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Miscellaneous - 190 BERKELEY ROAD 4/30/2018
190 BERKELEY RDAD 21W7.a009&D000.0 BUILDING PERMIT N0RTI1'"D ,b'+a F 9 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received SACHU5 Date Issued: IMPORTANT:Ap li t must complete all items on this page s LOCATION P PROPERTY OWNER , Pant MAP NO:PL__PARCEL: ZONING DISTRICT: Historic District yesKn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Ro &OA 2� dentification Please Timor Print Clearly) 7LI��j�r3� OWNER: Name. 1 t2m o� 1'Oh gloCq Phone: Address: CONTRACTOR Name: Phone Address: t! Supervisor's Constructor License: O K4 Exp. Date: AZO Home Improvement License: z,0 Exp. Date I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED BASED ON$125.00 PER S.F. Total Project Cost: $ U� FEE: $ 10 Check No.: b a-� Receipt No.: v NOTE: Persons contracting with unregistered contractors do not have acces=- , L ty n signature of�Agent/Owner 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 Location �! � / lG� Date No. MORTh TOWN OF NORTH ANDOVER O� t.•o ,•1h0 FO ; p ' Certificate of Occupancy $ ��'��°'•••° �', Buildin (Frame Permit Fee $ ss�CHO*. Building /Frame Permit Fee $ s Other Permit Fee $ TOTAL $ Check s 22UI6u Building Inspector 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 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 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street 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 Doe.Building Permit Revised 2008 14:19 RPR 21, 2009 ID: FRED C. CHURCH FAX NO: 978-454-6646 #346469 PAGE: 3/3 ACORD„d CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY) 04;21,1200914:17 PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 wellman Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lowell,i\4.A O 1 S51 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 500-225.1365 _INSURERS AFFORDING COVERAGE I NAIC# INSURED INSURER A. Peerless Insurance Company Abco Construction 10 Meghann Lane INSURER B. Lowell,MA 01552 INSURER C: INSURER D: 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'u I POLICY EFFECTIVE I POLICY EXPIRATION LTR NSR TYPE OF U NCE POLICY NUMBER DATE MMIDDI DATE MMIDDIYY LIMITS GENERAL LIABILITY EACHOCCURRENCE $500,000 50, COMMERCIALGENERAL LIP31LfTY DAMAGE TO RENTED $ 000 [PREMISES Eaoccurence CLAIMS MADE a OCCUR MED EXP(Anyone person) $5,000 117— A CCPS251803 4/26/2009 4/26/2010 PERSONA_&ADV INJURY $500,000 GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PR O LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ee accicent) ALL OWNED AUTOS BODILY INURY SCHEDULED AUTOS (Per person) H!R ED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per eccident) PROPERTYDAMAGE c (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EAACC jC $ AUTO ONLY. AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ 1 WORKERS COMPENSATION AND - WC SIATU- OTH- I FIR EMPLOYERS'LIABILITY ANY PROPRIETORPARTNER/EXECUTIVE E1.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-101-ICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Fax#1-978446.7103 CERTIFICATE HOLDER CANCELLATION City of Lowell SHOULDANY OF THE ABOVEDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 375 Merrimack St. 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 Lowell-MA 01852 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE }J�� 1 ACORD 25(2001(08) Client# a;F3 Mst# 08-09 GL Cert' ©ACORD CORPORATION 19BB RightFax N2-2 4/23/2009 6: 06: 36 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MMIDDIYY) 04-23-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FRED C CHURCH INC HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 1,965 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE LOW'ELL,MA 018531865 COMPANY 29H5J A HARTFORD GROUP INSURED COMPANY B GYS JOSEPH DBA ABCO CONSTRUCTION COMPANY 10 MEGHANN LANE C LOWELL,MA 01852 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PROD UCTS-COMPIO P AGO. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE(Anyone fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0448N539-09 05-01-09 05-01-10 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERWEXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVBRAGG THE WORKERS'COMPENSATIONPOUCYDOES NOT PROVIDE COVE-RAGE FOR GYS JOSEPH. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF LOWELL EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 375 MERRIMACK STREET FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. LOWELL,MA 01852 AUTHORIZED REPRESENTATIVE ACORD 25.5(3/93) Ramani Ayer NORTH Town of t _ 4Andover . No. 7n dover, Mass., Uf Y) T O `- LAKE COCHICHEWICK � 7 RATED PPS` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ...^'�..... ........j!!!'�'�� .......... ................. ................ ....................... ......................................................... Foundation hasp ......... buildings on .... Rough permission to erect............................... ..