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HomeMy WebLinkAboutBuilding Permit # 9/19/2016 BUILDING PER MITttoRTH A FORTH ANDOVER TOWN 0 APPLICATION FOR PLAN EXAMINATION Permit No#: i. Date Received 9- ldf?­ 0/ T.ED A Date Issued: IMPORTANT: A Tpjicantjmuq complete all items ..... LOCATION Print 7­ PROPERTY OWNER /VO C1 L Print 100 Year Structure yes no MAP (0 PARCEL: 6 .T- ZONING DISTRICT: Historic District yes no Machine Shop Village yet no ------------ ------------ TYPE OF IMPROVEMENT PROPOSED USE Residential on- Residential EJ New Building [] One family 11 Addition 11 Two or more family [I Industrial 11 Alteration No. of units: F.] Commercial 11 Repair, replacement 0 Assessory Bldg K- Others 0 Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: P E - c, Identification- PleaseType or Print Clearly ,4,1. & -.., 2,�-//c) OWNER: Name: 1VQ E LL � Phone: Address: Ar Contractor Name: C-071 a 1Q)5 rt, i' . Phone: Email: Address: e) 4-e c 8 'o V t4 Supervisor's Construction License: 15Y 13 _Exp. Date: Home Improvement License: � .= Exp. Date: ..._ � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ e Check 3 No.: Receipt No.: NOTE, Perspns contracting with iniregisteredconte actors do not have access to the guaranty fund magna g-nat t, ------------ NpRYy q Town of 2 s_ 6 ndover �a L.xR h ver, Mass, • 4 �,45 RA rF o U BOARD OF HEALTH Food/Kitchen PERMIT T LD� Septic System THIS CERTIFIES THAT ......CCp. .l�......It....... Af P X`............................................................ BUILDING INSPECTOR .x.... Foundation has permission to erect .......................... buildings on ....gr.grNe.o ..t........Q.'.... ......... S 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 C®NSTRUCTI STA/ S Rough ...... . . ........................... Service Final BUILDING INSPECTOR' GAS INSPECTOR Occypang Permit Required to ®ccuply Buitci* 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. The Commonwealth ofHassachuseUs Department qf1ndusM#1AeddeWE 0i Office qf Iniresfigadons 600 Washington s'h'eet Boston,JVA 02111 w1mv.annus s.govIeta ,qor9cers'1 Cornpensaflon Insurance Affidavit: AIlli 'on 07— (Businesslox8EimationOlrtdividualr_—d Address:— 4o Lc co Ar City/ 6/"7V1/Thune#: Are you an employer?Check the appropriate box. Type of project(required)' 1.F1 I-am a employer with I am a general contractor and 1 6. New construction employees(full and/or part-time).,* have hired the sub-contractors 2. I am a sole proprietor or partner- listod on the attached sheet. 7. Remodeling E1 ship and have no employees These,sub-contractors have 8. Demolition Nvoridug for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp.insurance comp.insurance. 10.[]Electrical repairs or additions required.] 5. We are a corporation and its 3.El I am a homeowner doing all work officers have exercised their 1 E]Plumbing repairs or addition.' myself.[No workers'comp. right of exemption per MGL 12.M Roof repairs insurance required.] c. 152,§1(4),and we have no 13.n other -510 employees. [No workers- comp,insurance required,] *Any applicant that checks box 111 must also fill out the section below sliowing their woricers'compansation policy information. t Homeowners who submit this affidavit indicating they are doing all worlt and then hire outside commetors niust submit a new affidavit indicating such. lContructors that check this box must attached an additional slice[sirdWitig;the mune of the sub-contractors and state whether MUM those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.pokey number. 1 ang an amployar that is ppoillding wark cps,compensadou insterance for my employees. Baloftisthe policy atidjob sitc-,, h!fOrmadoll. Insurance Company Name: :;t:- Jv-J> u,5 -/--R Policy#at Self-ins.Lic.fr: 19 a 3 1' — Expiration Date: Job Site Address,_ A1,6— t5 7--Ar U 7- (, r .City/State/Zip- Attach a copy of the Workers'ComPeRS86011 Policy declaration page(showing the Polley number and eNpiraflou 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 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 of the DIA for insurance coverage verification. I&I hapaby capfify under thepalas andpanafflas qfpeijWy that ilia illyaliliadonjurovided above is erre and con-act. Sim Date: - Phone 4: ? Official use only. Do nog iprife in ehis area,to be completed by city or foisin official City or Town. perwit/License 9 Issuing Authority(circle one). 1.: oaard of Health 2.Buifffing Department 3.City/Town Clerk 4.Electrical bspeetOr 5.Plumbing ImPectOr 6.Other ---- Contact Person, Phone 9: DATE(MMIODIYYYY) �® CERTIFICATE OF LIABILITY INSURANCE 12/21/2015 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 Victoria Lowes, CISR MTM Insurance Associates PHCN o( 978)681-5700,ExtI: I(ArcFAXNo):(978)68I-5777 1320 Osgood Street ADDRESS:vickiel@mtminsure.com INSUfi]ER(6)AFFORDING COVERAGE NAIL# North Andover MA 01845 INSURERA:State Auto Insurance INSURED _ -INSURER B:National Liability & Fire Ins Co Cote & Foster Contracting, Inc INSURER C: 20 Aegean Drive INSURER D: Unit 15 INSURER E: Methuen MA 01844 INSURER F: ^ COVERAGES CERTIFICATE NUMBER:15-16 & 16-17 WC 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 pF INSURANCE A ftF CY EFF POLICY EXP LIMITS LTR POLICY NUMBER MIODIYYYY MMIDDNM X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE IX-1OCCUR PR M SES(Ea occurrence) -- 100,000 PBP2747539 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Y $ 2,000,000 X POLICY❑ PRO JEC7 t,OC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY GMBINED t SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) $ 20,000 ALL OWNED X SCHEDULED BAP2370166 03 12/31/2015 12/31/2016 BODILYINJURY(Peraccident) $ 40,000 AUTOS AUTOS PROPERTY DAMAGE $ X- HIRED AUTOS X AUTO NN-OSED Peraccidan�) Medical payments $ 5,000 UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY y I N X STATUTE ER ANY PROPRIETOMPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,0001 OFFICERIMEMBER EXCLUDED? NIA $ (Mandatory in NH) V9WC749549 b/20/2016 6/20/2017 E.L.DISEASE-EA EMPLOYE $ __ 500,OO If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) Certificate holder as listed below This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CTC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS026 0014ni� C,"ilO'nr l E J CUSTOM BUILDING + REMODE' LING This agreement made this 161h day of August, year Two thousand and Sixteen by and between Cote and Foster Contracting, Inc. hereinafter called the Contractor and Noelle Lee,hereinafter called the Owner,witnesses that the Owner intends to reside the existing home at the address of 45 Chestnut Ct.,North Andover,MA. Now, therefore,the Contractor and the Owner, for consideration hereinafter named, agree as follows: ARTICLE 1 The Contractor agrees to provide all the labor and materials to do all things necessary for the proper construction and completion of the work shown and described on drawings. The drawings and specifications are the basis of the contract. ARTICLE 2 In consideration of the performance of the contract,the Owner agrees to pay the Contractor, in current funds as compensation for his services hereunder$38,835.00 to be paid as follows: Palmerit 1 - $5,000.00 at signing of contract y Payment 2 -$15,000.00 at start of siding demo Payment 3 -$15,000000 at completion of siding Payment 4 ® $3,835.00 at completion of electric & HVAC reinstallation of services ARTICLE 3 Finial payment on contract amount as agreed above to be paid within ten(10)days of project completion or occupancy. If final payment has not been made within this time a 10% charge per month on the balance due will be charged. All minor punchlist items will be complele as part of the one year warranty on the finish product. Failure to pay balance within ninety(90) days may result in legal action. Initials: 20 Aegean Drive - Unit 15 Methuen, MAO 1844 Tel: 978-682-6518 ® Fax: 978-682-1221 www,coteandfoster.com ARTICLE 4 Additional work above and beyond the contract agreement: All additional work done to be quoted at the time the client requests the work. The work will be done and billable at its completion. The client has ten (10) days to pay the additional costa er he or she has been billed for it. Initials In witness whereof they have executed this agreement the day and year first above written. Noel Lce,O�ncr­ Ste en tote DBA Cote& Foster