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HomeMy WebLinkAboutBuilding Permit # 8/18/2016 BUILDING PERMIT &�"�`•n �•_:c' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMIN N Permit No: "" ,► Date Received '� « Date Issued Cwaseq ORTA�i- ,Applicant roust com fete all items on this paae NOW TYPE OF IMPROVEMENT PROPOSED USE Residential _ _ Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition ,/"Other l � W v 9,rY �re Tom'/w Idtntification Please TI-pe or Print Clearly) OWNER: Name: Phone: /� :- 2 C(:; ��C Address - . C L C ti ,�� ` „rw n " OP SO. batww. 4. .. ..,..�,. s✓.,,r„K �..,w ., ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:512.00 PER$1000.00 OF THE TOTAL ES711WATED COST BASED ON$125,00 PER S.F. " ..F . Total Project Cash $ ,� ._. •' :.-.. � "� � Check No.: Receipt No.. :MOTE: Persons contrac ing Baa la unreg' t red contractors do not have access to.Oe guaranty fund � r sign t &1=tri I Plans Submifted Plans Waived Certified Plot Plan Stamped Plans TYPE(�)FSEW'ERAQE�DISPOSAL Public Sever Tanning',Massaize Bod,, Art sminu-ning pools Well 'Tobacco Sales Food PackagingSales Private(septic lank,etc. Permanent Dunipslef.on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTER D.EPA RTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVE PLANNING PLANNING & DEVELOPMENT yll-- 116 COMENTS Q 0 i%A 0 UA I F NEJEU I ED LJA /CO FE-AFPK()VEU--- NSERVATION COMMENTS 1\,Ip- . �oes' DATE REJECTED DATE P , U D HEALTH COMMENTS A zoning.Board of Appeals: Variance, Petition No: Zoning Decisiontreceipt submitted yes Manning Board Decision: comments Conservation Decision: Comments Water & Sewer Connectlon/siLnature& Date. ay Permit Located at 384 Osgood Street & yes no axe ..................... .............. V% RTy Town of � _ ndover O _,. 0 No. 0h ver Mass T O LAKE ot. 7 3 COCHICNEw�[K A�4ATED 0` 5 s U BOARD OF HEALTH R D Food/Kitchen P E �T Septic System THIS CERTIFIES THAT ............. ....a... ................. ...... .. ....,.,... .... ......................... BUILDING INSPECTOR has permission to erect .................. ,, buildings on . 1.6.4N� �....,,�,, „•, ........,. Foundation ...� .. � ' .. �. ........ir OIL Rough to be occupied as .... .. ................. ..... .... A ... .... ..... . ........ chimney provided that the person accepting this permit shall in every respect coorm 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 Inpectyn, Alterat' n 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS C® ST IO Rough Service Final BUILDININSPECTOR GAS INSPECTOR Occupancy Permit Required to Occuev 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. Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's Horne Improvement Contractor Law(MG] chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first 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 Regulation's Consumer Information Hotline at 617-973-9787 or 1-888-283-3757. Homeowner Information Contractor Information Name Scou I lansen Company Name: PROFFISSIONM,BI ILDLNG M"IRVIRT"S Street Address(do not use a Post Office Box) Contractor/Salesperson/OwnerNarne: 11F]11,114(Tit RM,01 W4 CokmialAv�,.,, North Andover, '0A 01845 Business Address(must include a street address) Daytime Phone Evening Phone 9 OLDE NVOODF, RID SA LE,k], 'Mil 03079 440-220-.290� Mailing Address(It different from above) Business Phone Federal Employer ID or SS Number 603-8980-2977 1rvn 1129617 Law requires that most home Home Improvement Contracloi Expiration