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HomeMy WebLinkAboutBuilding Permit # 9/28/2016 �OFiT�y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ©ate Received - y -- - =/✓� �� '� °4 �.,«;�. a +� �.q AS AiI.A IPG '(y Date Issued: } s ACElUS 4 IMPORTANT: Applicant must com lete all items on this paEc LOCATION Prt in PROPERTY OWNER l Print MAP NO: PARCEL: 60 ZONING bISTRICT: Historic District yes na Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Done family ❑ Addition ❑ Two or more family ❑ Industrial [(Alteration No. of units: ❑ Commercial U'Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 17 Septic ❑ Well 0Wetlands ❑ Watershed District C] Water/Sewer fi Identification Please Type or Print Clearly) OWNER: Name: ' Phone: 17- Address: CONTRACTOR Name: .�4 r� Phone. �h6 Address Staper►tisor's Construction License. ; —I , - Exp Date: f r 7 Horne Improvement License Exp Date. 1 ) rC � `I I 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: $ Check No.: _ 3 N 7 0_ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �z E ( _ (Ar... Signature of contractor 14ORTH own of z ndover IVTo. e �A_ h ver, Mass, 6/ 069 s � BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........CIM I'S. z... ...r. .. BUILDING INSPECTOR has permission to erect ....................... buildings on ...... .... . .......... ........... .........A.Vc Foundation S!7?!�_40. 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 CONSTRUCTJ6bL START Rough CService ....., ... ...... .................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy .Permit Rgquired to Occupy 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. Smoke Det. A & A SERVICES, INC. A&ASERVICES 115 NORTH STREET, SALEM, NIA 01970 Teleplione:(978) 741-0424 Pax: (978) 741-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal EIN: 04-3090162 CUS'T'OM REMODELING AND IMPROVEMENT AGREEMENT Buyer(s) Name Date of Contract L 'jv.l✓'�7�! 7"' e -'�"r%Lr' t`� '�Y'/lJ t l;" L�`� _f Buyer(s)Street Address,Ci ,State and Zia Code s 1111 l`I v DImo Telephone Number Evenin Tele hone Number Mobile Telephone Number E-Mail Address It.7wst%i7 The Buyer(a)listed above hereby jointly and severally agree to purchase the goods andlor services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement'),and Buyers)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contractor'),hereby agrees to install or rause to be installed The products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services.The Buyers) agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. f Purchase Price: r � Est.Starting Date:/ Down,Payment: iS v Est.Completion Date; tredit ash Amount Due on Start of Job: heck Card Amount Due on of Completion: No. Amount Due on of Completion: �j C Expiration [late: Balance Due on Upon Completion. �r5+'"Z `L CVC Code: It is agreed and understood by and between the parties that this Agreement,front and back and any addendum, constitute the entire understanding between the parties, and there are no verbal understandingschanging or modifying any of the terms of this Agreement.Bu tet( hereby acknowledge that Buyers)has read the front and the reverse of this agreement and has received a completed,signed and dated copy his Agreement,including the two attached Notice of Cancellation forms,on the date First written above.Buyer(s)also(€)acknowledge that they were orally Informed of their right to cancel this transaction;and(ii)request that they be contacted via their telephone numbers or email,as listed above,In the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services,Inc. Buyer(s) gy;—f�y' • t3 E Signature Signature Print Name Print Name Signature Print Name You,the Buyeril may cancel this transaction at any time prior to midnight of the third business day after the dale of this transection. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The wnuactor end the homeowner hereby mutually agree in advance Ral in the avant either party has a dispule concerning this contract.ellher party may Suhmil such dispute to a private arbitration seance which has been approved by me Sectataryof the Eaecutive Office of Consumer Afkdrs and in-iness Regulations and the other party shat!ba required to sm"I to such arbilraGan as proved In M.O.I.042A. c^ cnntwctar inkials: Dal,: !�L 7-ILI Dm.: NOTICE of CANCELLATION NOTICE OF CANCELiATION You may nance3 This transaction, Date Transaction You may nancel this transaction,without any penally or Dale of Transaction wslhoul any penalty or W abligation,wiptin three business days from the abova dale.If you cancel.any property Vaded In, obligation.vhlhln Ihrae business days fromthe above date.if you mro.I.any pmpertytradad iq any payments mads by you under the Contractor Sale,and any negotiable mstrurrnnl executed any payments nada by you underlies Combed or Sale,and any negotiabloinslrumentexecuted by you wip be returned within 10 days following rewipt by the Seller of your cancellation notice, by you wip be returned within 10 days following receipt by the Seller of ywr cancellation notice. and any secudty Inleresl Enring out or the transaction wul he rancellad.If you oare,4,you must and any security interest arising out of the transacgon will be cancelled.II you cancel.you must make avalfabis to the Seller at your residence,and substantially in as goad cendllion as when make available to the seller at your residence,end substanpally In as goad condition as v lien recelved,any goads delivered la you under this Contract or Safe:or you may,Nyou wish,wnply received.any goods delivered i0you under this Contract or Sale;or you may,i(you wisA,comply of t with the instrucpons of the Seller regarding the return shipment he goods at the Seller's enth the inshuclions of the Soper regarding the return shipment of The goods at the Seller's expense and risk,It you do make the goods available to the Seller and the Selfer does not pla expanse and risk.II you do make the goods available to the Seller and the Seller does not pick Stem up within 20 daysorthe defeat your Nocce ofcancefation,younay retain ordimseaf the them up within 20 days of the dale of your Nahce of Cance€la0on.you may xelain or dispose p1 liable ref pe goods without any lunher obki9alion.if you fail to make the goods available to the Selfer,or it you the goods without any luahar obRgaOon.kr you tap to make the goods ova€IaWa to the Sellar,or II agree to return the goods totig Seller and tail to do so.Then you remain liable Inc performance of you agree loretum Ihegoo is to the Sererandfall to doso,then you remain dormance e CanuecL To cancel this bansaction,maiF or tlel'wera signed and dated all obltgatins oandar the Conuacl.To cancel this Iransactlon,mail or deliver a signed and dated al an obligations under th ropy of the sencellafion no9w of any other wduen notice,Or send a*e7grs ttq A&A Services. wpy of the cancellahon notice or any other written novel.or send a telegram,Il Services. 115 Nonh SueeL Salem MA 01970.NOT LATER THAN MIDNIGHT OF 115 North street,Salem MA 01970,NOT LATER T14AN MIDNIGHT OF 're-1 I HEREBY CANCEL THIS TRANSACTION I HERESY CANCEL THIS TRANSACTION Consumer s Slgnalura Pale: Consumers Signature Date: Phone: 978-741-0424 AGr,ideAbove ALove Fax: 978-741-2012 sn e"M2 wwlv.a-aservices.corn A&A SERVICES 115 North Street �/� ® p Salem, MA 01970 10 Install GAF storm guard leak barrier 36" in valleys of home and at any roof penetration such as chimneys, exhaust vents, vent pipes and skylights for added protection against leaks. EInstall F-8" drip edge to perimeter of the roof deck. Drip edge helps support the roofing shingle at all edges of the roof, manages water flow off roof and into gutters, and also protects against wind-driven rain penetrating the edge of the roof. Available in 3 colors: Mill (Aluminum), Brown, and White. Install GAF deck armor to remaining area of the roof that is not covered with GAF stormg uard. GAF deck armor adds another layer of protection against leaks from wind-driven rain. It being extremely breathable, lets moisture escape from attic space and helps preserve your roof deck. Install GAF ProStart starter shingles at perimeter of roof. This is important because the starter rter shingle has additional adhesive which prevents the first row of shingles from blowing upward in heavy winds. Re-flash chimney: remove and dispose of old flashing, cut into mortar with grinder approximately 8" up chimney, feed new lead into newly cut mortarjoints, install lead in a step-flashing manner, and run approximately 4" onto roof deck. Seal all edges with Geocell sealant. Lead is used as a flashing material on chimneys because it is very pliable. Lead flashing molds to uneven surfaces and stays in place for years. Install aluminum vent pipe boot with rubber gasket around all vent pipes and then seal with Geocell /� sealant. This application prevents leaking around vent pipes. 0 Replace or ❑ Cut in For & Install ! Brown roof bathroom exhaust vent(s) with adapter and seal with GeoCell. Ventilation is a requirement for long-term roof performance and warrantee validation. It will reduce energy consumption and create a healthier and more comfortable home environment for you. A&A Services will utilize the following type of ventilation system for your home: Gable Vents: Add: • Utilize Existing: • Expand Existing: Soffit to Ridge: (Soffit Vent as Intake)Add: Type: • (Ridge Vent as Exhaust) Cut in as required and add GAF Snow Country Baffled Ridgevent to ridge(s). Location: Aluminum Slant Static Roof Vents: # Location: Mechanical Ventilation (Electrician Not Included): # • Type: Location: Buyer Initials; _ Dater [� Z:IA&A Common Folder\ReferraWReferral Kits\RoofinglRoofing Specifications Sheet-Jan. 2015(2).docx 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wfvw.