HomeMy WebLinkAboutBuilding Permit #899 - 172 CHESTNUT STREET 6/24/2013Permit NO: 01
LI
Date Issued: I I ti'(
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIONN61zq
Date Received
I X-1) I1qPORTANT: Anblicant must complete all items on this.Uai?e A I
LOCATIO
N
PROPERTY OWNER 6'j'
'Print
MAP NO PARCEL ZONING DISTRICT:
100 Year Old Structure
Historic District
Machine Shop Villa
yes no
n-
ves k no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ Rew Building
❑ One family
❑ Addition
0 Two or more family
0 Industrial
❑ Alteration
No. of units:
0 Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
0 Other
0 Septic 0 Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:
Address:
9aTs
CONTRACTOR Nam /� hone:
Address.
a
Supervisors ons ruction License: �1I Exp. Date: 7---
Home Improvement License: 6lD0Exp. Date:
ARCHITECT/ENGINEER
Address:
Phone:
Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BAS TM,
00 PER S.F.
Total Project Cost: $ S� s >' 0� FEE: $
Check No.: 'D�� Receipt No.: 62 5
NOTE: Persons contracting with unregistered contractors do not have access to the guara fi
Signature of Agent/Owner Signa of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stam Plans ❑
Location
I
No. Date,��,!�- k3
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $-
TOTAL $
Check #
Building Inspector
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
PLANNING & DEVELOPMENT
DATE APPROVED
El
i
COMMENT
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
® OF
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
It
Conservation Decision: Comments
Dater & Sewer Connection/Signature & Date Driveway Permit
DPW To -vv;^ ]Engineer: Signature:
Located 384 Osaood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Mair Street
Fire Departmerit signatureldate
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
NOTES and DATA — (For department use
D Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The fol,owing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofiv,g, Siding, Interior Rehabilitation Permits
6 Building Permit Application_.
m
❑ Workers Co - #fiida'vit Y s►- ��
❑ Photo Cop f H.I.C. And/Or C.S.L. Lic ses
❑ Copy of C tract
❑ -Pr Proposed Interior Work
q,-EAcfinee4FKjAffidavits 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 app, -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Bui";iing Permit Revised 2012 f
C®nt r
This 301M sages all basic requirements of the slate's Home improvement Contractor Law (MGL chapter 142A), but does not include standard
language se protect homeowners. SeeTc legal advice if necessary. Any person planning home improvements should first obtain a copy of "A
Massachusetts Consumer Guide to Home Improvement" before agreeing
Office of Coto any work on your residence. You may obtain a free copy by calling the
mer Affairs and Business Regulation's Cosumer information Hotline at 617-973-8787 or 1-888-283-3'157 or on ovr website. '
Homeowner mt"m� on 'Contractor 'n-matio»t
ane contractor agrees to do the following work for the Homeowner: v v
(Describe in detailthe worlcto completed, specifyingthe type, brand, and grade of materials to be used, use additional sheets ifnecessa
nekuired Permits - The following building permits are required
and will be secured by the contractor as•the homeowner's agent:
Peters who secure their own perwaits'vvM be
excluded from the Guaranty Ftmd provisions of
MGL chapter 1.42A.)
Proposed Start and Completion Schedule - The following schedule will
be adhered to unless circumstances beyond the contractor's control arise
when contractor will begin contracted work.
when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of-
Payments
£Payments will be Cmade according to the following schedule:
up -on signing contract (not to exceed 1/3 of the otal contract price
$ D y f 3 or upon completion of
$ by .ice/j or upon com letion of
-- pVV✓'1t
cosi of special order items, whichever is greater)
t _ . rf — 1
upon completion ofthe contract, (Law forbids demandingfanpayment \I-
-
Until contract is completedto both
'party's satisfaction)
The following material/equipmentmust be special $ to be paid for
ordered before the contracted work begins in order
to meet the completion §chedule.(* *) $ to be paid for
NOTES: (*) Including all finance charges (*:1.) Law requires that any deposit or down payment required by the contractor before worlcbegins may
not exceed the greater of (a) one third of the total contract price or ((m) the actual cost of any special equipment or custom made material
which must be sgeeial ordered in advande to meet the completion schedule.
Ex rens Warran -Xs an e. essw,
girrantybeingrovided b the contractor? ❑ No
El diothe
Sub contractors -The contractor agrees to be solely responsible for completion of the
work d sces ribed regardless of the actions of s of the ran any third ontracf
Party/subcontractor utilized by the contractor. The contractor farther agrees to be solely responsible for all payments to all subcontractors for
ate ials and aborunde this a Bement
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
caref-ally before si o*,i.,g t11;s ,.,,nt ,ct
C Don't be pressured into signing the contract. Take time to read and fuliy understand it. Ask questions if something is unclear,
aloe sure the contractor has a valid Home Trri rovement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director ofT_joie improvement Contractor Registration. You may inquire about contractor
registration by writing to theTirector at 10 ParkPlaza, Room 5170,130ston, MA 02116 or by calling .617-973-8787 or 888-283-3757.
Does the contractor have insurance? AsIc the Contractor for his insurance company information so that you can conium, coverage, or aslc to
see a copy of a "proof ofisurance" document.
o 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, of ace or branch office by ordinary mail posted, by telegram sent or U delivery,
third business day following the signing ofthis agreement. See the attached notice of cancellation form for an exnation Ofthis not later thanht. ofthe
D®lCT®T'SZGAT 7C[Q r*,O
entical NTRA.CT 7F TITERE A1t� ANS
co ' s ofthe contract must be completed and signed. One copy should go to the homeowner. The
Date
SPACE SIN
ibe Iceptbythe contractor.
M
Contracior Arbitration
The Home Impi ovement Contractor Law provides homeowners with the right to initiate an arbitration action (as an
'alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner.in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home improvement Contractor Law.
The 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 the dispute to a private arbitration fii�aa which has been approved by
the Secretary of the Executive office of Consumer AiEairs and Business Regulation and the consum-er shall be required
to submit to such arbitration as.provide d In. Massachusetts General Laws, chapter 14
H e is Signa we ontr or's S' ttiue
NOTICE: The signatures of the paries above apply only -to the agreem .the pax • s to alternative dispute
resolutimi initiated by the contractor: The homeowner may initiate alterative dispute resolution even where this
section is not separately signed by the varties.
Roameowner's Rights
A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 14.2A) and other consumer
protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners
may be excluded from certain rights if th contractor they choose is not properly registered as prescribed bylaw.
Homeowners who secure their own building permits are automatically excluded .From all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor, all goods sold•in Massachusetts cavy an implied warranty of in and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below).
]Execution of Contract-
The
ontractThe contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced
docuunents have been attached. Parties are also advised not to sign the document ental all blank sections have been
filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with a ttachments -it, to
be given to the owner and the other kept by the contractor. Any modification to the. original contract must be in writing
and agreed to by both parties. Contracted work may not begin until both parties have received a frilly executed copy of
the contract, and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the -Payment schedule in cases where the
homeowner deems him/herself to be financially insecuire. However, in instances where a contractor deems him/herself
to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a j oint escrow
account as a prerequisite to continuing the contracted work
signatures of both parties. . Withdrawal of finds Cron said account would require the
Additional Information
.If you have general questions or need additional information about the Home Improvement Contractor Law or other
consuuner rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Impiovement"
contact:
Consumer Information Hotline
Ogee of Consumer Affairs and Busin.css x�eg la don
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or-visittheOCABRwebsite atllttp:/lww�v.mass.gov/ocaU1l
If you want to verify the registration of a contractor or if you have questions or need additional infornation specifically
about the contractor registration component of the Home Improvement Contractor Law, contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and -Business Regulation
16 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the BIC website at littp://wvnv tnass.aov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
hii7a://dU.state.ma.us/hoaneimytovement/licenseelist asn
For assistance with inforrna7, mediation of disputes or to regisi:er formal. complaints against a business, calx:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
SOS -6S2-4800,508-.-755-2548 or 413-734-3114
Version 2.1-11/22/2010
The Commonwealth of Massachusetts
Department of Industrigl Accidents
Office of Investigations
600 Washington Street
Boston, MA. 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leizibly
Name (Business/Organization/Individual): M,f�(2 e4 jZ
Address: P1,P,.5 ST q4
City/State/Zip: (i�% �U� t�/ !�� �%��y Phone #:M " -//UQ Z
Are you an employer? Check the appropriate box:
❑ 4. PJ I I
Type of project (required):
1. I am a employer with
am a general contractor and
6. ❑ New construction
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet. #
�• FI Remodeling
ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working for me in any capacity.
workers' comp. insurance.
9. ❑Building addition
[No workers' comp. insurance
5. ElWe are a corporation and its
10.❑ Electrical repairs or additions
required.]
officers have exercised their
3111 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.❑Roofrepairs
insurance required.] t
employees. [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.
T Homeowners who submit this affidavit indicating they ace 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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:. �U1gi� /� ►�lP�i�ffr�/ //1/M4fi/Ce. !�2�P
Policy # or Self -ins. Lic. #: j� i? zv 6 qy3OZ 3 - O -- IL Expiration Date: a �K- 2 3
�Z i°5 urs S�
Job Site Address: City/State/Zip: &21 ]L /�/1l 4W14
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.
Ido hereby cert ypder thoains andpenalties ofperjury that the information provided above is true and correct.
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 5. Plumbing Inspector
6. Other - - -
Contact Person: Phone #:
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 of hire, •
express or implied, oral or. written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a j oint 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 producedacceptable evidence of compliance with the insurance coverage required"
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public 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 certificate(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 confirmation 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 (if necessary) 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 and fax number:
The Commonwealth ofM-assacl,usetts
Department ofladustdal .Accidents
Office of Investigations
6.00 Washington Street
Boston, AU 02111
TO, # 61.7-72.7-4900 oz t 406 or 1.-877, 'ASSAFB
Revised 5-26-05 Fax # 617-727-7749
--wwwanass.gov/dia
NOTICE
TO
EMPLOYEES
NOTICE
TO
EMPLOYEES
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
ZURICH -AMERICAN INSURANCE GROUP
NAME OF INSURANCE COMPANY
P.O. BOX 1450
MIDDLEBORO MA 02344-1450
ADDRESS OF INSURANCE COMPANY
(GZZUB-4873P23-0-12) 09-29-12 TO 09-29-13
POLICY NUMBER EFFECTIVE DATES
ALBERT J TONRY & CO INC 300 CONGRESS STREET
"'- QUI NCY MA 02169
NAME OF INSURANCE AGENT ADDRESS PHONE #
^
TEJADA, LUIS M DBA MIGUELIN 225 BROADWAY SUITE 203
o�
CONTRACTING &
METHUEN
.� MA 01844
EMPLOYER ADDRESS
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
'— connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
nmaaa 1AIMPIe:A9 TO BE POSTED BY EMPLOYER
iLlriiu•1.aA 110-1
07.LUIZU16 b:'L5:34 AM PAGE 2/002 Fax Server
'CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
T TIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICA7 S
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 and endorsement. A statement on this certificate does not confer rights to
the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
ALBERT J TONRY & CO INC
300 CONGRESS STREET
PHONE
(AIC, No, Ext):
LA g
QUINCY, MA 02169
E-MAIL
ADDRESS:
2873Y
INSURER(S) AFFORDING COVERAGE NAIC 4
INSURED
INSURER A; AMERICAN ZURICH INSURANCE COMPANY
TEJADA, LUIS M DBA MIGUELIN CONTRACTING
INSURER B;
INSURER C:
225 BROADWAY SUITE 203
INSURER D:
IvIBTI-IUEN. MA 01844
INSURER E:
INSURER F. -
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFYTHAT THE POLICIESDIFIRSURANCE LISTED BELOW-RAVFE-BEEN ISSUED TO THEINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT
TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY
HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADD
L
SUB
R
POLICY NUMBER
POLICY EFF DATE
(MKDDIYYYY)
POLICY EXP DATE
(hftDDIYYYY)
UMTS
GENERAL LIABILITY
=.ACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE r7 OCCUR.
