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HomeMy WebLinkAboutBuilding Permit # 12/19/2016 04 N,oT b�b4 BUILDING PERMIT ,6 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: s' Date Received SS ACHUS Date Issued: IMPORTANT: Applicant must complete all zterns on this page 777 77 LOCATIQN F Pant 'PROPERTY 4 n I OO Year Structur Y MAP � � �` PARCEL ZON[NG DISTRICT Historic Drs�r�ct �: yes nQ Mac1?ine Shop Vii]age ..`yeS , . pa :' TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Resid ' 1 ❑ New Building One family Li Addition O Two or more family L] Industrial El Alteration No. of units: Ll Commercial ❑ Repair, replacement ElAssessory Bldg [I Others', ❑ Demolition ❑ Other ❑k Septic ❑Wel1 ❑ Floodplain D Wetlands ❑ Watershed District DESCRIPTION OF WORK TO � PERF. RME Identification Ple e Type or Print Clearly � OWNER: Name- Address: 0dbtracor Name Ernatl Address` ,. .. e Supenelsors or3str�actIQ Lrcense �� Exp Date 40 Cr Horne"lm rouement License, .:: ,;�����. Exp " Date �_ �. .. �' ... : . ..., ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:SULDING PI11T:$12.00 PER.$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� FEE: $ Receipt No.: Check No.: NOTE: Persons contracting with unregistered contractors do not have access he gua •anty fund Signature of AgentlOwner Si nature of contract Ft%O R TH own of ) T ndover . . O - _ M No. — -�+�Ah ver, Mass,LAKE h► �..��� COC-0c"[W1CN 41. U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......:D1*V..lop......... 0.A.000*................................................ BUItDING INSPECTOR has permission to erect ... b ild,ings on4WFoundation Rough to be 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST . N Rough Service . .. . .. .. ..... . Final gBU&ILDINGINJOrCT GAS INSPECTOR OccupancyPermit Required 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. I i i Wage# of pages i CS # 022680 978-688-6737 HIC# 103858 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 i Proposal Submitted To: Job Name a Job# i Address �, Job t_ocatlon76 f Crate ✓ � Date of Plans Ph e# l a' ✓ Via# r �,,,, d,� Architect thereby �� � r " � ' �submit specffloations and estimates for: ad✓ ��nr"� a rf�/✓��' � ��`.,,^��/ ^ i!/9"A`,.R�,�`� „�p�°:�„mr�" rid',d'� �Nr�, f a„" '. �,�/,,�.f,,�Bf,,, �F� ..e ,.��,�., i°„,+�"��;�,�s °d�, N„Rf, d; „�w,d ��V � Y��,„� � ��rr.o!.Y,"„r�k",.,Mr N°�',✓�„����`�� ���„°�,,�Wr</�,�°""�,r��,�a ^y� N� y ��✓i n, rc d'',.�",,�; , ( it �"� �' �«� ,0/'`i _,;, p �,�� r krH✓t�' f ! rrrd, €',.y P J,ue.<,��„!� , o r sir, s r qq f r;;.ry d�'.,,�� ✓rl ti � t r ✓ f�r ,I illi,, d wl�, �”,, l 6� i” d°.'m'✓ /f`°`rl'' ^''a!„�„ >G pry a„��d`u,,.✓„�� 'a'�fir! ��a, �N, r i!,},✓✓'� }} �r4/il �„.J�fs�'l ,i� ,Gid __. ✓ ✓'�,".,^1, r,'�r 'r,, ✓'''�, '� ' o� A ✓ l'�A i",J, /v"n� `d�,� u,,,,n, i,,,, l�� ;/”,✓r ' t �� Ac"�o '"rP ... >",.✓1�,, .,o«�rarr?„�; a���Fr,`P. "� d �,,!%",rte^',� l";,r?�'�,„� r add yp �i q � �x ,rb ,a,t ° � „�lj�� ° P,0b"°�r n ,,p.:,^r a�4 r ✓^ ��%'` P '�,,,`� d,��"`'�'' �'w'�"j°' 4/04 77-777— We ro ose hereby to fumish material and labor—(,,complete in arrardance with the above spec[flcatior s for the surri of: propose a �Y'� �� Dollars with payments to be made as follows: �� ��'✓��' °� °� �� � � Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our cdhtrol. Note---this proposal may be withdrawn by us if not accepted within days^ acceptance of jkappol . j The above prices,specifications and conditions are satisfactory and are �� Signature hereby accepted.You are authorized to do the work as specified. 14/11111 p Payments will be made as outlined above. Date of Acceptance � 1 ���"��� Signature � '��F,,,�a� r ud � Z��� Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements ofthe 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 the office of Consumer Affairs and Business Regulation's Consumer Information liodine at 617-973-8787 or 1-888-20-3757 or on our website. Homeowner Information Contractor Information — Name —————— Company Name ev Sir t Adds 'do�_�no,?Xe, dr Post Office,Box addr a Contractor/ les Owner Name 71 - Z Z street dress) Ci Cfo st ',Code Business Address(must include a in Dayt' P one Eveningl'bone City/Tom Zi ode rsl Kiailinix Address(It different from above) Bu f..4o Federal Employer ID or S.S, umber H.