HomeMy WebLinkAboutBuilding Permit # 10/5/2016 OORTM 9
BUILDING PERMIT +
TOWN OF NORTH ANDOVER
APPLICATION FOR
` PLAN VN ,�^ YP�y Ie Receive NO: 0AT_m®n�aa
Date Issued: �IPClIiT
ANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
rt i:1 New Building I-1 One family
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Addition Two or more family ml Industrial
Alteration No. of units: Commercial
)(Repair, replacement €-:1 Assessory Bldg [i Others:
1 Demolition l Other
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Identification Please Type or print Clearly)
OWNER: Name: �; Phone: : m�, ID
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Address
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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:
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Check No.:Persons cont acts ith nr ist CO oars do not have access to ,
Receipt o.:
NOTE: the guarantyfund
Signature of A ent/ wn r �' ' na�fure o cont a fior'
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Q Y.M.#V
SepticSystem
THIS CERTIFIES THAT ......... .R ......... .� ......................................... ....... BUILDING INSPECTOR
has permission to erect .......................... buildings on ....... 97...... ..?76- J....................... Foundation
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tohe occupied as .....,... ... ................ ................... ................ ..... .. ............
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provided that the person accepting this permit shall in every 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
PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
UNLESS C® STRUCTI® STAR Rough
♦_ Service
........... ...........�./..... ....................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy .Permit Required to Occupy By 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.
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 966 Section 21A—F and G min.$900-$1000 fine
NOTES and DATA -- (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Buiding Permit Revised 2014
i
Plans Submitted ❑ Pians Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
well Tobacco Sales ❑ Food Packaging/,Sales ❑
Private(septic tank,etc. ❑ permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT El ❑ (; to
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COMENTS
CONSERVATION ❑ ❑ �3 t� U, ' 6
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connectlon/Signature& Date Driveway Permit
Located at 384 Osgood Street
rFIRE DEPARTM l Ternp Dumpster on alta yes �D T
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MASSACHUSETTS HOMKIMPROXEME NT CONTRA-Cl
Homeowner Information
First United Methodist Church
57 Peters St.
N. Andover,MA 01845
978-994-3631
Contractor Information
Turner Carpentry CSL## 108738 EXP 10/17/2018
Ryan Turner HIC # 178626 EXP 5/5/2018
17 Baypoint Ln. Tax ID 464976419
Haverhill, MA 01835
978-478-7756
WORK TO BE PERFORMED AND MATERIALS TO BE USED
Work to be done by contractor:
Remove Decking on rear deck, demo concrete steps under deck. Repair framing of deck.
Reducing the size of the deck from a 17x14 to a 12x17. This will require pouring footings and
adding a beam to the underside of the deck. Removing and replacing railings and railing posts.
Removing and replacing deck stairs. Replace lattice and trim. Remove and dispose of all
Debris
Materials to be used by contractor.
Builders tube, concrete, pressure treated 2x10 triple beam., all pressure treated 5/4x 6 decking, all
pressure treated framing and railings. Pvc lattice and trim.
Work Scheduled To Begin 9/26/2016 on or around
Expected Date of Completion: 10/7/2016
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to provide the work, furnish the material and labor specified above for the
sum of$5,583.78
Payments will be made according to the following SCHEDULE:
1
$1,842.65 Deposit before work is started.
Balance of$3,741.13 due upon completion of the contract.
In order to meet the completion schedule,the following material/equipment must be special
ordered before the contracted work begins:
D�UON(;T ' GNA. .,S CONTRACT IF THERE ARE ANY BLANK SPACES
Customer Signature Contractor's Signature
Paul arlotto Ryan Turner
9ZM� ----- // /
Date 0 bate'
You may cancel this agreement if it has been signed by a party thereto at a place other than
at the address of the seller,which may be his main office or branch thereof, provided you
notify the seller in writing at his main office or branch by ordinary mail posted, by
telegram sent or by delivery, not later than midnight of the third business day following the
signing of the agreement. See attached notice of cancellation for an explanation of this
right.
REQUIRED PERMITS
The following building permits are required: Town of North Andover, MA Building permit. It is
the obligation of the contractor to secure such permits as the homeowner's agent and any costs
which contractor will incur in doing so are included in the price for this job as set forth above.
Please note that homeowners who secure their own permits or deal with unregistered contractors
are excluded from the Guaranty Fund provisions of MGL C. 142A.
Is an EXPRESS WARRANTY being provided by the contractor? No Yes X
The following warranty will be provided by the contractor under this contract: 1 Year
Workmanship and material warranty any materials under warranty will be through manufacturer
of such materials.
Please note that all home improvement contractors and subcontractor shall be registered and any
inquiries about a contractor or subcontractor relating to registration should be directed to:
Director, Home Improvement Contractor Registration, One As Place,Room 1310li
Boston, MA 02108, 617-727-8598.
2
Unless otherwise noted within this document, the contract shall not imply that any lien or other
security interest has been placed on the residence.
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.
ARBITRATION
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 such dispute to a
private arbitration service which has been approved by the Secretary of the Executive Office of
Consumer Affairs and Business Regulation and the consumer shall be required to submit to such
arbitration as provided for in MGL C. 142A.
-
Contractor: Iomeowner:
Date: Date: 16
NOTICE: the signatures of the parties above apply only to the agreement of the parties to
alternative dispute settlement initiated by the contractor. The owner may initiate alternative
dispute resolution even where this section is not separately signed by the parties.
ACCELERATION OF PAYMENT
3
Homeowner's Financial Insecurity. 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.
Contractor's Financial Insecurity. 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 from said
account would require the signatures of both parties.
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.mass.gov/ocabr/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 617973-8787, 888-283-
3757 or visit the HIC website at http://www.wass.gov/ocabr/Go online to view the status of
a Home Improvement Contractor's Registration:
http://db.state.ma.us/homeimprovement/licenseelist.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
OTHER CONTRACTUAL DOCUMENTS
This contract includes as contract documents the following additional enumerated documents:
4
i.
i.
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 YOUR 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 DISPOSE OF THE GOODS WITHOUT ANY
FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE 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 A 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 CANCEL THIS TRANSACTION.
Date: Buyer's Signature:
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PI;RMI i iNG AUTHORITY.
Agpilefint Information Please Print Le ibl
Name (Business/Organization/individual): Y Y
�Y
Address: \ ' �_ � Qc%� \-.%VN -
City/State/Zip:'CcQ.��11r:,��l�i1 01 '3 Phone#: C9 `0
Are you an employer?Check the appropriate box: Type of project(required):
10 I am a employer with employees(full and/or part-time),* 7. ❑New construction
2. 1 am a sole proprietor or partnership and have no employees working for me in g. E]Remodeling
ny capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3-❑I am a homeowner doing all work myself.[No workers'camp.insurance required.]t
10 F1 Building addition
4.E]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 11.0 Electrical repairs or additions
proprietors with no employees. 12.rl Plumbing repairs or additions
S f j I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.instuanec.t
6.E]We are a corporation and its officers have exercised their right of exemption per WL c. 14.�Other f
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy information,
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such.
#Contractors that check#his box must attached an additional sheet showing the Heine of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
f ani ari employer•that is pi-ovidlrig 1por•lrers'eonipeissation ilisurarice for itiy employees. Belmp is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie,#: Expiration Date:
b Site Address: City/State/Zip:
Atte h a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required 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 of a STOP WORD ORDER and a fine of up to$254.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify and • lie pains and enaldes of pei jury that the information provided above is true and correct.
Si nature: Date:
Phone#:
Of,lcial use only. Do not sprite in this area,to be completed by city or tmpn official
City or Town: Permit/License#
Issuing Authority(circle one): i
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phone#:
DATE(MMIDDIYYYY)
A�R� CERTIFICATE OF LIABILITY INSURANCE
7/11/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Kimberly Savage
Sullivan Insurance & Financial, Inc. Vin.Exfl: (978)372-2790 IV o:(978)373-2281
487 Groveland Street ADDREs$ ksavage@sullivanlF.Com
INSURERS)AFFORDING COVERAGE NAIL#.--
Haverhill
WHaverhill MA 01830 INSURER A:Harle sviIle Worcester 26182
INSURED INSURERS:
Ryan Turner, DBA: Turner Carpentry INSURERC:
17 Baypoint Lane INSURER D
INSURER E:
Haverhill MA 01835 INSURER F
COVERAGES CERTIFICATE NUMBER:CL1671102904 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.
INSR TYPE OF INSURANCE ADD_.SUER POLICY EFF POLECY EXP LIMITS
LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY
X COMMERCIAL GENERAL LIABILITY FACH OCCURRENCE $ 1,000,000
DAMAGETORENTED $ 300,000
A CLAIMS-MADE I X OCCUR MICFS IEa rxtai rence]._
SPP00000027152Y 7/1/2016 7/1/2017 MEUEXP{Anycneperson $ 15,000
PERSONAL&ADV INJURY $ 1,0001000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO- {j II LOC PRODUCTS-COMPIOP AGG $ 2,000,000
X POLICY u JECT 1 J $
OTHER:
AUTOMOBILE LIABILITY Ea accid $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
Al1TOR NON--OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (P
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION $
WORKERS COMPENSATION PIATH
TUTE Er...
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $
OFFICERIMEMSER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEF $
I€ves.describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 161,Additional Remarks Schedule,may he attached If more space Is requiredl
Construction Operations
CERTIFICATE HOLDER CANCELLATION
North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION Building Department ACCORDANCE WITH THE POLICY PROVISIONATE THEREOF, S.
E WILL 8E DELIVERED IN
1600 Osgood St.
suite 2035
AUTHORIZED REPRESENTATIVE
N. Andover, MA
01845 � —
Rayt Holland/KSIaV
OO 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
_F Board of Bu latrroraq pia 91W afion.r arvi Standards
Umwi ructinrr Sup erOwl,
I._ucense CS-108738 ,
RYAN TURNER �
17 BAY POINT LANE
Haverhill MA 0'1835
Expiraflon
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yOffice of Consumer Affairs c"t Business Regulation
11HOME IMPROVEMENT CONTRACTOR
Registration: 178625 Typo: }
Expiration: 5/512018 DBA
TURNER CARPENTRY
RYAN TURNER
t
17 BAY POINT L.N d
FIAVERHILL,MA 01835 Undersecretary