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HomeMy WebLinkAboutBuilding Permit # 6/9/2015 BUILDING PERMIT TOWN OF NORTH ANDOVER p=6t,..•`..", _ APPLICATION FOR PLAN EXAMINATION Iu` I-h rte Permit No#: { - Date Received byssq, wusE sy Date Issued: IMPORTANT:Applicant must complete all items ontms page - LOC,S'{1ON . r MAR PARCE..LzO[ING DISTRIC,7 e Historic Dist/icY ✓ v ye no ,... ..., ,��...,,. <E «Maghln .4h4P Village,.`",•YP ,.R9i TYPE OF IMPROVEMENT PROPOSED USE Residential _ Non-Residential 0 New Building D�mily _ _ [J Addition ❑Two or more family 0 Industrial 0 Alteration No.of units: C Commercial _ F1Repair,replacement 0 Assessory Bldg ❑ Others: 0 Demolition 0 Other _ 3epGc ❑Well ❑Floodplain ❑,Wetlands 0 VCtafershed Distract ?•FTVtlater/Sewer; ` n DE�s/�RIPTION�OF WORK TO BE PERFgRMED: /`Ccx�''%L�rrj,-et�t:f ,�E' 2 - "- ,�`GoyL�� ,r.�-t arm /-�Lz` L�(✓ I d-tificaTio -Please Type or Print Clearly OWNER: Name: /t//t' I e13 •�T �r G S/n/01hone Address:- 901 It ddress:ontrNa[n � lbaPh one �vr 7 Su $ tso�sCon�tructmnxlicdnse a i _ HP[ifl�lrnpra�ement,Llcense �' � ` �' }Exp Da{e �, � ��" ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BOLDINGP T:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTEASED ON$125.00 PER S.F. Q Total Project Cost:$ eJ�r FEE:$ ��2_" Check No.: =1�I 2 Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund�,��� Signature of Agent/Owner Signature of contractorC� r /w"" tkOR A. Town of 11 1*,, Andover we- 20 BOARD OF HEALTH PERMIT To IL Pti'sy­ Rough It provided that the person accepting this permit shall in every respfct conform to tl-�MS of the application Fmal 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 mthe Zoning or Building Regulations Voids this Permit. Rough Fiml PERMIT EXPIRES|N0MONTHS ELECTRICAL INSPECTOR CONSTRUC RTS Rough Imul---',—�~—'_---------------' BUILDINGINSPECTOR GAS INSPECTOR Dixp|oyinoConopiououuP|amonthoPsmisoo—DoNotRomuvo NoLathing orDry Wall ToBoDone FIRE DEPARTMENT PageIf of pages, CS Of 022680 L VJCJ/ 978-688-6737 HIC#103358 A.J.Walsh &Sons or 159A Waverly Road 1-978-912-2853 North Andover,MA 01845 Pmposat Submidel To:&tj ` MV�:,F III Na Job# '.. Address F`.. Job Loo U n oet / Dafe or Plans Phan,# ( r ,w Fez# Architect f,hereby submit spoifiwbons and estimates for. ir';ta„ ��!'�f(2 C.d+v �,iY�., ml,d/ %L��N ••/r'ww k � FC,�`.,� j A4, t c nz r��d U A � re.- �<, a�„a��,.kf , !. �, +G r,..,�` it Vr, F�.��✓a'���.� i ..r,r<io,,,,,,.r �r,�rs,f.R..�/' 1/0""^`°,..✓<nM,' 'u/,i�r"."arr yf:�l a. 9,h WC+rra ,, l ✓u ,A+... a rA�e�, 'tl i�, .r. al^den i"'i r r f t. J 8, r a We propose hereby to furnish material and labor—complete in�accordance wlih the above specifications for,lYaersum of: g � �>��9J�) Dollars with payments to be made as follows: Avana,iliwora�,atan rmm amre spa�umat wa mvorvns ameaosw gnu ae Respectfully o✓,�`���^^,, �Pt� �r^� ,� tad arty upon wmlan order and wID ba.