HomeMy WebLinkAboutBuilding Permit #745-2011 - 30 MAPLE AVENUE 5/5/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: , 2d11 Date Received
Date Issued:��'
IMPORTANT• Applicant must complete all items on this page
0
("-cf
Print
Print
MAP NO: 0 �, 0 PARCEL: ODG7 ZONING DISTRICT:
TYPE OF IMPROVEMENT
❑ New Building
❑ Addition
❑ Alteration
aRepair, replacement
❑ Demolition
❑ Septic ❑ Well
Q Water/Sewer
PROPOSED USE
Residential
❑ One family
KTwo or more family
No. of units:
❑ Assessory Bldg
❑ Other
Floodplain ❑ Wetlands
Historic District yes no
Machine Shop Village yes no
DESCRIPTION OF WORK TO BE PERFORMED:
Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
❑ Watershed District
r -
A A X-ecx,PlzS P P., L
(Identification Please Type or P nt Clearly)
OWNER: Name: VA -le Phone: — `_ Z� ly
Address: �,,.4 7—/� /,� 7-C--.12
CONTRACTOR Name:
rti rt z�-2. Phone: 7c ( - 3 Sg - d7a
Address: 2
Supervisor's Construction Licens . c Exr. Date:
Home Improvement License: /0?—/ 7 oZ Exp. Date:
ARCHITECT/ENGINEER Phone:
Zb
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $�� FEE: $
Check No.: 1"3 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f nd
Signature of Agent/Owner _ nature of'contractnr ,rz IiI--;
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
Reviewed on Signature
0
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
h Conservation Decisio
Comments
Comm
j Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
a Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doe: Doe.Building Permit Revised 2008mi
O
b0
U
O
v
CD
U
o
O
w
Cf)
a
v
U)
w
�l
or.
O
w
°�°
O
c�
v
U
G
w"
w
W
°�°
p
w
G
w
a
w
a
w
W
°°
p
w
cn
co
p
w"
p
U
C7
O
w
G
w
w
w
v
z
as
2
,
U)
-
Q
v
cn
O
b0
U
O
v
CD
�co
O
;C O
CD
c �
C N
Z
C
.ca
O
0
C3
dC
(�
�j C ev
�L o
ca0
O
y �
CD
Oc m c
�N ts
a
CIO
ES
0
cc
m c
a
cma
ca
m o
CD/�
cm3
V•Y
caCm
C
vA _ m
y O
V
y
O
CDy
C
_c
m m
Li
'O
C a
E-
V y
z
m
'
co o. o
H
m y m C
H
r0.. to
W
C o+=+ -t
yr C y..
,y �o
dt C
O •y
C3
=
m, o ca m:G C
1--
z - a w m
O
b0
U
O
v
CD
O
CD
0
5
Z
p.
O
0
y
C
CO CM
C C
ca0
O
CD
cc
o oma.
a
cma
ca
C
CD/�
/C/c�
`v
V•Y
J 'p
C
Zts
0�
V
v�
O
C
C
_c
d
LU
0
m
LLI
U)
19W
W
19
W
U)
r ✓��>titiu o�n
F ~ (fairs & B sinew Reg
Office of Consumer A C.ONTRACTOR 1
HOME IMPROVEMENT Type.
►stration: ,:r 121752 DBA
Reg6111{2012
Expiration: i
COt•ITRA
C-TjNG' P
GENERAL
M.A f
JOSEPH
71 HIGH ST Undersecretary
MALDEN, MA 02148
;1lassaciiusetts - Dcpartntcnt of Public Safctr
Board of Building, Re,'tulatiOns anti Standard- s
Construction Supervisor License
License: CS 56518
JOSEPH J CONNEARNEY
71 HIGH ST
MALDEN, MA,02148 4F
Expiration: 1/23/2013
i iI►toll\!ajip►•!•
—_ Tr#t: 9500
D0 O
Ln
-Vm-0
'o -n - s `mKmX ncn
�
goy muc`n
0
ZCCn
�0
�r
M= m
_ ..? ..
� � D
n
C7
S
C1rtllfCL
C-) -0-0'v� m CD
o
.�
(o v z
ca
oD D
�mO
D';
CD CD , p S,
o
o
Z O
�.
o0
c D
m
V
r
>
c
Z0
o
cn
O
I
01
'"
D�Woo mxcom2moo
w W
5313 05 1=a
' o
�+
o c
cn'v v �' sy : EP m 3 cn 3
X
w
Q
N
°
; niA`N
m
,,,
o -p0G) c=m -icDc
G) �., 0 - CD = o :: a -o�
Q'
m
'71
^.C) Q EL ' 4y-< 'm M *5
K�l 0 a m co -n,
CO' 0 D D
D D'� D
p
' °'
mv' n�i
s v
3
O
y NA i`i
Q
1> CD
� ! D. C C) - Qj CA (A
Z
0) 000
I
CL
3DDC)'cn� WmooD
C
o � = o 0, 77J C) cn =3, cn
�' cn cn l c ' z 3 CO 3 ci
Dpi
-4- - `> r, G)3 D
(D
,v to, M_ a D o?
CD
CO
{CD M
C It V. _
°oma
2
isfD
o W
O
�m
_
c'
ca
v
w00�l
p
ml m_
rn in,
i
O O to
�
A a`
P. rn
o 3_
(D
mY`
O O
O. N.
I Z
W
J�
CD
MTI
((D
ism. C)
� v
Z
C
Q Q D
(Q (a r
0c) -t _
o; mr
a r
do°
D
D
to
Z
v (n
ED il
�2 t
oo
Z
�i1 ,�
Cl Z
D0 �
p
n N�
o, o
o
0
m
w
v
�a Q m
m
p
CL
V
�. >
Z'.
A a
"
m
•''..
p p
�. Z
.
V
r
=.._
��
(b t7
-0)0-
V (D
0:)
a s
CD
a
(n
A �00
CD C)�N4
z
D0 O
roaEv�
�
goy muc`n
0
ZCCn
�0
�r
M= m
D
� � D
n
o
0 z
y z A
m
r
o
.�
(o v z
ca
oD D
�mO
-
o
o
Z O
�.
o0
c D
m
V
r
>
c
Z0
o
cn
O
I
0
w
CD
N
a
W
r
i
0
0
0
0
0
3
3
ao
-r�wc
-nn0
0
CL D' rn a
v� m
CDCD
-I i
A
rn
+G) Cn'Cn'Cn (n
7l��� CD�CD
$<--10T
ID.. -0 Ill
C2 CD CD
m C4 CA
co O
X
ac o
m' 0 !�
A: ? V i
k W i
o
co
co
=Q�
CD
t -f
Y
CDN-tnCD
n' K 0 ; 0`'�"'
'
CD CD v
�
KImo
0
`O
N N
`O O
C,0
�O O
r-
0 Oj CD
O
CD O CCD
O pj
D�
CD
M'<
CD
00
0 Q
m v
U) CL
n
w
0
D
r
m
m
z
c
m
N
0
' j�ALeov 5Z�5 /� Q
9 7j, 6 V3 - S-6 4
HISTORIC DISTRICT COMMISSION
Town of North Andover, Massachusetts
APPLICATION FOR CERTIFICATE OF APPROPRIATENESS
Application is hereby made for the issuance of a CERTIFICATE OF APPROPRIATENESS under
Chapter 40C for proposed work as described below and on plans, drawings, or photographs
accompanying this application.
CHECK CATEGORIES THAT APPLY:
1. Exterior building construction: () New Building
() Addition
V
Alteration
--
Type of Building Home /7� 09(/?