Date Improvement contractors have a valid reg.number Regimation nutaber 708V70 0/p 8 The Conti-actor Agrees to do the following work for the Homeowner: (Describe in detail the work to be completed,specifying the type,brand,and grade of materials to be used,rise additional shcets.jfncccssary..) Retcrence Professimud Building Ser k,ices Vohriate 43456 Tr ex Det1dng Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following and will be secured by the contractor as the homeowner's agent, schedule will be adhered to unless circumstances beyond Owners who secure their own permits will be the contractors control arise excluded from the Guaranty Fund provisions of (t/'20I6—Date when contractor will begin contracted work. MCL chapter 142A.) 91120 16 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total surn of %3"7, 564,00 Payments will be made according to the following schedule: $1 2,5 2 L3 I upon signing contract(not to exceed 1/3 of the total contract price Pr-the cost of special order items,whichever is greater) $N 2,000.00 upon cornpletion of material drop and deck dernoed upon completion of deck framing S5,000,00 upon completion of deck installed rcm;Jndcr upon completion of tile contract.J.,aw forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special$--.N/A—.to be paid lot- N/A Ordered before the contracted work begins in order$—,N/A—to be paid for N/A ...... to meet the completion schedule.(**) NOTES:(*)Including all finance charges of 1.5%per month from due date until amount is paid in full plus$50 processing fee (**)Law requires that any deposit.or down-paymqqt required by the contractor before work begins may not exceed the greater of (a)one-third of the total 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 schedule. ---------- Express Warr -Is-,in express warralltv beirig provided i;v_i_jie_eonti',a"c_t""o_r?—No Yes (all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under t its aRreernent, Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautious and notices carefully before signing this contract. • Don't be pressured into signing the contract.'fake time to read and fully understand it.Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration.'Che law requires most home improvement contractors and subcontractors to be registered with(lie Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance?Check to see that your contractor is properly insured. • 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. Photography and Testimonials All Photos/testimonials and rights relating to them,including copyright and ownership rights in the media in which the photos are stored,remain the sole and exclusive property of the Contractor.The Contractor has right to reproduce,publically display,and distribute for promotional and advertising. 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 of this agreement.See(lie attached notice of cancellation form for an explanation of this right, 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. Homeowner's Si nature Contractor's Signature � 8111116 Date Date 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 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' Si ature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the patties to alternative dispute resolution initiated by the 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(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 duplicate 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 