HomeMy WebLinkAboutBuilding Permit # 11/9/2015 %AORTH BUILDING PERMIT 0q qLED 16 Q- TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION PermitNo#: Q (-2e) Date Receivedp0 �SsaCHU Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 0/<7 1,-A 4-LLz Print PROPERTY OWNER 112 t2/ A* _PARCEL0'7qPrint 100 Year Structure yes no MAP 00/�/ ZONING Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside al Non- Residential ❑ New Building 0'6ne family [I Addition [I Two or more family El Industrial El Alteration No. of units: El Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other w DES ,ffRIPTION OF WORK TO BEPr FORMED: zre-, de tification- Please Ty or rant Clearly /1 4— OWNER: Name: Z Phone: Address: // 7 19y ah"rll(--, CS Z— AO Contractor Name: �k FSP hIVP -S-0 Phone: Zk —6,73 Email: Address: A5 7TO~ 7C 77� Supervisor's Construction License: _Exp. Date: �/r'� - Home Improvement License: -Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINGRZir:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ,�5 0 ; JA Total Project Cost: FEE: $ Z/ Check No.: Receipt No. NOTE: Persons contracting with unregistered contractors do not have access o the guarantyfunt. -7- 7"77,; ic"l-n"k�i�—LEDnf, 7 -F I T.x I�ME 77, pr �wr Bill, WIT Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sonsor 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted To: 11 Job Name Job# Address ; Job Locations' „ p hate ! Date of Plans Phone# t^a * , ��� " Architect We hereby submit p cifications and estimates fo: p n � Of P .....,'„ wmy mm" �� s'"d " �,.^ , m r� "'„gym wwwr"rwim � "' ,,? ""'•^ aoo "'±�,,,,wam w+h� " *°� .� '0 z"?.A1,„ ' ? ate" e` 6Z' rl I rW7/; hereby to furnish material and labor—complete in accordance with the above specifieatlegn „for the sum of: $ 44.4 „M , 1 �„41„ Dollars with payments to be mae as follows:Any oion nlyor deviation upon written order,om ve andspecifications fbecome anving extra extrachargcests overlll be and Reti executed submitted shove the estimate.AA agreements contingent upon stakes,accidents,or delays beyond our cohirol. Note—this proposal may be withdrawn by us H not accepted within days. �CCE�11}BIXCCe The above prices,specifications and conditions are satisfactory and are g hereby accepted.You are authorized to do the work as specified. "Snature Payments will be made as outlined above. Date of Acceptance r), ” µ” / 5" , Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form,satis6es-'all basic requirements ofthe state's Home Improvement Contractor Law(MGL chapter]42A),but does*not Include standard language to protect homeowners. Seek legal advice if necessary. Any peisonplanriing home"' prove mens should fii'stobtain a copy oP"a Massachusett.,00nsttmerguide to home improvement"beforeagreeing.to any work on yourrtsidenee•You may obtain a free dopy by'calling the, ' Office of Consumer.Affairs and Business Regulation's Consumer Information Hotline at-617-973'8787 or 1#888,2834:717. Homeowner Information Contractor Inforimation Name f ... .� Company Nam .. ... ,. w � x d, N ✓✓ ( f6ca ox address) ntracto a1 Owner Name Street ddress do not use a stO City/ro Stat Zip Code usiness Address (matt include�aJ address) . �Z� DR PhoneEveningPhoifo ity�o state ip Code 7 ", �9,'m CJ S Mailing Address(It different ft&above) 3usiness Phoria edera]Emplo a ID or S.S.7Vumber ' lav rcqufro autmwt 6omcim• name lCmtr�etir ReaNmu"r nxpinuoo-dta -' Pm reg 000tridmf levet +tWw.uon arrow / (✓"„ ,57" �/"� The Contractor agrees-to do the following work for the Homeo per reg ,pry Required Permits-The following building pemtits are re4ftoposcdAd'Completion•Schedul: -The f illowing schedule will and will be secured:by the contractor'as the'homeowner'seess circumstances beyond the contractoes'control arise (Owners who,sectrretheir own permits wi116excluded from the,Gparanty Furid'provisionso when'contractorwill begin contractod work. MGL chapter 142A:) e when contractid .work will besubstantially completed.. Total Contract Price and Payment Schedule , The Contractor.agrees to perform the-work,fumiah the material and labor specified above for the total sum of. (*) yments will bejQe according to the following schedule: S upon signing contract(nottb exceed 1/3 of the total:oontract price.gf tho cost:of special order items,whichever is greater) $ by / / or upon completion of ' / / of or upon completion of R sM upon completion the contract. '(Lawforbidsdemanding full payment until.contract is completed to both party!s satisfaction) f� Ile following matedallequipmeatmust bespecial SueAo" �dfor ordered before the aontracted'work'beguts in order S. to be d for to meet flie..completion schedule(**) NOTES:(*)Including all finance charges(**)Law requires that any depositor down-payment require!by the contractor before work begins may not exceed the greater of(a)on&oiird of the total contract price or(b)the actual con of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an txoress warranty being provided by theto No Yes .tatlttrms of the warrenly mr_ hg B pd to the contract) Subcontractors The contractor agrees to be solely responsible for wmpletron of the work deacnbed regardless of the actions'ofeny thrid party/subcontractorutilized by the contractor, The contractor further agrees to be solely responsible for all payments to all subcontractors foi materiels and laborunderthis agreement Contract Acceptance-Upon signing,thm document becomes a binding contract under.law• Unless otherwise noted within this document,the contract shall not imply that any Gen or other security interest hag been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into sighing the contract•Take time to read'aad fully understand it'Aak'queationa if soniethins is unclear, * -M-69.111M the contractor has lid u The Itiry requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contmetai Registration, You may y.in quire about.coniractor registration by writing to the Director at One Ashburton Platt,Roam 1301,Boston MA 02108 orby.calling 617-727-3200 or _ 1-800.223-0933. .,. * Does the contractor have insurance? Check to see that yo»r'conasetor is properly insured * Know your rights and responsibilities. Read the Important Information on the ievern side of this foriu and get a copy of the Consumer Guide to the Home bntprovement Contractor Law: You may cancel this agreement if it has been signed at a phtee other than the co'ntractdr's'normal place of business,provided you notify the contractor in writing at his/her main offi6c or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight o]th. third 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 SPACES!!! MTwo*dwntiics0fthenxjmbeeomplcWandsigned•Owmpyabouldgototheho .The odic Amid be kept.by thelel - Contractor's Signat�ry � Dau Date �° a. 0 CERTIFICATE LIABILITY INSURANCE DATE(MMIDDNYYY) 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 t0 the certificate holder in lieu of such endorsement(s). PRODUCER 00775-001 -"R JA A/ Durso&Jankowski Insurance Agency Inc C.No.Ext; (978)682-5175 (978)794-0313 198 Mass Ave Suite 101 B EA�� Ess. North Andover,MA 01845 -INSURE COVERAGE INSURER A• A.I.M.Mutual Insurance Company 33758 INSURED Arthur Walsh INSUBER B: A J Walsh & Sons 55 Pleasant Street l Su ER D North Andover, MA 01845 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 cYYBEEYFFFFPAID ppCLAIMS. QTR TYPE OF INSURANCE INSR POLICY NUMBER ANN%) MM/DD�YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES E occurrence) CLAIMS-MADE 0 OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ ENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY EO OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMITtEa acciden $ _ ANY AUTO BODILY INJURY(Per person) S , ALL OWNED SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accide t S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE AGGREGATE $ yyp i DDEERDg Cpry� RNETEENNTIIONN $ �/c g 7H $ ANDEMPLOYER8€LIABILITY X TORYLAJITS OER A PROPRIETOR/PARTNERlpT EXECUTIVE E.L.EACH ACCIDENT $ T 1QQ�QQQ,QQ A o� ICERRJJMMEEMMBBEERExCCLUUDDEE Y N/A AWC-400-7014648-2014A 11/14/2014 11/14/2015 - (Manddatory In NCH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 6��asbWf�ON�F 9PERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/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 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department oflndustrialAccidents . : 1 Congress Sheet, Suite 100 A Boston,MA.02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTIC`1G AUTHORITY. Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): Address: City/State/Zip: hone#: �. Areyou ane ployer?Check&e appropriate box: Type of project(required): I.Ejfam a employer with < . employees(full and/or part-time).* 'l. U New construction 2.�I am a sole proprietor or partnership and have no employees working for me in 8. F1 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.insurance.t 6.Q We are a corporation and its o£�cers 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 the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must si ibmit 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 employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurancefor my employees.'Beloty is thepolicy andjob site information. /Y2 6` Insurance Company Name: /Yd',1 F Policy#or Self-ins.Lie. Expiration Date: : �A c Job Site Address: ! � ai'� ✓ir 1 City/State/Zip; Attach a copy of the workers'compensation'pollcy 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 enalties ofperjujy that the information provided above is true and correct. Si nature: Phone#• " Official use only. Do not write 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#: Board.of'03uillding Cojlatrllclion super%11or License: CS-022680 ARTHUR J WALS0 JR 159A WAVERLY,RD N ANDOVER MA 01845 Commissiooer 06/09/2016 Office of Consumer Affairs&Business Regulation �QME IMPROVEMENT CONTRACTOR egistration: 103358 Type: Xxpiration: 7/7/2016 Private Corporatio, A.J.WALSH&SONS,INC. Arthur Walsh 55 Pleasant St N Andover,MA 01845 Undersecretary