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HomeMy WebLinkAboutBuilding Permit #1050-15 - 240 OLD CART WAY 6/12/2015 w,. 04 % pORT11 1 BUILDING PERMIT 3?;•'' ao 11 TOWN OF NORTH ANDOVER ° o f� APPLICATION FOR PLAN EXAMINATION IS ; _ b Permit NO: Date Received ?—°I , rep CHUS Date Issued: �9SS� I�./MPORTANT: Applicant must complete allitemson this page LOCATION L'70 old E'aT Print PROPERTY OWNER P090Y Print MAP NO: 67 PARCEL:Q// ZONING DISTRICT: Historic District yes o Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE ResiSkntial Non- Residential ❑ N w Building ne family El ❑ Two or more family El Industrial Alteration No. of units: ❑ Commercial ❑ Repair,'replacement ❑ Assessory Bldg ❑ Others: ❑ D,gliolition ❑ Other eptic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District FEI Water/Sewer /1le� 5v art��,r• �9-Do,��aa, /�IASTE'/L �� 2e,�o4e� 1NST.111 Ale&J SvA0,paT" C'9rn S AA-1 1 S� 646cmev-r hae4 . (5ce Arek",aL Identification Please Type or Print Clearly) OWNER: Name: �/tl� / ,42L_41Phoner'��`6-c���-�-a�3 Address: 2,q D O L P- #1AJ96✓el . CONTRACTOR Name: 711 Phone: ;_3Y �! �/S�AIl✓1'� Address: `10 1nhusopp .J J�`. N , i4tiocieE2 q Supervisor's Construction License: 10 91:16 Exp. Date: Z Home Improvement License: NY8 3 Exp. Date: Z_/If !� ARCHITECT/ENGINEER (Pact) Phone: 617- &4 717 T- Address: A1i4Y-1— ja,�_ (4gl,g,gjeT 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: $ P90. coo, FEE: $ �?, /(, D Check No.: Ar>/�` Receipt No.: ' 2 �k Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'Signature of Agent/Owner ature of contractor __ _ _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i 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 PLANNING & DEVELOPMENT Reviewed On (o IS— Signature*L___�, COMMENTS CONSERVATION Reviewed on �- �natq�re ' COMMENTS HEALTH Reviewed o0 Si nature COMMENTS t ) VI ) S, PPD q0 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 IREDEPA�RRTt N TerriDumpstere4oriste tyes� L Jnb� � Locatedat{,124II%lain'�EStroet F rdj&part�men signatuireldafe F'C®MMENr S 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 i J 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 4 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks I .;6 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4� Mass check Energy Compliance Report (if Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Departmentrior to issuance nce 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 4� Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Copy of Contract 4 2012 IECC Energy code 4, Engineering Affidavits for Engineered products f OTE: 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 that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds0 One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 � C®�7111MENII Locationd No. & J Date . - TOWN OF NORTH ANDOVER ED . = Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#S1/ Building Inspector R.A.M. ENGINEERING ROBERT A. MASYS, P.E. 160 MAIN STREET HAVERHILL, MA 01830 TEL: 978-372-0449 FAX: 978-372-7183 RAMASYSPE@AOL.COM September, 17, 2015 MEMO :To Whom It May Concern SUBJECT : 240 Old Cart Way Renovations Property located at 240 Old Cart Way, North Andover, MA. 01845. 1 have inspected the renovations at the above location. I found that the work was done according to the approved plans drawn by Mark Wagner,Architect, and constructed by Dan Dussault, General Contractor.The work has been done in compliance with all local and state building requirements. N OF 4fq c ROBERT ALAN-- 0 LAN yGN o MASYS 0 be sys, P A 9 No.29174 a FSS/ONA1- �N� Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 180,000.00 m $ - $ 2,160.00 Plumbing Fee $ 270.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 270.00 Total fees collected $ 2,800.00 240 Old Cart Way Sunroom Addition 1050-15 on 6/12/2015 NORTH q Town of t E ndover O .�_. - `. . - i soh ver, Mass, COC NI CMRWICK ��A�RATEO PPP��S S fJ BOARD OF HEALTH Food/Kitchen P E R T T LD Septic System THIS CERTIFIES THAT ..... ..�,�..(4:'., C.{. � .................................. .................................... BUILDING INSPECTOR / Foundation has permission to erect .......................... buildings on . �:r1.....�(.���.. .... .�"::: X'& ........... Rough 0. 7to be occupied as ...... . /.044E:.').. ... C1r:}°.��.? ' .►:..... ��l.r:. l.?.�,I..........yChimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO FARTS 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. � owner O O ICiti;htKs Buttes ReKwoltU,wg-tnl"wu4ows 781-858-5134 { Homeowner Information Contractor Information Name Company Name PAOl fIAS D Street Address(do not use a Post Offict Box address) Contractor/Salesperson/Owner Name 2-40 oI 0 w 1� nJ tau S ' City/Town State Zip Code Business Address(must inclu e a street address) AJr 440ov f� 5� D �_O_1SONA Daytime Phone Evening Phone City/Town State Zip Code Mailing Address(It different from above) Business Phone I Federal Employer ID or S.S.Number Home Improvement Contractor Reg.Number 'n dart .. I,aar req�i,es that most home improvement ation ombhave IMS3 `fAo- The a valid ration nambcr Y/Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessarv.) 13UI d P49/7-/dN Rn/D 13fIS&Ig5/T go OJ 7r v nom.- A145tZ5t. &10,/t 0a, - firwhl'^l 1—b P/*,v 5 s'v k a 064 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be ,� excluded from the Guaranty Fund provisions of 5 S Date when contractor will begin contracted work MGL chapter 142A.) ` Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule ® , TO The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: ! M Payments will be made according to the following schedule: $ !PODS j upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ co-) by / 1 or upon completion of kJi1 ,j'S112-oV $ by _/_/ or upon completion of P/45kL A /'IV S il $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both 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:(*)Including all finance charges(*')Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being Provided by the contractor? ❑No❑Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this ageement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to r' Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(e 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 arbitr ' firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Re on an the cons r shall be required t to such arbitration as provided In Massachusetts GC cos, ap 42 omeownees Signature Contractors tgnature NOTICE:The signatures of the parties ove apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the patties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)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 the contractor they choose is not properly registered as prescribed by law. 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 mariner. 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 carry an implied warranty of merchantability 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 contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is 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 fully 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 insecure. 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 joint escrow account as a prerequisite to continuing the contracted work Withdrawal of funds from said account,would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at httl2-//1,V%vw.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information 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 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the RIC website at httn•/hvwiv.mass.gov/ocabr/ 00 online to view the status of a Homo Improvement Contractor's Registration: han•//dh state m3 us/holneimprovement/IicenseeIist.asn For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 version 2.1-11/2212010 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: The Commonwealth of Massachusetts F Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 • ,�` www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Please Print Le 'bl ApplicantInformation Name(Business/Organization/Individual):7Aii; l Address: ��lD �1•�.�J� N City/State/Zip: Phone Are you an "ployer?Check the appropriate box: Type of project(requited): 1. m a employer with '?-�nlmployees(full and/or part-time).* 7. ❑New'constrdetion 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.F1 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp-insurance.t 14.Q Other 6.❑We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they aze 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 state whether or not those entities have employees. If the sub contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: s. Expiration Date: Policy#or Self-inLic.#: tate/Zip: s Job Site Address: City/S Attach a copy of the workers'compensation policy declaratio page(showing the policy number and expir tion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri I do hereb ertify un er t e pain and penald of ry that th ion provided above is true and correct. z ` Date: Si ature: Phone#: r 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 joint enterprise;and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any 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 may be 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia IUIJ IIIVVI IIUVIVIIUI I\VR L11JIUIIU IV.VUJJUUIV VUI I/VIIV1)F VVI IVI Iv"11 VI 11. IIIIUVIVI \IVIVVVVVVILr VV.-I-1 VV/LV/IV Vlit V-1 1J V V Client#: 256754 DUSSAULTC ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)s/29/2015 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 CONTACT NAME: HUB International New England PHONE 978 657-5100 FAX 978-988-0038 AIC No Ext: A1C Nol: 4 West Mill Street E-MAIL ADDRESS: Medfield,MA 02052 508 359-4151 INSURER(S)AFFORDING COVERAGE NAIC#INSURER A:Safety Insurance Co 39454 INSURED INSURER B:Hartford Insurance Co Daniel Dussault dba Dussault Carpentry INSURER C 990 Johnson Street North Andover,MA 01845 INSURER D: INSURER E: INSURER F: 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. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER M/DD/YYY MM/DD/YYY A GENERAL LIABILITY BMA0012372 9/15/2014 09/1512015 EACH OCCURRENCE s300000 MMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $100 000 CLAIMS-MADE 71OCCUR MED EXP(Any one person) $10 000 CO PERSONAL&ADV INJURY $300,000 GENERAL AGGREGATE $600,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $600,000 POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE Per accident $ HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION 08WECEH1833 3/26/2015 03/26/201 wo STAT Ts ERR AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFiCER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 OO O00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) `*Workers Comp Information*r` Proprietors/Partners/Executive Officers/Members Excluded: Daniel Dussault CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved, ACORD 25(2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S1390230IM1367154 JC011 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supel-isor License: CS-090846 DANIIEL F DUSSM7L 990 Johnson Streef` 9 North Andover Nt 0 i r � �I'1441` Expiration Corrunissioner 12126/2016 Office OfConsumer�Affairs�&Busi ess Regulation r a� ME IMPROVEMENT CONTRACTOR egistration: ,J149853 xpiration: ,.2/14/2016-: TYPe: I a DBA ? DUSSAULT CARP ENTRYt G DANIEL DUSSAULT'- s _. 990 JOHNSON I STREET I NORTH ANDOVER,MA 018'45 ' �- Undersecretary f ti. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Constr ,uctilor, su en-jsor License: CS-090846 IS ,,,fir.r q� DANIEEL F DUSSAibLT- �r 990 Johnson Streef t oA„751 North Andover WA Of Expiration Commissioner 12126/2016 /�e cpa���2oncr Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 149853 N. xpiration:;-.2!1472016. TYPe: DBA DUSSAULT CARPENTRY r DANIEL DUSSA'ULT' { 990 JOHNSON STREETS NORTH ANDOVER,MA 01845 4 -z Undersecretary 1 i / d / 6' / r 7.s Q PROPOSED SUNROOM U 16, ADDITION-16'x 18' o EXISTING .0 [� HOUSE 18' io #240 90' SECTION OF DECK TO BE REMOVED ExiST.DECK p, 0 ,.W CERTIFIED PIAT PLAN OF LAND AT #240 OLD CART WAY NO.ANDOVER,MA SCALE: 1" = 40' DEED BOOK 9.832 PAGE 190 JEFFREY AS DRAWN FOR: AREA 47,142 SQ, FT. S. PAUL&SARAN NART1' HOFMANN #240 OLD CART WAY PLAN #36381 NO. MA . !�q�Fee c�-%, ASSESSOR MAP 107 •b MAY 6,2015 BLOCK Tows R.A.M. ENGINEERING 16+0 MA+++ street LOT 18 Havel,Mmmwhuwft 01830 TO 37?.0W4O FAIL• 372-7183 i E U CO E V U U N N C co Renovation at 240 Old Cart Way � North Andover, Ma 01845 GENERAL NOTES e • All work shall comply with all state and local building codes and ordinances. Architect • All work shall be done to the highest standards of craftsmanship and.shall match the existing building if applicable. Mark Wagner 617-661-7175 • The Contractor shall visit the site and become familiar with all conditions prior submitting his proposal. Mark Wagner—Architect cc The Contractor shall review these notes and drawings, and notify the Architect of any inconsistency or discrepancy co 5 Malcolm Road between these notes and drawings and site conditions, requesting clarification. Do not scale the drawings, use N dimensions. CD Cambridge; MA 02138 The Contractor shall do all cuttin fittin and atchin of work to make all arts come to ether ro erl Q 9 9 patching P 9 properly. Y < • Substitutions of specified materials or products for materials or products of equal performance and quality may only be Engineer made with written approval of the Architect prior to installation. a Robert Masys 978-372-0449 • The Contractor shall provide and pay for all labor, materials, equipment and services necessary for the proper R.A.M. Engineering execution and completion of the work unless noted otherwise. 160 Main St. • The.Contractor shat secure all necessary permits, licenses and inspections required. Haverhill, Ma 01830 • The Contractor shall be responsible for construction safety during this project. j • The Contractor shall keep the premises clean and neat at all times, and shall remove and dispose of all construction � related debris. E General Contractor • The Contractor shall discuss the construction schedule with the Owner to minimize the negative construction effects o Dan Dussault 781-858-5134 and how to prepare for them. 990 Johnson St. • The Contractor shall present the building to the owner clean ready for occupancy. � North Andover, Ma 01845 • The Contractor shall save appliance and equipment booklets with model numbers, installation and operation instructions for the owner. }CD Owners • The Contractor shall carry "Builders All Risk insurance" and shall present certification to the owner prior to signing the s Paul & Sarah Harty contract. j Single Family House Q Sunroom Addition and Interior Renovation CD s cis j x c� = v N O ao a=+ o CU E- (13 o L 0 -o C d > n v N o U LCU � N a° M C) 0 T [�ucsrcu aD II c ca i ! 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