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HomeMy WebLinkAboutBuilding Permit # 10/7/2015 %AORT#1 "do BUILDING PERMIT TOWN OF NORTH ANDOVER Z APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 'SAC 05 Date Issued: IMPORTANT:A licant must com Tete all items on this / ! /, / � � Irl r , �� ��,�///// r rr , r / / r r �/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family [I Industrial [I Addition [i Two or more family 11 Commercial El Alteration No. of units: ;KRepair, replacement ri Assessory Bldg El Others: Li Demolition ❑Ll Other Ex Identification Please Type or Print Clearly) OWNER: Name: Phone: fl Address: �/� �/ � � 1 � rl,, 11 11 � %////�� r . �f � f 1 l I ��� . Ile,,................... r / . III.....«rr rr rrrrrrrrr 1 , rr,r � I r �. �I a � rr II rrr I Ft ��/� f � 1, I � 1 ,1 II /J� 1 � 1 ,�111�I I �l . . �� rl r J��1(�1J1i11111����� / 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. 00 ! Total Project Cost: $ FEE: $_ Check No.: '2-,,L�,"1 7- Receipt No.: z,,,r14ZL NOTE: Persons contracting with q istered contractors do not have access to the uaranty fund icgiltrrf On,Y, FORTH U , , n Ot 11clu V cl[ ® 44 ® o LAK h h ver, Mass, /a 5— COC HICHEwICK ,®AERATED P.4 `�5 S U BOARD OF HEALTH Food/Kitchen P E RIM I T L Septic System THIS CERTIFIES THAT �..:. .� �-� � `0 ®^e-f BUILDING INSPECTOR ............ ....... ........................................................................................... Q` Foundation has permission to erect .......................... buildings on ..,.�. ., ..G; s............................................ Rough tobe as occupied p� .................... .�........................................................... 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 CONSTRUCTIONT T Rough Service ......... ...�gr__ "E�'�............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 Approvedthe 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(MGL 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 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 Infinuation Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Nance ConrparyNMme Street Address do not use a Post office Box address)+ f Contractor/Salesperson!Ont er Mine 00 01 City.Toml State Zip Code Business Wildress(must include a street adcbress) O `U©/t.2-r'IWO()lax A- &iFYS" 0/Fa DaythuePhot Everting Phone Citv'1'oi%it State lip Code /-7)3 - 3 y 3 �j Mailing Address(It ditierent firm above) Business Phone 1?ederat Employer ID or S.S.Ntunber ,�•,{ Home inw-minaC atamr Rea.Nwnlxr Expirnlimt date 00 Lotrreq.im that—11tome lmprontnmlroutractoas antro L00�_/M'y aVaad lYBnllYltaO a"Inht[ VRV'� C� The Contractor agrees to do the following work for the Homeowner: V rV (Describe in derail the work to completed,specifying the type,bland,Mnd grade of materials to be used,use additional sheets if uecessntv.) 00 (:N IMP AV9/ IM 01 /46711/ !T IAAX� _ , _rA fr—Aj& / C., rt- o � Jr'i'V&"es- Q p Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will Zdi rya and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractors control arise ►-a in (Owners who secure their own permits will be I` excluded from the Guaranty Fund provisions of /O Date when contractor will begin contracted work. 00 00 MGL chapter 142A.) V 0; /0//0 Date when contracted work will be substamially completed. Z tT Total Contract Price and Payment Schedule ,� an o0 The Contractor agrees to perform the work,famish the material and labor specified above for die total sum ofCut Payments will be made according to the following schedule: Cd t7 N IC pi s—_4��upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) S by !_/ or upba 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 S to be paid for ordered before the contracted wort-begbts in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires dint any deposit or down-payment required by the contractor before work,begins may not exceed the greater of(a)one-third ofthe total contact 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?XFNn❑]'es(alt tet nus of the eat rants must be attache'11—h­contract[ Subcontractors-The contractor agrees to.besolely responsible for completion of die work described regardless.of the actions ofany third party/subcontractor utilized by the.contractor. The contractor farther agrees to be solely responsible for all payments to*all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this docpnent becomes a binding contract under lay.Unless otherwise noted within this docmuent,the contract shall not imply that any lien or other security interest has been placed on the residence. Review die following cautious and notices carefully before sighing 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 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 the contractor have insurance?Ask the Contractor for his insurance company information so that you can confinn coverage,or ask to see a copy of a"proof of hmsurance'document. ` • Know your rights and responsibilities. Read the Important Information on the reverse side of this font and get a copy of the Consumer Guide to the Home hnprovement Contractor Law. You may cancel this agreement if it has been signed at a place other,d(an the contractor's nortml 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 that midnight of the third business day following the signing of this agreement. See the attached notice of cancellation font for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE A BLANK !!! Two identical e ' is tract mtut be completed and sighed One copy should go to the hot inn .Thr other mpy sho d be kept by he con rnctor. Homeowner's VSigp-nar Con ignatu Date Dare Contractor Arbitration The Home Improvement 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 he/she 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 funs which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and t nsumer shall be required to subuut rtoitrtion as provided In Massachusetts General Lawsc Ater 142 Homeown Tact 's Sigh e NOTICE:The signatures of the parties above apply only to the a een it of th Marti o alternative dispute resolution initiated by the contractor. The homeowner may initis emative dispute resolution even where this section is not separately sighed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement 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 own 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 all express warranty for workmanship or materials. Ill addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry 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 attaclunents 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 filly 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/herself 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 fiords 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 httn://w%%w.mass aov/ocabr/ If you want to verify the registration of a contractorpr 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 http:/hvw�",.m tss eov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: litti)://db.state ma us/liomeimuroveinent/licenseelist 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 4etAou 2.1-11/22/2010 The Commonwealth ofMassachusetts Department of IndustilalAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A_wylicant Information Please Print Leelbly Nxri ae(Business/Organization/Individual): s& m&IAML044�� 14- e Address• 1S.— City/State/Zip: S.,_.City/State/Zip: AJ Phone#: Are you an employer?Check the appropriate box: 1. I am a employer with__ f d 4. ❑ I am a general contractor and I �'Pe of project�(required): employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition --------- -1----.._. . .... ... .. _._._ ---__...__..__working for me m any capacity_.._..._.._-.._.._ en►Ployees ---------------._.... ....... .. .. .. [No workers'comp.insurance comp.insurance. -----_._.— required.] 5. ❑ We are a.corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑'Plumbing repairs or additions myself.TNo workers'comp, right of exemption per MGL insurance required.]t c.152,§1(4),and we have no MIR Roof repairs employees.[No workers' 13.❑ether comp,insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then buue 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 workers'comp.policy number. lam an employer that is providing workers'compensationinsurance for my employees, Below it the policy and job site information. Insurance Company Name:_ //\/ CIO , , Policy#or Self-ins.Lie.0: 6" �� ..(� Expiration Date: �t Job Site Address:_ ` -, f City/State/Zip:- vim 4' * V)d U �/ — ®r FY 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 MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year�' nsonment,as well as civil lienalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violatbr. Be advised that a copy of this statement may be forwarded to the Office of Inyestigahons of the DIA,for insur_..,c. .coverage verifcat�op, ..,.. Ido hereby cert jo under the p in ar penalties of perjury that the information provided above is trite and correct Si ature: Date: p 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#• NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In ac ordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 7i -VItz, ,r ,,"" is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL ell, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) Si ture of Permit Applicant d �7/[ 5- Date ag=o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDaYM) ik. - 8/14/15 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 thi s certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Circle Business Ins. Agcy, Inc PHONE 976 777-5619 AX No: (978) 777-469e 247 Newbury Street E-MAIL ADDRESS: Danvers, MA 01923 INSURE SAFFORDINGCOVERAGE NAIC# INSURER A:Hartford Underwriters Ins. Co. INSURED INSURERB:Main Street America National Management Team Inc. INSURERC:Torus National Insurance Co. 2 Austin Square INSURER D:Merrimack Mutual Insurance Lynn, MA 01905 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP NSR WVD POLICY NUMBER MIDDY WIDD/YYYY LIMTS B GENERALLIABILITY Y Y MPT7965M 2/24/15 2/24/16 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TORENTED $ 500 000 CLAIMS-MADE �OCCUR MED FRCP(Ary one person) $ 10,000 PERSONAL&ADVINJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG s 2,000,000 POLICY X PRO. LOC S AUTOMOBILELIABIUTY 2/29/15 2/24/16 COMBINED SINGLE LIMIT 1 ECT F B Y Y MPT7965M E09 do R) $ 1,000,000 ANY AUTO BODILY INJURY(Per poison) s ALLOWNED SCHEDULED AUTOS AUTOS BODILY Per accident) $ X NON-OWNED PROPERTY DAMAGE HIREDAUTOS X AUTOS eraccident) $ s C X UMBRELlALIAB pOCUR Y Y 85824I140ALI 2/26/15 2/26/16 EACHOCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION s $ A WORKERS COMPENSATIONU$2E71937-6 2/21/15 2/21/16 }{ WCSTATU- DTH-AND EMPLOYERS'LIABILITY Y/N O YPROP IET RPARTNERD?ECU � NIA E.L.EACHACaCEW $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If Yes describe DESG�RIPTION OOF OFFPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 D Rental Equipment cover IMC8-454-711 5/21/15 5/21/16 Limit 100,000 REPLACEMENT COST Deductible 5,000 MSCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional RenorksSchedule Ifmores pace Isregdred) 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(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Office of Consumer A.ffairsBusies s e ` n . 10 Park Plaza - Suite 5170 Boston, M,,�asachusetts 02116 Home ImproveniGontractor Registration i �'- Registration: 178186 Type: -Supplement Card NATIONAL MANAGEMENT TEAM, plration: 3/24!2016 GEORGE VASILIADES a 2 AUSTIN SQUARE LYNN, MA 01905 n F r � Update Address and return card.Mark reason for change. SCA I Co 2OM•05/7I [:] Address F� Renewal El Employment F� Lost Card Ofr �tL6�dlTT/ylLO%Z((!6[LGLiL O��JliL[t'QC201l,CQBt(d ice of Consumer Affairs&Business Regulation License or registration valid for individuI use only ME IMPROV NT CONTRACTOR before the expiration date. If found return to: egTstratlOffice of Consumer Affairs and Business RegulationType: 10 Park Plaza-Suite 5170 ExpTr tI N Supplement Card Boston,MA 02116 NATIONAL MANA C. Q GEORGE VASILIA P.O.BOX 365 Tnl'fOrlri n LA nl Ann _ ' • A t • � Massachusetts_pe nt df 1 Board oTg - pat3me Pubur safety E uitding Regnlatidns asci Stadc,4' ! ! Corislruchon;Supervisbr v j I <<License:C5(1807eifi ;{ VASW Cb'fN}A 0.038uv i ```'r- commisstonet EXpiration 4U/26/20't5 APIA