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HomeMy WebLinkAboutBuilding Permit #571-2016 - 43-45 Union 11/9/2015 Atl:,P /r-12-/s- Til BUILDING PERMIT of N F.ED q IN 'CSy16 TOWN OF NORTH ANDOVER oz y `'`' ='t° o APPLICATION FOR PLAN EXAMINATION SpA Permit No#: y° Date Received °R�rE° �SSACHUS�� Date Issued: IMPORTANT:Applicant Applicant must complete all items on this page LOCATION 1-G `'� �'J�e�� ,S-)/ G� �// � PROPERTY OWNER �` �� Print Print 100 Year Structure yes no MAP O_PARCELJ� 3�) ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One mily El Addition wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other ❑Septic I].Vllell u❑ Floodplain p Wetlantls ❑ Vllatershedistnct ❑Water/Sewer' ��.� � _; ..m &. . #. _ DES PTION OF WORK TO BE PERFORMED: dd e/1-1111D-111�z_ acs Identification- Please Type or Pri t Clearly f I_ OWNER: Name: �G/�� � �Lci i�d"a- Phone: Address: �f Contractor Name: /✓J �/��.�'/a�¢ � � Phone: Email Address: Supervisor's Construction License: ��i�P Exp. Date: ee Home Improvement License: Exp. Date: l� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE?ilT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C �, FEE: $ ` r Check No.: 5w, Receipt No.: 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 ❑ 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments t Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street -1. E DE tA'K-T ENK ;Tlb WNW owsit ,yes. ocated�at,12''4i<Ma ntSt�eet�, ., _ r � 4 FireDeparitment�s gnature/date a _ COMMIENT*S Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) j1-� .T re 1 U Notified for pickup Call Email Date Time Contact Name Doc.Buildin;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 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 4. Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application Certified Surveyed Plot Plan 4. Workers Comp Affidavit 4- 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) Copy of Contract 2012 IECC 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 No. �0` Date . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# tiJ =; it Building Inspector r 7 NORTH w: :, EAndover 0 No. 5 1 20 ver Mass 0126 15 o > > cocN1c«ew1c 4' is U BOARD OF HEALTH Food/Kitchen PER L D Septic System THIS CERTIFIES THATM BUILDING INSPECTOR has permission to erect buildings on ........ N . Foundation Rough tobe 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 CONSTRUC S TS Rough Service .......... ..... ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Propose!Submitted To� r.-;ez�b �., ��,�`� Job Name Job# Address /�. Job t ocjV !VI 14&V MA Date � � Date of Plans Phone# �� b"Pr—Fnrj Fax# Architect ?We hereby submit specifications/and estimates for. CIA-& r We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: ,;;r -- $ .-�-/1D D� Uri Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra casts wit be Respectfully executed only'upon written order,and will become an extra charge over and submitted above the estimate.AN agreements contingent upon strikes,accidents,or delays beyond our cohtml. Note—this proposal may be withdrawn by us if not accepted within days. Ofcceptame of op001 �--? ,a''oD0• � ', The above prices,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form.satisfies-:all basicre<gtrirements of the state's Home Improvement Contractor Law(MGL chapter 142A),hut tloes not include nttandard language to protect homeowners. Seek.legal advice if necessary. Any person•planning homeihinprovements should.first obtain a copy of"a Massachuseuconsumer.guide to homaimprovetaent"before agreeing to any work on yourriesidence:You may obtain-a free copy by'calling the' Office of ConsumeoAff airs and Business.Regulation's Consumer Information Hotline aD617-9738787 or 111757.