HomeMy WebLinkAboutMiscellaneous - 125 DALE STREET 4/30/2018 W 125 DALE STREET
210/037:E:-0016-00000
NORTH
Town of
0
No.
o
Idower, Mass.,
Q - C.E
COC MIC ME WICK
14' TED
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
.
THIS CERTIFIES THAT........�.�4�' ....... .G. �`j.4...................................................................................................
n Foundation
has permission to erect........................................ buildings on.... ..a7.......... Cd.I.G...4�. ....................... Rough
to be occupied as.......... ... ..... .... .. 'r' . .4 44-x. -oa.... .......! .......................................................................... chimney
provided that the person ac this permit shall in eve res ct conform to the terms of the application on file in
this office, and to the provisions of the odes and By-Laws relating to the Inspection, Alteration and Construction of Final
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 CONSTRUCTI ARTS Rough
- —
....................................'................................., ......................... Service
BUILDING ECTOR
Final
Occupancy Permit Required to Ocatpy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
NEW ENGLAND CUSTOM DESIGN, INC.
226 LOWELL STREET
WILMINGTON,MA 01887
#978-658-0881
Home Improvement Contract Registration No.102467
ROOFING AND SIDING AGREEMENT
This is a legally binding contract.Make sure you read this Agreement and understand it before signing it.Do not sign this contract if there are any blank spaces.
NOTICE:All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts law,must be
registered with the Commonwealth of Massachusetts.All inquiries about registration should be directed to:
DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION ,1 j(�` � �/ � j i L
One Ashburton'Place,Room 1301 /G1(f (j`
Al
Boston,Massachusetts 02108
Telephone:#617 727-8598
'his Agreement is made on �� 20,Z0_,by and between New England� Custom Design,
nd owner L4PA S.aUiu�A..47` gn (hereinafter,"Owntractof
�� // � \� ,�r� S�17 w h1.2 4' (hereinafter,"Owner,).of
;ity/Town Iva,-)-4 /� 1I0yll/A State._2714. Zip O��-y=
T (I1)Phone
lb Address(..The Premises') /1.2 / _I tlp �[T /�7S /�,g� rC'Y- (W)Phone 9j7e-
ew England ustom! eslgn,Inc.Salesperson _ r
Roofing will be applied only on slope roof surfaces below,over present roofing shingles unless specified under RE
W
MATERIAL --s
�
/ R
a. 1/fin �A/f'1�h .sem 3 rJ Color �l/tx
L
s $
Main Roof I i r.S Bay Windows A&W--e Extensions N w y
COO �
Porches:Front I
Side .Aeay-r Rear 4eo41e OtherRoo£s R.'r&, J-/'OT- AP
NOTE:Roof board replacement cost per foot OR <3.s-ou per 4'x 8'sheet of inch CDX plywood.
EMARKS/EXTRAS:Missing or defective lumber is not included in any category of work unless specified here.
d I I T rc 12af �.v J
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L�/gins
q/,/, �o:/ T Ifo�/ �.��tl 4i6��r//a 11' --z"'. aJ/
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QLD rePvnAS AQd,-riwroz '/Z .(ter s►nDr/) yv Fi�w/ ��s/mycw� E7 G�_�Op.�°
The Contracroragmees to perform in agwd and workmanlike mamteran uw*detailed above.'
CASH PRICE$ � 7 t- 0
DOWN PAYMENT
PAYABLE ON START OF WORK$ s New Ennd Custot3x n x a Itac w1�1 Ciet�` r
PAYABLE $
�{ ''�
PAYABLE ON COMPLETION$ ��' �- 8tn�dr��SP r IItf u �
lovable L
DATE: 20
RIGHT TO CANCEL W ry
e Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contactor,which may be his main office or branch thereof,provided that the Owner
ifies the Contactor in writing at his main office or branch b o mail posted,Y menti p d by telegram sent or by delivery,not later than midnight of the third business day following the signing elapsed. ofthis Agree-
nt.See attached Notice of Cancellation.A cancellation fee representing 30%of the contact price will be in effect if cancellation is requested after the legally allotted time has elapsed.
e Owner hereby certifies that he has read this Agreement,that the terms and conditions and the meaning thereof have been explained to him,and that he fully understands them and that there is no
lerstanding between the patties,verbal or otherwise,thanthat whichis contained in this Agreement,and agrees that the said Contractor is not responsible nor bound by any representations not con-
ted in this Agreement,made by any of its agents,unless the same be reduced to writing and signed byrhe Co ct
ON H OW�DONGN THIS CO CT IF THERE ARE ANY B SP CES.
t
fo I r7 /
m rgnature to Ne England Custom Desi4n. Date
mer's Signature Date
ti The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
fr Boston,MA 02111
s
www.rnass.g ov/dia
WorkerV Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): N_ L U J jC/e`+'1 9/ZS/Gds'' _�e-- _
Address: 2= 1-0ot,-G
City/State/Zip: Lk/ ole97 Phone_ #: - -
Are yq.0 an employer? Check th appropriate bog: - Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have°hired'the sub=contractors= 6. ❑ 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. E] Demolition
working for me in any capacity. employees and,have workers'
[No workers' comp, insurance comp:iiY urance.
9. ❑ Building addition
required.] 5. ❑ We are a.corporation`and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers-have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152,§1(4),and we have no "
13.❑Other
employe-es."[Nb workers'
comps insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
11rm�nNsf sr. '» c;hm7t this afuduVll iudiCatiLK they arc di7iii all work and thea 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 Mai is providipjq workers' :cc;c;r
information.
Policy#or Self-.ins..Lic.#: T ® ?�..,/ , `�- r?--/O Expiration Date: -3 { I Y"It`
Attach a copy of the.workers'compensation policy'de"elai atior`page(showing the policy number and expiration date).
Failure to secure eoverage as required u lder ctctiotl %`h' Ir 1,04G.r `_ 15.
? � n IP td to the impc,sitinn c,fcriminal penalties ofa
of ur)to S25n_nn a A— tb, ,.;,tit,r Ra�At ;-A A, t
I ij Vl_:va-aYit.i it iJl\laj(.alt:
I do hnrrh-it e4,rp 'anilE,r thy,j4ftin,- _ -dp ennities,ofpt,riif,i•v-1h 1 the inform_a_fian,n-rovMed a h o v e true aitd rnrrnrf,
0/ 79, 6 S-9- y /
ai Official use only. Do not write in this area, to be completed by city or town official. +�
a3 aF
4€
City or TGVvn: Per init/Laccluse# t1
• a
3sc€€i€ Authority
1.. Board of Edea€L.h .j. Buildiru Der;-rtsa ept I cit-TI-1€;;sr;P �;€t>ri� , .a, Electria ' �€:e AeerF-ar :5, Psamb.gqg irsnerttk€•
le
6.Other
II
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID KC DATE(MM/DD/YYYY)
NEWEN-1 03/22/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Kilgore Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR - -
5 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody MA 01960
Phone: 978-531-6550 Fax:978-531-9442 INSURERS AFFORDING COVERAGE NAIC#
.INSURED INSURER A_ western world Insurance cogLa_
New England Custom Design INSURER B: Safety Insurance Company 39454
In cor orted —
Ron Weinberg & Val Lanza INSURER C: Travelers ?rperty s casualty
226 Lowell Street / Unit B4-A INSURER D:
Wilmington MA 01887
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN-MAY.HAVE,@EEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY NPP 12 0 3 2 41 03-1-14V10 -03/14-/11 PREMISES Ea occurence $ 50000
CLAIMS MADE Fx-1 OCCUR MED EXP(Any one person) $2 5 0 0
PERSONAL&ADV INJURY $ 1000000
GENERAL AGGREGATE $2000000
GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 1000000
POLICY 17 JECT A LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
0062853 04/05/09 04/05/10 $
I B ANY AUTO (Ea accident)
ALL OWNED AUTOS POLICY RENEWS 04/05/10 04/05/11 BODILY INJURY
X SCHEDULED AUTOS (Per person) $250000
HIRED AUTOS
NON-OWNED AUTOS (Pe�ILY accidenl)RY $ 500000
-- _ -- PROPERTY DAMAGE $ 100000
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $-71 -
OCCUR a,CLAIMS MADE AGGREGATE $
DEDUCTIBLE _, $
RETENTION $ $
WORKERS COMPENSATION AND XTORY LIMITS ER
B , EMP;LOYERS'LIABILITY - 7PJUB0239N232-10 03/14/10
ANY PROPRIETOR/PARTNER/EXECUTIVE _ 03/14/11 E.L.EACH ACCIDENT $100000
OFFICERIMEMBER EXCLUDED? E.L.DISEASE,-EA EMPLOYE $.100000
S yes,AL P be under E.L.DISEASE-POLICY LIMIT $ 500000
SPECIAL PROVISIONS below
OTHER
i
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
t
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL5D BEFORE THE EXPIRATICIN
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE'HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES,
_ AUTHORI SENTATIVE f
1
ACORD 25(2001/08)
0ACORD CITPORATION 1188
--ter
/ ilations and Standards
0 Board of um Reg CONTRACTOR
� . HOMEIMPROVEMENT
Registrtloit� 102467 Tr# 269346—
' FPtor► Z 212010
?' pin4te Corporation.
Il7STOM[lEIN,INC.
t NEW ENGLANO�Cc
I �
I Val Lanza ' inistrator
226 LOW ELL ST µ;
_._
WILMINGTON,MA 01887
Massachusetts- Department Of Public SufetN
Board of Building Re"UhitiOns untl Stundurtls
Construction Supervisor License
License: CS 8828
Restricted to:.00
VAL J LANZA k
34 BIXBY ST
REVERE, MA 02151 .:
Expiration: 4/20/2012
Tr#: 20843'
('ununissiuner ,
i
AddressS Title of He
Page _
of
Date File Open:
Date fide closed:
Doc Document/Action Title
action Date of Refer to other purpose of DooumecntJActton and notes
filum. Document/ document/ ---
Action De artment
i
Board of Ap.peads — Board of Heal h Planning Board
onseruation COMMission — Building Departnlen; �----
d �
Please forward us as much of the following information that is possible;
1. Type of system
'i
2 . Age
3. Loc at ion;
4 . Maintenance records and date of last pumping out
Documentati.on of repairs and reconstruction
. 6. Site conditions
7. Builder of system
8. Engineer who approved;
-- Site
— System
a
,. 2 .
9. Installation Procedure
10. Problemw
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name jyllYS 7gahc:�-Z _72
2. Street
Address X2
3. How many members are in your household? l
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
A connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
yes ❑ no ❑ do not know .
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes ❑ no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher X garbage disposal
dehumidifier drain sump pump toilet —
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher 11 d cf
clotheswasher 11ZA2 5 0-v /04ti��r�y-
12. Does your property have a lawn? CS, yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre 13- 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres -
13. How often do you fertilize your lawn? 4
No. of applications per year D =
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.