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HomeMy WebLinkAboutBuilding Permit # 8/24/2015 BUILDING PERMIT IaoRTN a 0�,�.tL.ED I�q�O TOWN OF NORTH ANDOVER � - APPLICATION FOR PLAN EXAMINATION O TED Permit No#:t / Date Received �SSACH�1`'�R� Date Issued: 41PP-01RITANT: Applicant must complete all items on this page LOCATION - /''y W/e, PROPERTY OWNER 1�l C l� -- Print 100 Year Structure yes no MAP PARCEL: 1`7'� ZONING DISTRICT: Historic District yes po Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;I-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'm Se tc ®Y1/Vell rr Flood Mal ❑Wetlantls ❑ -h- H9 r .rc=r'❑»,. r p z'�ttrr�-r y.j` %,k' ,r,,,r r r� r:. rtf;.:: ter x ::r» ! /: �„J " �+'�� `; . '�` say' /�'�;.�:.<� r f��r � X �,.�� z ✓�.�r r`""„'rrlt�-??rs^t+r ���`� ��r����-n r,���~N��:� ��,,;��r rr rr ,_l,.r tr � ,r DESCRIPTION OF WORK TOT PERF�RMED: C / ' ✓L 06 Identification- Please Type or Print Clearly OWNER: Name: Phone:�``�° Address: CR L/ Contractor Name: ( - <� ' Phone j '72J- "6 `z7 Email: Address ' Supervisor's Construction License: ® Exp. Date: 6 Home Improvement License: / Exp. Date: f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER '$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ o- i FEE: $ z 3,y� Check No.: 3 q o � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces the g aranty fun �ORT}l n o E : A'. ndover 0 - : No. *310 20t h ver, Mass, coc.. Hl WICK 1 x.95 RATED V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THATBUILDING INSPECTOR ............kms..v�.��:....Y^Nt�C ............. .................................. has permission to erect .. ...................... buildings on . .. ....... .Q � Foundation . .. Rough tobe occupied as ....... ........... ...... ........................................................................................ chimney provided that the person accepting this p mit 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR t #38- . UNLESS CONSTRUCTION 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. Page#_of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Subm qd To: Job Name A Job Address Job Location DateDate of ns Z Phone# Architect We hereby stubmit specifications and estimates Mr- 01 4,9 C' 4 0 "?2 ine....... ("44�......... ........i 1AI -404, b7b VQbarl We propose hereby to furnish material and,labor—complew"K accordance with the above specifications for the sum of: $ Dollars with payments to be made asfollows: mr Any alteration or deviation t�bae Specifications involving extra costs will be Respectfully executed only-upon written order, and will become an extra charge over and Ikes,accidents,or delays above the estimate.AD agreements contingent upon at( submitted beyond our cohlrol. Note—this proposal may be withdrawn by 9 not accepted within—Ldays. Scaptanct of P00jagal The above prices atu he above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payments will be made as oufliqsd bove. / Date of Acceptance ILI Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary, Any personplanning hotho pprove'ro6ts should fmr8'f bbfam a copy of"a Massachusetwconsumerguide to homeimprovement"beforo agreeing to any work on yourrestdenoe.You may bbtaiina free oopy by'ealling the Office of Consumer:Affairs and Business Regulations Consumer Information Hotline at-617-9734787-or or 1+888:283-3757; Homeowner Information Contractor Information . Name L.,OmPany . )L. Strict d° (o of use a Post Offi ox_ oss) ntredo;/ n/O er Name str .IV � Ci own Ste de usiness A s(must include a street address) Da Phone EvemngPhona tY i !fawn State Code ailingAddress(It different fromabove) 3n Phmie �ederal7jftpl at orS. .Number ' LmtcQ�dm aur mon hom*im• Rome I Comngar ilea;Nm"to aarymiEmNiE -. rwvrmml contreambs"I illdmr(rtreaon mmtba' The Contractor agrees to do the following work for the Hom'eo mer: -MARTIM De Us ­.ypcjVT 0,Ran grace or *ive, Ile, RequiretiTertnits-The-following building poimits are required Proposed Start and`Completion Schedul'e-The fdlloviing scbedule will and will be secured:by the contractor as the'homeownerrs agent; be adhered tautness circumstances beyond,the contractors'control arise (Owners who,secure their own permits will be ' excluded-.from.the:Guaranty Furidprovisions of ` Date when'bontractarwill begin contracted work- MGL chapter 141A:) Date when contraetcd •work wjll besubstandilly completed.. Total Contract Price and PaymentSchedule The Contractonagrees to perform the work,famish the material and labor specified above for the total sum of: Payments will be U according to the followirtg schedule: $145 a u on.sigoing contmct(not•tb ekeeed I/3 of the totsl:contract price.gj the cost of special order hams,whichever is.greater) $ by / / or upon completion of $ by_/ / or upon completion of tf 10 l $ tJ V U, upon completion of the contract (Law forbids demanding foil payment Until Contract is completed ta•both party's satisfaction) Thefollowing meteriaUequipmentmust hespecial S to be paid for ordered before the'contraeted workhegins in order S to be paid for to rest Ria..complbtion sehedula(**) NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not,exceed the greater of(a)one-third of the total contract price or(b)the actual cost of ariy speaial.equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is as exoress.warraoty beiaeprovided by thecontracto No Yea loll r of the tverranty mu^ st be atinrhed to the conhactl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any diiid party/subcontractorudiized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and laborundcrthis agreement Contract Acceptance-Upon signing,this document becomes a btndmg contract under:law. Unless otherwise noted within this document,the contract shall not imply 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'tbe pressured into sighing the contract Take time to rmd'and fullyunderstand it'Ask'questions if eouiethihis unclear. * Make sure the contractor has a valid Home Imnrovcment Contractor Re iatr»t na The jay:requires most home improvement contractors and. subcontractors to be registered with the Director ofHomo Improvement Contractdb Registration, You may-inquire about.conitactor registration by writing to the Director itOne Ashburton Place,Room 1301,Boston,MA 02108 orby,caiBng 617-727.3200 or . 1-800.223-0933. • Does the contractor have insurance? Check to see thatyour'contm'ctor is properly insured * Know your rights and responsibilities. Read the Impottani Information on the reverse side of this'fonin'and get a'copy of the Consumer Guide to the Home Irhprovement Contractor Law: You may cancel this agreement if it has been signed at a place other..than the contmctriesnormal place of business,provided you notify the contractor in writing at his/her mein of ffoo or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the. third business day fallowing the signing of this agreement.See theattached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONT! T IF THERE ARE ANY BLANK SPACES!!! �- 4wo identical copies of the contact mart be eo�leted sn i One copy aboutd go to thehomeowaa. other cepy xbouW be kqn by the contactor. .. : _ '...... .M..resn= Contractor's Sign D- NS __� Date The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUT TING AUTHORITY. Applicant Information Please Print Le 'bl NaM0 (Business/Organization/Individual): Address: City/State/Zip: e!?Y 44Phone 73 7 Areyou an employer?Check the appropriate box: Type of project(required): 1.0 1amaemployer with /.. : employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working .for me in 8. Q 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.F1I 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.F,-]Plum ' repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.2<oof repairs These sub-contractors have employees and have workers'comp.insruance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c, 14.Q Other 152,§1(4),and we have nciprnployees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit thus affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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-contraciors have employees,'they must provide their workeis'comp.policy number. f am an employer that is providing workers'compensation insurance for•my employees.'Below is the policy and job site information. Insurance Company Name: ,w 99 Policy#or Self-ins,Lie.#: 2C/f ' - Expiration Date: —ZO _ Job Site Address: � V City/State/Zip: _ Attach a copy of the workers' compens n policy declaration page(showing the policy number and expiration dale . 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 WORD 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. I do hereby cert' under the pains an/dpennalties ofperjury that the information provided above is true and correct. Signature: `' Date: Phone# � �- 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#: From: 07/12/20-16 14:48 #161 P.013/016 ® CERTIFICATE LIABILITY I I I DATE(MM/DD/YYYY) 01/12/2015 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). 'RODUCER 00775-001 NRAEpCT Durso&Jankowski Insurance Agency Inc NC.No.Ext: (978)682-5175 A/C.No,; (978)794-0313 198 Mass Ave Suite 101B North Andover,MA 01845 Fdm'}lEss: INSUREWS)AFFORDING COVERAGE NAIC A.I.M.Mutual Insurance Company VSURED INSURER B: Arthur walsH A J Walsh & Sons 55 Pleasant Street INSURER North Andover, MA 01845 IN URER 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 yyB��Y��PAID CLAIMS. � �j� TYPE OF INSURANCE INDSR Bp POLICY NUMBER MMlDS/YYYY MW VEYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGEEE,RENTED $ CLAIMS-MADE OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'LAGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OPAGG $ OLICY RO- OC AUTOMOBILE LIABILITY COMBINEDISINGLE LIMIT(Fa acciden $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS tPer accident) $ UMBRELLALIAB HCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE S yypRKKDEEE}RD�gs CCQ°�� RETEgqTNTION 6 yyC gT 7H S AND EMPLOYERS�LpIgARBILITRY/EX X TORY LAMS OER _ A AOVXIcgRMPe�I R EXClllEW 9 ECUTIVEM7 N/A AWC-400-7014648-2014A 11/14/2014 11/14/2015 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory In NH) I—' J E.L.DISEASE.EA EMPLOYEE S 100,000.00 DYEFMIf��IOAOFebrPERATIONSbelow E.L.DISEASE-POLICY LIMIT S 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is raquired) 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 s ' rt A z��'� Vie�'omr�no�uaeccl��Cac�iic<r .•. Office of Consumer Affairs&Business Regulation e Y4, ME IMPROVEMENT.CONTRACTOR egistration: ; ''3368' Type: xpirat1on.f_�:Zg - Private Corporafip= A.J.WALSH&SOty54 Ts3 �'�� _ -� Arthur Walsh � a3 55 Pleasant St N Andover,MA 01845 Undersecretary t k Massachusetts -Department of Public Safety - Board-of Building Regulations and Standards Construction Supervisor License: CS-022680 ': e"ri.ti ARTHUR J WALS 159A WAVERLYtD N ANDOVER M9 01 • r • A. A Expiration 06/09/2016 Commissioner