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HomeMy WebLinkAboutBuilding Permit #007-2016 - 372 MAIN STREET 5/1/2018 r NORTH I BUILDING PERMIT O��zLE� bq"o TOWN OF NORTH ANDOVER o ; A APPLICATION FOR PLAN EXAMINATION -JKry Permit No#: Date Received qssArEDAC Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �' Z -3 3 y 6i✓l s r O�� /AS- Pr ti PROPERTY OWNER TO rm L�C G l�YL�r✓I I� Print 100 Year Structure yes no MAP y-3 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One amity ❑Addition o or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg. ❑ Others: ❑ Demolition El Other ❑ Septic ❑°Welli ❑ I®odplain µ. _ `Wetlands: ❑ a ershed�®istr�ct ®`Wate/Sewer - DE CRIP ION OF WORK TO BE PERFORMED: c7� Identification Plea a�TT,� pe or Print Clearly OWNER: Name: �t�Iv1 -I ci CAr �I ('� Phone: 9�-& 5- )7- IZ Iz Address:3 Contractor Name: �D�� C� Pone: �� - .3 Email 36 M Address: x- S4- D I Supervisor's Construction License:Tydn Qhh B q Exp. Date: $I6� ©�OY30 Home Improvement Licenser 11 _Exp. Date: I C> - ARCH ITECT/ENGINEER GtCn ��c7 Phone: Address - o c�1�7 . I JIpt'eg. 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: $ -60 •0C7 FEE: $ /jQ.00 Check No.:--,21 1 t,5T Receipt No.: 9�p��? NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tan„ing/Massage/Sody Art ❑ SwimIning Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennauent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes { A Planning Board Decision: Comments t Conservation Decision: Comments f Water & Sewer Connection/Signature & Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street �,..��.+.•v,*.�.;...s.» ..f `t'f?iL ��IREDEPSIRMEem © pstersonsegY�e ' _r no � . . ,- ” ;; - • Y� #, 6iLro`cated at°1x2„4 Main Street- ' *� p sire Departure"nit signature/date N`V{�'"'•• ..�.}�'�a$•�{}Yt ~+�� i--;'Try�' `iJ' ;g'�'� "[q�r§t" r f �� -...y,.v'r�••-a.3r. '' :l3•�rr� a s�.�'� Fti � 1��`�v.'f�''Rr:� ��r�.�6tr.�s �l'.} sa k.• � Ss` �.i;� »,�1 Y,rt'+;a f, .i* .s.(.`'r�''S:r 44 r). _.� y 4 FJ.. I ' COMIVIENTh.S4 3 fJI � m}� z n i#r1. ♦ .r, r .f'. II Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land areasq. 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) i ® Notified for pickup Call Email Date Time Contact Name E = Doc.Bnilding Permit 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 6 Building Permit Application .4.. 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 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) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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) C—o{ y of Contract 2012 [ECC Energy code Engineering Affidavits for Engineered products 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 from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location 7 7 No. 00—7— Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ r Building/Frame Permit Fee $- CaJ - Foundation Permit Fee $� Other Permit Fee $ TOTAL $ _ i Check#,42J 2309 Building Ins}ector ORT N N own of E No. t h ver, Mass, D SQA coc Nlc"IWICK y1' 0RAtED S V BOARD OF HEALTH PERMIT T Food/Kitchen LD/ Septic System THIS CERTIFIES THAT ............./�.�..�...... 1. .G 1.: r'G�,�� ............,,,,,.,,,,,,..., BUILDING INSPECTOR has permission to erect / _ �� Foundation p .......................... ulldings on . .�..........�G...�l!............................................... Rough to be occupied as ...............¢^� ..... .. :`...............................­­ . .................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ........... .... ... . ..4.1 ..,q,.................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reouired 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. DIAMOND CONSTRUCTION, INC. I Worcester St., Suite 10 ;5 Grafton,MA 01519 � :r `` Y diamondconstructionma@gmail.com HIC License# 1.76910 ` CS Lic. 080830—Hanna CONST."DUCTION AGREEMENT THIS AGREEMENT is made at On this day__ of of 2015,. by and between DIAMOND CONSTRUCTION, INC. (hereinafter the "Contractor') and, = r r /reel' "Owner") located.at (hereinafter the DESCRIPTION OF SERVICES Diamond Construction, Inc. agrees to provide labor, materials, equipment and other facilities required to complete the following work: Scope of work at the property located at which Owner warrants that it is the owner with Rill authority to enter into this agreement. Diamond Construction, Inc. agrees to start this project on "a (5 d shall complete the work on ( an If the project passes finai inspection and Owner refuses to sign Notice of'Completion, then.Contractor may sign this Notice of Completion on behalf of Owner as it will be assumed that he is satisfied with the work. PAYMENT I C/2015- This document is binding and has serious legal consequences_ Peel free to consult with a qualified attorney Prior to signing. � insured Full SCOOP 0yWORK i - ----� ' ' 1] Project Yjaua8er tb��r���aDtbmdo� �-------------inspecting the ~�--^�- 1OUq� . 2) Install���k �������0 - -- - - - - - . _ __ ~,,"�� 10096 3) Cover house&shrubs with tarpaulins Gxthe protection ------' -- I0096 � 4) -- ----�--------- I0096 b) ( Fachadditional byerPit's$30-O0per laver/per SQ) Of �� ---- --- � ccdar S3U/per SQ)(if Slate$0O/SO) � 6] Re-nail all loose rov[bnards --- 100% ,] /�mvmdinneeded,the extra dxrgeiuS47.O0pprplywood/ ur --- ----- - 14.00U/unrhmt { � 8) &otd19 feet ice and water shield utall gutter edges and - -�--'--- - ------� - ndh�6��an63��nn�b�}������M���� AAS ' ` 9) Tlgcrynvvfelt[] ncDeckaoner[] --- '--- ---- l0096 Diamond Deck CertainTee�r� ������ ���`��� � 1Ol Install 8^tothe roof deck jn1"overhangtutbw�scix ---- ---- - ----- - � aluminum drip edges U»all edges. White []Bn»wu � __� 11] -------`--'- -'-- ' 100% 1%} ( Nm,:l[dm sNiogremovn|ioneedelcstcacosrmaynppiy -- --- - — ' �v�bv�d materials. � �+ 13) Apply starter strip at eaves eel�~ o 14) California cotnr»vcuvcvalley ([fany) - - -- 15) Install new roof flanges or vent Pipes :7 16) Install new ridge vent cobra snow country � 17) TimberTex Ridge capsEl Seat Ridge capsa� � � � � � � DIAMOND CONSTRUCTION,'INC. l WORCESTER ST.,Suite 10i GRAFTON,MU\O1519 � Ph. 508-508-365-7300 **-* E-MAIL:diamondconstructionma@gmail.com � 20) Install new roof shingle Fife Time. ( JJ f I — 1 Clean all gutter of neve roof 22) Use 3 feet magnet to remove all nails froth around the house t —.... - — 23) C�, Hurricane nailing QPermits Qllutrpster f U j 24) Soffit I 9 25) Sky Light 26) Guttcr� 27) Gar:ap., 28) Fascia 29) Material supplied by the customer 30) Material supplied by the contractor � 31) RCD MEANS: NO INCLIMPT IN THE PRICE PROPOSAL OR --- CONTRACT. (I� ADDITIONAL CHARGER WILT APPLIY FOR LABOR AND MATE UA. i 32) GRANT TOTAL DIAMOND CONSTRUCTION,INC. 1 WORCESTER ST.,Suite 10,GRAFTON,MA 01519 Ph: 508-508-365-7300 V* E-MAIL:diamondconstructionma@gmail.com DIAMOND CONSTRUCTION, INC. Owner agrees to pay Contractor the amount of$ 1 t. 00,n (subject to adjustments such as additions and deductions pursuant to authorized change orders). Owner shall pay for all permits, licenses and easements for permanent structures or permanent changes in existing facilities. In the event Owner obtains their own permits, Owners shall be excluded from Residential Contractor's Guaranty Fund pursuant to Mass. General Laws Chapter 142A City permits and licenses to complete the work shall be paid by Diamond Construction.. All payments are due and payable upon receipt. Payments will be made according to the following schedule: $ f , - - .00 Upon the execution of this agreement. Includes material costs, permit costs, and dumpster fee; $ .00 (whichever is greater) of the contract sum upon commencement of the work; *�_-00 (whichever is greater) of the contract sum upon completion of the work. If material/equipment required were special ordered there will be no exchanges, refunds, credits, or returns. Payments shall be made in.available U.S. funds and payable to"Diamond Construction; Inc." Payments made will be non-refundable once Contractor starts to perform, starts to demobilize in any way, engaged subcontractors, or has ordered materials. All payments will also be subject to deduction for administrative expenses. Owner agrees to pay 4150.00 for each and any non-sufficient fund checks. If an invoice is not paid when due, interest will be added to and payable on all overdue amounts at 6%per year. Owner shall pay all costs of collection, including without limitation, coapt costs and reasonable attorney fees. PLANS/SPECIFICATIONS Prior to the start of the work, Owner shall provide to the Contractor all plans, surveys, specifications, drawings, blueprints, and reports describing the physical characteristics, soil, geological and subsurface conditions, utility locations, and similar documents that may assist Diamond Construction, Inc. in properly evaluating the extent and character of the work at the estimate stage. If any drawing, blueprint, floor plan, or specification violates or is in conflict with local law or/and ordinance, and where any such situation results in. any necessary changes in the work, then Diamond Construction, Inc. shall be entitled to a reasonable adjustment to the Contract.price and time to correct it. 2 C/2015- This document is binding and has serious legal consequences. feel free to consult with a qualified attorney prior to signing. DIAMOND CONSTRUCTION, INC. CHANGE ORDERS All change orders shall become part of this contract and incorporated by reference. The Owner shall notify Contractor of any changes in construction or plan and shall provide revised drawings, plans, or specifications followed by a change order. If the changes in the change order pertain to differing site conditions, errors in the plans and specifications, or other circumstances beyond the control of the Contractor (including acts by the government, fire, flood, unusual delay in transportation, abnormal weather conditions, labor disputes, strikes, war, lack of worksite access, acts of God, natural disasters, or acts of third parties), then Contractor shall submit to the Owner an estimate and proper adjustments to the contract price and time. If pricing is inapplicable, cost of the change or the amount of the adjustment shall. be determined based on the cost to Diamond Construe ' tionlus reasonable noble amounts for overhead and profit. Contractor shall not be obligated to perform changes :in the work or additional work until the Owner has approved, in writing,the changes to the contract rice and zd time. p SITE CONDITIONS Owner. acknowledges the duty to disclose any and all pertinent and known a z . ha rdous condition. Y information.to Contractor and subcontractors and may not mislead or I, conceal any material or property facts such as how many layers of roof or type of roof was originally installed. Where a site owner does not disclose facts that subsequently cause delay or need further cost then the Contractor 7 tractor will then be entitled to recover damages and a change order shall be allowed for additional costs. After consultation and agreement with the Contractor, Owner must immediately make an adjustment in the contract time and payment by issuing a change order if Contractor discovers and notifies owner of any of the following- (I)Hazardous Materials deemed by any federal, state or local governmental authority to pose a present or potential hazard to health, safety, or the environment; (2)Any Subsurface, visible, nonvisible, or latent physical conditions that are found. unexpected or that seem different from the work agreed upon; (3) Unknown physical or other conditions that seem strange or materially different from those encountered by Contractor's during and based on his construction experience. 3 C/20,15- This document is binding olid has serious legal consequences. Feel free to consult with a qualified attorney prior to signing. DIAMOND CONSTRUCTION, INC. Upon. discovery of any of the above, Contractor shall immediately stop work at that particular site. Contractor shall have no obligation to Perform any corrective or remedial work. TERMINATION Owner is required to first provide a 5 day advance notification of any alleged breach and allow Contractor 1.0 days to cure such.alleged leged breach. I Owner may terminate the Contract if the Contractor knowingly disregards applicable laws, statutes, ordinances, or local codes,has committed a material breach, if contractor made an assignment for a creditor, or becomes insolvent. Diamond Construction, Inc. may terminate this Contract if. Owner becomes insolvent, will not allow access to the site, Owner commits a material breach or fails to pay an invoice on time; work is suspended for 10 consecutive days through no act or fault of the Contractor or a Subcontractor, Sub-subcontractor or their agents or employees; or there is a stop work order by any court , or any stop work order issued by any town or authority. If