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HomeMy WebLinkAboutBuilding Permit # 8/6/2015 0ORT11 BUILDING PERMIT 'T, TOWN OF NORTHA NDOVER 10 APPLICATION FOR PLAN EXAMINATION -14p�,0111 A T: Applicant must complete all items on this page 7 0 16 Date Received Permit No#: t ACH usE Date Issued: LOCATION cl O'l N, AncLvQr, V'V)A 01�LIS- Print PROPERTY OWNER T0Q-Vb$=CRS6yh-0LyA Print 100 Year Structure yes no MAP IV'416-PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building M16ne family El Addition El Two or more family El Industrial 0 Ajteration No. of units: El Commercial Wkepair, replacement El Assessory Bldg_ [I Others: El Demolition [I Other 7(, wgm;m �y),,v �a Ejavy terz DESCRIPTION OF WORK TO BE PERFORMED: 3L-Q Identification- Please Type or Print Clearly OWNER: Name: Phone: as h M C,V1, Address: 0;j jrjov ew-,. M 4 0 t R y5- Contractor Name: SPhone: Email: co Address: 1,��'Jb 4 01 Supervisor's Construction License: Exp. Date: Home Improvement License: / 38S'6q Exp. Date: "///Z I ARCH ITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project C ost: $ C FEE: $ Check No.: Receipt No.: ;W72 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sighatute'o ;d6 7, -(nq htr�hto N®RTH own An . � E , ' over .:� 0 C,® �AK� h ver, Mass, Ph COC .41C HE WIC x V S � BOARD OF HEALTH Food/Kitchen r E T LD Septic System �j BUILDING INSPECTOR THIS CERTIFIES THAT .........(...... ...... ... . ........... ......................................................... Foundation has permission to erect .................:........ buildings on ..� .. ... . .. ..... ...................................... � Rough tobe occupied as ........................... .W..... �:.. �?. ............................................................... Chimney provided that the person accepting this permit 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-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 EXPIRESPERMIT IN MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION ST Rough _ ................ Service .........................�.... ........ ... ......... Final UILDING 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 Approved by the Building Inspector.- Burner Street No. Smoke Det. FREE ESTINL4TES PROPOSAL Construction Supervisor Lie.# CS102663 FULLY INSURED H.I.C. Reg,# 138569 WMGHTROOF]ING® l7 All Types of Roofimg& GuUers 350 BERRY STREET ® NORTH ANDOVER, MA 01845 TELEPHONE: 978-687-2247 PROPOSAL SUBMITTED TO PHONE DATE jba *csu�vina 6$3- �35"1 8A.//5 STREET JOB NAME/LOCATION Is- 6M CITY,STATE ANDZIP CODE JOB START DATE NZ A adoMr .MA 0L� E � C 10 f Roye . c C V-?-- V-00� 0-) aqzrs �6:1+ @-1,1100 ctsf, Sfr' U tov- e, �s-lwe . t r. a,ld Va Gfe scavo it t2c Ll h'1 viW` !1fs GiPVY t,,��� (,4( QWVV Y-e w043a Ly •fes d S kujQ� 0��Cy woods lie.- ) a wt h�t.,r s' �l•`� �"� `� L cv- Ll Ve "+ boos V• pi esF � � 3L 8 dryq4q- OkL W r% moi`"QAS G-A-F. av-cA,t -slit P� t t -A�. v1 x na,�s v d t i,,►, � rjips +- - ��i: q 50-00 We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:$ ly.5'0•0 0 Payment to be made as follow ' f (KI 66. 6(mr-P or-,c-Q- CO-00 1. OE All material is guaranteed to be as speci' ork to be completed in a substantial workmanlike Authorized I s submitted,per standard practices.Any alteration or deviation from - above specifications involving extra costswill be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to tarty fire,tomado and other necessary insurance.Our workers are fully NOTE: This proposal maybe covered by Workmen's Compensation insurance.Nonpayment by agreed party may result In llggation withdrawn by us if not accepted within days. with penalties including court cost and compensation both real and punitive. Acceptance of ]Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted,making this a valid contract. Signature ky;LA You are authorized to do the w1 as specified.Payment will be made as outlined. Date ofAcceptance: Signature Massachusetts-Dome Improvement Contract This form satisfies all basic requirements ofthe state's Home improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. SeeIc legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Cousu mer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name Street Address(do not u eaPostOfficeBoxaddress) Contractor/ lesperson/OwnerName7 0`1Q- 5-41 Q c , �CsD� t C City/Town State Zip Code Business Address(mustVncludo a street address) D ytimePhone Evening Phone City/Tovm State Zip Code 97i) 6 83--935`1 1\,/ +✓VV" A 14 D l &,C/S ,f� p �p/ Mailing Address at different from above) BusinessPhonal'7 ederalEmployerIDorS.S.Number 0/3 + 4 Ifrmermpraserttnt CantrzGcrRco.Namt>tt E.Tiratan ds(a Ian requires shatmosthomo '. Improsonkodorshm•e �Q (-/ /'� L` / avalid nsistmregtstmt(on number The Contractor agrees to do the following workfor the Homeowner: (Describe in detail theework to completed,specifying the types ' ` ,,brand,and grade of materials to be used use additional sheets if necessary.) 51crz iv � V\Z_rf�S�( 50-12 (rd r !"'-�'`ad wor's't Required Permits-Thefallowing buildingpermits are required 11 Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits will be ��yy r excluded from the Guaranty Fund provisions of 9 I > Date when contractor will begin contracted work. MGL chapter 142A.) O�Y]Date when contracted work will be substantially completed. Total ContractPrice and Payment Schedule The Contractor agrees to perform the work,fwnfsh the material and labor specified above for the total sumo 5-y:50,®® (�) Payments will be made according to the following schedule: $ - Q.0D upon signing contract(not to exceed 1/3 ofthe total contract price og the cost of special order items,whichever is greater) $ by ! (_or upon com lc$ b / / or upon comp $1(�3 CO,0 Oupon completion ofthe contract. (Law forbids de dman_ing wfull payment until contract is completed to both party's satisfaction) Thu following material/equipment must bespecial S tobbe_paidfor ordered before the contracted work begins in order to meet the completion schedule.