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HomeMy WebLinkAboutBuilding Permit # 11/13/2015 OORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO - Permit iVo#: Date Received I I7 Q00AYE gSSACHUS�� Date Issued: , M RTANT: Applicant must complete all items on this page r I / r / r r J //' ) { '1� 1/, /lll �,Il I 1��/ 1/ ll'l�/ ,r ,,,��%%!��//G'✓/�//f� ,J Il , 1, � , /,� r , , /'T r/r,�; 1 / y rZ �� TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building 2bne family 11 Addition El Two or more family 11 Industrial El Alteration No. of units: L1 commercial El Repair, replacement 11Assessory Bldg El Others: demolition ❑ Other rr r ✓.1rr r /r / , / / / DESCRIPTION OF WORK TO BE PERFORMED: IC Z. 1 y p / ALI Identification- Please Type or Print Clearly OWNER: Name: C , Phone: Po. .. . Address: �w � I rr / / �,. ✓ r ,r rr/r / , r f / / / � � /r ,/ ,. ✓?� ,�/l /f�, r.,�/�, f ✓/ ri, r/. �.�// ri�% ��/�% f,,.�. ./r. er,ra arc„/,/i // l 1 r �r%,,. ,n ., G //,%//✓'/((1l!! J .. r. .. ..� .� /( / tir,///Ir////. / � �.,1 11���C���/.�/i/../,... rr r 1 r. C ! Y l r r / 1 I / ARCHITECT/ENGINEER �t 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. FEE: $ r Total Project Cost: $ 1 ,5,/ ' 2 Check No.: 3 Receipt No.: ` NOTE: Persons co cti g with un a istered contractors do not have access to the guar find Signature of Ag "nt/ Sig ture of contractor AIM ORT H own ol nclover ®No. 9, L- T o LAK: h ver, ass, bmlm� COC MICHFWICK ,4 poRATED P`?V, � S U BOARD OF HEALTH Food/Kitchen PtRMI I T LD Septic System THIS CERTIFIES THAT .......... .. Ovi.tA... BUILDING INSPECTOR .. . .. . . . ... .............................................................. Foundation has permission to erect ....... ............... buildings on ..... ... ...... ... ®1 ....lz-mck... .................... n • Rough tobe occupied as ......................A.... . ............................................................... 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 I ELECTRICAL INSPECTOR UNLESS CONSTRUCT: A Rough Service ............. ....... ................. .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy 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. oo C � CJ i i I i 1 moo. i Ap M1 vv q Or s i . . N } (+ ! i r __ p � � i fix•' 2-M Construction Billerica, MA Tel: 617-839-2032 THIS AGREEMENT, made as of Nov 10, 2015 Between the Owner: Stella Chistyakov And the Contractor: Paul Vercellini Billerica, Ma 01821 (617) 839-2032 Home Improvement License #: 138378 Mass. Builder's License#: CS 083641 For the project: 128 Mill Rd North Andover ARTICLE 1. CONTRACT DOCUMENTS The contract documents consist of this agreement, construction documents, specifications, and allowances and all change orders or modifications issued and agreed to by both parties. All the documents noted above shall be provided to Contractor from Owner ARTICLE 2. SCOPE OF WORK 2.1 The Contractor agrees to build the above mentioned addition and or install fixtures attached there to in N Andover, Massachusetts according to, contract documents that were submitted to building dept, and permit issued on these documents only. All work must conform to local and state building codes. ARTICLE 3 . TIME OF COMPLETION The projected completion due is approximately ( 4 weeks) from the first day of construction. NOTE: Change orders and/or unusual weather might delay or otherwise effect the completion date. ARTICLE 4. ALLOWANCES: 4.1 Home owner has $ 1,000.00 allowance for 2 exterior doors DESCRIPTION OF WORK 5.1 .All work performed by 2M Construction and or any contractor hired by 2M Construction is to be done to Massachusetts state building code. 2M Construction is responsible for all building materials needed to complete project, and all paying of sub contractors hired by 2M Construction only. All trash removal as well. 5.2 BUILDING SCOPE INCLUDES : Supply and install 2 exterior doors, door to garage to be fire rated per building code. Install ceiling medallion supplied by homeowner. GYM AREA SCOPE: Demo existing shelving in proposed gym area. Frame new walls to create gym space, Insulate wall on foundation side of proposed gym area. Supply and install all building and finish materials needed to create proposed gym. Blue board & plaster walls in this area, ceiling to be a drop ceiling, will try to match what's in existing basement area as discussed. Frame for walk in closet, size roughly Tx7'. NOTE : Any custom built in shelving will be a additional cost to homeowner as this was added after agreed proposal price. Supply and install rubber ( gym rated)flooring in gym area color TBD.Trim out window by basement exterior door. Supply labor & materials for paint for all proposed work mentioned above, paint to be Bengamin Moore Regal Select 5.3 ELECTRICAL INCLUDES: N/A 5.4 PLUMBING INCLUDES: N/A 5.5 HVAC INCLUDES: N/A 5.6 INSULATION TO CODE: Exterior foundation wall only 5.7 Blue board Plastering: Walls& soffit areas to be smooth, closets to be textured finish 5.8 PAINT: To be Bengamin Moore ( Regal Select) 1 coat of primer and 2 coats of finish on walls &trim NOTE: Any colors that may take more than 2 coats of finish will be added cost to contract price. HOMEOWNERS RESPONSIBILITY Paying of any contractors not hired by 21A Construction Selecting of exterior doors style/door handles Paint colors ARTICLE6. PAYMENT SCHEDULE PAYMENT ONE $ 5,000.00 upon signing of contract and project beginning PAYMENT TWO $ 2,500.00 after rough inspection is completed by building inspector PAYMENT THREE $ 3,500.00 after blue board & plaster is complete