HomeMy WebLinkAboutBuilding Permit #103 - 39 LONGWOOD AVENUE 8/5/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: O' Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION I Print
PROPERTY
PROPERTY OWNER- •9GJ-1rl tc'-,FL ,4G11Ay&—xJ-r .�
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yeso
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
teration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
"Septic Well Floodplain Wetlands s Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Tr Print Clearly)
OWNER: Name: 'EA Phone:
Address: 3
CONTRACTOR Name: Afnw -s Phone: ',>r— 9 S<ot
Address: rt, "OX 21
Supervisor's Construction License: .Exp. Date _v
Horne Improvement License: 70S-;ZZ Exp. Date. ?fi I o
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 00 X^L FEE: $ [lU
Check No.: "Q r�2 O f c/2— Receipt No.: 2 22 2--
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ignature of Agent/Owner Signature of contractor
"I
"� mak,
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
1 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
❑ 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
❑ 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
Doc: Doc.Building Permit Revised 2008
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools r.
Well Tobacco Sales Food Packaging/Sales,_
Private(septic tank;etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED `DATE APPROVED'
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit j
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -teinp u :mps#er on site yes no
Located at 324 MainStreet � � ,• {,
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
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NOTES and DATA– For department use)
VhG �' W�ti• ��2 4-, c�
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❑ Notified for pickup - Date
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............................................................_........_......-- --...-..............................................._........------------ ..................._...._..............................................................—_..........._............................................_.._.._........................................................
_
Doc:.Building Permit Revised 2008
Location
No. Date S
Of
NORTH TOWN OF NORTH ANDOVER
; 1h.0
►O- 9
` Certificate of Occupancy $
Building/Frame Permit Fee $ �
swCHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
22292 `-
` Building Inspector
NORTH
o Of : Andover
_
L A K E = dover, Mass., Ave S" n�}
COCMICMEWICK
ADRATED PPS\ �C
`S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
L BUILDING INSPECTOR
THIS CERTIFIES THAT.......... ... ?<. '1. l.Q lr....:.......� ..................................................................... Foundation
has permission to erect.................................. ..... buildings o1�- �..... .. . t� a a f -c_ Rough
gh
tobe occupied as......C.?...... ........�.................../..c'vv.. .................................................................................................... Chimney
provided that the person accepting this permit shall in a ry respect conform to the terms of the application on file in' Final
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
110, PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU � TS Rough
............................................................................................. .................. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
-�� The Comrrtotawee*zlfh ofMassachusetts
kf I DeTartme"f o Industrial Accidents
.f ccidents
01TIce of Invesdg afions
600 Washinaten Street
Boston, MA 62111
Workers' Com nsation Itas' www-rn=S gov/dia .
Pe iu-si4ce A$sd$s,t Iafor�ation Builde
A ` rs/Contractors/Eiectr•iciansTiumbers
can _.
Name(Business! _ p ��
Please Print Leeiibl
drgenization/Individual):_`3
City/St81�/ZL�7: (-Y OAA
r Phone#: . 9 8' 00
A
rea employer?Cheek.tbe appropriate box:
a employer with 4. ❑ I am a Type of Pro jed,(required):
loyees(full and/or * generalcontractor and IPart-time). have Mired the sub-cntttsactors 6• ❑'New construction.a.sole proprietor or pier. . listed on the attacked sheet 3 7.and have no em I nes' ❑.Remodeling
P oy Thes_ su&contractocs haveing for me in any capacity. workers' comp.insurance. 9- Q Demolition
worers'comp. insurance 5. Q We>� a corporation and its 9' Building addition
] officers have exercised their 10•(].Electricala homeowner da' repairs or additions
t ` myself [No-work=' all work right of c cmPtion Per MGL I LO Plumbing
comp, .� 15'2, §I(4),'and,we have no g repairs or additions
insurance-required.].t enployeet; [No worms' 12•[]Roof Repairs
comp. hisuraicerequire&j I3.[].pther
.Ro eawn'f Char checks bot;#I must also fiII out ttt�section below ahowia
t Fiomeowrtms who submit this ate tlavk indjcsting Maye� B theirworkms'iiositpenaetkm policy infommfion.
_ 3Coanactora that cheek r&is box must �g An wt end thmr ham outside connectors malar submit a new ofiidavit rrtdi
den add.'tioaal sheat showing the none drd, cu �B such.
>f-coanactors and Eimir worm' k intam iOn.
I� �eorrer beat ianrovi�urg:worlers'�es�eezcati� �.rrieancejoret3p.
lnf =Fze ve=. B ey —
ts tlszFouzy andyab site . . .
insurance Company Name:
Policy#or Self-ins.Lic.#:
Expir$fion Date:
Job Site Address: .
A1#ach a copy of the workers' coo c�ls��tp-
pensation policy deefaration page(showing the policy number aad expiration date) .
Fwbre to secure coverage as required under Section 25A of .
fine up to S`1,5D0.00 and/or one-year MGL c. 152 can lead to the imposition of criminal penalties of a
Of up to 5250.00 a i Y..ar irnprisonmerrt;as well tis civil penalties in the form of a SMp WORK ORDER and a fine
�3 nst the violator. Be advised that a copy.of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verifimticn .
I do he nder the pains and emit=o .e '
P ,lp �ry tsfiar the information Provided above istree
5i and eoryed
Date: S
Ofj`lcial asp only, do not write in tfris ossa,m be completed by c�J'or town.official
City or Town
Permit/Licenee#
Issuing Aathoriiy(circle one):
1. Board of health L Snilding Department 3.C'
6 Other ! dY�own Clerk 4. Electrical Inspector S. Plumbing Inspector
Contact Person:
Phone#:
Information . i�d I 'Otructions-
Masizzychusetts
nsGeneral Laws.chapter 152 requires all emp Ioyers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"..:every peason in the service of another under any contract ofhire,
express or implied,oral or written."
An employer is defined as"an individual partnership,assodiation,corporation or other legal entity,or any two or more
of the'famping engaged in a joint enterprise,and includiszg the legal representatives of a deceased employer,br1he
receiver ert wsft,of an individual,partnership,,,,z cia6cxIn or other legal taa►tity,employing employees.'Howevuthe
owner-of a dwelling house having not more than three spa rfm=ts and who resides therein,or the occupant of the
dwelling house of another who employs persons to do ma-Imtrrumce,construction or repair wcirk an such dwelling house
or on the grounds or building appurtenant thereto shat nor- b-_cause of sucb erapioyment be deemed to be an employer."
MGL chapter 152,625C(6)aim states that"every state o-ar local licensing agency shall withhold the inwanceor
renewal of a licein
nse or permit to operate a business or *o construct buildings in the commonwealth for any
applicant who has not producedacceptable"cam compliance with the.insurance coverage required."
Additiomlly, MOL chapter 152,§25C(7)states`Neither olio commonwealth nor any of its political subdivisions shall
enter into any contract far the perfi nuance of public worse until-acceptable evidence of compliance with the insu==
requir==e s.of this chapter have bean presented to the cart racting authority."
Applicants
Please fill out the workers'compensation•atindavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s)rffime(s),address(es):$.rd phone number(s)along with their certificate(s)of
insurance. Limited'Liabik Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the
members or pm tners,are not r ecluund,to carry workers'ccsmTpensat}on insmince. Van LLC or LLP doeshave
employees,a policy is required. Be advised that tris afficavit may be submitted to the Department of Industrial
Accidsrris for confirmation of insurance coverage- Also Eye sure to sign and date the affidavit The affidavit should
be returned to the city or town first the appiication for the permit or license is being requested,notthe Department of
Industrial Accidents. Should you have any questions repr%ling the law or if you are required tD obtain a workers'
oompensation policy,please call the Department at the number,listed below, Self insured omnpaaies should enter fheir
self insurzncc ficensc number on d:i:'apprctsfiste'line.
City C or Town Officials
Please be sure that the affidavit is complete and printed
g . Tho 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 tete appli=t.
Please be sum to fill in the permit/license number which%%-M be used as a reference number. in addition,an appiicant
that must submit multiple permit/ficxnse applications in any given year,need only submit one affidavit indicating current .
ole 'information if n and under"Job Site Adds-ess"the
policy (. necessary) appircarrtshould write `all iocatzons in (city or
town)"A om of-f ac affidavit that has been officially stamped or, marked by tete city or town may be provided to the
applicant as proof that a valid afndmit is on file for future permits or licenses. A new affidavit must be Med out each
year.Where a home owner or citizen is obtaining a licensee or permit not related to any business or commercial vwture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT_required to completz this aftidaviL
7hc Office of Investigations would Ir'im to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call
Tire Department's address,telephone and fax number..
