Loading...
HomeMy WebLinkAboutBuilding Permit # 11/30/2015 BUILDING PERMIT "."'4 56 4"n, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Nott, Date Received l CH Date Issued: Ln WT POPUANT: Applicant must complete all items on this page gap, wo ri 7"j,no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building b One family D Addition El Two or more family 11 Industrial El Alteration No. of units: 11 Commercial ®"Repair, replacement 11 Assessory Bldg El Others: 0 Demolition 0 Other Y'a e* District I nos,, W dtbr- h, 7/1 DESCRIPT NOF WOR TOT PERFORMED: 2 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: 7 `Contractor- ,'N Phone: f"21"P"", e s e A, n 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the duaraWyfund r-mr-M AM tAORTH Town off2 '' ndover O m • , M wz LANE h ver, ass, C 0 C"1C"EW.C. 41. X1,9 RATED Jk? �(5 S U BOARD OF HEALTH PERMIT. L D Food/Kitchen Septic System THIS CERTIFIES THAT4.114Aee ... ... .......!...... BUILDING INSPECTOR 6; has permission to erect g .,,.,. Foundation Y........ ......... buildings on .. . ......... ... ..... .......... ....... Rough I " to be occupied as .... ..piting�this ...... .. .. ::........... ..................... . ......... :.................................. Chimney provided that the person accQ perm' shall in every respect conf r o the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relatin 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 PERMITI MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST 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 Approvedy the Building Inspectors Burner Street No. Smoke Det. M Y IN (,AGNSTFRUJCT101�1 `4 626 ESSEXST UNIT 1107 LAWRENCE MA 01841 ,rEl...,;978-397-9803 FAX;978-258-8311 ROOFIN(.'A',Sll)[N(.0',DR YWAI,t, ANI) MORE. PROPOSAL Submitted to: Job description LINDA Nj n n new roof 503 BOSTON ST. NORTH ANDOVER MA 01841 We propose to furnish all labor and materials to complete the following: -STRIP AND INSTALL 14 SQ. OF SHINGLES. -INSTALL DRIPEGE ALL AROUND THE HOUSE -INSTALL ICE AND WATERSHIELD THE FIRST 3 FEET FROM EDGE BOTTON THE REST COVER UP WITH TAPE PAPER -REMOVE ALL DEBRIS,AREA WILL BE CLEANUP -LABOR IS GARANTEED FOR 6 YEARS,ROOF MATERIALS ARE GARANTEED FOR 30YEARS. .-LABOR and rnaterial 'TOTAL ("10S`F $ 5,400 We propose to complete all work in accordance with above specifications for the sum of. ($5,400 WITH A DOWN PAYMENT OF$2,400. All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to specifications submitted, per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. If either party commences legal action to enforce its rights pursuant to this agreement, the prevailing party in said legal action shall be entitled to recover its reasonable attorney's fees and costs of litigation relating to said legal action, as determined by a court of compet nt jurisdictiq 7 Authorized Signature: Date:_L1 ACCEMANCE OF PROPOSAL p The above rices specificatigns and-oonditions are satisfactory and are hereby accepted. SignatureZ�, ,,1,6 Date of Acceptance ,Z o A�® CERTIFICATE OF LIABILITY INSURANCE °A�` 1130/'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(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 NAME: Armand P. Michaud Insurance Ag PHONE (g78) 685-2549 AIX No: X978) 794-0822 105 Haverhill Street E-MAIL ADDRESS: Methuen, MA 01844 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Essex Insurance Co. INSURED INSURER B: M&N Construction Enterprise In INSURER G: Juana Vasquez INSURER D: 525 Essex St. PMB 1107 INSURER E: Lawrence, MA 01841 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POUCYNUMIS ER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 3DY6888 4/2/15 4/2/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEENTED TORoccurrence) $ 50,000 CLAIMS-MADE F—x]OCCUR MED EXP(Anyone person) $ 1,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS Peraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OH- AND EMPLOYERS'LIABILITY Y/N TORY I ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) 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. 120 Main street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Trudy Lawler ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail: trudylawler@michaudinsurance.com ,acoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/30/2015 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 CONTACT NAME: Trudy Lawler MICHAUD INSURANCE AGENCY PHONE , (978)685 2549 FAx No. A/C No ADDRESS: trudylawler@michaudinsurance.com 105 HAVERHILL ST. INSURERS AFFORDING COVERAGE NAIC# METHUEN MA 01844 INSURERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B; M & N CONSTRUCTION ENTERPRISE INC INSURER C: INSURER D: 525 ESSEX ST PMB 1107 INSURER E: LAWRENCE MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER: 14884 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 LTR POLICYNUMBER MM/DD/YYYY) (MMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ '.. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS per accident L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I STATUTE ETH AND EMPLOYERS'LIABILITY Y/N A OFFICER/MEMBER EXCLUDE D7ECUTIVE N/A N/A N/A 7PJUB2E82404715 04/01/2015 04/01/2016 E.L.EACH ACCIDENT $ 100,000 '.. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. 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. 120 Main Street AUTHORIZED REPRESENTATIVE No.Andover MA 01845 Daniel M.Croa�ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndlustrialAceldents 1 Congress Street, Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILE,D WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name(Businesslorganization&dividtial): Address: !.,�? — e 5 /;/ 4 City/State/Zi . /,t,/C �s' Phone#: Are you an employer?Check the appropriate box: Type of project(required): 10 1 ama employer with employees(full and/or part-time).* 7. E]New. construction 2. 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, ❑Demolition In I am a homeowner doing all work myself[No workers'comp.nlsurance,required.]t 10 Q Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole , proprietors with no employees. 12.Q Plumbing repairs or additions 5,❑I am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors ' have employees and have workers'comp.insurance.t . 14.[]Other 6.FJ We are a corporation and its officers have exercised their right of'exemption per MGL c. 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. I homeowners who snbriuti 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 fiave employees,they must provide their workers'comp.policy number. lam an employer that is pNovidiizg worlrers'compensation insurance for my employees.'Below is the policy and jab site information. Insurance Company Name: h✓ �7 Ex irationDate: Policy#or Self-ins,Lie.#: � i' p rob Site Address: City/State/Zip: M 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 DTA,for insurance coverage verification. _ do Hereby c r of rider floe ins and penalties perjury that the information pr ovided above is true and correct. Si nature: ��� Date: S / .�: �� 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#: �B.Q�/�0111l7' a ltvo aaa��a�e Z'L 'La WUSAVWSET t x `?s 0 �z ra 5 medc,. fflee of Consumer.Affairs and Business Regulation 10 mark Plaza- Sure 5170 Boston, Massachusetts 02116 Home Improvernent Contractor Registration Registration: 181101 -Type: Individual Expiration: 2/25/2017 Tr# 262843 FRANKLIN A. FRENA FRANKLIN PENA -� 135 MAY ST -- ---- -LAWRENCE, MA 01841 Update Address and return card.Mark reason for change. sCh 1 Q 201vi-05/11 C] Address ❑ Renewal ❑ Employment ❑ Lost Card ���r�oruurr+rrrrjcrrrl�r�i^f�rf.;rrr�rrtrt(.t Office of Consumer Affairs&Business RegulationLicense or registration valid for individul use only g - f �IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: egistratiom 1811 o1 'type: Office of Consumer Affairs and Business Regulation � f xpiration: 2/25/2017 Individual 10 Park Plaza-Suite 5170 Boston,IMA 02116 FRANKLIN A,PENA FRANKLIN PENA 135 MAY S --- LAWRENCE,MA 01841 Underseere@ary Not valid without signature