-Imos—stc., Epinstiondt. Law raquirw lfist mart Is— The Contractor agrees to do the following work for the Homeowner: (Describe in detail the Work to completed,specifying tile type,brand,and grade of mi�l rials lobo ua�d add'd gs I�ae aa_ZirAAme if race a D 40 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as ate homeownees agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Mate when contractor will begin contracted work. MGL chapter 142A.) _(Vate 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: I Payments will be made according to the following schedule: upon signing contract(not to exceed 1/3 of the total contract price Ar the cost ofspecial order items,whichever is greater) by or upon completion of by or upon completion of payment until contract is completed to both party's satisfaction) V/ $ upon completion ofthe contract. (Law forbids demanding full in The following material/equipment must be special 44" id far ordered before flus contracted work begins in order to meet the completion schedule.(") 0a b paid for NOTES:(*)Including all finance charges(**)Law requires that any depositor down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual.cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express warranty-is an express warranty being.provided by the contractor? El No El Yes(all terms o[the warranty lunst be attached to the contract) Subcontractors-11te 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 forther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this a ee cot otherwise noted within this docunidndi die Contract Acceptance-Upon signing,this document becomes a binding contract under law, Unless 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. ako sura the contractor has?valid ilonte hnitMye�jjt(,Ontr4i;L requires most home improvement contractors and qL&e* The e law requ 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 ofa,,proofe,finsurance"document. Know your tights and responsibilities. Read the Important Infortnation on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law, You may—aycencel this agreementI ifithasbeen signed at a place other than the contractor's normal place ofbusiness,provided you notify the 'ti. t contractor ?ffic., actor _r signing rig fj on ay c� bi� th in writing athiAermain officeorbranch offirebyordinary mail posted,by telegram sent or by delivery,not later thatimidnight of the act-r for an explanation ofthis right. co iti� third business day following signing ofthis,agreement. See the attached notice ofeancellaflon form DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESU! Two Identical copies of die contract must be completed sad signed.One copy should go to the'owem Tho/other copy sh uldbe kept bythe contract Homeowner's Signature Con or a Signature Da_teDate ­ The CO min onit'ettlilt of';1"lassachtrsetts Department of Inflttstrl(tiflevitlettts Office Of Invwsftyafiotls 600 fflushinlqfon Street Boston, ;1111 02111 x i tvlvit).rrttiss.got-/rlitt Workers, CompellsRlttQ11 Insurance .Affidavit: 13tiilclers/Co;:ttt-actot•s/Electt-ici;ltls/Pitttnbers A > licant Information Please Print Le(gibly Name [dttsi�les�Otganiz��tian`Indiridtiill?: � � CttylStatel7ip: ��"� �� Phone 41: Are you an employer? Check the ppropriate box: Type ta('project (required): 4- ❑ 1 hilt a general contrndor and I l. I am a employer�ritl} 6. ❑ \ew co!asn'uction employees (full and/or part-ti113e). have hired the 4€li]-contractors I Remodeling 2.❑ E am a sole proprictor or partner- listed on tilt altacl�ed sheet. 7. ❑ Ship and have no employees [hese sub contrEtetors have S, ❑ Demolition working ill any capacity. employees and have �vcxl:ef s' g 1m•n9. ❑ Building itiot} [No workerscomp. insurance comp. il3surance." 5. ❑ We are a corporation and its IO.❑ Electrical repairs or additions reguil•ed-] ;.❑ 1 am a homeowner cloin4r all writ officers have exercised their I I.❑ Plumbin��repairs or additions mvsclf. (10 workers' comp. li«lttate�elnption per\rtGl.. 1� ool'rely airs insurance required.] ' e. 152- ti I('I): and we have no employees. [\o workers' 13.0 Other_ comp, lla5li3'aI1CC t'egllfl'ed.j --U\ attplicam thm checks box =1 11111;1 also fill out the ;CCliml belo++ sho.vitle 111eir++i+skess-cominensulom poltev illrmllwiioll, I IPtiiell+suers+cho sttbntit this arfidaril imeliultiita Ihev are doing atf+wl k and IheIl hire oulside Cominclors 11111st sulxllit a ilea altldarit indicalina strep. Cnnlractur itmi dieck This Nix ntnsl;tilttched all additional sheet sitlw i1w.the Ilanle M[Ile sutl-camn;liaots 1111d dale+rllclher or mol Ihnsc eirlilics have etnplo}yes. 11'111e sull•colmactors 1111%e cntplo}'ees.llwy must provide(heir +sur ets comp.Itoiic) number. I ant art enrplc�rer that is providing workers' compensation iusararree/i l rt I emplt?rocs. Beloit,is the poficl andjob site fornratiorr. / lnSllrance Company Name: T -- �a�_ IAK� ,. Policy Y- or Self ills. Lic. �l%._�Y��l --- -- ExpirationDate: /A/ �` iob Site Address: / � ,Attach €1 copy of the workers' compensation pollc).declaration page(showing till' policy lumber and expiration (late). Failure to sect.tre cllmrau,e as regilired under Section 25A oF.MGL c. 152 call lead to the imposition of Criminal penalties of a line up to S1.500.00 and/or one-year imprisonment. as well as civil penE€lties in the tot"nt of a STOP WORK ORDER and a fine of uta to 5250.0() a clavi against the violmor. Be advised that a coliN of'this statement may be forwarded to the OMice of Invesli-aiions orthe DIA I'm instn"ance coven 111 �eriEicalion. 1 do herebr eer•trf�ider thepains anelpencrllies of perjmy drat the itrfar•rnation provided above is true and correct, - Date: Official rrse oit11', Oo not ivrite in this area, to be completed hi, cit/'or tosser official. City or Town: _-- Pvrr€lit/L ice Ilse 9 Issuing Authorily (circle one); ! 1. Board of llcillth 2. Building Deparintcut 3, Cih"ffoain Clerk 4. Electrical Inspector Plumbing Inspector (r. Other C ontacI Person: 1'llonc AJWALSH-01 JONE L — DATE(117/ 0`16 I L CERTIFICATE LIABILITY INSURANCE 11IIr1za16 1 THIS• CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS BELTWCATHIS CERTIFICATE O AFFIRMATIVELY INSURANCESURANCOE DOES NOTY AMEND, EXTEND CO ST TUTEACONTRACT BETWEEN THE ISSUINGAFFORDEDVERAGE OINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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). CONTACT PRODUCER NAI E: Durso&Jankowski insurance Agency AfCC.iv,Ext):(978)688-7000 FAX No):(978)688-7001 11 Saunders Street '•Malt. -T North Andover,MA 81825 A RES.: INSURER S AFFORDING COVERAGE NAIC# INSURERa:A.I.M. MUtUaI Ens Com an INSURED INSURER e AJ Walsh&Sons INSURER C: 159A Waverly Street INSURER D North Andover,MA 01845 INSURER E INSURER F 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. INSR ADDL SUER POLiCY'r•P POLICY EXP LIMITS g TYPE OF INSURANCE POLICY NUMBER —JRMJQ0NY)MLIMM1QDfyYnl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS MAg1 ❑OCCUR P EMISES Eaa rrence 5 MED EXP(Any oneperson) S u PERSONAL&ADV INJURY $ u GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL RGGRI GATE 5 POLICY❑PRO ❑ LOC PRODUCT$-COMNaR AGG 3 JECT S OTHER: 60h781N-F-[)S INGLE LIMIT AUTOMOBILE LIABILITY Ea accidenf 5 - ANY AUTO BODILY INJURY Per erscn S OWNED SCHEDULED BODILY INJURY Par accident 5 AUTOS ONLY AUT�IOS�/�NEp PROPERTY AMAGE ESS ONLY N8 0 ONLY Per accident 5 S i UMBRELLA LIAB =CLAIMS-MADE EACH OCCURRENCE `a EXCESS LIAB AGGREGATE $ DED RETENTION$ S PER QTH- A WORKERS COMPENSATION STATUT ER AND EMPLOYERS'LIABILITY AWC40070146482016A 11/14/2016 11/14/2017 106,01 ANY PROPRiETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT S FILERrMEMBe�EXCLUDED? ❑ N A 100,0( Mandatory in NH} E.L.DISEASE-EA EMPLOYEE $ I'M f yas,describe under E,I_.DISEASE-POLICY LIMIT S $00'61 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserve, --A t.,.,..gra raniefnrr-ori marks of ACORD 1 i I Massachusetts Department of Public Safety Board of building Regulations and Standards License: CS-022680 Construction Supervisor k ARTHUR J WALSH JR 159A WAVERLY RD N ANDOVER MA 01840 Expiration: ' Commissioner 06/0912018 <� r��n�nr:r„rr,i+iun�f�r/G'r/lrr;;rr,�ri;r•/% Office of Cnnsumer Affairs&Business Regulation '?HOMEIMPROVEMENTCONTRACTOR -1 Re9 Iskrakion: 103358 Type: r\ � Expiration 7/7/2418 Private Corporation A.J.WALSH&SONS;INC. Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary