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Home My WebLink AboutBuilding Permit # 6/4/2015 I BUILDING PERMIT 01 No oT TOWN OF NORTH ANDOVER 02 16 0 APPLICATION FOR PLAN EXAMINATION N . Permit No#: 7 ®� Date Received �° q�R'7E0 gSSAC HUSE� Date Issued: PORTANT: Applicant must complete all items on this page r. LOCATION ismy X P not PROPERTY OWNER a �-• t1„00 Year Structure yesno MAP PARCEL ZONING DISTRICT Historic District yes no ; Machine ShopVillage -;yes TYPE OF IMPROVEMENT PROPOSED USE Residenti Non- Residential ❑ New Buildinge family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic p 1Nell; 0 Floodplain ❑UVetlands Watershed District: Water/Seviier DESCRIPTION OF WORK TO BE PERFORMED: A e � G9 �✓ � dentification- Please Type or Print Clearly OWNER: Name: Z ,� , ,cam Phone: p � Address: Contractor Name. Address ' Supervisor's Construction License Exp Date � , �� Home Improvement License p Dates , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING ERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o FEE: $ Check No.: Receipt No.: G -1 NOTE: Persons contracting with unregistered contractors do not have access to tl f guaranty fund Signature of Agent/Owner Signature of'contractor ��A - a -1 I IAORTH ®wn ® E ...'.��. Ait d v M1 ® No.e Ilw - . ooR ' h h V��9 MaSS9 cocnic"twicx 1' AERATE n PP¢`,��(5 � U BOARD OF HEALTH PERMIT T L U� Food/Kitchen Septic System THIS CERTIFIES THAT ................f(4..W-r,. ..........A(..,1,?l .. ........................................ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .4� ........ ..... .. ............ ......,..... ........................ Rough to be occupied as .......... ... ... ...........-{-... ...... I . . ........��....................................... Chimney provided that the person acceptin this permit shall in every re ct 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 E I E IN 6 MONTHS ELECTRICAL INSPECTOR 103 LESS CONSTRUCTION ART Rough Service .......................... ..... ... .. .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Islay 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. ropyVml Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH .North Andover, MA 01845 Proposal Submitted Job Name Job# Address Job Locat' n Date Z Date of Plans Phone# �� Fax# Architect We hereb sub ' specifications and estimates for:_. 7' We propose hereby to furnish ma eriai and labor—complete in accordance with the above specifications for the sum of, me Dollars with payments to be made as allows. > Any alteration or deviation from above specifications involving extra costs be Respectfully executed oniy'upon written order, and will become an extra charge over and Submitted above the estimate.All agreements contingent upon strikes,accidents,or delays 5 beyond our control. Note—this proposal may be withdrawn by us R not accepted within days, acceptance 01flpropwaf The above prices,specifications and conditions are satisfactory and areSignature v hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance �" �� Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This forrn satisfiesell basic r a quirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standaitf language to protect homeowners. Seek legal advice if necessary. Any person planning home"proveiments shoutdfiisf obiain s copy of"a' Massachusetts' m :consuer guide to homeimprovement"before agreeing to any work on yourrrsrdence.You may bbtain a fra copy by'calling the' Office of ConsumerAffairs and Business Reguladon's Consumer Information Hotline ab617-973'8787 or 3#888483-3757.- Homeowner :,888,283-3757.Homeowner Information 'Contractor Information Name Street (do not use a Post Office contractoroldOwner Name -W J- /,4,) ' Cityrrown Zip Code usiness Address(must include a street addresg=. .. . ! C Daytime Ph a Evening Phone ityffown�//�, State �ry Zip Code 7 �'•� .. �z� V e (fG-�� `��l ! /� Ler• Mailing Address(It different from above) 3usiness Phoria n6deral Employer ID or S.S.Numb; ' lav r•quhea nut moil]nmeim• Aome ICtmtnaor aeaYNumbe axp6ni.d.W .. ' pnnmmt evalnatas tuw s neosdoa The Contractor agrees to do the following work for the Homeo .r:rarer. � � c ✓ � RequiredPermits-The-following building permits are required Proposed Start&hd'Completioa Schedule-The fdllov/ing schedule will and will be secured:by the contractor-as the'homcownets agent; be adhered to`iitiless circumstances beyond:the contractoeveontrol arise (Owners whtisecure their own permits will be excluded.from the iGuaranty Fund:provisions of ,;----D when ahtractorwill begin contracted work MGL chapter 142A.) Date when contracted .work will:be substantially comple Total Contract Price and PaymentSchedule t The Contmetor.agrees to perform thework,furnish the material and labor specified above for the total sum of- Payments will byide accordtn the following seh S(%(S<tl{✓i upon.signmg contract'(nota ceed 1 th�elota�cyonfract/price. the costzf special order items,whichever is greater) S �—by_9=T=or upon completion of ( =k--1—orupon completion of o S q` V 0, upon completion of the contract (Law forbids demanding full payment until.contmct is completed to both party!s satisfaction) The following material/equipment must be specialS e paid for ordered before the'contracted workbegins in order S to be paid for to meet tfie.complbtion schedule.(••) NOTES:(*)Including all finance cbarges(•►)Iaw requires that any depositor 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 schist 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-warranty being nrovlded by theoontractor? No Yes (aliterms of the warranfv m�•'Ire attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions'ofany third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and labor under this agreement Contract Acceptance-Upon signing,thi's document becomes a binding.contract under:law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest)m 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 Mad'and fully understand k*Ask'iuestiolus if sonsething is unclear. • Make sure the contracrnr has a valid u r..,..-o r n tin The Itiw requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contract&Registration. You may inquire about.contractor_ registration by writing to the Dimetor at:One Ashburton Place,Room 1301,Bosron,MA 02108 orby.calling 617-727-3200 or 1-800.223-0933. • Does the contractor have insurance? Check to see that your'contractor is property insured. • Know your rights and responsibilities. Read the lmportanf lnfonnetion on the ievense'side of this foim and get a copy of the Consumer Guide to the Home In'tprovement Contractor Law. LINZ ay cancel this agreement if it has been signed at a placer other than the contractdr's'notmal place of business,provided you noti�U:t-fth- RQNOT r in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than musiness day following the signing of this agreement..See the attached notice of cancellation form for an explanation of.this rig SIGN THIS C NTRACT IF THERE ARE ANY BLANK SPACESM TW 'satin pins of the contract esus be co and sinnd.eOne copy abould coo to the homeowner.The other copy stamld be kept by the contractor. .. H er's Signature J ,r Con is 4.Z. Date �7 / -Dau f The Commonwealth Of tl'�ass(icltt[Setts Deprrdment o,Inditstrial flcciclents Oj`fce oflrrnesti-atiotts - t i ? = 600 [Vashim ton Street U% Boston, 11,14 02111 _ tvlvlv.nrrrss.�on/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NCi117e (t3usinessrOrcanization!Luiisidual): � ' ��i�, ��',,� �� Cite/State/Zip: ,.�� / f��2/I i Phone 1-i Are Nro�,rliia employer"Check the appropriate box: I Type of project(required): f. I employer with _ 4. ❑ I am a ,,eneral contractor and I employees(full and/or part-time).* have hired the sub-contactors 6. ❑ New construction �.❑ [ am a sole proprietor or partner._ listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contactors have S. F-] Demolition employees and have workers wort<ing for me iu am capacit\ p 9. ❑ Building addition [No workers comp. insurance comp. insurance.T required.] �. ❑ `,?,re are a corporation and its 10.❑ Electrical repairs or additions j ❑ I am a homeowner doin-t all wort: officers have exercised their I l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per A/IGL 12. oof repairs insurance required.] ' c. 152- §1(4). and vve have no employees. [No workers' 13.❑ Other C01111). insurance required.] "An s applicant that checks box=1 must also fill out the section helosshomcine their%corkers-compensation polies"information. i lomcmN ims scho submit this affidn it indicating thcv are doing all ss ork and then hire outside contractor,must submit a nese affidavit indicative such. �C�mtractors 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 emplocees_they'must pro ide their ssorkers'comp. yolk} number. tim tut employer that is-providim workers'compensation insurance for nil' employees. Below is the policy and joh site in f urvrrrrtiorr. - Insurance Company Name:----�� " Policy - or Self-ins. Lic. ��_-l��Q expiration Date: Job Site Address: �� e Citv:'State'Zip: 47 Attach a copy of the workers' compensation police declaration page(sliowing the policy number and expiration date). Failure to secure coverage as required ander Section_'SA of.MGL c. 152 can lead to the imposition ofcriminal penalties ofa III e up to S 1.500.00 and/or one-year imprisonment. as Well as civil Penalties in the form of-,I STOP WORK ORDER and a fine Of up to S250.00 a day against the violator. Be advised that a cope of this statement may be forwarded to the Oflice of Ir:yestigations of the DIA for insurance coverage verification. I till hereby certrfi'antler'they prtir?c azul perialtre.S(:j l:e'r jltrl'that the hit"I'alioll provided above is true and cor'Tea Date: — ��5 116- Official use onty. Do not write in this area, to he completer/hr vial,or town official. t City or ToNsn: - -- Permit/License#__ �I I i ssuurg Authority (circl(I one}: 1. Board of Health 2. Buildino Department 3. Cite/Town Clerk -d. 1 lecU teal Inspector 5. Plumhin; inspector 6. Other Contact Person: — Phone #:_ -❑ From: 01/12/2015 14:45 #151 P.013/016 ,4coRD® CERTIFICATE OF LIABILITY INSURANCE DATE01/12120011YYYY} 01/12/ 5 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). l PRODUCER 00775-001 �HQp�N�A�CT Durso&Jankowski Insurance Agency Inc A1C.No.Ext: (978)682-5175 rN.No.. (978)794-0313 198 Mass Ave Suite 1018 RMSS: North Andover,MA 01845INSURER A ! A.I.M.Mutual Insurance Company. 337 8s INSURED INSURER B: Arthur Walsh j A J Walsh & Sons INSURER C: 55 Pleasant Street N North Andover, MA 01845 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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 REDUCC��E��DDC yBA�Y PAID CLAIMS. p ILfR TYPE OF INSURANCE INDSR yBp POLICY NUMBER MNUDO/YWY MOONS YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ I CLAIMS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICV RO- OC AUTOMOBILE LIABILITY COMBINEDISINGLELlMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE 5 AUTOS (Per ACcidenn S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE $ yypRKDEERDgI RETENTION $ yy�gT U 7H S ANNNyyD ERRMp�PppLROR��YEEETTROoS€LV111T1LNIEPrWEX X TORY LAt�ITS OER A OFFICEWMEMBER EXCLUOED9 ECUTIVE- N/A AWC-400-7014648-2014A 11/14/2014 11/14/2015 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 D �SRIF�10�7 OF�PERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,tf more space Is required) The workers compensation policy does not provide coverage for Arthur J Walsh CERTIFICATE HOLDER CANCELLATION Town Of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ------- 0 1988-2 ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I i Massachusetts -Dep2:}`:Me7t Cr ?ub iC Sa=e`' 7—acense: CS-022680 ARTHUR J WAILS �fl JR 159A WAVERLY-'RD N ANDOVER Mk 01845 r rr Commissioner 06/09/2016 r'��c�`rrreirrcrrrocrc�/�rfC''lCrrfJrrr�rrde/G.i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only I ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: V egistration: 103358 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 )Expiration: 7/7/2016 Private Corporation Boston,MA 02116 A.J.WALSH&SONS,INC. Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary Not valid with t signature