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HomeMy WebLinkAboutBuilding Permit # 7/10/2015 ---------- ---------.................—........... -------- ---—--------------- %AORTH BUILDING PERMIT of TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION � Permit No#: Date Received 'TED CHU Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 0-3 5�7— Pril PROPERTY OWNER lft;`,6-�'(Z Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential [I New Building [I One family [I Addition [I Two or more family 11 Industrial D AI eration No. of units: 11 Commercial V'Repair, replacement 11 Assessory Bldg [I Others: El Demolition 11 Other ,p�,,,Se DESCRIPTION OF WORK TO BE PERFORMED: U/,V. Ie oe Ae �,- ,4' -V/- /f encation- Please Type or Print Clearly 0 OWNER: Name: V21( L IZ-�zPhone C C Z 0 Address: 7 ",6�( Phone:5-� Contractor Name: Email; Z- Address: ra Supervisor's Construction License: -Exp. Date: 2o Home Improvement License: f2, Exp. Date. - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 01V$125.00PER S.F. Total Project Cost: $ FEE: $ 2 Check No.: Receipt No.: ZIP) 6'A,5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund or ignature�'-q 's,i ra te t4ORTH f*lover ' ][ ' own of ? F ,. Anu ® 1. - � ..,.1 {•' ® _ 6 - �„K� h ver' ass, 1�. I02 0 COC MICHIWICK OATEo J"? S U BOARD OF HEALTH ERm m M MIT Food/Kitchen Septic System L U THIS CERTIFIES THAT ................................................ ................. .............. .................. .. Mt . ,, BUILDING INSPECTOR 11 We� 1 Foundation has permission to er t .......................... buildings on . ...�,*?. ..........l. .......... ..�...................... Rough 1 to be occupied as :.. .�.1�1. 0ISIAP. ,.... c ..................... ..5.1 ....... ..1>40V%.. ..... Chimney provided that the person ac epting this p mit 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-Law,%reliting to th22 Inspection Alteration and Construction of Buildings in the Town of North Andover. bw-0%e-&1WCVWjP'1 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations voids this Permit. Rough Final PERMIT EXPIRES IN ELECTRICAL INSPECTOR UNLESS CONSTRUCT Rough Service .............. . ......... .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. PRO-DESIGN BUILDERS.com Builder License # 43550, HIC # 123602 P.O. Box 4223, Andover, MA 01810 Phone 978-475-2999 Fax 978-749-9402 lenniesaltz@verizon.net Customer: Melanie Dube Address: 2303 Turnpike St. North Andover Phone: P i- Cell Phone: -975-2695 - 978-305-3966 S Fax: Email: The Owner represents that he/she is the Owner of the premises located at 2303 Turnpike St.North Andover, MA and the Contractor relying on such representation agrees to furnish and the Owner agrees to pay for the following: DESCRIPTION OF WORK 5 Build 1 12' Pt deck Frame and install one white 6 ` x 6/8 Vinyl sliding door, install a total of 18 Vi yl Tilt-in insulated low e glass Silver line by Anderson,insulate window weight pockets also install 7 cellar with hopper style Vinyl windows, cover casing with custom white aluminum Install new kitchen cabinets withranite c��``unterAops, new floor Bamboo or equal owners choice install Vinyl siding color choice( (i, Gv �' stall fanfold 3/8" insulating board underlayment, cover fascia, rakes with custom aluminum trin . Option Vinyl siding front of' garage and right side additi nal 13,250 Attached cost sheet dated June 15, 2015 �ti Total Job Price Sales Tax; N/A Down Payment $20% IUU Balance $ Terms of Payment: Progressive * We are not responsible for any pre-existing violations including any unforeseen rot! ..... Cost to replace rot would be about $16.50 up to 1 x8 per lineal ft., 1/2' plywood @ $14.50 a sq ft. * Any changes to the scope of work will be executed only