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HomeMy WebLinkAboutBuilding Permit #101-14 - 16 SUTTON PLACE 7/30/2013 BUILDING PERMIT TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION &- X04 F , * Permit NO: I®� Date Received z, "�A.T go �SSACHUS��� Date Issued: 1 M IMPORTANT:Applicant must complete all items on this page LOCATION f / Print PROPERTY OWNER Print MAP 210-NO PARCEL: ZONING DISTRICT: Historic District yes (QO Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair(replacemWP Assessory Bldg Others: Demolitio Other Septic Well Floodplain `Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: dentificttion Please Type or Print Clearly) / /� OWNER: Name: ,`,/� L �� on Phone: 104` !- 174 Address: A; CONTRACTOR Nartey! t hone: Address. zii;- iv�,, f c Supervisor's Construction License: z 7674-0 Exp. Date: Home Improvement License: 17x143 -77 Exp. Date: ARCHITECT/ENGINEER �14-x-- 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. $ FEE: $ Check No.: ®� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he guaranty fund Signature of Agent/Owner Signature of contractor f i 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 I 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site 'yes no Located at 124 Main Street Fire Department 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits ❑ 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) ❑ 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) ❑ Building Permit Application ❑ 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application A Doc:Building Permit Revised 2008 h Location CA.44-rj No. Vj — , Date D �f o - TOWN OF NORTH ANDOVER 6 f1 D",z � Certificate of Occupancy $ Building/Frame Permit Fee $ WL Ol7 Foundation Permit Fee $ Other Permit Fee $ } TOTAL $ r p�] f Check# f � � 266U0 � Building Inspector � r10RTf� own oAndover O - .:� to No. L„K. h , ver, Mass, SQA co..41crew�cw`y1 U BOARD OF HEALTH Food/Kitchen Septic System PERMIT T LD THIS CERTIFIES THAT .. ,Q,,,,,,,,,,,,,,,,, ,,,,,,............................ BUILDING INSPECTOR .........x. .11......Sw ,�s .� ............ has permission to erect .......................... b ildings on ... ...... . . ... .. rQ ...I....... Foundation Rough to be occupied as ...........N......5.%.. . . .A..... ............................................................. 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 CONSTRUCTI TARTS Rough Service ......... ...... . . . . .. .. ........ ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit 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. SEE REVERSE SIDE SN The Comrnonwe¢Ith of 1t14sachuselts 3epartment.of£ridustrial Accidents O.f Ce,of rnvesiiradons. 660 �1%¢shin�trn 5'ti-eet. Boston, AL4 OiII1 N7WW.mass.govldia Workers `Compensation Insura.nee_A fn gwi :Bu>rider s/ContractorslEieetrrciaas/P�uinbers 4v ) cantFnforma#ion N2t]t1e(SnsZnesslon/3nnividual) c4�1/� l���i•�. Address: / y City/StatelZiP:/ /r 1!�Z/' ,� Phone#. ���! � "®,�•�"� Are Yan emplover�Checl;the appropriate bon: T e of ro'ect re cored yP P J ( 4 ) am a employer with: Q. I am a meta conaac - for and I 6. New construction employees(full and/or part=rim)* have hired the sub-contractors 2: I.am a sole proprietor or parizLer- Iisi°,d or-the attached.`sheet`t Remodeling ship and have no employe-,s These sub-contractors have _ 8. Q Demolition wor�ng for m %in any capacity. ;�/workers' Comp insurance. - 9 Building addition [No workers'coma.imsurance 5. - V!Te are a corporaaion and its U required-) ofaccmhave exercised their ' M.0 Electrical repairs or additions 3: I.am a homeov+aer doing all work right os exemption per MGL l I Q Plumbing repairs or additions mysei£[No workers'comp. c:l�?