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HomeMy WebLinkAboutBuilding Permit # 3/4/2015 a BUILDING PERMIT ° ®°t TOWN OF NORTH ANDOVER ° t APPLICATION FOR PLAN EXAMINATIO - Permit NO: Date Received ` 1 4q c4pC H y-.N Date Issued: 2 i IMPORTANT:A licant must com lete all items on this Rage Ac"US LQCAfi1C►N 1 FZOI?ERTYQWNER ". Print 11lIAP NO'/. PARCEL �� � GPfLN �` fSTRICT Mist+ ric D�str�iat ydsn �. Machines/Sh p Village yep na. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial VA Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other d Septic n Well o Floodplain 0 Wetlands ❑ Watershed District g Water/Sewer - a rl Identification Please Type or Print Clearly) OWNER: Name: 6.. cj ( Phone: �_C� 1 �3 ' C v Address: 1'1'\ (� r\ Address „, ,,,, Superwior's Constictoin Llcnsecp pate: m MeprouementLicense. Exp, Date. O ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST rSED ON$125.00 PER S.F. Total Project Cost_: $ C ` 4 (� FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guara#0 fund Signature of Agent/Owner; Ad All Signature of contractor i o0RTly Town of : 1� ndover No. MOW T O LAKE h " ver, Mass, S COCNICNEWIC/t 1' S V BOARD OF HEALTH Food/Kitchen PERMIT T. D�/�/� Septic System THIS CERTIFIES THAT ........ apt C�--�i�. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ................................................................................ 9 �. .Kl.1 . Pt....... ............................. Foundation has permission to erect .......................... buildings on ... . ........ � ... .: Rough to be occupied as ........5VL .1........csmoA.� ...L^ '.'? 141.................................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 1 UNLESS.CONSTRUCTIONS S Rough Service .......................... .. ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Champion Home Improvements of New England, LLC Pkione: 781 937-9000 11 Sixth Road WoLurn, Ma. 01801, Home Owner nwk (. _ ��'�C Phone b 3 6 Address: 1 �`(vr� u n )U orrk L�JJUJ','-, OL� 5 Email 1. Agreement Date + I Y,s, 5. 4. Deposit 1 2. Contract Sum a-(p 5. Due at Commencement �u 3. Source of Funds C C,.I,(_ 6. Due upon Completion 7. Completion Schedule: Work will begin approximately on �7, J, and will be completed within weeks. Contractor is not responsible for delays due to a change in the scope of work, and other factors out of his control such as weather, utility failures and inspector's delay.Homeowner must provide a clear and safe path from parking location to project entrance. 8. Scope of Work:Work to be performed in accordance with contract sketch.Any changes to agreement must be written with homeowner's and contractor's signatures. Any additional work mandated by township to be priced at fair market value; labor and materials. Contractor will leave premises broom clean daily, 9. General Provisions: Contractor provides all labor and material to complete work unless otherwise stated. Contractor responsible for obtaining all necessary licenses,required permits and inspections.All work will be completed in compliance with codes and applicable laws. 10. Warranty: Contractor's warranty for labor will extend for a period of twelve months from date the work is completed. Customer must give contractor written notice within warranty period for any claim.Customer shall have no other remedy against contractor for warranty claim for loss or damage caused by intentional or negligent acts,loss or damage caused by acts of God or any other consequential damages. 11. Payment: Payment of the price is due by customer in full upon the terms set forth in this contract.In the event that the contractor declares the project complete but the customer determines items for"punch-list",it is agreed that the customer may be entitled to withhold 5%of the total contract price until such items are completed. The contractor has the right under Massachusetts and New Hampshire Lien Laws to use your home as security for payment for this agreement. 12. Remedy For Breach: If customer breaches this contract, contractor shall be entitled to recover the greater of liquidated damages in the amount of twenty percent (20%) of the total contract price, or such actual damages as the contractor may prove. In the event that the contractor cancels this contract,a written notice will be sent within thirty(30)days of contract date and all deposits or monies on account will be promptly refunded to customer. 13. Arbitration: Customer may contact the contractor with any questions or complaints regarding the contract. All disputes and claims between customer and contractor concerning this contract which any party believes cannot be resolved informally, including without limitation any warranty claims, shall be resolved by binding arbitration conducted by a single arbitrator under the auspicious, rules and procedures of the American Arbitration Association and in accordance with the applicable federal and state arbitration statues. The arbitration shall be held in the city or county where the premises are located. No discovery shall be allowed except as may be agreed to in writing by the parties. Either party may demand arbitration,and the arbitrator's final award shall be issued within ninety(90)days after the service of the arbitrating demand on the other party.It is agreed that all arbitration costs shall be bourne by the party that does not prevail. 14. Cancellation: Under Federal and State Law you have up to three(3)business days to cancel this agreement. Comments: Signatures ,,++ Owner: Print: ('� (4_ QL �. _ Date: Contractor: G t '""� Print L\`aF �_k(r Date: Complete Basement Remodeling Basement Living Systems Name I� 1 a f c- l,( e of New England,LLC AddressBASEMENT 11 Sixth Road LIVING SYSTEMS Wobum,MA 01801 Phone 781 937-9000 er � ® Contract Sketch JL 14 Al J R I N s - I 3G ' i l b' `\! ' �i r\,, �� S ri° (� v\1 BLS WALL SYSTEM GREEN BOARD WALLS SOFFITS AND POSTS LIGHTS ELE TRIC WALLS APPROX LN FT �� COLOR S SUB PAN PACKAGE: qq � SUB PANEL IV /t- GREEN 801 RD or P TE EO WALLS J�[J/\'t - OUTLETS: STANDARD _L GFI / DEDICATED TRIMCOLOR VJ�r_- up 6"RECESSED CAN LIGHTS / SWITCHES_.3 WINDOWS (e N t--k-S ` Uk(A PULL CHAIN LIGHT 3 SMOKE DETECTOR 6 PANEL DOORS 30"�_32" 36" CABLEJACK INTERNETJACK �,( BIFOW DOORS 30" 36" 48" 60" 8'BASE HEATERS WITH WALL THERMOSTAT�U_ EXTERIOR STEEL DOOR / OTHER CEILING APPROX SO FT .3bu STYLE Nf YhS�'U�1 Ni�• FLOORINGAPPROXSQFT 1-A SOFFITS APPROX SQ FT #POLE WRAPS n STAIRS C DEMOLITION A/ 6 �L / SIGNATURES: DATE ` REMARKS REPRESENTATIVE /-(> / 5- r_7 - HOMEOWNER Cbmplele Basement Remodeling Basement Living Systems Namet �a f C. lir e �� � of New England,LLC Address l� L n«1 n / 11 Sixth Road /`lJ'- (-LIVING '- h / (-Ll V I N G SYSTEMS !; Woburn,MA 01801 Phone 781 937-9000 oY ® Contract Sketch vej �.j i vk4aC CTA I -_I Q11- --, s ) �: V\1CA J��U BLS WALL SYSTEM GREEN BOARD WALLS SOFFITS AND POSTS LIGHTS ELECTRIC PACKAGE: WALLS APPROX LN FT COLOR SUB PANEL /V /t- GREEN BO/RD or P iE ED WALLS 1\4 J l`'� - OUTLETS: STANDARD GFI / DEDICATED TRIM COLOR lJ�r_ I 6"RECESSED CAN LIGHTS 7 SWITCHES WINDOWS M{-W C-�•t PULL CHAIN LIGHT r ZSMOKE DETECTOR 6 PANEL DO0RS 30"_1 32"�_36" CABLEJACK INTERNETIACK BIFOLD DOORS 30" 36" 48" 60" 8'BASE HEATERS WITH WALLTHERMOSTAT EXTERIOR STEEL DOOR OTHER CEILING APPROX SQ FT STYLE iM1�S�'Ur1 (u„lo_ FLOORING APPROX SQ FT bl I-A SOFFITS APPROX SQ FT 66 #POLE WRAPS Q STAIRS DEMOLITION J`t.6/ " / SIGNATURES: DATE REMARKS REPRESENTATIVE HOMEOWNER Y Massachusetts _Department Of Public Safety Board Of Building Regulations and Standards Licensa: CS-022200 DOMiMC G RICO 405 CARDINAL L`tq � TYNGSBORO M1 Ol$ 1 Expiration Commissioner 05/20/2016 CITY OF BOSTON Lice:No-819029 BOARD OF EXAMINERS _ MAYOR Martini Walsh T221 . a'x ' w . Y l4CENISEOTO TAKE CH DF 1 'A FEi��'t? s A �?•, 5H4 1@1Z511S BOARD 0;:EXAVINERS r%fir r,yyr�rrca>rrrirrr�l�cfb114f3:rrrrfrraellt Mee of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Registration: 180705 Type: ' Expiration: ,12/1812016'. Supplement CE CHAMPION HOME IMPROVEMENT OF NEW ENGLAND LLC. DOMINIC RICCI 11 SIXTH ROAD ,�� '---- WOBURN,MA 01801 Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investigations - I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'/Legibly Name(Business/Organization/Individual): U�k 0 X)h( T�/i')tuly/ f/�--) Address: UI,d City/State/Zip: (, d L rn 61 �-0I Phone#: Are you an employer? Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. Ex 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• ❑ Demolition workingfor me in an capacity. employees and have workers' Y9. F] Building addition [No workers' comp.insurance comp.insurance.$ 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 I I.❑ 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 employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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. lContractors 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. ff the sub-contractors have employees,they must provide their workers'comp.policy number. I an:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: E(4,1 r4✓-6,11-64,J JA 44 f "PI n d M t,A 4, _ Policy#or Self-ins. Lic. #: 1 > Jq U 0- 0696 Expiration Date: Job Site Address: City/State/Zip: <'l(oi(/► C�u✓�/� 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 for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the inforutation provided above is true and correct. Signature: Yti t:� u . Date: U G�/ Phone#: J�� 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#: ATE[M , 6. CERTIFICATE OF LIABILITY INSURANCE O/27/IDD(Y5 �� 2/27/2015 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(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 CONTACT NAME: Deborah Stanhope Elliot Insurance Agency A Division Of PHONE . (603)497-4143 AX No): (603)497-2521 Stanhope Associates, Inc EMAIL :dstanhope@elliot-ins.com 11 North Mast Street INSURERS AFFORDING COVERAGE NAIC# Goffstown NH 03045 INSURERAMSA Group 9939 INSURED INSURER B:Travelers ROBINTONS REPAIR & REVOVATIONS LLC INSURER C: 9055 35TH WAY N INSURER D: INSURER E: PINELLAS PARK FL 33782-5951 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1522701938 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED '.. X COMMERCIAL GENERAL LIABILITY PREM SESOEa occurrence $ 500,000 A CLAIMS-MADE F_x1 OCCUR 9PB38358 /25/2015 /25/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICYLIRO LOC $ P AUTOMOBILE LIABILITY COCT MBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acc dent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATIONWC STATU- 0TH- '..... AND EMPLOYERS'LIABILITY YIN E R ANY PROPRIETOR/PARTNER/EXECUTIVEN NIA E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 6KUBSB26093819 /9/2015 /9/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Champion Basement ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lynn Lavallee/LAVALL ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD �.•� OP ID:LO A�aRn• CERTIFICATE OF LIABILITY INSURANCE DAT02/17D/YYYY) 02/17/15 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). CONTACT PRODUCER Phone:781-935-8480 ME: DeSanctis Insurance Agcy,Inc. PHONE FAX 100 Unicorn Park Drive Fax:781-933-5645 No.E AIC No): Woburn,MA 01801 MAIL ADDRESS: PRODUCER BASEM-1 TO R ID 0. INSURER(S)AFFORDING COVERAGE NAIC# INSURED Champion Home Improvements INSURERA:Seneca Insurance Company,Inc. 10936 of New England,LLC INSURER s:Carrier Will Send Certificate New England,LLC. INSURERC:The Commerce Insurance Company 34754 11 Sixth Road Woburn,MA 01801 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE.ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MM/DDS POLICY/ IYYYY LIMITS . R GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BAG1020696 03/23/14 03/23/15 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,400,00 _X1 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (En accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ C X SCHEDULED AUTOS BBXZ59 07/17/14 07/17/15 PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON•OWNEDAUTOS $ X HCPD up to$70k $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LWB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION X WC STATU• 0TH- AND EMPLOYERS'LIABILITY MA-CERTIFICATE TO BE SENT 100,00 B ANY OFFICER/MEM ER XRTNECLU DXECUTIVE Y7 NIA 03!27/14 03/27/15 E.L.EACH ACCIDENT $ (Mandatory In NH) DIRECT FROM CARRIER E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under 500,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION CREDIMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Marc Credi ACCORDANCE WITH THE POLICY PROVISIONS. 18 Lyman Rd. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD