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HomeMy WebLinkAboutBuilding Permit # 11/9/2016 poRTlj BUILDING PERMIT oFt�,eo ,bqH TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXAMINATION .° Permit No#: 44q a o I Date Received 1(—q �SSac�+uS�S Date Issued: { (l atm -� IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER / Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT. Historic District yes' Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building . . . ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 pCd'm2 ,.�'+k' r �'. .. sY ,.„,..,,� yam✓ zr,�h110, ✓Y"rw. � . ,,.. �® R .. zelaflf .., . e e. qi -r 4r DESCRIPTION OF WORK TO BE PERFORMED: Identification-�Please Type or Print Clearly OWNER: Name: Phon �~ Address: Contractor Name: l d hone: - l Ema11: Address: Supervisor's Construction Licensed, 0(42 1� 60 Exp. ` Date: Home Improvement License / ✓� Exp. Date' Lz ARCH ITECTIENGINEER 'l- 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.: I Receipt No. NOTE: Persons contracting with unregistered contractors do not have access to Oe guaranty fund Y .............. ... _. ,. ,......., ............................... ...... _.... tkQRTil own of zAndover 0 1. Nr,�•"' � No. 1 ,► - - h ver, Mass, ,/ O LAKE LOC M1C Fol WIC K V digs RRTED APp"�.�5 U BOARD OF HEALTH Food/Kitchen PERMIT . T LD e Septic System THIS CERTIFIES THAT .�.�Iw!QAWTIMIM-ft...DeIrll!o-LON.... ...-Zay.& 114..... BUILDING INSPECTOR has permission to erect .......................... buildings on ...... ............ Foundation Rough tobe occupied as .,........ .................... .......... .. ..,....,.,,............................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Find 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®NSTRUC STA Rough ... ,..... Service .. ............................................. Final BUILDING INSPECTOR GAS INSPECTOR OccupantOccupancE Permit Required to Otto Buildina Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wali To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. r HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(M.G.L.142A4 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware. if such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract. Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS: If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or al with unregistered contractors will not have access to the Guaranty Fund. approvals are necessary.Homeowners who secure their own permits or de, 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within 7 days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractor's control:Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,governmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS:Contractor agrees to perforin the Work and to fiimish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract. Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel.Final payment shall he due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay Contractor's reasonable costs of collection,including attorney's fees and costs.Time is of the essence hereof. 5. WARRANTY: For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding homeowners.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Re istration No: 174377.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www,mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. S. ARBITRATION: Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A.No lien or security interest is I imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if tlrc i Homeowner breaches this Contract. I 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the ? Property to perform the work as covered by this contract;(b)the Homeowner has fiords available to make full payment under this contract to the Contractor upon completion;(c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under constriction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates and holds harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court casts)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10.CANCELLATION:Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day following the signing of this agreement. 'M HOMEOWNER: DATE: 1 � Shingle: DEPOSIT: 7'I1e Coriztriollivealth of Massachusetts Deportment of jndust3'ialAccidents + Office of billesfigations ` = 600 ff"ashington Sheet Boston, MA 62111 }V ow.i' ass.gov1di l Workers' Compensation Insurance Aff daAt: Builders/Contractors/Electricians/Plumbers licant Information 'lease Print Legibly f Name ((Btlsine-S/orgunization/Individual): t�r �,� ®���� �� �•, Address: 612 City/State/Zi p ' . '�' � Phone r Are yA an employer? Check the appropriate box: Type of project(required): 4. E] i am a general contractor and I 1_ I am a employer"Nritlt � have hired the sub-contractors G. 0 New construction employees(full andlorpart-time).* Remodeling 2.❑ I am a sole proprietor or partner- listed on tile attached sheet. 7. ❑ 711ese sub-contractors have 8, 0 Demolition ship and have no employees working for me in any capacity. employees and have workers` 9. 0 Building addition 0 workers' COIIl insurance 5. insurance,'- required. p' 5. © We are a corporation and its 14.0 Electrical repairs or additions officers have exercised their 1],.❑ Ph mg repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL myself. No workers' comp. _? 12. L oof repairs insurance required.] c.e. la-, §1(�€),and«e have no 13.❑ Other employees. [No workers' comp. insurance required-] �1-Ltn;applicant[lint checks box,'l must also fill out tilt section below showing their policy information. t who submit this affidavit indicating they are doing all work and then lure nutside cunimctors must submit anewaffidnt'it indicating such. Houteolvaers =Contractors[Jtat check this box utust attached an additional=_Meet shoa=in-.the name or the sub-contractors and state whether ur not those entities have employees, Irtlte sub-contractors hats employcas,they must provide their worl.ers'camp.polio-number. .E am an aniployer that is pro['iding workars'compensatioil illsill- ace for my employees, Belolu is the poliU alul job site i11f01'171atioli. Insurauce Company Name: ' i` Policy r or 5t:tE=ins.Lic.