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HomeMy WebLinkAboutBuilding Permit # 11/28/2016 BUILDING PERMIT �4 �oR�6�� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '.' '- m Permit No#: 7L A, ( Date Received 7 �RATEP hQ¢ { pate Issued: 1 P f LWORTANT:Applicant must complete all items on this page I�®GATION 2 Pnnt PROPERTY OWNER y xk [3�'YearStructere' yes rio Pnnt I MAP ZONING'DIHisto' rtc is) stnct yes n ` Y Machine Shop Vi no, TYPE OF IMPROVEMENT PROPOSED USE Resio6ntial Non- Residential ❑ New Building Wbne family ❑Addition ❑Two or more family ❑ Industrial ❑Al! ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Cl Sepfic p VlleJf Cj Floodplain ❑w t[2Mt s ❑ Watershed`District D WatrlSewer _. DESCRIPTION OF WORK TO BE PERFORMED: f Identifications-- Please Type or Print Clearly OWNER: Narne: �\K 7 oria kion Phone: q Address: , AJ 6,J /111 00ntracfor Narne Sc46 ( r,.A.x Phon.e: . Ac . .- Y. - Supervisor's:Coristructiori l icense _ f u6 Exp' rate t Horne Iri proveffierit Liec-n ARCHITECTIENGI NEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINO PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PFR S.F. rotal Project Cost: $�� � .mem C'' FEE. $ i Check No.: $ Receipt No., 3 i 2 _S 0 NOTE: �o c�rnactingvitli unregistered cor� cictors do not have;access to the guarantyfund j SiT"atia.re of_Ageritl : ` ' .er" Sidnatu.re f5f coritractor -T I►®RTH own of 2Andover No. x ver, Mass,Mass, �- "' ,�of O •••• CO[LAKEN[C HZ WICK ^� U BOARD OF HEALTH Food/Kitchen PERMIT T LD/ Fr." IereirtAN" Septic System THIS CERTIfIES THAT . ,. ,. ' �i�, .,...`1.. . . BUILDING INSPECTOR .. ....., has permission to erect.......................... buildings on .....(0..!.,.,.... .r.e! .d.�.��,,........... Foundation �a ,.�. . R /� Rough to be occupied as .....,... ., .....,. ..... ...... Chimney ................................................. y 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 V10LATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO , S ART 0 Rough Service .............. .. .. ...,..... .. ................,...... ................. Final BUILDING INSPECTOR GASINSPECTOR ®ccu any Permit Required to Occupy Puildin 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. R00FON6 ow ovement Contract Massachusetts Home IMPEW- This form satisfies all bashireqUirclucrts Of dleslatds ljonailhupsoveruent Contractor Law(MOL chapter 142A),but does not Include sstandard language tol)rottethomeowners. Steklegill advice ifnecessat-Y. My PorsOnPlanlihIg home improvements should ffist obtain a copy OVA Massachusetts Consumer Guide to Boma Improvement'before agreeing to any work on your residence.You may obtain a flea copy by calling the Office of Consumerinforination Hotline at 617-973-9787 or 1-888-2833757 or o a our website, Homeowner Inforniat on Contractor Information AamaCompanyNanto 0 't yx k Street Adeh:c,'—(do net�,�Apotofr�xamx�dam") Owner ame 6 C 0 CCityfTovm i 4-11 - . State 'Zipcodwusiness Address(moTt include • A f)Jo v te M 1-1 3150 0 S4 Cit yfilo NN71 late Zip Code ��veid ,,a n2;I'liona Al, lllid,,�Em Tloy�_"Mo,,S�S -7 _�u "'o Businessphonoil g,6 Federal Employer ID or S.S.Xurnble I forn..renrTovc—I.c"ell 3 &5-6 The Contractor agrees fl o the followiworfOr theHomer(Describeindetailthov<rktoe mpleted,specifying lija type,brand,andgradoof materials to housed,use aLdillonL11 I e I rlkl'�Ij' a h cury- 5'j)k06L — .., 'd C.r Ptc-as C, Required Perrallts-1110 following building pexardis are required Proposed Start and Completion Schedule The following schedule will and will be secured by the contractor as the,homeowner's agent: be adhered to n I raless circumstances beyond the contractor's control mise (()wjIerS Nyho secure their own permits will be excluded from the Guaranty V,and provisions of Dnfo when contractor will begin contracted work, MGL chapter 142A.) �LPA _Datwhen contiactedwork will be substantially completed. Total Contract Price and Payment Schedule ilia Contractor agrees to perform the work,AlMish the:material and labor specified above for the total sum of Payments will be made according to tiro following schedule: OC' upon sigrdng contract(not to exceed 113 ofthe Val contract Pricc.Rr the cost of special order items,whichever is greater) ' by ( ru or Won cO pletion of_ —2-1—f 0 0 P — by or upon completion,of Of S_1216_01 upon completion ofthe contract. (Law forbids demanding full Payment IM61 contract is completed to both party's satisfaction) The following MattriallejUipMentMUSt be 5PMal ordered before the Contracted work begins in order to elret tile completion schedu!e.(' paid for NOTES:(1)Jacludins all finance char8es(*t)Jaw requires that any deposit or dawn-payment required by the contractor before work begirs may not exceed iho greater of(a)one-third oftho total contract price or(b)the actual cost of any special equipment or custom made material Nvhjcjj must be special ordered in advance to meet the completion schedule. c t xwens N irr v elm ovide Illecontractor? ERXorl es nilterms F flip valmalltv must be -0-4 UmA ,Sutrcontractors-T71c contractor agrees to be 50102yrespolasible for completion ofthe work described regardless ofthe actions ofany third puty/,Sllbcoiltractorntilizedbythe contractor. 'rho Contractor hither agrees to be solely responsible for all payments to all subcontractors for rqate[, at%414 _kq mde Contract Acceptance-Upon signing,this document becomes it binding contract under law. Unless otherwise noted tvidda contract shall not iinpily that any lien or ogler security interest has been placed on the resideace, Reviovtliefollrjwiugcatitiorisaudiiodces carefully before;signing this contract. Don't be pressured into Signing the contract.Take time to read and filly understood it. Ask questions if something is unclear, "Iatiro ur) home improvement contractors mad subcontractors to inquire about contractor registration by MA 73-8787 or 888-2833757, t can conflina coverage,or ask to • Does the colaxact see a copy ora"proof ofinsw anc&'docunuml. • i(nowyour rights and responsibilities. Read the important Informal ton on the ievei so side of this form and get a copy ofthe Consumer Guidoto tile You may cancel this agreement Wit has been signed at a place other than the contractor's normal place ofliusiriess,provided you notify Can contractor ill writing AthlAer main Office Or branch office by ordinary mail posted,by lolegarn seat or by delivery,not later than ruidulght oftho third business day follawln tla signing afilds agreement. See the attached notice ofcancellodon form for an explanation ofthis right. DO T4T SIGN THIS CONTRACT IF THERE A-RE ANY BLANK SP.ACES1 1! copy rlx,aId b4lcpt by e.10 c=tVV".!0r, I fonleowner'l signature The Commonwealth of Massach usetts Department of ndustrial A cciden is I Congress Street, Suite 100 Boston,MA 02114-2017 www.massgov1dia Alorkers' compensation insurance Affidavit:-Builders/Contractors/Electricians/Plumbers. To BE MED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrgarLi2stionftdiv7idual): crf (A)r t,Q \J Address: 3,5-0 A QIr r 11- City/State/Zip._ALPhone -I '"PWYV0 04K" k rl (le %st you an employer?Check the appropriate box' Type of project(required): , am a employer with d/or part-time),* 7. El New construction I am a sole proprietor or partnership and have no employees working for mcin 8. E]Remodeling any capacity.[No workers'comp.insuranoc required.) 9. El Demolition 1 am a homeowner doing all work myself.[No workers'comp.insurance required.)t 10E]Building addition I am a homeowner and will be biting contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11-[]Electrical repairs or additions proprietors with no employees. 12.[:]Plumbing repairs or additions 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Rpof - sub-contractors have employees and have workers'comp.insurances airs OthS�rd V-e- ir,010-� EJWe we a corporation and its officers have exercised their right of exemption per MGL c. 14.ffer 152,§1(4),and we have no employees.[No workers'comp.ittawancercquircd.] iy applicant that;becks box"91 must also Sit out the scctionbelow sbowingtheirworkcrs'compensation policy information. nuarowners who submit this affidavit indicating they are doing all work and then biro outside contractors must submit a new affidavit iodicatingsucb, ntractors that check this box must attached an additional sbcct showing the name of thcsub-contractors.and mtewbctbcr or not thosccatitics have floycas. If the sub-contractors have employees,they must provide their workers'comp.policy number. rn an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site i rtnadon. amnce Company Name:' — icy#or Self-ins.Lic.M 3JS -3 8'718'?-, 01(-, Expiration Date: 9'130 f Z2,01 .Site Address: City/Statc/Zip: &IJO ve,� /yf/1, 0 tj ach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 /or-one-year imprisonment,as well is civil penalties in the form of a STOP WORKORDER and a fine of up to$250.00 a against the violator-A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance MgC verification. hereby certify der udie7painsand pe talties of per" the information provided above is true and correct. Date: ne#: f6 87- d a-'V 7 Wicial use only. Do not write in this area,to be completed by city or town official, :ity or Town: Permit/License fi ;suing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector Other ontact Person: Phone th DATE(MMIDDIYYYY) Aco CERTIFICATE OF LIABILITY INSURANCE 11/28/2(16 THIS ERT"' IS ISSUED AS A MATTER OROF NEGATRVELY AMENDMATION , EXTEND OR ALTER AND CONFERS NO TlHETCOVERAGE AFFORDED S UPON THE AI3Y THE POLICIETE HOLDER. S CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE OF INSURANCE CERTIFICATE NOT HOLDER.UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORISED REPRESENTATIVE OR PRODUCER,AN provisions or be endor ilk IMPORTANT: If the certificate holder is an ADDIIIO'111,oSdURpDr ns of the le!icy, certain iry(les)must hpolic al o sDmapNeq ire5an endorsement A statement n If SUBROGATION IS WAIVED,subject to the this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). i ONTACT w PRODUCER T A SULLIVAN INSURANCE AGENCY INC PHONE FAX No: ?. 135 MERRIMACK ST E nnalL0 Exf• i METHUEN, MA 01844 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Comoration 33600 INSURER H: INSURED SCOTT WRIGHT INSURERC; DBA WRIGHT GUTTERS INSURERD; 350 BERRY ST INsuRER E NORTH ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 32972503 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE TERM OR COND1ED TlONVOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOBEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE LWHICHICY THIS kNDICATED. NOTWITHSTANDING AN BY THE CERTIFICATE MAY BE ISSUED OOR MAY F SUCH POLICI S.L1MIT5 SHOWN MAY HAVE BDEEN RI DUCODIBY PAIjD CLAIMS HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION ADDL SUER POLICY EFF POLICY EXP LIMITS INSR POLICY NUMB TYPE OF INSURANCE ER MMIDDIYYYY M€JIfDblYYYY LTR EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AM GE O REN ED _ PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ PRO-P ❑ ❑LOC $ POLICY RO- OTWER: COMBINED SINGLE LIMIT $ Ea accident AUTOMOBILE LIABILITY BODILY INJURY(Par person) $ ANY AUTO BODILY INJURY(Per accident) $ OWNED SCHEDULED UTOS ONLY AUTOS PROPERTYDAMAGE $ AT'E& NON-OWNED Per accident AUTOS ONLY AUTOS ONLY $ EACH OCCURRENCE $ UMBRELLAL€AB OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ DED RETENTION$ 9/30/2016 9/30/2017 PER OTH- A WORKERS COMPENSATION C5_ 9/30/2016 ✓ STATUTE ER 100000 AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANYPROPRIETORIPARTNERIEXECUTIVE YIN NIA E.L.DISEASE-EA EMPLOYEE $ 100000 OFF-- ... EMBEREXCLUDED9 0 500000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ If yes,desTION criha under DESCOF OPER0.TION5 below RIP DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,AddHlonal Remarks Schedule,may be attached if more space Is required) WORKERS COMPENSATION TION INSURANCE OL POLICY DOES NOT PROVIDEPPLIES�OVERAGE FOR SCOTNLY To THE RT WRIGHT. COMPENSATION LAWS OF THE STATE OF NIA. THE WORKERS'COMPENSA This certificate cancels and supersedes all previously issued cestifiicates,only as they relate to workers compensation coverage. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PAUL HUTCHINS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING INSPECTOR ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER �1 120 NORTH /tIANDOVER MA 01845 AUTHORIZED REPRESENTATIVE 0 (�v� rf ! L tI Fk1,- LM insurance Corporation ©1988-2D15 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 32972503 11-307187 1 16-17 VIC I ,021025f, 111/26/2016 8:05:27 AlA SpnTl I Page 1 0£ i Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain License or registration valid for individul use only less than 38,000 cubic feet(091 cubic meters)of enclosed before the expiration date. If found return to: space. Office of Consumer Affairs and Business Regulation 10 Part(Plaza-Suite 5110 Boston,MA 02116 Failure to possess a current edition of the Massachusetts _._ µ State Building Code Is cause for revocation of this license. Not valid without signature DPS L Icensing information visit: WIN MASS.GOVIDPS ., rC in ti/90�.. JOUOM 4Matho") Cars,ar�aea�pujt Sb910bW'H3A0C3N`d'0N 'IS AHM313 09C 1H01HM 11005 t�l W UgAOONV NIHON 1s AuH38 09£ Si�311f101MIJi71M � 11-10Ik1M M 11033 V80 GIOZ/KAP :uollealdx3 y�,:adA 1 5958E;L awllejlsl6o Q �' �� %/%� � 1 013b11NO3LN3W3/0 cW13W0 . : .H � d£ 9p uulteina ssani��rit ap satyr �atuunao a ase�� lr � puks. pirog i 2WPoa °a4 a tl�r.tl `:ag, .�nls U tl: I��IY V S '83:9S1'V � i,. i �; �"ro M.m,