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HomeMy WebLinkAboutBuilding Permit # 9/21/2015 r BUILDINGPERMIT �o�Ta� O Krtteo � TO NORTH OV �� gb APPLICATION FOR PLAN EXAMINATION x f h � AW Date Received ��RAaR""``"•�Pp"^5 Permit No#: °'`�° Sqr�o a R AC Us Date Issued: „ IM RTANT: Applicant must complete all items on this page LOCATION . L)6wl- I/ Print PROPERTY OWNER r <-- Print 100 Year Structure yes no MAP PARCEL-, " "' ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [I One family El Addition El Two or more family 11 Industrial ,❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other 11 � /I / ,/ ., a ds:f! //// ,, ❑ /, /, r , 0, . /, /, , aod Ian �❑ /i /,. r / r DESCRIPTION OF WORK TO BE PERFORMED: Iden ca 'on- lease Type or Print Clearly ar OWNER: Name:,:3V Phone: 60-?-yff: 06 Address: Contractor Name: tPt 0, acle Phone: 27JI . Email: <Lv /t)( Address: Supervisor's Construction License: Exp. Date: 43 dAD _ 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. Total Project Cost: $ FEE: $ °No.:t Recei �, Check No.: p - NOTE: Persons contracting with unregistered contractors do not have access to IiF g a ty fund ry t%O R'TH over UW11 Uf n u" ® No. G1., )AI Y �O LAKE h ver' aSS' COCNICMEW.CK A0RATE O p'P¢,��� S V BOARD OF HEALTH Food/Kitchen PtRMIT T nor Septic System THIS CERTIFIES THAT , .. ........ q,I;�C.U ., ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR has permission to erect .............. buildings ... 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 Final EXPIRESPERMIT 0 THS ELECTRICAL INSPECTOR UNLESS TIO RTS Rough Service I.... . ..... ..... ..... ... .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz 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. a I 431T' ::::T; 21;e'—;' 13'- 12r, �W27'36 55"–W2�38 WE 6R . _ .� F � "FBF i � I tary�f ��,I� +r7u� P ��•��e��,IGIi I'tl; I � ���3 �i [".�d -;�- {p moa ,r� M I ��0���°w s �� 35 � M •. ae -.._.......:' Gam (<a5r� CP V-6\g N N :Z7 .._..._............... — 1�...... - i a N I 0 o O a a 5 O I E2 a a o .. _.... ......... r' .,90 U369024RT 5WD.4 PPkINGf*JGMS 30 ,0'PW4RTWTC ' o R G' m W361824 === __.�._.�. '.... � -:�- JSA Companies Home Improvement Contract This form satisfies all basic requirements for Massachusetts'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 of"A 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 617-9738787 or 1- 888-283-3757. Home Owner Information JSA Companies Information Name: JSA Companies Joe Sabella Street Address: Owner:Jeff Agnew 8 Alcott Way City/Town State Zip Code 55 Chase St. North Andover MA 01845 Day Time Phone Evening Phone Methuen, MA 01844 (603)498-2606 Mailing address if different from above (978)375-8041 Additional Licensing Information(may differ depending upon scope of work) JSA Companies agrees to do the following work for the homeowner: (additional pages may be attached as necessary) Required Permits—The following building Proposed Stated and Completion Schedule— permits are required and will be secured by the The following schedule will be adhered to unless contractor as the homeowner's agent: circumstances beyond the control of JSA (Owners who secure their own permits will be Companies emerge. excluded from the Guaranty Fund provisions of MGL chapter 142A) Date when JSA Companies will begin project Date when contracted work will be substantially completed Total Contract Price and Payment Schedule— JSA Companies agrees to perform the work, furnish the material and labor specified above for the total sum of: $42,500.00 (*) Payments will be made according to the following schedule: $ Upon signing contract(not to exceed 1/3 of the total contract price or the total cost of special order items,whichever is greater) $ by or or upon completion of $ by or upon completion of $ by completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) By leaving the scheduled payment terms blank above,the customer has agreed to pay the lump sum payment upon substantial completion. The following material/equipment must be special ordered before the contracted work begins in order to meet the completion schedule. (**) $ to be paid for $ to be paid for Notes: (*) Including all finance charges(**) Law requires that any 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. Express Warranty—Is an express warranty being provided by JSA Companies? X NO YES (terms of the warranty are attached to the contract) Subcontractors—JSA Companies agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by JSA Companies.JSA Companies further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance—Upon signing,this documents 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 time to read and fully understand it.Ask questions if something is unclear. • JSA Companies can provide verification of proper insurance and licensing at the homeowner's request. DO NOT SIGN THIS CONTRACT IF WHERE ARE ANY QUESTIONS TFIAT REMAIN UNANSWERED Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy will be kept by isA Companies Homeowner's Signature JSA Co p u orized Sign r Date pat Notice