HomeMy WebLinkAboutBuilding Permit # 6/13/2016 ., . .,„ BUILDING PERMIT 'I aT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: wo Date ReceivedAr�a
Date Issued: 1
IMPORTANT: App icant must complete all items on this page
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LOCATION 15016 , Pofd
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PROPERTY OWNER r wr
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MAP NO: PARCEL: I"I ZONING DISTRICT: Historic District yes no
/V, - ::'.Machine Shop Village :yes no. .
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
CI New Building CI One family
I 1 Addition Cl Two or more family Industrial
❑ Alteration No. of units: Commercial
Yfl,epair, replacement ❑ Assessory Bldg Others:
I Demolition _I Other
El Septic El Well ❑ Floodplain ❑ Wetlands Cl Watershed District
i.I Water/Sewer
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Identification Please'Type or print Clearly)
OWNER: Name: f m r" t"N S, Phone:
Address:
CONTRACTOR Name: Phone: m ,
Address:
Supervisor's Construction License: Exp, Late: � /Z104)
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Home Improvement License: Cs- 16421H\ Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F.
Total Project Cost: $ t 1 VC FEE: $® 1 �;
Check No.: Mo Receipt No.: .NOTE: Persons contras r - 'r unr�e erect contractors do root have access .o ta"'
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�tgoatarf Agnt/Cwn&r`" °Sigriture of contractor
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Town of Andover
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ... .......... ............ .... . .......... .. .... .... .. ..:.... . .. . ... .............. . . ......
BUILDING INSPECTOR
UIL
Foundation
has permission to erect..........................—buildings on15-9.10..*&7-49........ ..... ......
................ Rough
tohe occupied as .... . ... .... .....0 .. .. ................................................................. 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 IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CON C 10 Rough
Service
.. .. .... ......... ....... ........
Final
BUILDI INSPE TOR
GAS INSPECTOR
ccy2ancE Permit Required to Occupy Buildin Rough
Display in a Conspicuous Place on the Premises — ® Not Remove Final
No Lathing r Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
mNmCS9 ine.
314 Clark Street North Andover MA 01845
978-685-0568 /fax 794-3780
Roof Installation
June 1, 2016
Proposal submitted to: Roger&Annette Fasnacht Address: 1590 Great Pond Road, North Andover, MA 01845
Service Address: same Phone, Email: rafasnacht@verizon.net
Salesman: Norman V. Lee GC#102750; 104295 HIC#167900; 291658
We hereby submit a description of work and materials to be used with estimated cost,subject to all terms and conditions as follows:
Strip roof of(1)layer of shingles;
Re-nail all loose sheathing;
Replace plywood as needed for an additional cost of$65.00 per sheet installed;
Apply GRACE Ice and Water shield six(6)feet up from edges of roof;
Apply paper to remaining roof surface up to ridge. Type: IKO Cool Gray;
Install 8' aluminum drip edge—color(white);
Replace (2) pipe boots. Size: 3-2'/2'
Reroof with IKO Cambridge Lifetime Shingles. Color: Earth tone Cedar;
Install Lomanco ridge ventilation;
Clean up and removal of waste and debris;
Magnetic sweep of property;
Walkways and driveways swept of debris;
Dumpster provided and included in job price
Total Price: $12,440.00
IF Permits required to be obtained, obtained by Contractor AT COST TO CLIENT
Owners that secure their own construction related permits shall be excluded from Guarantee Fund
Mold,ledge, rotting materials,code related issues or other unforeseen situations encountered that affect pricing,job duration,or other issues will be
discussed with the client,and change order submitted and signed off on by client to continue work. Like or similar material will be substituted in the
event that contractor is not able to obtain specified material,pending designer's and/or client's approval.Slight fluctuations in texture,colors can be
expected-contractor will make diligent effort to match Items as close as possible.
This contract will act as the final bill,and final payments will be made from this document.Any additional work in change orders will be collected in the
same manner.
Massachusetts provides a three day cancellation right to homeowners. Non-payment can lead to liens on your property.
Questions?Call us,write us and check out our website @ www.ncsne.com for more information on our other services.
