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HomeMy WebLinkAboutBuilding Permit # 4/15/2016 BUILDING PERMIT %AORTJI TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 4 Permit No#: Date Received A US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION U Print PROPERTY OWNER /S Print 100 Year Structure yes no (7 PARCEL: ZONING DISTRICT:T: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential— [I New Building [I One family Ll Addition [I Two or more family El Industrial XIteration N-o. of units: El Commercial Li Repair, replacement El Assessory Bldg 11 Others: 0 Demolition El Other ` s`h d District t ,EhFIbbpi VV" /a DESCRIPTION OF WORK TO BE PERFORMED: &W tie 6- C e mayce�ot) J(_)s o- Identification- Please Type or Print Clearly OWNER: Name: Phone: i2,P -Address: A, 6:� Contractor Name: Phone: Email: zl, ,ee, e md�r ,µ 'wel- Address: ^4 Supervisor's Construction License: C a)9 xd` -Exp. Date: '2- Home Improvement License: Exp. Date: e 2 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: $ /,q , FEE: $ !2_ Check No.: 2— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund .................................... e of A to_r. 171-91 A" t%ORTH Ark qjwn ol-m- E �a - 1j cloverL ® - AIL • "KE h . Ver, Mass, �'�`— / AORATED S U BOARD OF HEALTH P K Mam I T. To * LD Food/Kitchen Septic System THIS CERTIFIES THAT . c al fw BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ,, .,c�C �... , n . . ........................................ / Rough to be occupied as ............................... ...t.c .P 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 MONTHS ELECTRICAL INSPECTOR UNLESSI STARTS Rough Service ............................. ✓.�® Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. a Gmw9, B r 7,71 r,a'u I �F ......................,".., "_.,._, ��.� ................�..�m... .. Cop� II Page No. of Pages I / �i 1 fir I%i I/ �H� P`; / li/ir iE r 4 1 !N�fr,> ,l � r // a f� I r r?ir r q, /ll/ i&r„/i I f/ U r dJ7rA/iJi o u f7^ viii r/i J�00v / 11/3 6 1 8 l� G i,/4w ln , (4i/ , �� `;,el ?! uro G / U „p f ; PROPOSAL SUpMITTEDTO PHONE DATE STREET JOBNAME 9 CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: rrI i` JG re, r f i f mo A r, r [, r b, d { I p , r I I I i r < dr 0 r. o MLI JIMPOSP hereby to furnish material and labor— complete in accordance With above specifications, for the sum of; dollars($ ). l Payment to be made as follows: I All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized J. involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance, Note:This proposg'i ay be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not acceptp'}idl within °_ days, ° ars Acreptaurrof proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature ✓to do the _-- Dat ofAe wwork asspecified. Payment,will,,, rna as outlined above. nce ,. , �a Signature�_-- Rome ffmem mIlet co-Etwact Ibis fmm an eftl� #s Ea�elot tkanLsseD®f�. 142A��;ei r jbtshnnldawgyof A �¢tmHamaib�meSgtn�q.�aay�a� Ymin�yal�afi�wgYYrt� - Ofr=of AffmmmtdBasaasiRegdW='s 617-973-SM 1-Mt't-283-3737eroaau C ��� SmxtAdda�(domi�aPaaOtEesBmcad�xss) Carte 'Sa ►Qc�sliaa'm p, OIRV-6 (w— Sl= Tptkda BasamA cas{m�ati�ketcasueet ) 99x' g9%-9's-e V 9 9 TX >zainarmm CWT— Sim 2ipcmb Ma rm-.Addr=ot&Mdfi=dows) + Slar3S.wmbw 'i'&aC.c 'a�a�tat".n�foli�f4r8s�Hnta�,� Perxp� /,�C.S�i�J �- /�.?"c,/2..� c>,:-B„�-n.-� 1•-cuc�.YJr2.. G'Lvte--gyp lGt7c.�.� /�z 4, Tv �.�i LL ��.8��. /'v t cr�v�v?P2. LccC Sin?.�. avow _mw w hmldiagpsmdismxiega' Fmgmm sgmt=d S&eftfe-4hef MmugsalmddavM mdwmbesesmedi3witkohomwavesaip& be to chcmmftnmbejwdffiz=W=WscmUd aft { aha et�ra�tn �� estdcxdea&um iise G Ft a�rmv 08 �/-ys=/G 1) eai�moaatr wiilbe t aaaimck&v;u& MGL cbs 'i42A.) t d=*wMbemk Hyoaatp'm& �COntrastflr�estop�the�tl�r�3�ad�barada6ave5arttxtatal�naE fly .�� �� (� Paymeatswtllberide m&afoftwiBsrhednte g to aao,`F0uauogtaottooccadlf3ofthecamlo�azctCa rs u�ewsiofsyecialwi cvhiisga)- 5 6000 by-_:_i— //6 arapanaampkimtof ce(L,.vc} s by � i/eI16 ararmcamfiftonof s umn anaresemm (Uwfinbi&demm&wfidlpwjmmtumR lscmmpbmdtoha&pWs ) '[tmfoltaaeag '' mm;bc�el s mh�taid£m m�brlaietLeaod:�iaaa3a tom�tdmam:gtednn�(”) S tobap�dtm- aote�d das�zRaaf iolaaa�aafshemalcsgres�ioe�(bjr�x�aa3ot�9s�e�i�ura�omasdam.�l vdadtmnubes�eealmdmd6tr3wmcemmssdaosaap'�s�date. mning3sa�ma�dall+at�easalsrzltssp©ttoyataSlt:acs,uxcsarrat.mmtrx�#3s�to�mnases� oa-Ideo+ doragnm6esy :efaroaae�t4ecmmtde�fiediofa#�saFe�ythad ulMalbytlmvaat ;RSe fW&w totessadyievmw?efora;lpaymaat-.mA wbommmmfar mdtsbarnads&i:amt Cam.aetAA -UpaudMaS&isdua��iha�sabmgoaafrst�s►aI tTale�om�edcidasdathe aoat��anaat�lyElaii�Y&za���uii9iateastfms6am�d.anthec�da�x sa�wdxfa$a�ag®uazsaas can feitybefo,e s�gniug this eoata�et o DodtbegxmsI agais lheoo Ta'aetimemvmlaedfuUyudustmdit.A*:pa a3sif isandam a Mst� N,rlesavaLdHomeYmaza�rmtCanhnmtRseaHoa_7l�sfmacegaii6mmahomimpavened ad Amb:awitlithelbc�tarofHameimpECua>r� -Yoa®Yaba� re bywgftgWgmnRacwatlopmkpim,Roma5l7QBmt=I ant6orby=lrmz617-973-tM—SN-2833757- o Dazsibeovaua hs�iamam=O A*fe farbis ,orwkto . -'saaeogyofa�raofofsa�ed'docm� - o $sawymga� RmisheInfar�mmshere+arsesdeo€tbisfiamaad�tacagYoflkeC�s Gmdt m ibe l�mte ho�mveenffit C�rlaBr_ Ytm amyrcaacdtlus�oeaveakifitt�bsatai�md�aplaxutba�ileeaon�sssa�lglmeef6asaz�.p¢ovidOdSoas�ytt� iia hisll�rmainoffaem• offetebgosdsarymal ,bytdega<asuaarbydd�m�lEatI�aaf&e ibirdbasiaessdt' ilsss[gaiagof Sestbeat�desdofiaafo��rsa udlbtstiglB Nor SIM C.�BN�AC�'IF THEM ARE AW MACM-l! �` aim�at� ad�a-ctz«yp�gomast�'ige�rmgs�aSiletsp63aaarsa.�e f"'77 f{ �7 �h 6 4f. V Date The Home Improvement Contractor Lav 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,chapter 142A. Homeowner's Signature ontractor's Signature NOTICE:The signatures o artier above apply only to the agreement of the parties to alternative dispute resolution initiated by 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(L:.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 d_piicate 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 ekecuted 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 OCABRwebsite at hthx//+w+�+.ma s.ao+/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 httn://++++++.mass.eov/ocabr! Go online to view the status of a Home Improvement Contractor's Registration: ham•//db State m,i us/lionieimprovemeiit/licenseelist.,sn For assistance with informal mediation of disputes or to register foritral 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 2.1-11/79/2010 PATCO CABINETS Office - 18 Patricia Drive, Hudson, NH 03051 Showroom— 17 Hampshire Dr., #15, Hudson, NH 03051 Office phone and fax 603-578-9763 Cell 603-345-2974 PROPOSAL April 5,2016 Ed Keisling 9 Dudley Street No. Andover,MA Kitchen cabinets=Wellborn Hancock Square Divinity(off white) $6,600.00 Includes dovetail soft close drawers, soft close doors and installation Kitchen counter top=granite, Black Pearl, standard edge and 4"backsplash$2,980.00 Includes the peninsula Total=$9,580.00 50%deposit required to order Thanks, Pete Ledoux The Commonwealth of Massachusetts ; . F Department oflndustrialAccidents _ F d 1 Congress Street,Suite 100 F. Boston,MA.02X14 2017 www.mass.gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le •bl APPIicant Information Name (Business/Organization/Individnal): S Address: %/ City/State/Zip: z"s V4 Phone#: Are you an employer?Check tfic appropriate box: Type of project(required): 1.❑I am.a employer with employees(full and/or part-time).* 7. Q New construction 2.�I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.E]I am a homeowner doing all work myself[No workers'compAnsurance required.]t 10 Q Building addition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11 C1 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.[�Plumbing repairs Or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 .0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.0 Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL G- 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] t . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information i submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. homeowners who $Contractors that o subiheckhfs box must attached an additional sheet showing the name of the sub-contractors and state whether or not,those entities have ri`tractors fiave employees,they must provide their workers'comp,policy number. employees. If the sub-co I am an employer that is providing workers'compensation insurancefol.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' compepsation 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 ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a and/or one-year imprisonment,as w ent may be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this statem coverage verification. I do Hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature Date- �� /�— D'O �l Phone#: .7 P 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 Cl exl� 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Farm Family Casualty Insurance Company Farm P.O. Box 656 Albany, New York 12201 -0656 Family SELECT BUSINESS PACKAGE DECLARATION PAGE Casualty Insurance Company _ ® Glennwnk New York - -- Policy Number: 2005X0431 Portfolio Number: Account Number: Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY, MA,01952-1702 Agent: 3485 D-JOHNSON INSURANCE AGENCY, INC. 7 GROVE ST STE 201 TOPSFIELD MA, 01983-1862 Agent Phone: 978-887-8304 Business Description: CARPENTRY Form of Business: Individual/Sole Proprietor Transaction Type: Renew Policy Period: From 03-21-2016 To 03-21-2017 12:01 A.M. Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THE POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE Buildings $0 Business Personal Property $5,000 Business Income&Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements See Schedules LIABILITY COVERAGE General Aggregate Limit(Other than Products-Completed Ops.) $1,000,000 Products-Completed Operations Aggregate Limit $1,000,000 Personal&Advertising Injury $500,000 EACH PERSON/ORGANIZATION Each Occurrence Limit $500,000 Medical Expenses $5,000 EACH PERSON Other Endorsements See Schedules PREMIUM Premium shown is payable at inception Total Premium POLICY SUBJECT TO ANNUAL AUDIT: Yes The Declarations, Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date:01-29-2016 X-3842 0214 Page 1 of 5 2005X0431 01-29-2016 19:26:38.00 Massachusetts-Department of Public Safety Board of Building Regulations and Standards -- - ' r---- --- Const1 UL'Ll rl.SUI/C1 V i01/1 License: CS-027489 STEPHEN M ICED 9 9TH STREET WEST _ SALISBURY MA�019 r ,A Expiration commissioner 07/16/2017 r ��v e CGdvanto�zcueal(�o�C���aJJc�c�rtde�- :a\_Office of Consumer Affairs&Business Regulation �1a kiDME IMPROVEMENT CONTRACTOR registration: 101846 Type: xpiration: 6/29/2016 Individual STEPHEN M.KEISLING Stephen Keisling 9 NINTH STREET SALISBURY,MA 01952 Undersecretary