HomeMy WebLinkAboutBuilding Permit #053-13 - 79 ROCK ROAD 7/23/2012 BUILDING PERMIT o*"°pT 6'sti
TOWN OF NORTH ANDOVER c *`
APPLICATION FOR PLAN EXAMINATION
Permit NO: ~� �4F
H T
Date Received 7 �DAA7ED •PP`q`�
S c►+us��
Date Issued: 3 2� �Sg
IMP RTANT:Applicant must complete all items on this page
L-OCAT1 ON
Print _
PROPERTY OWNER
'Print '
'MAP:-
MAP NO: PARCEL:6b .
ZONING p1STRICT , . Historic District yes no
.:Machine-Shop Village yes no
, ..j
TYPE OF IMPROVEMENT PROPOSED USE
Reside Non- Residential
New BuildingOne famil
Addition Jlr?lN(r Two or more family Industrial
Alteration No. of units: Commercial
Repai rept cement Assessory Bldg Others:
Demolition Other
Septic. Well Floodplain Wetlands V1/atersfied District
Water/Sewer-
DESCRIPTION OF WORK TO BE PREFORMED:
A16.,24nli�- nay bio/fir //>lJDUA-- Ai�;'I., VrNY�-
Identification Please Type or Print Clearly)
OWNER: Name: � l�jAVi,7ZPhone:
Address:
CONTRACTOR Name: •/7� o r �
Address: i -
4 e
Supervisor'sConstruction License:— _ Exp. Date - Z
Home,Improvement License:.__ Exp Date; Z
SY
ARCHITECT/ENGINEER 11�/�' 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: $ `� Z. FEE: $_ �J ,
Check No.: A /.�ld� ,
Z Receipt No.:
NOTE: Persons contracting=wiih unregistered:contractors do not have access toA@gUarantyfund
Signature of AggRV..Qwner 'Signature of-contractor°
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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
1
Public Sewer Tanning/Massage/Body Art Swimming Pools
i 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 Siqnature
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
DPW Town Engineer: Signature:
Located 384 Os o
FIRE:DEPARTMENT - Temp Dumpster h.'site ye' no ,
r . .
Located at.124'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
NOTES and DATA— (For department use)
❑ Notified for pickup - Date
i
Doc.Building Permit Revised 2008
Location !7 �O G
—7
No.��3�/ S� Date / 3 /Z
OP TOWN OF NORTH ANDOVER
e VII XDT,
- Certificate of Occupancy $
• Building/Frame Permit Fee $ LS d
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
s Check#
25533 BuTi dirUInspector
Paychex, Inc. RF 7/23/2012 1 : 29: 41 PM PAGE 3/003 Fax Server
»>:DATE MM/DD/YY
CORD . -. ...`I. ATE:::: :F..: I
OIL!:: :::;
( )
................ :.•.•.•.•.•.•.•:::::.:•:•07/23/12
..........................
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(les)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 COMPANIES AFFORDING COVERAGE
PAYCHEX INSURANCE AGENCY'INC.
150 SAWGRASS DRIVE coAANv GUARD INSURANCE GROUP
ROCHESTER, NY 14620 COMPANY
877-266-6850 B
INSURED
RD CARTER CONSTRUCTION LLC COMC,PANV
41 LEXINGTON AVENUE
BRADFORD,MA 01835
COMDPANY
........EF3�1C �.i: < <::;::;;;;;;;;;;: :: ::;GERTl EOATE:NU:MBEE#; z <:: ::: :REVISION:NU IIIFB R;: ......
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.
Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMP/OPAGG $
=�LAIMS MADE OUCCUR
PERSONAL&ADV INJURY $
OWNERS&CONTRACTOR'S PROT
EACH OCCURRENCE $
FIRE DAMAGE(Any one tire) $
MED EXP(Any one person) $
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY $
(Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EAACCIDE NT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRE NCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND RDWC241586 09/10/11 09/10/12 X WC STATU- 07H-
A EMPLOYERS'LIABILITYI�IBY I MIT FR
THE PROPRIETOR'
INCL
EL EACH ACCIDENT $ 100,000.00
O
PARTNERS,`EXEcuTIVE EL DISEASE-POLICY LIMIT $ 500,000.00
OFFICERS ARE: O EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required)
la �a �.
CANCEEEAYla[�:: : z«::<:: >: >: .... .:zz :: ....
TOWN OF NORTH ANDOVER SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
1600 OSGOOD STREET DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY
NORTH ANDOVER,MA 01845 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUT ZED REPRESENTA IVE
CQ......5.,��.�2Q0� ):•:. ::::::.:::::::::.•.•:.•.•:.:::::•.-. ......:::::::•::::::::::::::.•: ::::•::::::::::.::::::.•.•:.•.•.•:.::.::::....... ......
r10RTH
own o-
f t_E : 1, Andover
No. jo
C,, LA-AS h ti ver, Mass,
ATE1)
COCNICNl WICK 1'
�A�R
9S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD . Septic System
THIS CERTIFIES THAT ��' BUILDING INSPECTOR
has permission to erect .. buildings on .. ... ... ... Foundation
p �9 z .... ...........
Rough
to be occupied as ........ ........ dgl�7 k./.Ny
Chimney
provided that the person acceptingzisermit sha I in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
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 CONSTRUCTION ARTS Rough
Service
. —......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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 Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
- Office of Investigations
I Congress Street, Suite 100
e Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Hanle (Business/Organization/Individual):
R.D.Carter Construction LLC/Richard Carter
Address:41 Lexington Ave
City/State/Zip:Bradford MA 01835 Phone#:603-540-0167
Are you an employer?Check the appropriate box: Type of project(required):
1.❑✓ 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 6. F-1 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp.insurance.+
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself o workers comp.
right of exemption per MGL
Y � p 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no 13. Other
employees. [No workers'
comp. insurance required.] S)1J jN(s
*Any applicant that checks box#1 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.
'Contractors 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:Paychex Insurance Agency,INC
Policy#or Self-ins.Lic.#:RDWC241586 nn,,,,, Expiration Date:09/10/12
Job Site Address: �� _6)2�� �*i City/State/Zip: n% )WY2pl/L,� IM
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA fpj insurance coverage verification.
I do hereby certify undeWtile pains and enalties*erjury that the in ormation provided above is true and correct.
Signature: _ Date
Phone#:
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 and, 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 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,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4100 ext 406 or 1-877-MASSAFE.
Fax#617-72.7-7741
Revised 7-2010
www.mass.gov/dia
i
i
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 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 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,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE.
Revised 7-2010 Fax# 617-727-7749
www.mass.gov/dia
ACORD TM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY)
07/12/12
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 endorsements.
PRODUCER COMPANIES AFFORDING COVERAGE
PAYCHEX INSURANCE AGENCY,INC. COMPANY
150 SAWGRASS DRIVE A GUARD INSURANCE GROUP
ROCHESTER,NY 14620 COMPANY
877-266-6850 B
INSURED
RD CARTER CONSTRUCTION LLC COMC/PANV
41 LEXINGTON AVENUE
BRADFORD,MA 01835
COMPANY
D
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DDIYY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $
CLAIMS MADE OCCUR PERSONAL&ADV INJURY $
OWNER'S&CONTRACTOR'S PROT
EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) $
MED EXP(Any one person) $
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY $
(Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY
EACH OCCURRENCE $
UMBRELLA FORM
AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND X WC STAMIT OTH-
EMPLOYERS'LIABILITY RDWC241586 09/10/11 09/10/12
EL EACH ACCIDENT $ 100,000.00
} THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE EL DISEASE-POLICY LIMIT $ 500,000.00
OFFICERS ARE: XI EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00
OTHER
�II
I`I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
1
CERTIFICATE HOLDER CANCELLATION
CITY OF HAVERHILL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
4 SUMMER STREET DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY
HAVERHILL,MA 01830 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
,'mss-•t.--*�:L_.�ar"}�..,,.�.
R. D. Carter Construction LLC Estimate
41 Lexington Ave
Bradford MA 01835 Date Estimate#
7/13/2012 29
Name/Address
Manivon Williams
79 Rock Rd
North Andover,MA
Project
Item Description Total
13 Windows&Trim Wind o m Pella or harvey basement windows,installed,3 total 600.00
X
22 Specialty Specialti . - ii cap,soffit vent,post at deck,supplies from customer,N/C for 0.00
install X
12 Doors&Trim Doors&Trim-i II screen door extender and storm door,storm door supplied 150.00
by customer
14 Plumbing Plumbing-,,in all 2 new fr roof sillcocks,all materials supplied 250.00
Owner X�,�,
Contractor X
Total $20,235.00
Phone# Fax# E-mail
603-540-01.67 978-7024209 rickcarter@rdcarterconstruction.com
R. D. Carter Construction LLC Estimate
41 Lexington Ave
Bradford MA 01835 Date Estimate#
n 7/13/2012 29
V`
Name/Address
Manivon Williams
79 Rock Rd
North Andover,MA
Project
Item Description Total
01.2 Building Permits Building Permits 200.00
