HomeMy WebLinkAboutBuilding Permit # 3/10/2016 GG
BUILDINGPERMIT �aoaara�
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TO OF NORTH ANDOVER ®� =6 0
APPLICATION FOR PLAN EXAMINATION `
Permit No#: Date Received �vRQ�R°T
� Areo r R
SSRCHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION ''�I f� 4
PROPERTY OWNER , � j
Print 100 Year Structure yes
MAP 673S PARCEL: ce ZONING DISTRICT: Historic District yes
Machine Shop Village yes nob
TYPE OF IMPROVEMENT PROPOSED/USE
Residential Non- Residential
❑ New Building i'One family
❑Addition ❑Two or more family ❑ Industrial
H�Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PERFORMED:
\'\ -e-,rn-
Identification- Please Type or Print Clearly
OWNER: Name: �' _� Phone:
Address:
Contractor Name: i Phone:
Email �� � � ,j- 4-
Address: S A 6-E,-f -,.-
Supervisor's Construction License:_ (4:Z I I Exp. Date:
Home Improvement License: ° Exp. Date:.
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE;BULDING PERMIT. $92.00 PER$9000.00 OF THE TOTAL ESTIMATED COSF;BASED ON$925.00 PER S.F.
Total Project Cost: $ Kyp FEE: $
Check No.: Receipt No.: cp
NOTE: Persons contracting with unregistered contractors do not have acces, the guaranty fund
'Town Of Andover
t%ORTy
'k.
o . 6- ver, Mass,
CoCMICMl WICK
ORATEDMEN& �S
U BOARD OF HEALTH
Food/Kitchen
rERM T T LD Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
....................11"........ t.. .... ........................................................
Foundation
has permission to er t .......................... buildings on .. `�..... a..........................
�p ® Rough
to be occupied as . .... 1«1 .................... ® t..... . ....A=— .......... .......... .. .. ® Chimney
..provided that the person accepting this permit shall in every resect 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 t
ELECTRICAL INSPECTOR
Rough
Service
.................. ................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises ® Not Remove Final
No Lathing r Dry Wall o Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
TEmn S TA
Building and Rernodefing Start date 3/14/20,16
5 APPLETON .l' EES'" Fhfish date 5/14/2,016
NORI 14 ANDOVEFI , MA 01845 MC L.ic. 120296 Expires 1,1119/17
(978) 682 2023 CS1 w L,ic. CS 54718 Expires 6/8/16
11,1roposal
Proposal Submitted To: March 8, 2016
Eli Kalil Home Phone: (978)
117 Nut Meg Lane
North Andover, MA 01845
Job: Remodel Finish Basement
Job Description:
Obtain building permit
Complete removal of all demolition and construction materials
Generated by Testa Building and Remodeling and its subcontractors.
Main Basement
CONSTRUCTION:
Re frame parts of the basement, But Basement is already framed. Remove paneling, Leave
insulation where possible. Create a utility room and a coat closet coming into the basement.
ELECTRICAL:
Outlets, switches and lights as listed by code off of existing to include
Rework the electrical that is already in place where needed.
• NOTE All recessed fixtures supplied by electrician.
• NOTE All other fixtures supplied by owner installed by electrician.
PLUMBING:
Jack up the concrete and install a stand up shower unit.
HEAT:
Zone off the existing hot air furnace.
PLASTER:
All walls and ceiling will be hung with 1/2blue board and skim coat plaster.
PAINTING:
Paint all walls and ceiling in the basement. Paint all new trim in the basement.
FINISH:
All doors will be solid Masonite doors casing and baseboard will match existing.
A finance charge of V/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the
customer shall be responsible for all costs associated with collection,including reasonable attorney's fees.
I propose hereby to furnish material and labor complete in accordance with above specifications,
for the sum of:
$39,840 Thirty Nine Thousand Eight Hundred Forty Dollars
One-third to start, one-third after rough inspection, one-third upon completion.
Authorized signature ,
I reserve the right to cancel this contract if not accepted in 30_days
Signature
Signature
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
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 fust 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 ConsumerAffairs and Business Regulation's Consumer Information
Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work.
MGL chapter 142A.)
Express Warranty-Is an express warranty being provided by the contractor?
11
No
11
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.See the attached notice of cancellation form for an explanation
of this right.
DO NOT N THIS ONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical i f the ntract be pleted and signed.One copy should go to the homed r. a other copy should be kept by the contractor.
Hom er's SipaMe ntractor's Si ature
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 homeowner 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 fern which has
been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the
consumer shall be red submi such arbitration as provided In husetts General Laws,chapter
142A.
r r
Homeowner's tore r is Si nature
NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative 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 under the Home Improvement 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 manner. 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 carry 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 Information Hotline(listed below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all 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
attachments 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/herself 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 funds from
said account would require thesignatures of both parties.
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 lit�p://�,vwiv.inass,gov/oc,,Ibl�/
If you want to verify the registration of a contractor or if you have questions or need additional information
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 litip://wwv.tnass.gov/ocat)i,/
Go online to view the status of a Home Improvement Contractor's Registration:
l:kttl)://dt),stat�c.ri,ia.Lis/liotTicii,riproveineiit/liceiiseelist.asi)
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 2.1-11/22/201
NOTICE OF CANCELLATION
YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR
OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.
IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE
BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE
INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN
BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU
CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF
THE TRANSACTION WILL BE CANCELLED.
IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT
YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN
RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR
SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF
THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE
SELLER'S EXPENSE AND RISK.
IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE
SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF
CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT
ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE TIE GOODS AVAILABLE
TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER
AND FAIL,TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL
OBLIGATIONS UNDER THE CONTRACT.
TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND
DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place
of Business] NOT LATER THAN MIDNIGHT OF (date).
I HEREBY AN EL THIS TRANSACTION.
Date: Buyer's Signature:
The Commonwealth of Hassachusetts
Department of industrial.Aceldents
M
1 Congress Street,Suite 100
02114 2017
- Boston,MA.
~ www.mass.gov/dia
M 5y
' Workers,Compensation Insurance Affidavit:Builder/Contractors/E,Xectricians/i.'lwm exs.
TO BN FILED WIT),THE PERM[TTWG AUTI{ORIT Y. PIeas e Paint Le 'bl
A ' licant InfgMatiton
Name(Business/(jrga*aiionllndividual):
Address:
Phone#:
a y/State/Zi.P:
xo rl
1.❑T am a employer with atebox: Type ofproject(lrecluized)'
.Are you an employer, C4eck the app p
emP toy ees(Rill and/orparttime).* 7. QNe -eonstriictlon
2.0 I am a sole proprietor or partnership and have no employees Working forma in 8. �Remo deliiig
any capacity.[No workers'comp.insurance required.] 9• rl Demolition
3.[]1 am a homeowner doing all workmyself:[No workers'comp.insurance required]t 10❑Building addition
4.❑T am a homeowner and will be hiring contractors to conduct:all work on my property. I will l 1.❑EleetriGal cepa]Cs or additions
ensure that all contractors either have workers'compensation insurance or ate sole '� i1i]ibiSlg repairs Or additions
12
proprietors withno,oiriployees.
$.0 X am a general contractor and):•'have hiredthesub-contractors listed onthe attached sheet.
13:[]Ro6frepairs
These sub-contractors have employees and have workers'comp.insurance.t 14. Other
6,❑We are a corporafioii and its,officers have exercised their right o£exemption per MGL c.
152,§1(4) and vie have rio employees.po workers,comp.insurance required.]
xAny applicant that checks box#1 must also fill.out&a section below showing their workers'compensationpolicy information.
i Homeowners who submit tuns affidavit mdicating o aheegs owing th nthen hire outside contractors must subt a
ame of the sub contractors and state whether or nnow pot thoseindicating
nt tib have
such.
1Contractors that checktlus boxmust attacfied an ., ,„,„ . _
employees. Tfllia sub-coniractois have employees,they must provide their workers'comp.policy number.
X am are employer•that is providing-wor�ers'compensation insurance for°my employees. Below is the policy andjo�i site
information.
Insurance Company Name:
ExpirationDatez
Policy##or Self-ins.Lic.##:
City/State/Zip:
Job Site Address:
�vvoxl�exs' compensation policy declaration page(showing the policy number and expiration date).
Attach a copy of the
Failure to secure coverage as requited under MGL e.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 ded to theflx e O lnve ORDERRK a ons of the DIA for insuranc0.0 0 a
day against the violator'.A copy of ibis statement may be forwax
coverage verification.
--i—do hereby cer• " nder•tliepains andpenalties ofperjury that the information provided above is true and correct:
• �s Date• 3 l o r'�
Si ature:
Phone#:
official use only. Do not-write in this area,to lie completed by city or town official.
Permit/License#
City or Town:
Issuing Authority(circle one):
1.Board of Ifealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.other
Phone#:
Contact Person:
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