-an�m alamp, p,over and tM P w miC g'•^"' { l F arecubwa ma aasinata.nn eyreemams aowneam apoa sldue:,awiaams.oraawys submitted beyond our c I.L Note—this proposal may rbe withdrawn by us#not awepted within days. p rY x„ C PeYmrmmenis willbemdeasoutineda"'ohl..athomad to do the ..as P�'ad aAs}it�)Y�Sgfat 0� �f,.�Y/f�r�,.�"P%�Y'nF��a°�t���.PS:�f r'P;✓.,.,...;s Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT - Th'afom�.ae f 116 requvem fm aH Imp Con V (MGL cMp 14IAj bufdoei Lm lutleafvvdkrd Ivngue6e toP f ars S IB tlai If vryAnY�c 1 mgh '_�mymv ho Id fi'n[b opy of"e' Mevaechuaetle. guL mn p Chf' yW h yourrmrdwm Y mvy obmmaIree copy bycWingm& ' OR'im ofConavm¢A}iars:erNBuetvuaAagule4on'B Comimmr�N(grmetlon Hodme etdi]�9]}vti98) 1.8888}3)3]: BameowPermmrrRnann coolPncforinrrmnenn `.. ('- `•'''�°$jpk�.. °�if-!��-5 FF 4-..S c�rv.S t n zWdmlN emlm/g eepmoNownm Name'. - - _ am aPa cfacr e,J_ e t4a'7(fi K�'. �/✓F/(fSdt amrrem . Bmm zm�m c orae mmtndmwi - /O :/YU oe� /14/4— �m7.5`gYa g wH�`rR r2 m Pnwe Hvm BPnedn / mrawe a ZiPU - MWmgadme„@wRew�dam,�.N � �/L/7Hn&,_� /uzq- u./Yvf NaNFmpteyClD yr S.a.Hmvbv vrM1e followlv6 rfhe tlom m.l lC j'j ��®�I ���,/��+ ' lS©C31% /<ti-7✓!oU/�'L 7—Alm-WI-1-1 ,1v s' ,9i-c. Cvi4-1-1S. fle�rdL�e- of-A SrD:,vc� - .JTI s�i'��L ,Shv77���5 Rql aPerm Th foli gbv ldmg piitWn are rcgnhed Proposed&. dLvmpletidv&Ledwe�The Pollvwmg aeheaale will evd —d by she homwwnelssgwt; be aahiredm'dNua umumamnua beyvvd dm covmecmtawvxladae (Gwoera who.seemre tp,-ib owp,-ibwill be �.. ercloded.from,theGRnranryF'ud-provisions of wcoetne rwul bee,nionovdW work" MGG ch.pter 142AJ - whw a vecvi.work bervbatwnellYwmPlemd.. �. To[N Contras P 1 dole on `',J/h�, The Contractor p RDx tbe'rk rmeilhthememnal wdleborrpemEW above rotors mm aumof ,J t/ (.) '.. rmep�wdmamdda aa�ra;nsmme rmmwmsaaneawe: - - - a apw.aipavg wntmnr(we sin Dema mtatm�o-nm Pdxn[me naaeurapxlei aNerimma,wNcbevw;agrmmr) S by —l--t—�or upon vompiedoo of S iby_r—h---or upcv wmpledav or g mpleeomotme eonaect(Inw forb'm Umuvdiv6 tall Payment wdlmnvamsa<mpleW mbvmpmry auwGeeon) mtb bepla or T ' NOTES:(�Ntluam�gag fivmm Wugm(•71ewrzquWWmmy mpodtmmwvymymml.pWmdbyme wvweorbetmvwortbegioamar melpammoarm(n�oo o�@foe m cµm agWpmmtmammmmaaemamiat wNm bespdal m vwammmt e c aubaov orbs solely rsporu bl fv mpl ov orme kdm bed ardl {m Dna ImymN Pmb�aubwnpa tlby art The contracmrtmmmagremmbee lely mxpvw�blefordl paymwYm Weubcovvvcmrrfvi Conem[�AeupfvveedeUpov g,mta doc wt hco btvtlmgwvtnWwdeelaw.UNma oetwtwieemtW wimv,tlda documeve me - mPly@atwY�w mwswwiry weerothaebmvPlead Dome ruidwce.Review dm mllowivB uudovs wd notices mmfWly berate aigNvg miv wvvacL ro • OtovY be PmaeurM ivm aigNnB them c[iaka vm rrsdevd fWlyuvtlmvleodit'ASF'wrm - be neohmButmed Wimm fHem ��� omO hOe�_ ems ae tors md. um Imp Co tx A gi' Yo 61by In vvecmr c.- - 1oW 333-9.,l�degmme Duw O Aahbwmv Plat Rom 13U{,Ho mq MA 03168—yIImg7-7]�)2].}30Pv • Dom me mvtreWorbaveimurevice?Chmic iv sw tlm[yourcovvecmrhpropmly imund • Know yownghn end rcapvwtbiba R_den Importmt Wonvhdbv vv die Mex aide vfWU fdiidevd He[e copy afore Cpvnimm Hu'mmthc Home inlpmvemme Covvacw Gw: - oa ma�rsncel oris agumwe Vislma bew aigvvd etephwommmev meepvaam/avormN pinee ofbvaiveas,pmvided you noery me . .ew,mmm.m orfi�Pr w.aan stens byoNiwry man mama,by mmgmm aweorby aec.my,mmlamrenanm;md�tarme NDN b�mo�aa rrn the a�gnme of. gore wL.swm nW pHea or n wraxm afmia nsnL o DO El!IGN THI$CONTRACT IF THERE ARE ANY BLANK SPACESM ilim gmemvaww. '/'$/¢ Homwwver'x atewmm VV// Ca a5t The Commonwealth ofBTossacrhuseus _ ftepatainend of lesdusirial AcciefeflAs r4 , Office ofle vesfigations 600 Washington Street 1 t - Boston,MA 02111 wwrr.mass.gov/dla Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/P]umbers Atl 1n kcant Informafimn / _� /� Please Print Legibly NaMC(Rosiness/Organizationllndividnal): '_l�[�L-' �,�-F/ epi�'j�,rfy� Address:__ city/state/zip: /D- /YDIJI/ A� Ph--e4: 17f Ar€yo. n essp[oyer?Cf¢eck the approp,__ — I. I aim a employer ° I am a e Type of project(required): p yer with .❑ general contractor and 1 et n to yeas(ffill and/orpart-time).' have hired the sub-contractors 6. ❑New construction New 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling hi and have no employees These sub-contractors have ship a3. []Demolition working for mein any capacity. employees and have workers' 9 El Building addition [No workers'comp.insurance comp.insurance.'- required.] 5.❑We are a corporation and its 10.❑Electri al repairs or additions 3-❑1 am s homeowner doingall work officers have exercised their 1. p _.bin a 1 ❑ g repairs or additions myself.[No workers'camp. right of exemption per MGL his, required.]t c.152,§1(4),and we have no l2. Roof repairs employees.[No workers 13.❑Other _ comp,insurance required.] , "Any applicwrr Thaichecks box Ml must also fill out the section below showing their workers'compensation policy information. 5 Homeowners"Ire sobm,thisaffidavit indicatingthey are doing all work and rhar hk'outside contactorsm suff bmit a new a davi[ hidicafingsneh. iCnntmctors that cheek[h,,box musr attached an smid—I sheet'howl.&Are name alh,sob-conttaetors mrd stare whether or not rhos,,,titles have employees,if the sub-contractor,have employees,they must provide Iheir workers'comp_policy aumhcr. €an an ea player that is provi ling workers'compeeualecn insurane fav n y ei:peoyr es.Sferow Lc the policy and job site ultirre'saine, Lrsurance Company PoJeYfi or Self ms Lie.4 ��« y�'� ��C(� �V Expionxin Dat, f� f .b sae Addles,:_ c q/st t/zip: O1�0/3YXd 2 /y/ At[act¢a eepy of Gra workers'compensation policy declaraEeon page(shoraing tSe potty nninb€rand 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 all 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 maybe forwarded to the Office of investigations of the DIA for insurance coverage verification. I do barely ,,fy unp?Le�r th,pains a de3iR p rides of pe erk y that the info nation provided above is true and correct S tt=L sf�LZltz� n (Phone#: � ka—e-Z37 IOfficial use only.Do not write in this mea,to be conipleted by city in town official III City.1'room: Permit/License# 1,s,mg Authority(,trete ane): I.Board of Health I Building Department 3.City/Town Clerk 4.Electrical Inspect.,5.Plambjug Inspector i C Otho`nson: Phone M: Contact Pe_— -- _ I A�oRo CERTIFICATE OF LIABILITY INSURANCE °ADv1zI2o1s THIS CERTIFICATE IS ISSUED ASA 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 ceNifcate holder Is an ADDITIONAL INSURED,1h%.olicy(ies)mus[be entlorsatl.If SUBROGATION IS WAIVED,subject to !MP rtifi ate holder inllleu of such anldotsemenit(s)olici°s may require adorsement.A statement an this certificate d°as net confer rlghis to the PROD cER OG775-001 Cu Jankowski Insurance Agency Inc .EV.asl� (s]e)se- �_No. (971 198 Mass Ave SIN a 101B FA ss, North 845 Andover,MA 01 – ( _. A.A.I.M.Mutual Insurance Company waleh North Mdaveztraet01845 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 NDICATED.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. Ned` YSo MRBSME cl 1IL&YE1 SE COMMER IIAL GENERAL LIABILITY IMS MAD �OCCua xP IA,we ler¢onl PERSONAL&AIV INJURY GENERALAGGREGATE S EN'LAINREGATE LIMIT APPLIES PER. PROOUCTG CaMPIOP AGG S '.. AaIUTv RVIPer cerwn) ANY AUTO eoDILV INJU E ALL OWNED SCHEDULED -"---" —"� EJ ATL- DUTBOINLYRVIPeracelaen0 E DEDES e UAeAa CIAIMB MADE �19����SY'�s€"L�aTL4nN E X�A3IRa'is °dd' S I A B2 CR'M���4R�@iC6�€�UTIVEm NIA RLEAGHAGOI°ENT 1oo,0oo.00 AWC400-]014848-2014A 11/1412014 11114/2016 " -'-- — IManaamyln NBR) orEE s o,000.eo � "'RUP#i ll-°&PERAnoNs nel�, soo,ouo.00 IE-RIPTI°N 0101 A1011I LD°nTION1IVE—LES PRI—AOORDI Re--S—N.D,If—.o-,ee h r Nul-) The workers campensatlon policy does not provide Coverage for Arthur J Walsh CERTIFICATE HOLDER CANCELLATION Town Of N°rth ARd—, 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA D1845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THCRI2En REPRESENTATIVE =1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD -�g R-qu-C7� c� CS-022680 ARTHITRJWALS,UJR 159A WAVERM13D N ANDOVER M 01945 06/09/2076 1�'Off—of C—.—Aff—&B-1—s R,.l.ti.o License...gistmti,n ld for io,ditidul so only ME'IMPROVEMENT CONTRACTOR before the lxpi,lti,.date.'If found tot...to: tion: 103358 Type: ..to of Affairs and R.g.btj.. 10 P.,kPl.t.-S,dto5I70 Q'It pi...: 1112.1S Pliv..C.T. Boston,MA 02116 A.J.WALSH&SONSJNC. Arthur Walsh 55 pl..—t St N Anc.s,MA 01845 Ind--to, Not valid with tsignaLt(vre�T"C/