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HomeMy WebLinkAboutBuilding Permit # 9/14/2015 01,t%ORTIJ BUILDING PERMIT TOWN OF NORTH ANDOVER 1 0 APPLICATION FOR PLAN EXAMINATION Date Received E D Permit No#:— Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION <7,3 To k A s Print PROPERTY OWNER I 0�n Print i oo Year Structure yes no -1 Historic District yes no — MAP PARCEL: ZONING DISTRICT:— 01— Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Resi ntial 11 New Building One family 0 Industrial 0 Addition 0 Two or more family Ei Commercial [i eration No. of units: 0 Others: Repair, replacement 0 Assessory Bldg 0 Demolition LJ Other ell ❑Wetlands ❑�Watershed District g", vgg DESCRIPTION 0� Identification- Please Type or Print Clearly Phone: 97Y--6 2/6 OWNER: Name: PC,K�—r4L Address: 393 To "Sovi S+. Contractor Name: r , Phone: 978 -02-JAY7 W �- C' C Email: �-r-A s x�_i—0 LA17" Address: Supervisor's Construction License: CS— 1 0,)-6C 3 —Exp. Date: 9.L Home Improvement License: 13856c/ Exp. Date: ARCH ITECT/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. Total Project Cost: $ 17 -A30,00 FEE: Receipt No.: Check No.: (0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund inpr Town of' noover No. / , LANE hver, Mass,. ,g �A COC NIC NC W/CK 9,9 �J SATED S u BOARD OF HEALTH Food/Kitchen PERMITJ D Septic System 6 THIS CERTIFIES THAT10 ................ BUILDING INSPECTOR ................ .. . . ............................. .......................................... has permission to erect .......................... on Foundation ................. .... .. ..... . ..... ... . ........ . Rough tobe 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 p� 1A Final PERMIT EXPIRES 6 M T Ste* ELECTRICAL INSPECTOR UNLESS C ST C S S 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 Home Im rovement 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. Seek legal advice if necessary, Any person planning home improvements should first obtain a copy OVA 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 Consumer 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 t Company Name Joh e �ar�ara F0.r�tzc her W r� qct Street Address do not use a Post Office Box address) Contractor/Sales on!OwnerName 393 Tpktyon S-' SC()+ W rr; qh City(I•ovm State Zip Code Business Address(must include asfreet address) N, Andover m19 018Y5 350 Czfc St, DaytimePhone Evening Phone Cityffovm State Zip Code 9-78-- 686-a/65 Sog m F N, 14r over M A 0r9vs Mailin Address(It different from above) Business Phone Federal Employer ID or S.S.Number H<ma Tuprove.ncnt CcotracicrReg.N❑a,bs Eap alondafe zwlid uhim of nu ber / 385-69 [mprorcmcnt contractors bare �//1// J l Al/ a valid regatmtbn number 7 dGV The Contractor agrees to do the following work for the Homeowner: t (Describe in detail the work to completed,specifying the Type,brand,and grade of materials to be used,use additional sheetsifnecessarv.) 5 �� Q Shirt I.e.Gs-P_ Required Permlfs-Tbe.following building permits are required 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 contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of f S Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule �i U The Contractor agrees to perform the work,finish the material and labor specified above for the total sum of ��7 ow 0 d 0 ( ) Payments will be made according to the following schedule: $ 0.Oo upon signing contract(not to exceed 113 of the total conttxact price or the cost of special order items,whichever is greater) $ 3 8 qQ,OOby ( /�or upon completion of 1113 of f �U 6 $ 38go,00by / / or upon compleloaof 6, or iQ $ ,3 �Os Qo upon completion of the contract. (Law forbids demanding fun payment until contract is completed to both party's satisfaction) The following material/equipment must be special S to or ordered before the contracted work begins in order to meet the completion schedule.