02 Site Work Site Work-Dumpster 550.00
02.10 Demo Demo-strip entire house to sheathing X 1,500.00
11 Siding Siding-basic viny tall D4--Install Cypress Green Certainteed Monogram D4 3,875.00
siding X
13 Windows&'frim Windows&Trim-trim out average window with new white pvc and sill,material 2,355.00
included-windows are existing and installation stops will need to be left in and
covered with white aluminum. Window stops are the small peices of wood behind
the outermost window trim. Entire window,stop and trim will be sealed with
Dynaflex 230 white caulking
We will ing a 5/4x4 pvc with integral j channel
X
11 Siding Siding-' all f d insulation taped,3/8"foil lined Harvey insulation nailed to 2,000.00
sheathing X
I 1 Siding Siding-wrap R gables and eaves,including white coil stock 1,375.00
--Install white alumin all trim that is edging the roofline on main house,
breezeway,garage W
11 Siding Siding-install starter base strip whole house and garage 600.00
Material 1x8 pvc stock and screws and cap flashing white to entir m of house, 480.00
breezway and garage as a starter board for siding X _
Material Monogram siding supplied by contractor Cypress X 2,875.00
Material j channels sage green,trim peices sage green,nails,b cypress green,soffit 800.00
stock and F channel in white with hidden vent X
Material White solid pvc corners with j channel 20 1,155.00
11 Siding Siding-perferated it
soffit white with hidden vent installed supplied by 1,020.00
contractor X
1.1 Siding Siding-wrap garage door trim with white aluminum,squared off,door installer to 450.00
install new seal after we wrap
wrap sliding glass door,wrap for door and breezway entry door,stock and
sealant included by contractor X
siding total only************** *** 19.235.00
Total
Phone# Fax# E-mail
603-540-0.167 978-7024209 rickcarter@rdcarterconstruction.com
2012-. -
�Ne2a yrr/�nan cUea���i iusin
�i� edOffice of Consumer Affairs andess Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 161120
Type: LLC
t Expiration: 9/25/2012 Tr# 204205
R.D. CARTER CONSTRUCTION LLC.
RICHARD CARTER
41 LEXINGTON AVE. —
BRANFORD, MA 01835
Update Address and return card. Mark reason for change.
5OM-04/04-GtU
PS-CAI 0Address 0 Renewal 0 Employment � Lost Card
��tQQ2t6
z� Office o o sumer.`{Irirairs A inesf Kegufai on a License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 161120Type: Office of Consumer Affairs and Business Regulation
` Expiration: 9/25/2012LLC
10 Park Plaza-Suite 5170
�,� Boston,MA 02116
RaCARTER CONSTRUCTION LLC.
RICHARD CARTER
/
108 SOUTH RD. --�B�G,
LONDONDERRY,NH 03053 Undersecretary
Not valid wVtho�utiga�tur,
Massachusetts Department fit' Public tiafct%
Board of Buildim
` _, Rc ulatiuns and Standards
j Construction Supervisor License
License: CS 94814
i RICHARD CARTER
41 LEXINGTON AVE s
BRADFORD, MA 01835
lI
I �
Expiration: 9/12/2012
( um�i.xi,°rr Tr#: 873
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal.
:✓ P:0.Box.1025 State Road,Stow_NIA 01775 .
APPLICATION FOR PERMIT
Date:
N. Andover Permit No
(City or Town.) (Lf Applicable) Dig Safe Numb
In accordance with the provisions of NLGI. Chapter 10 as
provided in Section 527 .CMR 34 application is hereby made Start Date
(Full.name of person,Firm of Corporation)
State clearly Address % %� ��✓1,�,
purpose for
PSP (Street or P.O.Box CityorTown)
is req requested
. For emussioato locate dumDster for c o n s t r tion/ novati nn/rlPmnI i ti nn
is requested p
of building
Comments: dumpster must be .25 ' from structure or covered wh n not in „Ge
at
(Give location by street and no.,or descri a in such manner as,to provied adequate identification of location)
Name of competent operator
Cert No.
(If Applicable)
DateIssued-rejected L 3 — Z By
Si a
lure of
licant
. � AP )
P
Date of expiration 8 ' ( Z Fee S 50 -00 Paid Due
The C.o.mmonwealth of Massachusetts
Department of Fire Servicesir's
a
Office of the State Fire Marshal
P.0.Box 1025 Sote Road,Stow,My A 01775
PERMIT Date:
Norah Andover ]Permit No
(Cityof Tawn) (If Applicable) Dig Safe Num er
In accordance with the provisions of Nt G.L,]_4 8 Chapter 10 as provided in section
—U-7—CM 3 4
This Permit is granted to: Start Date
Full name of person,Firm or Corporation
Permissionto locate dumpster for construction/renovation/demolition of building.
Comments dumpster must be . 25 ' from structure if unable to place with required
Restrictions:clearance dumpster must be covered with plywood or tarD end of work -day
at
(Give location by street;and no.,or d ,in such mann provre adegpa identification of location)
Fee Paid$ 50.00zs
Fire Chief
This Permit will expire- S igna
lure of tc
al
t antinS Permit Offc
al
granting
Title)