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HomeMy WebLinkAboutBuilding Permit # 4/27/2016 "ORT" "do K BUILDING PERMIT 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ^van Date Issued: IM ORTANT: Applicant must complete all items on this i e 117 ee LOCATION A_ Pnnto PROPERTY OWNER__& ,"'t Print MAP NO: b"5T PARCEL:�D/5 ZONING DISTRICT. Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential U New Building cine family NAddition U Two or more family u Industrial U Alteration No. of units: U Commercial U Repair, replacement Ll Assessory Bldg U Others: L-1 Demolition u Other U Septic H Well U Floodplain LJ Wetlands U Watershed District U Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: Phone: Address- CONTRACTORPham: Address: 4& 14- 01 67) 7- Supervisor's Construction License: 35' 3 Exp. Date: Home Improvement License: ()> Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEESCHEDULE.BULDING PERMIT:$1200 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. TotalProject Cost: Check No.: nptaNTE: Personscontracting #h tinregisfeed contractors doot haaccess to lit, gu ranlyfund Signature of Agent/Owner ---"Signature of contractor-.,/ � Flans Submitted 11 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swirmning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Z Signature_i COMMENT'S D V �o o1a CONSERVATION Reviewed on Signature COMMENTS_ t C)0 HEALTH Reviewed on Signature COMMENTS 4oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connectiion/Signa$ure Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEI?AR3 ,IIIIENT TemprDumpster on site ,,yes no r '" res "� � ✓ ?] lF"kr"5.::,!' X4:;,5 '" F`.`` ;,u .,, y ' w L 1 r 1 v frr%'�tfi 4X✓/W ��frlG�' Fires Deprtrnenfksignafure/date a ✓, r r CQIVIMENT , t NORTH _t own of ? _ Amliftdover • O ..w'•' ry. .I OA '00 ® ® T 21 low L^�E h ver, ass, COC KICMl WICK 1. �,9 Q�RATED 16,Pa��,�5 S U BOARD OF HEALTH RM T LLO PE Food/Kitchen Septic System �� BUILDING INSPECTOR THISCERTIFIES THAT ................... .................................................. .................... ................. �,. \ .� ® .. Foundation has permission to erect.......................... buildings on . .. ♦� ........................ ' Rough A to be occupied as ....... ... .... .. .. ....... .. .. .................................. Chimney e 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ............ Service ................ .... . "r. .................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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 Approved by the Building Inspector. Burner Street No. Smoke Det. PLOT PLAN NORTHERN ASSOCIATES, INC. = v7. 2ND FLOOR ANDOVER, MA 01810 TEL:(978) 837-3335 FAX(978) 837-3336 MASSACHUSETTS '.v0R. DOREEN PRISBY DEED REF. . '.`_TION.• 364 JOHNSON ST PLAN REF. ASSESSORS _:_ FTATE: NORTH ANDOVER, MA SCALE. 1"=40' DATE. 4/20/16 JOB #: 23.01 9p I I I � I � of V i I O I �\ I oV (s' X zo') PROPOSED i H DECK y \, # 364 EXISTING DWELLING 120'f ABBOTT s'T ��°F� R.EFT ` (y J.firr 6 �?9 n , , or dill �+ " f Aa I, ! dv,�.b✓ p�err✓.� 2reee9Jd •� r t i I' C313 a k vA A-.pl'^q y � QOM •sad � , c,�' Vod 1411011 a f , Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the states Home Improvement Contractor Law(MGL chapter 142AX but does not include standard language to protect homeowners. Seek legal advice irnecessary. Any person planning home improvements should fust 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 Regulations ConsTaner Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information f� ,p / Co Nam o 01,1-e ell Street Address(do not use aOffice Bon ) C�� ers Salgponl Owner ae c�, Ci qwn J StatM Zip Code d r Boniness Address( mch�deJa s/tr�eet address) / ylimePhon Evening Phone ` rnr State L Code r L !e//`I�t�vi IV �?3 0/" 6 (6-0 50,151- 0,/ btailin9 Address,It different from above) Business Phone Federal Employer ID or S.S.Number 66 n�rq,�.�c�rmascsxo� r.�+em ra.+rr�•rtes�.r u.�s The Contractor agrees to do the fo➢owing work for the Homeowner. (Describe in del the the wn[kto completed,sneafvina the type,brand,and grade of mat® els to be used,use additional sheets if —fell, `,�, nn Sit':^✓�,'t _7 1 e 4 J 7 s(d e -rcl s = �:� s s ,� E c1 �i� �cz��, •� S'y�S'�e=i/�• i.�: hy� ��kff-�`� r�^67C6,c�^ter , 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 homeowners agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be /�7 excluded from the Guaranty Fund provisions of f �4aze when contractor will begin contracted work. MGL chapter 142A) Date when contracted work will be substantially completed- Total ompletedTotal Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: � (r) Pa ents will be made according to the following schedule: l ,C?pon signing contract(not to exceed 113 of the total contract p/nice or the+cost of special order items,whichever is greater) ,/ $Q7eq 6-7�C by_! I or upon completion of �(�e \ ! l'!Y• �G/f�1'_ / ^7 d�t/fit'?e• $ by_/ / orupon completion of S 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 S to be paid for ordered before the contracted auk begins in order to meet the completionscheMm("`•) S to be paid far NOTES:(•)Including all finance charges(")Law requires that any deposit or down-payment required by the conhadcrbefore work begins may '..'... not exceed the greater of(a)erne-third of the total contract prim or(b)the actual cost of amyspecial equipment or custom made material which must be special ordered in advance to meet the completion schedule. EEr reser Warranty Is an emremwa_ ntv bet provided by the contractor'' No❑yes(all tanss ofthe warranty must be attached to the mntract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any thud partylsubcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this a�reemenL - Contract Acceptance-Upon signin�v this document becomes a binding contract under law.Unless otherwrse noted within this document,the contract shall not imply that any Get 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 ContractorReeistration. 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 ofthis agreearient See the attached notice of cancellation form for an explanation of this right- DO ightDO NOT SIGNCONTRACT RE ARE ANY BLANK SPACESM ro identical raphes afthe wr4becamplcted=dsigned Onecopyspuldgotothe The other copy should be kept by the camractor. t \ H ;e.o.wnere's Signa CC ntractor DatDate 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 contactor 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 B smess Regulation and the consumer shall be required to submit t ch arbitration as provid assachuse era]Laws phapter 142A" 9 H e ees Signatur Contractor's Signature OTICE:The sign res of es above apply only to the agreement of the parties to alterative dispute resolution initiated b tractor. The homeowner may initiate alternative dispute resolution even where this section is not se 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 duolicate 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 contactor 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.orneed additional information about the Home Improvement Contractor Law or other consumer rights,orif 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 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 Contactor 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 Go online to view the status of a Home Improvement Contractor's Registration: 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 508-6524800,508-755-2548 or413-734-3114 Version 2.1-11/22/2010 License or registritiowvatid fob>Ei ividul use only before the expirationdate. If found r%urn to: Offtcq of Consgrner Aff.3ir�and Business Regulation 10 Paik Plaza-'Suite Sf76 Boston,MIA;Dfl16"" x ti Massachusetts Department of Public Safety f Board of Building Regulations and Standards y License: CS-075353 � i� Construction Supervisor AO& �i r Noty#44*ithoiftsigraa e DAVID M DEGAGNE 1049B MAMMOTH RD PELHAM NH 03076 ( #Ko;- " `w it �.n� Expiration: ��ieommca�acuea o� �c ae� Gf� Commissioner 08/23/2017 pf ase of Consumer Affairs&Business Regulation - _- DME RPOROVEMENt CONTRACTOR agistrafion: 178866 ; Typ4: x-piration: 5d26,/2016 Individual DAVID DEGAGNE DAVID DEGAGNE. 1049 MAMMOTH RD UNIT B PELHAM,NH 0376 Undersecrela:y CERTIFICATE OF LIABILITYINSURANCE DATE(MM/DDIYYYY, 03/18/2016 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(ies) 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). 'RODUCER CONTACT NAME: [NSURANCE SOLUTIONS CORP. PHONE JFAX A/C No Exit: A/C 50 Westville Road E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# >laistow NH 03865 INSURERA: AmGUARD Insurance Company 2390 NSURED INSURER B: )AVID M DEGAGNE INSURERC: L049B MAMMOTH ROAD INSURER D: INSURER E: 'ELHAM NH 03076 INSURER F: OVERAGES CERTIFICATE NUMBER: 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. ISR ADDL SUBRPOLICY EFF POLICY EXP .TR TYPE OF INSURANCE INSR WVD POLICY NUMBER MOML1 MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGES( RENTED PREMISES Ea occurrence) $ CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ PRO POLICY JEc LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ '.. HIRED AUTOS AUTOS Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ 4 WORKERS COMPENSATIONSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N R2WC658267 11/4/2015 11/4/2016 WC ORY LI 1 S E ANY PROPRIETOR/PARTNER/EXECUTIVEEACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? � E.L.N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 IESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The workers compensation policy does not provide coverage for David M Degagne :ERTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover, MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. tCORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Insurance Solutions Corporation - Page 1 of 2 ® DATG(NIM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 3/18/2016 'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED tEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. APORTANT: If the oertlflcate holder Is an ADDITIONAL INSURED, the polloy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to he terms and conditions of the pollcy, certain policies may require an endorsement. A statement on this certlflcate does not confer rights to the ertlfloate holder In Ileu of such endorsement($), �DucER Kathl®en Miller, CISR, CP IW suranc® solutions Corporation PRONG (603)382-4600 Ax No;(609)992-2094 AIC No Ext: Westville Rd ADDREe9:kmiller0i50-in5uranoe.00m INSURER 9 AFFORDING COVERAGE NAIC aistow ITH 038655 INSURER AMerahants 23329 URED INSURER B ,vid M Degagne INSURER C 149b Mammoth Road INSURGRD: INSURERE: dham NH 03076-2193 INSURERE: )VERAGES CERTIFICATE NUMBER:CL1631826091 REVISION NUMBER: PHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATED, NOTWITHSTANDIN© ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ;ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, °KCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 2 TYPE OF INSURANCE POLICY NUMBER MM/DDA'YYY MM/OO/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE Fx PREM18E9 EO Occurrence $ 500,000 sePI0878b9 11/4/2018 11/4/2016 MED EX?(Any one pomon) $ 15,000 PERSONAL&ADV IN URY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 }{ POLICY QCT EILOC PRODUCTS-COMPIOPAGG $ 2,000,000 Property damage-single Ilmit $ OTHER: AUTOMOBILE LIABILITY ffom COMBINED SINGLE LIMIT $ BODILY INJURY(Per pen on) $ ANY AUTO ALL OWNED F SCHEDULED BODILY INJURY(Per occident) $ AUTOS I AUTOS PROPERTY DAMAGE NON-OWNED Perse den[ HIREDAUTOS AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCE99 LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ PERT _ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE *gMIS BELot7 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Ifna,do3cribe undor E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below ;SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Rematl(a Schedule,may be attached If more apace le required) '.,. The insured hao purohascd Workers' Compensation Coverage through the MA Worker's Compensation Asoigncd isk Pool. We have requested the servicing carrier issue a Certificate of Insurance on your behalf. gents are not permitted to issue Certificates of Insurance for Workers' Compensation coverage on olicies issued through the MA Worker's Compensation Assigned Risk Pool. ERTIFICATE HOLDER CANCELLATION 978) 688-9542 SHOULD ANY OF THE ADOVI!Dt:9CRICMD POLICIES DG CANCELLED®PPORI: Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL lZE DELIVERED IN Attn: Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood Street North Andover, MA 01845 AUTHORIZEDREPREBENTATIVE I