({') S to be paid for NOTES:C')Including all finance charges(11)Taw requires that any depositor 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 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 tha contractor? Yo❑'Yes(nil terms of thewarranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aereement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,die contract shall not limply 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 unclear. 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 o£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 insmance"document. ® Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Homalmprovement Contractor Law. Xou 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 inwriting at lusher main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later titan midnight ofthe third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation oftlus right. DO NOT SIGN THIS CONTRACT IF THERE ARE A1vY BLANK SPACES!! Twoide❑dealwtizecantractinustbacompl ledmilsi&ned.Om copy shouldgo to die hommi"cr.The other copy sliould be kept by ilic contmctor, Horrteowne's Signature ontractor's Signature a - v! Date Date FREE ESTIMATES PROPOSAL Construction supervisor Lic.# CS102663 FULLY INSURED H.I.C. Reg,# 138569 WMGHT ROOFING=-GUTTERS AND HOME IATPROVEAMNT All Types of Roofrmg do Gutters 350 BERRY STREET * NORTH ANDOVER, MA 01845 TELEPHONE: 978-687-2247 PROPOSAL SUBMITTEDTO PHONE DATE STREET IJOB NAME!LOCATION 9 ©k a 30v\ 117 8 - (�_b566 CITY STATE AND ZIP CODE _ JOBSTARTDATE ri ©V. VV1 A 01 �y� T)��a� re-lp cocev e-ir ; c�c. '� cQ. C Sh0W. (ea.ked 11�q 0US-0- Jue- ro kzowy snow IF i C e *kt S ectsf Wih+e;r, '900F I �,� �-�c,� aspic ( - s�.�v1jh s dn�� 4,a ( pravAc wr QnS vex` t S'KI,1� S icQ c t�jo+e. sk,k)-U Qry aU QaQes. Usiz I CQ- F vce�,Sk Idd 0"p..- ZP�4�r>z Stn � 1.0,��c� mw( v'os��r roo� W� Sky 0.d ust2v-t V'akk ,boc rds pin wr t tCQ G M01hpZJ 4-6 v-ep Lett - Woo , CkSk 8 nc�t (4, P Izcy o A o& ecw Q- v d-alk -, LLS'L t ��� V��o r b�v r�sir- �r� res"�`o� v o��' (pG01') r S 4 JG'M-15 . t�� s}� ► tom A,-c k,�4e SSI► j -t; Ikaku�, 6tok-e*�/,s yA skk/ttf s wtk riQw �&S�tVj ��'�, tx(jo r:0ve C' �Ccim4��' 5- ' /;000.00 (3050 X VV 3$00.00 (3) f.o-�c.l I r\yftL0eA Now SKY(,fie �'l.ir$ ic r I We WOPOSC hereby to fumish material and labor-complete in accordance with above specifications,fix the sum of:$ 1-74-280Q0 P ant to be made as follows- 7; ollows: "7;EO; �� c�owh �� cie s c ��(Q1�cP ohck Cotipl / g) v12 �i'hoaak rot fo `f a.kv- Car- e' exfm cost All material Is guaranteed to be as specified.All work to be completed in a substantial workmanlike d manner according to specifications submitted,per standard practices.Any alteration or deviation from Authorized above spec4ficalions involving extra costs will 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 cant'fire,tomado and other necessary insurance.Our workers are fully NOTE: This proposal may be covered by Workmen's Compensation insurance.Nonpayment by agreed party may result In litigation 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. Signal e' Csr_f—w— �' I 1 You are authorized to do three w rk as s ecified.Payment will be made as outlined. Date of Acceptance: `7 ; 1 Signature The Commonwealth of Massachusetts Department of Industrial Accidents r. r 1 Congress St'•eet,Suite Y00 Boston,MA.02114-2017 O^M SJ`V www.mass.gov/dia Workers' Compensation insurance Affidavit:Builders/Contt�actors/Electricians/Plum ers. TO BE FILED WITH THEPERMMTTINGAUTHORITY. Please Print Le •bI A licant Information QQ Uk Name(Business/Organization/Individual): �J 1 h� Address: 35 0 e-V +, _ (� ®18gS- Phone#: 9°78-��?��d � City/State/Zip: M, And 1fe,rM ,:; Are you an employer?Check the appropriate box: Type of project(required): employe (full d/or part-time).* 7. ❑New construction 1.�I am a employer with 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. F]Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.E]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 11.[]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12,[]Plumbing repairs or additions proprietors with no employees. 5.F113.[]Roof repairs I am a general contractor and T have hired the sub-contractors listed on the attached sheet. z'r O O These sub-contractors have employees and have workers'comp.insurance J 14.❑Other S 6.❑We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] xAny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submitthis affidavit indicating they aze doing all work and then hire outside contractors must submit anew 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 employe�'that isprovidingworker's'compensation insut•ancefor•my employees. Below is tltepolicy atad,job site information, // , ,9 t v Insurance Company Name: (� �. 1n r' 315-387 )87m01y Expiration Date:_W®&15__ Policy#or Self-ins.Lie.#: . Job Site Address: 2 3 ) n Sa n , V11Q1)tJ�� M A City/State/Zip: Al, �n live l f'1'1 Ol8�� age(showing the policy number and expiration date). Attach a copy of the workers' compensation policy declaration p 0.00 Failure to Secure coverage as required under MGL c.152,the form of criminal25A is a 'T'OP WOIRI�ORDER and a fine of up to $2by a fine up to 050.00 a and/or one-year imprisonment,as well as civil penalties in ement may be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this stat coverage verification. andpenal nder te fy pains ' perjuryy that the information provided above is true andcorrect Y do hereby cet•ti . n , Date: 7 �� Si nature: (it/ Phone#: official use only. Do not write in this area,to be completed by city or town official. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: A�RI:> CERTIFICATE OF LIABILITY INSURANCE DATE/� 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(les) 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). CONCT PRODUCER T A SULLIVAN INSURANCE AGENCY INC NAME: 135 MERRIMACK STPHONE FAX METHUEN, MA 01844 EMAIL A1C No ADDRESS: INSURERS AFFORDING COVERAGE MAIC 0 INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: SCOTT WRIGHT DBA WRIGHT GUTTERS INSURERC: 350 BERRY STREET INSURERD: NORTH ANDOVER MA 01845 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 25682752 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. ILS TYPE OF INSURANCE ADDL S R POLICY NUMBER POLICY EFF MMIDOMW EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ MAGE TO CLAIMS-MADE D OCCUR REMISES EaEoccurrence $ MED EXP(Any one person) s PERSONAL&AOV INJURY S GEN%AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑JEtT FILOC PRODUCTS-COMPIOPAGG $ OTHER: BINED S AUTOMOBILE LIABILITY EO ccident) G LIMIT S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEbULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOS P NON-OVMEO UT SVMEO PROPERTY DAMAGE 5 Pere dant S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCE55 LIAB CLAIMS-MADE AGGREGATE $ DEO I I RETENTIONS S A WORKERS COMPENSATION WC5-31S 387187-014 9/30/2014 9/30/2015 ST EA ER" AND EMPLOYERS'LIABILITY YIN100000 TI ANY PROPRIFTORMARTNER(EXECUVE NIA E.L.EACH ACCIDENT $ OFFICER/MFMOFR EXCLUDED? Q E.L.DISEASE-EA EMPLOYEE S 100000 (Mandatory in NH) " ee,dela be under E.L.DISEASE-POLICY LIMIT 5 500000 D CRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) THE VFORKERS'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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE / own of Atdove r THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. f t AUTHORIZED REPRESENTATIVE ML LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD 25682752 1 1-387187 1 14-15 WC 1 shankar.gadalealibertymutual.com 1 7/22/2015 11:28:27 AM (PDT) I Page 1 of 1 Office of Consumer Affairs&Business Regulation 'AOME IMPROVEMENT CONTRACTOR 00 L�_tegistration: •'138569 Type: 1?' .yam;.: Expiration: 4/14/2017 DBA WRIGHT GUTTERS SCOTT WRIGHT 350 BERRY ST. NO.ANDOVER, MA 01845 Undersecretary 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 valid without gnature Massachusetts Department of pubhc Safety Board of BuUcling Regulations and Standards License: CS-102663 IM/1161)"M C onstruchon ui ervisor /,SCOTT W WRIGHT J360 BERRY ST ��'� iNORTH ANDOVER M ,�, r-1 `-�`�-- f:xpiratiow Conmiss,loner 08/12/2017 ------------ Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS