The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 3/24/2016 %AORTH BUILDINGPERMIT O&�zLED /b��o TOWN OF NORTH ANDOVER 7 - APPLICATION FOR PLAN EXAMINATION ® `, _ Permit No#: c� Date Receivedssq,Eo Ps��cS ACHU Date Issued: 3 41MORWTANT: Applicant must complete all items on this page LOCATION PG PROPERTY OWNERL�' s Print 100 Year Structure yesno MAP U PARCEL: ` ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residen I Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other l] Septic ❑Well ❑Floodplain ❑Wetlands , ❑ Watershed Distnct� y �t l r, / � r ! s , ]�f�s ., f'�'!�r s..,f� ,, r z `✓' DESCRIPTION OF WORK TO BE PERFORMED: Ate& dentificatio Please Type or Print Clearly OWNER: Name: Phone: Address: C5-' FEm actor Name: Phone: -73 ss: .G� Supervisor's Construction License: ��9 /l Exp. Date: Home Improvement License: �a `3 � Exp. Date: zzlz�7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINGP74fT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ( FEE: $ Check No.: C1 `1� Receipt No.: { NOTE: Persons contracting with unregistered contractors do not have aces, to the guarcc ty fund -- - --- -- ---------- P - - - Town of Andover 999- 261 Z 24� C, : L�KE " 2q h Ver, ass, COCMICMl WICK y1• 0 RATED Pei�,i5 U BOARD OF HEALTH Food/Kitchen PERIVI LD Septic System THIS CERTIFIES THAT ........................... BUILDING INSPECTOR .... ........ .. has permission to erect buildings on51Z Foundation Rough tobe occupied as ........ ......A.. ............ ............................................................................................ Chimney provided that the person accepting t is 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 c Final EXPIRESPERMIT I MONTHS ELECTRICAL INSPECTOR UNLESS I STARTS Rough Service .................................... .................:. .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Requiredto Occupy BulldlnRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisficrMl basicr�quirements of the state's Home improvement Contractor Caw(MGL chapter 142A),butdaea not Include standard language to protecthomeownera. Seek legs]advice If necessary. Any pets on'planninghome irtnprovements should fiis(obtain a copy of"a Massachusetts';consumer guide to hornaimprovement"before agreeing to any work on yourresidenee.You may obtain a free copy by'calling the':- Office of Consumer.-Affairs and Business Regulation's Consumer Information Hotline at617-9738787 or I4888i283-3751. ' Homeowner Information 'Contractor Infomation f NameCompany N .. .. ... .. !,... Street A (o not use a Post Bo dress) ntractor Owner Name aty/rown U to Zip Cede lusiness A s(must include a street address) Daytime one Ev eningphone ityrrown y BmpleyZerip Code MailgAd (Itdifferentfrom above) usiness Phone ��&,d ID or S.$.'Tlumlier • lar rsgWm lhtlmoll rnmeim•I Aome lCmtrutmag?h®Dv -axpvaliony Pmt moetefmshsxes / ,{ ry . sledtgirtntfo•maober (/Usf✓j 7— / The Contractor agrees to do the following work for the Homeo ner: 49(.csmoe is TO COMPICAM4 Specifying Me typ rte- /`K-e'` 6-/ Required Required'Permits-The following building palmus are required Proposed Start and''Compiethm Schedule-The following schedule will and will be secured:by the contractor as the'homeownet's agent; be adhered to uriless circumstances beyond the contractor's control arise (Owners who securetheir own permits will he excluded from the Guaranty Fund'provisions of i Date when bontraetorwill begin contracted work. MGL chapter 142A.) r Date when contracted .work will be substantially completed.. Total Contract Price and PsymegSchedule �) The Contractor.agrem to perform the-work,famish the material and labor specified above for the total sum of. Payments will b sde according to thefollowkschedule: S uponaigning contract(not to exceed 1/3 of the total.contract price gr the oost:of special order items,whichever is greater) $ by / / or upon completion of S :byby /` or upon completion of p// S�upon completion of the contract. (Law forbids demanding full payment until.contract is completed to both party!s satisfaction) The following ial/ g matertxitdpmentmustbeapeciat __,tdbepaid for ordered before the contracted'workbegins in order S to be paid for to meet the,coinpletion schedule.(••) NOTES:(•)including all finance charges(••)Law requires that any deposit or down-payment required by thecontractor 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.equipmmt or custom made material which must be special ordered in advance to meet the completion schedule. ExprressWarranty-Is anexoress-warrantvbeinenrovldedbytheyentract+M No Yes fa0termxofNrerrarrentr .tot atmcbed tothe cootrsctl Subcontractors The contractor agrees to be solely responsible for completion of the work desenbed regardless of the actions`ofany tfiiid . party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and laborunderthis agreement Contract Acceptance-Upon signing,this document becomes a bindiag.contractunder: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 Mad'and fully understand it. Ask' questioris if something is unclear, • Make sure the contractor It a with h r too of me ^ gretr dW The Ieiv requires most home improvement contractors and. subcontractors to be registered with tho-Director ofHonre Improvement Contractok Registration. You may inquire gni-7 7.32 contractor registration by writing to the Director et One Ashburton Place,Room 1301,Boston MA 02108 ocby_calling 617-72?-3200 ox _ 1-800.223-0933. .,. • Does the contractor have insurance? Check to see that your contractor is properly insured • Know yourrights and responsibilities. Read the Important Information on the ieverseside of"foirir and get a copy of the Consumer Guide to the Home Iolprovement Contractor Law: You may cancel this agreement if it has been signed at a place other than the-contraetdr'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, thud business day following the signing of this agreement..See the-attached notice of cancellation form for an explanation of.this right. DO NOT IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! ?wet I.,copies o fh contract must be completed and signed.One copy sbould go to the bumewne. other .. copy should be kept fry the contncsor. , - ' •� riDmeeWn 'a$lgnelut'e Contrauctoo Signature r� Date Date Page# of pages CS # 022680 978®688®6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1®978-912®2853 North Andover, MA 01845 Proposal Sub 'tted To: Job Name Job# Address _ V Job Location Date Date of Plans Phone# 17Zf Fax# Architect We hereby submit s ecifications and estimates fpr. We propose hereby to f/urnish material and labor—complete in accordance with the above specifications for the sum of:G �� Dollars with payments to be made as follows:- Any ollowsAny alteration or deviation from above specifications involving extra costs will be Respectfully executed only'upon written order,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays submitted beyond our cohtrol. Note—this proposal may be withdrawn by us ri not accepted within days. S.ccept=Signature Ool 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.3 ✓/ Date of Acceptance 7 3 1 tv Signature The Commonwealth of Massachusetts Department oflndustrialAccidents f F d I Congress Street, Suite 100 Boston,MA.02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information r ( Please Print Legibly Name (Business/Organization/Individual): C-fv' � �✓ ""' "'i Address: City/State/Zip: Phone#: 91�`_ '(moi r70 Are you an mployer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 'J• E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition 4.F1I 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.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbin repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13. oof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.E]We are a corporation and its officers have exercised their right of exemption per MGT.c. 14.F1 Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit:this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-coniractors have employees,'liey must provide their workers'comp.policy number. I am an employer that is providing worlrers'compensation insurancefor my employees.'Below is the policy and job site information. / Insurance Company Name: 1,no Policy#or Self-ins,Lie.#: Q 4,Expiration Date: r✓ Job Site Address: �J City/State/Zip: oU Attach a copy of the workers'co e,sation 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 WORK 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 DTA for insurance coverage verification. I do hereby eer• ;under thepain/s��anldpen,?alttiies ofperjury that the information provided above is true and correct. Si nature: / -/�' � Date: - Phone#• ,' �l ''(rte(1 l7 Official use only. Do not write 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.PIumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54'Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. AWC-400-7014648-2015A PRIOR NO. AWC-400-7014648-2014A ITEM 1. The Insured: Arthur Walsh DBA: A J Walsh &Sons Mailing address: 159A Waverly Road FEIN:*"-"*6792 North Andover, MA 01845 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from11/14/2015 to 11/14/201612:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensatia ne of We policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 40579 INTER SEE CLASS CODE SCHEDU E GOV GOV — STATE CLASS MA 1 5403 State Assessments/Surcharges $.00 x 5.7500% $ This policy, including all endorsements, is hereby countersigned by 11/05/2015 Authorized Signature Date Service Office: Durso&Jankowski Insurance Agency LLC 54 Third Avenue 11 Saunders Street Burlington MA 01803 North Andover, MA 01845 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. Board-of BL11"ding License: CS-022680 ARTHUR J WAI,,A JR 159A WAVERILY-" N ANDOVER MA 01845 oryinli-Sion 1,). 0610912016 ------------ dT-111 Y7i.J)l Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Plft�M Type: , egIstration: 103358 ' -'M xpiration: 717/20l16 Private Corporatio A.J.WALSH&SONSJNC. Arthur Walsh 55 Pleasant St N Andover,NIA 01845 Undersecretary