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HomeMy WebLinkAboutBuilding Permit # 11/9/2015 BUILDING PERMIT of NoeT b�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0-1 Permit No#: Date Received SSACHUSE Date Issued: 9-5 IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP _PARCEL: P ZONING DISTRICT: Historic District yesUno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One milt' ❑Addition wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �,��''" ;�".'5�'.'� ��`� � � g.r� rr.<x f,. � r 1• �.�x� ^'i f "� ru � � �j � r.�." � .. 10, R _ DES PTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: 14��r—l( ® EEC ? Phone: Address: Contractor Name: /✓�/ / �� Phone: Email: Address: Supervisor's Construction License: A�Z(-;, Exp. Date: A14 �T Home Improvement License: ��/ 3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE T.$12.00 PER$$11000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 9 Total Project Cost: $ ` c > FEE: $ c Check No.: A Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund FORTH qTown ofl An.do' ver 0 0% 1511 -- 20 - ® t.AKa ver, Mass, COCNICNEWOCK BOARD OF HEALTH PER LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............ ... ................. ............ ..................... ................ Foundation has permission to erect .......................... buildingson ........ .. .... ... ........... ....... .. .... . e........... a Rough tobe occupied as ................. .. .... ......... ....... ..... . ..................................................................... Chimney accepting this permit shall in ever provided that the person y 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITI IN T S ELECTRICAL INSPECTOR UNLESS CONSTRUC S TS Rough Service .......... ..... ...................................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on thePremises — o of Remove Final No Lathing or Be® Wall o Done FIRE DEPARTMENT Until Inspected and Approvede Building Inspector. Burner Street No. Smoke Det. Page# of pages CS #022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitted To• Job Name Job# r . r „ Address ~,y Job Location A/' /V'I Date ,b [late of Plans llwv Phone#� Fax# Architect We hereby submit specificatiort�and estimates for; " u �"",w �'uP���r^^' „u!� ,,,,,m„w^` ��m^'� r��"'4�mumu•'`"� �um�'^�'�'�m'm,.� ���""" 4. ������r � �V" v ^"'r+�N" a, ,r'��,.""�' ell �� f"r` ��P.�",.-,rnt i'� . �t' �� u�`��',.,o �^✓ . �' „�^,;��Yv� � �,��”, "�,�; ��;�„ s„.�.m�, � W „p „„m �, �� �+' '�wt�° d�o�" �*� u �r '"�✓.° � ��.�u�"n� m" m�'4��ma�" rt�^'� ~V�I�inW�'�' �"� w ,��^'""�P�m ��M�`� �,�.� "� ✓ ,. ��ip. �willuM� rvC�u°""� ��P rv�,'�'� ud m�'�'wmrm".w."'nYr^nroW � . umquA Y /' . � a �nnPw .� e m•^��. ,. :w�� ,mom m^;�mw'"'� 4d,.m�»+^ � .m",M.:«.,u',wm^m �wm °� "tl" �wmm�"" ��m,.. ?F�"�m � r�r m� i i F ropose hereby to fumish materia and labor—complete in accordance with the above specifications for the sum of: 151 � Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully � �� * �`�° /7 �r executed only-upon written order,and will became an extra charge over and Submitted " above the estimate.All agreements contingent upon strikes,accidents,or delays 1 beyond our cdhirol. Note—this proposal may be withdrawn by us H not accepted within days. rabove es,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MOL chapter 142A),but does no't Include standard language to protect homeowners. Seek legal advice if necessary. Any personplanning horhi ittuprovements should fiis'f obisin a copy of"a Msssachusetts',consumer guide to home improvernent"before ag wing.to any work on yourresrdened.You may obtaina free copy by'calling'the' ' Office of Consumer.Affairs and Business Regulation's Consumer Information Hotline at617-9738787 or 6888=283-3757. Homeowner Information Contractor Information- ameCompanYam Street Address(do not use a Post Office Boz address) contractort SajoiiSonl Owner Name Ci IT State Zip Cbc� usine"Address(must include a street address) . Daytime Phone Evening-phone- iryfrown State Zip Codd s7 Mailing Address(It different from above) 3usiness Plfohe ederat Employer M or S.S.Number lav"QWM lLamMLometm• Acme lCommdur Req.-Numbv E.Phtda4Nle pmmml ooaaaetm buyer c _ slid rtaWadoa numMr The Contractor agrees to do the following work for the Homeo per:- 1100 Jw 5�auul,anu gr i to De Required Permits-The following building pe'imits are required Proposed Start and'CompletionSchedule•The following schedule will and will be secured:by the contract nr'as the'homeownet's agent; be adhered tounless circumstances boyond:the contmetor's'control arise (Owners who,secure their own permits will be excluded'from,the Guaranty Fnkid:provisions of l I! v Data when coiifmctor will begin contracted work, MGL chapter 141A:) /a—Date Date when contractid .work willbeaubstantially completed. Total Contract Price and PaymentSchedule r 00 The Contractor.agrees to pdrfonn the work furnishthe materiel and labor specified above for the total sum of: ✓�F Payments will be made according to the following schedule: S upon.signing contract(notto ekceed 1/3 of the total.contract price.gt the coscof special order items,whichever is.greater) by '--7---/ orupon completion of — / or upon completion of //I S r upon completion of the contract (IAw forbids demanding full payment until.contract is core leted to both party's satisfaction) The following mattmal/equipmmt must be special S pard for ordered before the'contracted workbegins in order S to be paid for to'meet the completion schedule.