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HomeMy WebLinkAboutBuilding Permit # 6/9/2015 - f I'a gyORTFi BUILDING PERMIT O��tLeo ,b�tio TOWN OF NORTH ANDOVER I (6)_ APPLICATION FOR PLAN EXAMINATIONJV c«acne my Permit No#: Date Received �RQ�RA7ED " 45 �ssgcwus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION :r Pnnt PROPERTY OWNER,,,,' Pnn 10D Year Strucfure yes no MAP PARCEL ZONING RISTRICTHistoric Districtye no Machine Sf op'V llage �,y no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildinge family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑:Septic O V1%ell Flgodplain ❑We, nds � � � "JI UVatershed District ❑1Nater/Sewer J w DE RIPTION OF WORK TO BE PERFORMED: t �✓✓ 1 Identification- Please Type or Print Clearly OWNER: Name:—/A-9 /V 176)s eA77— C� 7 /h/0-Phone: Address: .Contractor,Nam00 Address p Construction License � ��� Exp Date s Horne lmproyement License �, �'; Exp ,Date, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Q -12 Total Project Cost: $ FEE: $ Check No.: ci Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor azwzleZ j rim Aga FORTH i own ot2 _ t e ;..1,, R nuover ® .:�•. . _ - �� h ver Mass, Ufje- 20 O LAME �• J COCHICMEWICK V S u BOARD OF HEALTH P �E� RMIT TW LD Food/Kitchen Septic System THIS CERTIFIES THAT .............R-06toew+ .. BUILDING INSPECTOR ........................... v �............ �Sv k............. has permission to erect .......................... buildings on . U ".On �C Foundation ........... ...... ..... ` ` Rough to be occupied as .... .P.. .f7C.C6 k.t....o . .j.....s.1.a.l.. ... .................................. chimney provided that the person accepting this permit shall in every respect conform to the�ms 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LES C RTS Rough Service .......... ............... Final BUILDING INSPECTOR p 1 GAS INSPECTOR ccupd ncy Permit Required t0 Occupy Buildin 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. Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. Jr Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted To: I Job Name Job# Address Job Location DateDate of Plans # Phone Fax Architect Phone# j e asW e 4e hereby submitspecifications and estimates for. -7 5 Y 4 ;"°f 'e"J,Ce'A'C'x A, Qd r" 6� 6G�-1 2 ("Alee "Y IIA41 Ce )"?2 4, '01,4Z Oe We propose hereby to furnish material and labor—complete irl'accordance with the above specifications fort o Sum of: Dollars with payments to be made as follows: IX Any alteration or deviation from ave specifications involving extra costs will be Respectfullyedrr M y„ and submi executed only'upon written ordebor, and Vill become an extra charge over tt above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our cohlrol. Note—this proposal may be withdrawn by us if not accepted within days. Scaptance lot Wqagal The above prices,specifications and conditions are satisfactory and are ,,"Signature CL'ole I hereby accepted.You are authorized to do the war spe d* Payments will be made as outlined above. 611 IK Date of Acceptance— )I �-- _ Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies-ell basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but doe;not include standard language to protect homeowners. Seek legal advice If necessary. Any personplanning home�inprovemcnts should 5rs'f obfain a copy of"a Massachusetwoonsumer guide Yo homcimprovement"before agreeing.to any work on yourresidenee.You may obtain=a free copy by'calling'the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at617-973?8787-or 1:888:2834757: Homeowner Information 'Contractor Information ° 1' • �, pant Name'' let . t s I. do not use a 1lostOffice Boz address) ntractor/Salesperson/.Owner Name Cityfro% q/ State Zip Code usiness Address(must include a street addresg) . %L rT� G�d �'�� �s"9 �t✓a�e5-'ei� Daytime Phone Evening Phone 7 iytiown State Zip Code 44 1 Mailing Address(It different from above) uainess Phoneederal Employer ID or S.S.Number ' lav MQuim LW mM b"i- AoOme 1Contm7or sea Mmprt 8xp'usuondnE pav®m mnusdmshave■ ( '3J imsaoo mnabrl p The Contractor agrees to do the following work for the Homeo per:nen:- AG� I' 1�1�1�'1 a /� — / ` i c4 ` /1l.j i�L.. i C is 14 5. 17 4 RequiredPermits-The-following building permits are required Proposed Start and Complefion•Schedule-The folloti ifi schedule will and will be sccured.by the contractor as the'homeowmr's agent; be adhered to uiilesa circumstances beyond:the contracto?slcontml arise (Owners whti;secure their own permits Will be excltided;from the-Guaranty F>tind provisions of Date wben contractor will begin contracted work MGL chapter 142A.) Date when contracttid .work be substantially completed,. Total Contract Price and PaymentSchedule , / The Contractor.agrees to perform the work,furnish•the material and labor specified above for the total sum of. Payments will be made according to the following schedule: S upon.signing c9ntract(not4b exceed 1/3 of the total:eontract price,gl the costof apeoial order items,whichever is greater) orupon completionof $ by or upon completion of S upon completion of the contract (Law forbids demanding full payment until contract is completed to both partyls satisfaction) The following material/equipment must be special $ oto be pazd for ordered before the contracted work begms in order Sri' to be paid for_ to meet tlie.winpletion schedule NOTES:(+)Including all finance charges(rr)Law requires that any depositor down-payment rcgttirul by the contractor beforework begins may' not-exceed the greater of(a)one-third of the total contract price or(b)the actual con of any special equipment or custom made material whicb must be