HomeMy WebLinkAboutBuilding Permit #601-14 - 10 OLD FARM ROAD 2/20/2014 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: `� I Date Received
Date Issued: Z �,
IMPORTANT:Applicant must complete all items on this page
Y. LOCAT IC� �cf t w\ _
hh."^1�, i�1.9�-L FA�L £ Print
PROPERTY OWNER f Y �vt,3�
Print 100 Year Old Structure yes no
MAP NO: ()35 PARCE4 ZONING DISTRICT: Historic District yes
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family f
❑Addition ❑Two or more family ❑ Industrial /
❑Alteration No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
0 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
T DESCRIPTION OF WORK TO BE PERFORMED:
I c�k
r
Identification Please Type or Print Clearly) _
OWNER: Name:Mrc"-1� � 11oA Is-t IAA�rr SC l Phone-/o17 6 J6-1563
Address:__L_��(.( (= rvy, 2c.� IV, AYt&yec M4 Gl SV.- '
CONTRACTOR Name: Ane tlee- Phone:
Address: 47 �HcJ �S+ GX�U��� lrlilJ
Supervisor's Construction License: CS -o'Pf 7 Exp. Date:
Home Improvement License: Exp. Date: V2 212cl-K-
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $ �
Check No.: ` ()-1 Z Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner Signature of contracto
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Samped Plans ❑
- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ElStamped Plans F1
_ TI'PE_OF;SEWERAGEDISP-OSAL-
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El
Well ❑ Tobacco.Sales 0 ToodPackaging/Sales ❑
Private(septic tank,etc... ❑ Permanent atunpster on.Site ❑
=THE FOLLOWING SECTIONS FOR-OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED: DATEAPPROVED _
PLANNING & DEVELOPMENT` ❑ ❑
COMMENTS
j .
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ ..
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Tow;; Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTW`NT =Temp Dumpster on site yes no
i -.Located-at 124,Mair Street:
FireDepar`tme►if
COMMENTS y
i
=-Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total-land-area, sq. ft.:
ELECTRICAL: Movement of Meter location, rust or service drop requires approval of
Electrical Inspector Yes No
DANGERZONE LITERATURE: Yes No
MGL-Chapter-166 Section 21A,--F and G min.$100-$1000.fine
NOTES and DATA— (For department use
El Notified for pickup - Date
i
Doc.Building Permit Revised 2010
Building Department
'the foilswing is 61istof the required.forms to be filled out for the appropriate.permit to be obtained.
Roofir?g, Siding, Interior Rehabilitation Permits
❑` Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or'C.S.L Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the ap».al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building Permit Revised 2012
Location/0 10/� l Imo •
No. 1 Date cQ10 L
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ �"
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# C�--
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/ ;: ! Building Inspector
NORTH
Town of 2 ? EAndover
O to
No.—bo( — * t
ver, MassAsk ILI
T O L^K5 law
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COCNICMl WICK
�.4 �RgTEO PPP,��y
S U
BOARD OF HEALTH
Food/Kitchen
PER IT LD Septic System
THIS CERTIFIES THAT .......... ...a .. ........... ,,,,,,r „1! ........................................... BUILDING INSPECTOR
. .......
g Foundation
has permission to erect ..
..................... buildings onto It�....' ,r�......AA............
Rough
I
to be occupied as ....... ......... .... ..7-0-4....V4�... ,..................................................... Chimney
provided that the person accep ing 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 IN 6 MONTHS ELECTRICAL INSPECTOR
�i UNLESS CONSTRUCTS TS Rough
Service
.............. ........................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
I
Smoke Det.
SEE REVERSE SIDE
The Commonwealth of Massachusetts
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLyibly
Name(Business/Organization/Individual): � � r
Address: y 7 I✓� '�
City/State/Zip: &-,_p I w Phone#: Q��" T`— S6 7-'5-
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I a employer with 4. ❑ I am a general contractor and I '
6. E]New construction
7mployees(full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet.# �• ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3111 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.❑Roofrepairs
insurance required.] employees.[No workers'
comp.insurance required.] 13.❑Other
*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 aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:.
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder 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 a 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 Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby cert under thepains andpe Zttes ofperjury that the information provided above is true and correct.
Si a Date:
Phone#:
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 5.Plumbing Inspector
6.Other - -
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,•
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
.Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
11e returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
Oity or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The CoxoM011wealth of Massachusetts
Department of Industrial Accidents
Office of.Iavestigations
600 Washington Street
Boston,MA.02111
`I`el,#617-727-4900 ext 406 or 1-877rMASSAFB
Revised 5-26-05 Fax#617-727-774.9
wwwanass,govfdia
JD Home Remodeling Estimate
47 b Pond Street
Boxford, MA 01921 Date Estimate#
2/3/2014 434
Name/Address
Michelle Harrison
10 Old Farm Road
North Andover,MA 01845
Project
Description Qty Total
Remove and replace tub
Remove Existing tub and flooring 1.00 500.00
Install Tub,New shower valve,shower head and trim fitting,new toilet. Pipe 1.00 1,300.00
and fitting included,fixtures not included
Add studs and repair walls where necessary 1.00 500.00
Install cement board in surround area and floor 1.00 500.00
Install Ceramic Tile on walls 1.00 900.00
Install Ceramic Tile on floor 1.00 600.00
Supplies: Costs may increase/decrease This is my best O.00T
guesstimate/allowances
Cement board walls 1/2" 5.00 50.00T
Cement board floor 1/4" 4.00 40.00T
Tub 1.00 350.00T
Basic Shower Faucet 1.00 150.00T
Basic 2 piece Toilet 1.00 175.00T
Ceramic Floor tile 75.00 225.00T
Ceramic Wall tile 50.00 150.00T
Thinset and grout 1.00 65.00T
Nails,Glue screws,studs,strapping,ETC. 1.00 75.00T
Delivery Charge 75.00
Any building permits costs will be the responsibility of the property owner 1.00 125.00
Disposal of waste products(Not necessary if customer takes responsibility for 1.00 150.00
disposal)..
Total
Signature �/
Phone# E-mail Web Site
978-809-8075 joedevelis@verizon.net http://mysite.verizon.net/jsdevelis/
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JD Home Remodeling Estimate
47 b Pond Street
Boxford,MA 01921 Date Estimate#
2/3/2014 434
Name/Address
Michelle Harrison
10 Old Farm Road
North Andover,MA 01845
Project
Description Qty Total
$1000 at contract signing. 1/3 of total estimate due on 1st day of project. 1/3 0.00
after rough inspection, 1/3 after final inspection.
NOTE:Any additional costs that may occur to meet local building codes are the
responsibility of the home owner.
Sales Tax 80.00
Total $6,010.00
Signature �,J ' 'iy ( /
Phone# E-mail Web Site
978-809-8075 joedevelis@verizon.net http://mysite.verizon.net/jsdevelis/
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Thursday, Feb 20,2014 08:45 AM
GENERAL CONTRACT FOR SERVICES
This Contract for Services(this"Contract")is made effective as of February 17,2014,by and between
Michelle Harrison&Donald Harrison of 10 Old Farm Road,North Andover,Massachusetts 01845,and
JD Home Remodeling of 47b Pond Street,Boxford,Massachusetts 01921. In this Contract,the party who
is contracting to receive services will be referred to as The Harrison's,and the party who will be providing
the services will be referred to as JDHR.
1. DESCRIPTION OF SERVICES. Beginning on or about February 17,2014,JDHR will provide the
services described in the attached Exhibit(collectively,the"Services")titled"Estimate"
2. PAYMENT FOR SERVICES. The Harrison's will pay JDHR according to the following schedule:
$500 at contract signing. 1/3 total estimate on the day project begins, 1/3 after rough inspection,
remaining balance after final inspection
3. TERM/I'ERMINATION. This Contract will terminate automatically upon completion by JDHR of
the Services required by this Contract.
4. WARRANTY. JDHR shall provide its services and meet its obligations under this Contract in a timely
and workmanlike manner,using knowledge and recommendations for performing the services which meet
generally acceptable standards in JDHR's community and region,and will provide a standard care equal to
or superior to care used by service providers similar to JDHR on similar projects.
5. ENTIRE AGREEMENT. This Contract contains the entire agreement of the parties,and there are no
other promises or conditions in any other agreement whether oral or written concerning the subject matter
hereunder. This Contract supersedes any prior written or oral agreements between the parties.
6. SEVERABILITY. If any provision of this Contract will be held to be invalid or unenforceable for any
reason,the remaining provisions will continue to be valid and enforceable. If a court finds that any
provision of this Contract is invalid or unenforceable,but that by limiting such provision it would become
valid and enforceable,then such provision will be deemed to be written,construed,and enforced as so
limited.
Service Recipient:
Michelle Harrison&Donald Harrison
Michelle Harrison Donald Harrison
Home Owner Home Owner
Service Provider:
JD Home Remodeling
By: 06Je ,&
VneeVehs
ess Owner
HIC: 138532 3/27/2015 EIN: 20-4200894
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 the signatures 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 littp:/hjvww.miss.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
617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
http://db.state.ina.us/homeiniproN,emeiit/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
Version 2.1 - 11/22/2010
Massachusetts -DapartmeOt ai' .oil,;Safety
Board of Building Regulations and Standards
Construction Supen-isor
License: CS-094417
JOSEPH F DEVELAS
47 B POND ST = -?
BOXFORD MA 61921
f
Expiration
Commissioner 08/17/2015
(Pyhorruau.�ue�cllli u CU!/GaddaC1wd01(4
f License or registration valid for individul use only
OAe of consumer Affairs&Business Regulation before the expiration date. If found return to:
OME IMPROVEMENT CONTRACTOR T e. Office of Consumer Affairs and'Business Regulation
egistration: {38352 DBA Yp 1,0 Park Plaza-Suite 5170
xpiration: ;..3/27/20,15 ( Boston,MA 02116
JD HOME REMODELING
JOSEPH DEVELIS
47 B POND ST � �'y�"e f
Not valid wi
BOXFORD,MA 01921 Undersecretary f out signature `