(••) 'NOTES:M Including all(mance charges(••)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 an express warranty being provided by the contractor? No Yes fnllterms of the warranfv muff be atrogbed to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work descnbed regardless of the actions of ariy ffiird party/mbcontractorudliu8 by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and laborunder this serecment 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 interesi�lias 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 fullyunderstand iL'Ask'questiotis its is unclear. • Make sure the contractor has a valid Homolinprovement Contractor Registration. The Vi requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement ContractIIt Registration, You may inquire about.conimctor registration by writing to the Director it:One Ashburton Place,Room Dill,Boston,MA 02108 or-by calling 617-727-3200 or . 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • 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 aw.You may cancel this agreement if it has been signed at a place otheithanthe contract6es'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 theattached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Twoideodeal copies of the beeon1plewandsisned,Onecopyrbouidsotothebomemvne. other copy should be kept by the contractor. .. �i! t Homcowne s Signature Contractor's Signature Date ;Date The Commonwealth of Massa chusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 ' Boston,AM 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information �� Please Print Le0bly Name (Business/Organization/Individual): (-/Z1J Address: City/State/Zip: ne#: ql7 —0- 73 A;reyo>,ua niplOyer?Check the appropriate box: Type of project(required): 1. I am a employer with •/. employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.No workers'comp.insurance required.] - 9. ❑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 Plumbig repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.81Coof repairs These sub-contractors have employees and have workerscomp.insurance.# 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL G. 14.F1 Other 152,§1(4),and we have na 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. T Homeowners who submit 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-conirae{ors fiave employees,they must provide their workers'comp.policy number. I am an employer that is providing►vorkers'compensation insurancefor my employees.'Below is the policy and job site information. Insurance Company Name: (2 Policy#or Self-ins.Lia )100 rad Expiration Date: c Job Site Address: /.� C/�i �� City/State/Zip: L /, 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. I do hereby creunder the pains andpenalties ofpeijury that the information provided above is true/ d corr•ect. Signature: Date: Phone# ��" `� �J�,�7 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#i: kb CERTIFICATE LIABILITY INSURANCE DATE(MMIDDIYYYY) 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(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 00775-001 RAJ?CT Durso&Jankowski Insurance Agency Inc A/ %.Ext: (978)682-5175 1 A/C-No.: (978)794-0313 198 Mass Ave Suite 101B �� ss: North Andover,MA 01845 AFFORDING INSURER A• A.I.M.Mutual Insurance Company 33758 INSURED INSURER B Arthur Walsh A a Walsh & Sons INSURER 55 Pleasant Street ( SURE North Andover, NA 01845 INSURER 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 yyB��Y����PAID PCLAIMS. ININ4 TYPE OF INSURANCE YVVBD POLICY NUMBER MM/DDlYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S P EMISES Ea occurrence) CLAIMS-MADE F—]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S OLICY E 0- OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) S , ALL OWNED SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) HIRED AUTOSNON-OWNED PROPERTY DAMAGE AUTOS (Per accident) S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE AGGREGATE $ yypRKKDEEEDgg CCppryry�� RETENTION S C g 7�J 7 S AND EMPLOYER8�LIABILITY X TRY LAMITS OR- A P R R/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT S 100,000,00 A OV KI �`�R EXCLUDED? Y N/A AWC400-7014648-2014A 11114/2014 11/14/2015 1� (Mand dat eP �t$N ory In NH)) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 6��sCRI9PERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000.00 LJ 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 I _ ibJassachusetts . 7opartmeni or hi r S as Or Board of Building Rcgulatron— ana Construction SuperA icor License: CS-022680 Y: ARTHUR J WAU01 JR 159A WAVERLY-RD a N ANDOVER MA 01845 Expiration 954— Commissioner 06/09/2016 \ Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 103358 Type: xpiration: 7/7/2016 Private Corporatio. A.J.WALSH&SONS,INC: Arthur Walsh 55 Pleasant St a N Andover,MA 01845 Undersecretary