§I(4) and We:have-no 1". koof repairs nsurance'r6cpiII'ed j� employees_ '[No Work.re inm,Ta^ce tvgtiired) 13.0 Other comp. <_.ny an.-slid*t..`:�_�=�=•�z�u i'sal oei fr:a s�-,;..,,„e^r.._'^.orn -- I3omeowa=who submit-fnis atadarrF inni tiny taR=zr-d__;-+-aU w and Tom him outside couaz.:to^��submit a new ainaavrt I +Cnes hng such onttachots titaL�R.�:this i)oF.must attaenee'an additional sheet showing the name of thesub-conaaciorm and their workers'combucq miotmztion:: . lam' an employer&w is providing workers'compeansaumt ilz a once for my empFovees.Below is tFie pnhe�:and�nb site information.- Insurance Comnany13,,Tzme:,�,�p`l Policy r or-Self-ins.LL..:.r te 76 3;,F'°1�Zoe'c >. 14 Expiration Dia /7 Job Site AddrAss: � �� ; ./l �" LC CiiylState/Zip: -` Attach a copy of the workers'compensation policy declaration.pave(showin;the policy number and expiration date). Failure to secure coverage as required under.Section_3A of MGL c Io2.:.an lead to the imposition of criminal penalties of a fin-_up to$100.00 and/or one-year imprisonment-as well as civil penalties in the:foim:of a STOP WORK ORDER and a tine of up to_SZ50.00 a.day a_*ainst the violator. Be advised that a copy of this stat„-meat maybe forwarded tc the Office of Investigations of the DSA for-insurance coverage verification. I do here cerin t h} f}: the pains and penalties ofperjun7 that titc information provided above is True and correct Simature:: Official use only. Da not writ in fids area, to be completed hj:citjr nr town offIc aL City or Town Permituceitse r FssiFi g,Authority(circle one): I.Board of Health .?.Building Deparrment 3-CitylTown Clerk 4.Electrical Inspector S.Piumbing Inspector 6.Other Contact Person: n •" Phone r. 4/23/2013 8 : 32 : 27 AM 8935 ® 03/03 r CERTIFICATE OF LIABILITY INSURANCE DATE 1YYYY) 04/2233112200 13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFiEkt 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(ies)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). CONTACT PRODUCER 00474-001 NAME: p Doherty Insurance Agency Inc (a1C.NL.Exq: (978)175-0260 jAlC.No.: PO Box 1985 EMAI Andover,MA 01810 Aoorss: INSURERS AFFORDING COVERAGE NAIC 0 INSURER : A.I_M.Mutual Insurance Company 33758 INSURED INSURER 8 Damphousse Roofing LLP INSURERC: 87 Belmont Street INSURERD: North-Andover,MA 01845 INSURER_E, INSURERF: 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. INSRR DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSR WVD MIDDIYYYY MIDDNYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES E RENTED $ PREMISESS(Ea occurrence' CLAIMS-MADE F]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG $ OLICY F_WCOT OC lesN AUTOMOBILE LIABILITY Eadenti SINGLE LIMIT $ ANY AUTO BODILY INJJRY(Per person) $ ALL OWNED SCHEDULED BODILY IN URY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYDAMAGEAGE $ AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ A1C STATUU- OTH- WpRKERSCOMPENSATION X TOP.YLIMITS ER ANyD EMPLOYERpS'LIABILITY�� YIN E.L.EACH ACCIDENT $ 500,000 oFFICERltPEPTMBERF,CCLU ED? cunv£ J NIA AWC-400-7028774-2013A 4117/2013 4117/2014 A EL DISEASE-EA EMPLOYEE $ 500,000 (Mandatory n In NH) DESSCRIPI ION OOPERATIONS below EL.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) No partners are covered by the veorkers compensation policy. CERTIFICATE HOLDER CANCELLATION Tovm of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE s ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 4454 APR-22-2013 MON 12:24 PM FAX NO. 9784750303 P. 03 Clients:14415 OAMPHOUSSE ACORQ- CERTIFICATE OF LIABILITY INSURANCE TE(M. PRODUCER A tH14 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONHY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Bolt 1988 HOLIDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BV THE POLICIES SEL_Ow. Andover,MA 01810 _ — INSUR�ERS AFFORDING COVERAGE NAIC INEUREO —�_,_ __ Damphousse Roofing LLPINsuREll A- Ataln SPpcialty Insurance Company- 87 Belmont St North Andover,MA 01845 INtURft{n —.. COVERAGES �—THE POLICIES OF INSURANCC LIS I-En BELOW HAVE BEEN ISSUED TO TME INSIJkEO NAM t�I�ADUVC FOk THE POLICY PtRIAp INDICATED.NOTWI fH$7ANUINt3 ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTH H DO(:l1MtN f WIT RESPEI r T()WHlf:ld THIS GF.RTIFICATF_MAY BE ISSUED UR MAY PfRTAw THE 1NSURnNGE ArTORDED ClY THE POLICIr DESCR18EU HEREIN IS U8.1 CT 10 ALL THE TERMS.EXWIS1ON6 ANn CON17)ITIONS OF SUfa I POLM,IES.AC'0REGATE LIMITS SHOWN MAY HAVE BEEN RL-DUCEO©Y)'AID CLAIM$ LTR NSR I TVPE OF INSURANCE POLICY NUM ER POucr EFFE TIVG FOLICY ExPIRAnON — •• - DATA MMID —DATE fMMIDD/YY} LIMITS — A GENERAL uAE11UTY CIP169387 04/12/13 04112/14 EACH OCCUNRENCF. 11 000.000 X l:OtdMEHCIAL GENERAL I IABILiTY I DAMAGE IA RCNTf:n CLAIMS MAUF �( grCUF Y�LWy`'ty F" rrauLu ? i100,fl00 x ed:l.o00 BI1PD 0 ' Mtu}Xr(Any nn..uernn) 15 _ ' i •'Er,'SfINAL G AUV IN.WkY S1,00010 0 OCNtHA1.AGGIN:CArE $21000y000 t-:EN'L AI;(,RGGA'tF LIM17 APPLIES PER: NRO. >'Raul,(:rs CC1naFM?r'At,c: s2,000,Poo X POI Y IFCT IOC AUTOMOBILE LIABILRV ANY AUTO (:OMRINF..0 SING f-LIMO I (Enam4agr.) i AI 1.OWNFO AUTO.-, I 9CHEDUI ED AU 10S i BODo Y I RIRY (Prr pa.nnn) 1 HIRCO AUT03 1 NON OWNE6 AI IOS I 601111 Y INJURY 3 (Prf nctidrnll r'ROPFRTY DAMAGE 1 (rr.I arr�rlr�lq S GARAGE LIABILITY 41)TU I1NI V-CA At:r.ID[iN I 4 ANY AIJ)U - •-- I T OTHCH MAN CAACn S AI LTO ON Y EXCCSaRrMOREu.A LIABILITY •••--- - I i F.ACn OV--•ift i NCF F Or.C11R Cf CLAIM:,MADE ACCkr-t:ATC I S LIETEN1.1ON S 1 WORKERS COMPENSATION AND I Vu(.:TATU 0TH " EMPLOYERS*LIABILITY i4fi7LLIM1` ANV PH(IrRICTOHIPARTNEII(CXEIaITIVC E.L.RncH ACi:u+cprr g OrFwI`R/MEMH f R CX(A UOCO?If vn:.(tiru:rina„ruler E.L.UIRFA'C r.A EMPLOYEE :f - OPF.CIAL PRf1VIE10NR IWlnw OTHER _ _ E.L.Ul:i(•A•^.0 Ytll ICY LIMI} .-- •� i OESCRIPAON OF OPERATIONS LOCATIONS I VEMCLE3I EBCLUSIONS ADDED 6Y ENDORSEMENT•I SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELL TION SHOULD ANYF THC ABOVE OESCRIBCO POLICIES BE CANCELLED OEFORE THE EXPIRATION Town of North Andover DATE 7HERE0 .T14E ISSUING INSURER WILL ENDEAVOR TO MAIL _U— DAYS WRITTEN 1600 Osgood Street NOTICE 70THGERTWICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO So SHALL North Andover,MA 01845 16 ;t NO pO1IGATION OR LIAGILIIY OF ANY KIND UPON TI4C INSURCR.ITS AGENTS OR RfPRESENTAT ES. AUTHORIZEDPRi-,SL;N� ---' I ACORD 25(2001108)1 of 2 #S29121/M29119 OM ¢ AC CORPORATION 1988 I • Massachusetts- Department iil.Pub is saint Board of S€iildin i Regulation i an Sta t3 ti tls i ds Kiri€ LSA%sut S'�E?T !IGS laB License: CS 67560 _SHAUN IIA TWOMEY 61 PATROIT.ST`.. N ANDOVER,-MA 01845 Expiration: 1012512013 ,tom 1:a3FnrnisNioilei- Tr» 4913 1 i MisSael �€sefts Jet3€4�f L� lcc 'l12' a�1 -BCa'Ct 3{Building r-platioi c nd St -7ni zfdz Cons ructjori Supovisar _4 CS=0551:0.8 DOUGLAS J LEGARE 79:GARY.AVE HAVERHIII L MA 01830 atiia ti rF;, €ssicste;- 0910212014 . ,�v, - �e�p¢��unra�rcaeccll�o�'��czaaac�cc�eLl� d Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR t —registration: 174377 Type: V' �2t4[2015--- LLP ' = DAMPHOUSSE ROOFING'LLP.__. SHAUN TWOMEY - 87 BELMONT ST N.ANDOVER,MA 01845 -- Undersecretary Proposal HIC#174377 Damphousse Roofing uP A trusted name since 1938 Roofing • Siding •Windows 87 Belmont Street • North Andover, MA 01845 P: 978-683-4588 • F: 978-685-7446 r , NAME OF OWNER ADRESS OF JOB / 011 GAO /r TEL. ! �l5 /�/G�' i� DATE: .. T We will remove all roof shingles off total roof area, up to two layers. Replace any boards or sheathing at additional cost. A new 8" white aluminum drip edge applied on all edges. Approx. 