HomeMy WebLinkAboutBuilding Permit #299 - 1041 JOHNSON STREET 10/1/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO.
Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION o /4,12_y GQ 2' /V/A
Print-
PROPERTY OWNER acdapi -Print 100 Year Old Structure yes no
MAP NVU7-PARCEL ZONING DISTRICT: Historic District ye no
Machine Shop Village yes no
TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
❑ New Building 7 One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
ya t�� �c�a � ' ►�.s Li U X J:� t,u 92a JA "I/ ti C1� �« 11407,
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
Address: tlO , Q/ r
Supervisor's Construction License: zf !' - n,02, Ci/Q Exp. Date:
Home Improvement License: JExp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ci�' �L FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund
Signature�of Agent/Ovvner Signature of contracto +
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ ans ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
-TYPE.OF::SEWERAGE DiSPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑. Swimming Pools ❑
Well ❑ .Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc... ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE.APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW'Tow;2 Engineer: Signature:
Located 384 Os ood Street
FIRE-DEPARTMENT --Temp Dumpster on site yes.. no
Located-at 124 Main Street
Fire Departine►it signature/date`
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
.Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGLChapter166 Section 21A-F and G min.$100-$1000 fine
NOTES and DATA— (For department use
v(- 4-k A, S
El Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The foliowing is--a list of the required forms to be filled out for the appropriate.permit to be obtained.
Roofivg, Siding, Interior Rehabilitation Permits
c3:- Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
a Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
a Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apo.-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Bui?ging Permit Revised 2012
Location
N Date
TOWN OF NORTH ANDOVER
n
Certificate of Occupancy $ J
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check 4/Ute
L; ;� 7, Building Inspector
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 1507000.00 m
$ - $ 1,800.00
Plumbing Fee $ 225.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 225.00
Total fees collected $ 2,350.00
1041 Johnson Street
299-14 on 10/1/2013
Remodel Baths, New Roof, New Flooring
1041 Johnson St,North Andover MA
Scope of Work and Work Contract
Ocean City Development LLC and Daniel Yanez Juarez dba J Home Service Company
Terms and Conditions
NOTE: all permits must be signed off by the Building dept. /punch list items must be corrected
prior to final payment.
Insurance
Contractor Agrees to carry necessary liability, property and workers compensation insurance.
Contractor requires sub-contractors to carry necessary liability and workers compensation
insurance. Insurance must be coverage in the amount of$1,000,000 liability insurance and
$500,000 workers compensation insurance.
Hold Harmless
The independent contractor hereby covenants and agrees to defend, indemnify and hold harmless
the owner, its agents, officers, directors and employees of and from all liability, claims, actions,
causes of action, lawsuits and demands including attorneys fees and costs, fines and/or penalties
for personal injury, bodily injury, death (including personal injury, bodily injury or death of the
independent contractor's own employees) and/or
property damage arising out of or in any way related to the independent contractor's work or
operations for or on behalf of the owner on, about or away from the owner's premises or
associated with the breach of the construction agreement or the construction specifications.
Contractor to accept all deliveries, i.e. cabinets, appliances, etc. Contractor must be available
to correct any necessary defects originated by city/town inspector, Ocean City Developments
inspector or Buyers Inspector
Scone of Work
Exterior:
• Roof/-strip/layer 3 tab ). /roof over shed.
• Paint clad boards/windows/Soffit/facia/trim/shed/deck /garage door/ Foundation.
• Replace any clad boards that may be rotted or cracked.
• Replace rotted trim if necessary.
• Front brick/power wash.
• Front brick, planter/repoint or replace
• Front steps/point if needed.
• Paint front shutters
• Electrical service/good shape/not replacing.
1
!. f
• Soft vents. /make sure they are venting properly.
• Re- cement (4x4)pad side garage entrance.
• New recessed rear entrance light/existing location.
• (3) front wall lights installed/existing location.
• Chimney/great shape/points if necessary.