('') S o be paid for NOTES:(d)Including all finance charges(s*)Lawrequires that any deposit or down-payment required by the contractor before work begins may not exceedthe 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 schedule. Express Warranty Is an express warranty being provided by the contractor? MrNlo❑Yes fall terms of thewarranty must be attached to the contract) Subcon tractors-The contractor agrees to be solely responsible for completion ofthe work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor fruther agrees to be solely responsible for all payments to all subcontractors for materials and laborunder this aereement Conti-actAcceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted witliln this document,the contract shall not hnply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is tmclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof o£insurance"document. • Know your rights and responsibilities, Read the Important Information on the reverse side ofthis form and get a copy ofthe Consumer CIA&to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at lusher main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing ofthis agreement. Seethe attached notice of cancellation form for an explanation ofthis right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK S ACES!!1 Two identical copies ofttte contractmustbe completed and signed.One copy should g:on-tra homeoim to atter c py should SMESM the contractor. reowner's Signatur—(_-- � ctor's Signature Dat- e �— Date The Commonwealth of Massachusetts ___Print Form-- t Iia r Department of Industrial Accidents Q tOffice of Investigations - 9 I Congress Street,Suite 100 / Boston, MA 02114-2017 - ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Legibly_ Name(Business/Organization/Individual): J �c1 � G-w l��((�ZtCY Address: _�5_0 B%4-f-� St i 01 City/State/Zip: vie r M 0(9t- Phone#: L7 7d V7—44q'? Are you an employer?Check the appropriate box: Type of project(required): 1.EE17I am a employer with 4. F� I am a general contractor and I employe (ful nd/or part-time).* have hired the sub-contractors 6. F-1 New construction 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' 9. ❑ Building addition [No workers' comp, insurance comp. insurance.$ required.] 5. We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F-1Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ of repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. 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-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: L/lu t/`T'7 m w — Policy#or Self-ins. Lic.#: Expiration Date: 9 1 130 40 S- Job Site Address: q0`7 6�c��� )\`� City/State/Zip: d tl.Qc,FYI A Q(tY 1/9- Attach a copy of the 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._Ido hereby cert der the pains and enaltiegjury that the information provided above is true and correct. Signature: Date: js® Phone#• 6 Y`7 -oUY 7 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#: ' ® DATE(MMI /YYYY) AC"R® CERTIFICATE OF LIABILITY INSURANCE g `5- 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(ies) 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). CONTACT PRODUCER TA SULLIVAN INSURANCE AGENCY INC NAME: 135 MERRIMACK STH ONE FAX AIC No Ext• AIC No METHUEN, MA 01844 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: SCOTT WRIGHT DBA WRIGHT GUTTERS INSURERC: 350 BERRY STREET INSURER D: NORTH ANDOVER MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25682_75_2REVISION 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. ADDL INSR POLICY TYPE OF INSURANCE INSD SWVD UER POLICY NUMBER MMIDD/YYYY MM DD/YYYY LIMITS EFF POLICY EXP LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE T '.. RENE CLAIMS-MADE Ll OCCUR PREM SES OE.occur ence MED EXP(Any one person) $ '.. PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO LOC PRODUCTS-COMP/OP AGG S JECT 5 OTHER: O '.. INED AUTOMOBILE LIABILITY Ea accidentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEL)ULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident 5 '.. UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE 5 DED F RETENTION 5 $ A WORKERS COMPENSATION WC5-31S-387187-014 9/30/2014 9/30/2015 �/ STATUTE I I EERH '.. AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 5 100000 OFFICER/MEMBER EXCLUDED? ❑ IA Y N (Mandatory in NH) E.L.DISEASE-EA EMPLOYE 5 10000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 SOOOI)0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SCOTT WRIGHT. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage. WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. 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 IN ATTN: LOCAL BUILDINC INSPECTOR BRIAN LEAF ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET, BLDG 20, SMITE 2035 NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25682752 1 1-387187 114-15 WC I shankar.gadale®libertymutual.com 1 7/22/2015 11:28:27 AM (PDT) I Page 1 of 1 SCOTTWWRIGHT 359 BERRY ST NORTH ANDOVER MA*W5 Office of Consomr Affairs.6 flushmn Regulation IMPROVEMENT CONTRACTOR —IR 691mrstim: IMM9 Type, :`Explraffan: 411412017 DOA WRIGHT GUTTERS SCOTT WRIGHT WO BERRY ST. NO.ANDOVER,MA 01845 Undersecretary