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HomeMy WebLinkAboutBuilding Permit # 9/16/2015 ............ ...... BUILDING PERMIT TOWN OF NORTH ANDOVER 7LNAPPLICATION FOR PLAN EXAMINATION Permit NO: Date Received, 1 Date Issued: IMPORTANT: Applicant must complete all items on this page "ma 11 a REIMAN- 3 rrr mg TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 5t One family 11 Addition 11 Two or more family [I Industrial 11 Alteration No. of units: El Commercial )(Repair, replacement 11 Assessory Bldg 11 Others: El Demolition El Other "Watershed u2Anw�-- jilz Q,_.0 r-; ._& tr A Identification Please Type or Print Clearly) OWNER: Name: -MAY zufy Phone: 7qv -Zq2_/ Address: L A A 4 Jffi, O'lK p"s/// 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 F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: 0/-19"'7c- NOTE: Persons contracting with unregistered contractors do not have access to th aranlyfund n 0 Agent/ tkoRTFj Cb'V d xj . N "L ® _ ]� h 954 LAKE ver,ver®® ass • T Q - COCKICKEW.CK V AERATED p'g�,��y S U BOARD OF HEALTH Food/Kitchen PER M I L 1111111f Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ....................... ... ..... ...... .. ............ ............ ... has permission to erect ........ ................. buildings on Foundation Rough tobe occupied as ........... .. .....4P......... ....re-COF.......................................................................................... Chimney provided that the person accepting this permi 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 . UNLESS CONSTRUCTIO T kIS4 .................................... Rough Service ................. ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough 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. National Management Team Inc. This form satisfies all basic requirements of the state's Home Improvement Contractor Law(hIGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planting home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Itnprovement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs slid Business Regulation's Consuner Inforniation Hodune at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Nance CompanyNanne r / ll Le Street Address(do not use o Pbst Office Box address) Conhactor,'Salespersott!Ottiner Naiiie oo 011 CityTomi State Zip Code Business Address(must include n sheet address) Daythue Pb rte Evening Phone CitvToun State Zip Code 7 , 47-70 Z Mailing A (It d i ffeAtut from above) Business PApue Federal Employer ID or S.S.Ntmtber ~ 0 - Home inT w.1 m Coutactor Rea.Numlxr Explrodon date t'Q Lorcrequhrs tial most home y.y improremeut eoutrattoas hatY 6j- ^ a vaad ngt,teaU..mm.htr � V� � // H t-- The Contractor agrees to do the following work for the Homeowner: 13 t66 O 00 00 (Describe in detail the work to completed,specifying the qpe,bland,and grade of materials to be used,use ndditional sheets if necessary.) 01 z o � � rf�-l� �� /t.(:��JI�' �o✓ iti9���f��e✓� .—t�/;J�r?��— C� tr"'"-� ®,� W PQ �, f t'�`-�•c�� �ytCra c�? eiat Greet SCS. � �'?� C r. Q p Required Permits-The follow-hng building permits are required Proposed Start and Completion Schedule-Tlne following schedule will f Q( ;�.'A, and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond the contractors control arise Z a kn (Owners who secure their own permits will be ��t y t— excluded from the Guaranty Fund proYisions of �-Date when contractor will begin contracted work. t� ooMGL chapter 142A.) 00 PCsGkt Date when contracted work will be substantially completed. Z Total Contract Price and Payment Schedule Q The Contractor agrees to perform the work,furnish the material and labor specified above for the total sunt ofiz (+) Payments will be made according to the following schedule: $ ,Do U upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order iters,whicliever is greater) S by /_! or upon completion of $ by_/ /_ or upon completion of S upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following materint/equipmeut must be special $ to be paid for ordered before the contracted wort:begins in order to meet the completion schedule.