of Cancellation You may cancel this transaction,without penalty or obligation,within three business days from the above date. If you cancel,any property traded in, any payments made by you under the contract or sale, and any negotiable instruments executed by you will be returned within ten business days following receipt by the seller of your cancellation notice,and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the seller at your resident, in substantially as good condition as when received,any goods delivered to you under this contract or sale; or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the cancellation,you may retain or dispose of the goods without any further obligation.If--you-fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to JSA Companies at 55 Chase St Methuen, MA 01844 no later than midnight of Sept. 12, 2015 (date). I Hereby Cancel This Transaction Date: Buyer's Signature: X"he Commonwealth ofMassachusetts µ ..'. Department of rz�dztstl^ialAccidents z. 1 Congress Street,Suite 100 _ y Boston,MA 02. 14.2017 ,�. www.mass.go v1dia, Wovhexs'ColnpenThTHE PERM[TxT���.UTJ�ORITX'ctricians/i.'Xuxabexs. O B FILED�VI'Z'H Please Print Lefytbl A licant Information C r Name(Bi7siness/Organization/Iudividual): �, > City/State/Zip: Areyou an employex?Checkthe appiopriate box: Type of project(),V' quired): 1.lIa aemployerwith employees(Rland/orparttime).* 7. ❑NOW construction 2. I am a sole proprietor or parfaership and have no employees Working for me in $, emodelitig any capacity.[No workers'comp.insurance required_] 9. Demolition 3.. I am a homeowner doing all work myself[No worlcers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner andwill be hiring contractors to conduct all work on my property, Twill ❑Electrical repairs or additions ensure that all contractors either have workers'compensatioII. E]insurance or are sole , proprietors with no employees. 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 repairs These sub-contractors have employees and have workers'comp.insurance.; 14.0 Other 6.[[We area corporation and ifs officers have exereisedtheir right of exemptionperM L c. 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicantthat checks box#i must alsoIl out the secfionbelow their-workers'compensation policy information. Y Homeowners who submit this affidavit indicating they are doing all work andthen 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. Tfthe sub-conitacfors have employees,they mast provide their workers'comp.policy number.• X arz ernployeN t1aatisprovidingworkers'cornpensatzon insurancefor my employees.'Below is thepolicy andjob site am information. Insurance Company Name; Policy#or Self ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'coznpensation•pol:icy declaration.page(showing the policy 1lumbex 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 be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this statement may coverage verification. __Tdo hereby ce un tl e pains. rid -aloes ofpetyuiy that the information provided a ve et. s true and corre Si nate : p Date. Phone#: I'A — 6 official use only. deo not Wite in this area,to be completed by city or•town official. City or Town: Permit/License I Issuing Authority(circle one): 1.Board of Health 2.Building]Department 3.City/Town Clerk 4.Electrical Inspector 5.PlumbingInspectox 6.Other Contact Person: Phone#: 0 DATE(MMIDDIYYYY) AC R" CERTIFICATE OF LIABILITY INSURANCE 08/24/2015 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 KEITH BEAUSOLEIL NAME: FORTIFIED INSURANCE AGENCY PHHcC o E.11: 603-644-3700 aC "o; 603-644-0001 911 CANDIA ROAD E-MAIL ADDRESS: INFO FORTIFIEDINS.COM MANCHESTER NH 03109 INSURERS AFFORDING COVERAGE NAIC# INSURERA: MERCHANTS MUTUAL INSURANCE CO INSURED INSURER B: JEFF AGNEW DBA JSA COMPANIES INSURERC: 11 ESTHER DR INSURER D: BEDFORD,NH 03110 INSURERE: 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 7ypE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP ''.... LTR INSD WV POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY BOP1084614 04/09/2015 4/09/2016 EACH OCCURRENCE $ 1,000,000 DA AGE ToRENTED CLAIMS-MADE ®OCCUR PREM SES(E.occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE OETRH- ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. RESIDENTIAL PLUMBING AND CARPENTRY REMODELING CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN INSPECTIONAL SERVICES ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET BUILDING 20,SUITE 2035 AUTHORIZED REPRESENTATIVE NORTH ANDOVER,MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD iMassachusetis -Department or Public Safety Board of Building Regulations and Standards Construction Supers isor License: CS-065690 ter.r rti vJ JEFFREY S AGNEW p 55 CHASE ST METHUEN MA 01844 EX !f ai(Gvn Commissioner07/31/2016 ✓�P, (C'o9J17Jtfi JtlUL.CII��0��7L<!JJ[!C�lIJeIYJ _Office of Consumer Affairs&Business Regulation f'qr0-20ROME IMPROVEMENT CONTRACTOR egistration: 172928 Type: KExpiration: 8/14/2016 Individual JEFF S.AGNEW JEFF AGNEW 11 ESTHER DR. BEDFORD,NH 03110 4 Undersecretary