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HomeMy WebLinkAboutBuilding Permit #138-15 - 212 BRENTWOOD CIRCLE 8/7/2015 BUILDING PERMIT ONORTH �St.ED 16�•rO TOWN OF NORTH ANDOVER o� y : - - °� APPLICATION FOR PLAN EXAMINATION ` A o ,. Permit No#: - Date Received 'Irl^0KITED Date Issued: " /3 SSACHUS� IMPORTANT:Applicant must complete all items on this page (L-OCATION o�I teen 7'lu�oo`: -` Ir< /� % ✓P1 N�0.��'YS` -{ +Print' - PROPERTY OWNER 0 VXI(A R,ri �10o Year Structure dyes- 1MAP .. tPARCEL ' ZONING DISTRLCT Histone'Distnct yes o � + - �v. i irie Sh illa geIJ yes° 5 TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building VOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Z" s mak: District, i r s❑;Septic ,Well r #, s ® Floodplainr ; Wetlands f ❑ Watershed District � sy ,Water/Sdwer ' y DESCRIPTION OF WORK TO BE PERFORMED: Lc Identification- Please Type or Print Clearly OWNER: Name: '16 k n Tiez t"Ito Phone: 61? 74 Address: , -O- - �}3 s r� a . �{ W `w ''' " .c: w 4,.�,,,ay. •' Hh itk„_. u -51 Cont�actor6Name ' �'S r `a�Phone :. Ad4dressesry / "d, (W' , s �" gEx ®ateA' ==Supervisor s(Construction1LicenseKT fLA Home(Improvement License -; - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 9,,)-00.DO FEE: $ t� Check No.: � Receipt No.: r& NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund Signature of Agent/Owner Signature of contractor r Location(r� L/ No. _ Date 1 i . • TOWN OF NORTH ANDOVER 'IMD, . • Certificate of Occupancy Y Building/Frame Permit Fee $ . - Foundation Permit Fee $— £� ._ Other Permit Fee $ r Alf Z11 }` TOTAL $ Check# i �' 0 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 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 Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE D'EP�►R rMENT Temp Dumpsfer on site yes Located:at 124 Matra Street 2 � t Fire Department signature1&dd COM1VlENTS 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 o Building Permit Application j Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks o Building Permit Application ❑ 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 Hydraulil Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 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 Dnc:I\SpL(110NAL SERVICES DEPAR'1'AIEN'r;BPFORN1115 l'a'te 4 of-t B/7/2014 3:50:06 PM PST (GMT-8) FROM: 100005-TO: 19786889542 Page: 2 of 2 A CERTIFICATE OF LIABILITY INSURANCE DATE' N" 8/7/2014 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(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). PRODUCER T A SULLIVAN INSURANCE AGENCY INC CONTACT NAME: 135 MERRIMACK ST PHONE FAX METHUEN, MA 01844 AIC No E><t: ac No: E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC tt INSURERA: LM Insurance Corporation 33600 INSURED SCOTT WRIGHT INSURERS: DBA WRIGHT GUTTERS INSURERC: 350 BERRY STREET INSURERD: NORTH ANDOVER MA 01845 MSURERE: INSURER ' COVERAGES CERTIFICATE NUMBER: 21153004 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. INSR ADDL SUER LTR TYPE OF INSURANCEINSD WVD POLICY NUMBER MMIDDTY MM/ DDY YWM'YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ D AG RENTED CLAIMS-MADE LIOCCUR PREMISES a occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea smidenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS NON-OWNED PROPERTYOAMAGE HIRED AUTOS AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION WC5-31S-387187-013 9/30/2013 9/30/2014 PER OTH- ANDEMPLOYERS'LIABIIJTYYIN STATUTE ER ANY PROPRIETORiPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? Y NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100000 UIf yes,descrI under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SCOTT WRIGHT. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. Workers compensation Insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION WN OF ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN BLD INSPECTOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST BLD 20 STE 2035 ANDOVER MA 01810 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 21153004 CLIENT CODE: 1623570 MAI Dangas 8/7/2019 6:47:30 PN (EDT) Page 1 of 1 08/07/2014 11:41 9787948570 TA SULLIVAN PAGE 01/01 WRIGSC2 OP ID:KN DAT@(MMIDDIYYY'!) colla- CERTIFICATE OF LIA131LITY INSURANCE 0810712014 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 pollcy(los)must be endorsed. If SUBROGATION IS WAIVED,subJeot 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 andor9ement a. CQ ACT PRODUCER NAME: T.A.Sullivan Agency,Inc. P"Cr1N 1.978-683-4700 c No 135 Merrimack St Methuen,MA 0184401849 ADDR SS: INSURER(81 pFFORDINGCOVPRAGE NAiCA MSURERA: enc Intermediaries INSURED Scott Wright INEURERe; Wright Gutters and Home INSURER C: Improvement INSURER D: 350 Berry St N.Andover,MA 01845 INSURER P: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CEREXCLUSIONS ANDMAY C E ISSUED OR MAY SUCH POLICIES.ES.LHE INSURANCE SHOWN MAY HAVE BEEN THE POLICIES D CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, IN POLICY NUMBER M DIYYT MM IYYYY LIMITS TYPEOPINSURANCE 1,000 OOO A X COMMEPCIAL GENERAL LIABILITY EACH OCCURRENCE $ ' L11TD01598 1210112013 1210112014 1, EMISES Es oc grange & 300,00 CI MNIS-MADE �OCCUR 50,000 MED EXP(An ons person) S ' PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000.00C PRODUCTS•COMP/OP AGO S RO- POLICY❑PRC F LOC S OTHER' L C BINE" INGLE LI IT 9 &DERETENTI BILITY Em acct nl BODILY INJURY(Perpers0n) S BODILY INJURY(Pm1 aedderd) $ SCHEDULED AUTOOWNED OPER DAM S Pe eGden OS AUTOS 5 EACH OCCURRENCE s LIAR OCCUR AGGREGATE $ AR CLAIMS-MADE S ETENTION PER ETH. WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y1 N E.L.EACH ACCIDENT $ ANY EMBER EXCLUDED?ECllnVE N IA EL DISEASE •EA EMPLOYEE S (Mandatary In NNI If 1cs,descrfbaunder E.LDISEASE•POLICYLIMIT $ DE RIPTION OF OP RATIO below L177001598 1210112015 12/0112014 A Commercial Applica A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 141.Addltlonel Ramsrks Schodule,may be attaelled If mole epees Ie.agvind) Inatallation of gutteie , aiding and some roofing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE NTH THE POLICY PROVISIONS. BLDG INSPECTOR 1600 OSGOOD ST BLD 20 STE 2035 AUTHORIZED REPRPSENTATFVE NORTH ANDOVER,MA 01845 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD —' Jnr #%f WNT I W14-0 =jq �! oine 1M -r®vealnen contract This k1m sdsfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard Ia ass age se protect homeowners. Seek legal advice if necessary. Any person planning home improvements should firsk obtain a copy of';A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of ColimmerkFairs and Business Regulations Consumer info=rmation Hotline at 617-reside residence. or Iu may 83-3757 or on our website. ]�omeowlaer)Ciaforimn� on 'Contractor Information Name Company Name StrectAddressCdonotuse&PostOffice Box address) Contractor/Salesperson/ wnerName A/ �, 4,f-e_y�+woad C scc)�� City/Town State Zip Code BpsinessAddress(must in ude.a street address) Al, %rl dal PAI, A/14 0 t 3 S-0 Ip C Daytime Phone Evellmg Phone J Q f `�� City/Town State Zip Code 337q Mailing Address(It differentfrom above) BusinessPhone 7b'-b87- y IederalBmployerID orS.S.Number Q/�-SB-a 666 HomermprovementCanhactorBeg:Humber Sxpirationdate Lmvragniresthatmosthome `�- ImprovemcntcantractersItave t* �• n-lid roo;stration nirinbor 385 6The Contractor agrees to do the following worIt for the Homeowner: .S4n prao (Describe in detailtheworleto eopipleted-s e ' m the a"� rxP r� k c,'rc�,pec P 5' g e,brand, grade materials 411- Tfe-tase_i additional sheets ifnecessm.) air l Q It sltiih0,40 mein w�h�lrre�FecQ. i�se 6d'f, o�r ceF wc+e�sl,e'p(�C on elf P �.,r vG od-Gnrvti'e, Ust 8 G�•.�,'(b.( or tel( ea��s.cu•�ra�er. �.t,i�r�� y.�,.•�i.� 2ak uS�E Co brr" Vz� u� ,keR �lcir,,, drrpznf (a,"Tbl, „l0 5' 0� �3O�-t� SI,,k�&@ Brno a rrdr� r�, o' vct�6Pr voo l l� gas r Yc 7 K cfQ6rrr /v des r'c�.ho_ S {reed��i nsk�a�eeQ�'C g @ 060o, cus�; Qri ce, alsD iwcltuc(ef r^11 Pe m rill a � L. o o2.2r �t 66ea-r„o� Required Permits-The follgwiiig building perrnits ate required Proposed Start an=d Completion Schedule-The following schedule will and will be secured bythe contractor as-the homeowner's agent: be adhered to unless circumstances Ueyond the coniractox's control arise (Owners who secure their own permits will be excl=uded from the Guaranty Fund provisions of8 q Z Y Date when contractor,will.begin contracted work. MGG cha=pter 142.A..) Date when contracted work will be substantially completed. Total Contract Priceand Payment Schedule The Contractor agrees to perform the work,fmiiishthe material and labor specified above for the total sum of: t Payments will be made according to the following schedule: 1$3 FBF?©,D 0 upon signing contract(not to exceed 1/3 ofthe total contract price or the cost of special order items,whichever is greater) $Q.0a0 0/2 by / / /y or upon completion of $_4A0_60 a by `a / / or upon completion of l op $ 0-)-/-� o.0o upon completion ofthe contract, (Law forbids demmiling fan contract is Completed to both party's satisfaction) . The following materiallequipment must be special $ to be paid for ordered before the eontractedworkbegins in order to meet the completionscbedule.(1,*) $ ` to be paid for NOTES:('!')Including all finance charges(.mid Law requires that any deposit or down payment required by the contractor before worlcbegins may not exceed the greater of(a)One-third ofthe total contract price or(b)the actual co which must be special ordered in advance to meet the completion schedule, st of any special equipment or custom made material resswarrnn Is an ex resswarran heir rovided thecantrnetor? list be nttg Subcontractors-The contractor agrees to be solelyxesponsible for completion of h work descr bed regardless of the actions of any third ontract party/subcontractoruttlized by the contractor. The contractor further materials and labor under this a Bement agrees to be solelyxesponsible for all payments to all subcontractors for ContractAcceptance-Uponsigning ,this documentbecomes abinding contractunder law. unless othexwisenotedwithin.thisdocument,the contract shall not implythat any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. C Don`t be pressured into signing the contract.Take time to read and fuliy understand it Ask questions if something is unclear., e Malce sure the contractor has a valid Home Xixl rovement Contractor Re 'stration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofI tome I registration by writingto theDirector at 1mprovement Contractor Registration. You may inquire about contractor 0 ParkPlaza,Room 5170,73oston,MA D2116 or by calling 617-973-8787 or 888-283-3757. e Does the contractor have insurance? Aslc the Contractor for his insurance company information so that yon can confirm coverage,or aslcto see a copy of a"proof of insurance"document. Know your rights and responsibilities. Read the Important information ' on the reverse side of this foriii.and get a copy of the Consumer Guide to the Tome Improvemenj Contractor Law: You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,pxovided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, telegram,serxt or by delivery,not later than midnight ofthe third business day following the signing of.tbis agreement. Seethe attached notice o•.f cancellation form for an explanation ofthis right )DG 1\IO�`'SIG� � ES CONTRACT IT 1JJZRE,ARE ANY.IBLAMK SPACES!i i dentical copies ofthe contract must be completed and signed. One copy should go to flee homeowner. The otber copy sholddbe 1ceptbythe conimetor. Home s Signature / Contractor's Signature Date Date Contractor.Arbitration The Hoare 1=pxovement 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 of Eordedto a contractor,however. The contractor would have to resolve any dispute he/she has with a homeownar.dn 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 firm,which has been approved by the S ecretaxy of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as.provided In.Massachusetts General Laws,chapter I A-2A.. Homeowner's Signature ontractor`s Signature NOTICE:The signatures of the parties above apply only-to the agreement ofthe parties to alternative dispute resolution.initiated by tb e contractor: The homeowner may initiate alterative dispute resolution even where this section is not separately signed by the parties. ' Elomeowner's Rights A homeowner's rights under the Home Improvement Contractor Lsw(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 e contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded roar all.Guaranty):Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worlamnlilce manner..Homeowners maybe entitled to other specific legal rights if the contactor guarantees or provides an express warranty:for worlamanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold•in Massachusetts carry an implied warranty of merchantability and:Tress:for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree maybe added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. Nyou.have questions abOut your consuraer/b.om.eowner rights,0ontaottile ConsumerInfoimationI otliu,(listedbelow)• ]Execution of Contract • The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties axe also advised not to siga the document-until all blank sections have been filled in or malted as void,deleted,or not applicable. One original.signed copy of the contract with attachments is to be.given to the owner aaa.d 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 parldes have received a fully executed copy of the contract,and the thtee-day resci:ssionperiod has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payam t*schedule in cases where the homeowner deems him/herself'to be financially insectiue. However,in instances where a contractor deems him/herself to be 5nancially insecure,the contractor may requite that the balance of funds not yet due be placed in a joint escrow account as a preregtusite to continuing the contracted work. Withdrawal of finds:from.said account would require the signatures of both parties. Additional Information xf you have general questions or need additional in foi`<nnation about the Roane Improvement Contractor Law or other consuimer rights,or if you wish to obtain a free copy of "A Massachusetts Consuianer Guide to Home Improvement" coaatact: Consumer]reformation Hotline Office of Consumer Affairs and Business Regulation 10 Patk Plaza,Room 5170,Boston,MA.02116 617-973-8787, 888-283-3757 or visit the OCABRwebsite at 1=://ww4v.mass.gov/ocabr/ Ifyoua.want to verify the registration of a contractor or i:fyou have questions or need additionaliaafoaxaation specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director ofHome Improvement Contractor Registration Office of Consumer Affairs and-Business Regulation 10 ParkPlaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the BIC website atlit'p://wvnv.inass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: , lltti�://db.state.ma.tls/Izorneimnxovear�entllice•nseelist.as•p ' Tor assistance wit informal mediation of disputes or to registier formal complaints.against a business,calx: Consumer Complaint Section Oface of the Attorney General 617-727-8400 AND/OR Better Business Btiueau 508-652-4.800,S08-755-2548 or 413-734-3114 Version 2.1-11/22/2010 08/07/2014 09:35 9787948570 TA SULLIVAN PAGE 01/01 WRIGSG2 OP ID:KN DATE(MMfDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0510712014 ND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY�XTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, 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 ondltionsflofatlTa policy,Certainpolicies Amay requUe�an endomoment. A statemen ont this certificate Adoes not conferprights,o the the terms and C Certlticate holder In lieu of such endorsements . NA TA PRODUCER PHONE 975-17$3700 C No T.A.Sullivan Agency,Inc, ExtG 136 Merrimack St ADDRESS: Methuen,MA 0184401843 NAIL e INSURER(S)AFFORDING COVERAGE INSURERA:A encirr Intermediaries INSURED Scott Wright INSUR4RB7 Wright Gutters and Home INSURER C: Improvement INSURER 0: 350 Berry St INSURER E: N.Andover,MA 01845 INSURER P REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POWHICH THIS LICY PER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THETN5URANCE AFFORDED 6ERM 0 Y THE POR CONDITION OF ANY LICIES DESCRIBED CT OR OTHER OHEREEIN S NT WITH TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS ICY NUMBER IDON MID R TYPE OF INSURANCE POLI1,000,00 EACH OCCURRENCE S A X COMMERCIAL GENERAL LIAS1Lm 12!01/2013 12!0112014 300,000 n 1-117001598 PRE I Es C.--rranoel CLAIMS-MADE L OCCUR 60,00 MED EXP Any one rson 3 PERSONAL&ADV INJURY 3 1,000,00 GENERALAOOREGATE $ 2,000,OOD pEMLAL70REGATELIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S 2'000,00 POLICY JE T LOC 0 HER; COMB ED 91N LE LIMI S aedaer� AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(PerBCCldara) S ALL OWNED SCHEDULED AUTOS AUTOS ROP DA GE g NDN-OWNED Pe aeelde HIRED AUTOS AUTOS S EACH OCCURRENCE 9 UMBRELLALIAO OCCUR S AGGREGATE EXCESS LIAO CLAIMS-MADE S D D RETEN N WORKERS COMPENSATION PTATU ER AND EMPLOYERS'LIABILITYYE L.EACH ACCIDENT 9 ANY PROPRIETORIPARTNERIEXECUTIVE (�NIA E,L,DISEASE-EA EMPLOwril n OFFICERIMEMBER EXCLUOED7 �J (Mandatory In NH) E.L.DISEASE-POLICY LIMIT S Ifes dealunder Drsd IPTION OF OPERATIONS W6W 1-117061598 1210112013 1210112014 A Commercial Applica A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Add all l Remarks SQheQule,may po otlatlted H more spade is reQulrod) Installation of gutters , siding and some s00fing CERTIFICATE HOLDER CANCELLATION SHOULD ANY of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERCOF, NOTICE WILL BE DELIVERED IN TOWN OF ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BLDG INSPECTOR 1600 OSGOOD ST BLD 20 STE 2035 AUTHORIZED REPRMENTATIVE ANDOVER, MA 01810 ®1 88-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD . The Commonivealth of Massach.asetts , ~ bepaYtanentof.�ridu,�t.�iFcclAccr�'eni=s Office of Investigations 6`00Wasftwgton Street ' .Boston,MA 02111 wwlvmassgov/dia tQrckexcs'Compen�a�ionJC� nxaneeAfzcav� : 3�xilersfConraeor / Iectxezaaxsl'Iaiero Apl±gant Momatiton PXeaseP�rzn e tXy 'Name(33usinessl0rganizationlkdivzdual): J Address: SZ - C4/9tateMp' dQ 00-Phone#: 9 &'-)-Y 7 ,A,ro ut an employer?cbecktile appropriate box: Type of project(rreguired} 1.Lv! i am a employer with 3_. 4. [11 am a general contractor and 1 6, n New cdnsixuctzon employees(falland(orpaxEtime). have Eked the,sub-contractors 2.[1 S am a sole proprietor or p artner listed on the attached sheet. 7. ❑R emodeling These soli-contractors have 8. [(Detrtolition ship and.'lraveno.employees working forme in any capacity. workers'comp.insurance. 9. ❑Building addition Ugo workers'comp.ansuxance 5. 0 We are a corporation and its 10.❑Blectriodrepairs or additions required.] Officers have exerchad.theix 3.[l x am a homeowner doing all work g p p right of exam tion or MGL 11.[ Plumbingrepairs or additions mysCE Flbworkexs'comp. c.152,§1(4),and wehave no 12,[]R frepai//rs , rr insurancere ed. employees.[No workers' 13. Oilier ~ comp.insurance required.] Auy apphcantthat checks box#I must also fdl outthe section be16w showingtbeir workers'compensationpolicy inforrnatiom Homeowners who sahmitthis afddavitindioat¢igthey ire doing allwo&k d then hire outside contractors muss submit anew affidapitind[cafing situ&. xCoffErW rst11atcheckthisbadmustattachedaptadditionalsheet showingtnemameofthesub-contractorsandtheirworkers'comp.policyinformation. XMMM an ernproyer that isVPaviaing Warlrers'co�npetasafion zr�sr�rar2ce fortny ear rtoyees. erol�is die alicy ccnd jots site in,fa:�mation. Tnsuxance CornpanyN'arae:�[_� ��' ��� ' - x:663 .Policy#or Selz ins.TJic. d /�/ Bxpiration Data: 4&241015- Tob Site Address- co /), bro n f wood e('r f ly[State/Zip: Al ncQayu, M4 d 1 ell.0 Atfach a copy OMB workers'compensation-policy declaration page(shpwing•the policy number and euixatzon.date). .Pailmetosecure covexageasregpixedunderSection25AofMGL 0.152 can.leadtothe imposition ofcrimivailSena7tieso£a fie up to$1,500.00 andlox fine-year imprisonment,as well as civil penalties in fhe form of a STOP WORD ORDM and a fne of up to$250.0 0 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of• Investigations of:the DSA.for insurance coverage verification, l do Iiereby certa rider 2e minis arxd r2 tie of pexjury t}'zat tate information providedabove is ftue andeorrect, 8i ataro: Date: P.honne# 47d 6 ��— Y7 — Off7cial use oidy. .Do not write hz this area,to be eorr &ted by city or toren official City or Town: .Permit/License# SssuingA uthoxffy(circle one): 1.$card of Health 2.73uildingDepartment 3.City/Town Clerk. 4-Electrical Xuspector 5..PluxabingJfnspector f.other Information and Instructions M'assachusetts General Laws chapter 152 requires all employers to provide workers'compensation fox thei.;r employees. Parma to this statute,an,employee is defined as",..every person,tri the service of another under any contract o�hixe; express orimlrlied,oral orwritten:, An.eWfayei jq defined as"an.individual,padnership,association,corporation or other legal entity,ox any two or more Of the t6xegoing engaged in a joint enterprise,and including the legal representatives of adeceased emplayex,.or ti xedeivex oxtrustee of'au individual,partnership,association or other legal entity,employing employees. Howevexfhe owner of a dwelling house having n otmore than three aparbr ends anal who resides t ereiu,ox the o ccupant ofthe dwellimg house of another who employs persons to do maintenance,consfxuction ox repair world on such dwelling house ox onthe grounds orbAdiug appmtenmttherefo shMnot because of such employment be deemedto 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 pro duced.acceptable evidence of compliance with the insurance coverage required." Additionally,It1rCxL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political sub divisions sha11 enterintoanycontractforthel'erfoxmanceofpublicworkuntilacceptable evidenceofcozn liancewith,theinswance requirements of this chapterhave been presented to the contracting authority 2' Applicants Please fill out the workers'c* ompensation affidavit completely,by chop ft the boxes that apply to your situation and,if iiecass ,supply sub-coniractor(s)name(s),addresses)andphonenumbex(s)along with their caMcate(s)of insurance. LimitedLiabilityCompanies(LLC)orLvnifedLiAilityFarWerships(LLP)Vifhno employees otRarthwhe members oxpartners,arenotrequiredto can7workers'compensationiusuxance. IfanLTC orLLP doeshave employees,apolicy1s xequired. Be advisedthatthis affidavit may be submitted to thoDepar6mnt of Industrial Accidents fox confiinzafion of insurance coverage. Also be sure to sign and date the affidavit the afd7davitshould I e xetuxaedto the city or town that the application fox the permit or license is being requested,not the Department of Industrial Accidenfs. Should you have any questions regarding the law or if you axe Teq*e.d to obtain,aworkers' eompensationpoliey,please call the Department at ifib uumbex listed below: Sel insured companies should enter their self-insurance license number on the appxopxiate line. City or Tom Officials Please be sure that the affidavit is complete andpriated legibly..The Department has provided a space at the bottom of the affidavit fox you to f al out in the event the Oface of Investigations has to contact youregarding the appzxcant Pleasebe-suxefofittinthepem�it/Iicensenumberwliieh.wlllhausedasaxe£ereitcanumbex. S�a.additio�anapplicant tbatmust submit multiple permit/lzcense applications in any greD year,need only submit one affidavit ittdzcating current poltcyinfoxrnation(irnecessary)andunder"J'abSiteAddress"the applicantshouldwxife"alllocationsin .(city ox town)" copy of the affidavit that has been officially sfatnped ox marked by the city ox town may be provided fo the applicantas.ptbo£#jatavalidaffidavit.isonf7le�oxfutuxepezmitsorlicenses. Anewafddavitrnitstbefxllectouteacb year.Where ahoxne owner or citizen is obtaning a license oxpemnit notxelated to anybusiness ox commercial venture (Le.a doglicense orpermitto burnleaves eta.)saidpexson is NOTmquiredto complete this a£ddavit. The Office 6f Zn-vestigadc ms would like to thank you in advance fox your,cooperation and should you have any questions, please do not hesitate to give us a call. The Depart eafs address,telephone anti faxnumber: VN The C ora �a t t o Mas ac!vsPlt D�parien�o�Zndu��al,�.ccxd�nts • t��co o�'Ti��eStrgo�� 6bG WasWingt(a Street B.Oft,UA02111 Tel 0 GM2�4900 W 406 ax X-a7?,MAS � Revised 5-26-05 FaX#617-727-7749 ' w4vww�,a�s,g4v�c�ia � NORTF{ Town of 0 SE No. �Dh ver, Mass, �— 'P coc«icnew�cw 1' RATED U BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT 740W� �Gl't!� .l��l................: BUILDING INSPECTOR has permission to erect buildings on . .�.1�.. "�d.^+ ,,, ,,,,,�,�,� Foundation ....... ...... ..... .............. .... Rough to be occupied as ............� T. .....1! -. t..aa. ... ....................................................... Chimney provided that the person accepting this permit shall in every resp 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 CONSTRUCTIO TS 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 Dr Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-102663 SCOTT W W RIGkj`I 350 BERRY ST NORTH ANDOVER 0184 ; Expiration Connnissioner 08/12/2015 �ie�pammancaea��.a��:zuxo�.uaelf� Office of Consumer Affairs&Busibbess Regulation ME IMPROVEMENT CONTRACTOR egistration:- 138569 xpiration: 4114/2015 DBA WRIGHT GUTTERS' SCOTT WRIGHT 350 BERRY ST. per_ NO.ANDOVER,MA 01845 Undersecretary