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HomeMy WebLinkAboutBuilding Permit #643-13 - 39 WEYLAND CIRCLE 4/4/201301 NORTH q BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 13 Date Received �' °q�tev nfdy,�5 Date Issued: �ssgc►+us�� E ORTANT: Applicant mast complete all iterris on this oai4e ' LOCATION :9 ��_*%l�A�l*�Z9 G (4�c � P�t�R'Ci i A'It t 3csy Print PROPERTY OWNER'P,P� l�.H t�t1S Print MAP NO: PARCEL J7ONING DISTRICT: Historic Districtes o Machine Shop Village. yes TYPE OF IMPROVEMENT PROPOSED USE 'TP r4\6 S WE{ % F-FZ-t4 Residential Non- Residential D New Building 5/,One family Address: 0 Addition 0 Two or more family D Industrial E/Alteration No. of units: ❑ Commercial o Repair, replacement 0 Assessory Bldg 0 Others: VDemolition ❑ Other D Septic E Well D -Floodplain.. 0 Wetlands D Watershed District . I_] Water/Sewer IMI � Re-Wova,r -o0 cnwSySTS ® P C-xTC-NDIrgCr i-1HE rAps r'iEP-- SA-r-tA]�oA �maitNG tsT SHo �o ��sfiN� %NAL1c x�N cwsc-rt-ILtv1NG P-ozirn c\ANLL 13CC- o,,r\C- P�,- WA<t.V-- or,N G�slwrt (-$GC S'S1 i e✓ �� Oly` MSS � (3 P�'4 'd, NUV Ar-nN(� U m-pri 9-s um-( P wD �ST T-LogQ y2pHl- iTc t—( N i & D I N G S c. e e, b 1pq: 6t tT��-t l p. L teAls T'O Co.DS JZC-F1Nt9tA V-LaoftS identification Please Type or Print Clearly) m ova -" -r-- xr4 S9-1MS. OWNER: Name: 'TP r4\6 S WE{ % F-FZ-t4 Phone: ca +) z2 l -1216 6 Address: 92.-? CA - SD Z:00(5,C- S -r. Sj9-L('NG-CbN, N\A d«o3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $123.00 PER S.F. Total Project Cost: $ 65, 00c). — FEE: $-1 ) Check No.:Receipt No.: NOTE.:. Persons c ntractiizg with unre is eyed cotztractors do not have access to the guarantti fund Sigrnature of Agent/Owner . Signature of contractor �� �>�r��5 mr►f f -6H Permit N0: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well 0 Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFUKMEu: Identification Please Type or Print Clearly) OWNER: Name: Phone: A,4Ar^n, CONTRACTOR Name:.. Phone: _ 1.... Address: Supervisor's Construction License: Exp. Date: Home Improvement License - ARCH ITECT/ENGINEER icense: ARCHITECT/ENGINEER Address: Phone: 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.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S nature, ofAgent/Ovvner Signature of contractor. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ k Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS x Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Commen Watr & Sewer Connection/Signature & Date Driveway Permit DYVy Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARfM'ENIT = Temp Dumpster on site yes no Located at-i24iMa Street Fire Deppi rn6nt•s gnature1date " ;< '• _ , � _ aY, �.. r COMMENTS t 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 UATA — (F -or department use El Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The folawing 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 app; al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm',¢ted with the building application Doc: Doc.Building Permit Revised 2012 Location ��2 No. 61�3 . Id Date Check A q I K 26251 TOWN OF NORTH ANDOVER Certificate of Occupancy , $- Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector 61, x O � O uz O W W x O QLLJ 095 m N uvYi w \ o LL N U Y a cu N d Z C7Q Z m o P C 00 LL j o w o1 E f U (0 LL Z Z D d sho 7 o W LL Z _ V_ W - oto 7 o CC 0l U ` v N f0 L LL a Z =to 3 o O' (0 LL ydj p U. c CO o Z N v N y; U1 Y o E N r �I Z i�9 O R J' O 0 •CL L 1 V O o V d CL L N ^y 0 L tm 0_ ca 0 L O H O R I: c. J - M o—=_°'c � 'a -a o� L) Z• E c 0 z c0 N o A, wo > o CL (D o' am L J L O •a as as _ � N CL V m .y d N C .La •c=L :E .2 v v L- oCD .0 d C m •5. = W O t r Q. O V E 4) IL t as w vm c 00 0 0 N O t O z O Q J O i O` r Lu Z Z W Li. H Z I— Z 0 J •,v LU N U) W W W N Im Enter construction cost for fee cal - NO►'fh Ahdover Fee Cakulaf1O11 Construction Cost $ 6''5,000.00 m $ - $ 780.00 Plumbing Fee $ 97.