HomeMy WebLinkAboutBuilding Permit #603-16 - 63 CROSSBOW LANE 1/13/2016L
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BUILDING PERMIT
TOWN OF NORTH ANDOVER
0 . APPLICATION FOR PLAN EXAMINATION
Permit NO G Date Received
Date Issued: __ _; t (d
IMPORTANT:
LOCATION C1 &LOSS))ouU (W
PROPERTY OWNER "Oe- urt IS `�)uF{
MAP NO _"ARCE&d ZONING
must complete all items on this
Historic District yes
Machine ShoD Villaae ves
no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
LJ New Building
*One family
❑ Addition
❑ Two or more family
❑ Industrial
Alteration
No. of units:
❑ Commercial
i i Others:
I i Repair, replacement
i I Assessory Bldg
❑ Demolition
❑ Other
Septic ❑ Well
Floodplain Wetlands
=: Watershed District
LD Water/Sewer
11
Identification Please Type or Print Clearly)
OWNER: Name: r-ry Phone:
Address: _ kV V/_JAI _ . CieZ.4 yS.
CONTRACTOR Name: Phone:
Address: e Old 5f
5
#1 �,m,4. VGQ1.
Supervisor's Construction License: Exp. Date:
Home Improvement License: \ ---% Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BOLDING PER_ MIT: 512.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $�3 • FEE: $
Check No.: Receipt No.:
NOTE: PersoWs 26111ioacting with unregistered contractors do not have ac s t t e g arantJfund
Signature of,Agent/Owner - — _- _ _ , __Signature .of contract r
w.
Location 1�
N o. e Date
9L
Check#R-5-4�
rN C. ji
4 -, ., 08
TOWN OF NORTH ANDOVER.
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
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Bid Date:
Owner:
Company:
Street Address:
City, St. Zip:
Phone #:
Phone #:
Siding - Replacement
I (if applicable):
Replacement
Brand (if applicable):
12/28/2015
Dennis Duffy
63 Crossbow Ln
North Adover, MA 01845
508-335-9181
United Home Experts
& United Painting Co., Inc.
60 Pleasant St. Suite 1
Ashland, MA 01721
508-881-8555 FAX 508-881-5584
www.UnitedHomeExperts.com
Everlast Composite Siding
Install new door(s) with proper flashing, sealants, and insulation
where needed. Dispose of old door(s).
Integrity by Marvin Total Cost of Labor and Materials:
El
Full Worker's Compensation Coverage
$4, 000, 000+ Liability Ins. Coverage
Industry leading Warranties
Flexible Payment Plans available
Family Owned and Operated
MA HIC License # 157108
MA Constr. Supervisors License
RI REG # 22948
RRP License # NAT -28008-1
Fed ID # 04-3541521
$33,150
21
PAYMENT TERMS:' A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon contract authorization with 1/3 of
EACH PROJECT due upon half of completion of EACH PROJECT, and the balance of EACH PROJECT due upon
completion of EACH PROJECT along with any additional work requested by customer.
LIENS DISCLOSURE'. State law requires us to inform the property owner of contract liens. A lien or security interest has NOT been placed
on the residence. Any contractor, supplier, or subcontractor may lien the real property if the property owner or the
general contractor fail to pay for goods or services delivered or installed at the work location. Some contractors and
suppliers automatically send letters of notification similar to this notice. At the owner's request, we will provide
original lien release documents from anyone who provides said materials or service.
NOTICE OF CANCELLATION: The property owner may cancel this transaction at any time prior to midnight of the third business day after the date
of the contract without any penalty or obligation and has been notified in writing of such.
NOTICE: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor
or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator, One
Ashburton Place Room 1301, Boston, Ma 02108 Tel: (617) 727-3200 ext. 25239
PERMIT: A building permit is required for work being done on the property listed above. The owner has authorized United
Home Experts to obtain such permits as the owner's agent for any work requiring a permit. Owners who secure their
own construction -related permits or deal with unregistered contractors shall be excluded from access to the
Guarantee Fund.
SCHEDULE:
The following schedule will be adhered to unless circumstances beyond the contractor's control arise.
Proposed Work Start Date 1/19/2016
Proposed Completion Date 3/4/2016
The Commonyeq#h of U=adsmsew
DeParbnefif of lmfm�DWAaldents
Offwe of ifivadgadons
I CORP= S&e4 'Sake 100
Boston, MA 92114-2017
uwwww. m=Lgvvldia
Workers' Compensation buuranct Affidavit Builders/CoatmctorsiElecUieLins/Plumbers
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Electrical repairs or additions
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2.[J Roof repairs
ME] Other
test also t awn the action toiartto 1 116,NMA. I.
