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HomeMy WebLinkAboutBuilding Permit # 2/3/2016 l BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received gsAci�u`� Permit�9®#: �s � ' Date Issued: IMPORTANT: Applicant must complete all items on rias page '" Y/r;u f y:- E,�{'! ,..r./ / z^r '<: l-ie"yvA` x,P.f nttr'f :a t r Id,✓F/F frF� y ,ar � r t , .rs �ll i✓c.,.✓✓ ' � ` �PROPERTY�QWNER � �r ✓�� ��� ���.,. ����� b,w � .✓ a[� -,.,,,,, t C�I..fOr 2� � 05r �, f10 :,oorYeaf rJ �U t ffwJ.,i kgyl Wiry, ,Nr `aMa`P`x ;��``'��f���"�P/ARCEL"J ✓ %'� , ZONING DISTRICT _ �.Histonc District � E �yresx no - r ., TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building W One family [I Addition Li Two or more family ❑ Industrial ❑Alteration No. of unify: ❑ Commercial %l Repair, replacement ❑Assessory Bldg 11 Others: ❑ Demolition ❑ Other ❑ Septic ❑}Welk ❑ Floodplain []Wetlands. ❑ Watershed District DESCRIPTION OF WORK TO DE PERFORMED: C/yode JA G �/��9Z 51 �IdI�G- G t) Identification - Please Type or Print Clearly OWNER: Name: J11AQ 1 ��� I Phone: 9178 6 k 7-70.5 Address: �tJe �C Phone 976 Contractor Name ! F J J Supervisor'sC©nstruction License GS C��6/�� xp E ° a Home,Irnpro�ement Licen 4 7 _-. 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.P. Total Protect Cost: $ / � FEE: $ " Check No,: Receipt No.: qC p NOTE: Persons contracting with unregistered contractors do not have access to the uar anty f d �ig�ature of Agert/Owner - -_- -----_--- --- ---Signature of_cq,ntractor NORTp-1 0 ..A (-town of L Andover ® ' . .: ® 2,61 4 _ 4 : `ANE h ver, Mass, A cocMicMew�cx �1• ®S RATED V BOARD OF HEALTH Food/Kitchen P R I T LD Septic System A ! � THIS CERTIFIES THAT �/ (r G N 1� � ci Sel BUILDING INSPECTOR ....................... ...�....................................C....................................................... `� // s'� Foundation has permission to erect .......................... buildings on .../..... �J 41 ...................................................... Rough to be occupied as . !:? ! ov .. �:�2.{.G.�-�..... C /. .y�.�'.1:Gr��:rx ...�... .. �{.�....(r'�'.�. �? ... Chimney provided that the person accepting this permit shall in eve�y respect confIm,to the terms df 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 PERM.IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough ............ .!. ..�l�Y.w ... . ... ...................... Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to ccupy 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 Approved by the Building Inspector. Burner Street No. Smoke Det. F/a/m, Sirois Construction �Pr ft" A 38 Juliette St. DATE: 2/2/2016 Andover, MA. 01810 Reg.# 120883 Phone: [978-4740056] MOMMEMM Virginia Unijewski 37 Abbott St. Andover, MA. 01810 Replace existing vinyl siding with new vinyl siding 13 squares due to damage and wear Remove vinyl siding and house wrap Re install Tyvek and siding same color Install Tyvek sills and 7 windows Replace bay window Harvey casement 4.Ox 7.6 same size and height as existing bay window Cable installation Roof to be shingled and insulated; site to be left clean SUBTOTAL $10,450.00 OTHER COMMENTS TAX OTHER TOTAL $10,450.00 Thank You For Your Business! Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name - CompanyNapne V11�04 h_)I A ��it ���ki 51961-S C 0 AJS i, Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name r 3 7 A T3 T3 0_7 T `s i 1(f L)e S 1 City[rown State Zip Code Business Address(must include a street address) ti ,;4k)avV-6"Z 3 ? _-T�z;??7f� 5- , Daytime Phone Evening Phone City/Town State Zip Code l7 0 - $-7 - 70,5­0 4PJ Do v-en M A U ! 4"/() Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home Improvement Contractor Reg Number Epvation date La requires that most home improvementcontn<mrshm•e 1�O T­33�� �� / valid regizlrarimr numher The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be L excluded from the Guaranty Fund provisions of 2 � / ate when contractor will begin contracted work. MGL chapter 142A.) 3&L/6�6 Date when contracted work will be substantialty,completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total stun of: (*) Payments will be made according to the following schedule: $ 3 S-00 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) by 2 .��lG or upon completion of 11�z f� �/aJA) $✓ by 3 �/0/L6 or upon completion of U L $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractor? ❑No❑Yes(all terns of the warranty must he attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of tine actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! T%w identical copies ofthe contract must be completed and signed.One copy should no to the 1--vner. they copy�sh--o�uvldd b/bee/kept by the co P11101, H reowne Signature Contracto s rgnature 2/3116 Date Date The Commonwealth ofMassachusetts I)epartinent of lndustrialAccidents 1 Congress,street,Suite 100 Boston,MA 02114-2017 www mass.gov/dna Workers,Compensation Insurance Affidavit:Builders/Contractors/Eiectricians/Plumber s. TO BE, PILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print I e�ibly Name (Business/Organizatiou4ndividual): Address: 3 F3 TO—" e P 1 City/State/Zip: Do M A . D!9l 0 Phone#: 0/ 20 q S� Y0 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. Q New construction 2.[„I am a sole proprietor or partnership and have no employees Working forme in 8. N Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition IFI I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑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 or are sole 11.F]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workerscomp.insurance.# 14.0 Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGI.C. - 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] •r:. . . `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this afCdavit 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,'&) must provide their workers'comp.policy number. X am an employes•that is pi ovidir�g tvo�kersl compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: 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 WORD 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. p do Hereby certify nder the pain andp allies ofperjury that the information provided above is true and correct. Signature: Date: 6 Phone#: �'I Official use only. Do not ivrite in this area,to be completed by city or town official. 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#: Preferred Mutual Insurance Company refierre Mutual One Preferred Way,New Berlin,NY 13411 1.800.333.7642 Live Assured" POLICY ISSUED ON THE CO-OPERATIVE PLAN Direct Bill Renewal BUSINESSOWNERS DECLARATIONS Policy Number: BOP 0100716585 Special Form Replacement or Renewal of: BOP 0100716585 Named Insured: STEPHEN SIROIS DBA SIROIS CONSTRUCTION 38 JULIETTE STREET ANDOVER, MA 01810 Agent: SULLIVAN INS & FINANCIAL INC 487 GROVELAND STREET PO BOX 1597 HAVERHILL, MA 01831 2077200 866 372 2790 Policy Period: From 04/01/2015 To 04/01/2016 12:01 AM standard time at the mailing address of the named insured as stated herein In return for the payment of premium,and subject to all terms of this policy,we agree to provide the insurance as stated in the policy. The Named Insured is: Individual Business of the Insured is: Carpentry This policy consists of the following coverages for which a premium is indicated. This premium may be subject to adjustment. FINAL PREMIUM $1,778.00 Countersignature Date Authorized Signature The final premium above includes the following:renewal credit-$80,protective device$0,and companion credit$0,totalling-$80. These declarations together with the coverage part declarations,the common policy conditions,coverage form(s),and forms and endorsements,if any,issued to form a part thereof completes the above numbered policy. BP DS 01 10 14 PM Insured Copy Page 1 of 6 AW Preferred Mutual Insurance Company Pr'eferr MutualOne Preferred Way,New Berlin,NY 13411 1.800.333.7642 Live Assured- SECTION I ® PROPERTY COVERAGE BUILDINGS AND PERSONAL PROPERTY SCHEDULE Policy Number: BOP 0100716585 Special Form POLICYWIDE OPTIONAL PROPERTY COVERAGES Premises deductible applies unless otherwise stated LIMITS PREMIUM Business Income-No Deductible Applies Ordinary Payroll 60 Days Included Exempt Employees/Jobs No Extended Period of Indemnity 30 Days Included Business Income&Extra Expense-Actual Loss Sustained 12 Months Included -No Deductible Applies Contractors Optional Coverage See Schedule $175.00 Electronic Data $10,000 Included Equipment Breakdown Coverage Included Forgery or Alteration-Optional Coverage Deductible Applies $2,500 Included Interruption of Computer Operations $10,000 Included DESCRIBED PREMISES AND COVERAGES Premises 1 38 JULIETTE STREET ANDOVER,MA 01810 ESSEX Premises Deductible: $500 Optional Coverage Deductible: $500 Protection Class: 03 Inflation Guard: 4% INCLUDED COVERAGES AND EXTENSIONS UNLESS HIGHER LIMITS STATED ELSEWHERE LIMITS PREMIUM Fire Department Service Charge-No Deductible Applies $2,500 Included Accounts Receivable $10,000 on/$5,000 off Included Business Income From Dependent Properties-No Deductible Applies $5,000 Included Valuable Papers and Records $10,000 on/$5,000 off Included Premises 1 Building 1 Construction: Frame Construction BP DS 01 10 14 PM Insured Copy Page 4 of 6 Preferred Mutual Insurance Company jpreferred Mutual One Preferred Way,New Berlin,NY 13411 Live Assured- 1.800.333.7642 Business Personal Property Replacement Cost $1,000 $15.00 Contractor-Carpentry-Construct of Residential Prop-Not Exceeding 3 Stories in Height-Office BP DS 01 10 14 PM Insured Copy Page 5 of 6 Preferred Mutual Insurance Company Preferred Mutual One Preferred Way,New Berlin,NY 13411 1.800.333.7642 Live Assured" Contractors' Installation, Tools & Equipment Coverage Schedule Limits Contractors' Installation Coverage Property at each covered job site $3,000 Property in transit $5,000 Property at a temporary storage location $5,000 Property at all covered job sites combined Contractors'Tools and Equipment Contractors' Tools and Equipment—Blanket Basis $3,000 No one item greater than $2,000 Total Premium $175.00 CNTRSCH 01 10 14 Insured Copy Page 1 of 1 . � ��e�pa-��ta�zancaeall�a���u��ac�cate� Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 120883 Type: xpiration: 3/14/2016 DBA SIROIS CONSTRUCTION i STEPHEN SIROIS 38 JULIETTE ST ANDOVER, MA 01810 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-006120 Construction Supervisor 4 4 f<< STEPHEN L SIROIS` 38 JULIETTE ST � ANDOVER MA 0181 , jp Expiration: Commissioner 09/1 9!2017 � c — ABs� � Licensed Real Estate Sehoal Continued Educalion Courses i Andrew B.Consoli—Instructor,Speaker,'h•ainer Eall&®mice Real Estate Training.ITI Trained-Member of REEA License#1147 r (978)373-2859-(800)556.4455 "Let our experience workjoryou!" 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