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Home My WebLink AboutBuilding Permit # 1/11/2017 BUILDING PERMIT �oTy � �tt.Eo TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit Ido#• Date Received CHUSO Date Issued: fWORTANT Applicant must complete all items on this page LOCATION ... �.� - e r Pnrit � :PROPERTY OWNER 1` t Writ1 OU YearStruct- yes MAP PARCEL ZQNING DISTRICTHistor[cDtstr[ct yes no - Yes Mach[Iie Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑ Nteration No. of units: WCommercial ffRepair, replacement 11 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other C7 Septic °0 Well El Floodplain ElWetlands ❑ Watershed District O.Waterl8ower DESCRIPTION OF WORK TO BE PERFORMED: Tdentification- Please Type or Print Clearly OWNER: Name: �°�' �' 6 Phone: Address: C_41 �r : Contractor Name '- .. ?hone Address: Supervisor's Construe ion License:: .- Exp Date . Ex Date.' Home lrnplovemenfi License: p ARCHITECT/ENGINEER 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. Fotal Project Cost: $ FEE: $ Check No.- ;-v Receipt No:: 31 y3 NOTE: Persons contracting with unregistered contractors do not have:access to the gugrafttyfund St r7ature offgentlOwrier Sigrtatre_of contract 9 - W._. Town of � _ V *y ►•' of , No. a� - Tggp� d.10 LocrKwC w.CK ti ATEU V BOARD OF HEAL PERMIT T LD Food/Kitchen Septic System . .�. .•,,.. � ,�.1•, BUILDING 111ISPEC THIS CERTIFIES THAT... ................. .. .. .,��. .�.�!`!fr!f�,�,�......�� Foundation has permission to erect...................I...... b ildings on .... Rough 04 to be occupied as .......5 .,... •.,. •••.,, ................................................................... 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 PLUMBING INSPEC Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPEC LESS CONSTRUCTION ARTS a� Rough .�. ...................I.,,.......,..,.... Service .,....,,.... Final BUILDING INSPECTOR GAS INSPECTOI OccupaneV Permit Required t® OCCUPY Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPAR7ME1 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts Home IM rovement Sam le Contract This fo m satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include stanJatJ language to protect homeowners. Seeklegal advice[f necessary. Any person planning home improvements should first freeobtain a copy of may Massachusetts Consumer A er Guide lousiness Regulationimprovemomees Consouner nfomtare,agreeing ton Hotline[617.97any work c 3 8787 or 1-888 2 3t 3757 or onain a free nour wcbsilc.py by calling J7e Contractor Information Hameorvner information Company Name r elh �r4 �t"T��S L.'6 C_ r Coat et r!Sal person!Owner e Street Address(d=-not ,+Post O Ice B�aaddress) C 5ta 'S(LZip Code Business Address(mustLins ld%et ja��treol addrefs�s,)y.I CityyiTown (�j I Al, f city(Sown state zip Code Daytime Phone�J(]Q ------------- Evening PhTone �� 9 � ( f L 19� / / Federal EmployerID or S.S.Number Business Phoae Ivfailing Address(lt different from above) Rometrnpmremrd conlmztorae$.Number Esp¢otin^dna fair ngulw[oat mort Tome tm`mYcmenl ronlsaetars a%vc (/� (�Y✓`� (JX �t(J yd mginrvtu n nambcr The Contractor agrees to do the fallowing work for the Homeowner: (Describe in detail the work to+completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) Proposed Start and Schedule-The Required d 11 b secured by follow atracgor as tine ho enwn t s agentg permits are : be adhered to unless circumstances beyond the contras or'sconttrollar se l (Owners who secure their own permits will be �+ yDate when contractor will begin contracted work. excluded from the Guaranty Fund provision s of J�� 71 MGI,chapter 142A.) �� / Date when contracted work will be substantially completed. Total Contract Price and Payment Schedulesum of: C1 (*) The Contractor agrees to perform the work,furnish the material and labor specified above for the total Payments will be made according to the following schedule: $ d upon signing contract(not to exceed 113 of the total contract price or the cost of special order items,whichever is greater) ( by ! 1 or upon completion of g 0 l�y by_ ! ! or upon completion of ent until contract is completed to both party's satisfaction) upon completion of the contract, (Law forbids demanding full paym to be be paid for The following materiallequipment must be special $ ordered before the contracted work begins in order to be paid for to meet the completion schedule.(*}) $ NOTES:(*)including all finance cbarges(*)Law requires that any deposit or doom-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 warrant -U an ex ress avarrms bein rovided b the contractor? ❑N ®'Yes all terms of the wnrran must bo attached la the contract cribed rega ss of Subs/subcontractorlutilized by the contractor. thiontractors-Tr contrattor agrees to besThe c ntra toolely rlfurther agreeslto be solely r sp ns ble for allrpaeymentstto all subcontrhe actions of ac ors for p�Y materials and labor under this a cement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this rid noticeent,the 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. n oke sure the cont actor has a valid Home IM rovement contractor Re'str tion, The law.requires most home ui epabout contractorent and • subcontractors to bo reg stored with the Director of Home Improvement Contractor lie istration. You may inq registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 1�2i 16 or by calling 617-973-9787 or 888-2rage,or ask to Does the contractor have insurance? Ask the Contractor for his insurance cam an information so that you can confirm coverage, • see a copy of a"proof of insurance'document. Know your rights and responsibilities. Read the Important Information on the reverse side ofthis form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you notify the third business in Ivriling day following h ingethe main nsigning of thice c,e agreemanch lhente Seethe attached notice of Cance atio form forby ordinary niall posted,by telegram sent or by danl explanationivery,not I tof his rer ight tght of tlra DO NOT SIGN THIS CONTRACT IF THERE e hARE ANYeBLANK SPACESon�etar IM Two'idenlical copies of the contract must bo completed and signed.One copy should Co tor'$Slgnattire Homeowner's S gnature - r�1 ,rr. 7 Date Date DATE(MMIDDIYYYY) 4C0 CERTIFICATE OF LIABILITY INSURANCE �N THE CERTIFICATE HOLDER. THIS THIT T(FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH TS E DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED CER71F1CATE DOES NOT AFFIRIVIATIVRANC R NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. THIS CERTIFICATE OF INSU CERTIFICATE MOLDER, ust be endorsed. I REPRESENTATIVE OR PRODUCER,AND THE 11 s ma require an endorsement. A statement on this certificate does not confer rights to the IMPORTANT: If the certificate holder is an ADDITIONAL l�SURED,the policy(ies)rof SUBROGATION IS WAIVED,subject to the terms and condttlons of the policy,certain p certificate holder in lieu of such endorsement(s). co TACT Elizabeth Chavez NAME: pRODUCER PHON£ (+j78 688-4474 � Na: EIAIC.NQ.�ldf �— DEGNAN INSURANCE AGENCY, INC. ADDRESS: eohavez@degnaninsurance.com NAlca INSURER 5 APFORDING COVERAGE 33758 85 SALEM ST. MA 01B� 43 INSURER A: AIM MUTUAL INS CO LAWRENCE� INSURER a INSURED INSURER C: JAMES DEBRECINI INSURER D: FAMILY ROOFING &PAINTING INSURER E: 2 TANAGER WAY NH 03053 INSURERF: LONDOND1 K.RY __-�.--•– ---------'� — REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: 117488 CONDITION OF ANY CONTRACT OR OTHER DOCURMEtN T I IS SUBJEO PTO ALL THE TERMS, THIS I5 TO CERTIFY THAT THE POLICIES OF—INSURANCE LISTED OR BELOW HAVE BEEN 3SSUED TO THE IN5 BEd N MED ABOVE FOR THE POLICY PHT ERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,T CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DES LIMITS POLICY EFF POLICY£xP EXCLUSIONS AND_CONDITIONS OF SUCH AOnL sUBRLIMITS SHOWN MAY HAVE BEEN REDUCEDrPAID CLAIMS, INSR POLICY NUMBER $ LTR TYPE OF INSURANCE EACH OCCURRENCE DA AGE TO RENTED $ COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence CLAIMS-MADE El OCCUR MEP EXP(Any one person) $ PERSONAL&ADV INJURY $ NIA GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG 3 PRO- ❑LOC S POLICY LA JECT COMBINED SINGLE LIMIT $ Ea accident OTHER: AUTOMOBILE LIABILITY BODILY INJURY(Par parson) $ 8013ILY INJURY(Per accident) S ANY AUTO NIA $ ALL OWNED SCHEDULED PROPERTY DAMAGE AUTOS AUTOS Per accident NON-OW NED $ HIRED AUTOS AUTOS EACH OCCURRENCE S UMBRELLALIAB OCCUR AGGREGATE $ EXCESS LIAR CLAIMS•MADE NIA S OTN- DED RETENTION$ X STATUTE ER WORKI✓RS COMPENSATION E.L.EACH ACCIDENT $ 100,000 AND EMPLOYERS'LIABILITY YIN 05I11I2016 05!11/2017 ANYPROPRIETORfPARTNERIEXECUTIVE NIA NIA NIA AWC40070259002016A E,L.DISEASE-EA EMPLOYEE S 100,000 A OFFICERIMEMBER EXCLUDFn7 E.L.DISEASE-POLICY LIMIT $ 500000 (Mandatory:n NHI if ves.describe under DESCRIPTION OF OPERATIONS helow NIA DESCRIPTION OF OPERATIONS!LOCATIONS I vEHICLES (ACORD 101,Additional Remarks Schedule,may b0 attached if more space is required) s hired those employees outside of Massachusetts. Workers' 'Compensation n benefits will be paid to Massachusetts empelohaes only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims For benefits to employees in states other than Massachuseils if the insured hires, status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at This certificate of insurance sehows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date o I carliflcate of insurance). The ationsl. Sole proprietor has not elected coverage. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBERE OF,ED POLICIES BE CANCELLED BEFORE THE ACCORDANCEEREOF, NOTICE H�HE POLICY PROV(S ONSNOTIC WILL BE DELIVERED IN TOWN OF NORTH ANDOVER AUTHORIZED REPRESENTATIVE 120 MAIN STREET CzS` MA 01845 Vice President–Residual Market–WCRIBMA NORTH ANDOVER Danie!M.Cro y,CPCU, ©1888-2014 ACDRD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD DATE (MMIOOrfM) CERTIFICATE OF LIABILITY INSURANCE 03131/2016 �Ro CE AMEND, EXTEND OR ALTER THE COVORDED BY THE POLICIES ERAGE AF INSURER(S). AUTHORIZED THIS CERTIFICATE )S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON jNGCERTIF)CA7E HOLDER. IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE IS LESEITATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. r tan endorsement. A statement on this certlflCate does not confer rlghts to the • if the certlfloate holder Is an ADDITIONAL. 1NSUR up, the policy{les) must be endorsed. If SU9ROOATION 1S WAIVED, subject to ITAN , rms and conditions of the policy,certain policies may req DEGNAN INSURANCE AGENCY -ate holder In lieu of such endorsement(s). CONTACT E• FAX 978-327-6558 R Phone, 97B-Bea-0474 Fa)c 978-327-6558 PNONE 978-6884474 c o AN INSURANCE AGENCY F HAIL° cdegnan@de9naninsurance,COm NAIc u _EM STREET ° 5 INSURfiR(S) AFFORDING COVERAGE ,ENCE MA 01843 INSURER A : NORTHLAND INSURANCE COMPANY INSURER a LECENI,JAMES D1B1A FAMILY ROOFING AND PAINTING INSURFRC ' JAGER WAY INSURER D: )ONDERRY NH 03053 INSURERE INSURER F REVISION NUMBER, ERAGES IOD CERTIFICATE NUMBER: 26019 ERM OR CONDITION OF ANY CONI'RACT OR STHREp0EEn 15 SIUBJECT TO ALL TH RESPECT OTHE ITE NAS CH THIS S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER IICATED. NOTWITHSTANDING ANY REQUIREMENT, RTIFiCATE MAY BE I5uUcD OR NRAY PERTAIN, THE INSURP."ICE AFFORDED BY THF ppL.C1ES POLICY EFF POLICY eXP LIMITS 1,400,009 CLU SIONSAND CONDITIONS OF SUCH POLICIES.u RIMITS SHO POLICY NUMBERIN MAY HAVE REDUCED BY PAID GLAIMS. PH OF INSURANCE WCY NUMBS 03105116 03105117 EACH OCCURRENCE $ 100,000 DAMAGE TGRENTED $ GENERAL LIABILITY PREMISES Eawwreme) ,000 MED.EXP(Any one person) $ COMMERCIAL GENERAL LIABILITY 100(6,000PERSONAL&ADV INJURY $ CLAIMS-MADE OCCUR 2,000,000 GENERAL AGGREGATE $ PRODUCTS.COMPIOP AGG $ 2,000,000 $ GEN'LAGGREGATEPIRMOTAPPLIESPER: COMBINED SINGLE LIMIT $ POLICY E T LOC (EaaWdent) BODILY INJURY(Per person) S AUTGMOeILE LIABILITY • BODILY INJURY(Per accident) $ ANY AUTO SCHEDULED $ ALL OWNED PROPERTY DAMAGE AUTOS (ar acrldenl) $ AUTOS NON•OWNED HIRED AUTOS AUTOS EACH OCCURRENCE $ OCCUR AGGREGATE $ UMBRELLA LIAR $ EXCESS LIAR CLAIM&MADE tOTH WC 5TATU• ER $ PIED RETENTION$ TORY LIMIT s E.L.EACH ACCIDENT $ WORKERS COMPENSATION AND EMPLOYERS, LIABILITY YIN E.L.DISEASE-EA EMPLOYEE $ OFFICewMEMBER EXC LUDED EOUTNE NIA E,L,DISEASE-POLICY LIMIT $ (Mandatary In NH) DESCRIPTION 59 ander DEBPTEON OF OPERAt{ONS 4eldror ACORD t0i,Additlanes Remarks Schedule,IS more space is required] )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach 1{ifas'suchu=sefls '•�'he common-wealth of , De r t�nent of fnoruv,&julAccidesafs� Z Congr'es's ,Srr��te 100 02174 20. 7 WWYV•Y12aSN-gOYlf�LGL actorsl+lecixiciax}5I �exs. y� 9 e ICortt� X dad-t_33nddd xi; (° ♦v ES15 -�InTl�Ilsuraned (X",E�,-Q;J.`9Ox'ZZ.� . Comp �?IEase 'x�tE '�i ,g. ' IicantTnfnxmatnon. � vidua�: N (gusinesslnzg�atioa3lJn •ch ' Address: -Pho--e'#: ' *hype 4pro3ect(rec�ua ed) necktlieappropxiatabax: 7, Are you an exapXayer CI? andlor parE tie) Toyer c' employees(full $. [ Remodelvig toxule izt 1• aztaers�p andhaYeno amp y 9• �T7e7no1it1o7?. 2.p S e asole}�ropxietoror p ce required addition- any capaci`yoworkers'camp.in5i�ran �y�ancezequirad.�t 10 $uilcg a�tworkurysel LN°w°zkers'comb. ez doirg E1ec cal zepaizs or a-dditigpB ahomeown ro arty.Iwiil 3.Q x am behiring cnntractozsto condncca114rork onmyp P �m insarame oz aro sole limbi;xepalTS o additiox 4.�I am ahomeownez audwiii �Zw'°�•`��='� �- ens�rethat cozdsactois eitLierhaYe�vozkers'comp oDTeilatS mo Play pzopzietors wig eh4zedthe sr -c° tors ibted outhe ttached sheet a euazal cozMcto gaud 1bpY e 9T erS comp.insurance.• lA. ether S�Iam g e e Ioyees andhav These sub-oultaotorsl}av` mP �ightofexemp#ionper iCTL°' cozpozatjgi an�• c Of cars ave z u g�uanco zaquized j amp. ahcp�fomzat[on ch dehav�ao KnopJoye. - coznpepsaf£orap srrbmitanewcatimgsu 152,§1(�)� tach vrarkers' entilie�,h�te a13 vrork thm�e o atside contraetom zaust & car�tthat checks boil#1 mu's't else X11 outer e sazctidav ovt showing ozs and statewhether or not diose.. y gpli �dai�%t indicating y tbB name ofthe sob-eontrect iHomeownerswhpsubud't'' ed•anAditionalsheatshowing °hcyn er. lcmdractorsthatcbeckfill?sUoXjtvsts lila aas,rheYznustprovidethazt t�orkers comp-p employees.If the sub-cont tozshaxe amp y to ees, Below is tFiepa�icy arxdjoX�site f am an emplo-va III at is providing rs, o�FGers'cor�•zpensation irxsurat2cefar my amp .� irzforfnation. � r[, '"17 7nsxauce Comye; ,�ah Epiratzox�Date' policy#or Sea LIG. ate/Zip #: � City/St : / Cthe olicy) umber=111egpiratia�a date)- G a e sSiog p a fire up to$7-,500.00 job SitaAddxess' c declaratioup g al v3olatio p hableb�' Ofecam�a?tsaon �' e ofv to $250.00 a Attach a copyo.152,§25A is a crimi� �� a aid a F P urance Failureto secure coexage as xeded,�nderM ell as civilpsnalties the 1111-111 aha STOp � e earjmpxisonznenas beax�Yardedtothepcoofln�estigatiox�o 'aLTAoz1Ys' Md/or on Y eo o thi9 statebaentmay day aha the Violator.A pY aeon provided rage lie aid correct aavez'age�rexif'teation. er a that tFie�f - apydpenulties ofp .1 r1' ._�_ ado IiereFiy cextify and P pate: p 1vnD#: ' d or LAVA affiCiGlr pfiflydal Use only. Da ryot•y�xzte i�x tFsis area,to�e completed by t]' pexztlLxeezise# City orTovn= i actor 5-pXuxobing actor AutTaoxity(circle one)' ant 3,Czty ° C�Erk d.Elecixicaip 7i5ving ealtTs 2-S ildingpepaxt 1.Board o�'� {,.OthEr phone#- covta.ct-pexson n��P II071PJI1 CY1/U('?lf/t nfr>,%ICIJJ[!('�!!J(��cl is P—\ Office of Consumer Affairs&Business Regulation If N��4HOME IMPROVEMENT CONTRACTOR 1� � ��Registration 122385 Type r Expiration 8!2612018 DBA i FAMILY ROOFING&PAINTING JAMES DEBREGENI 30 RIVER ST. METHUEN,MA 01844 Undersecretary Massachusetts Department of Public Safety f Board of Building Regulations and Standards License: CSSL-099685 Construction Supervisor Specialty JAMES J DEBRECENl TANAGER WAY LONDONDERRY NH 91663 CA— Expiration: Commissioner 1 210 612 01 7