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Home My WebLink AboutBuilding Permit # 12/10/2015 t%ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received L4 C Date Issued: I—1D - CH IMPORTANT:Ap2licant must complete all items on this page /,,///////%//,r / IN � /moi/r/ij M 1 , / / / TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building X One family 11 Addition 11 Two or more family 11 Industrial 11 Alteration No. of units: 11 Commercial XRepair, replacement 11 Assessory Bldg Li Others: —E] Demolition 11 Other / , , �/iii/, , f ��//i,/� �fi�/,��//rr„rr, .J�/ mcc',-4, TrothYq 0 kci--170 i/L,-�- 4-wO &406t�' Identification Please Type or Print Clearly) OWNER: Name: Phone:/9-2 c 17- 661 Address: o / /iris ,�I�t��/%��//�,,,,r/,,,;, . ,f r,, � / , r , , , ,rrr ,rrr / /i , �� /. ��iii off, ��f, re, t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. � 00 Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc&s'-d9eguaranty fund Signotore of Agent/Owner Signature of contractor- thORTH Town ofAndover - _ . 0 No. a T ® �AKF very ass, cocNIM..C. _Av I 1' P 0R�tE® P RR�y U BOARD OF HEALTH Food/Kitchen PER Septic System THIS CERTIFIES THAT ...... .. ..... BUILDING INSPECTOR .. .. .... . . .......... has permission to erect .......................... buildings on .07.. ........ .. ........ . ... ... . ...... ............... Foundation Rough tobe occupied as ....... .... ........ .......... ............ ..... ... .......,... ................................ Chimney provided that the person acc pting this permit shall in every resp 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T Rough .................. Service ............ ...... ... ....... .... ............ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occul2v BuLlding Rough Display in a Conspicuous Place on the Premises — Do NotFinal No Lathingr Dry Wall To Be one FIRE DEPARTMENT Until Inspected r e e Building Inspector. Burner Street No. Smoke Det. M- ama NORTH town ot Andover : ', IN_ n h ver, Mass, COCMICHE WIC.[ `y ATE® rpA �2 BOARD OF HEALTH Food/Kitchen PER Septic System THIS CERTIFIES THAT ........N... BUILDING INSPECTOR Foundation has permission to erect ...............:.......... buildings on . .. ........ .. ........ . ... ..... . ..................... Rough to be occupied as ....... .... ...... ......... ............ tpac.nlorm .. ..... ... ............................................ Chimney provided that the person acc pting this permit shall .. every 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 T L D VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT ELECTRICAL INSPECTOR ook L Rough Service rt ....... .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to ccumy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. National Management Team Inc. This form satisfies all basic requirements of the state's Horne Improvement Contractor Law(DIOL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planting home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home hnprovement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consuner Affairs and Bushtess Regulation's Consumer htlbnnation Hotline at 617-973-8787 or 1.888-283-3757 or on our website. Homeowner Information Contractor Information Name CompaityNaute �. �.� /•fit'-e Street Address(do not use a Post Office Box address) Connector"3nlespersoal OanerName o"�'o ��! Crll cIi��'�" �f ✓rl tT City,"fottn State Zip Code Bntsluess A ress(nmtsl include n sheet address) o IL44— ®j" Daytime Phou - Evening Phone CityToull State Zip Cade U q �71 F�- �7J tJ' hfailingAdd<vs(It difTefent$nmabow) BusinessPhouI Federal Emplo-verIDorS.S.Nwnber q � OC) rnytmmitut Contractor Reg,KwiWr E'aplmtlmdate til LorerequEes tuotmost home *read txgitisntlou mum: H00 The Contractor agrees to do the following work for the Homeowner: (/ ® 001 (Describe in detail the work to completed,specifying the ape,brand,and grade of materials to be used,use nddidonal sheets if necessary) CN 00 9 p %�i JW P_AAj,4,_ �-nGd Al 1) .17A1A7IL(_ 1V6-9w Xd)"J'—i i ® � I�4�'%�` �/ /Y�r+-'' /fes��• �J;"?I�-�--� %/M-�ir7'�-ti a/�� /!�'�ee�. ,t7iCrUr-n2, J"/�y,✓��5. W P,t Rf f ® ® Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will a a 000 and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of 'v / Date when contractor will begin contracted work. CD 00 MGL chapter 142A.) V /J Date when contracted work will be substantially completed. �+ � Total Contract Price and-Payment ;'schedule 4 The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of F-�I rn 9y94 0 Payments will be made according to the following schedule: N Q-1 $ 0 upon signing contract(not to exceed 1/3 of the total contract price or the cost ofspecial order items,whichever is greater) $ by--- _/ or upon completion of�X B/'/ cl�6 $ by _/ ! or upon completion of $-110-6 upon completion of the contract. (Law forbids demanding full in ayment until contract is completed to both party s satisfaction) The following material/equipmeut mast be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(•*)Law requires tint any deposit or dotvn-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contact price or(b)the achnnl cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranfv-Is an express warranty being nrovidetl by the contractor? No❑Yes(all ter..of the tsatranty const be attached to the contract) Subcontractors-The contractoragrees to be.solely responsible for contple ion of the work despribed regardless.ofthe actions of any third party/subcontractor utilized by the,contractor. The contractor fitrther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement ' I Contract Acceptance-Upon signing,this doctunent 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. Rettiety the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Tarte time to read and fully understand it.Ask questions if something is nuclear, • Make sure the contractor has a valid Hoare Improvement Contractor Registration. The law regWres 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 tate Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by catling 617-973.8787 or 888-283-3757. • Does die contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proofof insurance'document. Know your rights and responsibilities. Read the Important Information on the reverse side of this font 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 cite contractor's annual place of business,provided you notify lite contractor in t'Titing 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 eplangtion of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE NY BL K SP CES!ll Two identical copiesofthecantrnctMust beconyletedand signed,pnecopysbouldgotothehoru "id.Theaher yshouldbekep bytheeounctor, Homeowner's Signature p nitre or s Sign [are / J L/ Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/She has With a homeowner in court unless both parties'agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeovnrer by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and BusMptive t, con ►ner shall be required to submit to ssu�ucF�h.�arbitration as provided Ii Massachusetts General vv� Homeowner's Signature Co eNOTICE:The signatures of the parties above apply only to the agralternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights tinder the Home Inprovement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law, The contractor is responsible for completing the work as described,in a timely and workmanlike maturer. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts cavy an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Inforniation Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed_until-a copy of exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attaclunents is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/lterself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiords from said account would require the signatures of both patties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.nlass.iaov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional infortnation specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at bttn://wuxv.Mnss,eov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: littp://db.state.ma.us/itoineinit)roveineiit/liceiiseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 AOCOORO CERTIFICATE LIABILITY INSURANCE DATE(MMIDDIYYYY) T '1415 HIS 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(% AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an AbDiT10NAL 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 Circle Business. Ins. Agcy, Inc NAME: PHONE 247 Newbury Street 978 777-5619 FAX 978) 771-4898 EMAIL al No: Danvers, MA 01928 ADDRESS: INSURE S AFFORDING COVERAGE NAIC# INSURED INSURERA:Hartford Underwriters Iris. Co. National Management Team Inc. INSURERB:Main Street America 2 Austin Square INSURERC:Torus National Insurance Co. Lynn, MA 01905 INSURER D:Merrimack Mutual Insurance INSURER E: COVERAGES INSURER F: 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. LTR TYPE OF INSURANCE ADDL SUDR POLICY EFF POLICY EXP INSR WVD pOUCYNUMBER MM/DDIY MNIDD/YYYY LINTS B GENERALLIA81LnY Y, Y MPT7965M 2/24/15 2/24/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY TORENTED CLAIMS-MADE a OCCUR c $ 500,000 MED EXP(Any one person) $ 101-000 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER, GENERAL AGGREGATE $ 2,000,000 POLICY $ PRO' 1-1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 B AUTOMOBILE LIABILITY EE $ Y Y MPT7965M 2/24/15i/24/16 CaGdetOdSINGLELIMIT ANYAuro $ 1'000,000 ALLOWNED SCHEDULED BODILY INJURY(Per person) $ X AUTOS NON -OWNED BODILY INJURY(Per accident) $ HIREDAUTOS R AUTOS Pe�ac AMAGE $ C X UMBRELLALIAB $ OCCUR y y 85824I140ALI 2/26/15 2/26/16 EXCESSLIAB CLAIMS-MADE EACH OCCURRENCE $ 5 000 000 DED RETENTION$ AGGREGATE $ 5,000,000 A WORXERSCORS'LI ATIONILIT YIN UB2E71937-6 2/21/15 2/21/16 x WCSTATU• OTH- $ AND EMPLOYERS'LIABILITY ANY PROPRIETORPPARTNER/EXECUTIVE OFFICEtoryRIM In BER EXCLUDE N/A E,L.EACH ACC10ENr $ 1,000,000 (Mande In NH) DE3�RIPTIONOFOPERATIONSbelow E.L.DISEASE-EA EMPLOYEE $ 1,000,000 D Rental Equipment cover IMC8-454-711 5/21/15 21 16 5 E.L.DISEASE-POLICYLIMIT $ 1 000 000 / / Limit 100,000 REPLACEMENT COST Deductible 5,000 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 Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Janet Nichols ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. Phone: The ACORD name and logo are registered marks of ACORD Fax: E-Mail =rAka1rS ?Busi�ss e ation p�:ce of Consum 10 Park Plaza- Suite-5170 Boston, M saclhusetts 02116 Plozne improve ontractor Registration Registration: 178186 Type: •Supplement Card Explmtlon: 3/2412016 NATIONAL MANAGEMENT TEAM } GEORGE VASILIADES 2 AUSTIN SQUARE LYNN, MA 01905 C Update Address and return card.Mark reason for change. Address Renewal E] Employment Lost Card. SCA1 t5 2GM•05/!1 py �� J �tLe TpQ?3l/ylLdRtlle 6��1!/L[7CCLl4lttfde� ' ce of Consumer Affairs&Business Regulation License or registration valid for individuI use only ME IMPROV ENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation gIstratT OeESIX)PT TYpe: 10 Park PIaza-Suite 5170 tT Supplement Care! Boston,MA 52116 NATIONAL MAMA c;' GEORGE VASILT .` P.O.SOX 365 TOPSFIELD,MA 01983 'Undersecretary Not valid Without signature f y' r The Commonwealth ofllf'assacliusetts T Department of Xndustrial.Acculents Office of Xnvestigations 600 Washington Street Boston,MA 02111 s" ipww.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciazis/Plumbers Applicant Information Please Rrint Leggily Name(Business/Organization/Individual): A/ Address:__ 2 City/State/Zip:_ liYV / Phone M �c9 Are you an employer?Check the appropriate box: Type of projdet(required): I. I am a employer with_ /0 4. ❑ I am a general contractor and 1 g, ElNew construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees • These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'camp.insurance. 9. ❑Building addition [No workers'camp.insurance 5. ❑ We are a corporation and its I0.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have:no 12.[ZRoof.repairs insurance required.]f employees. [No workers' 13. Other camp.insurance required.] *Any applicant that checks box flI must also fill.out the section below showing then•workers'compensation policy information. t Homeowners who submit this affidavit,indicating they are doing all work and then hire outside contractors must submit a new affidavit indicakssuch. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inlonalion. f am an employer tliat is providing tporkers'conipensatioii insurance for my employees Beloip is the policy arul job site information. Insurance Company Name: /'r,pig /�t�e�12 C✓�✓i 1-6114 /A1,P 10, Policy#or Self-ins.Lie.M e °�'f ' , •- (d Expiration Date: A& Job Site Address: 2 i City/State/Zip: ZU0AM 414 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Officeo£ Investigations of the bIA for insurance coverage verification. X do hereby certify r r��m mid penalties of perjury that the iniforntation provided above is trite and correct Simature: Date: •. Phone#: 1 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 S.Plumbing Inspector 6. Other Contact Person: Phone#: ............... Massachusetts Department of Public Safety Board of Building Regulations and'Standards License: CS-080148 Construction Supervisor GEORGE VASILIADES 5 PITCAIRN WAY ,. IPSWICH MA 01938 `. . .. '�_/(►"^^ Expiration: C:oMmissioner 10/26/2017