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HomeMy WebLinkAboutBuilding Permit # 9/27/2016 NoRTN BUILDING PERMIT oF�sLfp .� �6`iso ..•.F,- ,6 d TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION * F + e Permit No#: 9� �` �4/7 Date Received 7 o M�ssac►+us�t�� Date Issued: -7— IMPORTANT: Applicant must complete all items on this page LOGRTION , PROPERTY ' DISI 70D l''ear�tructt�re yc� na � � TRICT � Historic Drstract ` .yes� no 1111achEne Shop\I�Ilage,.... ,Yes . ...ho, . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family Ll Addition Li Two or more family F1 Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septi ❑We[l ❑ Floodplain ❑1lVetlands ❑ Watershed District ..❑:1NaterlSewer . DESCRIPTIO OF WORK TO BE PERFO MED: _S�/J<f-" O1Vc Identification- Please Type or Print Clearly OWNER: Name: S-7-el *ily Phone: 1 Address: Contractor Name Phane Erna Address .. u- 5up rursor's Construe ion License Exp Date Horne Irnpro�ement License Exp Date ARCHITECTIENGI NEER Phone: Address: Reg. No. FFR SCHEDULE:BULDINGR IV!IT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125x0 PER S.F. O Total Project Cost: $ CI -FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access he g ranty fund Signature'of AgentlOwner Signature 0.1 contractor RTIN owe. of � �} b ndover o ��- "� 0 h ver, Mass, Kt / aol o,Q 1 Coc��tNtw�cx Y S U BOARD OF HEALTH PER T T LD Food/Kitchen Septic System SoNTHIS CERTIFIES THAT , t, ,,,. BUILDING INSPECTOR has permission to erect ........................... buildings on .........� ,0....V .%!,......0 ..... ...... Foundation . .� � .Q.). .subA ON ` Rough t© be Occupied a5 ................. .. .�...............,.... ..... .......,,. jp� ca ....... Chimney provided that the person accepting this permit shall in every respect conform to theterms of the ation 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 S ARTS Rough Service ,......,. .. ..... .. ..;";,Lao. .............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occu Buildin, 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 of Masnr chusetts . Department of1'ndustrzalAceidents 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.govldia '•-yY1 Workers',Compensation Insurance Affidavit:Builders/Contractors/Electticians/Pli mberg. TO BN FMED WITH TEE PERNIZ'l I"ING AUTI(ORIT ' Alicant Information A . Please Print Ise 'bl Name(Business/Organizationllndividual): �! �Ln 14619W6 Address: � � .�� G y/State/Zip: Phone#: l Areyou ane ployer?Cheekt&a ,pxopriate box: Type of project(y 6d)' 1. I am a employer with employees(fold and/or part-time).* 7.• Q Now colisttUGdOn 2.0 I am a sole propdotoKor partnership and have no employees working forme in S. Remodeling any capacity.[No workers'comp.insurance required.] 9. Q Demolition -[]lam a homeownerdoing all work myself Wo workers'comp..vasurancerequired,]t 10 E]Buitcyng addition 4.QI am a homeowner and will be hiring oontractars to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I J.❑Electrical repairs or.additioas proprietors with no employees. 12:Q Pl ing repairs or additions 5.FJ I am a general contractor and I have hired tha sub-contractors listed on the attached sheet. 13.-RJIGffiepairs These sub-contractors Have ei3iployees and h' eworkus'comp.insurance.1 14.E]Other 6.0 We are a corporation and its officers have exercised their right o£exemption per MGL G. 152,§1(4),and we have no,employees.[No workers'comp.insurance required] 7. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners,vrho sub0f finis affidavit indicatingthey are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that cheekthisbox must'attacbed an.additional sheet showing the name of the sub-contractors and state whether orgotthose entities have employees.'Ifhe sub-contractors have employces,they must provide their workers'comp.policy number. 1"am an employer that is pYovirlingworkers'compensation insurance for my errtployees.'Below is tl2e policy aril job site information. 6) Insurance Company Nau+e: / C.� kz& zn�.�—U Policy or Self-ins.Lic.#: G[. Expiration Date: Job Site Address: Ctty/State/Zip: �� ���� Attach a copy of the workers, compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a Erne up to$1,5fl0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against tb e violator.A.copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. rdo hereby ce under the pains andpenalties of-Pei jury that the information proviclecl above is true andcorrect. Si atuy c: Date: y Phone#: Official use only. Do not 11prite in flits area,to be completed by city or town official. City or Town: Permit/D:icense# Issuing Authority(circle one): i 1..Board.of Ifealth 2.Building Department 3.City/'I.'o Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Phone#' Contact Person: Page# of pages CS # 022680 978-688-6737 HIC# 163358 A. Jr Walsh & Sans or 159A Waverly Road 1-978-912-2853 Forth Andover, MA 01845 Proposal Submitted,T�s, Job blame Job# } Address '71 Job Location r Date Date of dans Phone# d _ �� Fax# Architect We hereby submit specifications and estimates for: `1r.,, ,:#$ N �,✓ '" �'O�Ci s �,,, F.�� {6"dl'` w�o+�ed'�„�,,, i�.:y''{,��, �, N�r� ,tr,a'��aC„r��„ M'e ��'{�„4�a;�N �<%��r��,rr y'�,,.,M re„i�„ W.�"t,a�a, r n.,, a��,p� �laa��a7f��� �e'a�,�r(dTM o5 if,r a' i. � ���'�o`{"{.�!'�ll.�dA°�'° .,, m°,�d%"fN,.'�',�^'jk,,.b ✓�, /PdJ, � �"�r�� ° AWN � ���m°"�N^,� �Y {N,+.�p�a�N�oGR 9'{""�y'�'� '�°YH»� �� N✓�, ^ "�d o{"� mV��,�:° �""r"J"„+° d'' � ", rC ;ni'�f i ,;N @a jdo �PN., a ✓r{"..v7 �; i P `'N,��' ” +�' m � U d d as ..w u c'a ` m 4,, a a°',,, �d r ` r ,rf d A I A �� i/" ff F r .�,W i�„n � �� � �a:�,�&� w �,tlU,{a � �'��rru _. � , We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: ,. K aA � �Na N d��� �r, ;. Dollars � with payments to be made as follows ' Any alteration or deviation from above specifications Involving extra costa will be Respectfully � o / executed onlyupan written order,and wt1'1 become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our cdhlrol. Note—this proposal may be withdrawn by us if not accepted within days. Sicteptalict /9, n' q,�0 V�wgn, nmmm The above prices,specifications and conditions are satisfactory and aro �� � ignature hereby accepted.You are authorized to do the work as specified Payments will be made as outlined above. Date of Acceptance 2.� � O �___ Signature �� WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. AWC 400 7014648-2015A' PRIOR NO. AWC-400-7014648-2014A ITEM 1. The Insured: Arthur Walsh DBA: A J Walsh&Sons Mailing address: 159A Waverly Road FEIN:*"-**'6792 North Andover, MA 01845 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from 11/14/2015 to 11/14/2016 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are. Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates rCode Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 40579 I INTER SEE:CLASS CODE SCHEDU E Total Estimated Annual Premium GOV GOV Deposit Premium STATE I CLASS, es State Assessments/Surcharges MA I 5403 j g ! - $.00 x 5.7500% $ This policy, including ail endorsements, is hereby countersigned by . . `�} ' `- - 11/05/2015 Authorized Signature Date Service Office: Durso&Jankowski Insurance Agency LLC 54 Third Avenue 11 Saunders Street Burlington MA 01803 North Andover, MA 01845 WC 00 00 01 A(7-11) includes copyrighted material of the National Council on Compensation Insurance, used with Its permission. I MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies all basic requirements of the state's Home hnpmvemonk Ctjntractor Law(MOL chapter 142A),but does not include stands rd' language to protect homeowners. Seek legal advice if necessary, Any peksonplanning Immo Vnprov"m6nts should fir'sf'obfain a copy of"a Massachusetwconsumer guide to homcfmprovcutont"beforo agreeing to any work on yourresidence,You may obtaiza fisc copy by'calling the Office of ConsumerAifairs,and Business-Regulation's Consumer Information Hotline at617-973'8787 Or 1488*283.375.9: Homeowner Information Contractor Information Nam e pony care.. Street Addr (do not use a Post Of6 Boz address) Connector/ CM we ]Name Cityrlown /�State Zip Ce Winces Address(must include a street } . 4X AJ ' .� to ' Da o Phone Evetun Phone 7 t� 1ty/7own S zip ca 20 Mailing Address(It diffaart from Allow centres oae Went F1up16yerID or S.S.Number ' t*v rcquSret tLa mon tnmeim• Hamm ICma.ddrrtaa�Nuarticr axlunilda � //" .' provabeol waeadmr haver '_, �„ sari reaimanoa numaC � �G+°t. .. �+, j The Contractor agrees to da the following work for the Homco nor; Mal.laLswbeus •r Required Perinits-The following building pe"mits are required Proposed Start arid''Completion Ssbedule-The fdlloviiiig schedule will and will he secured:by the contract or'as the'homeowhers agent; be adhered toiliidess circumstances beyond.the contractar's'control arise (Owners who ;secure their own permits will be excluded.from,the Guaranty Fund,provisions ofalto te whaiicohtnctorwill begin contracted wotk. MGI;chapter I42A:) to when contracted .work will be tantially completed. Total Contract Price and Payment,Schedule q p The Contractor.agreos to perform tbe'work,runtish the material and labor specified above for the,total suer of (� .„t L (f) .4.yments will o5 ide according to the following schedule: ��$ upon signing connect'(not to exceed 1/3 of the total."contract price.91 the cosCof special order items,whichever is.greater) $ by 1 or upon compledon of $ by �,� %.. or upon completion of " �j 4 upon completion of the contract (Law forbids demanding full payment until.contmet is completed to both party's setisfaatiort) The following matedal/equipment must be special S )gbepaid for ordered before the contracted'work paid "oegias in order" S � to be aid for_ tomeet ttio,rompl6tioa schedule(**) NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may' not uceed 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. .x W - an r td a es of e e n c Subcontractors The contractor agrees to be solely responsible for completion of the work desanbed regardless of the actions of any third party/subcontractor udlized by the connector. The contractor further agrees to be solely responsible for all payments to all subcontractors foi Mtcrials and labor under this aereement 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 Gen or other security interest`has been placed on the residence, Review the following cautions and notices carefWly before signing this contract Don't be pressured into sighing the contract Take time to read'aad fully understand it-'Ask'questions ifsotUdtitig is unclear. * Make sure(Ip contractor has a valid Hem 3mnro� +r n _ y The I&requires most home improvement contractors and. subcontractors to be registered with the Director ofHomo improvement Commetal'Registration, You may inquire about.coniractor registration by writiog to the Director it.Ono Ashburton Place,Room 1301,Boston,MA 02108 orby.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'fbiin and get a copy of the Consumer Guide to the Home Irhprovemcnt Contractor Law: " You may cancel this agreement if it has beea signed at a place otherthanthe-coutmetdr's'normal place ofbusiness,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 rho, thud business y fol ing the signing of this agreement Seethe-attached notice of cancellation form for an explanation of,this right OT SIGN THIS NTRACT IF THERE ARE ANY BLANK SPACES!!! a copi of the contract must canaplew and signed.One copy should,go to ora homeowner The ether should be kept by the contrwor. .. o co r' Con ar's Sigrmturc, Date J Cl ,Date Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-022880 Construction Supervisor ARTHUR J WALSH JR 169A WAVERLY RD N ANDOVER MA 01845 /"^'� Expiration; C:Imissioner 06/09/2018 �i+,., irr»rnirrnrsi�/�r./C�/�LrrJJric�rrsr/f � — —Office of Consumer Affairs&Business Re iilatiau VIEWHOME IMPROVEMENT CONTRACTOR �1 Registration . 103358 Type. Expiration: 7/7/2018 Private Corporation A.J.WALSH&SONS INC u _ Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary i �i