6ft of ice and water membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing step flashings to remain. A new base sheet applied. A 30yr architectural roof shingle installed. Install new.vent pipe boot flashings. Waterproof exist chimney flashing and remove debris. Shingle Color: 1 '� 1 Ridge Vent Upgrad&36 per ft. �� u !! Wood Sheathing Repair$-8-W per ft. We Propose herby to furnish material and labor-complete in accordance with above specifi do s, o e.st�m_o_ dollars($ ). Payment to be made as follows /� / � '� �/► ��- 1,--,41//Y\ Authorized Signature ��,, NOTE:This proposal may be withdrawn by us if not accepted with in/(''days Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature Date of Acceptance: 7b r J J� Signature HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(M.G.L.142A) 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware.If such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract.Lawn or Driveway may be damaged by dumpster or equipment.Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS:If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or approvals are necessary.Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within 7 days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractor's control.Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,governmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS:Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract.Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel.Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay Contractor's reasonable costs of collection,including attorney's fees and costs.Time is of the essence hereof. 5. WARRANTY:For a period of lyear after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowners.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Registration No: 174377.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www.mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. 8. ARBITRATION:Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A.No lien or security interest is imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract;(b)the Homeowner has funds available to make full payment under this contract to the Contractor upon completion;(c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates and holds harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court costs)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10.CANCELLATION:Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day following the signing of this agreement. Q� J r HOMEOWNER: v�!�' DATE: Shingle: ��� DEPOSIT: TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION i Permit NO: 5 Date Received Date Issued: -- "l I( IMPORTANT: Applicant must complete all items on this page LOCATION J vt T PL Print PROPERTY OWNER L L -ic. >`� Unit#_ Print MAP NO:( ­PARCEL:—hZONING DISTRICT: Historic District yes no Machine Shop Village yes o it 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'B..One family ❑Addition ❑Two or more family ❑ Industrial -H Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Floo in �t❑� .6fla dss. Ws d District �ar' -� - - DESCRIPTION OF WORK TO BE PERFORMS �� (Identification Please Type or Print Clearly) 7 OWNER: Name: L c, S Phone: �cJ c y c Address: S,�4-4-0� CONTRACTOR Name: I Phone: Address: c( �d ( � Exp. -- 2- Supervisor's Construction License: Date: Home Improvement License: [ (o �� Exp. Date: + + 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ q -�o FEE: $ Check No.: S Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t e guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ ,Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ I Food Packaging/Sales ❑ I Privatetanktic se ❑ Private(septic �etc. Permanent DumP ster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS I i 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124,Main.Street Fire Department signature/date I 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 MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perm Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) +' � g o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi __ I Location 141o,No. Date Date HpRTM TOWN OF NORTH ANDOVER Oi�«•a .•,�O .. 9 Certificate of Occupancy $ CNUs<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 4 4 G 6 5�-----,'� Building Inspector 1 r• . f The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02I11 1UV www.mass90v1dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers App icant Information Please Print Lezibl� ' cr.,p r /� Naffie(Business/Organization/Individual):' G d� 1 - !\ ro Address: U C� S \� Q ✓ 4161'r— city/state/zip: ,2 d Phone#: 7S// F�44 Y 7(o Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full.and/or part-time).* have hired the sub-contractors 2.0-1 am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have 8. [❑Demolition working for mein any capacity. workers'comp.insurance. 9. F1 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance form employees. Below is the policy and job site information. Insurance Company Name: y Policy#or Self-ins.Lie.#: iP S S�(o Expiration Date: 40 3 �� Job Site Address: /`y �t'{- i �� 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 required under 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenaldes ofperlury that the information provided above is true and correct. / Si O ature: Date: Phone#: [Other only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): I. Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.PIumbing Inspector son: Phone#: it .. ostt:natomr+�l! CERTIFICATE OF LIABILITY INSURANCE 07,13,2011 V Arm coN�s ao FWAM UPON TNF CEt'fI MATE TM oN� TM t�RtiwCATTc e5 a As A ptATT@t aF a�IP0ia1AT10N � �rrEM .� coveAAOe A BT TME CEffPFICATE DOER NO' AF AA7IYRY OR NEGATN!!.Y ,WEND, E%i81D e�fraAM GETWM YM iB8<UVQ MSL% M AUntORtt� BELOW. TMS CEWftWATE OF MMRAMCE DM tM GoNSTffM A ,,,,9ENTATNL70APRODNCER.ANDT"EConVpCATENOLOmIlRfit OC efleofeaa d B GAT�1I t8 WAN®. to WIND. OEM does nocolds► flow to toANr Vw as a h010sf eooYr P My �� an e.„ A ms sadetam+nan on ltus cefe>r e em terms Conom- of tlW 00my. ce ceNil, hokW kl Iku M such erdmeerller%&)- Mum emy ri450RANM � pyWplfgler. 28 CMV= 82 AtM= •S Muco �g�, » 02890 �pA$9t;<88 INSO'RA� a+l,>so Ilwelra�s/ Psic f'l�g 9 wildMood Rd sreuREae: ENRIM o:Et02155 PI REves NUMBER COVERA4E3 CEifriFlCATE Nu[aBt�s RED F� THE POLICY ig To CERTIFY T►us T1tE POup� OF esBl7 lt9TED BLOW w►VE OTHER 00009df1r wt�ME To TW RraM -MM OR COMffQN OF �N M SUBJECT TO AL< ttE TEa�s• INOICATM. NOTWRMGTANOIN6 ANY fiE0NRE1A9r1�. pgDFO SY THE POLCU O CVMKCA'M MAY BE ISSUED OR MAY PERTMN. nW MA "AVC VV BEEN RWUCm BY PAID CLAMOCAODNS MID CONORIONS OF M)CH POLICIES.LIMBS SHOWN Lome Am ow pd,KYlOI�i l s i,000,000 wuaQ 7f11D tJltif 00V111+11 ' � 6500,000 8 xn c"25565 10/03 1u s DJ aim e+�weroft o�a w.swOB Ocala ,A>,a,avnwmr a ,E 61,000,000 PROOUCIs_OONP>O�W6 6500,000 i�AG�+TiIAIIf�IPRIBB PEk j s Pale► PRO. ` D6eICri r=7n+rt a R�endeeo0 A,n,oeeoerEuaeam s AW AUTO 80OLTMA"w(ftwoodomo s ALLOWNOAM s so>,solu.Ev� ryarao�low0 9 ' MIa®AOT08 - S rpu.pNn7E0 su1bS rSICnOCCWIROICE 3 WAPA 1Awe OCCUR AGGee�Tf a occfasu.e s s oEOuensls Aff"NTION i 7OIIY WRa Ea Wpplcfef00WO+eI liE/IChAT s MID EMPLOY' Y,a S Fl MIA l.L..OI um-EABmLAI H EA.09EAM-f01.IC'fUMT a oym.Ofif,AOl,bet OF.B r IPTM OP AT OG�P� „a�,lA.la�a,I,00Atlae,Va�e�"10�0 7H.AAAYWLI�fWMCIU.II����� CANCELLATIO'F1 CWMRCATE MOLDER D AM TM ASO" oeD POtJDI� SMfJ1NCBlID JNA TO= OF T�TGSSOPA IM MVIAvlon OM Tt1EMOK l#UM TALL aE oEtllfr� N AOOOet1A"V'ffNTMLPOL=V>MOVMOM wYMORM Al1YE A conpORAT10K AB eipht6 iftACM naveGnd100* Mw of ACOfiD 2S MOM) rnnilnn •l �M1ZHALI1VA DOME Mai tzll Oak l H-SI-lllf NORTH ToNkm of _ Andover ., _- = - _ �a o , lover, Mass., COCHICHEWICK ORATED V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............. ..'.J. .....). ........... ��a o. . ..0` `............................................................................. Foundation has permission to erect........................................ buildings on ... ........... . .....�!�..... tom.. . ...................... Rough to be occupied as............7 .G.........�� <�l.(,�...... ...... . . Chimney provided that the person accepting this permit shall in every respect conform to the terms of the.application on file in Final 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 y y' jow- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR V ` UNLESS CONSTIZUCTI ARTS Rough ..................... ..................................... ................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. am�n�yn�lea�� °sines✓v R g�tt�° II t Office of Consumer Affairs&B CTOR HOME IMPROVEMENT CONTRA Type: = Registration: ,.0.63751 Individual Expiration: 7-1,2112013 'MURPHY +K,. ER I ERIC MURPHY 164 SHERIDAN AVE Undersecretary MEDFORD,MA 02it 155; Pul)lic afetN lNlassachusetts: ®cP`►um ti<tnst and Sta dards 2 Board of 8uildin.� R Construction Supervisor License License: CS 94270 Restricted to: 00 ERIC J MURPHY i 164 SHERIDAN AVE MEDFORD, MA 02155 Expiration: 31912012 C--G-- �� Tr#; 18994 ('utnmissiuncr - 07/13/2011 09:48 6036680246 REBATH OF NH PAGE 02/03 - -r f! M_- ' N®me: L� Address: City: Statey !. � �`•4 Zl p: Elm StIrMt,Unit 61 � - ManchesteTr, NH 03101 Horne Tei.: 503425-0303 . 1.000-BATHTUB Work Tel.: www.treb2lthnh. corn 'rnfOWebatitnh-aom - - Job Address: Cross Street: E-mail' COW: Marble 4ranito ----�- Surfaoe Roman Full Lengthiat CaHng Bar Soalp Soap Dish Comer Over TUb/ARs Q MARK ALL APPROPRIATE ITEMS D� A Shampoo 77 Sbbhyy))avyeemrrpoo OrnEr � -t8 COLOR• LLI 'S.SATHT.U13 ❑:Right LeeSHOWER BASE: - Flat Seated hae Bl�ll Almond -- S!S REPLACEMEF4 T TUI3 �,�, w DlmenslonS:_ a—T'h X-LdX-i 13alhgaro e- s Rwrnov9/ e Q-DRAIN SHD PAIR• rj p� HiOm6 r8i5;. 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'© 314^ ` Dinrensrmrrn� � .h• x �iZ-=iL w Other Material' WI-C ' -2— VVIndPvv Trim Kft: e� No Color-Ad�s 13 WAINSC AU SVST f Color � 'Ft: P C SMC 4":.8"a 1Y R9pTnaerrrent Wlndo+r: Vest No Ct br OB —B C Od Newport fry L T e: C7i1 .ii6aldS era tie Primary Payment Method klMomly Order ❑Dlncovar ❑MasterCard ❑Vtsa _- -�- r [ T T Ir —r pdMaryAccount Number. r.+ I.�t._ Seeondnry Payment Method. ❑Check/Mon Ardor Q Dis y cover ❑I 9tetGrrd C]err,w Secondary Account Number Ereplrapon: / conmll> lTsfNOTr:s: (other bath araftsblo?)nErF6(3) it ®work area? s0 noQ 1 rAnd-jg ?n o yea LJ noUN^ All dapositrt ere not rehtndable atter the three day prreelletion perlbd-Depoalhs will be applied to exImenses incurred for thlR aorrbaet. Son10 tub iras►tsllallons requite a test Shalt w determino an exact fit d regUlred.approximately 3 weaita VAII be added to esdrnated dellvery- .lob to:stat=rnq1naplNoxlmat¢lyw"k. JOB TOTAL $ TAX 5 OBAI.LTANT�t; • "L.' .7'i't Date: L ( '� mss- 1 TOTAL $ 7 i Customer (� ^ Signatlure DEPOSIT r Date Customer: DUE UPON p s'slnan'79 COMPLEflON $ !® 7G . . www•