special ordered in advance to meet the completion srLedule. Express Warranty-Is an express-warranty beine provided by the contractor? No Yes /altterms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the ections`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 airreement Contract Acceptance-Upon signing,this 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))been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into sighing the contract Take time to read and fully understand it'Ask'questioris if soidething is unclear. • Make sure the contractsr has a valid Homo r n ri a The hew requires most home improvement contractors and. subcontractors to be registered With the Director ofHome Improvement ContractOk Registration. You may inquire about.conitactor registration by writing to the Director it Ona Ashburton Place,Room 1301,Bus 1-800.223-0933. ton MA 02108 orby_calling 617-727-3200 or • Does the contractor have insurance? Check to see thatyour'contractor is properly insured • Know your rights and responsibilities. Read the Importad lnfomra6on on the i Guide to the Home Irrlprovement Contractor Law: everacside of this foim'and get a copy of the Consumer You may cancel this agreement if it has been signed at a placerotherthan the-contractd>;s'normal place ofbusiness,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 thea midnight of the. third business day following the signing of this agreement.See thaanached notice of cancellation form for an explanation ofthis right DO OT SIGN TH CONTRACT IF THERE ARE ANY BLANK SPACES!!! 4 nidcotl pies of the. et must Idea and signed One eopY should go to the bt neown t o other copy should be kept by the commW. .. _ Homeowner's Signature Contractor's Signature Date ,Date I s e Commonwealth of Massachusetts Depariment of Industrial Acciciem's a ' Office of Investigations �"- 600 Washington ,street Boston, MA 02111 www.tnass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AD0licant information Tease Print I,egibl� ari1e (Business/Organization/Individual): � z�� c=� Address: City/Mate/Zip: IGC' �� Phone#: —6eo'—(�-7d7 Type of project(re Are Vol employer`? Check the appropriate bo (required):1. !"am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New constriction 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 working for me in any capacity. employees and have workers' insurance.t 9• ❑ Building addition comp.[No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its ]0.❑ Electri al repairs or additions 3.❑ 1 am a homeowner-doing all work officers have exercised their 11.0 P bing 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' ( 11 3.F_1 Other comp. insurance required.] "Any applicant that checks box#1 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. !Contractors that check this box must attached an additional sheet showing the name of the sub-contractorsand state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. sant an employer that is providing workers'compensation insurance for racy employees. Below is the policy and job site information Insurance Company Name: e&�� /V-//7Z/AA 4 /,� Policy# or Self-ins. Lie.#: —7,0 A161 A)t a 6) Expiration Date: Job Site Address: 4�/ � ��� /t/c�% City/State/Zip: � G>l) r� I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration elate). 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 cer, ' under.the pains and penalties of perjury that the information provided above is trice and correct Signature:— Date:_ -.� phone#: L J� ' '—C Z3-7 Official use only. Do not write in this area, to be completed by cio or town officiat City or"Power: Permit/License# issuing Authority(circle one): J. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: __ Phone#. From: 01/12/2015 14:48 #151 P.013/016 0 CERTIFICATE F LIABILITY INSURANCE DATE01/12/DD/YYYY) ��. 01/12/2015 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 00775-001 5RAJ4CT Durso&Jankowski Insurance Agency Inc A/C.No.Ext: (978)682-5175 / -No„ (978)794-0313 198 Mass Ave Suite 101Edss: North Andover,MA 01845 1. INSURER A: A,I.M,Mutual Insurance Company 33758 INSURED INSURER 8: Arthur Walsh A a Walsh & Sons INSURER C 55 Pleasant Street N North Andover, MA 01845 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 CCyyB��Y��PAID CLAIMS.pp IN-�I� TYPE OF INSURANCE I` ER$yBp POLICY NUMBER MMIDOIYYYY A0WL6W'EYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES IEa occurrence) MED EXP(Anyone person) 5 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY RO- OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i nt ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS (Per eccidenti $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE S yypR{DEERDg NEW S $ AND EMPLR��YEE3€LT�ppIgA 'LLJIEPRf/EX y'N X TO Y LAtv11TS OER A o� IEMBER EXCLU0ED9 ECU71VEi Y r N/A AWC-400-7014648-2014A 11114/2014 11/14/2015 E.L.EACH ACCIDENT $ T100,000.00 (Mandatory In NH) u E.L.DISEASE-EA EMPLOYEE S 100,000.00 DYE�S�RIPf10t V9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if 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 ©1988-2010 ACORD CORPORATION.All rights reserved, ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts - e1 11 en o�F :Djb3 zc Sa` EcardofSU�Td;ng R Construction SupirFisiyr License: CS-022680 ARTHUR J WALS�I JR 159A WAVERLY-ID N ANDOVER MR 01845 f Commssioner 06/09/2016 (7%/1c' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 103355 Type: Office of Consumer Affairs and Business Regulation - 1��xpiration: 7/7/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 A.J.WALSH&SONS,INC. Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary Not valid with t signature