��0.........,�,�,....I.r��.....��.....1.. Chimney to be occupied as.... . .In Q.......�.✓..� ......... .f�..� .................................................................................. y provided that the ericce tin this ermit shall in eve re ctconform to thetermsofthea licationonfileinP PP g P every PP Final this office, and to the provisions of the Codes and By-Laws rola mg 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 140A . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU , ST TS Rough Service BUILDING IN TOR Final Occupancy Permit Required to Occupy 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. ✓Y E - Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR Registration: 108424 _Expiration: 8%18/2009 Tr# 132909 Type: DBA ABCO ROOFING;&CONSTRUCTION Joseph Gys 10�MEGHANN LANE LOWELL,MA 01852 Administrator „fir J!� l i!✓J7Z'l%LfY/'Lf/-I-:(Z��fZ Q�i/I•(FCf/JliE'�LLG.�v " BOARD OF BUILDINGREGULATIONS h� License,:. CONSTRUCTION SUPERVISOR Number: CS 092459 Birthdate: 09!27119514 Expires: 09127] �OS u. '32=60 � Restricted: 00 JOSEPH J GYS 10 MEGHANN LANE LOWELL, MA 01852 —�- Commissioner Massachusetts Home Improvement Sample Contract i This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter)42A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"a Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at617-973-8787 or 1-988-283-3757. Pomeo per Info on Contractor information Name (� p am o Strxt Address(do not e a Post 0 o ad s) mr alesperson/0 er e City/1ity/1 c)ivnState Zip Code lusuiesdress(mut m, de a street ass) Daytime Phone Evening PhoneItvfrown Stam Zip Code - - Mtiliag Address(It different Gom above) - Business Phone - ederal Employer ID or S.S.Nimrber - . _ lJu•regrrims Wer moa Mme hm. Home wment Conrtactor aca.Nwoba I Expbntinn m¢ -ivo�•®amt eonve¢ma Mree ad mgistlelioonuvrtKr .. The Contractor agreesto do the following work for the Homeo me esa e m e o rap aspecifying a yPe r m r o na s ee t ne Required Permits-The following building permits arc required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure•their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work MGL chapter 141A.) Dam when contracted work will be substantially completed. Total Contract Price and Payment Schedule ! The Contractor agrees to perform the work firm sh the material and labor specified above for the total sum of. (+) Payments wt I be made according to the ollowing schedule: $ 777! :--C-4;_ ,IetiOn of a total co tr miceortest of special o r m ever is greater) or upon of $ by _/_/_or upon completion of g upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special . S to be ordered before the contracted work begins in order $ o be paid for . to meet the completion schedule.(**) NOTES:(•)Including all finance charges(••)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. - Express warranty-Is an express warmaty beiaa pmJided by the contractor" No Yes (all terms of the warranty must be attached to the contractl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any 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 under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the ntmet shall not imply that any lien or other security interest has 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 if something is unclear. • Make sure the contractor as a valid Home Improvement Contractor Registration The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-80D-223-0933. • -Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at 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 anexplanation of this right DO NOT SIGN THIS CONTRACT IF THERE ANY BLMK SPACES!!! Two identical copies of the contract must be completed and signed.Oue copy should go the hom .The other o ou e k t by the contract Homeowner's Si re Cont ctor' Signature /a 3 0g Date Date t Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an altemative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however, The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contmctor'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 Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts.General Laws,chapter 142A. Homeowner's Signature Contractors Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties, Homeowner's Rig hts A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.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, Homeowners 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 and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees. or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness-for a particularpurpose. 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/boineowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in du lieate 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 beet 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 original contract must be in writing and agreed to by bothparties.Contracted work may not begin until both parties have received a fully 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 account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline. Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically 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 02108 (617)72773200 ort-800-223-0933 For assistance with informal mediation of disputes or to register forma]complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR- Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Pop No. of. ASCO ROOFING & CONSTRUCTION CO. CONTRACT LOWELL, MA 01852 HIC#108424 a Super Contractor License#092469 978-937-5840 or 978-475-7544 PROPOSAL—SUBMITTED TO PHONE DATE STREET 9 0 I 1 f� JOB.NAME CITY, STATE AND ZIPS CODE / JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and'estimates for: I R / t f "'[., j (r f i t•� j obi- '�COCA L L We Propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of,.- dollars t:dollars ($ ). Payment to be made as.follows: All,material is guaranteed to be as specified. All work to be completed in a workman- Ilke manner"according to standard practices. Any alteration or deJiotion.from.above Authorized specifications involving extra costs wilt be.executed only upon:written orders, and Signature will became on extra.charge over and.:obove the estimate. All agreements contingent upon strikes, accidents or :delay;,beyond.our control. :Owner to carry fire, tornado Note: This proposal may be and other necessary insurance. Our worker are fully covered by Workmen's Com. withdrawn by us if not.accepted within days. pensatian Insurance. Acceptance of Prod -The above prices, specifications and conditions are s6tfsfactory and are hereby accepted..You aro authorised to do the work.as specified. payment will be made as ootlined above: Signature Date of Acceptance- - Signoture -- ---- Pop No. R� of r� P ASCO ROOFING & CONSTRUCTION CO. CONTRACT LOWELL, MA 01852 HIC#108424 is Super Contractor License#092469 978-937-5840 or 978-475-7544 PROPOSAL SUBMITTED TO PHONE, TDATE STREET JOB NAME CITY, STATE AND ZIP-CODE r' 1 JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: �\ � f� ;, •. ' IF•"t orf t,.�4,t '�.E� � .�. � { i f 1 ' E,q ,. t ( t,- �t�` � c � J c/ f + tt, , ol We PrOpo" hereby to.fumish material and labor — complete in accordance.with above specifications, for the sum of: \ !♦ 3 L { dollars ($ ). Payment 'to be made as .follows: r All,material is guaranteed to be as s4effled. All work to be completed in a workman. C �� f like manner according. to. srondord.practices. An alteration or deviation.from abeJi Authorized d ) a speeifieations involvinextra 6sts/will bs,executed only upon.written orders, and Signature will became an extra charge over and.above the estimate. All agreements contingent y 4 upon strikes, accidents ,or delays.beyond our control. Owner to carry.fire, tornado Note• This proposal may be and other necessary insurance. Our workers are fully covered by Workmen's Com- Withdrawn by us if:not.accepted within days. pensation Insuronco.. A©e epta a Of PrOPMI The above prices, specifications and conditions are s6tisfoctory and are:hereby accepted..you are authorized ✓j✓_�.. y � � 7 n �; 1 to do the work as specified. Payment will be-mods as outlined above. Signature . - J � Dote of Acceptance_ '' `1;4 t{ Signature, i The Commonwealth of Massachusetts �1 JI Department of Industrial Accidents Office of Investigations 600 lCashi beton Street tij a Boston, MA 02111 c z . www.nwsr gov/din . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARRA nt Information Please Print Legibly Name(Business/orgeoiza6ar/Individual): r Address: /U city/,state/zip: Phone#: . Are�y tin employer?Cheek.the appropriate box: I•U I am a employer with _ 4. ❑ I am a general contractor and I Type of prep(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.Q I am.a.sole proprietor or partner- listed on the attached sheet.= 7. ❑Remodeiing ship and have no employees'. These sub-contractors have working for me in 8• Q lnoiition . g . any capacity, workers' comp.insurance. [No workers'comp.comp.insurance . 5. ❑ We aro a corporation and its g, Buildi fl n8 addition required.) officers have exercised their 10•❑Electrical repairs or additions 3.❑ I air a homeowner doing all work right of exemoon per MOL 11.Q Plumbing repairs m additions myself [No•workers'comp. C. 152, §1(4),and we have no insurance ired. .t 12.❑Roofr-pairs -required.]. employees.[No wormers' comp. insuuanco required.] 13.[]Other 'Any applicant that checks ba#1 must also 1111 out the section blow showing their workers'6ompeusation policy In t Iiomeowntirs who submit this affidzvh indicating they are doing all work sand than him outside contractors most submit anew affidavit indi ;Contractors that check this box mustatla�d art additicaal sheet showing the mm of the sub•comtractots and their workees'cern^ 1;�.•�S such. r Fc j Tfmmdon. !ar-an empfnyer that is'prouidng:workers'co a atron insurance or information.- .f Employees Below is the police and job site insurance Company Name: ' - Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: e Attach a copy of the workers'compensation pot' Iaratiou 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 50.00 d and/or one-year imprisonment,as well Us civil penalties in the farm of a STOP WORK ORDER and a fine of tip 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 for insurance coverage verification. !do hereby c fy untie the p o e f p rjwy that the information provided above is true and correct Signature: e: Date: Phone#: 7 �•- of iicia!use only. Do not write in this area,m he completed by Ciro,or town of cia[ City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Sniiding Departmeat 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone#: Information a nd Instructions ^ Massachusetts General Laws chapter 152 requires all emp layers to provide workers'compensation for their employees. Pursuantto 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." l` An employer is defined as"an individual,partnership,assodiation,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and includir-og 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 ort-local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or *a construct buildings is the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insumnee'coverage required." Additionally,MOL 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 corutracting 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 orpmtnas,are not required to carry workers'compensation insurance. If-an LLC or LLP does have empioyees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Aliso 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,notate Department of industrial Accidents. Should you have any.questions regarding the law or if you are rmpired to obtain a workers' oompensat:ion policy,please can the Department at the nurnber.iisted below. Self-insured companies should enter their ser€insurance license number on the'appmpTiate line. City or Town Officials Please be sure that the affidavit is compl�e and printed legibly. The Deparimerrt 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 appli= Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an appiicant that must submit multiple permitllicense 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,6e 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 flog license or permit to bum leaves et:.)said person is NOT.requimd to complete this affidavit The Office of investiptions 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 Departnent's address,telephone and fax number. The Commonwea-lth of Massachusetts Departmet of lmdustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL#617-727-4900 est 406 or 1-8.77-MASSAFE Fax#617-727-774 Revised 5-2ti-t15 wwwmass.gov/dia BUILDING PERMIT O NORTh �tt�eo ib�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * _ Permit NO: Date Received t s Ssac►+usE Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 13 Z EgAr�j� Print PROPERTY OWNER Ll�cx Pte( Print MAP NO: PARCEL: ""ZONING DISTRICT: Historic District yes Machine Shap Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO. BE PREFORMED: AISTA L M16 kl# _�} -71Cs 11G31 •tr.�Q ►�tyY�c3 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR. Name; JKLc- Phone: gilt 314 '42A& Address:-56q ctficte164 t.UlY i(aG\hf�. Mk- 01 Supervisor's Construction License: 5 Exp. Date: 31,412010- r Home Improvement License: 10 11-30 Exp. Date: �i 1�'� �23I ARCHITECT/ENGINEER AQ 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: $ 84b FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guara fund Signature of Agent/Owner Signature of contractor F 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 PermitApplication ❑ 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 Location .135- `(4— No. (4-No. �rS�� Date 5 . 1 NORTH TOWN OF NORTH ANDOVER Oft . o ,�,ti O 9 ` Certificate of Occupancy $ CHU Building/Frame Permit Fee $ Foundation Permit Fee $ #i Other Permit Fee $ t TOTAL $ Check # 5-33 2207U - Building Inspector 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 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 Osgood Street FIRE DEPARTMENT -Temp Dupster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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 21 A—F and G min.$100-$1000 fine NOTES and DATA— For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ Registrit ort:, 101730 Exp�irat�on 6129/2010 Tr# 267903 Type Pfiv2te Corporation HRH CONSTRUCTION INC !J t William Hope 589 CHICKBRING RD REAR? ee .` N.ANDOVER,MA 01845 , Administrator Board of Building Regulations and Standards Construction Stip'ervisorLicen'se License: CS 57754 Expirafaon 3/4/2010 Tr# 20207 fr2est�action Ol1�` WILLIA-M D WOP,E z i 589 CHICKBRING N ANDOVER,MA 01845 Commissioner VAORTH TO" o .. Andover . No. d12 I 0 over, Mass., 0 LAK A4 co CK PS` ��S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 00" • BUILDING INSPECTOR THISCERTIFIES THAT..................Z.................. . .......................................................................................6.............. Foundation has permission to erect.......i................... buildings on .kdl..r...... .......Cf.(Wft....... Rough %.V.%%....... ......W........ Chimney provided that the person accepting.this'-Fi�I- Maisi'- every respect conform to the terms of the application"**o*'n"file**i*n' Final to be occupied as...-.00.r 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 a PERMEXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU= TARTS Rough ................................. .............................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. The common we ofMassachusetts k� )t Department of Industrial Accidents ?, ! Offece of Investigations 600 Washinvion Street u� A Boston,MA 02111 www"WSS.goV1dna . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A01dicant Infornitation Please Print Le�bly Name(Business/Ory nim6on/Individuaw &M j 1 Z, �JILC Address: Jca pp City/State/Zip: Phone#: . Sd ' Are you an employer?Check.the appropriate box7� , IR I rim a employer with -3 4, Type of project(required): ❑ I general contractor and 1 Ployees(full andiorpsrt-time).* hed the sub-eotttracnrs 6. ❑New construction 2.❑ 1 am.a.sole proprietor or partner. lithe attached sheet.i 7. -Remodeling ship and have no employees Tsub-contractors have working forme in wcomp.insurance. 8. ❑Demolition9. Buildi[?�lo workers'comp.instu ance 5. ❑ Wcorporation and ids ❑ addition required J ofhave exercised their i 0.❑Electrical repairs oradditions 3.❑ 1 aan a homeowner doing all work rigxemption per MGL Piurnbingrtpttirs oradditions myself(Tlo workers'camp. G , 1(4j,and we have no 12.[]Roof insumce,required.]t employees,(No workers' repairs comp. inurce sanrequired_] 13 ❑Other 'Ae}appiieam that checits boz:#t must also fit out the section below showing their workers''oompensstio I policy information. t fiomeawners who submit this affidavit inditsinng they are doing ail work and tb=h ire outside contractors mhist submit a new affidavit indi 4Connactots that check this box must stmcked an additional sheat showing the name of the sub S such otteetors and their wotiars'txm h:— 'fo atm. r ••�J ha !arse an employer that is providing workers'cornpensadon Insurance for my employees: Below is the . information. p &y med job site Insurance Company Name: Policy#or Self-ins.Lic.# Expiration_?ate: 12 Job Site Address:_ mkt r ti-t'4L13ti� �CtP2 City/statczi p'A _. Attach a copy of the workers' M compensation policy declaration page(showing the policy number and expiration dated . Failure to secure coverage as required under Section 25A of MOIL c. 152 can lead to the imposition of criminal penahies of a fine up to$1,500,40 and/or one-year imprisonment;as well las 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 for insurance coverage verification. I do hereby c unde andenQlties ofP rle ' P wY that the infornrattoit provided above is litre and eotreeL Si titre: Date: Phone# 3 Of,jcw use nnfy. Do not write in this area,to he co►npleted by city or town olds( City or Town: Permit/License# Issuing Authority(circle one): I. Oohed ofHesttb 2 Building Department 3.CitylTow•n'Clerk 4.Electrical inspector S.Plumbing inspector, 6.Otber Contact Person: Phone#: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp 3 oyem 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,associatioin or other legal entity,employing employees.'However the owner of a dwelling house having not more that 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 appurLm=thereto shall not because of such employment be de med to be an employer." MOL 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 widr the insurance'coverage required" Additionally,MOL 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,supplysub-contractors)name(s),address(es)and phone numbers)along with their certificates)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' oompensation policy,please tail the Department at the numberlisted below. Self-insured companies should enter their sett=insurance license number on tiw'appropriate Tine. City or Town Officials Please be sere that the affidavit is complete and printed legibly. The Department hes 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 ftritve permits or licenses. A new affidavit must be filled out each year.When 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 bum leaves etxr.)said person is NOT,required to complete this affidavit The Office of investigations would irke 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 Lnvesttibations 600 Washington Street Boston, MA 02111 TeL#617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7741 P--viand 5-26-05 www.mass.gov/dia t aH 6raieslogtsFtis _. ..-............ 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