TERMS&CONDITIONS
PAYMENTS AND DISBURSEMENTS: Customer is responsible for obtaining any financing he deems necessary to comply with this Agreement. If
Customer is obtaining financing form a third party,Customer agrees to apply for such financing without delay and this Agreement is subject to Customer
being approved for such financing. All payments are due and payable as specified in the Proposal/Contract. Northeast Contracting Solutions reserves
the right to assess a$25.00 fee if Customer requests us to re-invoice them for any reason. Overdue payments will bear a 1.5%service charge. Failure
by Customer to pay any invoice within five(5)days after payment is due per contract shall constitute a material breach of this Agreement. All legal,
court or otherwise collection cost incurred by Contractor are to be paid by Customer.
LABOR AND MATERIALS:Contractor agrees to furnish the materials for the project and complete the work to be done in a workmanlike manner. All
materials furnished under this Agreement shall be construction grade and meet industry standards. Where brand names have been specified,
Client Initials - 1 -
Contractor may at his option select substitutes when such substitutions are due to unavailability or previously specified. Contractor shall pay all
subcontractors,laborers,and material suppliers, unless specified differently in writing.
SPECIAL CONSIDERATIONS: For those selections of materials requiring special considerations including, but not limited to,cash deposits to insure
their production,Contractor may at his option require Customer to pay such required deposits directly to distributor or manufacturer rendering such
services. It is understood that when matching existing conditions such as color,size,planes and texture,Contractor will provide materials so as to
match,as closely as possible,the existing materials. However Contractor does not guarantee materials will match existing conditions.
DISCLAIMED WORK: No soil testing,surveying,plan design or engineering are included in this Agreement unless expressly specified. Contractors
shall not be held responsible for any existing violations of applicable building regulations or ordinances,whether cited by the appropriate authority or not.
Contractor is not responsible for any abnormal or unusual pre-existing conditions including, but not limited to,damage caused by termites or dry rot,
filled ground or ground of inadequate bearing capacity,rock and other material not removable by ordinary hand tools, inadequate electrical wiring
systems for the load imposed by the work under this Agreement,and plumbing,gas,waste and waterlines not shown on documents or plans furnished
by Customer. Correction of any such violations or abnormal conditions by Contractor shall be considered additional work.
ADDITIONAL WORK: Contractor shall promptly notify Customer of any additional requirements necessary to facilitate the project's completion. Any
additional work required or ordered by Customer(or any regulatory agency having jurisdiction over the project)shall be set forth in a signed change
order, and the agreed price shall become due and payable as agreed upon between Contractor and Customer,or within 30 days if not specified,
payment is due in full. Contractor,his employees,subcontractors and agents are unauthorized to perform any additional work or to enter into any
agreement to perform additional work unless agreed to in writing by Customer and Contractor through a properly executed change order,which shall
become an integral part of this Agreement.
PROPERTY RIGHTS AND RESTRICTIONS: Customer represents that he owns the property described as"property address",or has authority to order
and sign for work. Customer shall locate and point out the boundary lines of the property to Contractor. Customer shall be solely responsible for
accuracy of markers and boundary lines indicated to Contractor and as detailed on plans and specifications approved by Customer. If a land survey is
required for any reason to confirm markers or boundary lines,Customer agrees to pay for such survey. Prior to the start of construction,Customer shall
give Contractor a copy of any restrictions,easements or rights of way relating to the property.
ACCESS AND FACILITIES: Customer agrees to provide free access to work areas for workers and vehicles,and to provide areas to store materials
and debris. Unless otherwise specified, all water,sewer,gas and electric utilities from the servicing agency to the point of entry at Customer's property
line(or to the metering device if such devices are required)are the responsibility of the Customer. Customer agrees,at Customer's expense,to provide
electricity at the project site as may be required by Contractor to effect the work described herein in compliance with federal,state and/or provincial law.
Contractor shall not be held liable for minor damage to curbs,driveways,walks,patios, unless caused by the gross negligent movement of workers,
vehicles,equipment,materials or debris.
START DELAY AND COMPLETION OF WORK: Contractor agrees to commence work and to continue to work in a timely fashion so as to insure the
project's consistent development and ultimate completion. Contractor is bound by the terms and conditions regarding start of work imposed by any
licensing or regulatory agency having jurisdiction over the project. Contractor shall not be held responsible for project delays caused"acts of God,"civil
unrest,acts of Customer or Customer's agent,inclement weather,strikes, labor disputes,material shortages,licensing or regulatory agency inspections,
or any other actions or causes beyond the Contractor's control.
