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HomeMy WebLinkAboutBuilding Permit # 9/19/2016 ............. tkORT4 BUILDING PERMIT p4�T4�n '6q"�o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIOIN 4E .. b Date Received Permit NQ#• P`jI"9b A �'?wr�n hQ¢ �SSacHos Date Issued: IMPORTANT: A plicant must complete al items on this page LOCATION R-j Priv PROPERTY OWNER C--7V!4 141 M 014- 11 Pd Print 100 Year Structure Yes no MAP S" PARCEL: ZONING DISTRICT:Machic District Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [Idition ❑ Two or more family [I Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I❑..Se tic Well D Floodplain ❑1Netlands D Watershed T7�str�c S P DESCRIPTION OF WORK TO BE PERFORMED; r Z K2, >� �' (e-,'A " ra )J P Identifie xon- Please Xype or Print Clearly OWNER: Name: Phone: 1C>� Address: / - �W2 > . Phone: / Contractor a e: U -LLkt2 ' Email Address: a f<VZvi Supervisor's Construction License. - Exp. Date: Home Improvement Licenser Exp. Date: "C° ��� ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE,SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ` FEE: $ �� Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces to thguaranty fund 4 �pRgk �q own of bAndover 0 ' ' No. 11LZ r Ooh ver, Mass ;kw �► O LAµ! CC1CMfC Ml WICK y�' 6/ S V BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT .........PER . '.flT BUILDING INSPECTOR . .. .............. .......... .. . .. ....... .......... . ................... Foundation has permission to erect ... ..................... buildings on ... ........ . .. .. .. . . ...... ........r................... flop Rough 110k to be occupied as ...... .. . 1�,��L. ..... �.. :................................................................... Chimney provided that the pers a epting 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 CONSTRUCTPN START Rough Service ..�..� .. .. ................... Final _ BUILDING INSPECTOR a GAS INSPECTOR Occupancy Permit Re wired to ®ccu 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. CONTRACT TO INSTALL OWENS CORNING BASEMENT WALL FINISHING SYSTEM Owens Corning Basement Finishing Division(the contractor)hereby submits this proposal to sell and install the Owens Corning Basement Wall Finishing System and related items as described herein at the residential premises set forth below.This proposal shall not become a binding commitment unless and until it has been signed by the Contractor and the Customer. Contractor: Owens Corning Basement Finishing Systems a division oI LUX Renovations,LLC. 60 Shawmu[Road,Canton,MA 62021 Telephone#(781)821-0066 Facsimile#(781)821-8552 Federal Tax ID 1114-1855297 Mass.Home Improvement Contractor Reg.#137943 Date Auq o�3 x+7((0 Customer: �A ff f Customer Name �,v� d-- 4 CC , Street Address 134 "TI ltd City,Stale,Zip Telephone This is a contract between the Contractor and the above named Customer to sell and install the Owens Corning Basement Wall Finishing System and related items specified herein at the Customer's residential premises identified below: Installation Premises: Street Address Aif City,State,Zip Scope of Work: Are Sketches andfor specification shir0le attachedy es' a 3f0 'Ai#aeaciunenSs a,a incorporated info entl,eeoomaa p@h 4f tnla eoa AcS � Description of Work)specificalicns, n x n> iw -e)li A3 . 7:7 L� cS �i 6t fS 4yfltf5 z ' w Work Schedule": Approximate Commencement. ale J Approximate Completion Date: JW /-7 90/6 "The proposed work schedule is approximate and subiect to change Contract Price: Tolal Contract Prkce: $ Deposit with order: $ y– �L�Lp7 o Cash o Check.k Balance Due: $ Terms: n Cash Xvinance {Cash terms are 10%deposit,50%ort commencement;4l11/6.ott completior3) Due on Commencement $ 5-0,0,1)05-0,0,1)0 � 70 57-AA)e e– Dce on Completion DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AMC UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT,INCLUDING ANY ADDENDUM ATTACHED HERETO,AS WELL AS ANY ATTACHED SKETCHES,MATERIAL LISTS OR THE LIKE,AND THE TERMS AND CONDITIONS ON THE BACK OF THIS CONTRACT DOCUMENT. YOU ARE ENTITLED TO A COMPLETE,FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. Witness our hand(s)and seal(s)below on this day of LUX Renov C./ ¢ed Representative: /f Slgn a and1filte ami-I � ,�l•e Print Mame DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES to er uC stomer Signature Print Nam stomer nature N 1 I Print Mame Contractor may have certain Ilan rights in the premises until the price is paid in full.You have the right to cancel this contract,without any penalty or obligation,at any time prior to midnight of the third business day atter the dale you signed this contract.See the notice of cancellation j below for an explanation of this right. 9 "'Customer acknowledges reeelpt of a hue copy of this co.tract which was completely tilled In prior to customer's execution hereof. Pillai,Veno&Radhika 84 Thistle Rd CONTRACT Customer Name. N Andover,MA 01845 Customer Signature SKETCHContract Date_ 978-65-1667 Sales Representative Signature ATTACHMENT Customer Phone- 978-302-1809 Contract Price- 2 < 5 G 7 a 9 1011 12 13 14 15 1& 11 -,a 19 n 21 22 23 21 25 M V, 20 M W M M 34 ZS 30 37 38 39 4p 41 42 43 48 45 46 47 40 49 SO 51 52 53 54 SS 56 57 58 59 60 —A ------ II L10 2 t't —---- ----- t - rj Vill tj 17 r T -T J —---------- T ----------- j 31 4 F Ud. N0 ES: box equals one foot unless otherwise noted.This sketch is a good faith T representation of the work to be done,it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to change if necessary. I I ® DATE(MMIDDIYYYYI. - ACC)R o CERTIFICATE OF LIABILITY INSURANCE 6/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 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(les)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 endorsoment(s). PRODUCER CONTJane Logan Andrew G. Gordon, Inc. PHONE (781)659-2262 FAX WC {781)659-4725 AIC No 306 Washington Street: ADDRIESS:Jane@agordon.com INSURERS AFFORDING COVERAGE NAIC N Norwell MA 02061 INSURERA i+ibert Mtltual A enC INSURED INSURER B:Commerce Ins. Co. 34754 Lux Renovati.Ons,LLC INSURERc;Peerless Insurance Co. 24198 dba Owens Corning of New England INSURERD:Libert Mutual 18023 60 Shawmut Road [NSURERE: Canton MA 02021 MSURERf COVERAGES CERTIFICATENUMBER:Master TL 6/8/16 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. NO'T'WITHSTANDING 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 %I-,,- L R POLICY NUMBER MMIDD EFF POLICYIEXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE lil OCCUR PREMISES MR pocurrence) $ 100,000 CBP8512851 9/5/2015 9/5/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JE O 171 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITYCOMB- Ea BINEDtSINGLE LIMIT $ 1,000,000 8HX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED yp7677 4/4/2016 4/4/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccl $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ 1100 0 000 L' EXCESS LIAR �{ CLAIMS-MADE AGGREGATE $ 1,000,00 DEO I X I RETENTION$ 10 000 CUS511953 9/5/2015 9/5/2016 $ WORKERS COMPENSATION XI PER STATUTE ERH AND EMPLOYER$'LIABILITY Y!H ANY PROPRIETORIPARTNEWEXECUTWE E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? NIA . (Mandatory In NH) ]CWS(17)$7350449 5/24/2416 5/24/17 E,4,DISEASE-EA EMPLOYE $ 1 000 000 9 yes,descdbo under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Cert Holder is added as an Additional Insured to General Liability Coverage where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance for Building Inspector THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jane Logan/LOGAN ©1588-2014 ACORD CORPORATION. All rights reserved. �', ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORID ,j"he commonwealth of Massachusetts { Department o fgndustrialAceldents Congress Street, Suite 100 - F Roston,MA 02114-2017 •, �� ,� www.mass g'ov/dfa '{ .rkers,Compensationlnsuranc®Affidavit:Builders/ContractorslEIectricians/)L'luna ers. TO SB FILED VATJI TM PFI WRT-I'NG AxTAORIl Y- Please Print Le 'bl ADWER11t.Information NaT17E(Iiusinassl0zgariizationIlradividual): LAM 95Z Address: /� d2C)Z/ Phone City/State/Zip: :t .:< sA,: , Are yo n employer?Checicthe appropriafe box: Type oi<projeat(7rectaixed): 1. I am a employer with employees(full and/or part time). 7. p New'Constrilctioxt 2,�I cin a sole proprietor or partnership and have no employees vvorkin-g forme in 8. ut-odel:iiig any capacity.(9() rkers,comp.insurance required.] 9• Demolition 3,[]I am a homeowner doing all work myself.[No workers'comp.vrsurance required-]t 10❑Building addition and will q.❑T am a homeowner ll be hiring contractors to conduct all work on my property. I will 1 E]EtecAricai repairs or additigAs exisare that all contractors eitherhave workers'compensation insurance or aro sole IZ�L�Pl iinbirkg repairs or addition proprietors with no eruployees. LJ $,❑)am a general eontractozand Ihave hiredthasub-contractors listed onthe attached sheet. 110 ROUrep airs These sub-contractors have einployees and have workers'camp.in,%urance� 14 ri other----. 6.❑We are a corporation and its.officers have exercised their right of'exemption per MGL a. 152,§1{4),and vve have no employees.[No workers'comp.insurance required.] *Arxy applicant that checks bbxl.rriust also 511 out the section below showing their workers'compensation policy information. such i Iiosneowners who submis�a aMd axttaehed an theY axenal sheegs owing the all work name of theonhire sub-contractorstside and statg wrs must heiher or not those entitieit s�have Contractors that check" employees. Ifthe sub-contractors have employees,they must provide their workers' comp.policy number. lam an employer that is providingworkers'compensation insurance for my employees. Below is tlaepolicy andjo site information. insurance Company Name: 1-7 "7;35 )qy ExpixationDate: Policy#or Self-ins.Lic;.r�#: , / 4 ®ft 1 C3 SI Y U Citty/Stat COP: Sob Site Address: //V. t-1T' r(— campensatiax�policy declaration page(showing the policy-number and eXpirat><on date). Attach a copy of the-workers' Failure to secure aov'erage as requited under civil penalties in the f rm of isarra S I OI'OL 152,§25A �W OiR[ ORDERIa�d a of up to $20.00 a andlor one-year imprisonment,as well a p copy of this statement may be forwarded to the Offzce of Investigations of the MA fox 1r15111'aItCB day against the vioia coverage verifxc on. .I do Icer=eby c r•tify under't par an aloes ofperjury that the information provided above 1is true and cor-rect Date: Si aturf: Phone#: Official use only. Do notW, in this area,to he completer)by city or town officiar permit/License# City or Town: issuing Authority(circle one): i 3.City/Town Clerk 4.IJlectriicaI Inspector 5.Plumbinglnspector 1.Beard of Health 2.guildingDepartruent 6.other Phone#- Contact Person: i I ' Office of Consumer Affairs idlusiness Regulation 10 Park Plaza - Suite 5170 Boston, M4ssa0husetts 02116 Home lmproveme&:.Contractor Registration Registration: 137943 Type: Supplement Card LUX RENOVATIONS, LLC. Expiration: 1/29/2017 DANIEL WALSH 60 SHAWMUT RD ' CANTON, MA 02021 SCA) 4 Update Address and return card.Mark reason for change. m Address Ej Renewal [:] Employment Lost Card &2e +1o�tt��ta�t[uea c�C'/�irwa�re elf Ve of ConsumerAflairs&Business ReguIa[iou License or registration valid For individul use only E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _- Type: Office of Consumer Affairs and Business Regulation Expiration 112r3/2017 10 Park PIaza-Suite 5170 Supplement Caad Boston,MA 02115 LUX RENOVATIONS,LL:Gi;,' OWENS CORNING BASENI� FItVISHING SYSTEMS DANIEL WALSH - = 60 SHAWMUT RD 9 CANTON,INA 02021 Undersecretary Not va' ithaut signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-079893 Construction Supervisor f _ DANIEL F WALSI-L 488 KENDALL RI .e TEWKSBURY MA 0. Expiration: Commissioner 10!0512017