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HomeMy WebLinkAboutBuilding Permit # 12/28/2015 %AORYy BUILDING PERMIT o`�zLEo TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION � s cM M1. Permit N®#: g/ Date Received �Rp�RA7ED Peps O� SS•acHus�� Date Issued: ' z IMPORTANT:Applicant must complete all items on this page LOCATION rt PROPERTY OWNER /�--Z/'" '5'�Z �7 Print 1 oo Year Structure yes no MAP 0 F/ PARCEL: ZONING DISTRICT: Historic District yes � ) Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family El Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other S*e tic ❑11Vell ❑ Floodplain Wetlands "❑ �Nate�shed Distract sr^:"`$ `"m`?- p L'i'✓/klg l' /ir f `;'W . i',,p7,^y„q, N' {. N ' r ��`� ��' ✓l t $/ " ; a � y� �/"�3�'�� / r�rr d r r ,, f '� ' ,.,,,,,%'rf,,Y �*n ,�r,.�a.f� ys'��ia,,,/'- ta r „ DESCRIPTION OF WORK TO BE PERFORMED: dentifi:eation- I.Ple 'Type or Print Clearly OWNER: Name: <�C�,�,�� /° � �� d Phone: ' Address: Contractor Name: "tel °y Phone: Email: Address ' Supervisor's Construction License: Exp. Date: �rJ 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. i Total Project Cost: $ 19o `" FEE: $ d � ' y Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to h guar n `f rind -- - —-- t%®RT H Town ofWi Andover2 0 0 No. e ilvt6e O LAI(@ COCMICNl WICK S Awl>e 11 BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System ... THIS CERTIFIES THAT ........ BUILDING INSPECTOR .. . ... .......................::: ....... . ...... ....... ...... has permission to.erect ... g . ... Foundation .........�............. buildings ............. ... .. .:.... ..... .. . .. ............. . Rough to be occupied as .. ..... ... . �. ....... .. . ...... ... Z-4..... .. .. ......................... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service .................. ............................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuouslac r ises — Do Not Remove Final No Lathingr Dry Wall To Be ®rte FIRE DEPARTMENT til Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. efivd..4 wfm cjx4v tyuctian Kevin McLellan 158 Dale Street North Andover,MA 01845 kbm@sloan.mit.edu (C) 617-510-3497 (H) 978-688-5007 December 28,2015 2°d Floor Bathroom Remodel Work to be included includes: • Acquire Building Permit • Demo of bathroom. • Complete all required plumbing. • Install new Panisonic light/vent unit. • Complete all electrical. • Install Electric radiant heat in floor. • Install 36 x 48 Cl Shower base. • Install DenseShield Tile board on shower walls. • Install the for shower. • Install two grab bars. • Install electric floor heat.. • Install new the floor. • Install new toilet paper holder,towel bars. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 9,000.00 Terms: $3,000.00 upon signing of contract(not to exceed 113 of contract price) $3,000.00 after plaster complete $3,000.00 when complete Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-794-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel: 617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. 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. Date /S' Homeowner Signature 'J6�A �._ Date el�Contractor Signature -"�" The Commonwealth of Massachusetts Department ofXndustrialAccidents !Soffice of Investigations i, i 600 Washington Street 4 ' Boston,AM 0211.1 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Please Print 'h App1]lcant Information �� ,%� Name(Business/organization/Individual): y r Address: City/State/Zip:,/Jo: fz ��;;���'>�: .�� PPhone#: "s � °� �• .�/��. Are you an employer?Check the appropriate box: Type'of project(required): 4. [] I am a general contractor and I 6 ❑New construction 1.❑ I am a employer•with � have hired the sub-contactors mpl We (full and/or part-time).* 7.. Remodeling � listed on the attached sheet ❑ 2.