The Commonwealth of Massachusetts
Dcpartmcnt oflmdmsbiat Accidents
Office of Envestdgntions
600 Washington Sfreet
Boston, MA 02111
TeL#617-727-4900 6=406 or 1-9-77-MASSA-FE
Fax#61 7-727-7744
Revised 5-26-45 www.n a .gov/dia
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FACORD. 7127f2o09
TH[S CERTIFICATE IS ISSUED AS A MATTER OF tNFORMIATI0ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEl insurance Agency,Inc- HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
374 Bchnont Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Worcester,NiA 01604 C MEANIES AFFORDING COVERAGE
coMPANr
A _ Atlantic Charter inauranee company VDAC
INSURED - COMPANY �W
Agamcnon Deaguiar B
Aguish Construction COMPANY
41 Coral Street,Apt.3 C
Worcester,NA 01604 COMPANY
D
mi
THIS ss TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT,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 PouCIEB, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLY EXPIRATION
LTR _ DATE(MMIDMYY) DATE(MWDD/YY) (in ThareMMtl)
GENERAL LIABILITY
BODILY INJURY OCC $
COMPREHENSIVE FORM BODILY INJURY AGO $
PREMISES/OPERATIONS PROPERTY DAMAGE OCC S
UNDERGROUND PROPERTY DAMAGE AGG $
EXPLOSION&COLLAPSE HAZARD BI&PD COMBINED OCC $
PRODU=3/0OMPLETED OPER BI&Pb COMBINEp AGG $
CONTRACTUAL
PERSONALINJURYA*0 S
)NOEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
AUTOMOBILE LIABILITY BODILY INJURY
ANY ALTO
(Pwpemon) $
ALL OWNED AUr03(Phvate Pave) BODILY INJURY
ALL OWNED AIfr03
(PBr acxidernl $
(Other than Pltvate Paeaenpix) .
HIRED AUTOS
. PROPERTY DAMAGE i
"Orr•ow"En AUTOS BODILY INJURY&
GANAGEUABILITY
PROPERTY DAMAGE
COMBINED $
EXCEas UASILITY
EACH OCCURRENCE $
UMBRELLA FORM -
AGGREGATE g _
0T ER THAN UMBRELA FORM
'A FMPLOWORKEYER'BAlII.I
OUPBi"STY ON AH° WCV00849400 7/22/2009 7/22/2010 smurORYuMIrs
EACH ACCIDENT s 1,000,000
The workers'ComPsnsation 3olicy does not provide coverage for Agamenon D Aguiar. DISEASE-POUCYLIMIT $ 1,000,000
DISEASE-EACH EMPLOYEE $ 1,000,000
OTHER
143CRIPTION OF OPERATIONBROCATION$/VINICLESISPECIAL ITEMS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Boxwood Development LLC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
56 Beechwood Drive 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LIFT,
North Andover,MA 01845 BUT FAILURE TO MAIL SUCH NOTICESLL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY,IT11GENT§FOR REPRESENTATIVES,
AUTHORED REPRESENTATIVE•-,
7.nn/I nnlat FINTITHMHgnNn IACAPPth) IA VW4 10-Qi ann7il7i,A
µORT" TOWN OF NORTH ANDOVER
�r 6t<?`" �`•a�°oma OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
'ls9p�A.,rpo::pp`t5 North Andover,Massachusetts 01845
�SSACHLis
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
GUIDING PERMIT APPLICATION
Please print
DATE: O�J
JOB LOCATION: 3l to/VCilicab 741le- I e j7Rc/"e,�� A44
Number Street Address r� r, Map/Lot
HOMEOWNER (T6MMY 7 C� 9S"1 d �7
Name Home Phone r Work Phone
PRESENT MAILING ADDRESS��&.;Q_
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and
to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be
considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other
Applicable codes,by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
J(
APPROVAL OF BUILDING OFFICIAL .
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
_ The Conzynonweahli ofMassachusetts
n, , -Department of Iidustrial Accidents
,/�
Of-& e
.f�Ce o stigations
600 Washington Street
. Boston,AIA 02111
www.inass govldia
Workers' Compensation.Insurance Affidavit:Builders/Contractors/Electricians/PIumbers
Applicant Information
Please Print Le 'bI
Name(Business/orgartizationlIudividual): 5 2
Address: S-�
City/State/Zip: A/ 2 Phone#: TdI
Lre
an employer? Check the a ro nate box: JLPP P a employer with 4- (&I am a general contractor aproject(required):
loyees(full and/orpart-time).* have hired the sub-contracew construction
a sole proprietor orpartner- listed on the attached sheemodeling
and have no employees These sub-contractors having forme in an ca act molition
y p ty. employees.and have workeworkers'comp.insurance comp.insurance-tilding addition
ired) 5. El We-are a corporation and itectrical repairs or additions:
a homeowner doing all work officers have exercised theirlf. 1.Q Plumbing repairs or additions
[No workers comp, right of exemption per MGLance required.]t c. 152, §1(4).and we have no 12-[ Roofrepairs
employees.[No workers' 13.❑Other
COMP.insurance required,]
Any applicant that checks box Yl must Nso fi11 out We section below showing theirw
t Homeowners who submit this affidavit indicating they are doing all work and then hireo numde onuac aon o �rS Man yu � C°n'�� t indicating yvc}i
tContractors that check this box must attached an additional sheet showing the name of the sub-con
employees. irthe sub-contractors have employees.they must provide their wocomp-policy rkers•co dactors and state whether or not those entities have
number.
I fo an information.employer that it providing xt+orhers'compensation
infoinsurance for my employees. Below is the policy and job site
Insurance Company Name:
Policy#or Self-ins.Lie.#: ..
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration {Pg a e showing the policy number and expiration date).
Failure to secure covers a as re
showing quired under Section 25A ofMGL 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 WORD ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may
Investigations of the DIA for insurance coverage verification. be forwarded to the Office of
I do hereby certify under the pains and penalties ofpetjury,that the information provided above is true and correct
Signature:
Date- c�'
Phone
Official use only. Do not iurite in this area,to be completed by efty or toren offuia,
City or Town- PermitlLicense#
Issuing Authority(circle one):
1-Boardof Health 2.Building Department 3-City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person_
Phone#:
- Contract
The contract below is prepared today(Aug 5th 2009) between °hti�710YL -ea (herein
called 'The subcontractor or The SC)of 41 C4 *«e.e A.bL*3 j,lc4xi nq A and
the customer Baljinder Pal (herein called 'The customer') resident of 31 Longwood Avenue, North Andover,
MA. The customer has hired The SC to install new roof at 31 Longwood Avenue, North Andover, MA. The SC
is a sub contractor and working on this project under license# t4 f C 270 5 7-7 This license
`belongs to the contractor C a 1 e- of .S-e vi Y* Orr" L L D
No 44 . This contract is lega b d by the terms and conditions
mentioned below:
1. The SC agrees to strip the whole roof up to 2 layers and install new roof including any rotten board, drip
edge to be applied on all edges, 6ft of ice &water shield on eaves, waterproof existing chimney flashing,
Soffit vents and Ridge vent for proper ventilation. e�,.,
2. The SC will start the job on lir-6~Z OT 4 and finish the job on ^10� f l he SC agrees to complete
the work on timely and workmanlike manner. .
3. The Customer will provide the material and dumpster to install new roof except the material for back room
with flat roof. This will be provided by The SC.
4. The SC provides workmanship guarantee for 10 years for any leak, any work not done correctly etc. and
agrees to correct the problem with no cost to The customer within 2 weeks from the date of acknowledgment
of the problem.
5. The SC will install architectual style roof.
6. The SC agrees to be solely responsible for completion of the work described here regardless of The actions
-ofany third party/sub contractor utilized by The SC or its agent.
7. The SC agrees to be solely responsible for all the payments to all subcontractors for the material and labor
under this agreement.
8. The SC agrees to leave the premises in good clean condition upon completion of the project.
9. The customer agrees to pay$4600.00 (Four thousand six hundred only)for the work to be done.
10. The customer agrees to pay($2,000.00) before starting the job and rest$2,600.00 upon satisfactory
completion of the job with check payable to The SC in the name of n W.
�c
11. The SC states that he is fully insured with Universal Insurance Agency 8f Worcester, MA and 9§rees to
provide documentation of insurance and workman compensation.
12. The SC agrees that he or his agents will not bring any lawsuits against The customer or the owner of the
residence in case of any injury during the project.
13. The permit# date k 5"01 is provided for this project by Town of North Andover,MA
Contract Acceptance: Upon signing, this document becomes a binding contract under law. In case of any
dispute concerning this contract both parties agrees to resolve the issue in a court in Essex County in MA.
By signing below, The SC and The Customer acknowledge that they have read and understand the above
terms and conditions of this contract.
Sign ture of the Customer Signature of the subcontractor
BaIjinder P / 9 G
� al / t, o/y 1��A4�
31 Longwood Avenue, A Gam? N
North Andover, MA 01845 Li i CO`s "-_<,rr"�r 3
l
978 984 0044 residence 508 757 5505 officeryj f} O 6 O
508 963 0582 cell