE TY DAMAGE $ HIRED AUTOS _AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I WC STATU-T. 0TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTNE E.L.EACH ACCIDENT $ OFFICE R/NIEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA=EMPLOYEE If Yyes describe under DES�RIPTIONOFOPERATIONS below E.L.DISEASE-POLICYLIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is requ red) i 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 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts -Dep,.rtment`of Public Safety Board of Building Regulations and Standards Construction Superi-kor License: CS-095381 Rene L Peront 2 Rag Rock Drive , Woburn MA 01801 � r Expiration Commissioner 04/01/2016 ��r— e�poa�t��zaaz�aeccll�o�C/l/���JJac�crte� Office of Consumer Affairs&Business Regulation -. (HOME IMPROVEMENT CONTRACTOR �egistrati on. 151906 Type: 1%Expiration: 7/13/2016 . pgq RENE'L PERONT CUSTOM C,ARP,ENTRY f RENE' PERONT 2 RAG ROCK DR WOBURN,MA 01801 4 Undersecretary