any of the above occurs, then Diamond Construction shall send a written termination notice to the Owner and recover from the Owner payment for work performed, including reasonable overhead and profit, costs incurred by reason of such termination, and damages. If the Owner terminates the contract on convenience he shall communicate' nrr unrcate of this intention writing to Contractor as soon as possible. Then, on or before the termination date, Contractor shall be paid its actual costs for that portion of the work performed to the date of termination and for all costs of termination, including demobilization and any termination payments already made to vendors and subcontractors, plus 20 percent of all such costs for overhead and lost profit. INSURANCE The Diamond Construction, Inc. shall carry and maintain throughout the project period valid Workers' Compensation and General Liability insurance. Certificates of insurance can be provided to Owner upon request prior to commencement of the work. Contractor ensure that the general liability coverage to includes the Owner as additional insureds for claims caused in whole or in part by the Contractor's negligent acts or omissions during the Contractor's work. 4 I C/2015- This document is binding and has serious legal consequences. Feel free to consult with a qualified attort icy prior to signing. DIAMOND CONSTRUCTION, INC. The Owner must have and maintain throughout the project and until completion property insurance coverage (Builders Risk Insurance or other suitable cover ) at minimum the amount of the contract price. Property insurance including loss or damage shall cover the Owner, Diamond Construction, Inc., Subcontractors and Sub-subcontractors for their interest in the Work and shall insure against the perils of fire with extended coverage and physical loss or damage including coverage for theft, vandalism, malicious mischief, collapse, debris removal.. Owner waives all rights of recovery against the Diamond Construction, Inc. for .loss of use of the Owner's property, including consequential losses due to fire or other hazards, however caused If the Owner does not have and will not obtain property insurance, the Owner shall inform Contractor in writing prior to start of the work. If the Diamond Construction, Inc. is damaged by Owner's failure to have or maintain insurance as described above, without notifying the Contractor., then Owner will be responsible for all costs associated to such damage. Owner and Diamond Construction, Inc. waive all rights against each other and against all other Subcontractors and. Owner for loss or damage to the extent reimbursed by any property or equipment insurance applicable to the work, except such rights as they may have to the proceeds of such insurance. If any applicable policies of insurance require an endorsement or consent of the insurance company to provide for continued coverage where there is a waiver of subrogation, the owners of such policies will cause them to be so endorsed or obtain such consent. Owner must not use or borrow any tools or ladders owned by Contractor. If Owner, without consent, uses Contractor's tools or ladder, then he shall hold Contractor harmless of any liability whatsoever and will not place any claim on Contractor's insurance. DELAY Diamond Construction, Inc. shall provide to the Owner notice of any delay in work. for changes .necessary due to work schedule, suspension of work or any other unforeseen cause beyond Diamond Construction's control and/or where there is no fault by the Contractor, its Subcontractors or suppliers. The contract time shall then. be extended as necessary to accommodate delays via change order. SUSPENSION OF WORK, 5 C/2015- This document is binding and has serious legal consequences. Feel free to consult with a qualified attorney prior to signing. DIAMOND CONSTRUCTION, INC. Diamond. Construction, Inc., may suspend work for Owner's failure to pay invoice on time, due to differing site conditions, or for changes requested by Owner where Contractor deems it may suffer financial hardship. If work is stopped for a period of 10 consecutive days due to no act or fault of the Contractor or a. Subcontractor or their agents or employees;. or if because the Owner has repeatedly failed to fulfill the Owner's obligations under the contract then. Cbrrtractor, at his discretion, may immediately suspend work, terminate the Contract, and recover from the Owner. The Owner may suspend work. with advance notice to the Contractor. The written notice shall specify the date and the estimated duration of the suspension. Any Owner suspension shall not exceed 24 hours. Once the suspension is removed, the Contractor shall resume performance of the Work as soon as it is possible. Owner will be liable then for all and any damages for suspension of work which may include costs of demobilization. extended overhead costs,jobsite costs, etc. Any suspension of work under this Contract will also suspend the progress and. completion dates. FORCE MAJEURE If performance of this agreement or any obligation herein isrevented restricted, p tr cted, interfered by reason of act of God, fire, flood, or other natural disaster, malicious injury, strikes, lock-outs, or other labor troubles, riots, insurrection, war or other reason of like nature beyond either party's reasonable control then performance of such act or obligation shall be excused for the period of the delay. If any delay under these circurnstances exceeds 5 days, then either party shall have the option to terminate this Agreement. INDEMNIFICATION Diamond Construction, Inc. shall indemnify and hold Owner, its employees, officers, directors, and affiliates harmless from any loss.. cost, expense, or damage claimed by third parties for property damage and/or bodily injury, including death, to the proportionate extent such loss, cost, expense, or damage arises from the negligence or willful misconduct of Diamond Construction, Inc., its employees, officers, or directors in connection with the Contract or project. Owner shall indemnify, defend, and hold Diamond Construction, Inc.. its Subcontractors, employees, officers, directors, and affiliates harmless from and against any and all claims, demands, causes of action, liabilities, loss, cost, expense, or damage claimed by third parties for property damage and/or bodily injury, including death, to the proportionate extent such loss, cost, expense, or damage arises from the negligence, fault, or 6 C/2015- "['his document is binding and has serious legal consequences. Feel free to consult with a qualified attorney prior to signing. DIAMOND CONSTRUCTION, INC. willful misconduct of Owner, architects, designers, its employees, officers, or directors in connection with the Contract or project. WARRANTY Diamond Construction, Inc. warrants that the work will be conducted in good professional workmanlike manner, and warrants that materials furnished will be of good quality and new. If within two years after the date of completion any of the work, it is found not to be in accordance with good craftsmanship, the Contractor shall correct it promptly after receipt of written notice from the Owner. The Owner shall give such notice promptly after discovery of the condition. During the two-year period for correction of Work, if the Owner fails to notify the Contractor then.Owner waives the rights to require correction.by the Contractor and to make a claim for breach of warranty. In the event that any of the provisions of the warranty shall be held invalid, the remainder of the provisions of the warranty shall remain in full force and effect. Where Contractor's repair warranty work involves the matching of existing finishes or materials, he will use his best efforts to match existing finishes and materials. However, Contractor does not guarantee an exact match due to such factors as discoloration due to the aging process, difference in dye lots, and difficulty of exactly matching certain finishes, colors, and planes. This warranty specifically excludes consequential damages and the fol owtng. I. Damage on shingles due to ordinary wear and tear, abusive use, normal wear and tear, improper use, misuse, or lack of proper maintenance of the home or its component parts or systems. 2. Defects, or loss or injury not caused by the negligence of Diamond. Construction, Inc. or its subcontractors. 3. Defects in items installed by the Owner or anyone other than Diamond Construction, Inc. or its Subcontractors or defects in items supplied by the Owner. 4. Conditions not caused by Diamond Construction, Inc. and or it's Subcontractors resulting from condensation, or contraction of materials. ACCESS C/2015- This document is binding and has serious legal consequences. Feel free to consult with a qualified attorney prior to signing. DIAMOND CONSTRUCTION, INC. The Owner shall provide ample access to the site to Diamond Construction, Inc. throughout the project. Any delay or blocking of access by Owner will entitle Diamond Construction, Inc. to a reasonable adjustment in the contract price and time. INDEPENDENT CONTRACTOR STATUS The parties agree that the contractual relationship between Contractor and Owner is of an independent. contractor. No documents signed create a partnership,join venture or any other relationship between the parties. ADDITIONAL CLAUSES. o Diamond Construction., Inc.'s suggestions are not a substitute for professional engineering, architectural, or design services, and are not to be relied on as such by Owner. o This agreement represents the entire agreement between the parties regarding the work described above and supersedes any prior written or any oral agreements or communications. This agreement may only be modified or terminated in writing. e No breach.of any agreement, warranty or representation shall be deemed waived unless expressly waived in writing by the party who might assert such breach. o If any clause of this Contract is determined to be illegal or unenforceable for any reason, it shall be severed from.the Contract and the rest of the Contract shall be given full force and effect. The terms, covenants and conditions of this Contract shall be binding upon and shall inure to the benefit of the successors and permitted assigns of the respective parties to this Contract. o The agreement shall be governed by the laws of the Commonwealth of Massachusetts. The pasties hereby agree to submit to the jurisdiction of the courts located within this Commonwealth for any controversies arising out of this agreement. o Owner hereby acknowledges he/she has had ample opportunity to consult with independent legal counsel, has read it, understands it, and is signing it freely and voluntarily. o If Owner is signing this agreement at his home, or at a place other than at the contractor's office or business, then there is a 3-day cancellation right. (See Cancellation Notice) Owner Name: Lk_ i A-It!I- (Kir 7-R-0 Diamond Construction, Inc. Owner Signat John Malo-President Cell Phone: !9-7 k -L-- (508)365-7300 E-Mail: -725rn Lt c G 4L Q_c7v� diamondconstructionma@gmail.com 8 C/2015- This document is binding and has serious legal consequences. Peel free to consult with a qualified attorney prior to signing. SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) _ U94) �- �'�-' License Number Expiration Date Nam of,�SLAet ider ,�() �j y�j{�yy�1 �r l✓C. � � List CSL Type(see below) ddr ssT e Description j U Unrestricted(up to 35,000 Cu.Ft. Signa R Restricted 1&2 Famil Dwellin M Mason Only Teleph ne RC Residential Roofing Covering WS Residential Window and Siding E-mail Address SF Residential Solid Fuel Burning A liance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address — Expiration Date Signature Telephone E-mail Address SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, —rT—tc 1 PoC °C c ,�fLd F �o 1 �t i��� as Owner of the subject property hereby authorize ,/�r-h..c�,.�2 �yy C to act on my behalf,in all matters relativ Zworkthorized by this building permit application. Z !Sinature of Owner Date I /--- SECTION 7b: OWNER}OR AUTHORIZED AGENT DECLARATION 1' as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Signature of Owner or Authorized Agent Date i (Signed under the pains and penalties of perjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work:,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 11.O.