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HomeMy WebLinkAboutBuilding Permit # 8/7/2015 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: // 7 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page r r ,r r r r / rrr r r zc...,./ rir ,, ✓, / rr.,l ,.. ,lr,. //,//r 1 / /. J I / / //r /r/.. ,. r /J,r i, J,r%.. i,/,, r.rl/ /� ,. / r +✓ ./. , / ,, ,,. / / , r/ -r /,/ ,,. /rrri/ ,ir � r,<i,/ !r./.�/ri �,r /, a >' /, rrr r, / r � /1� ✓ r /rr/ � r a i /,� .� ,r., /.rr /� l /. .., r ,r, 6 r � r,-✓ Y f. �' I / /� �, ,.r ,, %/ - ,. „e.. r ,///��/ ,rte. .r / rr.../r/ // ,rr.%lr(,r � c///,A �,. ,, ,, � r r ✓' r../G % / /...� „ ��fi. �r� r, /. ,r..,//i/r1 �/ir/ / ///.... I ,,. /r,/r�/°�o,,P,1r�/��/�/�(r cQ,r,U/i�Ef/R/l/,,'!,r/�,/�//�,Q.i/W,,/.,��N/E,/R, Jr//�r/a>�/�iri,;�..�/r//,,H�/f/°/r,r/,,�/ /.,-r r„���rrr�krrfy,�rrj�/// O/✓rIYr',,(.✓�,i,y1 t,rr,r rr,r//�r,,/r///r%lr/.,,,.O;ri„r//,r///,��r�„%,�/�//L/,/�/�,�l� /rI,rr�rr� 1/ / /r1 ,;. I „ /r T �. /irk/✓o //' ✓ ,-�////.�r�, , rr, , ,...r. r,/rr ,rrr/ �r/ .,.� ,.r /. ,/ r..,, r /,. ri.// /. .//. / ,/Gr,r/,/,r „.,i,z. ,,,, ,, r ,,, /Di /,:r„/r� ,;r,✓/ ,%i� / ,. /o :, ,,:, r//I // /, r G / i/l, /..� �$ r ,i,:n0 %J ,,, � ,,,r/ //,/�r r // ✓ rD.STRICT,/ �r ��//r�i/�,Histonc!Dist � tr / �,i/ J, rr r / r i / r,/ /,r, ✓ /. r /, J / ,rr ru r ;r/,rrri/� r „ ,✓!,l� r,r ,i %/ // , ////, , r //i i , / /iii .,r �(/i,,��//.,// rri //r ! /., .r„r ,/ ,✓,./ r/ ../ 0/ �,,,,.. ,,,r //.. / f 1 . ///,r,. ,,,,,..,. /„r f;r/��/i��/i/i��/r/%%r��l/��r�„l!„/ �„✓w,��r;,r„/,//,!C/!/„r/✓,1//,orGr%%�%��l��I�c4%��/,or/,r r.r,;r,, ,,ra,r/,a„rrr „r:r,,,,, ,,�„r „_. ,,,,r<�p,p,,,,,,,�.,,r„ L,Y,,:, TYPE OF IMPROVEMENT. PROPOSED USE Re ' -ntial Non- Residential ❑ New Building One family ❑Addition V(wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ii/Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic r ❑Well Floodplain;i,rr,❑Wetlands/ ;Watershed istrict ”' / / / /r/ % //%/ ❑rWater/Sewer; �� „��l �f/, y,�� DESCRIPTION OF WORK TO BE PERFORMED: C)e. ”. Identification Please Type or Print Clearly) re OWNER: Name: QPhone: '- N PAAddress: I I ////rri,r�r ,"„ r / i, rr /rr raj/%/�;!/rj�rif�/r/y�//i// �ii��i�// //i-r�,;�////r///,,.✓ // %i/i / �'' r,c / „� r a/ii// r /r ry a r r ri r /✓ i /rir/rj , � i rr r r+ / "`' ;,- •,r., ;�,,, ., i. ,, .,Y..,r //.,rr,,. l.,r., o ,:;,/,v%r rr:.e q/,/i o�j//f/.J../ /ir /,p, ,rr/% /r �/ // -. :,;,, rr,, Di /i r %0'r/ c„ /i///,,. ,, II r/ I/r'/G✓:���////i//i/ I�l,r�/r/// // / � ��i//tri//�� /,i, Ce, ./// /�i ., .✓/ o /1 /„ ,.,//..../,. „r r ,.., ,rr-: ,,, ,/rr,,,/ � ,r rr/,.,/i r:� r r, /,.., r, - ////. / r % i... �,G,,.:: r ..✓ ✓%.,, �/ � e/ r. //r.:/. / /,.. .../ r � / of,,; „ /� /�/ /r% ✓./ l/ / /„r// ,.:rr r !- r ira /ir // Cir r/ / . � // q.. / / r 1,/li,,,r i ✓v,/%,, ,,; .� ,,,, ri,,.:.. 1/<�,¢ro,�i/i/r r,,,,/✓ �:lo,; / //r// ////� //� a/i/i, ,.:.// r i/ -/ //// /,i JJD,r,:-r r ,, ;,, rrr r��`�,✓� ,, r.��,e,,, Ex Date �,. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. $ Total Project Cost: $ � FEE: e Check No.: Receipt No.: X 7e- 1 NOTE: .Persons contracting with unregistered contractors do not have access to the guaran fund Signature of Agent/Owner Signature of contractor 6 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ r-mr-91 AM t%ORT f ' town of 00 h ver, ass L^K6 COC KI C HE W.0 K BOARD OF HEALTH Food/Kitchen rERMIT T LD Septic System I.:.l..:.... THIS CERTIFIES THAT ...... �1. . ...................................................... BUILDING INSPECTOR ..... ...�...v has ermission to erect buildings on .. �� ....:�1....� �f Foundation Rough to be occupied as ......... ! : ... ..................................................................... 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 PERMITEXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO RTS 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. Massachusetts Dome Improvement Sample Contract This form satisfies all basic requirements ofthe state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard Ianguage to protect Homeowners. Seek 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 o£Consu mer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or I-888-283-3757 or on our website. Homeowner Information Contractor Information Name Compan Name - ppb C ' Street Ad&as (do not use a Posf Offiee Box addr Contractor/Salesp on/Owner Name e eb(-eC(?kA C City/rown State ip Code Business Address(must include a street address) h)r e 11P 10� �. c� Da rmePhone Evenin&Phone City/Tovm State Zip Code 7 9 71— u�n e f�C{ Mailing Address(it different from above) Business Phone Federal Employer ID or S.S.Number Ta vementConhzclorReg.Nmnlxr En#,.ndate Iaa requires thatmasthame aonnmbnvnild 2egisttnlion nomherThe Contractor agreesto do the following work for the Homeowner: f� J (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets ifnecessary.) R ��..YY .