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Home My WebLink AboutBuilding Permit # 2/24/2017 BUILDING PERMIT HoRrN OF�t�en rb��O p Z ye , sa 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h Permit No#I.:ADate Received Date Issued IMPORTANT: Applicant must complete all items on this page LOGATIOE�I ��. Pi' t Prinf , 1DD Year�truc#ure yes n MAIC, F'ARCEL� ZONING DISTRICT�H�stortc D�str�ct yes no , Machhe Ship Ui[lage . YeS., no.. TYPE OF IMPROVEMENT PROPOSED USE Resident' Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alt tion No. of units. ❑ Commercial ,21�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Wel! ❑ Floodplain ❑Wetlands ❑ lllfatershed Distract ❑WaterlSewer ,: ...�: , DESCRIPTION OF WORK To PERFORMED: A e– % WS Identification- Please Type or Print Clearly OWNER: Name: C-- �' Phone: - r –, � Address: �C C Z,1 _�✓ 1� 1 Avzo /qQ 4A�/q !e/$e Contractor am", I.........IWO . . Phone Email. : AddressMM,mi Su eru�sor's Construction Licenset, � Exp p —� Home Imp,ro�emen License Exp Date, ARCHITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDIN MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. h Total Project Cost: $_ FEE: $ 6, Check No.: Receipt No.: 1 � 1 _ NOTE: Persons contracting with unregistered contractors do not have access tojhe guaranty fund Signature;of AgentlOwner Signature of contractor _. �oRTphi --a- dover Town of , L��r h ver, Mass, ��+ Qq. qb,7 coc"'CHl Wlc oc Y RATEV BOARD OF HEALTH Food/Kitchen PERMIT T LLIF Septic System THIS CERTIFIES THAT 56"07 ,,.,,.. l, BUILDING INSPECTOR has permission to erect ....... ...... buildings on .lot . . .. . ,.. .,.. ...... ... Foundation Q► � � � Rough to be occupied as ....1..V.....R..... !@.�.... ...................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EI ES IN 6 MONTHSELECTRICAL INSPECTOR LESS CONS CTI® lie Rough Service .. .. ..... .......... ........ Final BUIL G INSP TOR GAS INSPECTOR Occupancy Permit Rfluired to Occupy Buildina Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wail To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Page If _of-2mes Pool CS # 022680 978-688-6737 HIC# 103358 Ad J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted To � Job Name ob# Address sf l8 Job Location oma„ Date Date of Plans f` /r° " "1 Phone fk Fax fk Architeot nd estimates for. --_71 eh :Wereby submit specs oat ons a � r spm ! / r �� ro" a it f 1�1, �G"r d/,d m '. / r r<✓ O�Kd �, �mm ,v4/')i ,. r". 4 41 i T—�—�.....w..... 411" r °l �V� �°' 21 We propose hereby to furnish material and labor—complete in accordance with the above speciticallns for the sum of: /r r (219 a l ki s, r r �� ,�, �.�a� � ��a� . r Dollars with payments to be made as follows: Any alteration or deviation from above specifications Involving extra costs will be Respectfully N executed only upon written order, and will become an extra charge over and submitted above the estiiviale.All agreements contingent upon strikes,accidents,or delays beyond our cdhlrol. Note—this proposal may be withdrawn by us rf not accepted within days. .acceptance of Vr70 p Oo,° ✓fi � Y ,� it", ld d�Pod��J�n„II/�„ [hereby 7of es,specifications and conditions are satisfactory and are Signature r i � d.You are authorized to do the work as specified. e made as outlined above.ptance "' Signature Massachusetts Home Improvement Sample Contract Tlus formsatisfies all basic requirements of the state's Home Improvement Contractor Law{MGL chapter 142A},but does not include standard language to protect homeowners. Seek Iegal 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 Hotline at 617-973-8787 or 1-888.283-3757 or on our website. Homeowner Information Contractor Information Name Company Name,,,, Street Addr/e�ss nein t ffca, xaddressj Contractod3alan/ erName City,Town /-� '• State Zip de Business Address must include a str t address) Dayu Phone Evening Phone City/fown to AipCode z Mailing AddFess at different from above) Business Phone Federal Employer ID or S.S.Number Hamelmpmvenrot C.At—WRea.Nmubrr Expiration date 7,awmquira taatwwthnma 9c�L3�.�� ' imp,ovemen[roa[nrrori have "-y �� slid mghtr Dumber e J The Contractor agrees to do the following workfor the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,psa additioaa[sheets if necessgm.) Required Permi -The following buildingpermits 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 unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of t!? ate when contractor will begin contracted work. MGL chapter 1.42A.) late when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,fultlish the material and labor specified above for the total sum uF (*) yments will be made according to the following schedule: W!!; + upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by or upon completion of �y=�/ or upon completion of $ + �upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) ((ff The follovitng material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)including all finance charges(**)Law requires that any deposit or 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 cast of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express warranty-Is an expresswarranty being provided by the contractor? ❑No❑Yes tall terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions o£any thud party/subcontractor utilized by the contractor. 'lire contractor further agrees to be solely responsible for all payments to all subcontractors for aterlals and labor under thiagreement. Contract.Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,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 pressuted into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid home lmosovement Contractor 12eeistradon. 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 "proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this 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 contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contmot must be completed and signed.One copy should go to the homeowner. olhcrcopy should be keptby the contractor. home no s$ igna[ttu/tre ///�J7 ? Contractor's Signature Date Date 'e I7re Connnon€teedth of'Alassrlc•husefts ;._ Department of lndustrialIfeciclews (7f f iee of I l vestf7(lliotls 600 fVashinyton Street Boston, ,11i4 02111 w€vi v.inaSS.g t)v1d is Workers' Compensation Insurance A! i(inih: 131iiltiers/Coilti'acWrs/ElutrletilI OPILl nbers L ) )Iicaiit I11f(1I niatlon Please 1'rillt Le.gil>'Iy Mlle]% ;[3u;inc ()r,!anization?luclililltrtl}:— � 1 �� Address: 1 , 11 a/ __- City/State/Zi1) i9NT:b11e'e - /�- a 'lone i#: 7 ' _�6s_s__C A€c �•o employer?Check the appropriate box: I'Ype of project (required): I 1.05 ant a employer with—� `1. ❑ I and a general contractor and I employees(hill anchor part-time). have hired the sub-contractors 6. E] -cw c nstRICtion 2.❑ I arts a sole proprietor or partner- liStCd oil tile. tittaelled Sheet. 7. tetnodc rig ship and have no enlplo)•ees 1 hese sub-contractors have S. ❑ Demolition working for the in any capacity.. employees incl have workers. 9. ❑ Building addition [\o workers' comp. insurance comp, iltsurance.-> €equire(1.] 1 ❑ lore are a emporation and its I0.❑ Electrical repairs or additions 3.❑ I am to homeowner dohg all worse clfficers have exercised their I LEI Plumbbig repair's or additions myself. [\o workers' comp. right ofexenlption per N4G1_ 12.0 Roof repairs insurance requiredj ' n 152. §1(4[ and we h"e no employees, [No workers' 13.0 Other C011tp. InSLIra11CC require(].] Any applicani Owt diecks 110,N-.1 1 ❑lust also 1,111 olit the section behm showing theii%wTkefs conipelisation policy lFltorillalt(rll, tkmteo"hers Wio submit this aflida\'it indicating they.Ire doing all"M:Ind[hen hire otuside co trot ms nimi wbis a nese al hila\loth hl;W. 'C'ontracturs that check this bus nitsst auached:ut addition;tl;fleet shsl\ring'the 1%1)w of the tlb-conlraeturs and stare lsheilm or nest Iho>e entities hate entpIocees. lF the stili-collIlaclws h,"o etlglloyces.they must ppm ide€Reil' \col;eIS'comp.polity number. I ant an eurptoper that Lv providing; ivorkers,compensation insurance fur Jus earplal•ees. Below is the polies'and jolt site lJ1fO!'rJl(l1101J. Policy V or SOON. Lk. � C� ZCA 1 Ex oration Date: — — Job Site Address:.... �� (� � z1v -- . CitynMe/Zip: //N ,V Attach a copy of the ts'orker•s' compensation policy declaration page (shawl€tg the polio° number and expiration date), l ailuro to secure co%vrage as required under Section 25A of VlGL in 152 can lead to the imposition ofcHminal penalties of t Ane up to S I-j0M00 and/or one-year iniprisonnten as well w civil penalties its the Arm of a STOP WORK ORDER and a I ine of up to 5250.00 it day against the violator, Be advisees that a coli) ctl•this mawman may be fort\arded to the Office of Investi,galions of the IFAA for insurance coverage verification. 1(lu hereby'cert' rndcr t c lxrirrs and penalties of pe loy NY the information proi,ided above is true and correct. ____ __[Date.-_� � Phone Of ficial use oafs'. Do not ii>rite ill this area. lobe completed hr citr or toli-lr q iciat City of-Town: Ile r•nli(/LiceIlse 4 Issuing Authody (eirde Ones: L Board of llealth 2. Buil Hng t)eps€rtnwnt I t-it)l I"ou n Clerk 4. Idecrrical lnspcetor• 5. Plumbing Inspector 6, Other Conwo Persue€; Phone #: r CERTIFICATE °�"p�' LIABILITY INSURANCE AJWALSH-01 JONE LI 11!17!2016 THIS CERTIFICATE 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 tNSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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!leu of such endorsement(s). CONTACT PRODUCER AIr1E-, Durso&Jankowski Insurance Agency PHONi 1Arc1.No,Ext);(978)668-7000 F,vc,Not:(87$)688 11 Saunders Street -70U1 North Andover,MA 01846 EMAIL APDRE55 INSURERS AFFORDING COVERAGE NAIC# INSURER A:A.I.R Mutual Ins CO3T1 ari INSURED INSURER B: AJ Walsh&Sons iNSURERC: 159A Waverly Street INSURER o: — — North Andover,MA 01845 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 01= 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. ISRADDL SUaR POLICY NUMBER POLICY EFF PDroC IY XP LIMITS LTR TYPE OF INSURANCE i D D COMMERCIAL GENERAL LIABILITY FACH OCCURRENCE S CLAIMS MADE OCCUR PAMMISESO auNccrEOnce $ MEQ EXPAAny one arson $ PERSONAL&ADV INJURY S GEN FL AGGREGATE LIMIT APPL€ES PER: GENERAL AGGREGATE S POLICY❑PRO- ❑LOC PRODUCTS-COMPIOP AGG S JECT l OTHER. — COMBINED SINGLE LIMIT 3 AUTOMOBILE LIABILITY Ea ace! e t _ ANY AUTO BOr11LY INJU3�Y(Per ereon $ OWNED SCHEDULED SOQILY INJURY Per accident 5 AIU{{��NE ONLY AUTOS PROPERTY DAMAGE AUTOS ONLY AUT03 DIVLY Per accident S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE_ $ EXCESS LIAR CLAIMS-MADE AGGREGATE _ $ DED I t RETENTION$ A WORKERS COMPENSATION STRTlTE _� F; R AND EMPLOYERS'LIABILITY YIN 100,0 ANY PROPRIETORIPARTNER!EXECUTIVE AWCaao�o1.4s4s�olsA 11!'1�1�016 11�1�12017 ELEACHRCCIDENT 5 FFFICERR7r MW EXCLUI3FD? N!A E.L.DISEASE-EA EMPLOYEE $ 700,0 Mandare NH} If yes,describe 11ndEF E L DISEASE-POLICY LIMIT S 504,0 DESCR€PT€ON OF OPERAT€ONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1D1,Addi1€onal Remarks Schedule,n3ay he attached if more apace 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 Andover ACCORDANCE:WITH THE:POLICY PROVISIONS. 36 Bartlett St Andover,MA 01810 AUTHOR3'LED REPRESENTATIVE ACORD 25(2016103) a 1988-2015 ACORD CORPORATION. All rights reserve -rk^ ArrnPn n, mit Mort Inr:n arP rPnisfiarpd marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-022680 Construction Sulaervisor Y 1 ARTHUR J WALSH JR 169A WAVERLY RD 0 N ANDOVER MA 01845 _/�L"^'� Expiration:Commissioner 46109/2018 Office of Consumer Affairs&Business Regulation rn HOME IMPROVEMENT CONTRACTOR Registration: 143358 Type: :. Expiration..:= 7/7/2018 Private Corporation A.J,WALSH&SONS;INC. Arthur Walsh 55 Pleasant St N Andover,MA 41845 Undersecretary