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Home My WebLink AboutBuilding Permit # 1/19/2016 BUILDING PERMIT :`a o` TOWN OF NORTH ANDOVER G; APPLICATION FOR PLAN EXAMINATION Permit No#: D 12 Date Received Date].sued: 61�l C IICIPORTANT:Applicant most complete all items on this page � LOCATION Pr't PROPERTY OWNER Print 100Year Structure ye no MAPj(T PARCEL:15t St ZONING DISTRICT: Historic District y s no Machine Shop Village y s, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building gjOne family C Addition ❑Two or more family ❑Industrial Iteration No.of units: ❑Commercial ❑Repair,replacement ❑Assessory Bldg ❑Others: ❑Demolition ❑Other DESCRIPTION OF WORK TO BE PERFORMED: R A�a;YiY,',{ k , �9-Nit 'mss'\ey1Y^r- Idenfification-Please Type or Print Clearly OWNER: Name: 5jix]v 5 Phone:S7f �5/`f Address: �� J- ' '-vim `�t> IS%�- - €�c'l � _ ContractorName: -+�T- '�' t'`'f"Phone: `�� Email` Address: S-f` Supervisor's Construction License: 5 Exp. Date: j� Home Improvement License: %f 1 (0 Exp. Date: �-:�it i l-7 ARCHITECT/ENGINEER Phane-->? Address: -_. — __.Reg.No. FEE SCHEDULE:BULDING PERMIT'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTRASED ON$125.00 PER S.P Total Project Cost:$ �L�, �G' -- FEE:$ C� � Check No.: l i Receipt No.: C1 19 NOTE: rsons cont acting wi unregistered contractors do not have access to the guaranty fund / t ' ii own ofNORTH a Andover h ver,Mas VAIe A 9q S U BOARD OF HEALTH PERMIT °°d/Kt hen I Sept e System O® Ydr..... BUILDING INSPECTOR THIS CERTIFIES THAT... ��.....�..... ..................... ..... .�......A........................... lizs:permission to erect..........................buildings on. .... !h�.W.�?.!?ii4...... ............. 0 \1 Rough to'be occupied as11 .:...................................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Fmel bn file in this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and .donstruction of Buildings In the Town of North Andover. PLUMBING INSPECTOR .4�VIOLATION of the Zoning or Building Regulations Voids this Permit. R°agn Final F. PERMIT EXPIREMO T S ELECTRICAL INSPECTOR UNLESS CONSTR S TS R°ugh Service _ ...... ........ ............................................................. Finel BUILDING INSPECTOR GAS INSPECTOR Occunancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises—Do Not Remove F°al No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ag BERT JUNNGEVIN Building&Remodeling,LLC Hose eassouserhafmindauthops Contractor Ifif---tim, Company Name Sue.Aninew(de..,usto Post Ctffiei,Bw,,ddcwa) Cumeneb Salesperson/().mer Noun CiVT.— Sun, Zip Code Business Address dounticuled—bonaddrew) i"kSf"o Jca�T)Cv;r_P- Nl",� -I)Arm s- D,pbma Plrone. Evening Phone Cityflum gone, Zip Cleo 7 M,ha,Addue,(Jtd,ffium1r11.bo_) —Inter lu or "nee.ar mpm em 7— M.— The Contractor a,wea to do the following-k to,the Homeowner: (Dauldo,se detail the ruilc 0 cautioned,specifying thetyp,brand,and 9.da of materials to be used,us dI Ashi o Required Pas—amts-The following building permits—required Proposed Stnrt and ComQletion Schedule-7he following schedule will and willbe secured by the contractor as homeowners lumewwra agent: be adhered to notes,circumstancesbeyond the contwoul's control arise (0—cro who secure their—.pernuta will be c.c,.d.d f,..the Guaranty Fund provisions of Dim,when contractor will begin contracted work MGL chapter 142A.) Date when coubaced work will be substantially completed. Tood Co.&..Moo and Payment Schedule Mi 71C The Contractor agrees to perform the wan,furnish the brands]and labor specified above for the total ance,ok Y_ Payments will be made according to the boll—mg;schedule: s7ccc, or the cost,fspecial,rderitems,whichever isaeafir) S 45 C:'OG 'prot"oul'tibe at or upon completion of up,,completion of the weramon.(Law finbide demanding fall tworeart until caumser is completed to both panty's estisfinliten) The onk"wi.a otounial/epap—M parar be special tR to be Paid for ordered before U.contracted work begins in order W mM 0,connection be paid to, ('7lneludivg all finance charges(�)Law requires that eny deposit or down-payment required by the cmmac[or befria work bins may aced thagreater of()one-third of the coral contras[price or@)NencNal costoYany special egnipmrntorcustom made material which must be special ordered in advance to meet the completion schedule. El— Ex ar.2= �. ow' . flit,.a Subcontractors —agrees. responsible wthe conA,described,,garft regardless of party/subcontractorI contractor.Tire connector former agrees to be solely responsible for all payments to all subcontractors for materials and labor td vin Contract Acceptance-Upon sighing,this hummock becomes a binding contract under law.Unless otherwise noted within this document,the wermi shall not imply that any lion or other security interest bas been pl..ad on the—to...Review the following.-hons andnotices —fully bed.e signing this o Don'tpressuredbe pressured into signing in,contract Talc,mus to orad and fully understand it Ask questions if something is uncl— ..sure the cothoinor has elphil ElMlhm avoo—t C m rati .The law requires most home improvement comm t—and ,ancelmonan,10 be registered with he unclew,Registration.You may inquire about contractor regismstion by writing tothe " Director at 10 PackPlon,Room 5170,Boston,MA 02116,by calling 617-973-8797 or 888-283-3757. Does the commonc,have i insurance?Ask the Contractor for his insurance company information an that you can confirm coverage,or adc to so,a copy f a"proof.faromance'duchapard. Know your rights and responsibilities Read the Important Information on true reverse side oftlo,from and get a copy ofthe Consumer Guide to the boune hamovencut Conmerm,Law. You may cancel this agreement if it has been signed of.place other than the contractor's normal plate of business,provided you notify the contractor in writing at hisiber main office or branch office by ordinary mail posted,by talegrappsent or by delivery,not late,than midnight,ofthe third business day following the signing afthis agreement S=the attached notice ofcancellation form for an onplarme.ofthis right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Tavo idevhenl copier of the cenhacrmuttbe completed and siymed.One copy should gin rod Iroiy alluto Ica,It,the Homeowner's sigrachare C.pilmoote's Signature f Dare Data ROBERT LANGEVIN MEN Building&Remodeling,LLC 795 Dale Street North Andover,MA 01845(978)686-3607 HIC#111990 FID#26-0816298 vuvuw.LangevhB,ilding_co, Job Description Mr&Mrs John Simons 35 Ironwood Road North Andover,MA<01845 Bathroom in the Basement 1.All necessary permits 2.Concrete cutting to access drains in floor and refill concrete 3.Plumbing rough-in and finish installation 4_Framing of partitions and strapping on ceiling 5.Blueboard and skim coat plaster on walls and ceiling 6.One passage door for closet,wooden baseboards,closet shelves,custom built vanity 7.Vent the ceiling fan to the outside 8_Install floor file 9.Paint all surfaces 10.All cleanup and trash removal Note:The following items are excluded from the job and not included in the cost: All electrical work and supplies,finish plumbing fixtures(shower base and walls, shower valve,sink,countertop,and faucet,toilet,light fixtures and ceiling fan Signed Date T The Commonwealth of Massachusetts r Department oflndustrialAeeidents Office oflnvestigations i!1 !•" 600 Washington Street Boston,MA 02117 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers AnDlicant Information Please PrinfLegil)HV Name(Business/Organization/Individnal):ROB£12r l-A111C-EVIIJ (j�l>]G IV �£MU}ELItiG Address:_79s pM-f ST City/State/Zip: IJe7 s2-14 of 4\1 fL Phone#: cy 7 P6 3-'©7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with 4.❑1 am a general contractor and 1 6.❑New construction employees(full and/or part-time).* have hired the sub-contractors _ 2.�am a sole proprietor or partner- listed on the attached sheet t y VJ rvemodeling Y whip and have no employees These sub-contractors have S.F-1Demolition working forme in any capacity. workers'comp.insurance. 9.❑Building addition [No workers'comp.insurance 5.❑We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑1 am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurance required.]T employees.[No workers' 13.❑Other comp.imam ..required.] 'Any applicantc checksboxkl must.. M - -m their workers'compensation polity information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submita new affidavit indic ring such. =Contractors teat check this box must attached an additional sheet showing Ne Dame of the subcontractors add their workers'comp.policy information. 1 am an employer Haat is providing workers'compensation insurancefor my employees.Below is the policy and job site information. Insurance Company Name: Policy k or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy alike 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 ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cert'Jv�nd/e/rfhe jad",and penalties ofperj.ry that are information provided abo e"tru and correct. Siena - /%�O'�l 1 --P/w�_ Date: ' )1 Phone 4, 5 7 2S F-t< -3 6 0-) Official use only.Do not write in this area to be completed by city or town official City or Town: Permit/License 9 Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A o CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER,THI5 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXPEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORREO REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER IMPORTANT:H the certificate holder is an ADDITIONAL INSU_Me policylias)must be entlorse0.HSUBROGATION IS WAIVED,sublet!to Ne terms and contllllvns A fh¢polity,certain policies may reguire an mdprsemene A sAlement on this mrtiBtate dcea not confer rights to the certlficale holder in Ileu of sato ondorsemantla. Edward W Hays Hays lnsulance Ag...y Mc. (g76)686�162 0.(9)8)609-4425 36 HawNome Ave. Amhaysmsurance®.romwsl.net Methuen Ma 01044 A.Nortolk$Dedham Mutual Flre Insurance Company wrEn Robert❑lanBevin 195 Dale 5l North Andover Me 010x5 COVERAGES CERTI--NUMBER: »suREa F; REVISION NUMB ER: CERTIFY THAT TIE F YLIGIES OF INSURANCE LISTED BELOW HAVE BEEN IsaI TO THEOINSURED NAME➢PBOVE FOR THE POLICY PERIOD ATED.NOTWrtn5TAN01NG PN!REquiREMENT,TERM OR CONDITION 01 ANY CONTRACT OR THE DOCUMENT WRM RESPECTT._TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOAD BY THE POLICIES DESCREED HEREIN is SVBJECT TO ALL THE TERMS. USIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REOVCEO BY FAIR CLAIMS. Lears sn)(c »tIALG IUTv »occuRRENCE s 1.000.000. .msMnoE ottuR s 100,000_ «oro. s 5000. A R0514351A 10252015 IOJ252016 PE ?000,000. P 2,OOp,000. Nip o�T P o�a y 2BDD.DDD. aILe.HeIDYIPo «I a IL .Ls 111L RYIPoI.—M,!5 a s °^ P LDaEa, aal Gare vy e c orEPA,wxsrwca wrarva»Ieua IPto o-.ne..u....a.....x.arn.a.i.....yw.n.enea.e.....w.....rwulnal CERTIFICATE HOLDER CANCELLATION —Ic=lv�i c'F rye:�T/-I A-vJDC VE(R, sllouLn.Nr oPTHEANovE.—..D INE CAHCELFia---FORE ACCOPOnN�c[WITHTIIE VOUC,PPROVISIONSF wu eE R ry IN 16 G O c S c---c'D 5'"� rHpxaev�P Nc_.'�tiaC;.lEf� MA 68-2014 AGORD CORPO N.All IgM reserved. ACORD 25(2014/01) The ACORD name and logo are 1e9ist—d marks of ACORD Ofliee of Consumer Afl'airs&Business Regularion I.' DOME IMPROVEMENT CONTRACTOR _Registration: 1.11990 Type: yExPirztioo 2/11/20]7 LLC ROBERT LANGEVIN BLDG&REMOLDING LLC. ROBERT-ANGEVIN 795 DALE ST — N ANDOVER,MA 01845 Undersecrehry - CS-002685 ROBERT M LANG&VIN 795 DALE ST NANDOVER NUE 01845 02/24/2016