�:��• ��>. � ; � , f Expiration Date, � .. Job Site Address': City/State/Zip: J" Attach a copy of the workers' compensation policy declaration Mage(showing thepolicynumber 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 ha the form of a STOP WORK ORDER and a fine of up to$230.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do lterehJ1 cerci.j� mdpr the pains and penalties Ofltaiji y that the information proilided[[bodet is true and cureet. Siettature: d'4"t- -A Date: Z 14-4 Fllone Official use onljry Do not lwite hi thus area, to be completed by city or town officiaL City or Town- Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Ulectrical Fnspectoi' S.Plumbing Inspector G.Other Contact Person: Phone ul: Aca aF CERTIFICATE OF LIABILITY INSURANCE DATI IMMIBDfrYYYI 1011311016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certilicate Holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. It SUBROGATION IS WAIVED,subject tD the tarns and conditions of the policy,certain policies may require an endorsement. A statement on this cardllcate does not confer tight$to the certificate holder Its lieu of such andomemont e. PAGDUCER HAM Diane LeBlanc rAi DOHERTY INSURANCE AGENCY INC PHONE 978 475.0260 Nai:_as.. P.0 dlehfanc�dahettyansurarxe.can P.O80Xloss INSURER(S)AFFORD1NOCOVEItA09 NAIC0 ANDOVER MA 01810 1NSUaERA: TRAVELERS INDEMNITY CO OF AMERICA 28666 ut4rsRi=o INSURER B• TNOMEY&I_EGARE CONTRACTING INC MURERC: INSURE o:: 87 BELMONT STREET 9MURBRB. NORTH ANDOVER MA 01845 1 INSURER : TM^ COVERAGES CERTIFICATE NUMBER: 93249 REVISION NUMBER, T141S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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: MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HMEIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONOrtIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TIP54FINBYRANCE PoLizvoumsen rI Y F ePrrLlcYExP Lasrrs COMMURCUU OG EMLIAGILrTY EACHOCCURREHCE S CLAIMS•MAOE Q OCCUR PREId18E wC(Sfto4 s '^ A{EDEXP{ pry 1 S FILA PERSONAL4ADV INJURY S _ GEWL AGGREGATE LIAUT APPLIES PER: OENERAL AGGRBOATE ~_ S P041CY F]$ECT F]LOC PRODUCTS•COUPIOP AGG S OTHER: S AUTON1001L8LJABILrrYIA N_90NOL LIWI ANY AUTO e004LY IN$URY SPM pawlALL OW810 -- AWGS AIfTO$DIII ED KA eOeILY tHlURY 4Per BDadcnll $ NONAWNEO P OPW f 6 t� HIRED AUTOS AUTOS i UMBULLAW1a OCCUR EACHOCCURRE"CE S EXCESS un CLAIMS-MADE WA AoGREGATE s D D I I RETENTIONS S --- NfORNERSCOMPENSATION YIN /� TATI TH ERH AND EMPLOYEPUT UA13ILCY _ A OAFFFIC RWMERIRPEXCtUDEEDD.?ECVTNE N1A WA NIA 61-IL180290MW16 0@11812016 0911612017 EL.EACHALCEDEHS S SGfl.011Q Imut""I"v�nI E L DISEASE.EAEMPLOYEE S 500,000 IID `scRIPnDNOPOPERATIONSWIow EL.DISEASE-POLICY LUT 1 500.000 N/A OE""*M Of OPERATIOrrar LOCAn(MS rVENICLSs tACORD tet,Aauwnat Ramalir eclleOuto.meT ua must,eQltmaro�puvo h r pu4atll Workers Compensation benefits will be gold to Massachusetts employees only.Pursuant ID Endorsement WC 20 03 06 B.no aulhorization Is given to pay daims for benefits to employees In stales other then Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts. This outiocate of insurance shows the policy in roma on the date that this certificate was issued(unless the expiration date on the shove poky precedes the Issue date of this certificate of insurance). The status of this coverage can be monitored dally by accessing the Proof of Coverage-Coverage Verificatl°n Search tool at www.mass.govRwdlwarkem-Compensetianrinvooggatlonst. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE6CRIBSD POUCtES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VWLL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICYPROVISICNS. 1600 Osgood Street AUTHORIseo RePREaISNrATnre North Andover MA 01845 1:_{ �4� Daniel M.Cra�y,CPCU,Vice President—Residual Markel—WCRISMA 01888.2014 ACORD CORPORATION. All rlghts reserved. ACORD 25(2014101) The ACORD name and logo are regletered marks of ACORD ClientN:14416 DAMPHOUSSE ACORD. CERTIFICATE OF LIABILITY INSURANCE 111091�sYY"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Bax 1985 BOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A Western World Damphousse Roofing LLP INSURER e: 87 Belmont St INSURER C: North Andover,MA 01845 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BFEN 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LNSR LTR TYPE OF INSURANCE POLICY NUMBER V EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY NPP8296488 04/12/16 D4112117 EACH OCCURRENCE $1,000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED[reroco S100,000 CLAIMS MADE D OCCUR MED EXP(Any one person) W000 PERSONAL a ADV INJURY $1,900,000 GENERAL AGGREGATE -s2.000.000 GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP1OPAGG $2000000 X]POLICY PROJEC- LQC AUTOMOBILE LIABILITY COMBINED SENGLE LIMIT ANY AUTO (Ea accident( S ALL OWNED AUTOS BODILY INJURY $ SCHEOULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON•OWNEDAUTOS (PoracddanO $ PROPERTY DAMAGE S (Par accident) GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC 5 AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FICLAIMS MADE AGGREGATE $ 5 DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND INC STATU• OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S ANY PROPRIETOPJPARTNERtEXECUTIUE OFFICERIMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE S II Vw,dvxdDe under SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELLATION 10 Da S for Nott-Pa stent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL --UL DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 50 SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF AN=ND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOgIZED REP EfiENTATI E ACORD 25(2001/08)1 of 2 #S34292/M34248 DML o D CORPORATION 1088