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HomeMy WebLinkAboutBuilding Permit # 10/9/2015 ,�kORTH BUILDING PER MIT TOWN OF NORTH ANDOVER 10 APPLICATION FOR PLAN EXAMINATION PermDate Received Permit No#: c Date issued: IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER Pgrarint 100 Year structure yes 0 Print MAP PARCEL: ZONING DISTRICT: Historic District yes no —PA 0) Machine Shop Village yes (no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential [I New Building [i One family [I Industrial [i Addition [i Two or more family o Commercial VAlteration No. of units, El Others: El Repair, replacement [I Assessor Bldg Ei Demolition Ei Other -77_7 Ar L ar/S�rEWe�il����„�/iG)�ira'l//rr��a/,�/,,9/,/�<<.. .a f, regi����)l���i�i/i%�1,/ll�� F�l /���������,�r E PERFORMED: DESCRIPTIONI” ( "0 kS 7 _-Jdenti45ation - Please Type or Print Clearly Phone: '17k3/L/ k 267 OWNER: Name: " I Address: Phone: ISI 2 7Z �32W Contractor Npme, P ') 01 Email: x Contractor Email: Mai [Address: S —Exp. Date:, /&"S 42 Supervisor's Construction License:— 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: $ Check No.: Receipt No.: NOTE: persons contracting with unregistered contractors do not have acts e guaranty fund 777 .77 q e n Picinatur, `XA tAORTH Town of Andover 0 No. 461-aw Alp � t _ T O LAKE h ver� Mass, I l COCNICMEW'CK ��• S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..............�.Pil 't........ . .E ................................................. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ..5S....... .!.L .�.1 ..... ..... . ......................... ,,Q/� Rough to be occupied as�? v .:!'�.:d4.......... ............................ ..... . .... .................................................. Chimney provided that the person accepting this permit shall in every re ct con-isform 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS S Rough Service ......................... ... ......... ......................... 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 Approved by the Building Inspector. Burner Street No. Smoke Det. CONTRACT TO INSTALL OWENS CORNING BASEMENT WALL FINISHING SYSTEM Owens Corning Basement Finishing Division(the contractor)hereby submits this proposal to sell and install the Owens Corning Basement Wall Finishing System and related items as described herein at the residential premises set forth below.This proposal shall not become a binding commitment unless and until it has been signed by the Contractor and the Customer. Contractor: Owens Corning Basement Finishing Systems a division of LUX Renovations,LLC. 60 Shawmut Road,Canton,MA 02021 Telephone#(781)821-0060 Facsimile#(781)821-8552 Federal Tax ID#14-1855297 Mass.Home Improvement Contractor Reg.#137943 Date Customer: / Customer Name JD��✓ �Rl/gmRrO Street Address— City,State,Zip Telephone( q 2 ss ) �3/5/ X17(0 This is a contract between the Contractor and the above named Customer to sell and install the Owens Corning Basement Wall Finishing System and related items specified herein at the Customer's residential premises identified below: Installation Premises: Street Address Sdf/Yt P City,State,Zip SA/YI Scope of Work: Are Sketches and/or specthcattgr,�haets at(eched4 es`t 9 Np 'All aeachments are incorporated+plO*4dyomer;pa-ot this corltrPcl - Description of Work/Specdipatio�s S CC J 4 u f dtt 1�1 f5 ft7 r < k�<!<5�i�'� �Wti�i �'7/ /.Y <r5 SwiiYlr5/ 5 73 T; T �/osr� at.d�r ;5lfliYCASe� aXa /�r�ca C�.��n �r /trAr�trp1�` SfAi/c Aspa���r`"d Co,� g �f Work Schedule": Approximate ComMopcement Date,' Approximate Completion Date: I2 j 15�I sr "The proposed work schedule is approximate and subject to change . t - Contract Price: Total Contract Price: $ y ,�5�' ( i I Deposit with order: $ Yt I SF.i o Cash i o Chpck; Balance Due: $ j7r x(002 Terms: >JCash o Finance' (Cash terms are 10%deposit,50%on commencement,40%on completion) $ 001 !!7 9. "Due on Commencement '.. $ - �Ci y 7 2 Due on Completion DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AND UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT,INCLUDING ANY ADDENDUM ATTACHED HERETO,AS WELL AS ANY ATTACHED SKETCHES,MATERIAL LISTS OR THE LIKE,AND THE TERMS AND CONDITIONS ON THE BACK OF THIS CONTRACT DOCUMENT. YOU ARE ENTITLED TO A COMPLETE,FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. Witness our hand(s)and seal(s)below on this o23 day of Sip¢' '/S LUX Renovations,LL rued Representative: �r N Signaaj— and Title. Y�u� TiiSt/'L Inn Name DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Customer"': Cgn to e Cu s me Ignare ✓o�,� C'g//gn,.rra Print Name Customer Signature Print Name Contractor may have certain lien rights in the premises until the price is paid in full.You have the right to cancel this contract,without any penalty or obligation,at any time prior to midnight of the third business day after the dale you signed this contract.See the notice of cancellation below for an explanation of this right. "'Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to customer's execution hereof. CaIlamaro,John 55 Pilgrim St CONTRACT Customer Name; N Andover,MA 01845 _ Customer Signature SKETCH Contract Date_ 978.314.8757 _ Sales Representative Signature ATTACHMENT Customer Phone_ _ Contract Price 1 2 2 4 5 S 7 a B 10 11 12 15 14 /S 16 17 16 _79. 2G 21 22 22 24 26 ,2_.23 29, 2G ,41 33 2-0 15 20 27 W 29 4 41 42 47 M 45 4G 47 as 49 50 51 S2 SJ 54 55 56 57 58 54 GO 10 '. j i I 19Is . _ i I I �h.ed j L4 I I I 7 15 1 17 011 19 21 el = j i I 25 27 i lei 1 , #. 21 34 { 1 35 I i 1 I I NOTES: 'Each box equals one toot unless otherwise noted.This sketch is a good faith representation of the work to be done,it is understood that all dimensions `$i' r' derived from this sketch are approximate,and that all locations of outlets,light rig ,� r f fixtures,plugs,jacks and/or switches are subject to change if necessary. Callamaro,John 55 Pilgrim St CONTRACT Customer Name_ N Andover,MA 01845 _ Customer Signature SKETCH Contract Dateu 978-314-8767 _ Sales Representative Signature_ ® ATTACHMENT Customer Phone: — Contract Price �S? 1 2 3 4 5 6 T a 0 10 11 12 /5 14 15 16 11.. i6 10 20 21 22 27 24 26 2...20- 24 ,30 31 ,107 N 90 72..�.. 34 55 26 40 41 42 40 44 45 46 47 40 44 50 51 52 S1 54 55 56 57 56 59 W V��aZI - ! 1 i I I 10 14 Is p, I ( 1 I Is a HE 20 I 23 I I , 24 27 Ion '0 a, 33 34 NOTES: Mo 0'e. t_A�.J.sv A'-yt �a`e i nrlo t �rccci oc�rd t c+e a Mbn� Each box equals one toot unless otherwise noted.This sketch is a good faith t�ritt �b-� G ,vLr j a x representation of the work to be done,it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light k Iry ,� r I!Nlfle P, fixtures,plugs,jacks and/or switches are subject to change if necessary. The Commonwealth of Massachusetts Department oflndustrialAccidents X Congress Street,Suite 100 Y' Boston,MM 02114-2017 www.mass.govIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNII`I TING AUTHOPJTX. Applicant Information Please Print Legibly Name(Business/organization/Individual): Address: w�" Phone#: `� ,, City/State/Zip: _� O . Are you an employer?Check the appiropriatebox: Type of project:(Tequir'ed): 1. 1 am a employer with . employees(full and/or part-time).* 7. []Ne construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. � emodclihg any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑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. Roof repairs These sub-contractors fiade employees and have workers'comp.insurance.t 14. Other 6.[]We are a corporation and its officers have exercised their right of exemption per MGL c. ® 152,§1(4),and we have na 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 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-contrac#ors have employees,they must provide their workeis'comp.policy number.' X am an employer t7iat is piovidiiig worlrers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: j Expiration Date: Policy#or S elf-ins,Lic.#: � � p Job Site Address: S1/ � 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 e. 152,§25A is a criminal violation punishable by a fine up to$1,50000 and/or one-year Imprisonment,as well as civil penalties in the for of a STOP OP WORD ORDER and a fine of up to$250.00 a day against the violato copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifiica I do hereby cer rfy under• le d penalties ofperjury that the information provided alcove is true and correct, m � ' Si nature: ,� Date: � 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): x.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspeetor 6.Other Contact Person: Phone#: ACCORDi CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F9/15/2015 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 Andrew G.Gordon, Inc. NAME` PHONE 306 Washington Street .781-659-2262 FAX e. 781-659-4725 Norwell MA 02061 EMAIL_AQDRESS.info@agordon.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance 24198 INSURED 4440 INSURER B:Star Insurance Company __ 1$023 Lux Renovations, LLC Owens Corning of New England INSURER C:PII rim Insurance company 21750 60 Shawmut Road INSURER D: Canton MA 02021 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 1319789055 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 POLICY EFF POLICYEXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MMI DIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CBP8512851 9/5/2015 9/5/2016 EACHOCCURRENCE $1,000,000 CLAIMS-MADE L X J OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,000 X POLICY❑ PRO- ❑LOC JECT PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY PGC10007161409 1/17/2015 1/17/2016 COM N D SINGLE LIMIT Eaaccdent) $1,000,000 _ ANY AUTO ALL OWNED BODILY INJURY(Per person) $ X AUTOS AUTOS BODILY INJURY(Per accident) $ XHIREDAUTOS X AUTOSSCHEDULED NON-OWNED PROPERTY DAMAGE 1AUTOS Per accident $ A X UMBRELLA UAB X OCCUR CUB11953 9/5/2015 9/5/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEOTX RETENTIONS $ B WORKERS COMPENSATION WC0428715 5/24/2015 5/24/2016 AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBEREXCLUDED? � NIA $1,000,000 (Mandatory in E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under nd DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lux Renovations LLC, ACCORDANCE WITH THE POLICY PROVISIONS. 60 Shawmut Rd Canton MA 02021 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs d Business Regulation 10 Park Plaza ® Suite 5170 Boston, M achusetts 02116 Dome Improvem ' � Registration Re istration � Registration: 137943 z1f Type: Supplement Card Expiration: 1/29/2017 LUX RENOVATIONS, LLC. DANIEL WALSH ("� 7 60 SHAWMUT RD CANTON, MA 02021 �r Update Address and return card.Mark reason for change. SCA. G 20M-05/11 (j Address E] Renewal F-� Employment E] Lost Card 011ie�omzmzo�uc�> o��/�suc/uae�i ice of Consumer Affairs&Business Regulation License or registration valid for individul use only E IMPROVENCONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business-Regulation ,�tegistration; Type: 10 Park Plaza-Suite 5170 Expiratipn. 2llfi;.:' SupplementCard Boston MA 02116 LUX RENOVATIONSWE­'-­_Lam__ OWENS CORNING 13itlSHING SYSTEMS DANIEL WALSH 60 SHAWMUT RDCANTON, MA MA 02021 Undersecretary. , Not valid without signature Massachusetts -Departrpent f Public Safety Bghr of Building•Regulatio ' arid 5�tandards struction Supe iso Lice a:.CS-0ZJ,$�9 J DANIEL F W I 488 FZM"4LLL 10 i TEWMURY NSA 0 Expiration, ' .�rrlmissroner « 10105/201`5 { massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-079893 Construction Supervisor DANIEL F WALSH- 488 KENDALL RD TEWKSBURY MA 01876, t Expiration: Commissioner 1010512017