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HomeMy WebLinkAboutBuilding Permit # 11/16/2015 t%ORTry BUILDING PERMIT TOWN OF NORTH ANDOVER � + ' - 0 APPLICATION FOR PLAN EXAMINATION ],. cocrir�new,c tlry P°' �^/ Permit No#: f5 Date Received //f RQ�RHTED aPa'R5 cHus�R Date Issued: I gSS� IMPORTANT: Applicant must complete all items on this page G , Y / �i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ., ,,, rr � , �r rr 'rar w r�rr, r r;r r r,ofr�/!(;%p(r a r.»✓I,�Nn/.4111!!I»l/,1�; ,r////,rd%/�, F loodp, DESCRIPTION OF WORK TO BE PERFORMED: G Identification- Please Type or Print Clearly /X OWNER: Name: Phone: Address: +Fail y y , I p , ii@'wuwl Y� 1.mu �i�im �lu moot an�ui�'lvrf&,ia7nrr na,r�Nwrflm,. ro m'rwr n��,. »Im oV o ilntt. ...._ ,. 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: $ 7 1 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �"-'a err aria;icrr r iuiaTr�r s! � iii /iii /�%/i���l/��Jiir FORTH "hwn ot2 e A'. n o _t ® ta+ LOP ® 041ver, IOLAKE ass' COC KICKEWICK ��S'a'gTE o ►`Pa,`,(y BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR ..... . .. . . .... Foundation has permission to erect .......................... buildin son .... S..... .. . 1. ... ... .:........... . Rough tobe occupied as ........... ...... . ...... ...... .................................!.. ................................................. 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIS Rough Service ................................................................................ Final BUILDING INSPECTOR 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Desmond Construction, inc, Date:10/24/2015 Proposal Maura Boucher 245 Blue Ridge Road North Andover, MA 01845 PROPOSAL—Master Bath Renovation Item 1: Permit Acquire Building Permit. Item 2: Demolition Remove existing vanity and sinks, shower area,floor tile,Jacuzzi panels, mirrors and towel bars. Item 3: Plumbing Install P.V.C. pan for shower tile floor. Move rough plumbing for double sinks. Install new sinks, toilet, shower valve and head. Item 4: Electric Move two existing recessed lights. Install G.F.I. receptacles, location to be determined. Item 5: Installation Install new vanity and Jacuzzi panels. Install shower and floor tile. Install new closet shelving, new door hardware, install bead board and chair rail, approx. 40" height. Install mirrors.Touch- up wall board as needed. Total $ 18,320.00 Note: Painting by Others. Tile, shower and sink hardware by provided by homeowner. Door hardware provided by homeowner. Desmond Construction,Inc.,P.O.Box 41,North Andover,MA 01845 Phone:978-682-2279/FAX.978-682-2279 bm-desmond@comcast.ngt. . „� Desmond Inc, c All material is guaranteed to be as specified, and above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of$ 18,320.00 25% upon signing $4,580.00 25% upon start of project $4,580.00 50% upon completion of project $9,160.00 An interest charge of 1.5 % per month will be applied to any balance due 30 days after completion of this project. Any alteration or deviation from above specifications involving extra cost will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on the above work to be taken out by Desmond Construction, Inc. Respectfully submitted . per Matthew Desmond NOTE:This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specification and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Signature: Date: Signature: Date: Desmond Construction,Inc.,P.O.Box 41,North Andover,MA 01845 Phone:978-682-2279/FAX:978-682-2279 bm-desmond@comcast.net The Commonwealth of Massachusetts . Department oflndustrialAccidents " = 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le:=ibly Name(Business/Organization/Individual): �'-",YV'y Address: /Y a1 GA~4 ' City/State/Zip: �t/� !'aco �' >?. �� f' Phone#: 7 i An an employer?Check the appropriate box: Type of project()required): /k I am a employer with employees(full and/or part-time).*-, 7, ❑New construction 2.❑ m a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition I❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.F]We area corporation and its of�cers have exercised their right of exemption per MGL c. 14.❑Other 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. t 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,'tiiey must provide their workers'comp.policy number. I am an employer that is providing wort ers'compensation insurancefor nzy employees.•Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#: ✓!,'3 A P311:6-S11 Expiration Date: Xh�3l` 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 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 certify under e pains and penalties ofperjury that the information provided above is true and correct. Si nature: Date: lJ" If" Phone#• b W- , b 2 a `?-S 3' Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitALicense# 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#: CERTIFICATE OF LIABILITY INSURANCE 1�3/20015Y) -11/31/2 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(fes)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 NAME: Victoria Lowes, CISR MTM Insurance Associates PHOU�mNE (978)681-5700No;(978)6B1-5777 1320 Osgood Street ADDRESS:Certificates@mtminsure.com INSURERS AFFORDING COVERAGE NAIL S North Andover MA 01845 INSURERA:Travelers casualty Ins Cc of 19046 INSURED INSURER a'Travelers Indemnity Company of 25682 Desmond Construction Inc INSURER C: 19 Upland St INSURER D: INSURER E North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:15-16 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 ADDLITYPE OF INSURANCE SUBRI POLICY EFF POLICY EXP LIMfTS LTR POLICY NUMBER M/D MIDDIYYYYI X OOMMEROIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES Ea occurtence $ 300,000 6003AS233671542 7/7/2015 7/7/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY❑PEO- LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: BlId Addl Ins Contractors $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ '.. Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ HIRED TSAUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Peracclde t UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION Beatrioe and Matthew R PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXEC '7 Des=nd are eroluded E.L.EACH ACCIDENT $ 1,000,000 B OFFICERRdEMBER EXCLUDED? �N/A (Mandatory In NH) 1Um3A83186S15 8/23/2015 8/23/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Add8lonal Remarks Schedule,may be attached If more space Is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. N Andover, MA 01845 AUTHORIZED REPRESENTATIVE ��/ L Mancinelli, CIC/SAM Cul".1/uU///ectv'hY/� '.. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORID INS025 nmantt c97ae 0-// 0 �j j a,C/ e a j/' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 143109 Type: Private Corporation Expiration: 6/18/2016 Tr# 254059 DESMOND CONST. INC. MATTHEW DESMOND 19 UPLAND ST N. ANDOVER, MA 01845 Update Address and return card.Mark reason for change. Address n Renewal R Employment F] Lost Card SCA 1 0 20M-05/11 Consumer Affairs o ess Regulation ealio ref( License or registration valid for individul use only Office of Consumer Affairs&Busifiess Regulation g y OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: A� Office of Consumer Affairs and Business Regulation 1—� egistration: .143109 Type: g xpiration: -6/18/2016 Private Corporaticn 10 Park Plaza-Suite 5170 Boston,MA 02116 DESMOND CONST.INC. MATTHEW DESMOND 19 UPLAND ST ga ;gyp N.ANDOVER,MA 01845 — - Undersecretary Not vali without signature jauoisSIWiuoo 91,I)M !£0 U0 e.ltdX, WI( I, i oslo WV.tanopud:giioli iaoj;S pualdII 61 &OW9ad A MAIUIVW 10NIAr13dns uonan.Usi[�r� sp.Repue}S pue suo1leinF5a�j buippma l.o p1e09 fi�q�.eS oilgnd J,-,JuaiuVedaa s�iasnyoesse�ti! t