HomeMy WebLinkAboutBuilding Permit # 7/20/2015 BUILDING PERMIT ,,,F.D
t%ORTH
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TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
0
Permit No#: Date Received
rev
Date Issued: CHIJ
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER_ 'A-
Print 100 Year Structure yes no
ZONING DISTRICT:
MAP PARCEL. Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
11 Addition 0 Two or more family El Industrial
$AIteration No. of units: 11 Commercial
El Repair, replacement 11 Assessory Bldg El Others:
El Demolition 11 Other
"S
11111 rl,I flim W "t
ul
'111111n 1141,111
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone: "lei - Z --t;-74'e
Email: V , .,
Address: i .
-
Supervisor's Construction License: —Exp. Date: 26)ie,
Home Improvement License: Exp. Date:. ae l)
ARCHITECT/ENGINEER vPhone:
Address: Reg. No.
FEE SCHEDULE;BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: -ro FEE: $ Q6 —
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not Z access to z"ut
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�oRTH
Town of
E ....p. An.dover
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ro h ver, Mass
coc"Ic MEWIc- 1' '
U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ........... ....... .......................................2- BUILDING INSPECTOR
has permission to erect
.......................... buildings on ...4R2 �.(d...t—'al('..... Foundation
Rough
to be occupied as J .t .,... .c,,,
....Y�............................. " ............................................................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final
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
UNLESS CONSTRUCTIO ST S Rough
Service
.......,., .............�........BUILDING�INSPECTOR. Final
Occupancy Permit Required to Occupy Building
Rough GAS INSPECTOR
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.
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ABOUT US DOAWL CONSTRUCTION Co., Inc.
DO-AWL Construction CO NC
in Saugus, 'MA was established
in 1951 and is a private
company specializing in'
General Contractor, New July 15, 2015
Construction & Remodeling of
Commercial Institutional &
Industrial Buildings & Single
Family Homes.
We are fully licensed in the
State of Massachusetts and
guarantee the utmost efficiency
and accuracy in work. ®p®Sal
Do-Awl Construction Co., Inc. proposes to furnish all labor and
materials as per plans. All Trade licenses, Insurances and
Permits will all be completed by Do-Awl Construction Co., Inc —
3 Permit cost to be determined.
Total Proposal Cost: $26,670.00
i
DO-AWL CONSTRUCTION Co., INC.
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ACCEPTANCE OF AGREEMENT
This contract is for immediate acceptance. Any delay in acceptance beyond 8/15/2015
will require renegotiation of the terms of this agreement.
You are entitled to a completely filled in copy of this agreement,
signed by both you and the contractor, before any work may be
started.
This agreement is made on the date written beside our signatures between Do-Awl
Construction Co., Inc. (Contractor) and (Owner). Owner has read
the entire proposal and agrees to the statements above within monetary standards as
well as scope of project.
This agreement is entered into as of the date written below.
Mr. and Mrs. Mike Katz
_ iG '�6
('S` /ignaturre) �m (Date)
(Printed Name
Craig'Giardu o
"2CY AS
(Signa r )(�U // r (Date)
C Com:rtpc; C-l'o
(Printe Na
Do
® wl Cos ction, Co., I c., Contractor
(Sig atur (Date
(Printed Name and Title)
ChangeOrder
Do-AwlConstruction Date-
2 5
ate•25 HowudSt. Owner:
Saugus, MA 01906Contracto -
r:
781-233-1029
Proj ectname.
Change ordernumber.
Originalcontractdate:
You are directed to make the following changes in this contract
Theoriginalcontractsumwas: $
Netamountofprevious changeorders:
Totaloriginalcontract amountplusorminus netchangeorders:
Totalamountofthischangeorder:
Thenewcontractamountincludingthischangeorderwillbe:
Thecontacttime will bechangedbythefollowing numberof days: P
Thedate of completion as of the date of this change order is:
Contractor: Owner:
Companyname Name
Address Address
City.State.Zip City.State.Zip
Date Date
Signature Signature
y end Schedule:
J Payment schedule will be set up between customer and Do-Awl
Constructions Co., Inc. Payment schedule must be signed by both parties
before work will begin.
Any unpaid balances at the time of completion will be subject to interest rates
in accordance to the federal short-term rate. Interest rates will increase
accordingly every 6 months from the time of payment due.
Job Duration:
✓ Approximate job duration is worked out among parties once a deposit is
made; this is subject to change according to issues such as inspections,
back orders, change orders, weather, illness and other unforeseen delays
may prolong completion time.
illing nExtras:
✓ Any extras requested during renovations will require a separate change
order and require signatures from all parties involved.
✓ Enclosed please find a copy of our current Change Order Form.
✓ Any Change Orders must be paid in full prior to that work being started.
✓ Differences or unpaid balances at completion of the job must be closed and
paid in full prior to signature on final occupancy permit.
✓ Owner is responsible for any and all attorney fees as well as court fees if
litigation is required due to a monetary discrepancy or discrepancy within the
work scope.
✓ Any request or demands by Inspectional Services not originally figured on
the contract will be an upcharge and will be priced accordingly.
✓ Police detail is only needed for Water and Sewer work, if further details are
required owner will pay directly to the town police department.
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The Commonwealth of Massachusetts
. s Department of IndustrialAceidents
X Congress Street, Suite 100
Boston,MA 02114.2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Eiectricians/Plumbers,
TO BE FMED WITH THE PERNUTTI G AUTHORI'T'Y.
Applicant Information Please Print Leibly
NaMe (Business/Organization/Individual): 0
Address: Q Ho f roc" ,"
City/Mate/Zip: Phone##: � �
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/orpart time).* 7, []New construction
2.[J 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.]
9. ❑Demolition
3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 F]Building addition
4.Q I 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.Q 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
These sub-contractors have employees and have workers,comp.insurance.t
14. Other
6.Q We are a corporation and its officers have exercised their right of exemption per MGL G.
�
152,§1(4),and we have no,employees.[No workers'comp.insurance required.]
*Any applicant that checks box 41 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.
1Contractors 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,%ck must provide their workers'comp.policy number.
X am an employer that ispi'oviding workers'compensation insurance for my employees.'Below is the policy and job site
information.
Insurance Company Name: Vat c-r . ._ r t, , —
Policy#or Self-ins.Lie.#; ° '~'1 �� �...� Expiration Date:_ t�
-
lob Site Address: C W -City/state/Zip:
pexpiration d
Attach a copy of the workers'compensation policy declaration page(showing polieynumber anda )
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 WORK 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.
Ido hereby certify under the pains and enill s of perjury that the information provided above is true and correct
Signature: _ a Date:
Phone#: t: ' M.° ..
Official use only. Do not write in this area,to be completed by city ot,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#:
IOAT07!15/ (MMIDDIYYYY)
ACOR-DW CERTIFICATE OF LIABLITY INSURANCE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Rizzo Insurance Group Agency,Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
310 Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Revere MA 02151 9
INSURERS AFFORDING COVERAGE AIC
N
INSURED Do-Awl Construction Co.Inc. INSURER Nautilus Insurance
25 Howard Street INSURER B: AIM Mutual
INWRERC, ......
Saugus MA 01906 INSURER D
INSURER
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT\AATHSTAN DING
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POL IICY-EFF-kTivii j0_6LICY EXPIRATION I
POLICY NUMBER LIMITS
EACH OCCURRENCE 1,000,000
GENERAL LIABILITY
DAMAGE TO RENTED
11/27/2014 11/27/2015 $ 100,000
A X COMNIERCIAL GENERAL LIABILITY NN512435 �_PRLtAISESAEa QD�UfePK;9)
EXP one rierson) $ 5,000
CLAI'MS MADE X j OCCUR MED (A rly
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE s 2,000,000
PRODUCTS-C MP/OPAGG s 2,000,000
-N1 AGGREGATE LIMIT APPLIES PER.