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 Consumer Guide to the Home Improvement Contractor Law," contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation I 10 Park Plaza,Room 5170, Boston, MA 02116 (617)973-8787 or 1-(888)2833757 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 Bureau of Building Regulations and Standards One Ashburton Place,Room 1301, Boston,MA 02108 (617)727-3200 or 1-800-223-0933 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)652-4800 (508)755-2548 (413)734-3114 B i Professional Building Services Estimate 9 Olde Woode Rd Salem NH 03079 www.professionalbuildingservices.com Date Estimate# L0 SERVICES info@t)profession a I b u i I di ngservices.corn 603-898-2977 f 781-995-2335 8/11/2016 3456 Exp. Date 9/11/16 Name/Address Scott Hansen 104 Colonial Ave North Andover MA 01845 Description Qty Rate Total SCOPE: Remove existing deck and construct Trex elevations frame. Install new Trex Transcend deck and rails. Building Permit-Administration Fee 1 375.00 375.00 Home owner can pull building permit themselves. If customer wishes Professional Building Services to pull permit, please add $375. DIGSAFE to be processed by whoever pulls permit ** Customer to reimburse Professional Building Services cost of permit fee paid to Town/City. Building Permit Fee paid toTown/City-TBD 1 0.00 0.00 This fee to be reimbursed to Professional Building Services or customer can pay directly to municipality DIGSAFE to be called in by person pulling permit 1 0.00 0.00 Estimate Valid for 14 days of Issue Total Page 1 Professional Building Services Estimate NOW ULOG 9 Olde VJoode Rd Salem NH 03079 www.professionalbuiIdingservices.coni pate Estimate## infoCii)professionalbuildingservices,corn 603-898-2977 / 781-995-2335 8/11/2016 3456 Exp, pate 9/11/16 Name/Address Scotty lansen 104 Colonial Ave North Andover MA 01845 Description Qty Rate Total Remove and dispose of existing deck and railings.Replace with 348 93.00 32,364.00 Trex Transcend flat post caps, skirts and 4x4 posts. Supply&install Trex Tran decking.fascia and stair risers to be wrapped. Trex Elevations framing with all appropriate fasteners and hangers Will use hidden fastener system and color matching screws where necessary. Install ice and water shield behind ledger Lag ledger to foundation sill in"zig-zag"pattern. Joists 12"O.C.doubled to support cantilever Picture frame deck Deck Size- 14"6'°x 24' Deck color-color of choice. Trex"Transcend Tropical colors are an upgrade Rail,Post,Crap&Skirt Color-White Foundation: 6 350.00 2,100.00 HELICAL PILE installation if machine accessible IF extensions are needed to go beyond the 7'pile,add$195 per pile. Estimate Valhifor 14 clays of'Issue Total Page 2 Professional Building Services Estimate 9 Olde Woode Rd Salem Nil 03079 _ www.profess ionalbuiIdingseryices.coin Date Estimate# info((r.7professionalbu ild ingservices.com SERVICES 603-898-2977 / 781-995-2335 8/11/2016 3456 Exp, Date 9/11/16 Name/Address Scott Hansen 104 Colonial Ave North Andover MA 01 845 Description Qty Rate Total 6 350.00 2,100.00 Stairs: Pressure treated stair tread stringers to be installed 12"o,c,with Trex matching decking and.PVC,on risers.Price per tread, Form and pour cement pad to width of stairs 1 0.00 0.00 Trex lighting pricing: 0,00 0.00 Post cap$125/light Riser light$65/light Recessed deck lights$65/light Side post light-$99/light Labor to install-$40/light Transformer with timer switch $275 20 yard dumpster with 3 tons. If additional dumpster needed, 1 625,00 625,00 customer agrees to pay for additional dumpster or dumping fee of $125 per ton. Lattice: 0 300.00 0,00 Will install privacy lattice around bottom of deck as an upcharge if requested. Will frame with pressure treated wood Will use PVC to trim out Price per section BECAUSE OF EXPANSION AND CONTRACTION TENDENCIES OF VINYL LATTICE,NO WARRANTIES ARE ISSUED NOR EXPRESSED FOR THIS LINE ITEM. Transcend decking and porch planks installed by`"rexPro Platinum's will receive a free 2 year labor warranty from Trex upon project registration,When installed over Trex Elevations Steel Deck Framing,this coverage will be extended to 5 years. Estimate Valid for.14 days of Issue Total Page 3 Professional Building Services Estimate 9 Olde Woode Rd Salem NEI 03079 '4 www,professionalbuiIdingservices.coni Date Estimate# WL Q SER " C " ` 603-898-2977 ft a 1/bit 7d81-995 ices. 2335 8/11/2016 3456 Exp. Date 9/11/16 Name/Address Scott Hansen 104 Colonial Ave North Andover MA 01845 Description Qty Rate Total CONCEALED CONDI'T'IONS:This Agreement is based solely on 0.00 0.00 the observations Contractor was able to make with the structure in its current condition at the time this Agreement was bid.If additional concealed conditions are discovered once work has commenced which were not visible at the time the proposal was bid, Contractor will stop work and point out these unforeseen concealed conditions to Owner so that Owner and Contractor can execute a Change Order fir any Additional Work. 0.00 0.00 ROT REPAIR-remove,dispose,purchase and install 4x8 plywood -$100/sheet Structure/frame repair rates: $165/hr for Master Carpenter&Carpenter Apprentice Materials receipt to be provided plus 15%for administration fee I i Estimate Valid for 14 days o f Issue Total $37,564.00 Page 4 DECK PLAN 24' 2616-171 1 9 1 4 z DRAWING# HOUSE c: � oLL U w EXISTING TIMBER LU RIM BOARD �� coN FLASH LEDGER L70Z OR I� ............ ____ [EQUIVAI-1111. �I (A,+) D I � I ................_,....__......_.....,._._..._..._._.___' f�l W B( B LU$ SCE Al rn �� APPROXIMATE RAIL CLIENT: POST LOCATION rVf1\LSV SEE TREX ELEVATION INSTALLATION GUIDE DOUBLE EVERY OTHER g15T JOISTS SPACING _ D.C. O 1 TREX ELEVATIONS M MID SPAN BLOCKING to T 7 1 7v BOX M DRD D ENA DZ 0 J_ G 6 X 6 PRESSURE TREATED POST- POST SUPPORT i POST TO BEAM CONNECTION PER NOTES AC67-I.PC6 AT DROPPED BEAM LOCATIONS ONLY J O TYR Q O Z co 0 I� N 1) Ln L L1 TRACK RIM PLATE I LJ_I U d. DECK FRAMING NOTES: TEKS SELECT OR BEAM BLO I- > I XEQ#10X a"SELF-DRILLING B TREX ELEVATIONS O m {REFER TO TREX ELEVATEONS INSTALLATION GUIDE FASTENER THRU TOp BEAM BLOCK ATOP ALL DROPPED LOCKNC FOR TYPICAL DETAILS); O (Y LJ_1 O ALL DIMENSIONS AS SHOWN ARE REFERENCE ONLY AND BOTTOM OF TRACK BEAMS EVERY OTHER AND MUST BE SITE VERIFIED AT EACH J0157 BAY GUARD RAIL-IF APPLICABLE-TREX MIN HEIGHT 36" MAXIMUM SECTION LENGTH 7 J 1 1„ z REVISION: IR BETWEEN RAIL POST 92" 1'-2$' 7'-3&" 7' o-" 7'-38 7'-2$' LEDGER-SEE TREX ELEVATIONS LEDGER ATTACHMENT Z 4, TYPICAL DETAILS FOR FASTENERS AND SPACING JOISTS -TREX ELEVATIONSJOIST O 12'O.C. APPROXIMATE HEIGHT DOUBLE EVERY OTHER JO15T ABOVE FINISH GRADE UNKNOWN ENGINEM G PER ELEVAIIONS SPAN CMAU FLUSH BEAM-TREX ELEVA71ONS BEAM DROPPED BEAM-TREX ELEVATIONS BEAM DECK AREA 348 SQ/FT TREX ELEVATIONS TEKS SELECTOR 7M SELECT QRXEQ#10 X j' TABLE BEAMS MUST HAVE FULL BEARINGSEL'-DRILLING FASTENER TYP, BLOCK ABOVE ALL DROPPED BEAMS EVERY OYHER BAY JOIST XEQ#10X?"SELF-DRILLING TDP AND RDTTOM 0 12'O.C. DECK POSTS-6 X 6 PRESSURE TREATED TYP. STAIR NOTES: FASTENER(1 AT FACHJ06T ALONG SPAN OF1or5T E-75 PIERS-REFER TO LOCAL BUILDING CODE OFFICIAL TOP SURFACE OF ABOVE ALL DROPPED BEAMS) 75 PIF HARDWARE-L70Z,AC5Z,LPC6Z, MAX 7"RISE MIN 11"RUN DROPPED BEAM i4' TRC,HANDRAILS-34'-38"HEIGHT TR ELEVATrONs ELEVATION$ OR X 318"X 2}'LAG SCREW,TEKS SELECT MAX HANDRAIL DIAMETER 2" — Jolla TRACK SHEET TITLE:OR XEQ INE X N APPR V L] F FASTENER HANDRAIL SPINDLE SPACING MAX 4' I-� DESIGN REQUIRES ENGINEERING APPROVAL IF HOT TUB IS ♦ DECK PLAN TO BE PLACED ATOP DECK HANDBALL POST LOCATIONS,AS SHOWN,ARE CONCEPTUAL ONLY. DO NOT EXCEED SPANS WITH TREX ELEVATIONS MATERIALS ACTUAL LOCATIONS TO BE DETERMINED BY CONTRACTOR.RAIL POST DESIGNED BY: CENTENNIAL CAD AS PUBLISHED IN TREX ELEVATIONS INSTALLATION MANUAL SPACING NOT TO EXCEED RAIL.MANUFACTURERS O DETAIL A O TYP RIM JOIST ASSEMBLY TABLE E-75(75 PSF) MAXIMUM RECOMMENDED POST SPACING JOESTATTACHMENTTO DRAWN BY: WSM PLEASE NOTE: TREX ELEVATIONS DROPPED BEAM THIS DECK PLAN SHOULD BE USED ONLY FOR AN ESTIMATE OF THE TREX ELEVATIONS O MATERIALS(PROFILES AND NUMBER OF PIECES) PAPER SIZE: A- 81/2X11 REQUIRED FOR THE DECK PROJECT IT SHOULD NOT BE USED AS A CONSTRUCTION DRAWING FOR THE DECK SUBSTRUCTURE. YOUR ULTIMATE SCALE: 311 e°=r DESIGN SHOULD BE PREPARED BY A LICENSED CONTRACTOR,AND MUST COMPLY WITH LOCAL BUILDING CODES. SHEET NUMBER 2 0€ 2 h LEGEND NOTES: 0 SB STONE BOUND SEE TOWN OF NORTH ANDOVER ASSESSORS MAP #107 LOT #139, FIND FOUND DEED BOOK #11978, PAGE #69, AND PLAN #12285 E.N.D.R.D. FOR SITE. /147 WETLAND FLAGS + EDGE OF WETLANDS 2, WETLANDS DELINEATED BY ROBERT PROKOP. W.F.D.W WOOD FRAME DWELLING BIT. CONC. BITUMINOUS CONCRETE PAVING CEM. CONIC. CEMENT CONCRETE PAVING TYP. CEMENT CONCRETE PAVING 58 I LOCUS MAP ,' Z 5S0RY 10 \NQEi 4 c COLONWL SB ~PROPOSEQ Qa CX'o` fRQ Nr6 4 \\ t , \ OPOSEQ ZFcE.P�4 L0.D0" R-175.00 ,,61Z• GVd�, \J` OsjS( � r� i pRi`rE �I� r� L-0 V-n1 'GEA"7 ALKtih y ` �'� s� "' I° AREA=26,336 S.F.20. DETAIL h G. W I r BE R£1dOjED t � � II 4 .05UPP R�� _._ - o= �; z � , PRQu,4� �` \\ PLAN OF LAND IN DEC s. NORTH ANDOVER, VASSACHUSETTS' SHOWING PROPOSED DECK i o + PREPARED FOR WILLIAM E PC WERS CIO SCOTT HANSEN 104 COLONIAL AVRNUE NORTH AA710VE9 MASSACHUSETTS 01845 i J- 238.45' n DATE` JULY 18, 2018 10-' 20' an' i ff a A.C. $U DERS, ttiC. SCALE'�k_20. j 0' 10' 20' Fil' 60' SITE PLAN MERRIMACK ENGINEERING SERV7CES 66 PARK STREET i 1"=20' ANDOVER MASSACHUSETTS 01810 r 44.3' 33,5' D�rSr � l57 aB �1ra 1'Tt*' I lS.S f 3 ,3' 11.L D-F3nx =156.G7 nz� 3 40.2 4Y,5' , DvrU fax rs6,.1fq 11cr�r- r� = i,JLg:--r =rs�•�z 5)JZ Ct a )S-6,Q, Eur =f s&•00 lwo'T"I a Z1a.33la s.�: 1 , �Fxks-r: I1 �00 r ! �• m V f+ � Vr�I�i7' la•o.c. y 7z°rqo I�� (tv rQ&0Q AL -- Ay uyi✓ AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH A MOVER, I�� AS PREPARED FOR A.C. BU I LDF-R S IMC - DATE; NC •DATE: JUK► E-; 30, 1997 SCALE: I"-q0` CGY.o ME.RRI[1fACK ENGINEERING SERVICES 66 PARK STREET ANDOVER MASSACHUSETTS 01810 j i The Corntrmonwettlth of Mossetclauselts Uepawtrrlertt of Itidustt•ed Aecident,s r1 1 C;'otigiwss.'Strc>et,Suite 100 Boston,MA 02114-2017 www.tuuss.gotrldia rra C1orkers'Compensation Insurance Affidavit: lltiil(lers,/('oiiti-nett,rslhlec;triciriiis/P'iun7bers. TO BE FILED WITH TIM PERMITTING AUTHORITY. A) licant Information �� Please print L(.T, ibty Name(13unincss/Oiginization/i11divi(tnal):Professional Building Services by PMC LLC, Address,9 Olde Woode Road City/State,/lip:Salem f NH/03019 __...__ 1>11ri e if (603)898-2977 Are too an etnlrloyeO Check(lie appropriate boxy Type of project (required): i.iam a employel with..... _employee,(full an(Uol par(-urnc)" 7, []New constfuction I aur it sole proprrictor or partnership and lime noemploycca work itip liar mem S. L,.J Remodeling any capacity,[No workers'comp,insunnic:e required.) ('). El 1:)enrolition 3.0 . I am a horneowwnel cluing!all work my+wll,[Nat wwrkets'comp.in,urance required.) 1tI El CIuIIGlinrt addrtiG>n I mn a;dmf all contractors will l be h huwwc onnactors(o conduct all work on uny aropotl 1«01 t Tum'r Itorncotuucl loci win Ix hlrulp I I 5 ensu eorkos'cooipensation ilmn Ince en dib.ruler I l.E:]Electrical repair's or adelitions proprietors with no employees. , I...[]f luruhirrl,repairs of additions 5.cj 1 arty a p eocral contractor and I I lave hied the sub-conuactol,Limed on Clic ifowhe.d sheet. 13.[:]1�oof repairs These sub-contractors haws cinployec+and hu":rw(Irkcis`camp olsnrali e. fr,E]AWc are a c•orpror(ttiun and its offiCCri haws excrtrse+d tltw^%r rtglrt of exenrptsorl put-Mu c. 152,§1(=I),hind we have no ernployee ,l Nowarkcr.,'c'ot npa.insurance iecluiicd.l �An}applretrnt th.tt necks hnx ff I must also fill out(nc wcdon below+homing!Thew w'orkcrs compacnaatrora Policy'irll0111146 t. F Hollicowrters wbo submit tnn4 ai'ri(lavit Indicating ilicy.lac doinp,all wol'k and(lien hire"Ont'ide colloaclorr 17\IIr(till}singe it IlcwafrldSa('It indicating'(16. fC ontraerors drat(;heck this box must auacned an additional shat sluawinu the n.nne of the suY>-ctamrautat'n;md statZ wnethol of alar lhose entities nave employees. If the suha cenrtracten.s have crupluyces,they must provide•their worker,'comp.policy lunnhor. I arra an employer(heat is providing workers'compensation insrrrrxrrce,�iar my employees. Below is the policy and_job site iuformatiorr. Insurance Company Marne:_.._ .._. ._ --�rS.t_... _ ...__..... ._.....,_ Policy#err Self-iris,Tic.N:._.._.. . 'A .. .. .. _ ._ { _.�...!"' _...... .. ,.. T xpiratii>rt Date. /�{ 0 Job Site Acldre5s;., _ � ! s 'ry"r. `�_........... C ltylstatc+ditir . . jt �>L'`11VA VA c����s3�W Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(late). Failure to secure coverage is required under M('al._c, 152,§25A is a crinfinal violation punishable by a fine up to$] 500.00 and/or one­year imprisonment,as well as civil penalties in the form of a STOP WORK(:)RLA,"R and a fine of(1l)to$250,00 a day af;nitist the violator.A copy of thin suiteme.nt may he forwarded to the Office of lnvi stigations of the DIA,lot,instirance coverage;verification. y 1.f (der the pains arra!penalties of peg juyy that the inlornrulion provided above is true andcorrect. t �r(it) f, -caste( t M Dat Phone.tp:603 X75-1506 Official use only. Do not write in this arca,to be completed by civ or town official. Citi Or'l o wn: _. ------ Pertilit/lAcens'e..____._...Perttlit/License#_..._.__.___.........----_._______.._ Issuing Authority(circle one): 1.Boar( of Health I Building Department 3.(`ity/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other _.._.__..M .,__. ------ Contact ._. ...