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HomeMy WebLinkAboutBuilding Permit # 10/14/2015 TH BUILDING PERMIT �F OORD 6 TOWN OF NORTHA NDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received CHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print 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 El New Building P-fine family El Addition El Two or more family El Industrial El Alteration No. of units: [I Commercial Zt,epair, replacement El Assessory Bldg El Others: [I Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: G Phone: Address: Ile"-4-z Li- Contractor i- 11P - Contractor Name: 4�14L61- Phone: 6JI- Email: Address: Supervisor's Construction License: Qk0 —Exp. Date: Home Improvement License: 103,364" Exp. Date: -7/7111 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDINGPER A5IT:$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 access the uaranty fund 79-//"6-6-1-ai—" r-1111111"911 9V tAORTH lbwn of .t E ..•Ir, Anctover 441 � ° o zol �O LAKE h h ver, ass, /0// ,// � .�/ COC KIC I+E WICK �� ADRATE D F �5 S u BOARD OF HEALTH Food/Kitchen PERMIT L 0 AV Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ......... � .::.. �........... .............. ....... has permission to erect .......................... buildings on :..,. �.�:.' :.C. .�. vy.v . ....................... Foundation /� 7 Rough to be occupied as �:r�� V- ......................... 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESSCTI® STA TS Rough Service ..................... ............................. Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® 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 Approvedby the Building Inspector. Burner Street No. Smoke Det. �,��� Page# of pages CS 022880 978-688-6737 HIG# 103358 A. J. Walsh & Sonsor 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal 5ubm ed To Job Name V Job# Address Job Loc 1 Date Date of Plans Phone# Fax# Architect We hereby submit specifications and estimates for. w � y 1dzm^ qrt d,� ✓,`�'" �w?'" ro�.. w�� �....,r ���".,� r .., m1G,a�'wr .M ' p y �., r of: We propose harsh to furnish material complete in accordance with the above specifications for the sum . aterla an labor �. �.��z,� �, � 1�, 4'1""a .. �.�� Dollars with payments to be made as follows: -- Any alteration or deviation from above specifications Involving extra costs will be Respectfully executed onlyupon written order,and will become an extra charge over and sUbmltted � '�" f�"A��""�' above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our cohtrol. Note—this proposal may be withdrawn by us if not accepted within days. Zie The above prices,specifications and conditions are satisfactory and are 41 Signature./' hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. 1 Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies-all basic requirements of the state's Home lmprovemenf Contractor Law(MGL chapter 142A),but does nit include standard language to protect homeowners. Seek)egad advice if necessary, Any person planriiog home irinprovements should first obtain a copy of"a MassachusetMconsumer guide to home improvement"before agreeing to any work on yourreiidence.You may obtain free copy by`calling the ' Office of Consumer:Affairs and Business Reguladon!s Consumer Information Hotline at-617-9734787-or 1+886.283-375_.7. ' Homeowner Information- `Contractor Information eine pangName* S t onot Port fficeBoxaddress ntract Se! nl0wnctName ' 2� Citytrown State Zip Cede usiness Address(mast include a street address) . DdytimePhone Evening Phone- itylro�wln State Zip Code / �Gwr� Mailing Address(It different from above) usin Phoria ederal7 mployer ID or S.$.iVumber ' rev nph=thWtmon hom•im• Rome tcmtnctorae93N—bcr pcatimNle ' ' pco�ml ooatradon Nva� ' The Contractor agrees to do the following work for the Homeowner: ' Required`Permits-The foliowing building permits are required Proposed Start atid'Completion•Schedule-The fdlloviing schedule will and will besecured:by the rbntractor'as the'homeowner s agent be adhered to iitiless circumstances beyond:the contractoes`control arise (Owners who secure their own permits will be excludedfrom the Guaranty Furid:provisions of l� r wh' bofitractorwill begin contracted work MGL chapter 142A:) / y /V / to when contracted .work willbe aubstantiaily completed. Total Contract Price and PaymegSchedule t The Contractor.agrem to perform the work,furnish the material and labor specified above for the total sum of'. Payments will t�pade according to the following schedule: S US d upon.signing CP ntract(notto exceed 1/3 of the total.contrect price,Qr the costof special order items,whichever is.greater) $ ------ by or upon completion of h by or upon completion of - K tfi S J C,.V upon completion of the contract (Law forbids demanding full payment until.contract is completedtq both s satisfaction) The following material/equipment must be special S e pard for ordered before tlte'contracted work begins inorder S to be paid for to meet tliecompletion sehedule.