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HomeMy WebLinkAboutBuilding Permit # 7/20/2015 BUILDING PERMIT %AORTH TOWN OFNORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 1 Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items,on this page LOCATION Prin PROPERTY OWNER Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential F1 New Building 00 roily [I Addition wo or more family 0 Industrial D Alteration No. of units: D Commercial D Repair, replacement [I Assessory Bldg 0 Others: 11 Demolition D Other I'M lfllffil�,(A IN o""pge In IN J) "to V,'V,5 )US, IS "IS �w DF-SCRIPTION OF WORK TO BE PERFORMED: Ida ti icaez ,ion- Please Type or Print Clearly OWNER: Name: Phone Address: 7A 7 7 Contractor Name: Phone: Email: Address: r, J�zz Supervisor's Construction License: -Exp. Date: 71 /Z61 Home Improvement License: -Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPyk.$12.00PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F. Total Project Cost: FEE: $ (i6d t T 12 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r FORTH Town ' ofEAndover , 11,19h ver, Mass, —7 a coc"Ic"a WIC. A3. V BOARD OF HEALTH Food/Kitchen PER..MIT T LD Septic System THIS CERTIFIES THAT ............ . BUILDING INSPECTOR Foundation hashas permission to erect .......................... buildings on ..../:.1. ..:...�J.Ca.......... N. �.A ..................... Rough tobe occupied as ... .. ...... .....................4 ............................................................................ Chimney provided that the person accepting this permit shall i very respect 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T TS Rough Service .................. .. .... ..... ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Pa}� of a es a06'2;aI 9 p 9 CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submi o: Job Name ,f Job# Address Job Location � Date � „� Pate of Wens � Phone# ' '" Fax# Architect We hereby submit specifications and estimates four: p +w'bdmrm" °"ddY''✓ ""'""0mrvm"" C.,..M"'4 ow "ns" ' �Y� �i ��I/PAdudO" S �,n.wWA"fl;"✓.+''wV" Lid" M r ., n0 "��l� " ' .^''��' y�•.n. � oma �" '� �� � � ~ mu" w �+ � "� '��^ � "� w m�r�„m+ ,�: �°,��� ��' "rv�.w'�"'�,;,�V N'� � „�"� � ' �4” „�' n�, � �..p ��, fr�:n'�'" 'b „V�� �`� m' ow�'r �^",�' '„ a"„✓�� ' �„�.,,wwno �., ,�� w' ��« � �i r✓� "'� wd�" ''" � � "�.. i ��� '�i,„ �,� �'�N,�,.:��^'0` � � �m�” uN" i�a"m{ ^�Gr� „r" ,."�+ iiv""'d'� °a A; We pro e hereby to furnish material and labor—complete in accordance with the above specifications fa the sum /n ADollars with payments to be rni/He as foilaws: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only'upon written order,and wi11 become an extra charge over and submitted above the estimate.Ali agreements contingent upon strikes,accidents,or delays beyond our cdhtrol. Note—this proposal may be withdrawn by us R not accepted within days. The above prices,specifications and conditions are satisfactory and are Signature °� " " 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 form satisfies all basicrrquirements of the state's Home improvemenf Contractor Law(MGL chapter 142A),butdoes not Include standard language to protect homeowners. Seek legal advice if necessary. Any personplann"mg home"pprovements should fiisf obtain a copy of"a ' Massachusetts consumer guide to home improvement"before agreeing to any work on youresidence,You may obtain,a free copy by'caMng the Office of ConsumerAffairs and Business Regulation's Consumer Information Hotline at-617-9734787 or 1488.283-3757. Homeowner Information Contactor Information f . Name A-1 C 114 rcf Street Address(do not use a Post Office Bmi address) contractor/SW 77�0 Name . Q- C771e I to Zip Code usiness Address(must include a street address) . Da"Phone Eveninghone ity/fown Zi de Mailing Address(It different from above) 3usiness rhone RidergEmployer M or .$.Number ' lar rcquitu autmotl bomsim- Aoma ICtaundaraq NumDc arlmalion-0rb ' p:ov®col aonurlon Wvet / '7 Lad irnnoaaumb ne: rr The Contractor agrees to do the following work for the Homeo e_r: 5_�Nl we wqrx 10 ,TPLCE Do U AV -4d1l Required'Perntlts-The following building permits are required Proposed Start and t7ompletl6 Schedule-The fdlloviing schedule will and will be secured.by the conbmctor'as the'hotneowner's agent; be adhered to uriless circumstances beyond the contractor scontrol arise (Owners who'.secure their own permits will be excluded':from,the.Guaranty Furid'provisionsof Date when'contractorwill begin contracted work MGL chapter 142A:) Date when contmct6d .work will be substantially completed,. Total Contract Price and PaymWSchedule The Contractor.agrees to perform the work,famish the material and labor specified above for thetotal sum of Payments will be made according to the following schedule: $ upon signing contract(not:to ekeeed 1/3 of the total.contract price 22 the costof special order items,whichever is greater) $ by_/ / or upon completion of t $ by _/_/_or upon completion of S � upon completion of the contract. (Law forbids demanding full payment until.contract is completed to both party's satisfaction) The following material/equipment must be special S��b e paid for ordered before the'contracted'workbegins in order S — to be paid for to meet Die coinplbtion schedule.(**) NOTES:(•)Including all finance ebarges(••)IAw requires that any deposit or down-payment required by the contractor before work begins may' notexceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion srLedule. Express Warranty-Is an express warranty being provided by the conh•actorT No Yes laltterms of the warranfv must be attarped to the emh actl Subcontractors The contractor agrees to be solely responsible for completion of the work described iegardleas of the actions ofany tfiird party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement 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 ms 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 mad'aad fully understand it'Ask'questious its is unclear, • Make sure the contractor has a valid Home Improvement Con ractor o_g:strati.. The ltv requires most home imp rovement contractors and. subcontractors to be registered with the Director ofHonm Improvement dontractok Registration. You may-inquire aboutcomraetor registration by writing to the Director et:One Ashburton Place,Room 1301,Boston,MA 02108 orby.calling 617-727-3200 or 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured • Know your rights and responsibilities. Read the Important Information on the ieverseside of this form and get a copy of the Consumer Guide to the Home l4rovement Contractor Law: You may cancel this agreement if it has been signed at a place other.than the contractries-normal place of business,provided you notify the contractor in writing at his/her main o1bce or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the. thiid business day following the signing of this agreement..See the attached notice of cancellation form for an explanation of.tbis right D NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identio copies ofthecontmct. beeompletcdandaianed One copy should Soto the homeowner,T a copy should be kept by the ommactor. Homeowner's Si lure Contractor's Signature Dau :Date Contractor Arbitration::..: The Home:ImprovementContractor L-aw;provides homeowners-with:the:right-to initiate an arbitration action(as an alterria#i e'io coi tt;action)if.they:have.a.dispufe.with.a'contractor. The,same.right is not automatically afforded to'a. contractor,however.-:The:contractorwould have_tp resolve any,dispute he/she.lias with a homeowner in court unless. ._. both parties agree to,the optio"1.61ause provided below..This clause would.give the.contractor the.same-right td' arbitration as is afforded to the•homeownerdiy the Home Improvement Contractor Law... . ` The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute- concerning this contract,the contractor may submit the dispute to a.private arbitration firm which has:been.approved by, the Secretary of the Executive Office of Consumer Affairs-and Business Regulation and--the consumer shall be required to bmit such arbitration as provided In-Massachusetts General Laws,ch a 142A omeowners Signitture Contractor's Signature NOTICE:"The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractox:.�he homeowner:may initiate alternative.Aispute resolution even where this section.is not separatelysigneS'by`:the 1 * es`.". Homeowner's Rights A homeowner's rights undo the Hboe'Iniprovement Contractor Law(MGL chapter I42A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement: However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowner who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The-contractor is responsible for completing the work as described,in a timely and:workm anlike.manner. Homeowners.may be entitled to.other specific legal:rights if the.contractor guarantees, or provides.an.express warranty forworkmanship o'r materials. In addition to.guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability:and�tness.for.a particular purpose, An enumeration of other.matters on which,the homeowner and contractor lawfully agree;may be added:to the- terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights;-contact-the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachmeiits is to be given to the owner and the other keptby,the,_contractor:-Anymodificationto the griginal'coniract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day recission period has expired . Accelerated Payments A contractormay not demand payments inadvance.of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a.contractor deems him/herself to be financially insecure,the contractor may require thatthe.balance of funds not yet due be placed in"a joint escrow .. account as a prerequisite to,continuing the contracted work. Withdrawal of funds from said account wouldrequire the signatures of both parties. Additional Information I If you have:general_questions,onneed:additional information about the Home Improvement-Contractor-Law or other consumer nglts,or:if.you wish to obtain a fi ee"copy of"AConsumer.Guide to.the HomeImproverrient Contractor m Law,"contact: . Consumer Information Hotline office-of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the,-registration.of a contractor or if you have.questions orneed additional infcirmaiion-specifioally ' about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton PIace,Room 1301,Boston,MA 02108 . (617)727-3200 or 1-800-223,0933 For assistancewith informal mediafton:of-disputes or to-register.