C-3 E
POLICY rT
1RO-
Fi
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY ALTO
ALL OV,1NED AUTOS, I BODILY INJURY i$
(Per Person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
(per accident)
NON AUTOS
PROPERTY DAMAGE
(per am'dent)
AUTO ONLY-FA ACCIDENT
GARAGE LIABILITY 'S —-----
ANY AUTO OTHER THAN EA ACC
- --------_
AUTO ONLY.
AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE -------I
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
RETENTION S
rX TNCSTATU TH
WORKERS COMPENSATION AND CRY M OEI
EMPLOYERS'LIABILITY VMC 100 7501 2014A 11 02/02/2016 02/02/2016 _F L,EACH ACCIDENT_ 100 0 00
ANY PROPRIETOMPARTNEWEXECILITIVE
0
FFICEPWAEMBER EXCLUDED? j E.L.DISEASE-EA EMPLOYEE $100,000
If yes,des rib under
SPECIAL PROVISION E L DISEASE-POLICY LIMIT 600,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Bath Remodel
CERTIFICATE HOLDER -CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
MR&MRS Michael Katz DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
23 Old Farm Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
North Andover,MA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE J <CR>
ACORD 25(2001108) 9 ACORD CORPORATION ION 1988
Rizzo Insurance Group Agency,Inc. ONLY AND CONFERS NO�RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
310-Broadway ------- --- --ALTER THE-COVERAGE-AFFORDED-BY—THE--POL-IGIES-BEL•OW.••-
Revere MA 02151 INSURERS AFFORDING COVERAGE NAIC#
WSURR,D Do-Awl Construction Co.Inc. INSURER A: Nautilus Insurance
25 Howard Street INsuggg a; AIM Mutual
INSURER C:
Saugus MA 01906 INSURER D:
INSURER E:
OVERAGE$
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 1$$UED TO THE INSURED NAMED ABOVE FOR THE POLICY PEA100 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 I$ SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TSR ADDI POLIGY NUMBER POLICY EFFECTIVE POum LICY EXPIRATION LIMITS
GENERAL LIABILITY EACH DAMAGE
OCCURRENCETO 1 000,000
RENTED
X COMMERCIAL GENERAL LIABILITY NN512435 11/27/2014 11/27/2015
CLAIMS MADE M OCCUR MED EXP(Any oneperson) $5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $2,000,000
.--""GEMC'AGGREC,A7E'L'IMIT'APLIES'PER'---"'--""'-"—'_ .------..__......__._...._---.,_.._...--.---._..___...__...__._...._.-PROOUCTS='COMP/OPAGG--$2-000000....
POLICY 7 URA M LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Es aeddanl)
ALL OWNED AUY08 BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNEDAUTO$ (Para=ident) $
PROPERTY DAMAGE $
(Per md(ent)
GARAGE LIABILITY AUTO ONLY•EA AC (DENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGO S
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE
OCCUR ❑CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
RETENTION $ $
WORKERS COMPENSATION AND X WC 3TATU. DTH.
EMPLOYERS'UAs1uTY
ANY PROPRIETOR/PARTNER/EXECUTIVE VWC 100 601507501 2014A 02102/201.5 02/02/2016 E.L.EACH ACCIDENT 100,000
QFFICERIMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE $100,000
SPECIAAL P Ov 810 'Wow E L,DISEASE-POLICY LIMIT $500,000
OTHER
SCRIP71ON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
E _-
ERTIFICATE HOLDER CANCELLATION
SHOULDANYOF YHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURETO DO SO SHAD_
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
THORIZED REPRESENTATIVE <PF>
r
CORD 25(2001/08) O ACORD CORPORATION 1988
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REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS
NAME INDIVIDUAL NUMBER DATE
DO-AWL CONSTR.CO GIARDULLO, 111140 25 HOWARD ST 11/25/2016 Current
INC CRAIG SAUGUS, MA 01906
0 2012 Commonwealth of Massachusetts.
Mass.GovED is a registered service mark of the Commonwealth of Massachusetts.
https:Hservices.oca.state.ma.us/hic/licenseelist.aspx 7/17/2015
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