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HomeMy WebLinkAboutBuilding Permit # 9/21/2016 tsoRTH BUILDING PERMIT °F��,�°.'6.q�4 TOWN OF NORTH ANDOVER ti i APPLICATION FOR PLAN EXAMINATION * k Permit Na#: _ t Date Received ��$SpCHu ��� Date Issued: � �'" � PORTANT Applicant must complete all items on this page PROI�ERTY OVI)NER �� , / / Prrr�t 7D0Year Structure yes n MAP PARCEL ZONING DISTRICT Historic Dastnct yes / Machine Shop Village yds n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ARepair, replacement ElAssessory Bldg Ll Others: ❑ Demolition ❑ Other ❑ Se tic ❑Well ❑ Floodplain ©;Wetlands ❑ Vllaterslled D[str�ct p glNaterl$ewer'� DESCRIPTION OF WORK TO BE PERFORM ED: I S �3 v J � C � .IPJ L t Identification- Please Type or Print Clearly OWNER: Name: �r- -rr Phone: Address: Contracar Narne ErnaII ► Address 5upenrisor's Coltsaruca�on License 0;� Epp .,,Daae � i�i4��r �1 Home Irn rouement License � � � � _' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEB SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C, tiod FEE: $ �� Check No.: MIA _Receipt No.: �� v NOTE: Persons contra ling with unregistered contractors do not have access to the ranty fund Signature of Agentlowner' Signature of cQnfractor �ORTil '9 Town of _ �� ¢ ndover or No. ?_ h r o h ver, MaSS, M 2112d t COCMICHlWICK �- �•9 S U BOARD OF HEALTH Food/Kitchen PERMI D Septic System THIS CERTIFIES THAT..............%IMA4...... ......4............ r......�% U*", C� ...... .. .. BUILDING INSPECTOR has permission to erect .......................... buildin S on .....l ...... �..,e!... , , ............. Foundation . .... Rough to be occupied as .....�.. ,.. . S. ►., ... ....�.. .54.0 ilot-r4_ u6. Chimney provided that the person ac epting this permit shall in every ect conform to the terms of the application Final on,file in this office, and to the provisions of the Codes and By-Laws r lating to Te Inspection,.Alteration and Construction of Buildings in the Town of North Andover. row PLUMBING INSPECTOR VIOLATION of the,honing or Building Regulations Voids this Permit. ����LA_�.W 4" Rough Fina[ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TI e��Rough Service .. ... .. ... . .... . ......... ..... .......... Fina! BUILD NSP CTOR GASINSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina` No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. J. Licensed S Insured Member of Boston Better Business Bureau Page No of Pages BROOKLINE =�4v -VU gauge�"0 1"ff MALDEN (817) 734-9100 (781) 322-0822 ,ANDOVER LGUO "TOLL FREE (978) 475-1145 11 HOME IMPROVEMENT SPECIALISTS FULLYINSUREo 8 $8_646'9 FULLY LICENSF� 405 WALTHAM, ST.#336,LEXINGTON,MA 02421 PROPOSAL SUBMITTED TO: PHONE DATE = a $� ° iar��ttr �`�9 .:�.. �39" � ..C.J(,�t< STREET JOB NAME i ;'"? ^ CITY,STATE AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS FOB PHONE � J+ � :t , ?t�.RJF W "`��� ;(ti i• <-G:..fl 1 r.;_�, ...,y l�� .rt-� �� i,#;�y` ', I�. 1 ( f.. .} IN 3Propf;C hereby to furnish material and labor-complete in accordance with above specifications for the sum of: dollars ($ 10,ql)C. } Payment to be made as follows. All materia€is guaranteed to be as specined.All workto be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving Authorized f extra costs will be executed only upon written orders,and will become extra charge and Y P 8 Signature above the estimate.All agreements contingent upon strikes accidents or delays beyond ourcontrol. e, owner to tarry fire,tornado and other necessary insurance.our workers are fully covered by Nat .his proposalm ybe Worrkmman'sCampensationinsurance. r withdrawn by us if not accepted within days. =rreptance of �rapagal " The above prices specifications and conditions are satisfactory and are hereby accepted.You are authorizes to do the work l- ` as specified.Payment will be made as outlined above. Signature �f r i]ateofAcceptance =1, ,L% Signature Massachusetts Home Improvement Sample Contract This forst satisfies all basic requirements of the state's Hosie Improvement Contractor Law(MGL chapter 142A),but does not include standard lauguagetoproject homeowners, Seek legal advicelfnecessary.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 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information CIAFF r tr Name CompanyNeme r u ' Street Address(do not use a Post Office Box address) Contractor!Salesperson/Owner Name t a Cityffewn tate ZipCodc Business Address(mustineludeastreetaddress) 33 01- 2?