• New chimney cap/or paint.
• Install Gfi out let in front/rear of house.
• Fill in assault at garage entrance/
• Paint rod iron front railing black.
• New lock set/dead bolts/--- front and rear.
• Landscape/clean yard ,trims grass, bushes/mulch where appropriate for a nice
appearance.
Demo/Clean out:
• All faming/walls per design/all cabinets/, carpets, bath fixtures , appliances, household
items in main house, garage, attic and shed. D
Garage:
• Door and opener to operate properly
• Add new stair pull down.
• Point chimney.
• Paint floor.
Attic:
• Neat up insulation/add if missing
• Paint chimney
• Repair any compromised joists if any
Kitchen: (12x13). (Stove Electric). 157 sq ft
• Install kitchen faucet.
• Install garbage disposal.
• Add hard wood floor.
• Add water line for ice maker.
• Install over range micro wave oven.
• Install cabinets.
• Install handles.
2
1 y
• Remove wall paper.
• Add(4) recessed lights.
• Add light over sink/remove existing center light
• Window. Ok.
• Tile backsplash.
Bath : (60 x22) sink. (12x5)
• New tub.
• New bath valves/trim for shower
• Replace vanity and top ( 2 sinks).
• Add (2)vanity lights over both sinks.
• Tile/durock floor.
• Tile tub/durock. /per OCD design.
• Bath fan/light.
• Remove tile walls and tub.
• 3/8 over damaged ceiling.
• New toilet (Home Depot specs ).
• Window Ok
Master bath : (6x5)
• Install 30" vanity and top.
• Remove shower tile/install new tile shower/(3606).
• Install new shower door. /single.
• Fan/light.
• Vanity light installed.
• Tile shower/durock.
• Tile floor/durock.
• Install faucet
• Window. Ok.
Living room/(13x22 ) hall: ( 6x 15 ). Sq ft/376
• Remove carpet.
• Add hard wood floor.
• Remove wall paper.
• Add ( 6 recessed lights. ).
• New door bell.
• New thermostats.
• Windows. Ok.
3
Den: (20x12). 240 sq ft
• Remove carpet
• Add hard wood floors.
• Remove paneling/remove beams.
• Remove fire place/patch walls.
• Add recessed lights. (6)
• Add center light for dinning room table
• Windows. Ok.
• Add 3/8 sheet rock
Mud Room. (10x10)
• Tile floor/durock.
• Remove carpet.
• Add center light.
• Paint steps to basement
• Sheet rock studded walls.
Basement (can finish to 7' 3" height )
• Paint oil tank. Pa
• Hot water heater Ok/ must operate properly/service if necessary. PI
• Electric panel. Very good/ (8) open slots. E
• Box in steps to basement if finished/box in a small hall at unfinished side/add door. C
• Has sump pump in corner near steps/. Needs to be operating properly. PI
• Add new forced air/Ac system/use existing duct work where possible. He
• Add 17x13 basement room: C
• 6 can lights. El
• (1) door to unfinished area from finished room
• Sheet rock ceiling
• Tile floor
• Trim out
• Add heat
• Add electric
• Insulate/fire stop per code
Garage:
Point brick chimney. Ma
Electric door opener/must work properly/service if necessary E
4
Nnew pull down steps C
Paint floor. Pa
Beds (3). (15x13)/(15x12)/(12x16). 570 sq ft
Remove carpet.
Add hard wood floors.
Add center lights/switch.
Entire House:
• All permits.
• Repair/add trim where necessary
• Paint all/walls, ceilings, trim, closets , doors, shelving.
• Repair all walls/ceilings where necessary.
• Remove all wall paper.
• All switches/plugs to white.
• Install blinds.
• Install mirrors.
• Install assessors.
• Install cable line in All rooms/including kitchen
• Install lock sets/passage sets.
• Install all shelving/poles.
• Install all hardware.
• All electrical to code where applicable.
• All plumbing to code where applicable.
• All framing per OCD design.
• Install all appliances.
• Take all deliveries.
• All windows and screens to operate properly/all glass/screens
• Repaired where necessary.
• Final house cleaning.
5
a.
a
Ocean City Development LLC to purchase the following items only
1- granite/sink/and install. (Kitchen)
2-kitchen cabinets
3-bath vanities/tops
4- carpet/and install
5- all tile and grout
6- garbage disposal
7-toilets
8- all lock sets/passage sets
9- all knobs/handles
10- all exterior doors/ sliders/French doors
11- all appliances
12- all blinds
13- bath Assesories
14- all plants (per design)
6
9/26/2013 10:04:06 AM PST (GMT-8) FROM: 100005-TO: 16175689677Page: 2 of 2
3 09/26/2013 13:39
_
CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY)
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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must 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 MAYA INSURANCE AGENCY
20 MERIDIAN ST CONTACT NAME:
EAST BOSTON, MA 02128 PHONE AIC No*
EMAIL ADDRESS:
INSURER S AFFORDING COVERAGE NAIC#
INSURED
INSURERA:
DANIEL YANES JUARES INSURERS:
DBA HEALTH WELLNESS CENTER INSURERC:
DBA J HOME SERVICE COMPANY
171 WASHINGTON STREET N3URERD:
SOMERVILLE MA 02143 NSURERE:
COVERAGESINSURER F:
CERTIFICATE NUMBER: 17778950
THIS IS TO CERTIFY THAT THE POLICIES OF INSREVISION NUMBER:
URANCE 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.
LT
TRR TYPE OF INSURANCE DL SUER POLICY EFF POLICY EXP
POLICY NUMBER MMID MM/OD/YYYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES a occurrence $
CLAIMSaMADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMB APPLIES PER: GENERAL AGGREGATE $
:71—POL PRO IOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIAB1nY $
ANY AUTO
Ea accident LI $
ALL OWNED 8 SCHEDULED BODILY INJURY(Per person) $
AUTOS AUTOS BODILY INJURY(Per accident)
HIRED AUTOS NON-OWNED g
AUTOS PROa�and1Y AMAGE $
PPee $
UMBRELLA UAB OCCUR $
EXCESS LIAR EACH OCCURRENCE $
CLAIMS-MADFWC2-31S-390155-013
MDED RETENTION$
AGGREGATE $
A WORKERS COMPENSATIONRS'LtILrr 4/9/2013 4/9/2014 $
AND EMPLOYERS'LIABILITYJ TORY LIMITS ER
OFFICER/MEMBER EX UD ANY D7 ECUiNE a
(Mandator E.L.EACH ACCIDENT $ 10000(
n in NH)
If yes,desenbe under E.L.DISEASE-EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below 100000
E.L.DISEASE-POLICY LIMIT $ 5[)0000
L-1
DESCRIP OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remark;Schedule,if more space is required)
THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR DANIEL YANES
rn ' n'IsUrance cove a li th a co ati laws st f
CERTIFICATE HOLDER CANCELLATION
OCEAN CITY DEVELOPMENT LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1 SEAL HARBOR ROAD #412 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
WINTHROP MA 02152 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
1 )44A�IL Ute .
. --eldrid e
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACO DORD CORPORATION. A@ 1988-2010 ll rights reserved.
CERT NO.: 1777950 CLIENT CODE: 1674425 Anne Chand1p 9/26/2013 1 01:,06 AN a qe 1 0£
This certi icate cancels and supersedes AL preva.ous�ly Issued ertUicates.
NORTH
Town of t E ., ndover
No.