CANCELLATION CLAUSE: Option of Customer to terminate contract in the event of Contractor's failure to complete work. If the Contractor shall refuse
to or fail to perform the work with such diligence and force as specified in this contract,or shall fail to complete said work in a timely manner,or if
Contractor does not perform the work in a professional manner according to industry standards,Customer reserves the right to give written notice to the
Contractor of its intention to terminate this contract unless said violations of the specifications are corrected within fifteen(15)working days after serving
of said notice. If after fifteen(15)working days the violations have not been corrected or satisfactory arrangements for the completion thereof made,this
contract may,at the option of the Customer,be terminated. In the event of termination,payment in full for all services performed to date by the
terminated Contractor shall be made immediately at the time of termination. Option of Contractor to terminate contract in the event of Customers failure
to make timely payments as specified or to abide by all terms and conditions as outlined by this Agreement hereto,also,but not limited to any actions by
the customer to circumvent, interrupt or otherwise,any relationship with a subcontractor and the Company. Contractor's option to terminate will be
immediate and communicated in writing.
DAMAGE AND INSURANCE: Contractor agrees to carry worker's compensation and business liability insurance to insure the Customer against
damages or defects caused by Contractor,his employees,or any agents acting in his behalf. A valid insurance certificate will be furnished upon
request.
MISCELLANEOUS: Contractor may subcontract all or any portion of the work and may assign this Agreement to another Contractor,provided such
assignment shall not affect the rights and privileges of Customer under this Agreement. In case one or more of the provisions of this Agreement or any
application thereof shall be invalid, unenforceable or illegal,the validity,enforceability and legality of the remaining provisions and any other application
thereof shall not in any way be impaired thereby. If any legal action shall be instituted to interpret or enforce this Agreement,the prevailing party shall be
entitled to recover all litigation costs,including reasonable attorneys'fees. It is agreed that this Agreement shall be governed by,construed,and
enforced in accordance with the laws of the State of Massachusetts.
CONTRACT ADJUSTMENTS: In the event of an unanticipated increase in the cost of fuel or materials used by Northeast Contracting Solutions, Inc.,
reserves the right to pass through to the Customer such increases or,if the Customer does not agree to pay any such increases,to terminate the
contract.
LIMITED WARRANTY: Northeast Contracting Solutions guarantees workmanship,subject to the following conditions.
• Contractor warrants all labor for 2 years,and manufacturers warranty on materials is a 25 Limited Residential Warranty on materials(please
see individual Company policies online).
is purchased. This limited standard warranty extends only to Customer and is not transferable.
• Contractor will provide replacements as stated above on a one-time basis only at the request of the Customer,at no charge to the Customer
except for supportive materials deemed necessary and labor. Please note,however,that Contractor is not liable under this limited standard
warranty for actual of consequential damages resulting from"acts of God,"excessive weather conditions(extreme cold/drought,washouts,
etc.),soil conditions,abuse,vandalism,poor drainage,salt damage,theft, or fire.
Client Initials - 2 -
^ Any warranties given by manufacturers pertaining to materials used by Contractor in with the projectwill ucpassed through and inure mthe
benefit ofthe Customer.
° There isnoimplied warranty vfmerchantability nrany implied warranty of fitness for any particular purpose.
There are no warranties either express or implied beyond the description within this section.
All home improvement contractors and subcontractors shall be registered and that any inquiries about contractor or subcontractor no|ounq
ooaregistration should bvdirected to:
Office ofConsumer Affairs and Business Regulation
Ten Park Plaza,Suite*1/OBoston,NmVu118
Phone:(V1Oo7x8/0u
/he contractor �
contra t -dis ute to a private arbitration service i� Business Regulation
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and the c ns;ume halslne'requi ffdto submit t9-8�c arbitration as proved in MG c
Owner- -TAX Contractor
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4coa�ad:The sign�uesbelow indica�that the above phces.specifications and cundiVunoo�ouUo�mo�and he�byo�epmd. Paymemwill be
made asouUinodabove.
7PA ES!
Owner Signature: Date: o7i L9
Contractor Signatur'�& Date: I/to t'
Date»muestarted* Date muocvmp/mom"
Payment Schedule
sVY6Due Upon Acceptance
5VY6Due Upon Commencement ofWork
Company Policy requires credit card number,v-cvdoand expiration date nnfile mprocess project. �
oo v-Couo Exp,Date
*Based on receipt of bankable check,and availability of materials.
"Assuming nvweather,material availability orunforeseen issues.
Excluding change orders,unforeseen issues.
Client Initials - 3 -
The Commonwealth of Massachusetts
M.1 Departfnent of Industrial Accidents
c 1 Congress Street, Suite 100
Boston, MA 02114-2017
wwminass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Business/Organization Name: & )cj 4tj [,ojrc-j, � �4 -1 . i.
Address: 31 L�
City/State/Zip: �� I't� tr , i Y �t`�q Phone#:
Are. u an employer? Check the appropriate box: Business Type(required):
1.u�j I am a employer with Z�r employees (full and/ 5. ❑Retail
or part-time).* 6. ❑RestaurantBar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate, auto,etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] g• 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.❑ 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 91 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#1.
I am an employef•that is providing iv! ]*rs'con ensatton iiisrirance for my employees. Below is the policy information.
Insurance Company Name: , rc"VR ,2rj
Insurer's Address: 7 Vt II < `V
City/State/Zip: d-4'1 `r `1'' a -1 I
Policy#or Self-ins.Lic.11 Pa Expiration Date: 01 L
1
Attach a copy of the workers' compensation policy declaration page(showing the policy number an expi ation date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations f the DIA f iu rance coy rage verification.
I do hereby ct• {nde 1 ai s i pe alties ofpeijuly that tl:e information provided ab ve is tr we and correct.
Signature: (� l r� Date: c ZG 16
Phone#: l �� ® 0� 1p�
Official rise 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 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
VDAC
TRAVELERS!'
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (7PUUB-8D88464-9-16)
RENEWAL OF (7PJUB-8D88464-9-15)
INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
1. NCCI CO CODE: 13579
INSURED: PRODUCER:
NORTHEAST CONTRACTING MTM INS ASSOCIATES
SOLUTIONS INC 1320 OSGOOD ST
314 CLARK STREET NORTH ANDOVER MA 01845
NORTH ANDOVER MA 01845
Insured IS A CORPORATION
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 01 -07-16 to 01-07-17 12:01 A.M. at the Insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s)listed here:
MA
f
--= B. EMPLOYERS LIABILITY INSURANCE.: Part Two of the policy applies to work in each state listed in
Item 3.A. The limits of our liability under Part Two are:
h�IW�m
Bodily Injury by Accident: $ 500000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 500000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 068
-
D. This policy includes these endorsements and schedules:
h�
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
4= Plans. All required information is subject to verification and change by audit to be made ANNUALLY.
DATE OF ISSUE: 01-11-16 WC ST ASSIGN: MA
OFFICE: DIRECT ASSIGNMENT 701
PRODUCER: MTM INS ASSOCIATES 7766P
oazeao
j Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-104241
Construction Supervisor
MARK DELGRECO
F
2 FOX HOLLOW ROAD
DERRY NH 03038
r-,J.�n C Expiration:
Commissioner 08/1812017
471
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement,Contractor Registration
Registration: 167900
_ Type: Private Corporation
Expiration: 11/17/2016 Tr# 258009
NORTHEAST CONTRACTING SOLUTIONS
NORMAN LEE -
314 CLARK ST
N. ANDOVER, MA 01845
Update Address and return card.Mark reason for change.
SCA 1 ro 20M-05/11 Address F� Renewal n Employment ❑ Lost Card
UfLB 4792471 d7t10¢CLL�IL G1Q1 ajjc(cX(ejBf
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 167900 Type: Office of Consumer Affairs and Business Regulation
xpiration 11!17120[6 Private Corporatio: 10 Park Plaza-Suite 5170
$gston,MA 02116
NORTHEAST CONTRACTING SOLUTIONS INC. 1
NORMAN LEE
314 CLARK ST
N.ANDOVER, MA 01845 Undersecretary Not valid without signature