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HomeMy WebLinkAboutBuilding Permit # 10/20/2015 BUILDING IT �,o�rH F p- Q��.L@ O I g�•Yo TOWN OF NORTH V E .y APPLICATION FOR PLAN EXAMINATION ® ` 7° Permit No#: Date Received sSACHUs� Date Issued: �� IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER ,.. ` � . �. � . 0 Print 100 Year Structure e . no MAP °`� 2- ZONING DISTRICT:_ Historic District es nog PARCEL:M2- y Machine Shop Village yes roe TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1 -One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .Y/ J//f/ / I , // , /, �/ J / / / ,, Wetland ,f ,/ 0 r / / r J r �� �����/l%�1�'1�/���ii��i//,�������,, DESCRIPTION OF WORK TO BE PERFORM w ,,. oo Pleas Ide tification- e Type or Print Clearl OWNER: Name , ti �P � ,4 l w. " - Phone"7 � 79;071 d" Address: . :m. � ... " r Contractor Name: C a . i . : Phone Email / t2-41 .,: �, t Address: " m,: JD Supervisor's Construction License: e 4 K Exp. Date: r Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone:—----, hone: .. Address: Reg. No. ,,,,.w.,....... FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. w , � Total Project Cost: $ �°_ FEE' $ Check No. Receipt No. r� NOTE: Persons contracting with unregistered contractors do not have access the aranty and „ - NORT#1 Town ofAndover - , / ® ' ..� 0% �.KE h ver, Mass, COC KICME WICK ��• AOOATE D S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .... ....Al. ��......�1�r � BUILDING INSPECTOR . ............... has permission to erect ............ buildings on � ; lt ' Foundation .............. . ....... ..................... %I,. � �� Roughto be occupied as .. . .. .. pok........................... Chimney provided that the person acceptin is permit shal 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 16 MONTHS ELECTRICAL INSPECTOR NLESSCT1 SS ARTS Rough ............. ., _ ....................... Service '�"""' BUILDING INSPECTOR Final GAS INSPECTOR 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. ROBERT LANGE I 795 Dale Street iv �'ty [North Andover, MA 01845 ti g0C, h(0 LO ilk `F`J7C�c-.U7�2C3 ��e; � F 2 N ROBERT LANGEVIN 0 Building& Remodeling, LLC 795 Dale Street North Andover,MA 01845 (978)686-3607 HIC#111990 FID#26-0816298 www.LangevinBuilding.com Stephanie and Allan Murphy 280 Salem Street North Andover, MA 01845 Job Descriptio Single story mud room 8'6"X 6'0" • All necessary building permits • Hand digging for concrete piers and floor • Pour concrete • Frame floor, walls and single pitch roof • Roofing and siding to match existing • One exterior wood door up to a cost of$500 • One stock Windsor double hung window as close as possible to those on the house • Remove old window in living room and seal the hole (frame and plaster) • Insulation to code, but no allowance for heating • Electrical: move entry light, 1 ceiling light, switching, I exterior outlet,2 inside outlets • Blueboard and skim coat plaster walls and ceiling • 1/2"durock on floor and tile up to a cost of $5 per square foot • Mopboards , door and window trim • James Hardie cement board to seal crawlspace • Harvey Industries Lifetime storm door • Open storage shelving on one wall to your specs • Interior and exterior painting • All cleanup and trash removal Contractor Initials Homeowner Initials DAT A�O® E.( M10. _ ) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H LDE . 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 endorsement(s). PRODUCER - CONTACT Erik Hays Hays Insurance Agency Inc. PHONE0. • (978)686-3162 JX No): (978 89-4425 36 Hawthorne Ave. AIL ADDRESS: haysinsurance@comcast.net INSURERS AFFORDING COVERAGE NAIC# Methuen Ma. 01844 INSURER A: Norfolk&Dedham Mutual Fire Insurance Company INSURED INSURER B: Robert DangeVin INSURER C: 795 Dale St. INSURER D: INSURER E: North Andover Ma 01845 INSURERF: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDPOLICY/YYYY MEFF POL'D(YYY) LIMITS XP LTRSo Wyn COMMERCIAL GENERAL LIABILITY. EACH OCCURRENCE $ 1,000,000• AGE CLAIMS-MADE D OCCUR PREMISES(Ea Ea occurrence $ 100,000• MED EXP(Any one penton) $ 5,000• A R0514357A 10/25/2014 10/25/2015 PERSONAL&ADV INJURY $ 2,000,000. GEN_'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000• PE� D LOC PRODUCTS-COMP/OP AGG $ 2,000,000. POLICY D —{ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AU r0 i 60DiLY INJUKY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED $ _ HIRED AUTOS AUTOS Perr acofRdentDAMAGE $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ ~: EXCESS LIAB CLAIMS-MADE AGGREGATE $ —t— I DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE OTH- ER PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S Ifyes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. AUTHORIZED REPRESEtfATIVE Building 20 Suite 2035 North Andover Ma 01845 \ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street �'�WBoston,MA 02111 -1 § www.mass.gov1dia ns/Plumbers Workers' Compensation Insurance Affidavit: Builders/Contrac.tors/Electricia Applicant Information Please PrintLeaib ly Name (Business/Organization/Individual): Address:. City/State/Zip: N I+N_D 0V-UA M A Phone#: 76'3 1<0 Are you an employer?Check the appropriate box: Type of project(required). I am a employer with 4. El I am a general contractor and I 6., New construction employees(full and/or part-time).* have hired the sub-contractors 7. FIRemodeling ""'J'uy�a listed on the attached sheet.I 2. I am a sole proprietor or partner- These sub-contractors have 8. n Demolition hip and have no employees workers' comp.insurance. working for or me in any capacity. 9. n Building addition [No workers'comp.insurance 5. F1 We are a corporation and its IOTI Electrical repairs or additions officers have exercised their required.] right of exemption per MGL 11.0 Plumbing repairs or additions 3111 am a homeowner doing all work c. 152,§1(4),and we have no I2.FJ Roof repairs myself.[No workers'comp. insurance required.]t employees. [No workers' 13,F1 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the se*ction 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 a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and jab site information. Insurance Company Name: Policy 9 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby c tify u er the palan(�penalties ofperjury that the information provided above is true and correct.' qs� Signature: Date: Phone#: ff Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): Electrical Inspector 5. Plumbing Inspector 1. Board of Health 2.Building Department 3.City/Town Clerk 4. 6.Other Contact Person: Phone 9: ���r. �cnrneeyrrr..enlf�c/r'-f�rJ�nr•�rt:in// Office of Consumer Affairs&Business Regulation NOME IMPROVEMENT CONTRACTOR va -1Registration: 111990 Type: �,\ ;Expiration: 2/11!2017 LLC =. ROBERT LANGEVIN BLDG&REMOLDING LLC. ROBERT LANGEVIN 795 DALE ST N ANDOVER,MA 01845 Undersecretary UMassachuseiis -Depat-tment of.Public Se eiy Board of Building Regulations and Sandards L o Iiit Yu ction�uw-,'':ii:nr - ;cense: CS-002685 - - ROBERT M LANG-$VIN _. 795 DALE ST N ANDOVER MA 01845 if ilk C o mmnssione: 02/24/2016