® I am a sole proprietor or partner- These sub-contractors have g. F]Demolition ship and have no employees working for me in any capacity employees and have workers' 9 ❑Building addition comp. instirance.1 • [No workers'comp.insurance S. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself.[No workers'comp• right of exemption per MGL 12.[]Roof repairs c. 152,§1(4),and we have no insurance required.]t employees.[No workers' 13•❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeownets 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. - I am an employer that ISP rovidh.tg workers'compensation insurance for my employees• Below rs thepolicy and job site information. - Insurance Company Name: � � , Policy#or Self-ins.Lie.#: ✓ ' %�� g Expiration Date: `7 t �> Ci /State/Z' Job Site Address:_ �: 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. I do hereby certify up ��lie p ns a penalties of perjury that the information provided ab ve-is ue and correct � .i°. Date: � ��. Phone#: [[6.Other al use only. Do not write in this area,to be completed by city or town official r Town: Permit/License# Issuing Anthority(circle one): ard of Health'2.Building Department 3.City/Totvn Clerk 4.Electrical Inspector 5.Plumbing Inspector act Person: Phone#• OP ID: OUJA ® p �+ DATE(MM/DD/YYYY) C TIFICA F LIABILITY INSURE' NC 09/21/2015 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(les) 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 Phone:978-688-6921 NAME CT Jane Ouellette Macdonald&Pangione Insurance Fax:978-688-5350 PHONE I AX Ne): 978-688-5350 P.O.Box 428 _(AIC,No Ext):978.688-6921 E-MAIL 104 Main Street ADDRESS:jane@mpins.net _ North Andover, MA 01845 PRODUCER CHRIS-5 Michael Pangione CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE_ NAIL# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. INSURER B: North Andover, MA 01845 -INSURER-C: _ INSURER D: INSURER E:-- INSURER :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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR I TYPE OF INSURANCE NSR (ADDL SU11 POLICY NUMBER MM/DD/YYYY I MM/DDCY EFF PIC%YYYY I LIMITS GENERAL LIABILITY j EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED A X j COMMERCIAL GENERAL LIABILITY IBOP 0100719749 09/26/2015 09/26/2016 _PREMISES Ea occurrence S 100,000 CLAIMS-MADE X I OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 j GENERAL AGGREGATE S 2,000,000 J 2 000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: � j � � PRODUCTS-COMP/OP AGG S , XJEQI .POLICY -. PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO � BODILY INJURY(Per person) $ ._�ALL OWNED AUTOS � BODILY INJURY(Per accident)I$ -. SCHEDULED AUTOS i PROPERTY DAMAGE $ ! (Per accident) i I HIRED AUTOS . - i NON-OWNED AUTOS ) ! $ UMBRELLA LIAR i OCCUR f E_A_CH OCCURRENCE I S i EXCESS LIAB , --_ CLAIMS-MADE I AGGREGATE _ $ DEDUCTIBLE I _ $ RETENTION $ $ WORKERS COMPENSATION WC STATU- I I OTH-1 AND EMPLOYERS'LIABILITYY/N j TORY LIMITS i I ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1 E.L.EACH ACCIDENT j $ OFFICER/MEMBER EXCLUDED? N/A l (MIf andatory in NH) E.L.DISEASE-EA EMPLOYEE$ DESCRIPTION OF OPERATIONS below ! E.L.DISEASE-POLICY LIMIT $ I i i I i 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St No Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD f'dassachL,setf �Dep artux an did i'. a6�a f a B%frd Of SUui d i Re LflaflWar Standa: rds #_ensu CS-072173 rr a CHRISTOPHER TRIVET 207 WINTER ST,' N ANDOVEk AM 01b, 1 8 � uua �«::gin o rrnr ssic neu 06/02/2016 a,, �/�r�rtrartrr«rtrar�r�l�c�r''/lif.Jrrr•�r%ic«f!t Office of Consumer Affairs&Business Regulation 41 HOME IMPROVEMENT CONTRACTOR q� Registration: 139962 Type: k Expiration: 9/8/2017 Individual CHRISTOPHER F.RIVET CHRISTOPHER RIVET 207 WINTER ST. N.ANDOVER,MA 01845 Undersecretary