(") S to be pnid for NOTES:(")Including all finance charges("")Lnw requires that arty 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 any special equipment or custom made material which must be special ordered in advance to meet the completion schedule.tit Express warranty-Is an exoress warranty belna Provided by the contractor? No El Yes(all terms of the warranty must be a(Inched to the contradl Subcontractors-The contractor agrees to be solely responsible for completion of die work described regardless.of the actions of any third party/subcontractor utilized by the.contractor. Tlne contractor thriller agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement 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. • Don't be pressured into signing the contract.Take tune to read and fully understand it.Ask questions if something is unclear. • Make sure the contractor has a valid Home Inturovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of 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 die contractor have insurance?Ask the Contractor for his imsurmce company information so that you can confine coverage,or ask to see a copy of a`•proof of insurance•'document. • Know your rights acid responsibilities. Read the Important Information on the reverse side of this fornt and get a copy of the Consumer Guide to the Home hnprovement Contractor Law', v You may cancel this agreement if it has been signed at a place other than the contractors nomral place of business,provided you notify lite contractor in writing at his/lher main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than nridnight of the third business day following tine signing of this agreement. See die attached notice of caucellati font for an explana' his right. DO NOT SIGN THIS CONTRACT IF THERE ARE BLANK ACES !! V Tiro i enticnt copies of dee coutmct must ba completed sad sinned One copy should go to the bona he other coppsh d be kept by the !tractor. r Honheov Sgnature ontrae 's Signature UN Date Date / Contractor Arbitration The Home hnprovenient Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute lie/sire has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consgincr sliall be required to submit to such arbitration as provided In Massachusetts General Ladispute '1 Homeown r ignature. ahu NOTICE:Th signatur s f the parties above apply only to the agre to alternative;where te resolution initiated by the contractor. The homeowner may initiate asolution even this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home huprovernent Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their otvn building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts cant'an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fiilly executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/lierself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiends from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.eov/ocabr/ If you want to verify the registration of a contractor;or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at litro://www.mass.eov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: litti)://db.state.ma.tis/lioineimproveineiit/liceiiseelist asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Veisiou 2.1-11/22/2010 The Commonwealth'ofltlassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual Address: SQ Ci /State/Zi �A/ t3' P� A /_�v 5�Phone#: r 70 Are you an employer?Check the appropriate box: 1. am a employer with- /0 4. ❑ I am a general contractor and It:T of projects required): employees(full and/or part time)* have hired the sub-contractors New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shin and_have-no-employees- These-sn-1 --contactors-have- _g.❑ljemolitson --- _.___ wor g one m an ca act :--1 a an - ave_workers ---- ____.. ...... .:: . ..:........ [No workers' comp,insuranceCOm .~ p • menranCe. .' dnrg-addltrnn---•--__.__..----..... _. -,required.] .. 5, ❑ We are a.corporation-and.its*. 10.❑Mectricalrepairs or additions 3..❑ I am a homedw"ne'r doing all work officers have exercised their l is ' Plumbin r'' ❑ g epairs:or additions myself,'[No workers' comp. right of exemption per MGL repairs insurance required,]t c.152, 12. §1(4),andwehave no [Ooof eP-• employees.[No workers' 13.❑Other comp.insurance required,] *Arty applicant that checks box#1 must also 511 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 wodmm,comp,policy number. j am an employer that is providing workers'-compensation insurance formy employees. Below is thepolicy and job site information. Insurance Company Name:_ ��'l(l /-�,�A -f/, A-1 Policy#or Self-ins.Lie.#:_ r (; / ,�j _ Expiration Date: Job Site Address• ff'� City/StateMp:-N�I✓�C �yl/���/ - 0/ S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure Coverage as required under Section 25A of MOL,c. 152 can lead to the'imposition of criminal penalties of a fine.up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK bRDER and a fine of up to$2_50.00 a day against the viola= r..Be advised that a cppy of this statement may be forwarded to the Office of Inv ti ions o the D — --- -----_ - _ I.....­......­_. �for inenran '..overage verification=. ..... .. Ido hereby certt&under the pa nd enalties of perju,-Y that the information provided above is true and correct: Si ature• • Date• Phone 7 Is v Official use only. Do not write in this are , o be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Bqard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 6.Other 5.Plumbing Inspector Contact Person: Phone#• '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM0/1. YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 15 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 Circle Business Ins. Agcy, Inc PHONE 247 Newbury Street 978 777-5619 A/X Ne; (978) 777-4898 EMAIL Danvers, MA 01923 ADDRESS: INSURE S AFFORDING COVERAGE NAIC# INSURED INSURER A:Hartford Underwriters Ins. Co. National Management Team Inc. INSURERB:Main Street America 2 Austin Square INSURERC:Torus National Insurance Co. Lynn, MA 01905 INSURER D:Merrimack Mutual Insurance 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 LTR TYPE OF INSURANCE POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MMIDDIY MOUC/Do/YEXP LIMTS $ GENERAL LIABILITY Y Y MPT7965M 2/24/15 2/24/16 EACH OCCURRENCE g 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED occurrence) $ 5OOOOO CLAIMS MADE a OCCUR PR MISE5 MED EXP(Anyone person) $ 10,000 PERSONALBADViNJURY $ 1 OOO OOO GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APP LIES PER POLICY X PRO-T 171LOC PRODUCTS-COMP/OPAGG $ 2,000,000 AUTOMOBILE LIABILITY $ $ Y Y MPT7965M 2/24/15 2/24/16 COMBINED SINGLE LIMIT Eaaccider# $ 1,000,000 ANY AUTO ALLOWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS X HIREDAUTOS NON-OWNED BODILY INJURY(Per accident) $ }[ AUTOS PROPERTY DAMAGE $ (Peraccident) C X UMBRELLALIABFCLA�IMS.MADE OOCUR Y Y 85824I14OALI 2/26/15 2/26/16 EXCESSLIAB EACH OCCURRENCE $ S,000 OOO AGGREGATE $ 5,000,000 DED RETENTION$ A WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY UB2E71937-6 2/21/15 2/21/16 X WRy CSTATU-IMIIS 0TH- OFFICERIMEANY MBREXCLUDED?E� 7 NIA E.L.EACHACODENT $ 11000,000 (Mandatory In ME.L.DISEASE-EA EMPLOYE $ 1,000,000 es describe under ndS6RIPTION OF OPERATIONS below D Rental Equipment cover IMC8-454-711 5/21/15 5/21/16 E.L.DISEASE-POLICY LIMIT $ 1,000,000 Limit 100,000 REPLACEMENT COST Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is requi red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Janet Nichols ©1988=2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: d Office of Consumer Affa* s0 B usmessegulation . 10 Park Plaza - Suite 5170 Boston, Ma sachusetts 02116 ' Home Improveeen,t C ractor Registration 4 g I Registration: 178186 Type: Supplement Card z w NATIONAL MANAGEMENT TEAMExpiration: 3/24/2016 GEORGE �I GEORGE VASILIADES �� , 2 AUSTIN SQUARE a� LYNN, MA 01905 Update Address and return card.Mark reason for change. SCA 1 �, 2OM-05/11 // Address [] Renewal El Employment Lost Card �/l7� (Q0777/yl?.O�It.G!/ O��LtOI'Lt[6P. *ExpI ice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROV J.ENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistratio.• � Type: do: r. , . 10 Park Plaza-Suite 5170 T Supplement Card Boston,MA 02116 NATIONAL MAN A x NC. i GEORGE VASILIA _ P.O.BOX 365 @;y 1 Massachusetts_Departm Board oent df Public Safety gaitdin Building Regulatidns and standards �0fruetton•Supexvisbr I I 4 License: d8D146 3 I 0ZtG YASM •''•,' �s�5 i 5 ��ob38 r f commissioner Expiration ,IA { t