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Home My WebLink AboutBuilding Permit # 12/9/2015 UILDIN "ORT6{ PERMIT e T TH ANDOVER � Fermat N®: m, Date Received i ION — , z/ APPLICATION FOR PLAN EXAMINATION ass Are. Date Issued: c INIP'ORTANTd Applicant must complete all items on this page LOCATION m , Print PROPERTY OWNER t"` a, e,, Print MAP NO: ffPARCEI / ZONING DISTRICT: Historic District yes n Machine Shop Village yes ho TYPE OF IMPROVEMENT _ PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial [ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer of d �,"vl o" . c 0 eyN f °oma m, A/,,t u, x I Ck re n 0% " .. Te �-q, I. I Identification Please Type or Print Clearly) F OWNER: Name: �(� Fv ��i C c" Phone: C I r o Address: l lU � 11 1�t'l /y" I�" !/� 6)CLI— CONTRACTOR Name: .. P ne: ... °3 i S e Address: -7 ° � „. . � C ,. r � . W Supervisors Construction License: .., Exp. Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ � t.l� �� FEE: $ Check No.: '° r Receipt No.: 2 'Z 2iL NOTE: Persons contracting wit unr ste d contractors do not have access to the guaranty fiend I Signature of AgentlOwner. ,,' Signature of contractor "w� �F NORTown ofH Anduver . - ' t ® w` to ® .® _ �{� *— h ver' ��' 1?!1 d `J � COCHICN[WICK V .AA0RATE® S U BOARD OF HEALTH PERMIT T L D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .... � -- j Foundation has permission to erect.......................... buildings on ... g... ............................... �J Rough to be occupied as ......... G�Gr� ... ....................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final - PERMIT EXPIRES IN 6 THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service ................... . ......... .. .......::.............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Bu Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected r e the Building Inspector. Burner Street No. Smoke Det. Continental Window Company 357 Concord Rd. Billerica,Ma 01821 Date 978-764-3353 / 1 —F— Estimate# Name/Address EMILY&GREGORY BOURBEAU 66 COLONIAL AVE. NORTH ANDOVER,MA.01845 Project Description Qty Rate Total DATE OF WORK STAMINATE 12-8-2015 BATHROOM WORK WILL CONSIST OF: 14,000.00 14,000.00 CONTRACTOR WILL DEMO BATHROOM CEILING,WALLS AND FLOOR DOWN TO STUDS AND SUB FLOOR. CONTRACTOR WILL REFRAME WALLS AS NEEDED TO CREATE NEW BATH DESIGN. CONTRACTOR WILL REINSULATE TO CODE. CONTRACTOR WILL BLUE BOARD AND PLASTER WALLS AND CEILING. CONTRACTOR WILL PERFORMED ALL TILE WORK AS NEEDED. CONTRACTOR WILL INSTALL NEW WOOD TRIM AS NEEDED. CONTRACTOR WILL INSTALL BATH FIXTURES AS NEEDED. CONTRACTOR WILL PAINT BATHROOM. JOB SPECS. COST OF ELECTRICAL WORK IS INCLUDED IN PRICE. COST OF BUILDING TYPE MATERIALS INCLUDE IN PRICE. COST OF TRASH REMOVAL INCLUDED IN PRICE. COST OF PLUMBING IS NOT INCLUDED IN PRICE. COST OF ALL BATH FIXTURES NOT INCLUDED 1N PRICE. COST OF TILE,GLASS DOORS AND BATH FAN NOT INCLUDED IN PRICE. PAYMENTS WILL BE FOUR PAYMENTS DIVIDE EVENLY. CONTRACTOR WILL SIGN BELOW (GERARD MICHAUD) HOME 0 RS W L Sl N BELOW G, ~� 1 Total Page 1 Continental Window Company 357 Concord Rd. Billerica,Ma 01821 Date 978-764-3353 Estimate# Name I Address EMJLY&GREGORY BOURBEAU 66 COLONIAL AVE. NORTH ANDOVER,MA.01845 Project Description Qty Rate Total FIRST PAYMENT START OF JOB. $3,500.00 SECOND PAYMENT AFTER ALL ROUGH INSPECTIONS ARE SIGN OFF. $3,500.00 THIRD PAYMENT AT START OF TILING $3,500.00 FINAL PAYMENT JOB COMPLETION. $3,500.00 i Total $14,000.00 Page 2 Xhe Commonwealth of.lMassgchusetts Department of1ndustrialAccidents 1 Congress Street,Suite.100 r Boston,HA.02114-2017 ~ www.mass.go-P/dia Workers'Compensation insurance Affidavit:Buildexs/Contractors/Electficians/PXumbers. TO BE,FIG1;D WITH THE PERMITTING AIJTHORITY. Please Print Le Applicant Information ibly NaMe(Basin.ess/organization&dividual): 1 ° C Address: 3 5 Q C City/State/Zip: ► c lr t Phone#: "/ " Are you an employer?Chec'ktlie appropriate box: Type of project(]required): 1. 