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HomeMy WebLinkAboutBuilding Permit # 8/24/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER O APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ATeo �Ssac�05�� Date Issued: l IMPORTANT: Applicant must complete all items on this page R LOCATION 't Print PROPERTY OWNER IJ_e Print 100 Year Structure yes no MAP 6 7-- PARCEL:: / ZONING DISTRICT; Historic District y no Machine Shop Village y no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family El Addition Ll Two or more family Li Industrial ❑ Alteration No. of units: ❑ Commercial Ykepair, replacement ❑Assessory Bldg ❑ Others: Li Demolition Other Demolition �c' ;: d o"-..ra✓ „r?Ea. Kzu T' �e rs �-" '-* , ,y, E VAett DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: C Phone: Address: S4 Contractor Name: e Cekj(. Phone: Email: Address—) Supervisor's Construction Licenser ` Exp. Date- z) ate: " Home Improvement License'. �" Exp. Date: ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,SULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST SASED.ON$125.00 PER S.F. Total Project Cost: $ � FEE: $ Check No.: ?) Receipt NOTE: Persons contracting with unregi red contractors do not have access to theguaranty fund Qf _, r t tt®RTH Town of ` y, 6 Andover r No. - o ver,LAE1t h Mass, A col COCNEL Mt W+LR 4�• S &X—VU BOAR©OF HEALTH Food/Kitchen PERNI! T LD Septic System t1�� BUILDING INSPECTOR THISCERTIFIES THAT .................... ............... .�. .....,................................................... has permission to erect...... ............... buildings on ... l, Q!s ....WOd. +. ,,,,,,,, Foundation fRough t0 be occupied as ,......... . .. .. fis' ...... +......, ...........................,............................... Chimney provided that the person accepting 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 16 MONTHS ELECTRICAL INSPECTOR.. . UNLESS C®NST TION Rough Service ... ..... ........ ... Final BUIL NSPEC R GAS INSPECTOR Occupancy Permit.Required to QccupE By 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 Sample Contract 'Phis form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL 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 Infonnation Hotline at 617-973.8787 or 1.888-283-3757 or on our website. Homeowner Information Contractor Information Namer Compan me R 4), 71.4 Street Ad ree'ssrr(do not use a Post Oftice Box address) Conlr I Salespe on/Owner Name AlCityfrown State Zi ress ode Business Add (must include a s3,le�t address) Daytime Phone Evening Phone Cityyrr St e Zip Cade Mailing Address([t different from above) Business Phone I Federal Employer ID or S.S.Number Home Impmvem lmpro�xrcKnt Con4+c[erReg.Number €apimtion Jsle r+w rna th+S mon home � �� •�r i emnm eon[r+vi"n hove f'i}`y +v+tld rey3ruadon number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use addslienal sheets if uecessarv.) Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will he secured by the contractor as the homeowners agent: he adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be p+ excluded from the Guaranty Fund provisions of r7 Itc f Date when contractor will begin contracted work. MGL chapter 142A,) 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 sum of., M Paymentswillbe made according to lite following schedule: $ (/ upon signing contract(not to exceed 113 ofthe total contract price or the cost of special order items,whichever is greater) $ ® by �! ! or upon completion of by or upon campIction of $� upon completion ofthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(") $ O to be paid for NOTES:(*)including all finance charges(**)Lawrequires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(ti)the acivat cost of airy special equipment or custom made maierial which must be special ordered in advance to meet the completion schedule. / Express Warranty-Is an exuress warrnnty being provided by the contractor? ❑No ErY.(nil terms of the warranty must be attached to the con lractl Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless ofthe actions ofany third party/subcontractor utilized by die contractor. The contractor further agrees to be solely responsible for all payments to at]subcontractors for materials and labor under this agreement 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 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. r Make sure the contractor has a valid home Improvement Contraeux Registration, The law requires most home improvement contractors and subcontractors to be registered with the Director of Hame 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 die 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 ofthe 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 ol'business,provided you notify the contractor in writing at his/her main office or branch office by ordinary rnail posted,by telegram sent or by delivery,not later than midnight ofthe B third business day following Ilse signing of this agreement. See the attached notice of cancellation form for an explanation of this right. 9 DO NOT SIGN"PHIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies ofthe contract must be completed and sigacd. One copy should go la the homeowner-The other copy shoc kept by a c contractor. e i - .�tt/ rNo owner's Signatua Contr car's Signature B _ The Commonwealth ofMassO-1chUsetts M .Department of IndustrialAceldents I Congress street, suite 100 Bosto,2,MA 021,14-2 017 w www mass.gol'fdia Warkers'Cox piwationJusuranceAffidavit:BuuderslCoRtrac�oxsl��ecixacia�nslP�a�ra�exs. TO BE MBD VaTB:TEE FI�TINGA T )'ORZ' Z' Please print Le ' X A icant �Jforxnatiou _ Name (B€Esme,ss/Oxgam%eLtiongndivid'a,ol): " _ 7 -7 City/Statel.�ip: ,� IAi0:'hw1e#: � Areyau an employer? Check lie apixopriafe hart Type o€project(rggotixtd): JJ // �em Io ees full and/or art time).* 7.• [ New colistructiolx I,I y J.�am a emplayezwitlth.. p Y � P . 2.'''fffQ���'''I am a sole proprietor or parEnersbip andhave no employees-W0r3cing£or me S. Fj Remo OHM erxy capacity.[No-Workers'Pomp.insurance required] 9. 0 Detnolition. 3.❑I am a homeowner doing sill work myself,ENO workers'PAmp."Murano required.]t 10❑Evil(Png additzor. 4.�I am a hnmeownor and will be hiring contractors to conduct all work on ray property. I will ensure that all contractors eitherhave workers'coanpensationinswanee or are sole 1LQ Electrical repairs or additions propirietors withrlP emplo ees. 12 0 PI=batzg repairs ox additions I13:�.obf iepaixs 5.[]Iamageneralconfractorand fhavehired t] sub-contmotc)rslistedontheattachedsheet ghese sub-cantractors3aave eiuplayecs andhapeworkers'comyp.insurances 14.E]Other 6.FI We,are a corporatiort pod ik gYoi��ers•bave exereisedtheir light of'exemptiarr per'dGI, 152§1(h),andwehaYerto..�nc. ees o workers"comp.insurance required.] � p1 ;� •�. . Any applicantthat cheelcsbox lmustalso;Moutthesectianbelowshowingtheirwarkcm'compensation1?0"cyWanuation c Sameowrters vvho submit Xvs affidavit hi ii ung they aw doing all workQlfhenbhe aufside contractors must submit a neer affidavit t indiaaisr9 such ?Contcactom ghat checkthis box--t'0tacJEed au additional sheet showing the nam$afthe sub-contractors audstate whether argatiIrase entities ave o p-p Y employees. Uthesub-cAtracbrshavaemployees, bey mustpravEdetlxeErwozkers'cAm clic number.. �ara2 m2 erriployertlial is aro-P cd zgFvorker•s'compensation insurancefo:rmy empfbyees:'13eLoty is thepolicy anc�job site infoimaaon- Insurance Company :-A -7 6Expiration Data: PORGY or Self firs. + V , ' �� City/State/Zip: lo /10 b Site Address: ttac7a a cnpyofthe oirl�exs' cozapexxsationpone eclaratiob.page(sho-rri:agtSaepoReynumbexande�pixatitonr date . PazXuxe to seour e coverage as required Lmder MGL G. 1.52, §25A is a eriminal violation punt able by a Eme lip to$1,500.00 and/or one-year hrrprisonment,as well as cavil penal�es i-atheform of a STOP WORD ORDER aril a fine of tip to$25fl_00 a day against the violator-.A,copy Of gats statement may be forwarded to'd7 e Office of Investigations Of the,DIA for insttxarxtce coverage ver cation. Zdo ileieby ce u crer rite rxi s -penaI Sa?f Iyaly that tiie zrzfasrazaiionprot+zcted aiiai�e is�t�eaid corgiect Si attire: Phnno#_ of Wal rise only. po nopwrite in this apex,to he completed iiy city ar tot Vn off ciaZ. City or Town: Pex >tl iceuse# Usuing A&hoxstp(circle one): i epax sent 3.CityfTowx.Clerk 4.Elect3ried Inspector 5.Plumbingluspectoz I.Z;oaxd of 1 ealtiEx 2.76riiTd»gl 6.Othex Cozxtaci I'exsnxx: Plxoxte#. 12412()18 10:44:55 AM Degnan insurance 978-327-8551 111 9 A�o CERTIFICATE OF LIABILITY INSURANCE DATrjMMt0D'YYYY) 06/24/2016 THIS CERTIFICATE 18 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 cartlflcate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, sul)ect to the,terms and conditions of the polley,cortaln pellcleo may raqulra an endorsement. A statement an this cartlfleate does not confer rights to the cartlfleate holder In Ilsu of such endorsement(s). PRODUCER NAME:�CT Elizabeth Chavez DEGNAN INSURANCE AGENCY, INC. PHONE976 688-4474 w Nn: MAIL ADDRESS: schavez de nanlnsuranCA,oOm 85 SALEM ST. INSURERS AFFORDING COVERAGE NAIC;9 LAWRENCE MA 01843 INeURUR A r AIM MUTUAL INS CO 33758 INSURED IN@URER 0 1 JAMES DERECIN I INBL€RERC; FAMILY ROOFING & PAINTING INDURERG I 2 TANAGER WAY INSURER 9.' LONDONDERRY NH 03053 INSURER FI COVERAGES CERTIFICATE NUMBER: 79579 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 TYPEOPINSURANCE lMgn U n POLICYNVMBER POLICY POLICY MWDD EXP LIMITS A001LTR COMM ERCIALGENERALLIABILITY EACHOCCURRENCEDAMAGE TO RENTF-D $ CLAIMS-.MADEOCCUR PRGMISES 6a nccurrrmrm $ MED EXP(At)y ens ar$an) $ NIA PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS•COMPIOP AGG $ JECT S+ OTHER: I AUTOMOSILELIAMILITY CED SINGLE ANY AUTO BODILY INJURY(Per person) $ALL OWNED SCHEDULED NIA BODILY INJURY(Por me idrnt) $ AUTOS AUTOS NON--OWNED PROPERTY DAMAGE $ I HIRED AUT08 AUTOS Pr-r arridcnt 9 UM11RELLALIA11 OCOUR EACH OCCURRENCE $ I EXCESS LIAM CLAIMS-MA€JE NIA AGGREGATE $ DED RETENTIONS X _ $ l WORKER80OMPENBATION /� STATUTE ERH AND EMPLOYERS`LIABILITY Y I N ANYNHONHIL I OWPAH t HtHraXteu I IVEE.L.EACH ACCIDENT $ 100,000 A OEFICtH?m6M66H"CLUL xt-A NIA NIA AWC40070259602016A 05/11/2016 05/1112017 (Mandatory In N3-1) E.L.D€SEASE-EA EMPLOYEE $ 100,000 Ir ysa,doPodbe Undef E,L,DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS boloW WA DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (ACORD I OI,Addltlonal Ramarkx Sohadala,may ba attoahad If mora spaca Is roqulrod) Workers'Compensation benefits will be paid to Maasaahueeits employees only.Pursuant to Endorsement WC 20 03 06 B;no aulhoftation is given to pay claima for bane is to j: employees in stales ocher than Massachusetts if the insured hires,or hes hired those employees outside of Massachusetts. This certificate of insurance shows the policy in farce an the date that this certificate was issued(unless the expiration date on the shove policy precedes the issue dais of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Va6 fie tion Search tool at www.meas.govlWdiwarkere-compenestlonrnvaaliRaGcnsl. o Sole proprletor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET BUILDING 20 SUITE 2035 AUITH}ORIZEDREPAESENTATNE NORTH ANDOVER MA 01845 Daniel M,Cr y,CPCU,Vice President—Residual Market—Wf:RIBMA p 1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety . Board of Building Regulations and Standards License: CSSL-099685 Construction Supervisor Specialty JAMES J DEBRECENI 2 TANAGER WAY ter¢ LONDONDERRY NH 03453 1= Y, tl� y Expiration: Commissioner 12106/2817 t� U1te�pa�r��za�uue�xll o Vvura�acfu6elfd License or registration valid for individual ase only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: lugHOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration:rP� 2385 Type' 14 Park Plaza-Suite 5170 £xpiratioc�$ OBA Boston,MA 42116 FAMILY ROOT ING t JAMES DEBRECEN� 11 30.RIVER ST, •.'IAF-'el.-�„� � • METHUEN,MA 01844 l Uudersecretary Not valid without signature R