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 97.50 Total fees collected $ 1,075.00 39 We land Circle 643-13 on 4/4/2013 2 Bath Remodel, Expand Master Bedroom, Refinish Floors The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): II;GLv.a F:�vt 61-_ 13GDr= I LU— . Address:—\I ^. City/State/Zip: 2D MA p t13n Phone #: 2 g k - Z'? S —S o 0 2 kre you an employer? Check the appropriate box: 9 I am a employer with 2. 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors FJ I am a sole proprietor or partner- listed on the attached sheet. t 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 F1 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. [J Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other iy applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. )meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. poli6y information. Baan employer that is providing workers' compensation insurance for my employees. Below is the policy anti job site irmation. urance Company Name: C vR'Ti N ^r\,Aj I t,4 9 (Zoo knn_ Z.'ht S - CQ icy # or Self -ins. Lid. #: V S' 4 t 69 P 4 9_5 — 1,l Expiration Date: ( 3 Site Address: 39 W6N L A p,4 J> C- 112CQC- City/State/Zip: 1\4 • A'N_%JXVE—V_ t 1Vvl*-%- ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ture to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a s 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 ip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. iature: Date: '-A �l 113 no #: ') $ t — "'11 t —5 -? 8-.5' )fficial use only. Do not write in this area, to be completed by city or town official. ;ity or Town: Permit/License # ssuing Authority (circle one): . Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Other Wntart Pnrenn• Phnna #- 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-contractor(s) name(s), address(es) and phone numbers) 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, ?lease do not hesitate to give us a call. he Department's address, telephone and fax number: The Commonwealth of Massachusetts Department ofXndu.strial Accidents Office of Investigations 600 Washington Street Boston, MA 021.11 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE XiaY V (,17_797_774.9 ACORD® CERTIFICATE OF LIABILITY INSURANCE °"7("'d"D°/6/ L.►/ 3/6/13 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 statemert on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Twinbrook Insurance Brokerage 400A Franklin Street Braintree, MA 02184 CONTACT NAME: Maureen Curran PHONE 781 817-6814 FAX N (781) 848-6100 E-MAIL ADDRESS: maurran@twinbrook.com INSURE S AFFORDING COVERAGE NAIC # INSURERA : Acadla Insurance 1/1/13 INSURED INSURER B: Deluca Builders of Bedford LLC 2 Battle Flagg Road Bedford, MA 01730-0307 INSURER C: INSURER D: INSURER E: INSURER F: GEN'LAGGREGATE LIMITAPPLIES PER POLICY PRO LOCjECT 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 LTR TYPE OF INSURANCE ADDL INR SUBR VIVID POLICY NUMBER POLICY EFF MIDDIY POLICY EXP MM/DDVYYYY LIMITS A GENERAL LIABILITY X COMMERCIALGENERAL LIABILITY CLAIMS -MADE � OCCUR Joseph Rizzo / do CPA 0196926-16 1/1/13 1/1/14 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED REI gel $ 250,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER POLICY PRO LOCjECT PRODUCTS - OOMP/OP AGG $ 2,000,000 $ AUTOMOBILE LU181LITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS _ AUTOS COM 1NEDtSINGLELIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ eraccident $ UMBRELLA LIAR EXCESSLIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE 7 OFFICER7MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- FIR E.L. EACH ACO DENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rerrerks Schedule, if more space is required) Workers Compensaton requested from