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Avylicant Information Please Print Le ibl Name(Business/organization/Individual): 1-_ .... �-C'V's/ I CSt,S r�ltC _.,.,.,. Address:- city/state/zip: ddress:_CE /s'tate/zi �+ t� C Phone#: f I Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with LJ 4. ❑ 1 am a general contractor and 1 6 El New construction employees(full and/or part-time).* have/tired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet,t 7. 0 Remodeling ship and have no employees These sub-contractors have S. []Demolition working for me in any capacity. workers'comp,insurance. g, ❑Building addition (No workers'comp,insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing at work right of exemption per MGL 11.❑Plumbing repairs or additions myself,[No workers'comp, c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.(No workers' comp.insurancer-quired.] 13.[]Other 'Any applicant that checks box t!f must also flit out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating They are doing all worts and then hire Outside contractors must suhmit a new affidavit indicating such, 1Contractors that check this box must attached an additional sheet showing the name of the subcontractors and Their workers'comp,policy information. I ani an employer that is providing workers'compensation insurance for my employees. Below is tke policy and job site b formadon. Insurance Company Name:�V_C. 11 2 l ^ Policy#or Self-ins.Lic.#: vv1 � ( � Expiration Date, Job Site Address:,_� atS 6 WSQ±�� City/State/Zip:. d� t1 Attach a copy of the workers'compensation policy declaration page(showing the policy numlrer and expiration 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 a 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 do Hereby certify it er Irep�ains and penalties ofperjury drat the information provided above is true and correct. Si nature: ✓/ � Date: Phone Official use only. Do not write in this area,to be completer/by city or tarvrt offleial. City or Town: Permit/License f# Issuing Authority(circle one)- .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORDaDATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 9/19/2016 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ,PORTANT: 1f 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 Ileu of such endorsement(s). PRODUCER CONTACT David Barrese NAME: EA Stevens Company, Inc. PHONE (781)322^2324 FAC No, (781)397-7572 389 Main St. E-MAIL ADDRESS:davidb@eastevensins.com P. O. Box 188 INSURER(S)AFFORDING COVERAGE NAIC# Malden MA 02148 INSURER A:Liberty Mutual Insurance Co INSURED INSURERS:Safety Indemnity CoLapapy 33618 A 5 A Services Inc. INSURERC: 115 North Street INSURER D: INSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 Master 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. IN5R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ACLAIMS-MADE OCCUR DAMAGE TO RENTED 100 0 PREMISES Me occurrence $ 00 CBP8799047 8/14/2016 8/14/2017 MED EXP(Any one person) $ 5,()00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PECOT- LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 Ea cciden r ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 6209032 2/9/2016 2/9/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Medical payments $ 5,000 UMBRELLA LIAII HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY y I N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E-L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatary in NH) E.L.DISEASE-EA EMPLOYE $ ff yes,describe under ❑ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT, $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street: ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE /* Thomas Cares, Jr/VH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS 025 fgni ane i A'30 Phone- 78-741-f,,424 sa-.uiz Fax973-7,4 -?012 A& '�"� '"° �;r�rrara aserr�c 5 cn� A f;Rv 115 `forth street 9 - Salem, MA 01770 DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a property licensed facility as defined by M.G.L,c. 111, Sec. 150a. The debris will be disposed at: Waste Management 877-515-2845 c/o Melrose Transfer Station 740 Broadway Melrose, MA 02176 or Waste Management, Dumpster Service at 115 North Street Salem, MA 01970 Signature of P' rmit Applicant Christopher Zorzy, President Name of Permit Applicant 2 Date Massachusetts -Department of Public Safety A&A SERVICES, INC Board of Building Regulations and Standards Christopher Zorzy . ,,,,....�.,,,, .,.,,.L. ..... .. License: CS-057733 , 115 North Street -I..r Salem, MA 01970 �`` CI3R15TOPH)ER 7,4lR26 115 NORTH ST : Salein MA 019707 �6 SCn t..._S 20M .`f„nn iir rrrrr�/� r I/ri.iarir�n.ir*//i � J�' '� tl 14l� Expiration —,Office of Consumer Affairs&l3asiness Reauiation Commissioner HOME IMPROVEMENT CONTRACTOR Registration:. 101$09 Type: P Expiration 6!261201,8 Private Corporation A&A SERVICES: INC.' Christopher Zorzy 115 North Street Salem,MA 01970 Undersecretary