'OR
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a copy Of stiiaiwt me'Y'be'b.4I "
to iii: of
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'Am, b vat-Od comia
OVA to be wx~by e"d
ma unite iv" dly or
Chi or Two:
Waims Astbority (circle am*
L Board of Reefth 2. BuDding Departimant I City/Tows Clark 4. glec&icaf Inspector S. Plumbing Inspector
& Other I
Ceew Perms: Pbom
OP ID: KG
CERTIFICATE OF LIABILITY INSURANCE D08/0U°°"YYY,
08/06/2015
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 i
certificate holder in lieu of such endorsement(s).
(PRODUCER
East Douglas Insurance Agency
PO Box 1370
Douglas. MA 01516
Marc Larocque
INSURED United Painting Company, Inc
dba United Home Experts
60 Pleasant St. Ste 1
Ashland, MA 01721
r7V�C
(AIC, No, Ext:
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID t UNITE 51
INSURERS) AFFORDING COVERAGE
INSURER A: Essex Insurance Company
INSURER B: Commerce Insurance Company
INSURER C: Essex Insurance Company
INSURER D: AEIC
INSURER E:
IAA
(AIC. No)
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
NA:C
34754
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 ADOL SUBR POLICY EFF POLICY EXP
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
LIMITS
GENERAL LIABILITY'
EACH OCCURRENCE
$ 1,000,000
A X COMMERCIAL GENERAL LIABILITY 2CU3629 04/15/2015 04/15/2016
DAMAGE TO RENTED
PREMISES (Ea occurrence,
S 100,00
CLAIMS -MADE X OCCUR
MED EXP IAny one person)
S 5,00
_
PERSONAL S ADV INJURY_
S 1,000,000
GENERAL AGGREGATE
S 2,000,00
GEN'L AGGREGATE LIMB APPLIES PER.
PRODUCTS - COMP OP AGG
S 2,000,00
j POLICY PROT- LOC
S
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
1,000,00
B ANY AUTO BDGTQN 04/15/2015 04/15/2016
IEa acoaemJ
BODIL:' INJURY ;Per .person;,
S
ALL OWNED AUTOS
BODILY INJURY (Per acrader%6
S
X SCHEDULED AUTOS
X
PROPERTY DAMAGE
HIRED AUTOS
;PER ACCIDENT)
X NON•OWNEDAUTOS
I
j
S
UMBRELLA LIAR, X OCCUR
EACH OCCURRENCE
S 4,000,00
C X EXCESS LIAS CLAIMS -MADE 10105017AGGREGATE
04/15/2015 04/15/2016
S 4,000,00
DEDUC F ISLE
3
I RETENIION 5
;
WORKERS COMPENSATION
`NC STATU- O T H-
X
AND EMPLOYERS' LIABILITY YIN
D
TORY LIMITS ER
ANY PROPRIETOFLPARTNER.EAECUTIVE WCC5010274012014 08/15/2015 08/15/2016
E.L EACH ACCIDENT
S 500,00
tMF CER-A&MBLR LX1100EUI ) NIA
(Mandatory in NMI
E.L DISEASE - EA EMPLOYEE
S 500,00
U yes. desenoe under
DESCRIPTION OF OPERATIOIWS below
E.L. DISEASE - POLICY LIMIT
S 500,000
r
DESCRIPTION OF OPERATIO IS I LOCATmNS I VEN►CLES (ARsch ACORD 101. Additional Rarnsrks Schedule. if more space is nnuired)
All corporate of are covered under the workman's compensation policy
�.cr[ r rr �a,,r+r c nvwctc CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
AUT►IORQED ,
;an; LarZ; � __4"
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
Office of Consumer A airs ao d usiness egulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvem �ntractor Registration
UNITED HOME EXPERTS
MICHAEL DUDLEY
60 PLEASANT ST STE1
ASHLAND, MA 01721
SCA 1 Q 20M•05/11
C-��/ue �p'a�m��aurea,/,l�i �C�ii�,aaau�,u�v,!•ld
of Consumer Affairs & Business Regulation
IMPROVEMENT CONTRACTOR
UNITED HOME
MICHAEL DUDLEY
60 PLEASANT ST ST
ASHLAND, MA 01721
Type:
Supplement Carl
,IR
Undersecretary
Registration: 157108
Type: Supplement Card
Expiration: 9/5/2017
;e Address and return card. Mark reason for change.
U Address E] Renewal 0 Employment n Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
4r.
Not valid without, signature
s" _