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HomeMy WebLinkAboutBuilding Permit # 11/3/2015 1 BUILDING PERMIT �����T TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ _ Permit Not#: L>�� Date Received �AATED Date Issued: l o �� �SSgcHus�� IMPORTANT: Applicant must complete all items on this page Z - tx^n�'e ✓:, 9..Ja �r"L ,r srJ t,✓a°I ,00' print '✓' ��.� � ri 100 a r e u e es ono� ���ry AP PARCEL Z NG ®IS"TRIQ 1�� His or c ®is r ct es TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building YOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other iv�„dir��r.}r'x'rs" 'r r "' s r ;i z ..;t t,-�q ,{ sr ',5„�,✓�'„ r.,t,„mIl .rr':7fc" "r1 .rr t r® Septic Well ✓ hr pK ,❑ I'A odnla n W7 a ; !, , s" DESCRIPTIO"F WORK TO BE PERFORMED: Identification- Please Type or Print Clearly 1 OWNER: Name: hnnc, 6 ro wn Phone: Address: 30. 5 1)MI'I cot /V�7 d ' ` rY '''rfl' jr:r t✓ Xr ,�a,-1 ✓ X, r r 1' :,jr r r1rM r`,"a Uri,,, r',. r "- L. 3` " r� f r r rs r rt ,srr rrx 1 % rig �`U-,.- �a`� r''rl,✓..� . „:.,.�`� ,:���rY 9�0 ,.t^^�m%#''�"' 1�d N3 r ,rte rt�l''' �d�47 k rata..;:. r.rllt��� .�j,r � f '. 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".`x. ?ar Ui,F r��r�C��l?" ,_..m�, "si .n��� .r.,a.<1r,:✓,✓r",rvrr!�.ter` �t.s:,r:���i�,i,1,i,..,�rr.:.:r,'"j3,'.Jr,��1rx,;-.s ,�'�i3'f,,✓ r„ ,.,r;J.'tr u,,,,r�,x-�rr.�'r',":`.?.'� lx.� M��✓ �� �'�„� .s�i.'''�is,;6,?,�"Zr;ua.,.1,f ,:ri �.�'�.� ,� x ._ �'r ;�,i„' "'"x��t�-�t1 �d;�w�G s^' �rr�; £rt*�1 J ,^rte �,�,`,��l "a" J,r ,fin"Y% "'” to €�4�`" ,a'=-✓` ; . ,yr�'.S,±f✓"'dam' .� s,,.�.�rsrr rr';,xrj r -xa,"•" rn ,rte F f '`? fir,! `, r,�"'�� r ,.�.ax t r Supe $iso.r s Co�strut ian;-.Lice Y se ,���_� NEWg" 101 �Ho' elrnp�o�emen�L`icense ,✓` ��n ° Exp Date J , n � � �..�.,w f5;.`.. .,�-.. ✓�ts%V. .r11�"�cn,+, n.` r,..65i+� r? _ w. �r,�'�, xsh».✓Yr*`Y`�;rn,�,..,x 3r mrbx.xaYm� xr�i. ._ _ - urz.a'° ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�,c�� FEE: $ Check No.: 7 - Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t ,Signature;of AgentLOwner Signafiure, co,rifractor :' r,; , IAORTH I ' lown o f ndover No. T r o LAKE h ver, ass, o6r COCMIC"t WIC 1l.41 �,9 AORnr�o C) � U BOARD OF HEALTH Food/Kitchen PEKI T D Septic System THIS CERTIFIES THAT ................... . BUILDING INSPECTOR Foundation has permission to erect ........ ................. buildings on ... ... l/.�411f.�1.. ...... .............. g Rou h tobe occupied as .......... .. ....... ............ .... ... .. .......... .....,............................................................. Chimney provided that the person accepting is per- 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 PERMITIN 6 MONTHS ELECTRICAL INSPECTOR UNLESSRTS Rough Service ........ ................ .. ............................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancv 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 Approvedthe Building Inspector. Burner . Street No. Smoke Det. -ormation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of anotherwho employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall- enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." -Applicants Please fill-out,the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub contractors)name(s),addresses)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance: If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affiidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.##617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 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 firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, a ter 142A. / e� $o eowner's Signature C ctor's ign e NOTICE:The signatures of the parties above apply only to the agreem of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed 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 an express warranty for workmanship or materials. In 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 attachments 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 fully 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 funds 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 http://www.mass gov/ocabr/ If you want to verify the registration of a contractor or 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 htti)://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homei=rovement/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 Version 2.1-11/22/2010 DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSUR NCI 05/21/2015 TH�RTIFICATE 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. s_ 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 02025-001 CNAmONTACT NNE: Degnan Insurance Agency Inc MCI.,Ext: (978)688-4974 NC.No.: (978)327-6558 85 Salem Street EMAIL ADDRESS: Lawrence,MA 01843 SU Eft S AF ORr11D1G COVERAGE NAIC# '.. INSURER • A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: James Debrecini Family Roofing & Painting SUE C 2 Tanager Way _ INSURER —_-.--..---- Londonderry, NH 03053 INSURER E: COVERAGES CERTIFICATE NUMBER: JREVISION 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. ICTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDIYEYYY MMIDD/YYYY ____ LIMITS INSR WVD EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS-MADE D OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ '.. OLICY r7tERCi OC —_ COrvlBlhlED—SINGLE LIMIT $ AUTOMOBILE LIABILITY - Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ '.. AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED per accident $ AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ $ yypRKDEERD pM RETENTION $ — Tq TH A<JD EMPLOYERS�LIABI�QTY X TORY LIMITS OER qN ypR�pR�Fr�R/pqRTNE R!P�ECUTIVE YIN E.L.EACH ACCIDENT $ 100,000.00 q oFFICERlMEMBEREXCLUOED? NIA AWC 400-7025900-2015A 5/11/2015 511112016 E.LDISEASE-EAEMPLOYEE $ 100,000.00 (Mandatory in NH) {Yes describe under E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS below '.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) The workers compensation policy does not provide coverage for James Debrecini CERTIFICATE HOLDE CANCELLATION _ Andover Town Offices Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 36 Bartlett Andover, St 01810 THE EXPIRATION DATE 'THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE P&ICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD . V�B �f>Q71LJJ1(1.71!!JG'CCII�Q�[J/�CClJ.1CGC�lIJCi�J. Office of Consumer Affairs&Business Regulation OME W-PROVEMENT.- CONTRACTOR egistration: 122385 Type ,xpiration: 8/26/2016 DBA J&D WEATHERSEAL JAMES.DEBRECENI - 2 TANAGER WAY LONDONDERRY,NH 03053 g �g"— – Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 "–Boston,MA 02116 N4' t - valic�.,Njoutsignature 'vtassachusetts -Department of Public Safety Board Cit-Euildiny Regulations and Standards Construction Supervisor Specialty License:-CSSL-099685 i.r rw j JAMES J DE$RE(� NI I 2 TANAGER WAY QNDONDERRY NH305� Expiration Commissioner 12/06/2015 �I r