1fam a employer with , ( employees(full and/or part-time).* `/. Q NOW construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9, []Demolition 3.❑I am a homeowner doing all work myself,.[No workers'comp.msuranee required.]t ]0 E]Building addition 4.F1 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 oz aro sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[JPlumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.❑Other 6.Q We are a corporation and its ofcers have exercised their right of exemption per MGL c. 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Auy applicant that checks box#1 must also fill,out the section below showing theirworkers'compensation policy information. i Homeowners who submiti flus afbdavit indicating they are doing all work and then hire outside contractors must submit anew 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-conlracfors have employees,ley must provide their works'comp.policy number.` orkers'compensation insurance for my errt_ployees.'Below is the policy and job site X am an employer Haat is pr6vidir1g w information. Insurance Company Name: r` ,- rYV Policy#or Self-ins,Lic.#: e ExpirationDate: fob Site Address. �4 4 C C `✓ Ciiy/State/Zip:JL% , t t c Attach a copy of the workers'compepsation policy declaration page(showing the policy number and expir anon date). Failure to secure coverage as required under MGL e. 1.52,§25A is a criminal violation punishable by a fine up to$1,500.00 and/ox 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. X do Xiereby certify under tl:epains andpenalties ofpeijuly treat the information provided above is true and correct. • Date: , Sign Phone#: l Official use only. Do notwr'ite in this area,to be completed by city or town offacial. 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#t: CERTIFICATE F LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/07/2015 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 endorsement(s). PRODUCER NTACT NAME: Darlene Villaras MERRIMACK VALLEY INSURANCE AGENCY INC. P"CON a E.11: 978 667-2541 (AA/C No): E-MAIL ADDRESS: dvlllaras@mvinS.COm 655 BOSTON RD#1A INSURERS AFFORDING COVERAGE NAIC# BILLERICA MA 08121 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: GERARD MICHAUD INSURERC: DBA CONTINENTAL REMODELING INSURERD: 357 CONCORD RD INSURER E: BILLERICA MA 01821 INSURER F: COVERAGES CERTIFICATE NUMBER: 16413 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 EFF POLICY EXP '...... LTR INSD WVD POLICYNUMBER MMIDDIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE FIOCCUR -PREMISES Ea occurrence)$ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F—]PE7 F—]LOC PRODUCTS-COMPIOPAGG $ '.......... OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLELIMIT $ '........ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Peraccident) PROPERTY DAMAGE $ HIREDAUTOS AUTOS $ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ '... DED RETENTION$ $ WORKERS COMPENSATION '.. AND EMPLOYERS'LIABILITY Y/N X STATUTE EOR ANYPROPRIETOR/PARTNERIEXECUTIVE E.L EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? NIA NIA NIA WC231S365342035 04/25/2015 04/25/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 ff yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits Will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gregory Bourbeau ACCORDANCE WITH THE POLICY PROVISIONS. 66 Colonial Ave AUTHORIZED REPRESENTATIVE N Andover MA 01845 Daniel M Crowley,CPCU,Vice President-Residual Market-WCRIBMA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a '"/�r Y�arrrrrtorra.rr�lf�r�"l`lcr,lctr Office of Consumer Affairs&Business Regular, • 4AOME IMPROVEMENT CONTRACTOR Registration: 136279 Type 7 Expiration:-:, 7/112016 Individual GERARD MICHAUD" GERARD MICHAUD 357 CONCORD RD. BILLERICA,MA 01821 g � Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards t',ratstruction 5a{aer%isor License: CS-082124 GERARD J MICHMJ001,11. fi 357 CONCORD RD '% ¢ BILLERICA MAois Expiration commissioner 01/0712016