() Garage
() Commercial
/ () .Other / L
2. Demolition or Removal of. e)oc.t,
o
3. Signs or Billboards () New Signs
O Existing Sign
() Other
4. Structure: () Fence
() Wall
() Other
TYPE OR PRINT LEGIBLY
Address of Proposed Work: 3o myk Ay -e Date:
Owner: Lt C0 0*) e_4 cc, Telephone#
Home Address (if different from above): / LGc i�✓ �''� S i ��r�i �-
Agent or Contractor: C�n/1Gcc/l-) —Telephone # 3 S� 07oe
Address: %/1 / / S' .` � 19�
/%79 .
Assessors Map #: 019--o Assessors Lot #:
Detailed Description of Proposed Work: Give all particulars of work to be done (see #8 below), including materials to
be used, if specifications do not accompany plans. In case of signs, give locations of existing signs and proposed
locations of new signs. (Attached additional sheet if necessary.)
r
A)C .v
� /I c
ivl t Lt -JO('4 iye4v �2�'4�(Z f rUC6-
�f CQ tir-w-
9i"-e,j doc)r—./. A/%r L,- ,j -I CJ hU✓SG .
Owner (Agent, Contractor)
DO NOT WRITE BELOW THIS LINE
Received for historic district commission:
Time:
Date.-
By:
ateBy:
Application No:
THIS APPLICATION FOR CERTRIFICATE OF APPROPRIATENESS:
APPROVED
( ) Disapproved
Reason for
Disapproval
'XNO CERTRIFICATE OF APPROPRIATENESS REQUIRED
A CERTIFICATE OF APPROPRIATENESS IS
IN THE APPLICATION ABOVE AND ATTACHED DOCUMENTS
Chairman:
Members
SECRETARY:
o
ro
FOR WORK DESCRIBED
Note: This drawing is an artistic
interpretation of the general
appearance of the design. It is
Designed: 4/29/2011
Printed: 4/29/2011
not meant to be an exact rendition.
4290A4FI.KIT All Drawing #: 1
Note: This drawing is an artistic Designed: 4/29/2011
interpretation of the general Printed: 4/29/2011
appearance of the design. It is
not meant to be an exact rendition. �Wg
4290A4FLKIT I All I Drawing #: 1
Note: This drawing is an artistic
interpretation of the general
appearance ofthe design. It is
Designed: 4/29/2011
Printed: 4/29/2011
not meant to be an exact rendition.
4290A4FI.KIT All Drawing #: 1
Note: This drawing is an artistic
interpretation of the general
appearance of the design. It is
not meant to be an exact rendition.
Designed: 4/29/2011
Printed: 4/29/2011
4290A4Fl.KIT All Drawing #: 1
Note: This drawing is an artistic Designed: 4/29/2011
interpretation of the general Printed: 4/29/2011
appearance of the design. It is
not meant to be an exact rendition. �Fjo
4290A4FI.KIT I All I Drawing #: 1
L'14
i
a°�Lj LL
Note: This drawing is an artistic Designed: 4/29/2011
interpretation of the general Printed: 4/29/2011
appearance of the design. It is
not meant to be an exact rendition.
4290A4FI.KIT All Drawing #: 1
This
Massa chusetts Honie Ininrov�emen Contr-act
rm satisfies all basic requirements of the state's Dome
ge to proitnprtivcMrnt'Contractor Law (MGL chapter 142A), but does not include standard
tect homeowners. Seek legal advice If necessary. An
,bosetts consumer guide to home improvement" before agr eing for any wok Person on your r ln
sidence�Y u mayvements sobts n hould nmfree ropy by calling the
of Consumer Affairs and Business ReguJatiun's Consumer Information Hotline at 617-973-8767 or 1>888-283-3757. al inst obtain a ropy of a
$omeow •er Information
�!IGG __ �ZMtieG./✓1?1 p �onirac*Information
Street;Address (do not use
• Citylfown
Req»ired Vermits -The followinom., aildingpermits are required Praposed Start and Completion Schedule - The following schedule will
and ill be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractoYs control arise
(0 ners who secure their own permits will be
exclpded from,the Guarantsi Fund provisions' of
MGL chapter 142A.) -------- tar when contractor wilt begin contracted work.
�. L_ ��,. �/ _Date when contracted work will be substantially completed.
Total Contract?i ice'and Payment Schedule
The Contractor agrees, to perform the work, furnish the material and labor specified above for the total sum of �f 6Qt7. 0.7
will be
Payn{ents made according to the following schedule:
V 00 -Pon signing contract (Aot to exceed 1/3 of tbe'total o
ce ithe co
contra t p rar '
st of'specia] order items, whichever is greater)
�a
$�-.�, •-_. hY or upon compledon•of-
$ Oct°" / •'
by 12// •or upon completion ofT.
/V
upon completion of the CO
ntiact
(Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following anterial/equipment must be special $
i ordered before the contracted wall begins in order $ ti to be paid for /l/1 fi_ t
to meet the completion schedule.(**) ----- to ba paid for A, .
NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment
not exceed the greater of (a) one-third of the total contract price or (b) the ac lcast of any speuired by cial equipmenntractor before custom made mataay
which must be special ofdereMn advance to meet the completion schedule,
E crial
re'ss Wn an I _ Is ane rens warm beta rdvided the con acta:r?
Sube6ntractors - ;lie contractor agrees to be solely responsible for coiapl , on of the vvorlc described regardless of the act9ons of any third
Yes all terms of the warrno must bo attnc ed o the contract
patty%subcontractor utilized by the contractor. The contractor further a�Teg to be solely'responsible for all a
atettia s and labor under this. n Bement
• payments to all subcontractors for
Contract Acceptance - Upon• signing, this document becomes a binding contract under law. Unless othervrise noted within this document, the
contr5ct shall not imply that any lien or other sectrrity interesthas bean placed on the residence. Review the fallowing cautions and notices
carefully before signing this contrack
• Don't be pressured into signing the contract. Take tim4 to read and fully understand it Ask questions if something is unclear.
• ' e sur a contractor has a valid Home T
subcontractors to be registered with the Director ofHorge Itnprov nlent Contractor Re
1 he law requires most home improvement contractors and
registration byiwridng to the Director at One Ashburton Place, Room 1301, $ostp MA 02] 08 orb calling inquire
Registration. 'You may inquire about contractor
]:800-223-0933.
• Does the contractor have insurance? Y g 727-3200 or
Check tp see that Your contractor is properly insured.
Know your rights and responsibilities, Bead the Im
Guide to the Home- Improvement Contractor Law. portant Infa 6laticla on the reverse side of this forth and get a copy of die
Consumer
You may cancel this agreement if it has been signed at a place oflier than the contractor's. normal place of business, Provided
you contractor in writing at his/her main office or branch office by ordinary waif posted, b tele
third business day following,the signing of this agreement See the atprcltcd notice of cancellation form for de explanation off tlri notify the
Y gram sent orby delivery, not later than midnight of the
DO NOT STAN TH[S CONTRACT W THERE s right.
Two identical coptcs ofthe•contractmustbe completed and signed, t}ne w `u� Y B'Lr r NIK SP r t 1 t
llYshnuldgotothcbaincownor 'rhe other co` ACES.
F py should he kept by tha cantractor.
Homeown s Signature
-3-
�/ s Con tor's Sig tare
Date 'r
Date
Contruetor Arbitration
The Dome Improvement Contractor Law provides homeowners with'thd right to initiate an arbitration action as an. ^
alternative to -court action) -if they have a dispute'witb to contractor. The same right is not automatically afforde . 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 tb the h6meovmn r by the Hdme Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree iri. advance that in'the event the contractor has a dispute
concerning this- contract, the contractor may submit the dispute toa private arbitration ficin which has been approved.by
the Secretary. 6f 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 142A..
H'omeowner's Signature Contractor's Signature
NOTICE; The signatures of the parties above 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 parties. -
,
Homeowners Rights
'A homeowner's rights vender 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, homeowpers
may be excluded from certain rights if the contractor they choose is nat properly registered gs prescribed by Iaw,
Homeowners who secure their own building permits are automatically excluded from all Guaranty. Pund 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 warraniy for workmanship or materials. In addition to guarantees or warranties provideu#ad,by the
contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a panic ''lar
purpose; An enumeration of other matters -on which the homeowner and contractor lawfully agree may be added to the
terns§ of the contract as long as they do not restrict a homeowner's basic consumerrights. If you have questions �1ab6ut
your c6nsum6r/homeowner rights, contact the Consumer Itnforruation Hotline (listed below).
Execution of Contraci
The contract must be executed in du licgte 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 kepf by the contractor. Any modification to the original contract must be in writing
and agreed to by both' arties. Contracted work may not begin until both parties have received a fully executed cgpy o£
the contract; and the three day recission 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 lie firiancially insecure. However; in instances where a contractor deems liim/lierself
'to be financially insecure, the contractor may require that the balance of funds not yet due be placed iri a joint escrow
account as a preirequisite to continuing the contracted worn. Withdrawal of funds from said account would require the
signatures of botli parties,
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or• other
consumer rights, ortf you wish to obtain a free copy ,of A Cons
Law," uontact: umer Guide.tn the Home Improvement Contraeior
Consumer Information Hotlibe
- Office of Consumer Affairs and Business'kegulatioa
.10 Park Plaza, Room 5170, Boston MA 02116
(617) 973-8787'or 1(8.88) 2833757 'z
Ifyou want to verify the registration of a contractor or if
about the contractor registration component of the Home mproaveVe ment ns or need additional information specifically
tractor Law, contact;
Director of Home Improvement Contractor Registration
Bureau of Building Regulations and Stacidards !
One -Ashburton Place, koorn.1.301, Boston, MA 02108
(617) 727-3200 oi• 1-800-223-0933.
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 Buteau
(508) 652-4800
.(508) 7�5-2548
(413) 734-3114
The Commonwealth of Massachusetts
Department of Industrial.Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors(Electricians)Plumbers
Applicant Information Please Print Legib
Name (Business/Organization/Individual): b na -e
City/State/Zip: IVII . is t4 M`/ - Phone #:--? ` LC S F 1� — d-2-2,.
Are you an employer? Check the appropriate box:
1.�am a employer with aZ
4. ❑ 1 am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
listed on the atta6ed sheet. z
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] i
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling .
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
fain an employer• that is providing workers' compensation insurance for my employees Below is the policy and job site
information. _ \
Insurance Company Name;
rim
Policy # or Self -ins. Lic. #: _ _ �ildi�� Expiration Date:
Job Site Address: MA'IftiG `C City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains an ties 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 ofRealth 2. Building Department 3. City/Town Clerk 4. EIectricaI Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone
M A K General Contracting
71 High St
Malden Nia 02148
ESTIMATE
JOE CONNEARNEY
Ph. 781-389-0726
Fax. 781-321-3725
HIC. # 121752
BILI, Janice Connearney
TO 30 Maple Street
North Andover MA
ORDER DATE ORDER NUMBER JOB
4/18/2011
040111 _3jMaple,#0YU<
ITEM #
DESCRIPTION
QUANTITY
1
Demo and install 2 new kitchens per kitchen layouts
$20,000.00
2
Demo and install 2 new baths including new plumbing and electrical
$15,000.00
3
Demo and build new front porches same as exiting
$8,000.00
4
Purchase and install new vylne windows
$3,600.00
$15,000.00
5
Install new Vynle siding on exterior of house
6
Install 2 new boilers in basement _
$8,000.00
7
Install new ashault driveway
$10,000.00
8
Install new garage doors
$3,000.00
9
Paint interior of house
$5,000.00
10
Install new carpet in bedrooms
$3,000.00
11
Sand and poly wood floors
$4,000.00
Total »»» $94,600.00
-r,,jr; xxz,,e-
rtignLrdx nl_-L
To: CONNEARNEY JOSEPH DBA MAK GENERAL CONTRACT
Company:
Fax: 9786889542
Phone:
From: Bansal,Puneet
Fax:
Phone -
E -mail:
NOTES:
Certificate of Insurance 4585P1 9A-1 1 - 3/29/2011
This communication, including attachments, is confidential, may be subject to legal privileges, and is
intended for the sole use of the addressee. Any use, duplication, disclosure or dissemination of this
communication, other than by the addressee, is prohibited. If you have received this communication in
error, please notify the sender immediately and delete or destroy this communication and all copies
Date and time of transmission: Thursday, May 05, 2011 5:52:00 AM
Number of pages including this cover sheet: 02
ACORD. IE CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/04/2011
THIS C&TIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
PAUL T. MURPHY INS AGCY
16 LEBANON STREET
MALDEN, MA 02148
75Y8J
INSURED
CONNEARNEY JOSEPH DBA MAK GENERAL
CONTRACTING
CONTACT
NAME:
PHONE FAX
(A/C, No, Ext): FAX
(A/C, No):
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
INSURER A: TRAVELERS DIRECT ASSIGNitIENT
INSURER B:
INSURER C:
INSURER D:
71 HIGH ST INSURER E:
MALDEN, MA 02148 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
LTR
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
ADDLSUBR POLICY EFF DATE POLICY EXP DATE
POLICY NUMBER (M%DD\YYYY) (MMADD\YYYY)
INSR WVD
LIMITS
EACH OCCURRENCE $
It yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
THE WORKERS' COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR CONNEARNEY JOSEPH.
ATTN BRIAN LEATHE/ 30 MAPLE AVE
CERTIFICATE HOLDER
TOWN OF NORTH ANDOVER
1600 OSGOOD ST BLDG 20 SUITE 2-36
NORTH ANDOVER, MA 01845
ACORD 25 (2009/09)
NAIC #
100,000
100,000
500,000
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Charles J Clark
1988-2069 ACORD CORPORATION. All rights reserved.
DAMAGE TO RENTED $
CLAIMS MADE OCCUR.
PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL && ADV INJURY $
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $
POLICY PROJECT LOC
PRODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILITY
COMBINED SINGLE $
ANY AUTO
LIMIT (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULE AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY $
(Per accident)
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB OCCUR
EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE
AGGREGATE $
DEDUCTIBLE
$
R ET,EIWT4GN-$— `'+��\
-
$
., EN
KER'S COMPENSATIONA DLOYER'S
WC STATUTORY LIMITS OTHER
LIABILITY � Y/N
f
UB-4585P19A-11 03/29/2011 03/29/2012 E. L. EACH ACCIDENT $
ROPERITOR/PARTNER/EXECUTIVE Y
E.L. DISEASE - EA EMPLOYEE $
ER/M E MBERA EXC+LUDEDf�
(Mandatory in NH)
E.L. DISEASE - POLICY LIMIT $
It yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
THE WORKERS' COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR CONNEARNEY JOSEPH.
ATTN BRIAN LEATHE/ 30 MAPLE AVE
CERTIFICATE HOLDER
TOWN OF NORTH ANDOVER
1600 OSGOOD ST BLDG 20 SUITE 2-36
NORTH ANDOVER, MA 01845
ACORD 25 (2009/09)
NAIC #
100,000
100,000
500,000
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Charles J Clark
1988-2069 ACORD CORPORATION. All rights reserved.
Location �a 1G/�� �yf
No. —0//' Date S f
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ !
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
241Lp
Q
Building Inspector