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HomeMy WebLinkAboutBuilding Permit # 3/16/2016 BUILDING PERMIT 'oRTH ® o�at`'Eo 06'9h0 TOWN `'F IYRTFI D VER ®? g� d sb oto APPLICATION FOR PLAN EXAMINATION 1o�, wr Permit No#: Date Received �,yA°RarEa PPp;��cy SSgcHusrc Date Issued: ` 71 IM ORTANT Applicant must complete all items on this page r r,' ... , „a/.r d.. rr• 't� // ar rrF,f 'r, r 7 /r,fl,F r„rf: r % ",.;,;,,. r: s u r:” C >•'., ,r. f. .ri...r" r 7':Fx:l y ,e �,, �.+� fi,l f:. ...-t,, i .^x x�a�. .t <,:r ../ r.rs` .!'., f'",F'r,;;t /^l ✓� .�^ ,frr r -a'- 1/'�"y! !„. „a I,K-. �sT r'r t .r-�f n-.r 1<'.:,er:J. .� :fiJr �� -/:', .rru - t.. � �'7r,?r�' t ..'f� ✓' �.' vr. -,w x..,,;� .-.:i' r''. �'k / .✓..,✓ ,. �..,. �.. r. .. �! r � ,� d- r<� :..fir. �r -n. a^r✓.'..;! a f � .rr y r'r �”;�;: .,firf r„/'i ;f..r/r r.rr rr .F /i /,i'. ,✓;r.w,;, r<.. .t.. ,..., r .G r� „ ., r. J, �.. :1,.::r f l ..,/.. ! f/ ..? � ;/ l., h rr „➢ r! *'t .<. �r ✓, 'I( +,- .v( `l :✓t✓ �, .ry'r �"f„f.arf�%: �xr✓„ al:' t 3� !�f rr, v,:ssr a.rFr�,w�r�. 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AY ���r��'.,�'F,r�.��m`,�� Fai!f� as,�..�°> w�rn u;;t e �rt�€^� ,;� � ��r`�, err, r'ftii � i; ���'w'�., `� fr d✓� ar�� .j r Su ,e arr saConstru�ction Lice se �� r:��! p � >D � �f� �' �✓� f;,..; p '''^rt'" ✓` �' arF't '� .�na�r :f?r.7T', ..l°"< ;:a .wr rx r �rsr, w� s �..,� ,,' y, r`. �-� r-I- A. ,Crq h,"-`trr,. .r r&.�. x`a"�'' r+'A'b x.f 3�,?`/,.xi' s' r�/fir �tl,t'`' �3. F.,7',,"� / ✓"'y/�,. ,'�#',s�'rrr�,. {r'�'�'"' r� ,s�,'v7 r'J'�f/,c.. �.. 1`. ,.ah 'rr'4rr.. x,{- .d.,IrF�r' f_:� ,fir/� r �y/;,:�d1r,,/ar. ,� ><.�l �' rf=,:' ✓_. f "ra ,.e� yr r�''r`rG:. a� .zs --.a� r�' �����.r` f r��. .far.,�r2 Y�:i r.....r� fir:..l � ��.,� �' rrrF r"':4/'rlr �cr�t�YtYx'�✓^e'f_u���, '�ar�� .. s✓rr�;.'�fr,:�/fi �✓�'r' ,rfrr ,,r�r � ,`�'�✓ 2` :�'f'nu^w r,.,m a. fr._ /r ...w ✓. �, w F ..•� .r x T,rr.•�-,r t r lr.rr°';. '�w3, 'r. r"A�/rr.✓..,`z;l�..ir'7 r' w,w t„<?:/rte:. P. :3'''�r ,r�u%f r'"✓ � Yrr17a r.r�'�%11� �'�rl,.:y' �� .�. �' �a�rr? ,f r„' tf...o�. .��� ;r rr.� nF ey��w' aa+ r ' ,'er rjy„✓ . - s� r--” f r (lr f t '% al`r.r; ,,xr �;u�.. .��� 7�.,r. ,1,. �,��,r�-,ml ,x r/ . 'r< � ,a.„������,d�f.� `,t,,: .,,,arab r rr,,.�i�J.k� J r n/��,.,, �I S=-�Y rr+ T<a�. lr`,<ms..,!',. �"f Ua;;,„ r,. /' f ?��r- ✓r �ti��wr '✓ ✓ .: /�f 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.F. Total Project Cost: $ FEE: $ �-- t Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guard ty and P o Signature of Agent/Owrier,; ' attire ofco,ntractor t%®R'TH Town ofAndover - :. L ® .y: ` 0 a . ic No. * C1 ver, Mass, COCMICKEWICK ,95 SATED U BOARD OF HEALTH PEKMIT TL) LD Food/Kitchen Septic System THIS CERTIFIES THAT .. C eA�$ 4IF14S BUILDING INSPECTOR Foundation ................... buildings on ....... . has permission to erect ....... ..... ... ... ... . ...5W.Va, Rough tobe occupied as .......... .. ......... .... .. .. ................................................................................. 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 EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS l Rough Service ............ .... .................................. Final BUILDING INSPECTOR y GAS INSPECTOR Occupancy Permit Required to Occupy uildln� Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 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 Compan me ` i VLQI Street Address(do not use a Post Office Box address Contractor/Salespe n/Owner l e eCM City/rovm State Zip Code Business Address(must include a street address) M m 14- Daytime Phone Evening Phone CityfTown VState Zip Code Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home lmproremem Conueaor Reg.Number Espimt{on del, law requlro Ihal marl M1ome vdrd regb Impmvtniton number have � •� � �� . mher 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.) r e r 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 excluded from the Guaranty Fund provisions ofDate when contractor will begin contracted work. MGL chapter 142A.) tt:Date when contracted work will be substantially completed. I Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum o Payments will be made according to the following schedule: $ U upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ 0 by / /_ or upon completion of $ 6 by _/_/ or upon completion of $ 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.(**) $ 0 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 terms of the warranty must be attached to the contractl Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the 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 ifsomething is unclear. • Make sure the contractor has a valid Home Imorovement 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 ofinsurance"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. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed.One copy should go t4C.. �':tolrl'S wne.The other pys ould a kept by the contractor Homeowner's Signature ignature Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws hapter 142A. &A A q A./J Homeowner's Signature C. tractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor/they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in delicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections.have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds,from said account would require the signatures of both parties, Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.Rov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeiinprovemenUlicenseelist.asa For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22J2010 The Commonwealth of Massachusetts F Department of IfidustrialAceldents M r Congress Street,Sd ite 100 02114 2017 Boston,MA. - 9r www mass.gov/dia ORM Sy1v` y1vo3T exs'CompensationInsuxanceAffidavit:Buiddexs/ContxactorslL+,lectrxcians/Plumbers. TO BB FILED WITH THEPBRNnTTMG 4UTBfOWTY' lease print Le 'bl A ' licant Information Name(Businegsl(3igariization/Indiv:idual): Address: Ap tate/Zi #: ` City/S p� Phony �;. .:. r Type of�project(JNequiii'ed); _Are you an employem?Checktlie aQpxopriatebox: :. em to ees £all and/or part time).* 7. Q Ne-vv 6nsftd61ion 1:01I am a employer With p 3 2.El X am a sole proprietor or partnership and have no employees W01king for me in 8. �Remo deliiig any capacity.[Noworkers'comp.insurance required.] 9, ❑Demolitiobt 3.Q X am a homeowner doing all work myself.No workers'comp.insurance required.]t 10 ❑Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work ou my property. 'will dditions ensure that all contractors either have Workers'compensation insurance or are sole 11[]Electrical repairs ox•a proprietors with no,employees. 12 # 'Elu�nbiHg repairs Ox additions 5.El I am a general contraefor and I have hired the sub-contractors listed onthe attached sheet. 13•, o of repairs ,'S These sub-contrac#ors have employees andhaveworkers'comp.insurance ]d q Other 6.❑We are a corporation and its,officers have exercised their right of bxemption per MGL c. 152,§1(4),and'wehav6rio employde '-[Noworkers'comp.insurance required.] *Any applicantthat checks box#i mast also fill outthe section below showingtheirworkers'compensation polmust submit i Homeowners who submit thus of idavrt indicating they are doing all work andthenhire outside contractors must submit a now affidavit indicating such. $Contractors that checktlus box must attacfiedan additional sheet showing the name of the sub-contractors and state whether o not those enti es have employees. Iftha sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providingwopkers,compensation insurance for my employees. Below is the policy andyoh site information. Insurance Company Name ExpirationDate ® r Policy#or Self ins.Lic.#: C-m° . 5oil City/State/Zip: 3 WA/, H# rob Site Address: totlzcy declaration page(Showing the policy number and expiration date). Attach a copy of e workers' compensation p o Failure to secure coverage as required under MGL o.152,§25A is a criminal violation punishable by a f b up to$1.,500.00 and/or one-year imprisonment,as well as civil penalties inorwaoded to theff%e rm of a STOP O TnvRK ogations of the DTA for InsurancER a-Ad a fine of UP to e a day against the violator.A copy of this statement may b f covexage-verification. X do hereby e t�under'tla ins andpenalties ofperjury that the information provided above is true and correct. Date: Si #1:e. Phonee official use only. Do not write in this area,to he completed by city or tolvn 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 Phone#: Contact Person• AC®R®® ". DATE(MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 03/15/2016 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). CONTACT PRODUCER NAME; . Carla M Degnan DEGNAN INSURANCE AGENCY, INC. PHONE 978)688-4474 ac Ne, ADDRESS: cdegnan@degnaninsuran ce.com 85 SALEM ST. INSURERS AFFORDING COVERAGE NAIC N LAWRENCE MA 01843 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: JAMES DEBRECINI INSURERC: FAMILY ROOFING & PAINTING INSURER D: 12 TANAGER WAY INSURER E: LONDONDERRY NH 03053 INSURER F: COVERAGES CERTIFICATE NUMBER: 37186 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDIYYYY MM DDIIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -DAMAGET E TED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑PRO LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO , BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON--OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Paraccld I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I STATUTE ORH _ AND EMPLOYERS'LIABILITY — ANYPROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ 100,000 '. A OFFICER/MEMBEREXCLUDED7 NIA NIA NIA AWC40070259002015A 05/11/2015 05/11/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/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.gov/lwdtworkers-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 TOWrI Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Bldg 20 Suite 2035 AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety kt Board of Building Regulations and Standards rY. �e�pa��zmavuae�r��i a�6aaclivaellJ:� � License: CSSL-099685 Office of Consumer Affairs&Business Regulation Construction Supervisor Specialty '. VXegistration: ME iM?ROVEMENT CONTRACTOR 122385 Type: JAMES J DEBRECENI piration $l672D1$, DBA 2 TANAGER WAY �. J,&D WEATHERSEAL + LONDONDERRY NH JA T/IES DEBRECENI } 2 TANAGER WAY gayg�P — LONDONDERRY,NH 03053 ..v� CA_ Undersecretary CommissionerExpiration: 12/06/2017 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 V 4. Not outsignature