The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 12/8/2016 (2) µORT}. BUILDING PERMIT Q` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINA�ONu, 1 4 Permit NO, $p l Date Received a 1 }� �w�..a,,.,:•c 1 RSSACHu`-'F� Date Issued: IlVIPORTANT:A licant must com Tete all Mems on this a e / f . . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family LiAddition LlTwo or more family Li Industrial ❑Alteration No. of units: ❑ Commercial 4Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other e Weld EII�tYa n, t Identification Please Type or Print Clearly) t -771 OWNER: Name: An M Phone: q71 - Address 3-71 1 �-W- A�dr�ss I HII Ir�iltl�� up ARCH ITECTIENGINEER 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. $ S0 FEE: $_ Check Na.: 9 Receipt No.: i :3 i _ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund er7O /C1eCt . lgr OAA . Stgat [t a corrkraota ,AOR H own o ndover �. ..,� V, No. _ 2b(7 4 ver, Mass, / COCMIC FiL WICK RA TE o U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT ...... A WIE. BUILDING INSPECTOR has permission to erect ............... ...... buildings on ... 3 .9.4.1ru, . ... .. �I + .. Foundation Rough to be occupied as . .. .... !.f............ .. .. ... ..... ........... ..................... .............. Chimney provided that the person accepting permit shall in every respect conform to the terms of theapplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough Service ......} .. BUILDING INSPECTOR INSPECTOR' Final GAS INSPECTOR Occupancy Permit Required to ®ccum Buildinz Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Miall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. BLA6 HLIN1957@GM,IAL COM—, MASS REG. # "iii , LAUGHLIN HOMES INC. MEMBER BETTER BUSINESS BUREAU �j FED ID # 41-2054365 MEMBER BEVERLY CHAMBER OF COMMERCE Charles Street/P.O. FiOX 252 MEMBER BEVERLY KIWANIS Beverly Massachusetts 019155 WARREN PEARSON CSL. # cs40996 SINCE 1978 �; ';. �°' (978) 922-5579 ( 78) 828-3979 Hlc Lfc. # 107999 d SPECIFICATIONS SUBMITTED TO: t, PHONE: STREET l a t1O,,B NAME:,... r � pi CITY STATE ZIP: JOB LOCATION: rr° p t * ,'0 . : ', _ .__.................... JOB PHONE: ARCHITECT:_......... ,�� ,. DATE OF PLA S, Color: 1 Shingle roof to the entire house. ,.. ,� � ''�.� / � ...,�ifi Colollatan of a complete Certainteed I. Incli ne 's 1 11"61 gles, we haul all debris, clean lobsite thoroughly and pay all dump fees.. ; a° Includes Install: e and - ice water membrane to main house eaves, .around chimney and in valleys pap g bash and flanges to stacks tarpaper er n um dripedge to all edges Color: r„� " ," 8 aluminum � �� "� �� - starter shingles to all rakes and fascias - cobra ridge vent to all heated ridge areas 0.. e u,11" / - repair, reinforce as necessary and neatly seal chimney flashings, any step and apron flashings. a procure permit,we p customer eI reimburses Dost. ps ^� r d� Option IIry Reos (no me s eolficaticns as abCve but we,,wlll o over st"rip"pings)M thew xlsting roof and-exclu,des.ice and,,water Ile r embrahe, and tarpaper�base: u Colilr: � Ait ,Customer responsible to cover/tarp attic items and clean any resulting debris in,attic. Ten Year workmanship guarantee .tt We Propose hereby to furnish material and labor-complete in ac ordance with above specifications for the Sum of: dollars( +_._ _ _................................____ ) Payment to be made as follows: 1/3 start, 1/3.,atmbalf�, emplat and balance upon completion. Thank you. ;recording rdi rgjtorstandardntecd to practices.Anyspecified. alterationo ll dev deviation frontork to be pleted abovenspciheations involving.......__.____. Authorized. extra costs will be execaued only upon written orders and will become an extra charge over o gym" r Y� and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our Slgnatur6, " w"" control.Owner to carry fire,Oonnado and o,her ncessary insurance.Our workers are covered by workers compensation insurance. - 1`dpte:'Chis proposal may be Owner agrees Shat i demand lwcut it n rho ovent oil his brrauln unties contract borose work Is starred,Ocrntrac[or may withdrawn by is if not accepted within days, y percent(25%)or the con line bprice as its slip ulared damages far the breach. - - ---- i Acceptance of Contract and arepherebycu pied.You arcarrlconditions are satisfactory _� - Slttlf,-' ✓t. , - , d tri^'do the work Sign ° __._as specified.Payment will be made as outlip d above. Date ofAcoeptatrce„ � � "a ' Signature You may cancel this Agreement cif it has not been consummated by a party thereto at a,place other than an address of the Seller,which may be his main office or a branch thereof,provider']you notify Seller in writing at his main office or branch by ordinary mail pasted,by telegram sent,or-by delivery,not later than midnight of the third business day following the signing of this agreement. The Conintonivealth of Massachusetts £ Department of Inehistrial Accidetrts a 1 Congress Street,Srrite 100 Boston,MA 02114-20.17 tvww. nassgovIdia Workers'Compensation Insurance Affidavit:Guilders/Contractors/lllectricians/Plumbers, TO BE FILET)WITH THE PERMITTING AUTHORITY. Appilicant Information Please Print Legib Name (Business/Organizationllndividual); o Address. (ISO _�i Nml+�t ��'• City/State/Zip: ~f'v+ ,tJ`" Phone#: �e' `"Zq '� Are you nn employer?Check the appropriate box: Type of project(required): I. t ran a employer with 7.(811i and/or part-€une) 7. ❑New construction 2QI ata a sole proprietor or partnership and have no employees working for Inc hi 8. ❑Remodeling any capacity.(No workers'comp.insurance required-] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'romp.insurance required]t 10❑Building addition 4.❑1 ama hotneownerand will be hiring contractors to conduct all workon my properly. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.[J Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.g]1t00f repairs These sub-contractors have employees and have workers'comp.insurance-4 6.❑We are a corporation and its officers have exercised(heir right of excrnption per 1VICL c. 14.❑Other o 152,§1(4),and we have no employees.[No workers'camp.insurance required] 'Any applicant that checks box fit must also fill out the section below showing their workers'compcnsution policy infnnnatinn. +I lonicowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such, tContractors that cheek this box must attached an additional shLet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, lain air eutployer that ispr•ovidiag workers'coittperrsatiort iiisurarrcefor my employees Below is the policy aedjob site inforinrttima. �A Insurance Company Name: vl T' ttl' � — Policy B or Self-ins.Lic.#: S(347 Zd<6 b Expiration Date: �l Job Site Address: 7 P_ , City/State/Zip: Vel Attach a copy of the workers'compen tion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains aur]penalties of perjury that the informationprovided above istrueand correct. signal re: Date: &116.,Y,6 _ _– Phone _3 Official rise only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cite/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: u 6-12-08 13:59 EZOLOTAS 9787741318 >> P 1/1 1 GA DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 12/013/2016 9HIS17CFR�71FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or 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 lieu of such endorsement(s). PRODUCER CONTACT Elaine Zolotas Phil Richard Insurance, Inc. NAME' 27 Garden Street PJCN[E Ext: 978-774-4338 � No:(978)774-1318 Unit 1B E-MAILS$, elaine@philrichardinsurance.corn Danvers, MA 01923 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Utica First Insurance Company 15326 INSURED Pearson Builders, Inc. wsURERB: Arbella Protection Insurance Co 41360 150R Winona Street INSURERC: TRAVELERS AIR TRC Peabody, MA 01960 INSURER D: INSURER E: INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN$ L S BR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYW MMIDDIYYYY A COMMERCIAL GENERAL LIABILITY ART5047208 11/28/2415 1/28/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE IV OCCUR DAMiO ED PREMISES Ea occurrence $ 54.000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,444,044 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PDQ LOG PROpUCTS-COMPlOPAGG $ 2,000,400 OTHER: $ B AUTOMOBILE LIABILITY 1020004331 07/18/2016 07/18/2017 cOMBINEDSINGLELIM $ Ea accident ANY AUTO BODILY INJURY(Per person) $ 250,000 OWNED SCHEDULED BODILY INJURY(Per accident) $ 500,040 AU TOS ONLY AUTOS HfRED NON-OWNED PROPERTY dentDAMAGE $ 100,000 AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION 7PJUB-2E10143-5-16 03/26/2016 43!2612017 STATUTE °RH- AND EMPLOYERS'LIABILFEY ANY PROPRIETORIPARTNERIEXECUTIVE Y� NIA E L.EACH ACCIDENT $ 140,004 OLFICERIMF-ME3ER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 wys, L_ describe under E [DISEASE-POLICY OMIT $ 500,000 DE5CRfPTION OF OPERATIONS below s DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Re: 373 Raleigh Tavern Road 1 V I 0 p9 N dq1 l u CERTIFICATE HOLDER CANCELLATION ') SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE t �+ O 1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD t i I PEARSON BUILDERS Vlawen.- �Cv�ractar _ _• A.Peaman : . waxrenpe3�so�ex 9501}.WWOM St Mom WS-751iwM swbo&A MAMS?60 FM Massachusetts -Departinent of Public;Safety Board of Build-Ing Regulations and Standards Cen+truction'oer-Osos - License: CS-040996 _ W �7 �]'q� p� .- A31RE L'L PEARWN-,..ry— -•ter 1508 WINONA.S � PEABODY Mk 11146WT,,N- 3 Expiration Commissioner 0$112f2017 Office of Consumer Affairs&Business Remliation License or registration valid for individual use only NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 107899 Type; Office of Consumer Affairs and Business Regulation � 10 Park Plaza-Suite 5170 Expiration: 8/1 1/20'18 Individual Boston,NIA.02116 WARREN A.PEARSON Warren Pearson 950R Winona St. Peabody,MA 09960 Undersecretary Not valid without signature Pf