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Home My WebLink AboutBuilding Permit # 9/9/2015 BUILDING PERMIT o� IaoRro-� 1 � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® Permit No#: Date Received ZEo"Pe" �y �SS ic"usEc Date Issued: IMPORTANT: Applicant ust complete all items on this page 1 , LOCATION Print PROPERTY OWNER f�(>J L-15 fk Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed Distract D„Water,�Sewer f r DESC PTION OF W RK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: cl_7S{ Email: Address: Supervisor's Construction License: U-1 Exp. Date: 1,39--1tp Home Improvement License: Exp. Date: � � �(� ARCHITECT/ENGINEER 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. tal Project Cost: $ �t'� (;� FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the go u ranty fund A�- - t%®RTH 'Town of . s_En.dover ® K' 0 r y T Q LAKE h ver, ass, COC KIC Kl WIC 1' �•9 �R^TE V 0"4��5 S U BOARD OF HEALTH Food/Kitchen PERMIT U Septic System THIS CERTIFIES THAT ....'........'I . .. .�1 ......... .V. .. !. ............................... BUILDING INSPECTOR .. buildings On ,. Foundation has permission to erect....................... g .�(,�lfl ..�.`.�....�!�+!!!��..... g ® Rou h Fyb.!q to be occupied as .. .... .. ..�"'.'.'.'�.. ... ��.!`.......t'.......��!.: 1V6.%........ 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 53. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC 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. Back River v 231 North End Boulevard Salisbury, MA 01952 (973) 352-3733 CONTRACT To: Walter Radulski Date: September 8, 2015 Re: Exterior repairs to residence at 100 Phillips Common N. Andover, MA Scope of services Back River Development will be responsible for the following: - Front door o Remove and dispose of existing front door o Install new door with interior and exterior trim o Prep area around door for painting - Exterior siding and trim o Remove and replace approximately 15-20 pieces of siding and trim - Rails o Install 3 new 36" Transform rail system o Install 5"posts throughout with base and cap TOTAL COST $ 4,400.00 Terms and Conditions 1. Contractor agrees to furnish all necessary labor, materials, tools and equipment to complete the work outlined in the scope of services. 2. Contractor shall provide copies of a valid builder's license and proof of liability and workers' compensation insurance prior to commencement of any work. 3. Contractor agrees to complete the Scope of Services in a timely, professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. 4. Contractor agrees to clean all debris from construction only and to keep job site in a clean and workable condition at all times 5. Homeowner shall be responsible for any costs occurring from engineering or architectural plans and site work and any costs incurred from permitting, zoning board of appeals, planning or DEP. 6. Any costs incurred from hazardous materials found during construction are the responsibility of the homeowner 7. Homeowner is responsible for contacting utility companies for disconnect and new hook ups, cable,telephone,gas and electric and any costs that results from these services. 8. Manufacturers' warranties will be turned over to the homeowner and become the homeowner's responsibility to file and pursue any defects or problems that may occur. 9. Any materials, products, or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner 10. Homeowner is responsible for any price increase in materials prior to signing of contract 11. Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices PAYMENT SCHEDULE The payment for the contract will be as follows 50% upon execution of contract 2,200.00 50% upon completion of project 2,200.00 Walter Radulski, Homeowner William J. F rris, Back River Development The Commonwealth ofMowsachusetts „ . Department of IndlustriarlAceldents M X Congress Street,Suite 10 0 e _ ad ' Boston,MA 02114-2017 Vit www.mass.gov/dia. 5y Workers'Compensation Insurance Affidavit:Builders/Confractoxs/Electricians/i'X�ambevs. TO BE TILED�'TH THG PERMITTING AUTHORITY. A 1zcantlnformation Please Print Le2b Nalrla(,Business/organizationlab idual). � VV" .Address: t� City/state/zip: a='✓ 11A_ ,12-: Phone Areyou an employer?ChecktEe appropriate box: Type Of project()Vequired): e l.KJIam.aamployerwith_ Q, .—Omployees(fulland/Orpalttime).% 7. New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in &. F1 Remo delixig any capacity.[No workers'comp.insurance required.] 9. El Demolition 3..E]I am a homeowner doing all work:myself[No workers'comp.insurance required.]t 10 Q Building addition 4-[]f am a homeowner aadwill be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or aro sole 11.❑Electrical repairs or additions proprietors with no employees. 1i Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repasts Theses ha4e employees and have workers'comp.instuance, 6.❑we area corporation and its officers have exerclsed their right of exemption per MGh e. 14.❑Other 152,§1(4),andwehaveuo.empl', cs.[Noworkers'comp.insurancerequired.] hAny applicantthat checks box#1 must also£ill out the section below showingtheirworkers'compensationpolicy information. Homeowners wfio submit this affidavit indicating they are doing all work andthen hire outside contractors must submit a new aff"rdavit indicating such. ?Confractors that check flus box musE•attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthesub-con�ractorshaveemployees,�tieymnsfprovidetheirworkers'comp.policynumber.' ' A'am an employer that bpi'ovidingworkers compensation insur'aneefor my employees.' Below is thepolicy andjob site information. Insurance Company Name: �yti� o l{ �✓k '�6�` Policy#or S elf ins.LiG.#: �/" �r 1 n '� �� —t� Expiration Date: t� Q. Job Site Address: �V D ��t•� (�`m ��^^`� �� City/State/Zip: Attach.a copy of the workers'compepsat nio 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 the violator.A copy of this statement may be forwarded to the Offtce of Investigations of the DIA for insurance coverage verification. X do hereby certify under thepains andpenarties ofperj�uiy that the in fovrnationprovided above is true and correct. Signature: Date: Phone#: Official use only. )o not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.BuildingDepartm.ent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 ® DATE(MM/DD[YYY) ,4coR® CERTIFICATE OF LIABILITY INSURANCE 9/1/2015 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 CONTACT NAME: M P ROBERTS INS AGCY INC PHONE (g78) 683-8073 a A/C No Ext C ND;(978) 683-3147 1060 Osgood Street ADORIESS:Paula@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# pip INSURER A:MERCHANTS INSURANCE GROUP INSURED BACKRIVER DEVELOPMENT, LLC. INSURER B 231 NORTH END BLVD INSURER C: SALISBURY, MA 01952 INSURER D:ASSOCIATED EMPLOYERS INS CO 978-852-3733-Bill INSURER E 978-804-9383-Brian 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,000 X PRIMARY & BOPI080037 06/20/15 06/20/16 MED EXP(Any one person) $ 5,000 A NON-CONTRIBUTORY Y PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY x I JECT L—I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 F-1 OTHER: $ '.... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO OWN BOPI080037 06/20/15 06/20/16 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ A AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN WCC50050142202015A 01/12/15 01/12/16 E.L.EACH ACCIDENT $ 500,000 '.... D OFFICERIMEMBER EXCLUDED? F-1N/A '., (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION WALTER RADULSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 PHILLIPS COMMON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACOR COR ORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD 11M Massachusetts -Department of Public Safety Board of Building Regulations and Standards License: CS-065.005 BRIAN A LYNCH—` WO 31 SEVEN STAR.RD GROVELAND WA 0183 r Expiration Commissioner 11/15/2015 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza=Suite 5170. . Boston,MA 02116 Not val' wit ou ' affire 1