Loading...
HomeMy WebLinkAboutBuilding Permit # 5/9/2016 tAORTH IJIL ING PERMIT 3�ot�s��o °e�°� TOWN OF NORTH ANDOVER 7 ,� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received q ry 9A�AA7aD hPP~K� Date Issued: 9SSA C HUSK IMPORTANT: Applicant must complete all items on this page jj/i///j/ // ////iii///.✓-,%/ ,%�j//j///i���i////%ii:.,. / %. % i,i "/% .i; � '/'�j/�/��jj TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential C1 New Building One family Addition Two or more family Industrial 1 Alteration No. of units: Commercial epair, replacement Assessory Bldg Ei Others: I Demolition I Other 0 F/ /F777 /! F// / Identification Please Type or Print Clearly) OWNER: Name: U)ux-w Cp n t Phone: Address: /%,;�;/,//;f�//�/ / :iii' i,_ i ✓i,///i..e/����i✓,:,///ii/ /��s/a./////./j '. /, //,;/i � �i i�� �/ � ,✓iii/, i, //� / // i///,;. / / ,j,; ARCHITECT/ENGINEER �1`� Phone: Address: _ Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5�) FEE: $ J0. vo Check No.: Receipt No.: 3oyy y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �f // , g1jUre' Q / /// / ,,� o Mr, S/! ..,, /i ,,,,,,,/, ON tkORTII Town of Anduvut L ® No. 41ROP .261 'q. h ver, Mass, dl cocMicHew�cK 1' ATE® s',? S V BOARD OF HEALTH Food/Kitchen RIVI IT T Lftw Septic System THIS CERTIFIES THAT ......... � `'"� C��i�rl BUILDING INSPECTOR .......................... ........................................................................... • has permission to erect ... buildings oy �?. ..C/..::. Foundation 7 % Rough to be occupied as r. ......!!`.l�:.tiSl�G�� . 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ............................................................... ..... yGt�.' _ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz 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. T k hovie- (603)887-4,468 CONTRACT Cell: (603) 235-7624 T Free: (800) 458-4468 HIC#106603 Fax: (603) 887-8300 AJ. WOOD CONSTRUCTION, INC. 337 Haverhill Rd Chester,New Hampshire 03036 Email: in fb((baj woodconstruction.net Website: www.,Iiwoodcoiistruction.net ROOFING a SIDING @ WINDOWS e DECKS e KITCHEN & BATH REMODELING Workinen's Conipensalion and General Liabilidy Carried on All Work Date— April 1,201 No. 284 Brentwood Ci. N.Andover MA (Street) (City) (State) (Zip code) Owner's Name Lauren Connelly ______,______Telephone: 978-807-47*18 Address SAME AS ABOVE Ernail: I (we), the undersigned, hereby accept your proposal to fin-nish Labor and Materials to perform the following work oil premises located at the following address: SPECIFICATIONS OF CONTRACT The contractor a2rees to do the followiniz work for the homeowner: * James Hardie Board Siding $32,500 0 �'�/elP� * Derno existing siding. * Install Tyvek. ,j �/ * Install James Hai-die siding—Color to be Pearl Gray it/ * Install Azek Trim * Install 8+/-pairs of shutters N/C v * All permits and debris removal included. Homeowner is responsible for the protection of all trees, shrubs, and flowcrbeds. We guarantee our workmanship and provide a one(1)year Labor Only Warranty from date of completion. The contractor af-yrees to perform the work furnish the the materials and labor specified above for the Total Sum of$32,500.00 (Thirty Two Thousand Five Hundred Dollars and 00/100) Total amount of each e: 1/3dt.jewith si�tie(icontract: $11,000.00(Eleven Thousand Dollars and 00/100) j/3due 50%cornV1ete: $11.000.00(Eleveii"Thousand Dollars and OO/100) 1/3 Due When Project Is 100%Complete: $10,500.00(Ten'rhousand Five Hundred Dollars and 00/100) NOTES: (*) Including all finance charges (**) Law requires that any deposit or down payment required by the contractor before any work begins may not except the greater of(a) 1/3 of the 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 of schedule. You may cancel this agreement if it has been signed at a place other than the contractors 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 ofthe third business day following the signing of this agreement. See attached notice of cancellation form for an explanation of this right. „quired permits — The following building permits are required and will be secured by the contractor as the homeowners' agent. Proposed start and completion schedule will be adhered to unless circumstances beyond the contractors control arise. The contractor will start the project within 30 days and the project will be done within 60 days of the start day. 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 to the homeowner.The other copy should be kept by the contractor. _ ® All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation—(617)973-8700 10 Park Plaza,Suite 5170 Boston,MA 02116 Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their)hand(s)the day and year first above written. Buyers)Acknowledge Receiving a Completed Legible Copy of This Contract. This contract may be voided by the Owners giving written notice to the Contractor by ordinary mail within three full business days following the date hereof. By 63,1-had ry 03m1th r � L.S. (Richard J. Smith, President) (Legal owner of property t e improved) 337 Haverhill Rd., Chester,NH 03036 FID: 20-0487037 HIC#: 106603 (Date Signed) AJWOO-1 OP ID: N13 DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0310412016 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). PRODUCER CONTACT NAME: James A Santo Planright Insurance-Salem PHONE FAX 224 Main Street Suite 3C AIC' 1C No Ext):603-890-6439 Arc No): 603-890-6521 Salem,NH 03079 -ADDRESS:James A Santo ss:jamle SantOIltSUranCe.COm INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:ACadla Insurance 31325 INSURED AJ Wood Construction, Inc INSURER B: Julie Smith 337 Haverhill Rd INSURER C: Chester, NH 03036 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD YYYY MM DDIYYYY AIJUL Z$U1,$11 POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE J OCCUR CPA5136932 02/23/2016 02/23/2017 DAMAPREMGEISES S(ER,ocRENTEcurrence Do $ 250,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PES a LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO CAA5136933-11 02/23/2016 02/23/2017 BODILY INJURY(Per person) $ ALL OWNEDrx SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE CUA5136934 02/23/2016 02/23/2017 AGGREGATE $ 3,000,000 DED X RETENTION$ O $ WORKERS COMPENSATION XER AND EMPLOYERS'LIABILITY STATUTE ER H A ANY PROPRIETOR/PARTNEREXECUTIVE Y f N WCA5136936-11 02/23/2016 02/23/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER FXCLUDED? N I A (Mandatory in NH) 3A: MA NH E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A CRIME CPA5136932 02123/2016 02/23/2017 Empl Dish 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Richard Smith is excluded from work comp coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Coinionwealth of Massachusetts D'epartinent of Industrial Accidents " 1 Congress Street, Suite 100 Boston, MA 02114-2017 1"��� �''� wtivtiv.naass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization.Name:AJ Wood Construction Address:337 Haverhill Rd. City/State/Zip:Chester, NH 03036 Phone #:603-887-4468 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 5 employees (full and/ 5. Retail or part-time).* 6. Restaurant/Bar/Eating Establishment 2.Ej I am a sole proprietor or partnership and have no T Office and/or Sales(incl,real estate, auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. Non-profit 3.® We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required] 4.F1 We are a non-profit organization,staffed by volunteers, 11.❑Health Care with no employees. [No workers' comp. insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box 41. I ain air eniployei•that is proviidiiig workers'conipensatioii iiisuraiiee for my employees. Below is the policy irrfbrinition. Insurance Company Name:Acadia (Agent-Santos Insurance) Insurer's Address:224 Main St., Suite 3C City/State/Zip: Salem, NH 03079 Policy 4 or Self-ins, Lic.#WCA5136936-10 Expiration Date:2/23/1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of tip to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Z do hereby certify, under the pains and penalties of pei juiy that the information provided above is true and correct. Signature: Date: Phone#:603-887-4468 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.Licensing Board S.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia i <21w It>KAol b IkF,';,s, ,:¢�.�.0 t-l"..m. A k ^ 0 Rirk Plan _ Suite 5170 0 o tc3n, 'N/lasnjjj 116 1 t Home fInprolvement: Contuic3tor, Regi t at:iotl Ree)istratiom 106603 Typea Pfivates Corporation AJ WOOD CONSTRUCTION, INC, ExPir tNt:n: 7/24/2016 TO 253856 Richard Smith 337 HAVERHILL ROAD CHESTER, NH 03028 Update Address and return card,N'Tark reason for chartge, Address Renewilal :rtttalown'aeatt t..rast Gard 4 ft f<;:011s1111l er."k�ffairs� Business tie ur:da°fc a! S�icen e or registration vaNd for lfxa�ividUl t�Se ortly d011 M 'IMPROVEMENT CONTRACTOR CCTOR before the expiration dale. If fou nd return to. Dia&rat'aaara: 106603 Type' WfiC e of a:o nsunler Af aae,s and t3rssietevs Regaalatio�n 10VExp€rat ow 712412016 Private Corporation Eta Park Plaza Suite 5 l 70 Boston,MA 02116 T)JrJ D CONSTRUCP"iON, INC., te,ard Srnith HI w°E:RHOI_t EiCkAD 1` f Ctrl 0303 Not w�lrat ww srti:crrzre i l _. • 'IthC�dzt"+If;Stat'trB .. Masaat Saad C a merit of Not bbc Safety �. a�;�at~Pa tt �, wdaww Htttla on and Standards COMIT1100wealth of N .% 'ttj ,S l rcense CS-070882 DePartmeRt of Latwr standards arts (-,(:mlllstruchon 0ldcl rwnrcsaod SDPervisor RICHARD d SMITH, 337 HAWERHILLRDdtC RD,,,,,, CHASTER AIH OOSS t� �� riff, Bate 7/1 Wmtw of C 0 4 N.r �l ` 4., n .�..�"4, w„ "f Ur2 ' tf COMMdSSIIoner 07/28/2017 ad R r r at r a rr ru-1111 loll 11111111111 aa.+v- nt eW ., / re 1 ✓ iij �/ f mo i ��� �✓ � tri i, .f i ON MASS i � s r l r c cal ;ar r A, 4 <ar ✓r r � r 1r t ' a ' 1 „ I , r d X s" a1 S, S �,> .a�, ✓i1 0/ //✓J 9ii ' 1°rr� .eJ�l;�"fr ;,"i✓hi r� 1/q�r ,�;, ^, ,,, '^r, �, a;.� y,' i;�✓� o{{�° �l ra )�r�r� i '/ Ii