� 1 ero �� ��� �� 0V_SC Required Permits-The following building permits are required Proposed Start and Completion Schedule-The followingschedulewill and will be secured by the contractor as the homeovmer's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be �� excluded from the Guaranty Yund provisions of qe`vhen contractor will be&contracted work MGL chapter 142A.) to when contracted work will be substantially completed. a Total Contract Price and Payment Schedule The Contractor agrees to perform the work,fiunish the material and labor specified above for the total sum of 0M (*) Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) by / / or upon completion of $ by / / or upon completion of $ 000 upon completion ofthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order 1 - tomeet the completion schedule.(**) $ to be paid for NOTES:('r)Including all finance charges('A#)Iawrequires that any deposit or down-payment required by the contractor before work begins may . not exceed the greater of(a)one-third ofthe 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 expresswarranty being provided by the contractor? ❑No©Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless ofthe actions of any third party/subcontractor utilized by the contractor. The contractor fiuther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement ContractAcceptance-Upon signing,this document becomes abindiag contract under law.Unless otherwisenotedwithinthisdocument,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefullybefore signing this contract • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is imclear. • 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 of insurance"document. • Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy ofthe Consumer Guide 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 his/her 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 of thus agreement. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies ofthe contract mustbe co Acted and signed.One copy should go to the homeowner.Tho other egpy stlould be kept by the contractor. " 41 4 Homeot r' Signature ii Contrton's Sigaaturrfe Date Date DATE(MMIDDIYYYY) . � 0 CERTIFICATEF LIABILITY INSURANCE05/21/2015 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(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). PRODUCER 02025-001 NAME: pp Degnan Insurance Agency Inc MC No.Ext: (978)688-4974 A/C.No.: (978)327-6558 85 Salem Street EMAIL Lawrence,MA 01843 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: James Debrecini Family Roofing & Painting INSURER C: 2 Tanager Way INSURER D: Londonderry, NH 03053 INSURER E: INSURER 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 REDUCEDyyBY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR SWVD POLICY NUMBER MMID�/YYYF MM%DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERALLIABILITY PREMI ETORENTED $ PREMISES Ea occurrence CLAIMS-MADE [_1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'LAGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OPAGG $ OLICY ECT OC AUTOMOBILE LIABILITY - (Ea acCOMBodeDSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED ' PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ Tp TH $ WORKERSCOE@1PE�JSATL�IJ, X TORY LIMITS OER '.. AND EM1IPLOY RS' IA I T1Rl E.L.EACH ACCIDENT $ 100,000.00 MY��/ �CL�DED?/EXECUTIVE YN/A AWC-400-7025900-2016A 5/11/2015 5/11/2016 A o� Ic��PM (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 DcSCR?TION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) The workers compensation policy does not provide coverage for James Debrecini CERTIFICATE HOLDER CANCELLATION Andover Town Offices 36 Bartlett Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover,MA 01810 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE • �:.y.�y�` '�-X`-4 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public safety- Board of.Puiiding Regulations and Standards Construction supeij-isoi Speeialtt, License: CS SL-099685 JAYMs J MBREO.M •� y 2 TANAGER WAY ` � � > NONERHC395 r J M �r Il. ✓./;w Expiration Commissioner 12/06/2015 ' c C �e�pa����zaracaeall/z a�C�/l��caaa��catel�J; Office of Consumer Affairs&Business Regulation OME InAP?OVEMENT CONTRACTOR egistration: 122385 Type: xpiration: 8/26/2016 DBA J&D WEATHERSEAL.. - JAMES-DEBRECENI "I 2 TANAGER WAY LONDONDERRY,NH 03053 { Undersecretary