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HomeMy WebLinkAboutBuilding Permit # 8/21/2015 (2) m r 99 ' i- l➢IL I PERMIT �oRTw qq'. TOWN OF NORTH ANDOVER o : .... APPLICATION FOR PLAN EXAMINATION yy a m OR LN v M Permit No# °°° SDate Received S CH 5 t`a • � � �OCFCU`��'t Date Issued: ) U !MPORTANT: Applicant must complete all items on this page LOCATION 41 L)awl Print be, PROPERTY OWNER 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 Li One family Li Addition ❑Two or more family [I Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg [I Others: Demolition ❑ Other � , ,, , ,/,%/ ,,, lam � ❑W, I / ,, `, / „ rrr ❑ Flo. , / DESCRIPTION OF WORK TO BE PERFORMED: r� Iden ' ca 'on- lease Type or Print Clearly a OWNER: Name: Phone: Address: Contractor Name: J CPhone: Email: /UC _ x Address: 10 L� Supervisor's Construction License: Exp. Date: 3 t 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: $ ' c� FEE: $ Check No.: r� Receipt No.:_ °° NOTE: Persons contracting with unregistered contractors do not have access to h'm'"°g a ty fund F ttORTH UW11 utE. ._ Ir nctover ® ..`•, r Gl-,- )AI No. LAK! h ver, ass, COCr11CMl W.CK �.95 RAT'ED p.4P��5 1Jmff_'�M T� T U BOARD OF HEALTH Food/Kitchen P E Septic System THIS CERTIFIES THAT I�C� ... BUILDING INSPECTOR ....... .. .. has permission to erect .......... ............... buildings on ....... .......�.�,�. .....r/4,1.... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS . b.%TS Rough Service 0000 ... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Displayin 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. 13,t 27" Z qi2l! IA ,31A111 � X138„ 2".1 736-55 '—VV27-S6—VJ 6 .......... ....... 7 i AA A 0 X 0 CO , se / 3 7 M q 0011, CU U) 0 0 :3 M CO 0 0 0 (if 12 CL CL U) U) .................... . ................ .............. ............ '7,�_77777 P PM4 Ce) W361824 ........... . . ............... 0 N W3336 W3018 W3336 k .......... L M 4" TV f 171 All dimensions-size designations 20 20 This is an original design and must Designed:4/25/2014 given are subject to verification on f_EC HTR OtoG,Es� not be released or copied unless Printed: 4/25/2014 job site and adjustment to fit job applicable fee has been paid or job - conditions. order placed. 18 Abbott Way Kitchen 4-25-14 DIA.kit All Drawing 9: 11 No Scale. 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 ISA 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 , J 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. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY QUESTIONS THAT 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 l5A Companies Homeowner's Signature !SA Co p u orized Signoi- e5; 0 DDa_Ye/ Dat 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: the Commonwealth ofMassachuseeis .Depowtment oflndustrial Aceldents 1 Congress Street,Suite 100 Boston,.MA.0.2. 14. 017 www.mass.gov/dza �ovkers'Compensation Insurance Affidavit:B-ail.ders/Contractors/Electricians/Plumbers. TO BE k'ILED WITH THE PERAUTTING AUTffORZTY. Au licant Information Please Print Legibly NameQ3asiness/0rganizafion/fndividual): ,� .A.ddress: CG144-(�e ��T City/tate/Zxp: hone#: q Areyou an employer?ChecktIie appropriate box: Type of project(required): 1.❑1,,ap a employer withemployees(fulland/orpart time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees Working for me in $, emo delirig any capacity.[No workers'comp.insurance required.] 9,]Demolition 1E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 100 Building addition 4-E]I am a homeowner and wilt be hiring contractors to conduct:all work on my property. 1 will. ensure that all contractors either have workers'compensation insurance or are sole IQ]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-confractors have employees and have workers'comp.insmaace.T ' 14.[]Other 6.Q We are a corporation and ifs officers have exercisedtheir right of exemptionperMGL c. 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] ,-Any applicant that checks box 41 must also fill out the section below showingtheirworkers'compensation policy information. T 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 ave employees,they must provide their workers'comp.policy number. employees. if the sub-contractors h f arm an employer't7iat ispi'oviding workers'compensation insurance for my employees.'below is the policy andjob site information. Insurance Company Name; Policy#or Self ins.Lie.##: ExpirationDate: Job Site Address: City/State/Zip: Attacb.a.copy of the workers'compensation'policy declaration page(showingthe 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 farm of a STOP WORK 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. I do 7ier'eby ce un t/e pains, ndpnnalties ofperjury that the information provided a ve s true and cor'r ect. Si nate : Date: Phone#: q Official use only. _Do not write in this area,to he completed by city or tolvn 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#: q�•^"`.-y�r�0 DATE(MM/DD/YYYY) /tea.. CERTIFICATE OF LIABILITY INSURANCE 08124/2015 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 IPA No,Ell: 603-644-3700 A C Ne; 603-644-0001 911 CANDIA ROAD E-MAIL ADDRESS: l.INFO�rFORTIFIEDINS.COM MANCHESTER NH 03109 INSURERS AFFORDING COVERAGE NAIC# INSURER A: MERCHANTS MUTUAL INSURANCE CO INSURED INSURERB: JEFF AGNEW DBA JSA COMPANIES INSURER C: 11 ESTHER DR INSURER D BEDFORD,NH 03110 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR IND D POLICYNUMBER MM/DD/YYYY MM/DD/YYYY '.. A X COMMERCIAL GENERAL LIABILITY BOP1084614 04/09/2015 4/09/2016 EACH OCCURRENCE $ 1,000,000 DA AGE ToCLAIMS-MADE ®OCCUR PREM SES(E.occurrence)RENTEe $ 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 1:1 LOC PRODUCTS-COMP/OP AGG $ 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 Peraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION Y/N AND EMPLOYERS'LIABILITY STATUTE EER ANY PROPRIETOR/PARTNER/EX.ECUTIVEN/A E.L.EACH ACCIDENT $ D? OFFICERIMEMBER EXCLUDE (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,descr be 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 r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 11 It Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supers kor License: CS-065690 JEFFREY S AGNEW � r r 55 CHASE ST METHUEN MA 01844 '` Expira ion Commissioner 07/31/2016 J�B U,%C77lJ11C7J1UCCII��(T/�/��OJJCIC�!!JC'lXJ N-Office of Consumer Affairs&Business Regulation ROME IMPROVEMENT CONTRACTOR 2egistration: 172928 Type: jSExpiration: 8/14/2016 Individual ,_. JEFF S.AGNEW JEFF AGNEW 11 ESTHER DR. BEDFORD,NH 03110 Undersecretary