-ULG Daytime Phone EveningPltone City/1•own State dip Coda azo zc Mailing Address(it differantfrom above) Business Phone Federal Employer U)orS.S.Nttmher Home rmprovement Coatra<lorRtg.Hm.her Fap'vaztond�l" raw rtpl—IL.r mast Lome improv—t c",Ir�dars Lave .valid ngrsfrallo.number lLA1674f n 1()/U424A The Contm•actor agrees to do the following work for the ldonrcowner. 1�Y (Describe in detail the work io completed,'specifying ilia type,brand,and grade of materials to be used,use additionnl sheers ifnecassary.) —Dj5wrtA, "-" OfJYL, SlAl>J 12L'QI/lYt,l�r 31�-� " WX-J Y C-,(s " ��C2 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the bomeownces agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of j'_"Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Conft.tPricc audPaynacnt Schcdulc Time Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: (�) Payments will be made awarding to the following schedule: $ upon signing contract(not to exceed 113 of time total contract price or the cost of special order items,whichever is greater) $ by 1 I or upon completion of by I 1 oruponconmpletionof $ fj t1C) upon completion ofthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) T]taro/]owingmateriallequiprnentmustbespecial $ to be paid for ordered before the contracted work begins hi order to meet the completion schedule.(1$) $ to be paid for NOTES:(')]ncluding all finance charges('r°)Law requires that any deposit or down-payment required by ilia 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 spceial ordered in advance to meet the completion schedule. Lrxnr ass war laniy-Is au exm ass warranty hem=m ovided by lire coun•aetm? ❑No Yes(all terms ofilte warranty nmsi be.#ached to the cmltract) Subcontraetors-The contractor agrees to be solely responsible for completion of fie 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 this agreement ContractAcceptance-/Upon signing,this document becomes a binding contract tinder law. Unless otherwise noted vvithin this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Pevietw 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. • Make.sure the contractor has a valid Home Improvement Contractor The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome hriprovement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,IM 02116 or by calling 617-973-8787 or 886-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof ofinsi rance'document. • Know your rights and responsibilities. Read the important Information on the reverse side ofthis form and get a copy oftho Consumer Guide to the/tome Improvement Contractor Law. You may cancel this agreement if it has been signed at aplace other than the contractor's normal place of business,provided you notify the contractor inwritin„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. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY B ICSPACESM Tmo identical copies orthe mnimct n3usth>e complelcd and signed.One copy should go to the homeowner. copy should be kepi by Ilse pMraclor. f LRQ" - an eowner's Signature nira s Sign tura Date Rate die Commonwealth of.7VIasso,cAwellffl a C0jw8-S'vS`h'eet, Suue 100 S Boston,MA 02114 2017 SQ1, t S xs'fox tae afza Tnmrance davat.B Ir erslGoxl rac arsL� eebrzc rslPXma oexs. TO BIi�I{',TLM)WTM T 1,MnRT`-TNC AUTRORM A iCaCLtaxmatin� . P�e.$sePi'zx€.t Leek ��Ce (Sus�ness/bxg�af[oz�nc3iv%duad.}: •'�2 � . Addross: t O ST #33( �3tyl �atelzp: �- r t�`�C r.l az z ' Qt #:_ ltt7-33 - Areyou an employrx2 meek tic appropriate PDX, Type of project l.E]I am a employervv employees Gull andlozpaz iiiue).* 7. New COA9tr.aol ion 2.�IRM a sole propdctorozparinership andhavene erAployeasyVorlcing formeia S. Rez tadelhig sny-capacity.ENO wolkels'Comp.insm'ance re at:d_j 9, De7IlO Q71 3.[:]Iam ahnmaavnezdaingall-vorkmyse]£}No Yrorkers'pomp.insorauce [luueci x0 fj.B,,A iing addition 4_0 lam a0o33hacLors'L0eonJucta7l-woxkonmygrope4- 1will ee or are sale I1.Q E�.ectt�.cal rapairs or additiox s msmetha.talleoz�traciazseitherlsYes�ozicers'cozupe�sationarvsuran . propkzetas-with ao iaplayees. �- —' �2:QP usnlaiagxepairsaradcitions 5_ xamagerreralLronfra-ctarquellhrvebiredthasuh-cantactarslisLadon �Roaf&PaftS rhesesub-conha iors7iavep±n Ryees=dhayrw,Ims'comp.ius==,D s 14.00thb 5.� eareacflzparazifsofiZcershaveeercisedtherigbtnl'exemptionperlCrT n. 152,§1(�),andwehave nq.ed ciployes.�Tn Suorlrers'oo:lxp.insuraaeerecprared _ Auy applicant that chedksbrixrl must also(outlhc seeonbelaW slno�ing#heirworkers'compensauonpoTicymfosroation a Somea�ersTa3io suls�.il'4'�adadaYztindicafhlgtheyaie doing a3l�rlcaudthenhize ontsirle cautractozsmus'tsi�mit aneyv aft'ida�iindicating such. Coni-ractazstF�tr�.eels-7�is6o�mnsc•a'tacf�edauadrTitionaisheets7zo�gthex�amao��s`r�-caz�iranYonsa�€dstatew�edreroxpo�r7ioseentiuesli�.Tie employees, cthasubeontacnis eemplayees,�eymnstprQYideFhefrworkers'Cnmla.pbIioy�mnber Z cr rz an e iproyer tlx at asp o z cam"ng 'orkexs'comp enEation 19srayc icefor MY e�pZoyee�:'Betoxu b tA--p0ley aradjob site �tzfor�natiox2. _ Insurance CnmPany:Na=0 ver �,JE. dmDate: PORGY4 or Self-ins.TIc.�:� ePs M o �( ' lob eAddzess: 1 IWcc9 S'T" Ni ,t/W PA City/state&-* ark lob Site a copyoft ��b exs' coxnpextsa [artpaTicy declaz'adonpage(showi gtft8p0RCYRumbex and e�pzxatioxz daze). AffFaiIurt to secures aov erage as xequixed under GxC- 1�2, §25A is a cxlmir ax 4[o7atiox p s ai}ie by a fine up to$1,500-00 and/or o e gear zPr onment;as-we-A as cid panalF-`�'es i -Ehe form,of a STOP WORK ORDRR a-ad a fine,d-ap to$250.00 a dap against tho Violator.A,copy of th€s statement racy ire fol warded to the Ofrica of Tuvestigatiom of th e DTA for fzm�xance coverage verification. ,.ado Aex� b eer1ify ax trze pa�t'!.s an �s tj��y t7acrc he h7for�tzazio,nXDFided�io;�a as&9e cwd co?-red Date: Oni t..Lt1 Si atnta: Pho pffacial rrse oPbl- _10 not-wxne to M&area,to be COMPIe`ed by city or IOV'z offcczaL Cxxl�y or Tower: Permff[LiCause# Xss-uIugAntoxi.w(circle nxa-s): ` eetor ate.�'�ro�n7�ingTxus�tec�ax I.]Boardoiffeaith 2.uffdingDepartEmmt 3.c�yJT'owa Cxex•k 4,EXectrzcaZ Cbsp 6.Other Cwxtact pars a�- I'�axe e�: ® DATE(MMIDDIYYYY) A`C�o CERTIFICATE OF LIABILITY INSURANCE 09120/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 ondorsement(s). PRODUCER CONTAGI NAME: ECIC Jansen Hasbany&Regan Insurance Agency nlc No Ext: 978-685-3188 FAAIC,No): 978-685-9460 254 Pleasant Street E-MAIL eric(a7hasbanv.com Methuen,MA 01844 INSURER(S)AFFORDING COVERAGE MAIC 1! INSURER A: Nautilus Insurnace Comi3anv INSURED INSURER 13: American Zurich Insurance ComDanv Cohen Construction,Inc INSURER C: 405 Waltham St.-Ste 336 INSURER D: Lexington,MA 02421 INSURER E 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. !LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMl�DNYYY Y EFF POLICY M DDYIYYYY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 GLAIMS,MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP Any one person) $ 10,000 A WS246378 07/05116 07105/17 PERSONAL&ADV INJURY $ 1.000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 X POLICY ❑PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per aeddent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ pED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS`LIABILITY STATUTE X ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 1.000.000 B OFFICERIMEMBE EXCLUDED? NIA 6ZZUB-9F80793-4-16 07/06116 07/06/17 F.L.andatory in NHI DISEASE-EA EMPLOYEE $ 1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Exclude Craig Cohen,President of Cohen Construction INC from Workers compensation as he has elected to exclude himself. Operations: Siding and basement windows Location: 13 Glenwood RD North Andover MA 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. Building Inspector North Andover MA AUTHORISED REPRESENTATIVE Eric Jansen ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety . .f Board of Building Regulations and Standards License: CS-096405 Construction Supervisor CRAIG R COHEN 7 PATRICIA DR HUDSON NH 03051 i i Expirn; atio Commissioner 0 pi6' i 4/2018 C rwiw?'6)1eueaz u�P�f`uJdccc�nSeCfa OfGee of Conseimer Affairs&Ttusiness*RIu atzon License or registration valid for individul use only or Nit i'IiPROVE IyfENT CONTRACTOR before the ax[�ration date. Jf found return to-- `. eglstratron: 148746 Type: Office of Consumer Affairs and Business Regulation $ xpiration 10/20]2017 individual ` 1Q-Park PIaza-Suite 5170 ¢ I§bston,MA 02116 j CRAIG COHEN Gi iIG CO HEN -,tPATRICIA DRIVE HiJbSON,NH 03051 Ld;tderseci"eiaRy 4 .. Not valid withou signature °