HomeMy WebLinkAboutBuilding Permit # 12/9/2015 V%OaTH
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BUILDING PERMIT
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION
Permit NO. Date Received
Date Issued: �SSgcwuS��
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE "`
Residential Non- Residential
❑ New Building (*One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
epair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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Identification Please Type or Print Clearly)
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OWNER: Name: ����, � � -�� - �� Phone: LO
Address: N
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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: $
NOT Check N Persons contracting: istered contractors do have ac'cess'to
with nreg' s'
h.. ora fund
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Slgnature'of Agent) weer Ngnaure +�f'contractor // ,
'Townof
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BOARD OF
BUILDINGLD
PERMIT Septic System
a_ .
RoughTHIS CERTIFIES THAT .................. .................... .. .....................................................
has permission to erect .......................... bui,Iding's on ......Mar-b%&...., ...400� Foundation
o `•• occupied
Final
provided person • • thi • i ��1 • !' ! • '...•
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMIT EXPIRES
> E J,. MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI
f , • Rough
Y
Service
BUILDING •-
SmokeGAS INSPECTOR
Occupancy Permit Required to Occupy Bu Ro u*gh
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 Approved by the Building Inspector. Burner
Street No.
.
Bid Date: �- 11/27/2015 United Home Experts Full Worker's Compensation Coverage
$4,000,000+Liability Ins.Coverage
Owner: Rich+Maureen Fields &United Painting Co.,Inc. Industry leading Warranties
Company: 60 Pleasant St.Suite 1 Flexible Payment Plans available
Street Address: 450 Marblefte Rd Ashland,MA 01721 Family Owned and Operated
City,St.Zip: N.Andover,MA 01845 508-881-8555 FAX 508-881-5584 MA HIC License#157108
Phone#: 978-975-8100 www.UnitedHomeExperts.com MA Constr.Supervisors License
Phone#: RI REG#22948
RRP License#NAT-28008-1
Fed ID#04-3541521
Qty:
Roof Shingle Replacement Remove existing asphalt shingles and install new asphalt shingles, 50 Year Warranty
underlayment,flashing,and proper ventilation:Owens Corning
system.
Brand(if applicable):
Brand(if applicable): Total Cost of Labor and Materials: $14,023
PAYMENT TERMS: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon contract authorization with 1/3 of
EACH PROJECT due upon half of completion of EACH PROJECT,and the balance of EACH PROJECT due
upon completion of EACH PROJECT along with any additional work requested by customer.
LIENS DISCLOSURE: State law requires us to inform the property owner of contract liens.A lien or security interest has NOT been
placed on the residence.Any contractor,supplier,or subcontractor may lien the real property if the property owner
or the general contractor fail to pay for goods or services delivered or installed at the work location. Some
contractors and suppliers automatically send letters of notification similar to this notice. At the owner's request,
we will provide original lien release documents from anyone who provides said materials or service.
NOTICE OF CANCELLATION: The property owner may cancel this transaction at any time prior to midnight of the third business day after the
date of the contract without any penalty or obligation and has been notified in writing of such.
NOTICE: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor
or subcontractor relating to a registration should be directed to; Registration Division,Program Coordinator,One
Ashburton Place Room 1301,Boston,Ma 02108 Tel:(617)727-3200 ext.25239
PERMIT: A building permit is required for work being done on the property listed above,The owner has authorized United
Home Experts to obtain such permits as the owner's agent for any work requiring a permit.Owners who secure
their own construction-related permits or deal with unregistered contractors shall be excluded from access to the
Guarantee Fund.
SCHEDULE: The following schedule will be adhered to unless circumstances beyond the contractor's control arise.
Proposed Work Start Date 12/19/2015
Proposed Completion Date 2/2/2016
7 B
Contractor ignature Date XorizedAgent Date
The Commonwealth of Alassachusens
Department of 1nd fat Accidents
Office of Invesdgadons
' 1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/die
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrieians/Plumbers
ADDUC26t Info anon Please Print L `blv
,.
Name (Business/Orpnizaaon/ladividual): l / mJ
City/state/ ' 1 Phone tJ
Ar to employer?Chectt''the apPropriaste Fina. TyO of projeirt(requir'ed):
4, [� 1 am a general contractor and I
1. I am s employer with 6. ,�New construction
have hued the`sub-contractors
emloyt!es
or
listed on the attached shat. 7, . • odeling
2.❑ 17 critic , „ „t c�r'p rtaer-
ship and have no employees These subcontractors have S. Dein&l ion
tvt5 for`ista
in s►city, employees.and have workers9. ❑ Building addition
[No workers' comp. insurancecomp, insurance.'
5. ❑ We are a corpm*on and its 10,0 Electrical repairs or additions
officers have ez ire":ised i ieir 11. Pltdnbfas or additions
3.❑ 1 a¢n a ho{neowncr doing aU work r Q , g�epaars
right of exemption per MOL
mysela~ [No waters comp. 12.[ Raof repairs
insurance required.]t i."t$2, 1( ),maid we have no
employees No vvoriim' 13,[] Other
co ice'
iweq that chceb box�l,Mt*also 00'0469 secttat 6010 +siwwing t C . =-Vpestsaui�a policy` rtn lion. �`>
tnib
t�opvvouers'�tvhib'sttbanciUtas 4M&d * ~` 0M ae doiag'aU vrui�t egad ttezn'�iire da�tsiibs'aai►63ctm&Uat submit a am affidavit Wkattng such
tContractoa tttat clueck"unit'ittnt cfmiasf`atascitwmd'�td
MdOW shat sbowft4 thinaki of'uae"sulY=contiadors and ouft whethir or not those entities flava
awwyem Ube dwy 1444 PMVi c-*Ale ,wacky'Camp.policy' ;
[am an-employer that is ro urgers'eo ensadton.1nmrance or iii: ``{ ee� Below-1,me wand b wle
e�►aypluy p vl�leg mp 1� .���'.Y Pa'�Y .�
informadom
Insurance Company Name: ,r�
Policy#or Self- . Lic, #; yzpinatian Date: Cilli
Job Site Address:. City/State/Zip: Ljwylrz,
t►ttach a Or,of tl4e.ergt�ie eompe tion pulley tieclkratlpa page(s6owiing the poik� number and eipi 'tlQq date).
Failure irloy,
roe 4 t uxtde�r Witton 25A of MOt c. f$2 ran lead to.the uxsposrtiop of ties of a
@ ` l t one `t prisonmenit,,`ass wed ale civil pernalttes in me form of sTC7P WOR I ¢ t and a fine
ofu►I►W ,t?O ai "s���vi¢ t" a t:opy of this Viten may be a t7cc of
t,' ±e advised that E 'forwarded
tea the,
Ga 070090"atoo coverage yetdon.
r do h n " dkd "aced ii P nr1''that the laforirtodirrr pr6vlded above is true e and r correct
a .
�w vete:
Uf cw use only. N not wr*e In `area,'to be completed'by d ty or toren qff1dat.
City or Town: Perwit/License #
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.Clnty/Towa Clerk 4. Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
CIP ID: KG
' I LIABILITY INSURANCE DATE IMWDDIYYYY)
CERT08/06/2015
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(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
Douglas Insurance Agency NAME:
East Dou
9 9 Y PNONE FAX
PO Box 1370 INC,No,Ext): (AIC.Nor
Douglas, MA 01516 E-MAIL
ADDREss:
Marc Larocque PRODUCER UNITE 51
CUSTOMER ID#:
INSURERIS)AFFORDING COVERAGE NA:C n
INSURED United Painting Company, Inc INSURER A:Essex Insurance Company
dba United Home Experts INSURER B:Commerce Insurance Company 34754
60 Pleasant St. Ste 1
Ashland, MA 01721 INSURER c:Essex Insurance Company
INSURER D:AEIC
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.
i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR Y EFF POLICY EXP
TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DD/YYYY MM DOffYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
A X COMMERCIAL GENERAL LIABILITY 2CU3629 0411512015 04/15/2016 DAMAGE 10 RENTED
PRER11SE5IEa occurrence) 5 100,000
CLAIMS-MADE X OCCUR MED EXP[Any one person) S 5,000
PERSONAL&ADV INJURY_ S 1,000,000
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMI-r APPLIES PER. PRODUCTS-COMP OP AGG S 2,000,000
POLICY PRO-JECT LOC 5
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000
IEa accident)
B ANY AUTO BOGTQN 04/1512015 04/15/2016
BODILY INJURY(Per oersow S
ALL OWNED AUTOS
BODILY INJURY(Per acadenC S
X SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS tPER ACCIDENT) 5
X NON-OWNED AUTOS 5
I
5
UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 4,000,000
X EXCESS LIAR CLAIMS-MADE AGGREGATE 5 4,000,000
C 10105017 04/15/0015 o4/1s/2o1s
OEDUC r IBLE $
RETENTION 5 3
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N TORY LIMITS X ER
D ANY PROPRIETORrPARTNERExECUTIVE WCC5010274012014 08/15/2015 08115/2016 E.L EACH ACCIDENT S 500,000
c*lkJI:FWMlEMBLHLXCLI)ULI NIA
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE S 500,00
II pas.descnbe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule.if more space is required)
All corporate officers are covered under the workman's compensation policy
I
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
404
AUTHORIZED REP ,
Marc Larocq .
071988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
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V60/0 ""J-I el
Office of Consumer Affair
_ sad usmess Regulation
10 Park Plaza - Suite 5170
Boston, Ma achusetts 02116
Home Improvemo, I ."ontractor Registration
_ Registration: 157108
Type: Supplement Card
UNITED HOME EXPERTSn � F °(r Expiration: 9/5/2017
MICHAEL DUDLEY �r./ y --
60 PLEASANT ST STE1 \v� y- ''� --- ----- _
ASHLAND, MA 01721
u ?% Update Address and return card.Mark reason fo change,
SCA 1 Co 20M-05n1
Address F] Renewal [] Employment Lost Card
d-1/IU ((J(A'!!P//ILfJYLIIIQ(G�C�.O � /(/1,pdJC7{_�f(tJ(;. il
ice of Consumer Affairs&Business Regulation License or registration valid for individul use only
E IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
gistratioo 157i,�iType 10 Park Plaza-Suite 5170
Expirati n��M R Supplement 7 -,. Su
qi<x r;,r pP Carl Boston,MA 02116
UNITED HOME EXPO
MICHAEL DUDLEY Q Get c
60 PLEASANT ST STE
ASHLAND, MA 01721 Undersecretary Not valid without signature
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