PAYMENT FOUR$ 3500.00 when gym flooring and finish work begins PAYMENT FIVE $ 1,400.00 after final inspection is completed by building inspector NOTE: ADDED COST TO ORIGINAL AGREED PRICE FOR ADDED SPACE WITH WALK IN CLOSET $ 550.00 ARTICLE7. THE CONTRACT PRICE 7.1 The contract price of the project is $15,900.00 subject to approve change orders Please note: Any changes the homeowner decides on before or during project may result in a change of the total cost and change the finish date ARTICLE 8. MERGER CLAUSE The agreement represents the entire agreement of both parties and supersedes any prior or oral or written agreement. All changes must be writing and agreed upon before work can be performed. Owner ( 1 Paul Vercellin i(2-M Construction) Owner 11/13/2015 09:56 FAX 7813959454 Bates Insurance 1910002/0002 ` CERTIFICATE F LIABILITY INSURANCE DATE(I11ii'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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Bates Insurance Agency Inc. PHONE F (781) 396-4985 Ax No: 781) 395-9454 92 High Street, Suite B1 E-MAIL ADDRESS: Joan batesins.com Medford, MA 02155 INSURE134S)AFFORDING COVERAGE NAIC# INSURERA:Preferred Mutual Insurance Com INSURED — ---- INSURER 8: 2M Construction INSURERC: Paul Vercellini INSURER D: 4 Berry Street INSURER E: Billerica, MA 01821 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 ADDL SUBR P EFF PODGY EXP __..__.__ _..._...._.. LTR TYPEOFINSURANCE POLICY NUMBER M/DDIY hTA/DIXYYYY LIMITS p, GENERALLIABILITY BOP0100718249 7/5/15 7/5/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREWSET occurrence) cc rr $ 100,000 CLAIMS-MADE W OCCUR RED EXP(Anyone person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-OOMP/OPAGG $ 2,000,000 _X1 POLICY PRO- nLOC $ AUTOMOBILE LIABILITY COMBINED IN LELIMlT a accident)$ ANYAUTO BODILY INJURY(Per person) $ ALLOWWD SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED P ROPaE�RT�YtDMMGE HIRED AUTOS —AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYTORsir ANY PROPRIETOR/PARTNER/EXECUTIvE YNIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandabry in NH) E.L.DISEASE-EA EMPLOYEE $ K es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMff $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additlonal Remarks Schedule,If rrrore space is recid red) 128 Mill Road, North Andover CERTIFICATE HOLDER ..CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE "THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department North Andover, MA AUTHORLZED REPRESENTATIVE ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: The Commonwealth of Massa.chusetts Department of IndiustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY- Applicant InformationPlease UTHORITY.A litcantInformationPlease Print Legib Name (Business/OrganizationUdividual): V�(` Address: City/State/Zip: L L ✓i c �' c Phone Are you an employer?Clreckthe appropriate box: Type of project()required): 1.❑1 am a employer with ,. : employees(full and/or part-time). '1. WR-emodeliiig Onstxuction 2, am a sole proprietor or partnership and have no employees working for me in 8. any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 Building addition 4.F]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 repair's 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.F!Roof repairs These sub-contractors have employees and have workerscomp.insurance.) 6.Q We are a corporation and its off,tcers have exercised their right of exemption per MGL C. 14.F1 Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] `Any applicant that checks box#1 must also fill out tho section below showing their workers'compensation policy information. Homeowners who subri if'thus affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetors 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,tliey must provide their workers'comp.policy number.' X am an employer that is providing workers'compensation insurancefor my employees.'Below is the policy and job site information. Insurance Company Name: �� (-C1 � � `'t r e' Policy#or Self-ins.Lic.#: C) d� �3 C�,) Expiration Da7A= Job Site Address: �e~� � t ( I jeC%t City/State/Zip: AL L " 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 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 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. X do hereby cer ' under the paIns ndper alties of perjury tlzat the information provided above is true and correct. Si nature: Date: �� /l� ' Phone 3 2. Official use only. Do not rpr•ite 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#: Office of Consumer Affairs and Business Regulation _ P 10 Park Plaza - Suite 5170 Boston, Massachusetts 0211 actor Registration Home Improvement Contr Registration: 138378 Type: DBA Tr# 264640 Expiration: 3/28/2017 2M CONSTRUCTION - --- ---- PAUL VERCELL ----- 4 BERRY ST. MA 01821 - BILLERICA, I Lost Card Update Address and return card.Mark reason for change. –, Address I�; Renewal r] Employment SCA1 Zi 20M-05/11 License or registration valid for individul use only beforethe expiration date. If found return to- office r= office of Con suAffairs CONTRACTOROffice of Consum Regulation er Affairs and Business Reg 1OME IMPROVEMENTType: 10 Park Plaza-Suite 5170 Rregistration: 138378 DBA Boston,MA 02116 ;Expiration: 3/28/2017 2M CONSTRUCTION PAUL VERCELLI - ----— 4 BERRY ST. _ __---- Not valid without signature BILLERICA,MA 01821 Undersecretary 9 OZILWL ��,,� Z3,iSySPtdSEiECrary iZ810:Nw d31HR'I'IIg IS AURRH h rzMda uiu Sp u t3 uC c 1 n we wyt^n ':+:.0^+.. � s ,Dison� c ;,j a uu.:q:.daC sZ�j,)sr:.foesssy� G