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft) (including garage,finished basement/attics,decks or porch) Dross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open j ' . The Commonwealth o,f Massrachuseas w Deparbwkit ofln&strial Accidents Office of Investigations 600 Waaskington Street p Boston, l4 02111 ..4d WWW Mms,golvfahaa Workers' Compensation Insurance Affidavit: B uniders/Cont-actrolrs/Electricians/Plumbens Agglicant Information Please Print Leablv Name (Business/Organization/Individual): ' Address: QV ce�et City/State/Zip: Qt• It�iL�"ln K( - 6 In Phone#: —:: 3&o Are you an employer?Check the appropriate bo Type of project(required)- 1_❑ I am a employer with _ 4. TrI am a general contractor and I employees(full and/or part-time),R have hired the sub-contractors b. New construction 2.R I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for mein any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t � I� Building addition required.] 5. ❑ We are a corporation and its IO.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.R Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.E Other 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the naive 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'compeaasadon insaaraance for nT employees. Below is the policy andjob site in ormaadom Insurance Company Name: N UI K1J- v - Policy#or Self-ins. Lic.#: \/W C- t a a r 6(:-q {q 20 15-T- Expiration Dater Job Site Address,34Z_3�-� �a�kt .57_ City/State/Zip: o t/P�✓ (l} 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 p a s a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby a errti.fy under thepains and penalties of perjuoy Haat flee in ormaadon pr oWded above is true and correct. Signature: Date: D Phone# S"53 a c7 Official use only. Do not writr in ddv area, to be completed by city or town o,ffacirai City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector b. Other Contact Person: Phone#: i CQ CERTIFICATE OF LIABILITY INSURANCE °ATEIM"u°°""YYI 06/23/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poiicy(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: ART CALVILLO NEIGHBORHOOD INSURANCE LLC. PHoae 978-682-1178 Pa Ne; 978-582-1182 9 MAIN ST AccyNa eaq. E MAa ACALVILL0128 YAHOO.COM „SODE SUITE 3A1 INSURERS AFFORDING COVERAGE NAIC t SUTTON,MA.01590 INSURER A: CATLIN SPECILATY INSURANCE INSURED INSURER B: COMMERCE INSURANCE DIAMOND CONSTRUCTION INC. INSURER C: A.I.M.MUTUAL 1 WORCESTER ST INSUREto: INSURER E: GRFTON MA 01518 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 ADDLISUBR POLICY EFF POLICY EXP LTRPOLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11 0001 000 A CLAIMS-MADE LX i OCCUR 2000200208 D410612016 0410612016_PFEsnls6sloNcw�ne0nce)_ $ 100,000 MED EXP(An one erson) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT AP(nPL�IEjS PER: GENERAL AGGREGATE S 2,000,000 O. POLICY�JET L—!LOC I PRODUCTS-COMPtOPAGG S 2,000,000 OTHER: S B AUTOMOBILE LIABILITY COMBINED deISINGLE LIMIT 6 1,000,000 X ANY AUTO BODILY1NJURY(Perpertwn) 5 ALL AUTOOS X SCHEDULED AUTOS D32577 310112015 3101/2016 BODILY INJURY(Par accident) S HIREDAUTOS NON-OWNEDI PROPERTY DAMAGE AUTOS 1 Per nt 1 S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S C WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN ST R ANY PROPRIETORIPARTNERIEXECUTIVE VWC-100-617419-2016A 041081201504/0812016 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED ®NIA _ (Mandatory In NH) E.L DISEASE-EA EMPLOYE S 1,000,000 K yes despite tmdp E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS tOtaw i I I DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES(ACORD 101,Additional Rernarka ScMduhe,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRP7 SIGNS. 1600 OSGOOD ST BUILDING 20 AUTHO MA �/ SUITE 2035 NORTH ANDOVER MA.01845 @f'998-20`14 ORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD HIC DIAMOND CONSTRUCTION, SNC �/lenf�euri}tauktllf rf �ja ac�tt�r/l.; A��.Office of Consumer Affairs&Business Regulation License or registration valid for individul use only -_ '2]ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation c egistration: 176310 Type: g 7 expiration: 10/10/2015 Corporation 20 Park Plaza-Suite 5170 <` y Boston,MA 02126 DIAMOND CONSTRUCTION INC. JOHN MALO 637 GRAFTON ST APT 3 � T WORCESTER,MA 01604 Undersecretary Not valid without signature Ij i, fi i i it ;1 ii I I .a Massach uS trs -]L?Fc11iST3�'It tai Pub-tic Sqi@_j 'card Of 3u€(ttlnc€ �Ogula c,:s and S,a.-laar Construction Supe,-;'4snr I ICs^SB: CS.080830 RYAN K HANNA i 10 B MAYBERR)�DR SIS WESTBORO AW 01581 �`,urissioner 04/09/2016 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) re of Permit Applicant Date ,12Q ep�-- hlis % j5sa c �2 4 ree