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HomeMy WebLinkAboutBuilding Permit # 9/28/2015 RTH BUILDING PERMIT o` T%L D TOWN OF NORTH A V 3� � ' " '` 6 oL APPLICATION FOR PLAN EXAMINATION o Permit No#: Date Received �,�A�RZED PePyR�� AC US Date Issued: hei, I TANT: Applicant must complete all items on this page l6 6 ,. �i.iJiffivi � ;„�/�'x�r r , r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 66ne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other lJ %✓ r",�/ /d ./r, / /. ., ,../%/ .,...,.r/1//% G. ....,. ,//// ,/ "./l! , // ".,... /%/1r,1GG ../// ...1/",.,.r. . , //"" IN/, ,,❑ Flood .Lam.//,//❑ t a ds , / /rr❑ atershe rDlstr ct ,, ,,,r�J r / ,, / , r r / � 0 P � /, f ��il ✓�0 � � � , 1 / � /�% r DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: lh'd rrr Ile Phone° Address: iq4 R r N c,." ,, �..,: ,..✓, , . r �� /, r, ///,, ✓r/r�, � ..i//./ ;. ,,./ ! / ,. � �, it /;. �//,/,� � /%//// / /�;' / r / /iiifrL / / c / J r / r. / I J I r 1, r 1' r .rrr. r F,II II 9 u.. i 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12°00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ m p Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signafiure of Agent/Ouuner fiure af'contractar„ { SORT H Town of E. :..•.1,. , ndover ® _ ;� W.. 0% ® IL o `'o �AK� h V�)r9 `dSSy cam. COC NIC H@W'CK y1. ®, u BOARD OF HEALTH PER T Food/Kitchen Septic System THIS CERTIFIES THAT .. .tET! .......... .. .. ... . BUILDING INSPECTOR .............. .............................. has permission to erect g .............. Foundation .......................... buildings ............ ..... . . . ... .. ..... . .................. Rough tobe occupied as ...................... ... .. ........ ......................... ... ... .......................... Chimney provided that the person accepting this p it shall in every respect conform 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 IN 6 MONTHS ELECTRICAL INSPECTOR ]&Wool' UNLESS Rough Service .............. .. ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® OccupV Buildi Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Massachusetts Home Improvement Sample Contract 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. 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 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information NameNCompany Name cw .a i l.. Street Address(donotuseaPostOffice ox add Contractor/Salespers OvmerName C,9 R4V 4 191 �. City/To Slate Zip Code Bu' Ad s(mMt include a street ad ess) t 4 W Day imePhone Evening Phone City/Town State Zip Code Mailing Address(It different from above) Business hone Federal EmployerID or S.S.Number Home Tmprovenxnt Contractor Ree.Number Expiration dale raw requires that wort home ,Q tmprow—tcontradars have �` 0 n valid reehtretian number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necesss ) e Required Permits-The 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 w excluded from the Guaranty fund provisions of to when contractor will begin contracted work MGL chapter 1.42A.) , ate when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of (*) Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ 2191 by / / or upon completion of $ by / ( or upon completion of $ 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 $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ 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 the contractor? ❑No IVYes Call terms of the warranty 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 tinder this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless othenvisenoted 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 carefidly 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 mosthome improvement contractors and subcontractors to be registered with the Director of Home hnprovement 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 confine coverage,or ask to see a copy of a"proof of insurance"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 Home Improvement Contractor Law, You 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 in writing at hitvher main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight oIthe third business day following the signing of this agreement Seethe attached notice of cancellation fomi for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be completed and signed.One copy should go to the hon er.11m other copy sho t by ata contrector. 1 % Hon owners St nature tractrs Signature Date Date /� /� �/ p��+ /� /+ DATE(MMIDDIYYYY) Ac4c?R" CERTIFICATE OF LIABILITY INSURANCE 05/21/2015 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). ACT PRODUCER 02025-001 NAME: Degnan Insurance Agency Inc CWCOM.Ext: (978)688-9979 FAX No.: (978)327-6558 85 Salem Street EMAIL Lawrence,MA 01843 ADDRESS: INSU ERS AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: James Debrecini Family Roofing & Painting INSURER C: 2 Tanager Way INSURER D: Londonderry, NH 03053 INSURER E: INSURER * COVERAGES CERTIFICATE NUTABER: 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. ILTR TYPE OF INSURANCE INSR SWVD POLICY NUMBER POLICY EFF POLICY/ /D YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMI ESESS( RENTED $ PREMIEa occurrence CLAIMS-MADE [_—]OCCUR MED FRCP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY ECOT- OC AUTOMOBILE LIABILITY COMBINEDdem)SINGLE—LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY a cRdentDAMAGE $ '.. AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ '.. A �O WC gT IUT OTH- WpRKERS CAMP NS BTI X TORY LIMITS ER '.. AtVD ERM�PpLRO�Y�ErR�SR�pLIgAR INER EX ON yPER/MEMBER/EXCIUDEID?ECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000.00 A FFIc NIA AWC 400-7025900-2015A 5/11/2015 5/11/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 DEAdescribe sc ON under PERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 '.. 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 James Debrecini CERTIFICATE HOLDER CANCELLATION Andover Town Offices 36 Bartlett Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover,MA 01810 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Quildirig Regulations and Standards Construction Supervisor Specialty License: CSSL-099685 r," JAMES J DEBRE 2'fANAGERWA�Y ` CONDONDERRMT NH >� 0u Expiration Commissioner 12/06/2015 rroe$'011/4 a n aaja�'hWdlw l,• f u�rjr.o'c ul do usiuessReg License or registration.valid for individul use only Office of Consc1ne1 Affairs& A CTOR before the expiration date. If found return to: ME IDAPROVEMENT CONTRType; Office of Consumer Affairs and Business Regulation egistration: 122385 DBA 10 Park Plaza-Suite 5170 Xpiration: 812612016 -Boston,MA 02116 y J,&D WEATHERSEAL JAMES DEERECENT �.._ 2 TANAGER WAY Undersecretary 4. Not signature LONDONDERRY,NIS