EMISES (Ea occurrence)
Ll
ED EXP (Ary one person) $
GEN'L AGGREGATE LIMIT APPLIES PER:
RSONAL & ADV INJURY $
ENERALAGGREGATE $
POLICY PROJECT ❑LOC
ODUCTS - COMP/OP AGC $
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE $
LIMIT (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULE AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY $
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
CEDUCTIBLE
$
RETENTION $
$
A
WORKER'S COMPENSATION AND
EMPLOYER'S LIABILITY YIN
UB -4873P230-12
09.29/2012
09/29,'2013
WC STATUTORY
X LIMITS
OTHFR
ANY PROPERITOR/PARTNER/EX=CUTIVE Q
N/A
E. L EACH ACCIDENT $ 100,000
CFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $ 100,000
If yes, desmN under
DESCR PTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTMCTIONSISPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO TEE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
ATTN RICK
CERTIFICATE HOLDER CANCELLATION��
GREY ROCK CONDOMINIUM] SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
C/O SUTTON MANAGEMENT BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IAUTHORIZEDTA
IN ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 773, 200 SUTTON STREET
REP TA._ .k�:.•--:.w
NORTH ANDOVER, MA 01 845 i?g'T""" t
,; rt .' ,...••
ACORD 25 f9010/n51 Tha Arr)Ph name a d 1 �� - -� ......
n ogo are registered marks of ACORD 1988-2010 ACOR CORPORATION. All rights reserved.
UO)MOCAN
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• pow
JO (PT66) lao.; arqno 000,;E Ump
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Office of Consumer Affairs and Business Regulation
s --
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175629
Type: Corporation
Expiration: 5/28/2015
MIGUELIN CONTRACTING INC.
LUIS TEJEDA
38 KENDALL ST. REAR #1
LAWRENCE, MA 01861
SCA 1 t3 20M-05/11
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`L. Office of Consumer Affairs & Business Regulation
) ME IMPROVEMENT CONTRACTOR
C
^Pegistration: 175629 Type:
:expiration: 5/28/2015 Corporation
MIGUELIN CONTRACTING INC. .
Tr# 240852
Update Address and return card. Mark reason for change.
l i Address ❑ Renewal F-� Employment ❑ Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
LUIS TEJEDA
38 KENDALL ST. REAR #1 �4 _
LAWRENCE, MA 01861 Undersecretary of v i without ig ature
t-.
MIGUELIN CONTRACTING INC.
225 BROADWAY SUITE 203 METHUEN MA 01844
978-794-1182 Cell 978-420-8052; Fax 978-327-5599
* ROOFING * SIDING * REMODELATIONS * BOILER
*LEAD PAINT REMOVAL * ASBESTOS REMOVAL
CONTRACTOR LICENSE #CS -089346
HOME IMPROVEMENT LICENSE: # 175629
FREE ESTIMATE - FULLY INSURED
E-MAIL: mi¢uelincontract(a)aol.com
PROPOSAL SUBMITTED TO:
SUTTON MANAGEMENT
NAME: GRAY ROCK CONDOMINUM MANAGEMENT.
ADDRESS: 136 Chestnut Street
North Andover, MA 01845
PHONE: 978-689-9994
FAX: 978-388-2590
. DATE: MAY 20, 2013
WORK TO BE PERFORMED AT:
176 Chestnut Street
North Andover, MA 01845
We hereby submit specifications and estimates for
SHINGLE ROOF 52. SQUARE FEET):
1. Strip Roof 2 layers.
2. Replace 20% of Damage Wood.
3. Ice and Water Shield 6 feet.
4. 8" Aluminum drip edge on all edges of roof.
S. Replace damage and all step flashing.
6. Install water shield around flashing.
7. Effective attic ventilation.
8. Labor ten years warranty.
9. New boots on vent pipes.
10. Shingle CertainTeed XT Extra Tough 30 years warranty stab black
11. Premises will be cleared of all debris, including any nails.
JOB TOTAL:
Fifteen thousand dollars»»>$15,000.00
The propose hereby to furnish materials and perform the labor
complete in accordance with above specifications.
COST SPECIFICATION:
Fifteen thousand dollars»»»»»»»$15,000.00
Payment to be made as follows »»»»»»»»$ 5,000.00 is require to start work.
When half of the work is done»»»»»»»»> $ 515000.00
Balance Upon Complexion»»»»»»»»»»>$ 5,5000.00
NOTE: MAKE CHECK PAYABLE TO LUIS MIGUEL TEJEDA
All material is guaranteed to be as specified, all work to be completed in a workmanlike manner according to standard
practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written
orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered
by workmen's Compensation Insurance. Thank you for your business and look forward to our relationship.
k- -.. .! I
Authorized c'/
Signature Date:
uis el Tejeda
ACCEPTANCE OF PROPOSAL
the above prices, specifications and conditions are satisfactactory and'are hereby accepted. You
are authorized to do the work as specified. Payment will be made as outlined above.
Signature: Date of acceptance
t
This form satisfies an basic requirements of the slate's Home improvement Contractor Law (MGL caapter 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 agreeingto 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.-3'757 or on our website.
Homeowner Wormat,7loII1 J
. ., Contractor IniF®l-matinn
The Contractor agrees to do the following worIc for the Homeowner: , '..� � ,I
(Descn'be in detail the woricto completed, specifyingthe type, brand, and grade of materials to be vsed, use additional sheets ifnecessar
Required Permits - The following building permits are required
and will be secured by the .contractor as•the homeowner's agent:
(Owners Who secure their Owen Permlts :will, be
excluded &OM the Guaranty' Fund provisions of
MGL chapter 1.42A.)
Proposed Start and Completion Schedule - The following schedule will
be adhered to unless circumstances beyond the contractor's control arise
when contractor will begin contracted work.
when contracted work willl be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform. the work, furnish the material and labor specified above for the total sum o.
Payments will bemade according to the following schedule:
upon signing contract (not to exceed 1/3 of the oral contract price
$ �l Y -7— �3 completion p on letion of
$���j �by�/�q,�.,
or upon completion of -,,/(' Or 1G
cost of special. order items, whichever is greater)
T_ . — -rr
upon completion ofthe contract, (Lawforbids demandingfull.payment until, contractis com letedto both
•p party's satisfaction) .
The following 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: ("D Including all finance. charges Law requires that any deposit or down payment required by the contractor before worlcbegins may
not exceedthe greater of (a) one-third of the total contract price or (b) the actual costo£ any special, equipment or custom made material
Which must be special: ordered in advaude to meet the completion schedule.
Express Warranty -Ts an e-mresswarrant beim rovided b the contractor.
Subcontractors -The contractor agrees to be solely responsible for completion of h work describedregardless ofthe actions ofeanythird Contract)
pa renals Lntractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
Materials and aborundertiris a Bement
Contract Acceptance -Upon signing, this document becomes a binding contract under law. Unless otherwise noted witbin this document, the
eonteact shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carcfally before Si -n -b .q c^retract,
C Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear..
o aloe sure the contractor has a valid Home Ymrlroyement Contractor Re et,•a
tion subcontractors to be registered with the Director ofl-Iome improvement Contractor Registration You omayst ome improvementire itcontractors
ox ctors and
registration by writing to thoDirector at 10 ParkPiaza, Room 5170, aoston, MA..02116 or by calling .617-973-8787 or 888-283-3757.
c Does the contractor have insurance? AsIc the Contractor for his insurance company information so that you can confirm coverage, or aslc to
see a copy of a "proof of insurance" document.
o Xnow your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the
Guide to the Home Improvement Contractor Law. Consumer
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 offf cc 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 ofthis agreement. Seethe attached notice of cancellation form for an explanation ofthis right.
DO NOT'SIGN TMS CONTRACT IF TI-CERE ARE M1Bk—AMKrtrxwo idenfi0 -cc' s of the contract must be completed and signed, One copy should go to the homeow5� �9 C�S ontractor.
'Date
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` SHAHEEN GUERRERA & O'LEARY, LLC
Jefferson Office Park
Peter G. Shaheen** 820A Turnpike Street
Nicholas S. Guerrera** North Andover, Massachusetts 01845
Sean P. O'Leary** Telephone: (978) 689-0800 Toll Free: (866) 665-5834
Carol A. O'Learyt Facsimile: (978) 794-0890
Kyle J. Scandore* E-mail: pshaheen@sgolawoffice.com
* Admitted in MA
** Admitted in MA and NH
t Admitted in MA, NH,
ME and CT
December 14, 2010
Gerald Brown, Inspector of Buildings
Building Department
I own of North Andover
1600 Osgood Street
North Andover, MA 01845
RE: Grey Court Condominiums —172 Chestnut Street
Dear Mr. Brown:
.����•r�� a tt'c, iLy
(rpt ► � ('�,�1 y"% , 6✓ C''�
Please be advised that my office represents John DeAngelis. Mr. DeAngelis has
requested that I respond to your letter of December 8, 2010. As an initial point, you should
J know that there is currently a dispute ongoing between Mr. DeAngelis and the current Board of
Trustees of Grey Court Condominiums regarding the use of two apartments located in the former
stable building. Unfortunately, due to that dispute I believe that you have been given either
incorrect or incomplete information. These apartments are currently located in the former stable
and have been in continual use for approximately 20 years. Although I have not had a chance to
review your file on this property, the absence of a building permit is not surprising given the fact
that this is a pre existing structure. Moreover, pursuant to MGL Chapter 40A, §7 no action can
now be brought to enforce a violation of the building code relative to their use. Therefore, the
use and occupancy of these apartments is not illegal under current Massachusetts law.
Thank you for your attention to this matter. Should you have any questions or wish to
discuss this further, please feel free to give me a call.
Very truly yours,
Peter G. Shaheen
PGS/jcj
f cc: John DeAngelis
V ,..
BUILDING DEPARTMENT
Community Development Division
John DiAngelis
P.O. Box 660
North Chelmsford, Ma 01863
RE: Gray Court Condos
172 Chestnut Street
North Andover MA
December 8, 2010,
Please Be Advised a recent Inspection revealed that a Building Permit was never issued for the
two residential dwelling units in the stable/barn building. The Massachusetts Building Code 780
CMR 5110.1 Permit Applications: ( It shall be unlawful to construct, reconstruct, alter, repair
remove or demolish a detached one or two family dwelling; which is regulated by 780CMR
51.0-99.0 without first filing a written application with a building official and obtaining the
required building permit and all other required permits therefore). Occupying a structure without
a Certificate of Occupancy is a violation of the Massachusetts Building Code 780CMR, and the
Town of North Andover Zoning Bylaw.
You must discontinue this Illegal use and Occupancy and remove the two illegal apartments
immediately.
Thank you for your attention to this matter. If you have any questions, please call the
office of the Building Department at 978-688-9545.
Very truly yours,
Gerald Brown, Inspector of Buildings
Building Department
Cc: Sutton Management Co.
200 Sutton Street
North Andover ma
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9545 Fax 918.688.9542 Web www.townofnorthandover.com