upon signed change orders. * Customer agrees that by signing this agreement, customer is hiring PRO-DESIGN BUILDERS to perform the above described work. * The customer agrees to make payments as per payment schedule. If customer fails to pay, customer will be responsible for interest at 1.5% after 10 days, reasonable attorney fees and costs incurred by PRO-DESIGN BUILDERS to collect these amounts. * Changes to this contract must be followed in writing and signed by both parties and will be governed over this contract. * Delays beyond PRO-DESIGN BUILDERS control such as acts of God, abnormal weather, delays by Towner, or other contractors, labor or market disturbances, acts of civil authorities, or crime shall cause an extension of time to complete the contract and adjustment in the contract price allowing for storage charges, etc. * All job is Materials are fully warranted by MFG ... Pro-Design Builders will service all any issues with installation if necessary within one year after which MFG warranties will apply.. * All work to be done in a workmanship manner with upmost attention to construction standards and state codes. * Service work and preventative maintenance outside.one year will be billed on a time and material basis and is recommended annually. PRO-DESIGN BUILDERS will not be responsible for consequential damages. Clerical errors are subject to correction. * Job to be started 10 days after permit and to be completed in(16 days. * Unit pricing is subject to change if the proposal is not accepted in its entirety. PRO-DESIGN BUILDERS scope is limited to items on proposal. - * This proposal is subject to the terms shown on the face hereof including any additional sheets *** The customer may request their deposit back within 3 days if they decide to cancel the job. We,the undersigned, have r u tood and agreed to each of the provisions of this contract -G Leona d)% tzman/PRO-DESIGN BUILDERS O er Date Owner l` Date The Commonwealth of Massa chusetts Department oflndustrialAce dents p 1 Congress Street,,quite 100 Boston,AM 02114-2017 www mass.gov1d1a Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED'WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly r , Name (Business/Organization/Individual): .Address: ° Ci /State/Z1 ,, F ��� ,,., -Phone#: "_� � �� � Are yon n employer?Check We appropriate box: Type of project(required): 1.VA am.a employer withmployees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 ❑Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs Those sub-contractors have employees and have workers'comp,insurance. 6.F1 We are a corporation and its officers have exercised their right of exemption per MGT,c, 14. Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 employees,they,must provide their workers'comp.policy number.' lain an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: I Policy#or Self-ins.Lie.#: ) 6 Expiration Date: �._ Job Site Address: wm City/State/Zip: 1 l Jr. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. i` Ido Hereby certify ands z a' dp alties o fperjusy that the information provided above is true and correct. a Si nature: Date: Phone#: 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#: ■!07/08/2015 23:33 FAX 9789577230 CLOUTIERINS Ij001/001 ■ ■ DATE(M IDDrYYYY) ■�:� CERTIFICATE OF LIABILITY INSURANCE 7i9 35 THIS CERTIFICATE 15 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, IM RTANT: If ills certlflcate holder Is an ADDITIONAL INSURED,the poligy ies) must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the pollcy,certain POIICIOS may require an endomomeriL A statment on this certlfleate does not confer rights to the certiticats holder in lieu of such andoreomen PRODUCER ME! mmacran Allison Cloutior insurance AgencyH°Na 57-4 1 (976) 957-7230 1996 Lakeview Avenue mallison@insurer.com Dracut, MA 01826iNSupER{)9 AFFORDiNO COVepAGE .. NAIc u INSURERA t ATLANTIC CASUALTY INSURED e INSURER D Leonard F Saltzman INSURERC:- DSA Pro-Design Builders INsuRER,R: 5 m±llcrest Road .1 R _ Andover, MA 0161.0 INs RERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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, gEXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN N REDUCED BY PAID CLAIMS- __ _ LTR - $tiwR ppuu LIMr>'1 TYPE OF INSURANCE P UCYNUNOMR PM/DDK MrmoT111Y A GUNERALLUIBILITY L117001838 7/13/14 7/13/15 EACHOCCURRENCE —5 -11-A 00 040 DAMAGETO RENTED' 6 OQ L O X COWERCIAL GENERALL"ILITY _E♦?@MUSES(Ea eoeuen CLAIMS-MADE OCCUR MED E7 3IAMore sem S _ 5,000 PER80NAI-9 ADVINJURY S --J-,000,000 GENERALAGGREGATE S 2,000,OO GEN'LA©GREGATT uMITAPPLIESPER PRODUCTS-COMP/OP AGO S 000 000 POLICY PR LOG LIMIT $ AUTOMOEtLE UABIUTY a eccltl>re S BODILY INJURY(Por poison) S ANYAUTO ALLOWNED SCHEDULED BODILYINJURY(Per acidwnU S AUTOS AUTO$ 9 NON-OWMRD P e�eoelnt HIRED AUTOS —AUTOS S UMHREIJ.ALIAB OCCUR EACH OCCURRENOE S EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTIONS WORKERS COMPENSATION WC STATU- 0TH- _ ORY.LNALTS .-.� AND EMPLOYERS'LIABILITY Y I N ANY PROPRIEORIPARTNEWEXECUTNE 7 N/A _L,gACH ACCIDENT _ MFendARMEn NM)EXCLUDED?tary E EA86•PA�NPLOYEE — I(yyes Cesaribe under E.L.DISEASE-POLICY LIMIT DESC I Tl NOF OPERATI NS below DEOCRIPTION OF OPERATIONS/LOCATIONS IVEMICLO (AttmhACORD 101.AddldalalRo,wrlaSchedule,Irmoruspa coism qui red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE YMEREOF, NOTICE WILL BE DELIVERED IN Town, of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood 9 rest N.Andover, MA 01845 AU-n{pt�¢EDREPRESENTATn/E M Q ®1989-4010 ACORD CORPORATION, All rIghts reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD Phone: Fax: (978) 688-9542 E-Mall: Rightfax N2-1 7/10/2015 6 : 49: 34 AM PAGE 2/002 Fax Server DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) T .. .. R`jFIC'TE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CLOUTIER INS PHONE FAX 1996 LAKEVIEW AVE (A/C,No,Ext): (A/C,No): E-MAIL DRACUT,MA 01826 ADDRESS: 73LYS INSURER(S)AFFORDING COVERAGE NAICIt INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA SALTZMAN,LEONARD DBA ALL PRO DESIGN BUILDERS INSURER B: INSURER C: INSURER D: PO BOX 4223 INSURER E: ANDOVER,MA 01810 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DMYYYY) (MMIDD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) MED EXP(Anyone person) $ ff::: PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [�]PROJECT [�]LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X t WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-06O9N493-15 06/10/2015 06/10/2016 LIMITS I ANY PROPERITOR/PARTNERIEXECUTIVE N/A E.L.EACHACCIDEN $ 100,000 OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATE ON POLICY DOES NOT PROVIDE COVERAGE FOR SALTZMAN,LEONARD. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD STREET IN ACCORDANCE WITH THE POLICY PROVISIONS. F AUTHORIZED REPRESENTby VE N ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Qze 'Coowiwroaatucccll/a o/"WWroj«c/rrrdelle !'` Office of Consumer affairs&Business Regulation ! UV Massachusetts -Department of Pul;i is Safety j, Board of Btai(dirtg Re�ulaftons'"and Standards" OME IMPROVEMENT CONTRACTOR i egistration. '12,, .02 Type; I{t11 Skp�tci�oi Expiration- 1�� Private Corporation Licelise..Ca 043 ..0 i All Pil ro Design Builder$r0l Ya LEONARD F SAL ' 5 HII LCREST RY} , Leonard Saltzman \Y � t- 4Andover MA 018,0 P.BOX 4114/5 Hillcrest Rr�r� � ,�y •r« h %Y �� Andover,MA 01810 Un s >... CUndersecretary ��M� )I'�ti- �`'`�Xplr�tlon 08/19/2015 •, � � Commissioner a 1 S'