- Homeowner .:888:283-3757.Homeowner Information -Contractor Information J Name . Zompany am . 1-1 Street ddress(do not use.a Post Office Box address) tractor/S Lwner Name (S Roan State Zip Code usiness A (must include a and address) . f Daytime Phone Evening Phone iryRown State Zip Co Mailing Address(1t diffaeot from above) 3usiness P968 ederal Employer M or S.S.Number tawiI nmmwlhomeiot Rome Camtrmoraea:Nrbw ampnliDndtle powm�mntraet•n 6rvei -7 7 ' alidignmtimmnohe The Contractor agrees to do the following work for the Homed ner. �•I (/ �`1`�� Is RequiretiTermits The-following building permits are required Proposed Start and Completion Schedule-The fdllowing schedule will and will be secured by the contractor as the'homeou n s agent; be adhered to unless circumstances beyond-the contractor's`control arise (Owners who.secure their own permits will be excluded from:the;:Gparanty Fnnd'provisions of �[[_o Date when contractor will begin contracted work. MGL chapter 142A:) - /�Date when connacuid .work will be substantially completed. Total Contract Price and Payment Schedule 70, The Contractor.agrees to perform the work,fiunish the material and labor specified above for thetotal sum of. �F�•�� Payments will be made according to the following schedule: $ upon.signing contract(not to exceed 1/3 of the total:contract price,gr the costof special order items,whichever is..greater) S ------byor upon completion of or upon completion of upon completion of tate Contract (Law forbids demanding full payment until.contract is cam tq both parry's satisfacdoa) The following material/equipment cozen be s}teaei S paid for ordered before the contracted workbegins in order S to be paid for to meet the..completion schedule-M) NOTES:f7 Including all fnsace charges(••)Law requires that any deposit or down- ent not exceed the 1actu req�d by the contractor before wodt begins may greater of(a)d in advance cethe total contract prize s he the actual con of any epeciel.equip n or custom made mataial which must be special ordered in advance to mat the complaion schedule, >. Express Warranty-Is an exorets watrsaty beinw provided by fhe contractor? No Yes !an term,of the warranev stb cu bed to the contra Subcontractors The contractor agrees to be solely responsible for complenon of the work descnbed regardless a the ectionaofany third Party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor unde_r this aereement Contract Acceptance-Upon signing,this document becomes a binding contract under-law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security intereg)ms been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract Take time to read'and fully understand it Ask'questions ifsomething is unclear. • Make sure the contractor has a valid Home Immovement Contractor Registration The ldi requires most home improvement contractors and. subcontractors to be regiafered with the Director ofHome Improvement Contraetob Registration. You may inquire about.contractor registration by writing to the Director atiOne Ashburton Place,Room 13Q1y_Boston,-MA 02108 or by_calling 617-727-3200 or 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is proparly insured. • Know your rights and responsibilities. Read the Important Information on the ioverse side of this foim'andget a copy of the Consumer Guide to the Home bnprovement Contractor Law.. You may cancel this agreement if it has been signed at a place other than the.centractdr's'normal place of business,provided you notify the contractor in writing ai his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the. third business day following the signing of this agreement.See the attached notice Of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! two idmticel copies ofthe"4434.Wbecomplacdand.igj One eopy.should ao a the bm www. other copy abI be .. DeptM%co�n:o�onaaetor�� Homcowne s Sigmture Contractor's Signature Dau -Dau Contractor Arbitrgti6 The Home-4"yement,Contractor Lawprovides.homeowners with thenglivto initiate an arbitration action(as an alternative to court actiop)if they;have.a,dispute with a contractor. 