The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 6/13/2016 BUILDING PERMIT �aorary O��.cL@D 16 6 TOWN OF NORTH ANDOVER � ® APPLICATION FOR PLAN EXAMINATION Permit No#IV Date Received �gssgcwus��5 Date Issued IMPORTANT: Applicant must complete all items on this page LOCATION � 1 Print PROPERTY OWNER '1� cL�� ' � ' (\L Print 100 Year Structure yesOno ,MAP PARCEL:&S ZONING DISTRICT: Historic District yeMachine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building One family [IA 'tion [I Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �FSepfi» ❑Well f ❑ Floodplain ❑Wetlands ❑ Wafershed District r CZ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please'Type or Print Clearly OWNER: Name: (aay\('A�- Phone: Address: o c ie 5V ` rA i,� Contractor Name: ,-1))t Phone: ��``�5G SS/ 3 Email e-, - L _ Address: V� CSS Supervisor's Construction License: 5-1 Exp. Date: 0 0"-pa Home Improvement License: i V5W Exp. Date: C b(wv ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ / '< Ci( FEE: $ l� Check No.: � ' Receipt No.: NOTE: Persons contra ing with unregistered ontractors do not have;access to the guaranty fund %4®RTH Town of0 'a ndover ,1 No. C)b ® �AK� VAI°' SSS' COCNICA.11. U BOARD OF HEALTH Food/Kitchen PER D Septic System s THIS CERTIFIES THAT ..........•............ BUILDING INSPECTOR has permission to erect g , , .......... Foundation .......................... buildings .......: .... ... ..... ... Rough tobe occupied as ........ ...... ... .. ...... .. ......... .... ... .. ................ ..................................... 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 CONST CTIO T Rough Service . ...... ... ... .... ........ ........ Final BUIL INSPE T®R GAS INSPECTOR Occupancy Permit Required to Occupy Bu Rough Display in a Conspicuous Place on the Premises - ® Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Quality Abatement Contractors LLC DBA Rosario Construction Services 49 Blanchard St Suite 205-2 Lawrence, Ma 01843 Tel: (617)756-5513 Fax: (978)258-8595 Email:Joser.gac@gmail.com WWW.QAC-LLC.COM Contract Agreement Homeowner information: Name: Matthew Barnett Street Address: 40 Salem St City/Town: North Andover State: Ma 01845 Phone Number,-&1-7--908-3- --7-&4,- l q CIS ' `'/�( Contractor Information Company's Legal Name: Quality Abatement Contractors LLC (DBA Rosario Construction Services) Business Address: 49 Blanchard St Suite 205-2 Lawrence, Ma 01843 Phone Number: (617)756-5513 Email Address: Joser.clac@gmail.com Home Improvement Contractor Reg# 184596 Expiration Date: 02/09/2018 Contractor License # 109723 Expiration Date:02/07/2020 Contractor agrees to do the following work for Homeowner: Per approved estimate. Proposed start date and completion of schedule-The following schedule will be adhered to unless circumstances beyond the contractor's control, arise. Contractor will begin contracted work on or by: 06/13/2016 (Tentative) Contracted work will be substantially completed on or by: 08/13/2016 Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish all equipment,tools and labor as specified,for the total sum of: $21,786.61 $6,535.98 30%of the total contract price is required upon signing contract. $6,535.98 30%of the total contract price is required at the start of the project. $6,535.98 30%of the total contract amount. This will be submitted upon completion of finish phase. (all materials installed) $2,178.66 10%of the total contract amount.This will be submitted upon completion of any punch list items. General Provisions: Any alterations or deviation from the above specifications, including but not limited to any such alterations of deviation involving additional material and /or labor costs, will be executed only upon written order for same, signed by owner and contractor and if there is any charge for such alteration or deviation, the additional charge will be added to the contract price of this contract. If payment is not made when due, contractor may suspend work on the job until such time as all payments due have been made. A failure to make a payment for a period in excess of 30 days from the due date of the payment shall be deemed a material breach of this contract. In addition, the following general provisions apply: 1. All work shall be completed in a workman-like manner and in compliance with all building codes and other applicable laws. 2. The contractor shall furnish a plan and scale drawing showing the shape, size dimensions, construction and equipment specifications for home improvements, a description of work to be done, description of materials to be used or installed and the agreed consideration for the work. 3. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 4. Contractor may at its discretion engage sub-contractors to perform work hereunder, provided contractor shall fully pay said sub-contractor and n all instances remain responsible for the proper completion of its contract. 5. Contractor shall furnish owner appropriate released or waivers of lien for all work performed or materials provided at the time the next periodic payments shall be due. 6. All in change orders shall be in writing and signed both by owner and contractor and shall be incorporated in and become part of the contract. 7. Contractor warrants it is adequately insured for injury to its employees and other incurring loss or injury as a result of the acts of contractor or its employees or sub- contractors. 8. Contractor agrees to remove all debris and leave the premises in broom clean condition. 9. In the event owner shall fail to pay any periodic or installment payment due hereunder, contractor may cease work without breach pending payment or resolution of any dispute. 10. All disputes hereunder shall be resolved by binding arbitration in accordance with rules of the American Arbitration Association. 11. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty, or general unavailability of materials. 12. Contractor is not liable for any hazardous materials discovered, its removable or disposal. Client agrees to pay all owed amounts to contractor upon completion of the contracted work. Interests and finance charges will be charged to the maximum allowable by law or at 1.5% per month, whichever is less on all account over thirty days past due.Time is of the essence. contractor's Signature Date Homeowner's Signature Date The Commonwealth of Massgehusetts .Department of Indlustrial.Aceidents _ - d I Congress Street,Suite 100 Boston,AM 02114 2017 www.mass gov/dza Workers'Compensation Insurance Affidavit:Builders/Contractors/E le.etricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. I Applicant Information Please Print I egibly NaMe(Business/Organization/.bidividual): i t (A 11dY1 D n�-r'u)U- Address: City/State/Zip: (.c�wr�/��L 1�� 1 �( Phone#: 60 ' '�S SY 13 Are you an employer?Che,k& appropriate box: Type of project()required): 1.❑I am a employer with employees(full and/or part time)?' 7. []Ne onstruction [.]2, I am a sole proprietor or partnership and have no employees working for me in 8. - emo delitig any capacity.[No workers'comp,insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. [I Demolition ❑4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions pzopiietors with no employees. 12.F]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ r 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6. are a corporation and ifs officers have exercised their right of exemption per MGL c. 14 ❑Other 152,§1(4),and`ye have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also£ill out the section below showing their workers'compensation policy information. homeowners who subniif this affidavit indicating they are doing all work and then hire outside contractors niust submit a new affidavit indicating such. tConfractors that check this box must•atfached an additional sheet showing the name of the sub-contractors and state whether or not those entities bave employees. if the.sub-coritrac6s tave*employees;:Iiey must provide their workeis'comp.policy numbEi.• I airs an employer that is pi�oviding ivorlters'compensation insurance for•my employees.•Felow is the policy and job site information. Insurance Company Name: 11Z'✓�� 1 �rc�/��Q �(1U�, Policy##or Self-ins,Lie.#�N� � Expiration Dater _ Job Site Address: -10 s0 e'r-, �4- City/State/Zip:,M,/'S/ y r1. (` 0.YL/S� Attach a copy of the workers'compenisation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certif up der the pains andpenalties ofperjuiy that the information provided above is true anti correct. sign ro: — - / `.� Date: 6 Phone## Official use only. Do not write in this area,to he completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 2016-06-13 15: 14 Phil Richard Ins 9787741318 >> P 2/2 ��/dU� uAl�(raMnnvvvvv) CERTIFICATE OF LIABILITY INSURANCE 06/13/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OE INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 'BEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE' DOLS NOT G 3TITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the curtiflcate hvldur Is art ADDITIONAL INSURED,the policy(ion)must ho ondorsod. If SUBROGATION IS WAIVED, subjuct to Lho torme and conditions of tho policy,certain policios may requlru an endorsement_ A statement on this cortificato door not confor r1UhtS;to tho cortlficato holdor In II011 of Such oadoroomom(s). -6717"1vKiwuCtK NAMF:61 Flalny 7olotas — Mass!"ay Insurance Services,LLC PHONE (978)774.4336 x118 27 Garde•I SLI-cot,Unit*1 D0 ac,No.. )_.__-- INC,No): _ .. . Danvers,MA 01923 0 A70.0' olah�e(rphlhl0harilinsurenc:c?.i:nr)) nD_D_R_e_s_s: _- INSURCR(S)AFrORDINGCOVEHAGI� NAI(:0 INSIIHFH A: Main 8t Artier AsS-Ur Co 20030 INSURED OUalityAbf, ment Contractors LLC INy1JKFRfl: NATIONAL GRANGE MUTUAL INS CO '14786 88 Willow:;:Apl 1 --__. "..._.....' I.awrencti,MA 01841 IN\IJkFR(:: IN$IJHFK D INSUKF.fi F IN1.,1JHFFK F: COVERAGES CERTIFICATE NUMBER, _ T� REVISION NUMBER: T1115 IS 1'0 CERTIFY TI IA- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSIIFD 1*0 THI-' IN$I.Iltl U NAMI.I)AIJOVI- I ORTHE PO_ICY PERIOD INDICATED. NOTWITI ISTI-LADING ANY REQUIREMENT, TERM OR CONDITION OF ANY C.ONTLlA(,;I'C)1i 01111.1( nr_)r:UMLN I'WI'I1 I RUSPE-CT TO WHICH I TI IIS CLR•r11'ICATE MAY BE IS'=UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THh 1101 ICII=S 111 S(;Nllll f) 1•I1.1(I.IN h� SIJLIJL:C'I' TO ALL TIIE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.I-IMIT S SHOWN MAY HAVI_I'll"FN 141'I)IJ01.0 IIY PACU CLAIMS. —. - — INtiR fuAjr J1T3' � ��-•�� POLICY CrF POLICY t:kP I ilx TYPE OF INSURANCE Nul K:v rn,r+IHFH (AIMIDUIYYW), (Mrnluu,Yvvv) LIMITS A V COMMCRCIALGCNCRALLIAOILITY MPT7323T 10/23/20'15 10/23/2016 ,.n;;,.,r,ajCUKKF.N(.r 1,000,000 '.. "" r� OAMnGCTO'RCNTCD 5CU,000 1;1-AIM1i-MADh 1y 1 OCCUR PRCMI^C"(Eli uccununcu MW LXh(Any.one person) _ 10,000 — PERSONAL$ADV INAIRY 3-.•- 1,000,000 GFN'I AG GA FGATF I IMIT AFPI 1V:$KFR: GCNERAL AGGRFGATF :) 2,000,000 -RO P 1,U1.1C[Y U I LUG.A 2,000,000PRO 1� ... - .... .-_. R AU'I'OMODILC LIAUILI I Y M'I r737.1T 11)/26/2015 10/26/201 G COMOINCD 51 GLC UM 1.000 000 ICP oTil- lffl _ ANY AU IU BODILY INJURY(Pef parson) ALL OWNED SCHEDULED BODILY INJURY'(Pef3ccldenl) S AUTOS AUTOS NON-OWNED I'KUI'hRIYI)AMAGE S ruKw,nU 1 i Ig AUTOS PuI uccldeul UMBRCLLA LIA:' I;li;l)IJH —•_•• ••. •.-.---_ hkf�H OCCVHRkNCE _ '., EXCE55 LIAR CLAIMS-MADE nC;GKF 1',A I, Dr-o aFT;�nirarlN s WOKKF'KR COMFhNSAl ION 1�C-R UTI-I '.. AND EMPLOY ERV LIABILITY v I N .TATI T f;[{_-_-_•-, ANY ifFICFHI-HOlIM'KFIAF9HE-K A ( I NIA C.L.cnc1IACCIDENT S ( ryF XCI 111IFI)! nIn NH) ------ C.L.DISEASE CA EMPLOYEE S u n9,,1mcrlhn n�tiGHIP I ION UI-UI'tRAI 10A6 Dolmy C.L.DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEIIICLES(ACORD 101,Addldunul Rcumrku Schedule,miry hn nrtnchnd it ninrn npnrn Ie re(jUliva) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T)1E ABOVE Dr:SCRIRED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION F)ATr; THEREOF, NOTICE WILL BE DELIVERED IN 1600 6.39ood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA O184h AUTIIORIZGOiiLFRLStNIAIIVt I _ (c)19BB-2014 ACORD CORPORATION. All rights reservod. ACORO 25(2014101) Tho ACORD name and logo art)mgislelred miirkS of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-109723 's Construction Supervisor JOSE ROSARIO fr 88 WILLOW ST.APT 1 �Fs# LAWRENCE MA 01841 �"� -lExpiration: Commissioner 02/07/2020 Office of Consumer Affairs&Business Regulation r HOME IMPROVEMENT CONTRACTOR WE Registration: .;,184596 Expiration: 2/9/2018 LLC Type: QUALITY ABATEMENT CONTRACTORS LLC. JOSE ROSARIO 88 WILLOW ST APT 1 LAWRENCE,MA 01841 ^'-- Undersecretary