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HomeMy WebLinkAboutBuilding Permit # 9/16/2015 & pORT" q BUILDING PERMIT 3?o`�f4no"6'60 TOWN OF NORTH ANDOVER --- -q APPLICATION FOR PLAN EXAMINATION Permit NO: / CDate Received Date Issued: I I �9SSAC IMPORTANT: Applicant must complete all items on this page r r rF ? r r LOrGATION��r % Pratt x t{ � MAP NO' � PARCELZONING DISTRICT Histonc District ryes no ti � r 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 Ci Well ❑ Floodplain ❑ Wetlands ❑ Ul/atershed District V1�atet/Sewer ` r u 4 A � Identification Please Type or Print Clearly) OWNER: Name: 66 LOA Phone: q7 ®OS- Address: 7N %\60V � (00 CONTRACTOR rNarne J (( r Phone7� �.. ` f"i k�i<✓f tf"rJT'.y. 9 f.k: G'✓�, r 1 (° F'°�f �:[ t r �'1,: 1 „rr f r r r?r y .r ,'"!rt n,a'�t r I v'd,'?s �;x 1 -r ■ r"' +r t J ;y adcress f rx r uperu�sorf��Construction License, Exp DateYF 7 t •� 4� r �� { t J r f '" I r 1 + s Home (mpto�emeht License Exp Date ' r 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. Total Project Cost: $ qCA , 30 FEE: $ % NP . Check No.: 1 Z Receipt No.: t2 )-z `V NOTE: Persons contracting w',h n egistered contractors do not have access to the guaranty fund Signature of Agent%Owner, ,ignature of;contractor�� I FORTH To' wn of ndover 2 E. :-•., ® .�`' 0% ® is % L^KE h ver, Mass,41 . cOC"Ic"tWICK 1' ORATED PI? V S BOARD OF HEALTH 5M Food/Kitchen PERMIT T LD Septic System t AM THIS CERTIFIES THAT BUILDING INSPECTOR ........... ............... ........... ..................... ........................... ........ ....... Foundation has permission to erect .......................... buildings on .. .................... .. ..�,...... .... !r....... ® Rough to be occupied as ................... . .. ..e... A. ... 1�il�AS. ..:.. 1%r"O S . ... ....... Chimney provided that the person accepting this permit shall in eve respect conform to the terms o thea application p p p g p � p pp Final on file in this office, and to the provisions of the Codes and By-Laws relating to a Inspection,Alteration d Construction of Buildings in the Town of North Andover. ea Rough PLUMBING INSPECTOR e VIOLATION of the Zoning or Building Regulations Voids this Permit. Final IT EXPIRES IN 6 MONS ELECTRICAL INSPECTOR LESS CONSTRUC S Rough Service .......... ...... ................... .................. 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. Donaldson Home Improvement Contract for Services 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. You may obtain a copy of the Massachusetts Consumer Guide to Home Improvement by calling the Office of Consumer Affairs and Business Regulations Consumer Information hotline at 617-973-8787• 1. HOME OWNER INFORMATION CONTRACTOR INFORMATION City Light Homes MA Home /r N S i MA Unrestricted Improvement IN'ALD� Construction 392 MdSS Ave License#177721 �,0�__ ..,�, Supervisor CS-105410 Expires 1/28/2016 .� Expires 11/30/2015 North Andover MA 01845 Donaldson Home Improvement,LLC—Emp#45-3364045 98A Billerica Ave. Billerica,MA 01862(978)502-4325 Diane Donaldson,Owner D.Todd Donaldson,Estimator,Licensee 2 Donaldson Home Improvement, LLC agrees to do the following work (*detailed in attached estimate)for the homeowner: Home Remodel including roofing, exterior work,kitchen, and garage. Proposed Start Date: io/oi/i5 Date work will be substantially completed: 3-4 months Required Permits—The following building permits are required and will be secured by Donaldson Home Improvement, LLC as the homeowner's agent: Building Permit, Siding Permit, Electrical, and Plumbing Permit. 3. Donaldson Home Improvement agrees to perform the work,furnish materials and labor specified above and in the attached documents for the total sum of. $249,738.00 Payment Schedule: $15,00o.00 due upon Contract Signing 5 Payments of$46,947.6o upon progress of work. (Initiates scheduling,permitting etc.this is a non-refundable deposit) Payment will be discussed and finalized prior to start of work. 4. The following material/equipment must be special ordered before the contracted work begins in order to meet the completion schedule. Special payment arrangements if needed noted below: Page 2 of Donaldson Home Improvement Contract for Services 5. CHANGE ORDERS Both parties acknowledge that unforeseen items may arise during the project that can impact the timeframe and cost of the project. If and when any of these items arise, it is agreed that any items requiring additional work will be addressed in writing with a representative of Donaldson Home Improvement prior to beginning said work. A customer may initiate additional work orders as well, and they will be addressed in a similar fashion. These change orders must be accepted before the work begins, or in some instances before the contracted work continues if said work impacts the completion of the project. 6. WARRANTY Warranty Terms as Follows: Donaldson Home Improvement,LLC agrees to be solely responsible for the completion of the work described regardless of the actions of any third party/subcontractor that is contracted by Donaldson Home Improvement,LLC and utilized in the scope of work of the project. Donaldson Home Improvement,LLC agrees to be solely responsible for payments to all subcontractors for materials and labor under this agreement unless otherwise negotiated prior to acceptance. (See section 4) Donaldson Home Improvement,LLC offers a One-year Express Warranty of workmanship and installation(all labor)associated with the scope of work and materials described in the project,normal wear and tear excepted. Materials and products utilized in the project are the responsibility of the individual product manufacturer/supplier. (Customer is responsible for retaining and registering all products procured for project) 7. ADDITIONAL CONSIDERATIONS Donaldson Home Improvement, LLC reserves the right to use photographs taken of our projects for use in media, advertising and web use. Donaldson Home Improvement will not use personal information or specific locations to describe the work featured in any of these areas without express written consent of disclosure. 8. CONTRACT ACCEPTANCE Upon signing,this document becomes a binding 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. Neither party should sign this document if there are any blank spaces. This contract is to be signed in DUPLICATE. One copy is to go to the customer/homeowner or business owner, the other copy to be on file at Donaldson Home Improvement,LLC. You may cancel this agreement if it has been signed provided you notify an officer of Donaldson Home Improvement,LLC in writing at his/her main office or by ordinary mail posted,byTeleram or personal delivery,not later than midnight of the third business day following the signing of this agreement, Cu tomer/ ' o eo ne Signat re: Date: ctIV Donaldson ome p vement Representative: Title / Date: G1 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 ' Rncfo — –fit?17 ,.:-= _: - __ .. .n;jl�lA 02.114� . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH T14E PERMTMNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: GNA J11� { ACG (—NV � City/State/Zip: Phone#: a 0 3 Are you an employer?Check the appropriate box: Type of project(required): I 1 am a employer with( % mployees(full and/or part-time).* New construction I am a sole proprietor or partnership and have no employees working for me in $, F1 Remodeling any capacity.[No workers'comp_insurance required.] 9. F1 Demolition 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensurethat all contractors either have workers'compensation insurance or are sole 1 I.o Electrical repairs or additions pjeprietors with no employees. 12.E]Plumbing repairs or additions 5. am a general contractor and I have(tired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6-Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.QOther 152,§1(4),and we have no employees..[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t 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 workers'comp.policy number. I am an employer that is providing workers'compensation insurance for fny employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 1 Expiration Date: (� r Job Site Address: g ARCA S VI City/State/Zip: Attach a copy of the wot kers' compensation policy declaration page(showing the policy number and expiratt'oddate). 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 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 Office of Investigations of the DIA for insurance coverage verification. I do hereby certer t airs and penalties of perjury that the information provided a ove is true and correct. Si nat .0f /VL Date: Phone#: a 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 Cleric 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ACO/tO' CERTIFICATE OF LIABILITY INSURANCE 09/10/2015DIYYYY) 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). NTA CT Paychex Insurance Agency Inc toDUCER CO PAYCHEX INSURANCE AGENCY, INC. PHONE FAX 150 SAWGRASS DRIVE EX • 877-266-6850 . 585-389-7426 ROCHESTER, NY 14620 E-MAIL Certs@paychex.com AD R INSURER(S)AFFORDING COVERAGE NAIC# SURER INSURER A: NorGUARD Insurance Company 31470 DONALDSON HOME IMPROVEMENT LLC INSURER B: 98 A BILLERICA AVE NORTH BILLERICA,MA 01862 INSURER C: INSURER D: INSURER E: INSURER F: OVERAGES 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. IR TYPE OF INSURANCE ADDLBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSR D (MM/DD/YM) (MM/DDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES E occurrence) CLAIMS-MADE[::::]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY 1=1 PROJECT=LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED SCHEDULED (Per person) $ AUTOS AUTOS ' HIRED AUTOS AUTOSWNED BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS'LIABILITY DOWC663376 03/10/2015 03/10/2016 --- E.L.EACH ACCIDENT $ 100,000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? � E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory In NH) r l N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 If yes,describe under iSCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) ERTIFICATE HOLDER CANCELLATION CITY LIGHT HOMES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 392 MASS AVE DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY NORTH ANDOVER,MA 01845 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE CORD 25(2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: PW DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE `..� 09/10/2015 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 Todd Donaldson Segreve&Hall Insur.Assoc.lnc PHONE FAX 305 North Main St. A/c No Ext):978-502-7789 A/C,No): Andover,MA 01810 E-MAIL Patrick D.Hall ADDRESS: PRODUCER TODDD-1 CUSTOMER ID#: INSURERS)AFFORDING COVERAGE NAIC# INSURED Donaldson Home Improvement LLC INSURERA:Commerce Insurance Co. 34754 98A Billerica Ave. INSURER B:Utica National Ins. Co. No.Billerica, MA 01862 INSURER C INSURER D: 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR R D POLICY NUMBER MM/DDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO`R��TE X COMMERCIAL GENERAL LIABILITY -PREMISES(Ea occur ence) $ 100,000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 5,000 B PERSONAL&ADV INJURY $ 1,000,000 A BGPYKG 06/25/2015 06/25/2016 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PEO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BGMMZH 02/15/2015 02/15/2016 BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (PERACCIDENT) X NON-OWNED AUTOS Underinsured $ 100130 Uninsured $ 100/30 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit Light Homes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 392 Mass Ave North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i » M2iS2Chusetts-Denariment of Publi Safety Board of Building Regulations and St indards con"Itrucdan SuPcr'vi%ijT '-.. Jcense:In-IONIC 'gyp 77��,pppp��77��y3��� D 7 t 01gALDS0" Sia® mmA UYS{A76 f Expiration 95Z...° q�130i�9� * Commissioner .office of Cdssnmer Af(Mn&So gnm Replation lEE llEPitOVMATt CON11 ACTOR 177721 Type: pieatioo: 912812016 Corpordtlon DONALDSON HOME IMPRbVEMPNT.IN 01. TODD DONALDSON 23 ELLIOT DRIVE LOWF-U-MA 01852 adeirsecretsry c