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Home My WebLink AboutBuilding Permit # 11/22/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER o= APPLICATION FOR PLAN EXAMINATION permit No#: Ta �� Date Received . C HUS��C Date Issued: I t a EWPORTANT:Applicant must complete all items on this page Pant PRDPEf= RTY WNER-_ r ` � a , _.... ..._ . ... . . Pnnf 10�Year Structure yes no MAP PARCEL. ZONING DISTRICT Histanc Distract yes no Yes Machine Shop Village ; no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic IT] Well ❑ Floodplain 11 Wetlands ❑ Watershed Distriat FI Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED; Tdentitictc—scndi's ion.- Please Type or Print Clearly OWNER: Name: ` 7 (e Phone - '9V 1, G Address:Yy ltrs�� Contractor Name.. 4' ' .. Rhone J Address: Supervisor's Construc#ion License ` Exp. Data: . J_ Home Irn rovemen# License P Exp. ARCHITECT/ENGINEER Phone- Address: Reg. No. FEE SCHEDULE.BULDINC�PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ' Total Project Cost: $ i FEE: $ Check No.: �j � - _Receipt No.. _ 1 NOTE: Persons contracting with unregistered contractors do not have.access to the g ty and Stgriature of.Agentl0wnr Signature of contrac#ar ...................................... °RT Town ® Andover : : T a ver, Mass 5615 ,o,c16'7 VLV� - h � O t.AKa coc"I "I-Jew R' S U BOARD OF HEALTH Food/Kitchen P E R441 D Septic System �I BUILDING INSPECTOR THIS CERTIFIES THAT ...... .. ,....... ..... .. .` . ,,, 1,. Foundation has permission to erect........ ............. buildings on . ........ .. ......._. Rough to be occupied as ................................. chimney $A provided that the person accepting th 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Fina) PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC STARI74f, Rough Service ..... L., Final BILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to QccupE Ruildin 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. Massachusetts Home Improvement Sample Contract 'this form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. 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 she 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 Name Compan nine litStreet Address(do not use a Post Office Box address) Contra r!Sal pars n!Owner Neme a �© d ea Ci ,fawn S State Zip Code Business Address(must include a street address) = Dtime Plrone Evening Phone Ci fCawn state Zip Coda aN-eegnl61-_ter Mailing Address(it different from above) Business Phone ederal Employer TD or S.S.Number Homelmpmveinrat Cantrsctorneg.NamUer Expimiiandate Improvementilll hove X .va116 regtslratEon lumber !l The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to complW�g ng the type,brand,and grade of materials to be used,use dditi nal s eets if necessa .) l let Required Permits-The following building permits are required Proposed Start and Completion Schedule-Tic following schedule will and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond die contractors control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of when contractor will begin contracted work. MGL chapter 142A.) pate when contracted work will he substantially completed. Total Contract Price and Payment Schedule ] (•) The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: Payments will be made according to the following schedule: $ upon signing contract(not to exceed 113 of the total contract price or the cost of special order items,whichever is greater) $ by 1-1 or upon completion of S by _l1� or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special Sy to be.paid for ordered before the contracted work begins in order $ (f' lobe paid for to meet the completion schedule.(') NOTES:(')Including all finance charges(ti)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third all total conlsacl price or(b)the actual col of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Ex ress warren -Is art n ex rens nan bin rovid d b can the tractor? ry Q N t�I Yes all terms or The warrant must be att ched to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the 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 I contract under law. Unless otherwise noted within this document,the Contract Acceptance-Upon signing,this document becomes a bindi contract shall not imply that any lien or other security interest has been placed on the residence, Review 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 th contractor has a valid Ham [inrovement Con ac or Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • 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 of insurance"document. e Important Information on the reverse side of this form and get a copy of the Consumer • Know your rights and responsibilities. Read th Guide to the Home Improvement Contractor Law. r ay cancel this agreement if it has been signed at a place other than the contractors normal place ofbusiness,provided yoLnolify he tor in writing at hislher main ofce or branch office by ordinary mail pasted,by telegram sent or by delivery,not later t11ght oftheusiness day railowing the signing afthis agreement. See the attached notice of cancellation form for anexplanation of th DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract Plus,be completed and signed, one copy should go to the homeowner.'10 al shoo a ep c con aoclor. Co tar's Signature Homeowner s Signature �� Date Hare oe Commonwealth of Hassac1111setls Department of industrialAceldents et I Conga'es�,S`tre , Ste Y00 2017 -may' 4 II'IY r✓wmIdss.gO v1d1,a r ' elasation)insurance�day.�t:Bu�dex�/Can�acfoxsf��ectricXa�asC�'ltr�.�axs. takers' Cozxrp TO73� ILEllWJ' ['1 P�.l�lldTTT�GAU�Od21fiS measa Print Le A licantaxla11on- Name(Business/OgaazalaanlCndi�idual): Jai Address: ,? city/statefzip: � Type,n�project(Yegdxed); Are You anernpkoyer?C7?e*tliea propraatel�ox: 7 Neercor�striiation employees(i'iali andlor pat-time)." 1 aemployerwithzn 8. 0 Remodeling 2.E]X am a sola propzietor or paztnership andhave no employees-Working porma oworkers'camp.insurance zequired_l 9, ❑De�olit1011 any capacity_jN addition r 0❑Building 3,pT amahov3.eawnes d"oingallworkmysel��Toworkers'comp.insurancaxecluued.]i 4.EXaroahomeownerand'WWbehuzngcontractorstoconductallworkonmyproperty_ Swril Electrical epaixsox additions ensure that all contcacfiors either have workers'anmpensation insurance or are sola l2 W—plTMb5ug]repairs off'additions pzopzietozswithmo employees., oafxea%rs 5.❑x am a general contractor and xhaYabiredthe sub-con#ractnrs listed on the at€ached sheet. Other These sub_contractors have eruPloyees andhavewarkers'cnrorp.insurance# ❑we are a Corporatiotj and its,oft!r Srs have exercisedtheir right of bXemP�on der MGL a. 152,§1(�€),and yve haY�no employees.�7o v7orkers'comp.insuxance required] the are doing all work andthenh-ka outside contractors must submit anew affidavit such -- ----- ntthatcheokshb #1 rust alsotillouttheseotionbelowshowingtheirwoskers'compensaflonpolicyin.formation'.' i�Tomeowuers vrho submtbthis afahavit indicating Y tCantracfiors that checktlus liax roust attachod'an add taond Pr vihde thein he"Me aomp policy number.�d state whether or natfhose,entities have employees. Tithe sub aoniractorshavo canPloye ern to ees. Below is triepo�icy andf'ob site X am art emplayer�tlaatisprovidirtgworkeP8'compensation insurancefor ny p Y information. Insurance Compapy Nance: Expiration Date. . 1 Policy#or Self-ins.LIC'.#:. J , 1 City/State/Zip: V lob Site Address: WHO tel. a e shavvmgt7aepolicyuumber and expirati a�.date). Attaclx a copy ofthewo;rkexs' compepsatmnpolicy deelaxatiou.p ( to 500.00 the forth of a STOP W ORK ORDER.and a fMo of uli to $25a0,0c0 a p a taclLluTo a secure coverage as xequixed under MOL o.152,§25A is a cxinainal violation.punishable,by a ode up , and/or one-year hnPrisonmeut,as^mall as civ]l penalties rn dayagainst tlse violator.A copy Ofthis statement map be forwarded to the OfYica o�'Sravest[gation:s of the DIA fox �isux coverage verifcation. that the information p ovidecl al ove s ague at?d cv)',r Vt under•the as s penalties ofperjury I do 71 ereby c Date: Si atiu'e: Phane#: in this avec,to be corrtpleted by city or toxvrz official Official rise Drily. Do notwrzte 1'erxnit/Lxcense# City or Town: issuingA.uthority(circle one): � o Clerk 4.FlectricalSnspeetor 5.1'lumb'ngInspector 1.)Board of Real& 7,-Building DePay"nent 3.Cftyi ven 6.other Phoxte#: Contact l?e-son: =DATE(MM/DDNY' ) ACC:ori CERTIFICATE OF LIABILITY INSURANCE E CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO XTEND OR ALTER THE COVERAGE AFFORDEDGHTS UPON THE ATE BY THEDPOLIGEIS DOES NOT AFFIRMATIVELY OR NEGATIVI=LY AMEND,IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURt R(S}, AUTHORIZED ATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. tthis ecDs IMPORTANT: If the certificate olderIan ADDITIONAL IURE©,the atment on ertifiate dos not onferrightto the the terms and conditions the certain l endorsement. A s certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME; Elizabeth Chavez PHONE 978 688-4474 ac No: DEGNAN INSURANCE AGENCY, INC. IVQ_K ADDRESS: echaVOZ@degnaninsurance.com INSURER 5 AFFOROWGCOVERAGE NAIC# 85 SALEM ST. 33758 LAWRENCE MA 01843 INSURER A;_AIM INS CO INSURED INSURER B JAMES DEBRECINI INSURERC: FAMILY ROOFING & FAINTING INSURERD: 2 TANAGER WAY INSURER E LONDONDERRYNH 03053 INsuRERF: T_ ---�-REVISION NUMBER: --- COVERAGES CERTIFICATE NUMBER: 105376 N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED sF PAID CLAIMS. ADDL SUER LIMITS 7"I'TSR TYPE OF INSURANCE POLICY NUMBER MMfDDNY'YY MM)DDlYYYY EACH OCCURRENCE $ RCIAL GENERAL LIABILITY DAMAGE TO RENTED AIMS•MADE OCCUR PREMISES l a occurrence NIA PERSONAL&ADV INJURY $ GENERALAGGREGATEEGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY❑ ECT LDC $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED NIA AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLALIAa OCCUR EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DEO RETENTIDN$ OTH• WORKERS COMPENSATIOM X STATUTE ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 100,000 ANYPROPRIETORlPARTNERIEXECUTIVE NIA NIA NIA AWC40070259002016A 05/11/2016 05!11!2017 A OFFICER/MEMBEREXCLUDEO7 E L,DISEASE-EA EMPLOYEE $ 100,000 (Mandatory in NH) �QQ,000 If yos,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below NIA DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (ACORD 161,Additional Remarks Schedule,may 6e attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in stales other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This Certif€cate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance), The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gGv/iwd/workers-compensation/investigationsi. Sale proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. t TOWN OF NORTH ANDOVER 1600 OSGOOD STREET BUILDING 20 SUITE 2035 AUTHORIZED REPRESENTATIVE y,CPCU,Vice President— Market—WCRIBMA NORTH ANDOVER MA 01845 Daniel M.Crn� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099685 Construction Supervisor Specialty kg - JAMES J DEBRECENI 2 TANAGER WAY LONDONDERRY NH 03053 n r"-jL' LA—�— Expiration: Commissioner 1210612017 /�; ! a rr.rrnrrn,eo/lir a Glru trc�u eta License or registration valid for individual use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: lA-:r.?HOME IMPROVEMENT CONTRACTOROffice of Consumer Affairs and Business Reaulation Registration: 122385 TYKE= g 10 Park Plaza-Suite 5170 I! r. Expiration: 812fi12018 DBA „ Boston,MA 02116 FAMILY ROOFING&.PAINTING !' .TAMES DEBRECENI 30 RIVER ST. METHUEN,MA 01844 Undersecretary Not valid without signature