7be same rightis not automatically afforded to'a. contractor,how.ever.-:.17ie contractq would have:tp resolve any..dispute he/sTte.ltas with a homeowner in court unless ..,. both parties agree to.the optional clause provided below:.This clause would give the.contractor rthe.same.right to arbitration as is afforded to the homeowner.by the Home Improvement Contractor Law. . ' The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a.private arbitration firm which has.been.approved by the Secretary of the Executive Office of Consumer Atfairsand Business Regulation aadthe consumer shall be required jpwiubmit to such arbitratio asp vided In•Massachusetts General Laws,ch 142A Home ner' Signature Contractor's Signature NOT E:`ThC signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.:Thetomeownermay initiate alternative:dispute resolution even where this section-is not • separately signed-by the parties:` Homeowner's Rights A homeowner's rights undl�-thp t ome'Improvement Contractor Law(MGL chapter I42A)and other consumer protection laws(ie.MGL chapter 93A)may not be waived in any way,even by agreement: However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. . Homeowneris who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. -The•contractor is responsible-for completing the work as described,in a timely andmorkmanlike;marine.r. Homeowners.maybe entitled to.other specific legal.rights if the contractor guarantees or provides.an.express warranty,for:workmanship or materials. In addition to.guarantees•or waianties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability:and:fitnesslor:a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree.may be added:to the. terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,.contact the Consumer Information Hotline(listed below). Execution of-Contract The contract must be executed in du lice and should not be signed until a copy of all'exhibits and referenced documents have been attached Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by..the contractor. Any modification.to the Iriginal'contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a frilly executed copy of 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 be financially insecure. However,in instances where a.contractor deems him/herself to be financially insecure,the contractor may require that the.balance of funds not yet due be placed in'a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said accountwould require the signatures of both parties. Additional Information If you have general questions or.need additional information about the Home ImprovementContractorLaw or other consumer rights;or if you wish toobtain a free:copy of"A Consumer Guide to the Home.Improvement Contractor Law,"contact Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 14888)283.3.757 If you want to verify the registration of a contractor or if you have.questions or need.additional informationSpecifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA O2108 (617)727-3200 ort-800-223-0933 For assistance with informal mediation of disputesor to register formal complaints against a business,call: Consbffie coniplaintSection Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 The Commonwealth of Massa chusetts . Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Applicant Information Please Print Lepibly Name(Business/Organization/Indiv �t%J idual): �f� (�(/ C�%C C� 10017, Address: 45 7 612) �"eZ,006 City/State/Zip: one q7S ��o�d Are you a ployer?Check the appropriate box: Type of project(required): 1.6 I am a employer with /: employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3..F1I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbin. repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *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. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. ���� Insurance Company Name: _ Policy#or Self-ins.Lie.#: D <�� e �d�Od l�Expiration Date: Job Site Address: C/� SQ�: & 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the pains and penalties of petjuty that the information provided above is true td correct. L Signature* �i Date: i Ors Phone#: � d `��� Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out the workers'compensation affidavit completely,by checking the boxes that apply to your situation if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Depaitment of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia AC RJ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 01/12/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00775-001 �RopAJACT Durso BJankowski Insurance Agency Inc A/C.i(o.Ext: (978)682-5175 A/C.No: (978)794-0313 198 Mass Ave Suite 101B �Sss: North Andover,MA 01845 .INSURER A.I.M.Mutual Insurance Company 33758 INSURED Arthur Walsh INSURER B A J Walsh & Sons 55 Pleasant Street INSURER North Andover, MA 01845 INSURER E: [INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED yBEYFFPAID CLAIMS. ILTR TYPE OF INSURANCE INSR VVNBD POLICY NUMBER M�-aD/ItWY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ P E Ioccurrence) CLAIMS•MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ ENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S OLICY RO OC AUTOMOBILE LIABILITY COMSINGLE LIMIT $ (E,,= ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOSr $ NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident UMBRELLA LIARHc,:MSMADE_ OUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ yypRKKDEEEDgg IC ry RETENTION $ WC g 77UU H $ AND EMPLI)YERSVLIABILiTY X TORY LAMI% OER Ayy PR�pR��7pR�pART{�E EXECUTIVE / E.L.EACH ACCIDENT $ 100,000.00 A OFFICE ory In NH) F�cCLUDE ? Y N/A AWC400.7014648-2014A 11/14/2014 11/1412015 ((MyyanSsdaddteeossry in Nu�Hd)�r E.L.DISEASE-EA EMPLOYEE $ 100,000.00 DE�t:RIPfION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The workers compensation policy does not provide coverage for Arthur J Walsh CERTIFICATE HOLDER CANCELLATION Town Of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE j� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 0 Massachusetts -department of Public Safety Qoard.of Building Regulations and 0-11 ard� Construction Supers icor License: CS-022680 F x { 11 ARTHUR J WALs0 JR. 159A WAVERLY-2D N ANDOVER Mk 01845 v-ld.- .f1 ,+ +" Expiration. . Commissioner 06/09/2016 � 1 .-�.. ��e Lca�/a�izontuea.�a, � v.trcc r�rJell3 Office of Consumer Affairs&Business Regulation wME IMPROVEMENT CONTRACTOR ­ffi..'gistration: 103358 Type: .expiration: 7/7/2016, Private Corporatio. A.J.WALSH&SONS,INC. - Arthur Walsh 55 Pleasant St �s - z— N Andover,MA 01845 Undersecretary 210/014.0-0021-0000.0 14 UNION STREET KEVIN HUGHES 14 UNION STREET 210/014.0-0028-0000.0 17 UNION STREET LINDQUIST, PATRICIA A 94 WASHINGTON STREET 210/014.0-0057-0000.0 18 UNION STREET CONE, PATRICK S 18 UNION STREET 210/014.0-0029-0000.0 23 UNION STREET NEARY,WILLIAM F. 23-25 UNION STREET 210/014.0-0030-0000.0 29 UNION STREET BARRON, CHRISTOPHER 29 UNION STREET 210/014.0-0036-0000.0 30 UNION STREET BREEN, KEVIN 30 UNION STREET 210/014.0-0035-0032.0 32 UNION STREET HAYES, DONNA PO BOX 2552 210/014..0-0031-0000.0 33 UNION STREET JOHNSON, PATRICIA L 33 UNION STREET 210/014.0-0035-0034.0 34 UNION STREET KLAPPER, LENNY 34 UNION STREET 210/014.0-0035-0034.A 34 UNION STREET BENNETT, PAUL A. 34A UNION STREET 210/014.0-0032-0000.0 37 UNION STREET VANASSE, RICHARD A 39 UNION STREET 210/014.0-0033-0000.0 41 UNION STREET FICHERA, ALFRED C 43 UNION STREET 210/014.0-0034-0000.0 42 UNION STREET SANDMAN, KURT 23 FROTHINGHAM ROAD 210/009.0-0008-0000.0 50 UNION STREET MARINELLI, DONALD A 50 UNION STREET 210/009.0-0023-0000.0 56 UNION STREET STEWART, FRANK 115 BLUE RIDGE ROAD 210/009.0-0006-0000.0 61 UNION STREET R D E REALTY TRUST 61 UNION STREET 210/009.0-0024-0000.0 66 UNION STREET DUFRESNE, DENNIS E 66 UNION STREET 210/009.0-0026-0000.0 68 UNION STREET GILLIGAN,JUDITH A. 68 UNION STREET 210/009.0-0007-0000.0 69 UNION STREET BANDLE,JANET 69 UNION STREET 210/009.0-0039-0000.0 78 UNION STREET DUBOIS, PAUL 57 SECOND STREET 210/009.0-0038-0000.0 84 UNION STREET CALLAHAN,WILLIAM R, JR. 84 UNION STREET 210/009.0-0037-0000.0 86 UNION STREET SNELL, EDWARD R 86 UNION STREET 210/009.0-0078-0000.0 87 UNION STREET CAOETTE, PHAEDRA 87-89 UNION STREET 210/009.0-0036-0000.0 92 UNION STREET ATLANTIC REALTY TRUST 92 UNION STREET 210/009.0-0029-0000.0 93 UNION STREET CROSSFIELD,WARREN T 03 UNION STREET 210/009.0-0034-0000.0 100 UNION STREET HERNANDEZ, KIZZELLA 100 UNION STREET 210/009.0-0030-0000.0 101 UNION STREET HAYES, FRANCIS L' 101 UNION STREET 210/009.0-0064-0000.0 104 UNION STREET HUNT,SUSAN L 104 UNION STREET 210/005.0-0004-0000.0 114 UNION STREET JEFFCO, INC 77 MAIN STREET#2 210/005.0-0005-0000.0 122 UNION STREET MC CARRON,JOHN J 75 STERLING LANE 210/045.C-0012-0000.0 34 UNITY AVENUE LIVINGSTON, DAVID W 34 UNITY AVENUE 210/104.0-0000-0000M 0 UNKNOWN TOWN OF NORTH ANDOVER 120 MAIN STREET 210/068.0-0012-0000.0 11 UPLAND STREET VINING,JESSICA W. 11 OLAND STREET 210/067.0-0070-0000.0 12 UPLAND STREET NOONE, DANIEL & DENISE 12 UPLAND STREET 210/067.0-0054-0000.0 19 UPLAND STREET DESMOND, BEATRICE &`MATTHEW 19 UPLAND STREET 210/067.0-0069-0000.0 22 UPLAND STREET COPPETA FREDERICK 22 UPLAND STREET 210/067.0-0067-0000.0 30 UPLAND STREET HERON JR, MICHAEL F 130 UPLAND STREET Page 256 -"I ����uvv- ii HIVIJULULK N0. APT. NAME BORN PCT V NO. APT. NAME BORN PCT TURTLE LN UN10N ST 9 DURFEE,ALEXANDER 1995 8 * 50 * 9 DURFEE,GRACE HMARINELLI,DONALD A 1937 2 1962 8 * 50 MARINELLI,MARYANN R * 9 DURFEE,WILLIAM M 1956 8 * 58 1937 2 25 BOULANGER,PAUL W 1R 1971 8 GRAY,MARY 1943 2 * '25 * 58 WAKEMAN,TRACY V GALLAGHER,KATHLEEN M 1954 2 i * 26 BELIVEAU;SUSIE B 1965- 8 � * 58 2 BOROIAN,MARTIN 1946 Z 1919 8 * 58 3RD JIMENEZ,DOUGLAS 11 * 26 DICKEY,ARTHUR M 1943 8 * 69 1987 2 * 26 FINOCCHIARO,PATRICIA L 1957 8 * GESING,DEBORAH L 1949 1 35 TRONIC,BRUCE S I 61 GESING,ROBERT A 1948 1 * 35 1948 8 * 66 DUFRESNE,ANN M TRONIC,JOAN 1951 2 * 45 1946 8 � * 66 DUFRESNE,DENNIS E CARDER,JOE R 1962 8 * 1989 2 4 I * .45 KRAFFT,BRENDA R, 66 DUFRESNE,MATTHEW THOMAS 1981 2 *' S0 1970 8 * 68 GILLIGAN,JUDITH A SCHOENE,ADAM J 1881 8 * 68 1942 2 * 50 SCHOENE,CARL MARK 1982 8 * GILLIGAN,JULIE ANN i * 50 SCHOENE,KATHLEEN 78 CRISTOFORO,DERICK J 1978 2 1975 2 'i 55 SWEENEY,KRISTIN D 7972 $ # 78 FOURNIER,DANIELLE! 1983 2 * 55 SWEENEY,WALTER P JR 78 LECKEL,JENNIFER R 1976 2 !i 1969 8 * 80 MATTUCHIO,JACQUELINE D 1951 2 TYLER RD * 84 CALLAHAN,WILLIAM R 1969 2 * 84 MCLEOD,AMY E 1971 2 * 11 EICHLER,JANET L 1950 2 * 86 SNELL,FLORENCE J * 19 DUGAN,JOAN M 1940 2 * 1944 2 * 86 SNELL,TED DUGAN,PETER E 1940 2 * 87 1938 2 19 MARTIN,JUDITH E 1959 1 * 24 ARMANO,ANDREW MICHAEL 1984 2 * 89 24 ARMANO,GINA M. CALLAHAN,ELIZABETH 1981 1 1955 2 * 89 GAOUETTE,ANASTASIA E 1981 1 ARMANO,LAUREN 1982 1 24 1986 2 * 89 GAOUETTE,BENJAMIN A 24 ARMAND,MATTHEW 1983 2 * 89 GAOUETTE,ISAAC A 1982 1 * 24 ARMANO,MICHAEL J ' * 27 CASWELL,EMILY E 1951 2 # 89 GAOUETTE,MEAGAN RAE 1977 1 *� 27 1990 2 * 89 GAOUETTE,NATASHA MARINA 1983 1" CASWELL,ROSS T 1962 2 * 89 GAOUETTE,PHAEDRA B 1974 1 * 27 CASWELL,SARAH ELIZABETH * 89 * 34 1965 2 GAOUETTE,SUSAN 1951 1 ROGATO,KAITLIN M 1984 2 * 92 MIKOLS,CONCETTA M 1929 2 UNION ST * 92 MIKOLS,JOSEPH J 1963 2 * 95 CROSSFIELD,WARREN T 1967 1 ' * 5 CURLEY,BRYAN R1964 1 # 100 3 CORTES,JAVIER 1985 2 * 5 GALLAGHER,GRETCHYN A 1963 1 * 101 MYERS,DOROTHEA 1926 1 * 6 RUSSO,MICHAEL A JR 1969 2 * 101 MYERS,JOHN J 1957 1 * 8 STEVENS,KATHLEEN J 1989 2 * 103 HAYES,FRANCIS L 1933 1 10 A SAMBUCO,ANDREW W 1987 2 104 LEO,KRISTINA 1980 2 4 # 10 A SAMBUCO,VALERIE J, 1987 2 * 106 LORD,BOBBI 1995 2 I` 10 A SENTER,MARK J 1984 2 106 WILSON,MOLLIE 10 1990 2 * 10 B AUBRY,MARCY LYN * 122 BREAULT,CASSANDRA L 1967 2 122 1970 2 # 10 GRAY,KARYN E i * 10 1987 2 FILLIPON,105EPH JR 1973 2 * AUBRY,BRUCE ALAN 1967 2 * 122 FILLIPON,STEFANIE 1980 2 i 13 MCNEIL,HEATHER LYNN 1974 1 # 122 HEWITT,VANCE A 1976 2 13 NEALEY,JUSTIN R 1971 1 UNITY AVE I * 14 HUGHES,KEVIN MICHAEL 1974 2 * 15 SHAW,ALISON 1994 1 * 34 LIVINGSTON,.CAROLA i # 15 SHAW,ANDREW JOSEPH 1959 3 * 15 1988 1 * 34 LIVINGSTON,DAVID W 1961 3 SHAW,JENNIFER M 1962 1 * 34 LIVINGSTON,TAYLOR E 1990 3 * 17 BRUNER,KERRI A 1982 1 * 18 WRIGLEY,JESSICA L 1976 2 UPLAND ST * 18 WRIGLEY,STEVEN M I1971 2 * 19 1 FREDERICKS,JESSICA LYN * 11 MAXWELL,JOSHUA ALAN 1994 1 I 23 A 1976 1 # 11 VINING,JESSICA 1971 1 FLAMMIA,GAIL 1958 1 # 12 •' 23 FLAMMIA,JAMES E ERB,ERIC S 1980 1 25 1958 1 * 12 ERB,JESSICA MARY 1980 1 CERULLO,MICHELLE 1967 1 25• CERULLO,STEPHEN R 12 NOONE,AMY L 1983 1 * 30 BREEN,HOLLY LYNNE 1954 1 * 12 NOONE,DANIEL J 1958 1 * 30 1972 2 * 12 NOONE,DENISE M BREEN,KEVIN AA 1971 2 19 1958 1 * 32 MORIN,KIMBERLY A DESMOND,BEATRICE 1966 1 * 32 1970 2 * 19 DESMOND,MATTHEW FRANCIS 1960 1 MORIN,WILLIAM E 1968 2 19 DESMOND,MATTHEW MAX * 33 SULLIVAN,DUSTIN J 1987 1 19 1995 1 # 34 KLAPPER,LENNY DESMOND,NICOLE A 1991 1 * 34 1958 2 * 22 KOZITZA,KATHERINE 1965 1 BENNETT,NICOLE M 1875 2 * 24 * 34 BENNETT,PAULA REINKE,ANGELA M 1977 1 * 37 1975 2 * 30 HERON,MICHAEL F JR 1966 1 ARVANITIS,WILLIAM GEORGE 1946 1 * 30 HERON,RENE F * 37 SEGUIN,JUDITH F 1947 1 * 31 QUIGLE1970 1 * 37 VANASSE,JAMIE L HAKIM,Y, NEMOLIN 1975 1 * 37 1988 1 * 33 HAKIM,ANNEMARIE VANASSE,RICHARD A III 1974 1 * 33 1987 1 * 39 VANASSE,BARBARA A HAKIM,DANIEL CHARLES 1985 1 * 39 1951 1 * 39 CRAIG,CHRISTINA J VANASSE,RICHARD A 1950 1 * 39 CRAIG,KEVIN L 1983 1 * 43 FICHERA,NELLIE J 1935 1 * 43 1979 1 * APPERTI,ALBERT M 1970 1 45 FICHERA,ALFRED C 1958 1 * 43 APPERTI,MELISSA B * 45 SIMMONDS,JOAN AQUELLA 1961 1 * 49 DOUCETTE,MICHELLE A 1973 1 I 45 THOMPSON,MIGUEL AM 1987 1 1977 1 #=INACTIVE VOTER 130 *=VOTER t� F t Page# of pages 'CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted TOX FIezZ b ��„� Job Name Job# Address - UtiJob location Date � � Date of Plans N Phone# P � p�w-y �^j Fax# Architect We hereby submit specifications and estimates for. Z r G 1 f AAAF r � ►'' , We propose hereby to furnish materia labor—complete in accordance with the above specificatioVandr the sum of: 00771 . $ ,G .flaw as 4� © Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully / executed only upon written order,and will become an extra charge over and t above the estlinate.Ail agreements contingent upon strikes,accidents,or delays submitted beyond our cdhirol. Note—this proposal may be withdrawn by us if not accepted within days. Cr �l.?1 G13 !accepta nceQpOla 7ab6ves,specifications and conditions are satisfactory and are hereby accepted You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance. Signature