Loading...
HomeMy WebLinkAboutBuilding Permit # 1/27/2016 I %AoRTf1 BUILDING PERMIT o¢��L�o "-1,'06 TOWN OF FORTH ANDOVER '. a APPLICATION FOR PLAN EXAMINATION f Permit No#: Date Received �Rp�garEoWPe" �� Date Issued: ' IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER d Vz-L Print 100 Year Structure ye J' n MAP PARCEL: ZONING DISTRICT:c Historic District y s Machine Shop Village y s TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential - ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _. rr,,, ... _r�.. ,r L.,. . ,.. � ,. /; /., // „"r ,i,. ell 1, % �,: /. i/,r ,.1 �1,r. 1J „✓ ,/ ,�;: ./ � / ��y, , „,f Wa e edr,District/, � D r /„ elands, , / ❑,/J t / ,, F a d F i n / // i, / r r / r/ r /i Se tt r. r it ,r i / / /r / r , � � f � o. / / � r. r � / 1�j„ /,d�l.,,�,:,/„ ,:... �i,,,,,,,,1X•,, �ir���//, CFtIPTlt7 F UV T® BE PIFOR ED; _ t � DEQ � � Gk' � I ✓ t � 5` x9�1. <--- r 6 f Identification- lease'Type or Print Clearly OWNER: Marne: r.J .L- C i Pho e I� _ Address: / G �� ' IU - -- - --- ------- Contractor Name Phan Email: ✓ / . I & Address: r 1 w -Q. Supervisor's Construction4icense: sfjl 06a3 Exp. Date: Home Improvement License: ' ' Exp. Date: s ARCHITECT/ENGINEER X � Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ / FEE: $ n Check No.: Receipt No.. , NOTE: Persons contractz zg with unregistered contractors do not have access to the guar n " � nd � o F ttORTH Town oft, AndoverO No. � Z h Ver, Mass, ' «..,�«�w.�� x,95 RATED U BOARD OF HEALTH Food/Kitchen PERMIT I LD Septic System THIS CERTIFIES THAT ...../t .....C ��..!......................................................................... BUILDING INSPECTOR p �!�,�'.. t .toko.. .......................... Foundation has permission to erect.......................... buildings on ....... ..... � . Rough to be occupied as .............. .. .. .. ..... ...�.! ....T.� a ............ Chimney provided that the person accepti g this permit shall in every respect cd orm 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 CONSTRUCTI TSRough Service .................................. ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuildinZ 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts Nome Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Comp amen Ay\ I 2,1/l, /✓L� y 112 t' Street Address(do not use a Post Office Box address) Cc tract r/Salesperson/Owner City/town State Zip Code Business Address(must include a street mess M' ) w i q � `5 ,✓ ,�� s Dame Phone �., � Evening Phone lCit own � State Zip Code �^�/) Vl (J r � Mailing Address(It different from above) Business Phone Peacial Employer ID or S.S.Number L­requicut Home lmpravcmerit Contmcter Re,.Number rm�cmFxpiration ate res that most home �"7/ impcoulracfors Lavc 5 avalid rsgis/ntion number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifyi the type,brand,and grade of materials to be used,use a(iditio ml sheets if necessary.) Required Perihits-The following building per its are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: be ad Bred to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of l l� Date when contractor will begin contracted work. MGL chapter 142A.) �4 00 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total stun 61 i > (*) Payments will be made according to the following schedule: $_C�upon signing contract(not to exceed 1/3 of the total contract price/or the cost of special order items,whichever is greater) $ \ VAby or upon completion of 1LkL t/ t $ y____L_L_or upon completion of $ �pon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $7n I A 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 that any deposit or donvn-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 Warr ante IS an express warranty beiaZ provided by the contractor? 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 fully 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 confirm coverage,or ask to see a copy of a"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 the 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. Seethe attached notice of cancellation form for an explanation ofthis right. IDO NOT GN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM *onieowncr'5S 'aeb identical c p+tespf tl contract must be completed and signed.One copy should go to the homeowner.The other copy slwt a kept by the ntmctor. e afore Contr .ctor's Signattue Date Date Yhe Commonwealth of Alassgehusetts _ Department of'Industria dAceldents M 1 Congress Street,Suite 100 = r d Roston,MA©2z1�201 7 www.mass.gov/dia W,03:kers'Compensation insurance Affidavit:JBaUdexs/Contractors/EZectFicians/PXumbers. TO BE YMED VaTH TEE PERMITTING AYITHORIT - please Print Legib A licant Information Name,(Busmess/Oxganization/Indivil,,al): Addxess: t V�I_/ (� 7 City/Skate/Zip: (S2 Phone#: T JO 7 Y d): Areyou an employer?ChecI 6e appropriate box: Type of project(.Tggi fire em to ees full and/or pare time)* 1. [I New construction 1.�I am a employerwith •.. - p Y ( 2. I am a sole proprietor or partnership and have no employees Working for me in 8. Remodelixlg any capacity.[No workers'comp.insurance required.] 9. E]Demolition 3.E]IM a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will II []Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12. Plumbing repairs oradditions proprietors with no employees. _ __ 5.El I am a general contractor and I have hired the sub-contractors listed onthe attached sheet. 13,0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.I 19.❑Other 6 We are a corporag9n and ifs offfgers have exercised their right of exemption per MGLG. I 01�� 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box4l must also fill.outthe sectionbelowshowingtheirworkers'compensationpolicy information I Homeowners who submitithis affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. tContraators that check this boxmu' an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. that subkthiirbox have employees,they must provide their workers'comp.policy number. I am an employer that is pidvidirzg workers'compensation insurance for my employees' Below is the policy arzd/ob site information. Tusurance Company Name: ExpirationDate: Policy#or Self-ins,T,ic.#: City/State/Zip: fob Site Address: Attach.a copy of the woxl(ers' cbmpepsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOLc.152,§25A is a criminal violation punishable by a f me up to$1, 00.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD.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. Ido hereby eerd u der thepa' a, allies of Ijur�treat the in f rm0t'onpr oviclecl above is true and correct / Date: Si nature: l Phone#: ' t Official use only. Do not write in this area,to be completed by city or town official.. City or Town: PexmtitILicense# issuing Authority(circle one): 1.Board of'Ifealth 2.Building Department 3.CityJown Clerk. 4.Electrical Inspector 5.Plumbing fuspector 6.Other Phone#: Contact Person: ��e�pav�no�zcueu���a���uaJa c«tem � i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration 105931 Type: Expiration 1113/2018 Individual THOMAS'HURLEY Thomas Hurley 70 ARLINGTON RD WOBURN,MA 01801 Undersecretary- Massachusetts ndersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-052309 Construction Supervisor 1 & 2 _ Family THOMAS M HURLEY 70 ARLINGTON ROAD WOBURN MA 01801 Expiration: Commissioner 01/14/2017