O LhN� h , ver, Mass,
COCHIC"RWIC. "
�.v ARRA' E O r"P�.(5
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT �j ���!!N!....`.��.. ......... 77 BUILDING INSPECTOR
.. ....
has permission to erect .......................... buildings on .....'(>.Y(.......unto ►.A4.0.0%L.......... ......M... Foundation
� .` ............................ Rough
to be occupied as ..........C4.N!1.. .. �.....12.....�.b...... .......F.�•P Chimney
provided that the person acce tin 'this permit shall in eve�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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU O4ST RTS Rough
Service
....... .. ................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
SEE REVERSE SIDE
t
The Commonwealth of Massachusetts
.Department oflndustrialAccidents
Office oflnvestigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/ContractorslElectfricians/Plumbers
Applicant Information Please Print Lealbly
Name(Business/Organi'zation/lndividual): U. 14,1 �o C�A ru�t 7- �CJ V s
Address: /w a ul P--,Ir
City/State/Zip:�T vt ti Phone#: o�7z�1,3 7 Z
Are you an employer?Check the appropriatUI
9x: Type of project(required):
1.El am a employer with 4. am a general contractor and I 6. ❑New construction
employees(fall and/or part-time).* have ned the sub-contractors
2.El am a soleproprietor orparener-
listed on the attached sheet.t �• E]Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. g. Building addition
[No workers' comp.insurance 5. 0 We are a corporation and its 10.[{�Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner,doing all work right of exemption per MGL 11.- Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance �ired.re q uemployees.[No workers'
13.❑Other
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
i Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the,policy and job site
information. ff �n
Insurance Company Name:. L /yr
Policy#or S elf-ins.Lic.#: Expiration Date:
Job Site Address: City/State/zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certlounder the pains andpenalties ofperjury that the information provided above is true and correct. -
Signature: Date:
Phone#:
Official use 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.City/Town Clerk 4.Electrical Inspector s.PIumbing Inspector
6.Other - -
Information and Instructions .
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,
express or implied,oral or written."
An employeY is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.".
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance With the insurance coverage required"
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certiffcate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confinmtion of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only-'submit one affidavit indicating current
Policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone anal fax number:
`fhe Com
monmaltl ofMa:.ssarhvsPtts
Depaximeat ofh dusWal Accidents
Of oe ofIavestigat ion
600 Washiu&, .&t ea
Boston?MA.021X1,
Tel,#617-727-4.900 OA406 qz 1-877-MA.SSAFE
Revised 5-26-05 Fax#617-727-7749
ACCEPTANCE
By signing below, Daniel Yanez Juarez dba J Home Service Company and Ocean City
Development LLC agree that the above work will be completed for the agreed upon price
noted below and in the agreed upon time frame noted below. Ocean City Development will
allow a 5 day grace period above and beyond the agreed upon date below to complete the
work. Ocean City Development LLC agrees to pay for the work in thirds. 1/3 of the work is
to be paid on the project start date. 1/3 at halfway point and 1/3 upon completion of approved
work. AMOV
Project Start Date:-Septor-41, 201
Price: $75,000 �GV�� Q h —�
Payment Schedule:
$25,000 Due Upon Fully Executed Contract
$25,000 Due Upon Completion of 50% of work on scope complete
$25,000 Due Upon Completion of Project
Amount Of Days To Complete Project: 50 Calendar days
Additional days of work due to approved overages: Contractor Name:
Daniel Yanez Juarez dba J Home Se Company
c
ell
Print Sign Date
Ocean City Development LLC
i hc/�
Print Sign 7 Date
7
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-082919
AUGUSTO USTA%Z
108 NEW PARK STREET
LYNN MA 0190f
ell
* )I lit Expiration
Commissioner 09/24/2014
r T1,
(Me of Consumer Affairs&Btisiness Regulation
- u
140ME IMPROVEMENT CONTRACTOR
;_ Registration: 125715 TYpe-
t= 2/20/2014 DBA
Xpiration:
ustafiz Home Improvement
Aii#Usto Vil4k
Arsi Apt 1 -
'I�f�iMMAi�-�3�b5. t>i'}'ude secretary