____.. _ Phone .._..._ ALCM ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) L� 1 3/21/2016 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). PRODUCER CONTACT Patricia Blais NAME: Financial Insurance Services Inc PHONE N (603)432-6414 � �NC,Na ;{603)432-3852 PO Box 950 ADDCRIo.ExtyESS:Pblaio0f'Sins.com INSURERS AFFORDING COVERAGE NAIC# Derry NH 03038 INSURER ANational Grange Insurance Co 14788 INSURED ENSURER B Professional Building Services By PMC LLC INSURER C: 9 Olde `i+WOode Road INSURER D INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 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. INSR TYPE OF INSURANCE AODL SUBR POLICY POLICY EXP LIMITS LTR POLICY NUMBER MYYMlDD MM1DD X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE § A CLAIMS,MAOE Fil OCCUR DAMAGE TO RENTED500,000 PREMISES Ea occurrence § MPT1630H 2/5/2016 2/5/2017 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0 )ECTPRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER, Employment Practices Liability $ 100,000 A AUTOMOBILE LIABILITY BIT1630H 2/5/2016 2/5/2017 COEa accidM8INEOSINGLELIMITent $ 1,000,000 ANY AUTO BODILY INJURY(Per person) S ALL OWNED x SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S x HIRED AUTOS x NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident I Medical paymenis $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ANY PROPRIETORIPARTNERIEXECUTiVE NIA A rEL. EACH ACCIDENT $ OFFIGERIMEMBER EXCLUDED? (Mandatory In NH) DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be atiaohed if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover Mass THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sam Fragala/SET13 ^ ..a ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 ign l4mi u CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYYI T TIFICATE 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 P`RqQUCND ME CERTIEICAIE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HAYS INSURANCE BROKERAGE PHONE ::TFAX133FEDERAL ST (A1C,No,Ext): ,No): E-MAIL BOSTON,NIA 02127 ADDRESS: 7691'I) INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: 'FRAVliLIiRS INDFJNINII Y CO\4PANY OF AAdERICA SURGE RESOURCES 11 INC INSURER B: INSURER C: INSURER D: 920 CANDIA ROAD INSURER E: MANCHESTER,NII 03109 INSURER F: COVERAGES 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, INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDOIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY FACH OCCURRENCE COMMERCIAL.GENERAL LIABILITY DAMAGE 70 RENTED j$ CLAIMS MADE 0 OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGA7E LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT Q LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE s DEDUCTIBLE S RETENTION 5 A WORKER'S COMPENSATION ANDWC STATUTORY OTHER; EMPLOYER'S LIABILITY YIN UB-9F438417-15 12/39!2015 12/31/2016 X LIMITS ANYPROPERITORlPAXECUTIVE OFFICERIMEMBER EXCLUDED? ETI NIA E.L.EACHACCIDFNT 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE:!$ 9,(}00,0()0 Ir yes,describe under DESCRIPTION OF OPERATIONS botow E.L.DISEASE-POLICY LIMIT ;$ 1,000,000 DESCRIPTION OF OPERATIONS)LOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY Pkioi. CERTIF[CATE IssuED TO THE CERTIFICATE]COLDER AFFECTING WORKERS COMP COVFRA(iF. COVE RAGE 1S RESTRICTED TO THE LEASLD EMPLOYEES 01'PROFESSIONAL BUILDING SERVICES CERTIFICATE HOLDER CANCELLATEON SCC}TT HANSEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 104 CULONIAi.,AVE \ AUTHORIZED REPRI_SENTATIVE NORTH ANDOVER,MA 01,45 ACORD 25(2090105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. :\ CS-097650 PETER e e&RAL D `» - 9 OLDE wooer RD SALEM NH 03079 \ \ \ \ \ \ \ \ , . . . . ,. :. : . . . ... < .. . 07 03.2017 - HOME IMPROVEMENT CONTRACTOR +mss q«: 2A T « w rgom «wyxaS0-,9 \/} / } 5