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Home My WebLink AboutBuilding Permit # 8/17/2015 t%0RT#q BUILDING PERMIT F.D TOWN OF NORTH ANDOVER 10 APPLICATION FOR PLAN EXAMINATION % Permit No#: Date Received Argo S C US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure y --ne-,mat, MAP 00�1� PARCEL. ZONING DISTRICT: Historic District es yes W Machine Shop Village yes w . TYPE OF IMPROVEMENT PROPOSED USE Re ide tial Non- Residential 0 New Building One family 11 Addition 0 Two or more family El Industrial 11 Alteration No. of units: 11 Commercial WRepair, replacement [I Assessory Bldg 11 Others: D Demolition El Other rf I VZ, DESCRIPTION OF WORK TO BE PERFORMED: Identi icatioA- Please Type�or Print Clearly -7 OWNER: Name: Phone: Address: 14 e L:7 / -_3 Contractor Name: LC/ Phone: 17, Email: (IC t// e Address: 76 Supervisor's Construction License: Lt 7 Exp. Date: Home improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINGPEI�WT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3�5, ecr FEE: $ Check No.: 1,509 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarontyfund own ofAnc'lover 2 IE 0 ® aLoq 20, ._ h &t ri �6 �® LAKE Vel' Mass.� coc"Ic"tWICx a. � . S � BOARD OF HEALTH M 10 Food/Kitchen P ,6= R I Lai Septic System THIS CERTIFIES THAT �,., BUILDING INSPECTOR .................... ..... ........ ....... ............... ... .............................. .. .. ... ..... has permission to erect ........ ...... buildings on ... �. QGQ,. Foundation ........... .. .. ....... ........ . A......................... ® ......................................... Rough to be occupied as .....Iv. ..... 61 ....... .. .......... ...........A.4!� ..... Chimney provided that the person accepting his 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 PERMIT MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service .................. .. ...... :: zr;:-: ................................... 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. REMODELING AGREEMENT Independently Owned and Operated Business: DPG Home Improvements LLC. 28 W.Wyoming Ave.Melrose,MA 02176 tJl t l' D Ph:781-620-2679 THIS CONTRACT is made this day of ' < 20 / aL by and between DPG Home Improvements LLC., (hereinafter referred to as"Seller")and the parties as olloWs hereinafter referred to as'Buyer"): Customer(Buyer): Phone 1: Email: f21�JG> rJ Phone 2: 21 Install Address: 212 / 16_ f AM Bill Address: IJ,r"j; � Seller agrees to sell,and the buyer agrees to buy,all those materials and labor necessary to install the same as set forth in the following Specifications and in accordance with the Terms and Conditions below: SPECIFICATIONS Color Grid No. QTY Window TYPE INT EXT Glazing PKG OBS TEMP Pattern Other Instructions: 79111 1pgm w Total Price: � � �f� Down Payment:$ /l Silty ey Unpaid Balance:$ 1.This price reflects all trade-ins,specials and discounts.All consumer financing is subject to credit approval and existing interest rates with approved lending institution. 2. Buyer is responsible to remove and replace any existing window treatments,blinds,alarm systems,as well as the associated hardware as required for installation unless otherwise noted in this agreement. 3. For owners with homes built before 1978,customer acknowledges receipt of EPA"Renovate Right"booklet. INITIAL: 4. Final Payment(any unpaid balance)MUST BE MADE UPON INSTALLATION. If additional work is required as part of the installation, a change order with associated costs will be presented by your installer. 5. Buyer may cancel this transaction at any time prior to midnight of the 3rd business day from the date of this transaction. Notice of cancellation must be received in writing within 24hrs,following the 3rd business day. INITIAL: y �( 6. Buyer acknowledges that all warranties and representations contained herein are between Buyer and Seller.Further,buyer acknowledges (/ that Seller alone is responsible for the installation,craftsmanship and any field service warranties presented with this agreement. I(WE)HEREBYAGREE TO THE TERMS AND CONDITIONS OF THIS REMODELING CONTRACT. Customer / / Customer Signature: !��(�t1 �� t�� PRINT NAME: The Commonwealth of Massachusetts Department of IndlustrialAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Sy;V�t www mass.gov/dna Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTIIORITY- Applicant Information / /Please Print Le 'bl Name(Business/Or�anization/7ndividual): �" Address: City/State/Zip: �✓CzS L)a_/7,6 Phone#: (Pa 7 �117"3 x �— Are you an employer?Check&e appropriate box: Type of project(xequired): 1.Flam a employer with employees(full and/or part time).' 7. ❑Now construction 2.41 am a sole proprietor or partnership and have no employees Working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. Demolition 3_F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 10 [_]Building addition 4.❑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. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insnuance.t 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c• 14.El Other 152,§1(4),and we have no employecs.[No workers'comp,insurance required.] kAny 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. if the sub-contractors have employees,They must provide their workeis'comp.policy number. X am an employer that is pi o'viding workers'compensation insurance for my employees.'Below is the policy and joh site information. /� f Insurance Company Name: /��a� ��✓/' ` ' � S�� rJC L Policy#or Self-ins.Lic.#: A&L— Expiration Date: �J �6j(1 Job Site Address: 71115 GU/�C� � N City/State/Zip: 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 o.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 th e violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby c/er ify under /tlie ai andpenalties ofperjuiy that the information p�'d ed oho e is ttrrue and correct. Dat Phone Official use only. Do not write in this area,to he completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: _ _--_--------........_._..._._..._......... 1 TI r T - LIABILITY INSURANCE DATE(MA7IDD YYYY) 6 g 1s 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. ff the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions ofthe 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 CONTAC NAME: �Tame3 G. Beaulieu Paul T Murphy Insurance Agency PHONE (781 321-9700 FTX N : (781) 324-4253 628 Broadway Rt 99 ADDRESS: 'limmy@;>tminsurance.com Malden, MA 02148 INSURER(S)AFFORDING COVERAGE NAICY INSURER A.perch INSURED INSURER B. APG Home Improvement LLC INSURER C: 28 W. Wyoming Ave INSURERD: Melrose, MA 02176 INSURER E: 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 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. INSR ADDLSUBR POLIOyyEFF PO—o ff—y M LIMTS LTR TYPEOFINSURANCE S POLICY NUMBER MiDDN MMIDDIYYW A 65NERALLIASILITY Y AGLOO13747-01 5/28/iS 5/28/36 EACHoccuRRENCE $ l'000"000 000 A00 X COMMERCIAL GENERAL LIABILITY PREMISO DAMAGET occurrenc $ 100,000 CLAIMS-MADE FX1 OCCUR MED EXP(Anyone person) $ 10,000 PERSONAL&ADViNJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUC(S-COMPIOPAGG $ 2 OOO 000 POLICY , LOC $ AUTOMOBILE LIABILITY CO acoldeeDnlSINGLELIMIT $ ANYAUTO BODILY INJURY(Per poison) $ ALLOWhED SCHEDULED BODILY INJURY(Par accident) $ AUTOS AUTOS TNON-OWNED PROPEfiTY DM6AGE $ HIRED AUTOS _AUTOS eracrident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTB- AND EMPLOYERS'LIABILITY ANY PROPRIETORlPARTNERIEXECUTIVE Y� NIA E.L.EACHACCICENI' OFFICERIMEMBER EXCLUDED? E (Mandatory in NH) L.DISEASE-EA EMPLOYE S tfYYes describe under DRIPTiONOFOPERATIONSbelow E,LIONSbelow _DISEASE-POLICY LIMIT $ ES+ DESCRIPTION OF OPERATIONS/LOCATIONSIVEICLES(Attach ACORD 10i,Additional Rorraft Schedule,[I'More space Is requlmd) Window and Siding Contractor. Policy terms,conditions and exclusions apply Decroteau Brothers Realty, Inc is scheduled as Additional Insured per form CG 2011 01 96. Form Attached. CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE L BE DELIVERED IN Decroteau Brothers Realty Inc ACCORDANCE WITH THE POLIC-PRO sl 28 West Wyoming Ave Melrose, MA. 02176 AUTHORIZED S 1989.201 D _ RAT r% hts seiVed_ ACORD 25(2010(05) The ACORD name an erect marks o Phone: Fax: E-Mail: dennll@yahoo.com ��e tpa�u»zo�zraeall�a�-C/�Cavrclrr. Office of Consumer Affairs&Business Regularttionat ME IMPROVEMENT CONTRACTOR egistration: 179900 Type: xpiration:-_,.9/22/2016.. LLC DPG HOME IMPROVE-MENTLLC .:- DENNIS GRYNKIEIMCZ`i 28 W WYOMING AVE. 4 MELROSE,MA 02176 - _ Undersecretary artment of Public Safet`/ Regulations and Standards Massachusetts Dep d of Building Boat N1,;( c"nstruct",CS 07667 License: p ,NNts GRY 73 URC"ARD 0,1146 Cambridge N� 06111/2017 C,fnm�ssjoner r THECOMMONWEALIr1 Or MASSAE;IIus>✓I IN EXECUTIVL OF1:1CL-'OF LABOR AND WORKFORCE DEVELONMEN'I DEPARTMENT OF LABOR STANDARDS 19 STAIIFORD STREET,BOSTON,MASSACILUSETI-S 02114 LEAD-SAFE RENOVATION CON'T'RACTOR LICENSE DPG HOME IMPROVEMENT LLC 28 W.WYOMING AVE MELROSE MA 02176 LICENSE: LROO1825 EXPIRES: Monday,Ma),20,2019 IN ACCORDANCE 1NTITH M.G.L.C. I 11, 5 19713(6)AND 454 CMR 22.04,THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENGAGING IN LEAD-SAFE RENOVATION AND/OR MODERATE-RISK DELEADING WORK. i THIS LICENSE IS VALID FOR A PERIOD OF FIVE(5)YEARS. i THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M"G.L. C. I I L § 19713(6)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION AND/OR MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT PERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR,WHO HAS TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR22.00,TO OVERSEE THE WORK. IEATHER E.Rowi-,DIRL'CTOR Please detach this mailing tab and keep your license certificate in an accessible location.A copy of this license must be maintained at each worksite. .'DPG HOME IMPROVEMENT LLC I23 W"WYOMING AVE MELROSE,MA 02176