(r*) NOTES:(41)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not rxceed the greater of(a)one-third of the total contract price or(b)the actual cost of any speciai.equipment or custom made materiel which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty bein¢provided by the contractor? No Yes (aa terms of the warranty m�•*be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions`otany third . party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and laborunder this 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 interrst)ns been placed on the residence. Review the following cautions and notices carefully before signing this contmct. • Don't be pressured into signing the contract Take time to read and fully understand ii'Ask'questiotis if aovsething is unclear. • -Make sure the contractor hfls a valid Homa Improvement Contractor R icfrat The Wi requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about.coniractor registration by writing to the Director at One Ashburton Place,Room 1301,Boston,-MA 02108 or-by,calling 617-727-3200 oG . 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]nformation on the teveru'side of t}fls foiiir and get a copy of the ConsumerGuide to the Home Ithprovement Contractor Law: You may cancel this agreement if it has been signed ata place other.tban tho contractd>is'normal place of business,provided you notify the -contractor in writing at his/her main olBde or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the, thud business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPAC'ES!!! ? o Wend 1 6 the contraet mast be cm*leted and signed One eopyshould so to the homeowner.The other copy should be kept by the contactor. .. - (��' Homeowner's Signature Contractor's Signature l a1/.31/i Dau .;Date T--? The Commonwealth of Massa chusetts .Department of IndustrialAceldents 1 Congress Street,Suite 100 Boston,MA. 02114-2017 www mass.gov/dia SV• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. Applicant Information Please Print Leidbl Name (Business/Organization/Individual): ✓ _� Address: G � City/State/Zip: �U , x Phone#: q/ 7 13 7 Are you an employer?Check the appropriate box: Type of project(required): 1. amaemployerwith �. . employees(fulland/orpart-time).* 7, F1 New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. E]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 F1 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.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insnrance.t 6.❑We are a corporation and its officers have exercised their right of'exemption.per MGL G. 14.[]Other 152,§1(4),and we have nq employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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 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,%ch must provide their workers'comp.policy number. I am an employer that ispi'oviding workers'compensation insurancefor my employees.'Below is the policy and job site information. _ Insurance Company Name: / Policy#or Self-ins,Lic. Expiration Date: //th Job Site Address: ZKZZ14,at City/State/Zip: Attach a copy of the workers' campensatio 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. I do hereby certify under the pains and penalties ofpeijuiy that the information provided above is trice and correct. Sig nature � � Date Phone#• 6, 7,37 Official use only. Do not write in this area,to be completed by city or town official., City or Town: Permit/Liceuse# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TE ® DADD/YYYY)mac RteCERTIFICATEFLIABILITYI U 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(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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00775-001 fiRAJACT Durso&Jankowski Insurance Agency Inc A/C.No.Ext: (978)682-5175 A/C.No,; (978)794-0313 198 Mass Ave Suite 101 B �� ss: North Andover,MA 01845 INSURE A• A.I.M.Mutual Insurance Company 33758 INSURED I ER e Arthur Walsh A J Walsh & Sons 55 Pleasant Street INSURER D: North Andover, NA 01845 INSURER 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 ��yyB��Y���PAID PCLAIMS. ILTR TYPE OF INSURANCE INDSPR YYVBD POLICY NUMBER MMIAD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S PREMISES(Ecc rr n CLAIMS-MADE F OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S ENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S OUCY RO' OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea ac Iden') ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS P r'c idem $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE S rDDEDg oM RETENTION $ gT 7U TH $ AND EMPLOYERS€LIABI�ITY X TRY LAtv11TS OER A TOR/PARTNER/EXECUT11E N E.L.EACH ACCIDENT S 100,000,00 A o��I���n��k98ER EXCLUDED? Y N/A AWC-400-7014648-2014A 11/14/2014 11/14/2015 (Mandatory ?(rIn NCH)) E.L.DISEASE-EA EMPLOYEE S 100,000.00 DsCRIP �ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 -a. �:t- 1t •sZ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 10, iNlassachusetts !)apartment o nw. > >e r r Boaru.of Building Rcgulations and Construction SuperN icor License: CS-022680 ARTHUR J WAI,�A JR 159A WAVERLY.RD N ANDOVER MA, 01845 9,21 Expiration Commissioner 06/09/2016 �%�C �CC1J11J10I7lOC'Cllf�(/�/�(CIdJCIC�lIJP�J t'\ Office of Consumer Affairs&Business Regulation S= OME IMPROVEMENT CONTRACTOR `! a# egistration: 103358 Type: expiration: 7/7/2016 Private Corporatio. A.J.WALSH&SONS,INC: Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary