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HomeMy WebLinkAboutBuilding Permit # 9/18/2015 `yoRTJ1 BUILDING PERMIT °� ��LeD '6"s TOWN OF NORTHANDOVER APPLICATION FOR PLAN EXAMINATION ® _ .p eoe.n�xewicK�1• Permit No#: Date Received area PPa c5 �SSACHU5 Date Issued: I POIdTANT:Applicant must complete all items on this page LOCATION �Os' Z Print, PROPERTY OWNER /� a / iZ 724OV Print 100 Year Structure yes no MAP -w PARCEL:—ZONING DISTRICT: Historic District yes n Machine Shop Village yes n TYPE OF IMPROVEMENT PRnPtFn-,�iF ❑ New Building 11 Addition Location, � a . ' [I Alteration Alteration No, ❑ Repair, replacement � p p ' ❑ Demolition � t 331 Ca � ' ' � ol� � TOWN OF NORTH AN®®VER terli, PSGRK� Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $— en ifica TOTAL $ OWNER: Name: Address: �� ,. � C L t Check# y Contractor Name: / ✓ Building inspector Email s Address: /,�—Y Supervisor's Construction License: F-0 Exp. Date: Home Improvement License: 0 Exp. Date: - A& ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING P. MIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces o the guaranty fund *w',/Ok_ C - _ - - r'77u r - FORTH i own ot I F. -11., ndover ® - No. ver, Mass, Al [OCHICNEWICK U BOARD OF HEALTH Food/Kitchen P � RMT LD Septic System THIS CERTIFIES THAT .............O .............. . .... ................................ BUILDING INSPECTOR .................. ........ Foundation has permission to erect .......................... buildings on ........ ....... ... . . .1 ae . ............I...... Rough tobe occupied as .................... . ..-.�...... .................... ......................... l .. ................... Chimney provided that the person accepti this permit shall in every r ect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Lavas 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 ELECTRICAL INSPECTOR e UNLE SS ..I Rough Service .......... . .. ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occu,2v Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form.satisfiesall basic rGquircments ofthe state's Home Improvement Contractor Lew(MGL chapter 142A),but does not include standard language to protect homeowners, Seek legal advice If necessary. Any personplanning home iniaproveiments shotildfust obtain a copy of"a Massachusetwconsumer guide to home,improvement"before agreeing to any work on yourresrdence.You may obtain-a free copy by'calling'the ' Office of ConsumerAffairs and Business Regulation'a Consumer Information Hotline at617-973e8787 or 6888.283-3757. Homeowner Information Contractor Information Name ,.� Pant nine.., 4 Street Address(do not use a Post Office Boz contractor/ Owner NamE City/rown St& Zip Code I lusiness Address(must include a street address) . Daytime Phone EveningPhane ity/Town State Zip Code Mailing Address(It different from above) usi Phone 4ideralEmploya 10 or S.&.Ntunlier ' Lv u9uirn aulmort Lometm- Rome tCaot Waea Numbv Bxtmxtiondtle gi,uatioo amnber The Contractor agrees to do the following work for the Horteo mer,e:- I 103 Mi Lac worx rd edmpletea;specuyurg me type, now RequiredPermits-The-following building permits are required Proposed Start arid''Completien-Schedule-The following schedule will and will be secured:by the cbntractor'as the'horneowner's agent; be adhered tauriless circumstances lieyond:the contmetoes'control arise (Owners who,secure their own permits will be excluded from the.Guaranty Fuiid:provisions of /• /into when confractorwill begin contracted work MGL chapter I42A.) //f � / ate when contractEd .work will be aubstantiallycompleted.. Total Contract Price and PaymentSchedule , f/ f� The Contractor.agrees s toperform file work furnish tiro material and labor specified above for the total sum of �/i�dC P(*) Payments will be tggde according to the following schedule: upon signing contract(notto exceed 1/3 of the total.contract price,gI the cost.of special order items,whichever is greater) $ by -7—7 or upon completion of $ . y_"7=T=or upon completion of e 0 $ /V upon completion of the contract (Law forbids demanding full payment until.contract is completed to-both party.s.satisfaction) '...., The following material/equipment must be special S to be paid for_ ordered before the'conaacted'workbegins in order 5 . to be paid for to'meetflieeainpltrtionsehedule(*•) i NOTES:(*)Including all finance charges(**)Law 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 con 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 beine provided by a eontractori No Yes .lsllterms of the warranty m�ae'be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work desenbed regardless of the actions'ofany 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 aemement Contract Acceptance-'Upon signing,this document becomes a binding.contract underlaw. Unless otherwise noted within this document'the contract shall not imply that any lien or other security interestlas been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into sighing the contract Take time to read'a'nd fully understand it.'Ask'questions ifsonit thing is unclear. • Make cure the contractor has a valid Home t rovemcnt Conti- oro_„'strati,... The lax,requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about.conhactor registration by writing to the Director tit One Ashburton Place,Room 1301,Boston,MA 02108 orby_calling 617-927.3200 of 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor isproperly insured. • Know your rights and responsibilities. Read the Important Information on the efnsf ' ndgopy of the Constimerioia Guide to the Home Itrlprovement Contractor Law: You may cancel this agreement if it has been signed at a place,otherthanthe contract6es'normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the. thiid business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of.this right DO NSIG IS CONTRACT IF THERE ARE ANY BLANK SPACESW �4 idmdml pirsofthe. ct be-Tleudandsianed Ow copy should go to the homeowner.The other copy should be kept by the contractor. Homeowner's Signature ,Contractor's Si lure Date ;Date `Y mra mW � �y. TW Page# of page& CS # 022680 978-688-6737 HSC# 103358 A. J. Walsh & Suns or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted To Job Mame Job# Af Address Jab location J Date Pate of Plans t' Phone# Fax# Architect rWe hereby submit;specifications and estimates for; r, r ;, �; ,„ ?„g'`,? 1 r/..r✓' ,?`,",i ,,a�,, r,`t,. b, ,✓„a'Im „�„:✓,m�: �m ;a,✓'„ rri0��.� a ✓ ,Y� /, °1,,, c' '�” 1,q”�" m, 0 r fiat, r„ i 3 ui ,d✓ l y. !, ,o`, � !re%� d`o„ 1,'«°' n< ,V�S `i , ,lm i��l�!i,,,✓gym;''ori r�Y rr ,v,"'„ri H lr' �wmi� r r e , f�<. i' Lei� � i Vii," ✓, r%,4� �,e ✓y n d '„ f r we propose hereby f mish material n i bor —complete in accordance with the above specifications for the sum of: Dollars with payments to be made as follows: r Any alteration or deviation from above specIficalions Involving extra costs will be Respectfully executed only'upon written order,and will become an extra charge over and ''' submitted above the estimate,All agreements contingent upon strikes,accidents,or delays beyond our cuhtrol. Note—this proposal may be withdrawn by us 9 not accepted within� ,�days. acceptance Ot propos The above prices,specifications and conditions are satisfactory and are Signature " hereby accepted.You are authorized to do the work as specitied. Payments will be made as outlined above. Date of Acceptance Signature The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia sJ• Workers'Compensation Insurance Affidavit:Builders/Contractors/Eiectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LedblV Name (Business/Organization/Individual): LZ✓ � y Address: '� �' 4- City/State/Zip: /W P99- Phone#: V7f'___6 73`7 ArTyou a ployer?Check the appropriate box: Type of project(required): 1. am a employer with �.. : employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition I[J 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 ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 3. oof repairs These sub-contractors have employees and have workers'comp.insurance.t ' 14.[]Other 6.❑We are a corporation and its of kers have exercised their right of exemption per MGL G. 152,§1(4),and we have nq employees.[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 this affidavit indicating they are doing all work and then hire outside contractors must s4bmit 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-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#: 7 0 vee,' V(-fa 1 ea/4 Expiration Date: Job Site Address: �` �' JGrJ, 0/Y City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 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 certify under thepains andpenalties ofpeijuiy that the information provided above is true and correct. Signature aDate: ��%� Phone# Official use only. Do not write in this area,to he 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: 01/12/2015 14:48 4P151 P.013/016 DATE(MM/DDNYYY) mac® °TIFI T' LI ILII° I 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(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). 'RODUCER 00775-001 fiRWCT Durso&Jankowski Insurance Agency Inc NC,No.Ext: (978)682-5175 ,No,; (978)794-0313 198 Mass Ave Suite 101E ROLSS: North Andover,MA 01845 A.I.M.Mutual Insurance Company 33758 VSURED Arthur Walsh A J Walsh & Sons INSURER Q,. 55 Pleasant Street INSURER North Andover, 14A 01845 INS 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.pp ITR TYPE OF INSURANCE INDSRVep POLICY NUMBER MMIb�/YYYY Mn�O/YYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGES( a morn n $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOP AGG $ __]POLICY RO- OC AUTOMOBILE LIABILITY COMBINEDidenilSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS JPe Accidenti $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE S yypR{D:EERDg cp RETEENNTIION $ yyC g7 U H $ AND EMPl9YE 3�LIABIION Y X TORY LIIJIITS O R AN yPRo PR�ETp R/�qR7N �/EX ECUTIVE� �/N� E.L.EACH ACCIDENT $ 100,000.00 A OFEICER/MEMBEREXCLU�EO? t 1 NIA AWC-400-7014648-2014A 11/14/2014 11/14/2015 EL.DISEASE•EAEMPLOYEE $ 100,000.00 (Mandatory inPA OFNH) UTCRMZPERATIONS below E.L.DISEASE-POLICY LIMIT S 600,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) 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 C__�0� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD • Office of Consumer Affairs&Business Regulation e ~ ME IMPROVEMENT-CONTRACTOR Wegistration: 'O^'33h50`• Type: piration: Private Corporatio` A.J.WALSH&SON'J LI — I Arthur Walsh gpi 55 Pleasant St j'`f >>: N Andover,MA 01845 Undersecretary a - Massachusetts -Department of Public Safety Board•of Building Regulations and Standards Construction Supervisor License: CS-022680 '; ARTHUR J WALS, i 159A WAVERLY kD N ANDOVER M9 01 _ r , Expiration Commissioner 08/09/2016