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Home My WebLink AboutBuilding Permit # 12/22/2015 �a RTn BUILDING IT TOWN OF NORTH ANDOVER 0 - APPLICATION FOR PLAN EXAMINATION Permit NiDate Received tl °Argo Date Issued: « w 1 �s��CP9u`�� EVIPORTANT:Applicant must complete all items on this page LOCATION G «, Print PROPERTY OWNER ICS C Print MAP NO M PARCEL: �31'zONING DISTRICT: Historic District yes no Machine 8hab Vili ge yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential I I New Building One family 11 Addition ❑Two or more family I I Industrial Alteration No. of units: ❑ Commercial I I Repair, replacement I I Assessory Bldg I I Others: ❑ Demolition ❑ Other I i Septic I I Well I I Floodplain I I Wetlands I I Watershed District ?(Water/Sewer . p �s Identification Please'Type or Print Clearly) � V�q gv 41 a _ OWNER: Name: \l- 14 . f c I el Phone' y� I Address: . A'J e- „, CONT TOR Name: Phone: Address,: Suporvisbe's'Construction License: Exp. Date: � . 106,70 O Hom0,Improvernerit License. Exp. Date: „ � but ARCH ITECT/ENGI NEER 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. r Total Project Cost: $ CC FEE: , r Check No. Receipt No. NOTE: :Persons� l'SoiBS CiDit*,,. tI'LlC l61 1Fit�1 !$� � i° lSt�'�'L°GI C ,� � ontr�actol�S do not Piave�zcce�s to tVaty nd k Signature of A en Ow ° e- ignature of eontraeto W-1mr,19 IOU NORTH Town ofE - Andover ® ® C% Ver' Mass, coc"Ic"tw.ca �ds RATEo U BOARD OF HEALTH RMIT T LD Food/Kitchen Septic System PE • THIS CERTIFIES THAT ...............ZAAel....... .... ... ..4-c'o........................................... ............. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... . ...... amu. .. .............. .. ..®...... ... fir.. Rough to be occupied as .. . . ..... t .. .- 0.................0..�.....� . ..... ....... :cT. ... d chimney provided that the person ac ting 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 E IRS IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO T S 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. "Quality craftsmanship with a personal approach" jujilld.je ,.,rrs :w LLC Muilders.craftsman@gmail.com Jamie 978-857-4598 40 Pillsbury Rd. Sandown, NH. 03873 DATE: 11/2/15 Job Name/Address: Jane Rici R,- c.ni i 0 Waverly Rd. North Andover 1-508-265-6440 Description: First Floor Bathroom Price: Enlarge first floor closet to allow for half bath. Connecting sink and toilet to existing drain. Vanity supplied by owner (21 Sink, toilet, and faucet supplied by owner All rough plumbing, waste and supply included, to code. Electrical to code, one outlet, ceiling light and heat combo. Wall finish sheet rock take finished and primed, ready for paint by others. Floor vinyl Start job $3,000.00 Demo and framed $2,000.00 Rough plumbing and electric $2,000.00 Complete $2,000.00 Total Cost $9,000.00 We purpose to furnish materials and labor-complete in accordance with the above specifications for the sum of: $9,000.00 Respectfully submitted by: J&J Builders Any alteration or deviation from above specifications will become an extra charge over and above the estimate. Extras will be executed only upon written order and payment of 50-100% within 24 hrs. of agreement. Any unforeseen issues will be dealt with accordingly between J&j Builders and client and will be performed to meet all building code regulations. Any extras or delays from anyone outside contractor and/or subcontractors will result in immediate change to timeline if given. Note- this proposal may be withdrawn by us if not accepted within 30 days. Acceptance of proposal The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Sig ature Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: martin provost Location: 40 Pillsbury rd. City Sandown NH Phone 978-857-4598 F-1I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity Q I am an employer providing workers' compensation for my employees working on this job. Company name: Address Clty. Phone#: Insurance Co Policv# Company name: J&J Builders LLC Address 40 Pillsbury Rd. City: Sandown NH Phone#: 978-857-4598 Insurance Co Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature martin provost Date 12/22/15 Print name martin provost Phone# 978-857-4598 Official use only do not write in this area to be completed by city or town official' ❑Building Dept 0 Check if immediate response is required Building Dept a Licensing Board ■ ® Insurance Solutions Corporation - Page 1 of 1 a% ® 20CERTIFICATELIABILITYINSURANCE12/23/ 15 iii-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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the forms and conditions of the policy, certain policies may require an endorsement_ A statement on this certificate doss not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER NelUT Cynthia S t. Amand Insurance Solutions Corporation PHONE (603)382-4600 FAX (60.),82-2054 60 Westville Rd - cstamandOisc-insuranc6.com Plaistow NH 03865 INSURER A,Merchants 23329 INSURED INSURERB>Uo Insurance Company 15997 Martin a Provost INSURER C liiberty Mutual AR - WC dba a & T Builders Sandown NH LLC INSURER D; 40 Pillsbury Road INSURERE: Sandown NH 03873-2703 INSURERF: COVERAGES CERTIFICATE NUMBER:CL7.592823878 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/ODIYYYY LIMITS GIMI±RAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY $ 500,000 A CLAIMS-MADE ®OCCUR OD1071086 /20/2015 /20/2016 MED EXP(Any oneperson) 15,()00 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY F7 PRO- LOC $ FrT AUTOMOBILE LIABILITY COMBIElccNED SINGLE LIMIT 500,000 H ANYAUTO BODILY IN,AIRY(Per person) $ ALL OWNEDX SCHEDULED 0111319 2/5/2014 2/5/2015 BODILY INJURY(Per aoddent) $ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Peracddent Uninrumd motorist mmhincd $ 500,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE 6 DED I I RETENTION _ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PRO PR IETORIPARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT 100,000 OFFICERIMEMBER EXCLUDED? 5-319-610522-015 /7/2018 /7/2016 (Mandatory In NH) E.L.DISEASE-EAEMPLOYEE $ 100,000 Ifyee,deecnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addltlenal Remarks Schedule,II mora apace la required) The WC Policy does not provide coverage for Martin J_ Provost_ 3A State: NH CERTIFICATE HOLDER CANCELLATION (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DR CANCELLE=D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street N Andover, MA Ole45 AUTHORIIEDREPRESENTATIVE Keith Maglia/CLB ACORD 26(2010106) ®1900-2010 ACORD CORPORATION. All rights reserved. INS025 ronlnnatn1 Tho OroRn mama and Innn arP ronletorosrl mark¢of aroRn — ,ciirg (u ,sit uCifu 1 itiu7• � � i ll 517.7c rti ...75 CS-106705 AIARTIN PRpVpST 40 PILLSBU Sandoyvn RYROAD 1�II 03873 04/03/2016 OfTce of Consumer Affairs&Business Regulation a� rOME IMPROVEMENT CONTRACTOR ztegistration: 174685 X - Eic Type: tion:4 P ration: 3/11/2017 Individual MARTIN PROVOST . MARTIN PROVOST 40 PILLSBURY RD SANDOWN,NH 03873 ` Undersecretary' `