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HomeMy WebLinkAboutBuilding Permit # 10/13/2015 %AORTH BUILDING PERMIT 01 Al�s 6 4! TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ArED Date Issued: J lm 'ORTANT: Applicant must complete all items on this page LOCATION Prin PROPERTY OWNER AYQX� Po- - Print 100 Year Structure yes no MAP PARCEL: I?—.—ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial El Repair, replacement [I Assessory Bldg El Others: El Demolition [I Other er, a gp� ,w DESCRIPTION OF WORK TO BE_PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: 92J-<-K,�2 2"/7 Address: Contractor Name: Phone: 7 Email: Address: Supervisor's Construction License: Z-6 90 -Exp. Date: Home improvement License: 35- _Exp. Date:_ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER IT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. V61 Total Project Cost: $ 5'6 0 0 FEE: $_4 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce to the guaranty fund Si c haf 7""r'7 Sr,k- tu Inatu[e, -- Tk®RTH Town of It _� No. 4(,Pl— - Y nO LAKE h y ver/ 6Ess, COCKICKEWICK ��• A�RRTEc) S u BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT l CJ BUILDING INSPECTOR: Foundation has permission to erect .......................... buildings on ... .. ... ........ ... . . ..... ............... � �/ Q� Rough to be occupied as ...... ........ ..�'Ar6 ..... G. a.. .......... id, . ..................................... Chimney provided that the person accepting this permit shall in ev respect conform to th 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 E I IN 6 MONTHS ELECTRICAL INSPECTOR s LESS CTI T Rough Service .................... ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Qccu,2y Puildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Latin or Be® Wall To Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massa chusetts . Department oflndustrialAccidents f tl X Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Lesibly NaMe (Business/Organization/fndividual): Address: City/State/Zip: / hone Are you an employer?Check the appropriate box: Type of project(required): 1. I 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. Q Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q 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. Plumbing repairs or additions 5.❑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.# j 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14. then 152,§1(4),and we have na employees.[No workers'comp.insurance required.]/� h( *Any applicant that checks box 41 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 submit 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. )'am an employer that ispioviding workers'compensation insurance for my employees.'Beloiv is thepolicy and job site information. /a j Insurance Company Name: — // / Policy#or Self-ins,Lie. Gt 10 /1S Expiration Date: ,rye, Job Site Address: C-;,- 7 N�G dy%� �z 77 City/State/Zip:�t� N/t/�G�el� v yf11� 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 WORD 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. X do hereby certify nder the pains andpenalties of perjury that the information provided above is true and correct. Signature: Date: 1� J Phone#: 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. ,Jr Walsh & Sonsor 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted To: Job Name Job Address Job Location Date Date of Pians Phone# R � Fax# Architect We hereby submit specifications and estimates for: m We rp e hereby to furnish material and labor— specifications compete in accordance with above sp ecl ca ions� r the sum o ') .� 22 , Dollars with payments to be made as ollows: 6AV, Any alteration or deviation from above specifications Involving extra costs will be Respectfully , executed only upon written order,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays submitted beyond our cdhtrol. Note—this proposal may be withdrawn by us H not accepted within days. The above prices,specifications and conditions are satisfactory and are ' Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfierall basic requirements of the state's Home Improvement Contractor Law(MOL chapter 142A),but tloes not lntilude standard language to protect homeowners. Seek•legai advice If necessary. Any peison'planning home�- Vnprovtiments shohild first obiain a copy of"a Massachusetts:consumer guide to home improvement"before agreeing to any work on yourreshdence.You may obtain a free copy by'calling the Office of Consumer Affairs and Business Regulation'a Consumer Information Hotline U617-9734787-or or 1.#88&283-3737.Homeowner Information Contractor Information Name / parry N. All Street Address(do not use a Post Office Box addres ntractor/S espasoa/Owner Name S City/Town StatA Zip Cede ess A s(must include a street address) . fYy yj `DayumeP ne Evening Phone i rrown z;�ry > P ty cede Mailing Address(1t different from above) usiness Phoria JWEmpibyer ID or S.$•.Numba la-nQW—L&tmop b"lm•` )1 mo tCooftddraegA—ba :E<pvation-& ' p�mt�onher e: I r end teglmsdw—m®ba The Contractor agrees to do the following work for the Homeo ner: s Required`Perntits-The following building permits are required Proposed Start and Completion Sihedule•The lnllowing schedule will and will be secured by the contractor as tihe'homeowners agent; be Pr= 1h rid to iirilesa circumstances beyond the contraetotscontmlcrise (Owners wha.securetheir own permits will be exeluded<from.the:Guaranty Fundprovisions of ( whe;;cotlnsetarwill begin contractW work MGL chapter 142A.) when contracted .work will be substantially completed.. Total Contract Price and PaymentSchedule , The Contractor.agrees to perform tyle work,fiunish'the material and labor specified above for the otal sum of Payments will be m de according to the following schedule: $ - �� upon signing contract(noGto exceed 1/3 of the totel:contract price,gj the cost:of spebial order items,whichever is greater) S by_ / or upon completion of ------------- S by or/ or upon completion of Vk�upon completion of the contract (Law forbids demanding full payment until.contract is completed to both P Pm?Y's satisfaction) The following material/equipment must be special S be paid for ordered before the'contracted work begins inertia be paid for to'meet tfie,complittion schedule,(**) 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 con of any special.equipment or custom made material which must be special ordered in advance to mat the Completion schedule. Express Warranty-Is an express warraety bein¢provided by the contractor? No Yes fall terms of @re rvarranty must be attacbed to the coetractl Subcontractors-The contractor agrees to be solely responsible for completion of the work— dear— poet 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 laborunderthi aereement 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)1as 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 fullyunderstand it.'Ask'questions ifsomothing is unclear. • Maker sure the contractor haDZist0tioThe 9,;v requires most home improvement contractors and. subcontractors to be registered with the Director ofHodle Improvement Contract&Registration. You may inquire about.contractor registration 93 writing to the Director at:One Ashburton Place,Room 1301,Boston,MA 02108 orby_calling 617-727-3200 or . _ 1-800.223-0933. - .,. • Does the contractor have insurance? Check to see that your contractor is properly insured • Know your rights and responsibilities. Read the Important lnformation on the icverse side of this foiat'end get a copy of the Consumer Guide to the Home Improvement Contractor Law: You may cancel this agreement if it hes been signed at a placerotherthan the contraet6r's'normal place ofbusiness,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent orby delivery, thrid business day fallowing tine signin 'this a not later than midnight ofthe. g greement,.See the.attached notice of cancellation form for an explanation of.this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two idenntial copies of the contract rust be completed and signed,pee copyshould go to the bo er.The other copy should be kept by the contracw. .. Homeowner's Signature Contractor's Signature Dau ,Date? t 0 TE CERTIFICATE F LIABILITY INSURANCE DA01/12/DD/YYYY) � 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(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 00775-001 N2A J( CT Durso&Jankowski Insurance Agency Inc A/C.No.Ext: (978)682-5175 rcNo.: (978)794-0313 198 Mass Ave Suite 101 Bd�iiss: North Andover,MA 01845 SU E AFFORDING COVERAGE N INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B Arthur Walsh A J Walsh & Sons E 55 Pleasant Street INSURER D: North Andover, MA 01845 N URER E; INSURER E, 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 CyB�Y��PAID CLAIMS. ILTR TYPE OF INSURANCE INDSI2 � POLICY NUMBER MM/DD/YYW MMI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea 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 R OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea a idem ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yyyypo KKDEDgg ppryry RETENTION $ W g 77UU 7 $ ND EMPLOYERS�CIABILITY X TORY LAtv11TS OER A P O E R/PARTNER/EXECUTIVE /N E.L.EACH ACCIDENT $ 100,000.00 A o� Ic�R�n��M��R EXCLUDED? N/A AWC400-7014648-2014A 11/14/2014 11/14/2015 (Mandatory in NH)) E.L.DISEASE-EA EMPLOYEE S 100,000.00 U93CRI' ON OF BPERATIONS 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 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 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD oMassachusetts - Department of P im'-' y 3iet w, Board.of Building Regulations za„u Construction super�icor License: CS-022680 t . ARTHUR J WALW JR ;- 159A WAVERLY RD N ANDOVER MX 01845 Expiration Commissioner 06/09/2016 V7l C' [/'c IN 11tc77lOerl�f�cf C�/��rlJJr(r�rrJc'�3 Office of Consumer Affairs&Business Regulation IMPROVEMENT CONTRACTOR i7 �_egistration: 103358 Type: xpiration: 7/7/2016 Private Corporatio A.J.WALSH&SONS,INC. Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary