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HomeMy WebLinkAboutBuilding Permit # 11/30/2015 bUILUINU FLKMI I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION a Permit NO: Date Received Date Issued: -1 IMPORTANT A hcant must com Tete all items on the a e ��;, ,, f r / r r,/i.r/� r/i r//���r..,i l/,r / �:./.,rr/ /.. i„✓, //vr�,,/� -/////i //,,.:,,,,r,,,/„i / .., /r % , // ,.-./4.r/ r,o/% r..%�.�,/ ,,,,� r.✓ r ,/rrr ��� /i ri./..//. ,. ,,,,.✓ i/a„r, . . / / / TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ElAssessory Bldg 11 Others: ❑ Demolition ❑ Other ❑ � �� ❑ 1/UII7777777777777 � 1 � �; ��,%,/,d"�r�lr�ds/ %' ►" terh 'drDi a uUtr Se�u / Identification Please Type or Print Charly) OWNER: Name: ,. r Phane: t. Address: / / ,, <. ,/, e// rr/i ri / / r//„ / / ,, %. r/f r / ✓/i/ / / / /rir, i',,, ;; ,,, � r // „� ., / ./r ./�.l r ✓ � „ / / ,,,,, r ,/,/, // l/,r ,rrr,.. - „�,,,.. r / / /i r.i,r„ rr,l ,,r 1,.,,,, r., / ✓ ,,, /. r/;. ,. r !r,,i/- r ,r; /ll ,,,-,�.,. r r,. rt/r r,/ „i r r%% ,///�/ /i��,j r ra/r // r��� !�i r„/ /,i,/�r,,,, r/0/„,//�a,vif�/i,,,lr.li.,c✓���i„f/.�6,/, /,I/�,le,.. /�, U ;; / / r /✓ r rir r r% r/ i , , f, ,. .f/�.�` ,r,r /r./ // / //.✓.G, /ii //„ .,, ./ I �. r r ,r � r,.,/,. / /..r. r r l ✓,,, r- rr / r,r r/ r l / ✓i, r, . ✓i„ / r / t / r r l r,,,rr r � � ✓r � r r r r / / � /ilii r, /, ARCHITECT/ENGINE R -- Phone: -� Address: Reg. No. FEL SCHEDULE:EULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST EASED ON$925.00 PER S.F. Total Project Coit: r ., e. FEE: Check No.: Receipt No.: � ' NOTE: Persons contractingwith unregistered contractors do not have access to the guaranty fund igriat ar df Agent/Owne Igriatur �o�odntr ctor Town of ttORT Anc'tover ? 0 ® - 6g 611401 00"'n� h ' ver, aS! S \, COCHICMEWIC 'V �®Q04ATED BOARD OF HEALTH Food/Kitchen PE �RMJT T LD Septic System 4 CBUILDING INSPECTOR THIS CERTIFIES THAT ..................... .................................. .... ....... ......................... •.................... ...... 061 Foundation has permission to erect ............... buildings on ........ ... ....jbh .. ... . .�'................. ••••••••••• Rough to be occupied as .... . ......................................................................... Chimney ....... . .... .......... ........ .... provided that the person accepting his 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final Il ® i ELECTRICAL INSPECTOR PERMIT UNLESS CONSTRUCT Rough Service ... ... ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuildiRough Display in a Conspicuous Place on the Premises — ®o Not Remove Final No Lathingr all ® Be Done FIRE DEPARTMENT Until Inspected an Approvedthe Building Inspector. Burner Street Na. Smoke Det. Julien Dupont 24 Merrill Ave.Salem NH 03079 508-243-4191603-893-4385 HIC 17524 CSL-106330 Homeowner Information: Contractor Information Peter Calkins Julien Dupont 79 Johnson St 24 Merrill Ave North Andover Ma 01845 Salem NH 03079 The Contractor agrees to do the following,work for the homeowner: Strip all shingles off of house Install 6 ft.of ice and water shield on bottom edge,3ft.in valleys and roof wrap on remainder Install 8"drip edge Will re-roof using CertainTeed lifetime architectural shingles.Color.Colonial Slate Install new vent pipe boot Install new ridge vent Dispose of all debris. Required Permits-The following building permits are required and will be secured by the contractor as the homeowners agent(Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) Proposed Start and Completion Schedule-The following schedule will be adhered to unless circumstances beyond the contractors control arise 1'r week of december 2015:Date when contracted work will be begins contracted work 3 days after start date:Date when contracted work will be substantially completed. The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: Seventeen Thousand Dollars($17,000) Payments will be made according to the following schedule: $8,500 when job started $8,500 upon completion(Law forbids demanding full payment until contract is completed to both party's satisfaction) NOTES:(")Including all finance charges(s')Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-is the contractor providing an express warranty?-No-Yes(all terms of the warranty must be attached to the contract)Subcontractors -The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement 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 interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract Don't be pressured into signing the contract.Take time to read and filly understand it.Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757 •Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confimh coverage,or ask to see a copy of proof of insurance document Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than fire contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the 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 CO CT IF THERE ARE ANY BLANK SPACES!!! Two identical cqe contract must be co leted and signed.One copy should go to the homeowner.The contractor should keep the other copy. Homeowner's Signatu e C ntractor's S'gnatu , j J� Date Date The Commonwealth of Massachusetts Departznent of IndustrialAceidents F X Congress Street, Suite 100 Boston,MA 02114-2017 �t www mass.gov/dna Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (susiness/Organization/7ndividual): ) I✓� �/�1i7 ��1!�� EP Address: City/State/Zip:_ S /, rJ� �� l Z9 Phone Are you an employer?Chec'kthe appropriate box: Type of project(required): 1.❑I ama employer withemployees(full and/or part-time).* 7. Q New cons[ruction 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. ❑Demolition 3..❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.E]Electrical p ical xe airs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and T have hired the sub-coiztractors listed on the attached sheet. 13.F!Roof repairs These sub-contractors have employees and have workers'comp.msurance.t 14. Other 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we haveno-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 sjibriif I)iis 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-ci nfractors have employees,they most provide their workers'comp.policy number. I am an employer that is providing rvorlers'compensation insurance for my en2ployees.'Belortv is the policy and lob site information. Insurance Company Name; Policy#or Self-ins,Lie.#:_ b�fi r / / / -,l _ Expiration Date: �� �� �� iil� /✓ Y/State/Zip: fob Site Address: `� -- — 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. lties of vely, that the information provided above is Prue and correct Ido hereby certify unde-triep ins andpena . Signature: Date: ffi0 Phone#: 3 57 Official use only. Do notrprite in this area,to be completed by city or toren 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#: °�`�`" ® IFII I I I DATE(MM/DD/YYYY) 11/20/15 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 pollcy(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 endorsemen s. PRODUCER CONTACT NAME: Eric Jansen Hasbany & Regan Insurance Agen PHONE (978) 685-3188 FAX N (979) 685-9460 254 Pleasant Street ADDRESS: eLic@hasbany.COm Methuen, MA 01844 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield INSURED INSURER B:Travelers '.. Julien Dupont INSURERC: dbaJulien Dupont Construction INSURER D: 22 May Lane Dr INSURER E: Salem, NH 03079 INSUR 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 ADOL SUER POLICY EFF POUCY EXP '.. LTR TYPEOFINSURANCE POUCYNUMBER M/DD/Y MMDD/YYYY LIMITS '..... A GENERALLIABILITY WS256622 7/20/15 7/20/16 EACH OCCURRENCE $ 1,000,000 '..... X COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED '............ PREMISES Ea occurrence) $ 100,000 CLAIMS-MADE ®OCCUR MED EXP(Ary one person) $ 500 ''........ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE L IMIT APP LIES PE R PRODUCTS-COMP/OPAGG $ 2,000,000 '.... X1 POLICY JECT L] PRO' LOC $ AUTOMOBILE LIABILITY COMBINEED(Ea accideNSINGLELIMTf $ ANYAUTO BODILY INJURY(Per person) $_ '......... ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PReOPPE DAMAGE $ HIREDAUTOS _AUTOS $ UMBRELLALIAB F OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION '.. B WORKERS COMPENSATION 7PJUB-2EI8812—A-15 5/2/15 5/2/16 WCSTATU- X OTH- AND EMPLOYERS'LIABILITY YIN OLL ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENr $ 1,000,000 - OFFICE RIMEMBER EXCLUDED? 7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1,000,000 If yyes,describe under DESCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Emily Crossman ©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: AC® CERTIFICATE LIABILITY IN DATE(MMIDD/YYYY) 11/20/15 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 endorsemen s). PRODUCER CONTACT NAME: Erxc Jansen Hasbany & Regan Insurance Agen PHONEFAX97a) 685-9460 (978) 685-3188 Ne: ( 254 Pleasant Street ADDRESS: eric@hasbanv.com Methuen, MA 01844 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Northf ield INSURED INSURER B:Progressive J&S Allstate Contracting INSURER C:Essex C/O Stephen Nolan INSURER D:Travlers 5 Hampshire ST INSURER E: Salem, NH 03079 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 INSR WVD POLICY NUMBER M/DD/Y MM/DDIrM LIMITS A GENERAL LIABILITY y WS217993 5/31/15 5/31/16 EACH OCCURRENCE $ 1,000,000 $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE F_x1 OCCUR MED EXP(Ary one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUcrS-comp/op AGG $ 2,000,000 X POLICY PCa LOC $ B AUTOMOBILE LIABILITY 02376094-2 8/29/15 8/29/16 COMBII..)INGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS eraccident C UMBRELLA LIAB X OCCUR CUBW5223714 5/31/15 5/31/16 EACH OCCURRENCE $ 3,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 3,000,000 - DED RETENTION$ 10,000 1 1 $ D WORKERS COMPENSATION 7PJUB-6B20508-1-15 8/30/15 8/30/16 WCRY STATU- X OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE —N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE 1,000,000 If yes,describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space isregrired) 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 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Emily Crossman @ 1988-20 10 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts Department of Public Safety IV Board of BuildingRegulations and Standards License:,CS-106330 Construction Supewisor a STEPHEN NOLAN x 16 L PHILLIP ROAD DERRY NH 03038 -xpiration: Commissioner 07/19/2017 _ '.'i/t��s-r i�rn«rrrrulfii ry;^>Jltt:afc•:iri.;._•/% N.'- rueeofconsumer'shairsc' BusinessRegulation !Af =WE IMP ROVENIEN i COM1RACT 0-R Registration: 172624f,IPe: -piration: 7!2/2016 Ind'anduat STEPHEN P.NOLAN STEPHEN NOLAN 16 L PHILLIP RD DERRY.i1IH 03038 Undersecretary