carrier CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: (978) 688-9542 E -Mail: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Joseph Rizzo / do © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: (978) 688-9542 E -Mail: ' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDmrYY) 03/07/2013 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 CONTACT NAME: PHONE FAX TWINBROOK INS 400A FRANKLIN STREET (A/C, No, Eat): (A/C, No): E-MAIL BRAINTREE, MA 02184 ADDRESS: 22LDG INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY DELUCA BUILDERS OF BEDFORD LLC INSURER B: INSURER C: INSURER D: 2 BATTLE FLAGG RD INSURER E: BEDFORD, MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY :ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE F__1 OCCUR. AMAGE TO RENTED REMISES (Ea occurrence) $ ED EXP (Any one person) $ ERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PROJECT [] LOC ENERAL AGGREGATE $ RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULE AUTOS (Per person) BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ EXCESS LIAB LJ CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y/N UB -4109P485-13 01/01/2013 01/01/2014 XWC STATUTORY LIMITS OTHER ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El N/A E. L. EACH ACCIDENT $ 500,000 DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH)E.L. If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 120 MAIN STREET BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPR TA VES '9 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. ���e �•azzzazzasrrrseaff� a��'C��trt:rac>irttelli _Office of Consumer Affairs & Busifiess Regulation - OME IMPROVEMENT CONTRACTOR' egistration: 106558 Type: 9 xpiration: 7/24/201.4 Private Corp oratir BEDFORD BUILDERS, INC. t. i NICHOLAS DELUCA 2 BATTLE FLAGG RD BEDFORD, MA 01730 Undersecretary t r Massachusetts - Acijartrncnt of.puhlic Sa#'rT� Boat d of Building Regulations and Stand'11-6'::. Construction Supervisor License License:. cs 88348 NICHOLAS Q DELUCA� 2 BATTLEFLAGG RD BEDFORD, MA 01730 a— ��.G_ Expiration: 8/9/2013 C Tr#: 20126 ' 0 To: James G. Whiffen 127 Cambridge St. Burlington, MA 01803 From: DeLuca Builders of Bedford LLC Place of work: 39 Weyland Circle North Andover, MA Contract Please refer to attached, "Whiffen Residence Plans 1-6 for details on work specifications" ALLOWANCES 1. Deck material to be GAF pvc decking. cedar rails. no stens off deck:. 2. Front door handset and lock $150.00. 3. Ceramic tile (material) $3.50 per sq. foot 4. Marble the (material) 8.00 per sq. foot 5. Electrical fixtures $3,000 6. Mirrors (materials) $100.00 each ($500.00 total) 7. Shower door in master bath $2,000.00 8. Bath sinks $100.00 each ($500.00 total) 9. Bath granite tops (2) materials only $800.00 each ($1600.00 total) 10. %2 bath granite top allowance $360.00 , 11. Faucet allowance 5 units- $100.00 each ($500.00 total; 12: Master shower and -faucet head: $350 - -1-11 Main bath faucets and shower head: $ 150 Page 2 Terms: Deposit upon signing of contract $10,000.00 1st payment upon demolition substantially complete: $10,000.00 2°d payment upon flooring materials substantially delivered: $10,000.00 3`d payment upon installation of vanities and closet built ins: $10,000.00 0 payment upon plumbing rough substantially complete: $10,000.00 5d' payment upon hardwood floors re -finished complete: $10,000.00 6d' payment upon ceramic the installation substantially complete: $5,000.00 7d' payment upon plumbing finish installed: $5,000.00 8d' payment upon contract items substantially complete: $5,000.00 Note: Any unfinished items can be incorporated into a punch list with values attached to each item and any additional labor or materials not in contract can be added thru D.B. LLC change orders Total Due: $75,000 39 Weylan j.. e N ' Hover, Ma Owner: I Contra t r. S�LhJWt�- 127 Cambridge St Burlington, MA 01803 DeLuca Builders of Bedford, LLC 2 Battle Flagg Rd Bedford, ma 01730 (781)771-5785 Dimension grx33 Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 2 1, gad S/(� 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 !....-....._ ..-_..-.._....____..... ......... ... ._............ _...__..__......_...._____.._.._.__....----._._._.........._--. __._____._..__.._._.._..__._._.__.--------- ......_...._._..__.._.___...__..-.......__...__.____..._.__._..._._..._...._._ _..._..__._._I Doc.Building Permit Revised 2012 LAN LOT 7 LOT 4A ..... 1�#`t 1'C�i , 1V, 'P 'G'1 O.N PLAN 0�39 WEYLANU CIRCLE, NORTH ANDOVER, MA D.. 57 0 124-d LOT 13B a; 21,830 S.F. w ' LOT 125 55.57 141.45' 144.87' P X4,5' WIDE USE EASE45NT THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. THERE -ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED DEED OR ENCROACHMENTS WITH RESPECT TO 8UILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN. THE LOCATION OF THE DWELLING SHOWN DOES NOT FAIL WITHIN A SPECIAL FLOOD HAZARD ZONE. THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER WAS IN COMPLIANCE WITH THE LOCAL ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY), OR IS EXEMPT FROM VIOLATION G L ITLE VII CHARTER AOA +STONE BOUND C��U� MORTGAGE LENDER USE ONLY QMDEs LiAuRims A t NC. 130 WEST STREET, WALPOLE, MA 02081 TEL :(800)287-8800 FAX., (505)6$8-4512 OF 00, M MARIO DOMINIC MANDANIC] No. 19841 LAND ENFORCEMENT ACTION UNDER MASS. T SECTION 7. GENERAL NOTES: (1) The declarations made above are on fihe basis of my knowledge, information, and belief as the result of a mortgage inspection tope survey made to the normal standard of care of registered land surveyors practicing in Massachusetts. (2) Declarations are mode to the above named client. only as of this date. (3) This plan was not made for recording purposes, for use In preparing deed descriptions or for constructions, (4) Verifications of property line dimensions, building offsets, fences, nr Int nnnriniiration mnv be accomolished only by an accurate instrument survey. t � } i ! � .�a�t•st,�p�rY.roowsa9�v a��p ffTv-jS Al i.ON-1,iNO samfuf1d Nsp11vii. i.IM301 UO,.4 t4V-1d ;WOOld :.__..... £'SxL-0�$-t T9 uosuyor gad ol lel � ._.......-�-�-� � ' .___._.... ' --- . ......._.----.........�.�.,�,___...._. ...._ ,,.... .... . . 1 1 •I 94: I Q c.Q to 0.5 COD (4.M *Piz C, Des Deb Johnson FLOOR PLAN FOR IDENTIFICATION FsURrOSFS ONLY -NOT TO WALE deb@bestfloarplalls-net.; tlu • I p ;, I - i I to •� t'' � �. a O ' 40 � M P www I 1 I 1 C� 06 ;,A M Z w r"d r z �1 ppb 1oAnson 61T-89o�r133 FLOOR PLAN FOR IDENTIF=iC;1A1TION PURPOSES ONLY 440T TO SCALE _ _4. __._...,.• devCt�bestff�vr pP�zns.rreg , i i � ; 1 � 6oyix tbo ws' W� am BEDFORD BUILDERS, INC. IF &N t P.O. Box 307 SHEET NO.. OF— BEDFORD, MA 01730-0307 CALCULATM By DATE 1. OFFICE (781) 275-5002 FAX (781) 2764416 GHECKWUY DATE _ i i ,31 C,Ac na , i 1 ._ o14 4-6 � , INa : d •r i , 13 ' OF i• a; ..... ...... Q,� r 1r� , ..... i ' 3 pry 05 Oe0 ilN, 11Gc S' L _ , : I :ry .._ .._ , ... _..._a...... .. ........... 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Box 307 SHEET NO. c-el OF--_-_� BEDFORD, MA 01730-0307 MCUL tTEb uyAUCAk DATE 3-16-013 OFFICE (781) 275.6002 FAX (781) 275-4416 04EMB ATR SCALE IFi' Wo �*T i i i , :_. ._.... ....... yp, Ckk few: Ail i b PIX �� .....,. i , a , iot'a , } i W • i I A/ IS n} Qca j j ; i at;.u1 ; v , ,.. ; ......s. ;. , N :r 2 , f , : , , , i 1 i i , i At 4. o.• • � �: �� ��. BOA } : iNrzr.._...., ._h,,I_.c.�.` �Y`y.( ata �.3„rr 1�,► ` ` � ..._). ....-_..� ... ... ........ .... __ .. ....._....e. ... .. ..._ _ ..... ......... ". ... : ..._. `� ►� Soh �I�...�.�..... _.; ra M i i Nil JEW 42 i i I , i , : ; : i � i ;•-}� j �m ign3 .r - :.....:.. _.......... - . _ . pSH oROCIMf ay.•. bAvrowhiiail RSOCp, .