-.formal complaints ag.ainsta Lias .essi'call: . "ConSniiet'ComplairitSe6tion Office of the Attorney General (617)727-8400 SAND/OR Better Business Bureau , (508)652-4800 (508)755-2548 (413)734-3114 Thee Commonwealth of Iilossachusetts r epartment of Industrial Accidents Office of Investigations T us 600 Washington Street Boston, MA 02111 PN w W .mass.gov1dia workers' Compensation Insurance Affidavit: Build ers/Contr acto rs/Electricians/Plu m bers Applicant Information Tease Print Legibly Name (Business/Organization/Individual): ( °QQZtej.,-&� Address: ,�.�- City/State/Zip: Phone #: Cq7 &7,37 Are you arr-employer? Check the appropriate box: Type of project(required): 1. 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. ❑ New construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' T10 workers' comp. insurance comp. insurance.t 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3-❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumtiing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 oof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] `A�Zy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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-contractors and state whether or not those entities have employees. f the sub-contractors have employees,they must provide their workers'comp.policy number. am can employer that is providing workers'compensation insurancefor nay employees, Below is file policy sand job site infor"fation< insurance Company Name: (-I f /� Policy# or Self-ins. Lie.#: 7 a` �r� � ��(� / � Expiration Date: Job Site Address:_ �/19 �`al City/State/Zip: G' i�pct Attach copy of flee workers' compensation policy declaration page(showing the policy number and 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 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•ti fader the pains antipenalties of erjury that the information provided above is true sand correct. •, Si nature: �, �/ Date: E? Phone#: 9z� At Official Pse only. Do not write in this area, to be completed by city or town of leicaz City or Town: Permit/License# Issuing Authority(circle one): 1 f. Board of Health 2. Building Department 3, City/Town Clerk 4.Electrical Inspe'-for 5. Plumbing Inspector S. Other C ontact person: Phone#: l From: 01/12/2075 14:48 4t15'1 P.013/016 CERTIFICATE I r L IT I DATE /t)DIYYYY) 01!1122/2015 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). 'RODUCER 00775-001 Durso&Jankowski Insurance Agency Inc (978)682-5175 MN,: (978)794-0313 198 Mass Ave Suite 10113 RRMSS: North Andover,MA 01845 A.I.M.Mutual Insurance Company 33758 VSURED INSURER B, Arthur Walsh A a walah & Sons INSURER G. 55 Pleasant Street INSURER North Andover, MA 01845 INSURER E, 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 BY PAID CLAIMS.pp 1 TYPE OF INSURANCE W& yep POLICY NUMBER MMIDO/YWY MRILOYM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMI SES(Ea ETOREN7EDn $ CLAIMS-MADE F__]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPlOPAGG $ OLICV RO• OC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY i nt ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED ip $ AUTOS i nt S UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yypR{ ___ T DEERDg Gp RETENTION 5 y/C gT 7U 7H $ qND EMPL9YEs�LIABILITY X TORY lAtv11TS OER ANNyy PRROoPRR��EETTppR! ECUTIVE E.L.EACH ACCIDENT $ 100,000.00 A OFFICER/MEMBER EXGLUOED9 Y N/A AWC-400-7014648-2014A 11/14/2014 11!14!2015 (Mandatory in H) E L DISEASE-EA EMPLOYEE $ 100,000.00 N uu�� 'MrtR1pf 10t V9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I 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(2010105) The ACORD name and logo are registered marks of ACORD f cJ�ieamv�iyoo2iuecc ^pC%(uaac�icut 61 Oft'ice of Consumer Affairs&Business Regulation E ME IMPROVEMENT-CONTRACTOR egistration: x',0'`3359'• Type: xpiration: - /#7 - Private Corporation A.J.WALSH&SONS L Arthur Walsh 1 ' 55 Pleasant St �a - - N Andover,MA 01845Undersecretary Aft Massachusetts -Department of Public Safety Board•of Building Regulations and Standards ' Construction Supervisor ' License: CS-022680 :; ARTHUR J WALS, i 159A WAVERLY RD N ANDOVER NIA 01 r V-- �riQ ` Expiration Commissioner 06/09/2016