HomeMy WebLinkAboutBuilding Permit #524-14 - 100 ADAMS AVENUE 1/7/2014 t NORT1�q
BUILDING PERMIT �? f. ._�.,•• °oma
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: A Date Received "°9 L,M.'.�M r
Date Issued: )
cKus
ORTANT:Applicant must complete all items on this page
LOCATION Zm A&ms Ave— ,PROPERTY OWNER
s� Print
MAP NO:U PARCEL0 ZONING DISTRICT: Historic District yesnn
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE j
Resi tial Non-Residential
❑New Building One family
❑Addition ❑Two or more family ❑ Industrial
El AJteration No. of units: ❑Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑Other
❑Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
l� old rwr end 1�S�1J no.W
Identification Please Type or Print Clearly)
OWNER: Name: Mara 0Phone: �7 �SJ S7o
Address: JJQ &I&Yls jJ&
CONTRACTOR Name: -'11rJj
Phone:
G'
Address: 35 � IDr-f-k r'Oad Sak,--n f-1 Lg
Supervisor's Constructions License: Exp. Date:
CS -03-7(003 LI 17 10
Home Improvement License: to � Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT,'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
C� i
Total Project Cost: $ _FEE: $ 1 Z °
Check No.: Receipt No.:
NOTE: Persons contracting With unregistered contractors do not have access to t e guaran and
Signature of Agent/Owner Signature of contract r
Location ,b o " S e'
No. Z�—` Date 4
L ^
. • TOWN OF NORTH ANDOVER i•=--
. Certificate of Occupancy $
Building/Frame Permit Fee $ —
_ Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
�A
�y
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE QF°:S EWERAGEDISP_OSAL '
Public Sewer ❑ Tanning(Massage/Body Art ❑ .. Swimming Pools ❑
Well .Tobacco.Sales ❑
-Food Packaging/Sales ❑
Private(septic tank,etc._
❑ --= =Permanent Dempster on Site ❑
THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
_ DATE REJECTED: DATE_APPROVED
PLANNING & DEVELOPMENT` ❑ ❑
COMMENTS
j
i
f
.CONSERVATION Reviewed on Simature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS i
" I
a
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
I
Planning Board Decision: Comments
Conservation Decision: Comments J
Water & Sewer Connectionisignature& Date Driveway Permit
DPW To` x! Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTIV EN'' =Temp Dumpster on site yes . no
Located-at�124tMair Street:
r
Fire"Departmehf-s§kk fie /date";
COMMENTS .
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. ®NE LITERATURE: Yes No
MGL-.Chapter-166 Section 21A-F and G min.$10o-$1000 fine
NOTES and DATA— For department use
® Notified for pickup - Date
E _
Doc.Building Permit Revised 2010
- i
Building Department
The foliowing'is a-list of-the required-forms to be filled out for the appropriate.permit to.be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑' Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L: Licenses
o Copy of Contract
o 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
I ..
1 o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
j ❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
j NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
i
New Construction (Single and Two Family)
❑ Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable) i
o Copy of Contract
❑ Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apu�-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be sabwted with the building application
Doc: Doc.Buil,ding permit Revised 2012
1
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION. .
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: _ PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT, PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: 0 Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic ❑Well 11 Floodplain ❑Wetlands ❑ Watershed District
11 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date: _
Home Improvement License: Exp. Date:
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: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner % idnature of contract- _,.
Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ -tamped Plans ❑
DALE(Ieluoum.n
,4► CERTIFICATE OF LIABILITY INSURANCE 01/0512014
N THE CERTI
ERTI
THIS
CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COOICIES
K THE COVERS NO RIGHTS ERRAGE AFFORDEOT
D 13Y THE o
ORIZW
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
EXTEND BELOW, THIS CERTIFICATE OF INSURANCE C� HDCONSTITUTE A CONTRACT eE'1W01 M
EEN THE ISSUING INSU NtA�p� to
HTS
REPRESENTATIVE OR PRODUCER+A >� molt be endorsed. K SUBROGATION 15
IMPORTANT: lithe ceRlflcate hotder is��1INSURED,$thendolraement A staten+ent on tMs ee dog not coater r1Aht6 to the
the teTm+t and conditions of the Policy,ce
certf eta holder in Ileo of stich endorseme a.
cDNr
PRODUCER
NAME:
PfanrlgM Insurance-Salem PNO� AXPRNo.
224 Main Street Suite 3C Eall
Salam,NN 03079 NMC
James A Santo INsu A�oImINO 31928
jauRERA:Acat is Insurance
INSURED Pelledn Vinyl Siding " B'
364 Broadway `
Salem,NH 030T8 INeuRERo:
R P:
COVERAGES C RTIFICATE NUMBER:
REVISION NUMBER!
_ TO WHICH THIS
THIS IS TO CNOj Ilry THAT
NG POLICIES
REQU IIftETAENT TERM OR CONDi1lON OFOANY C SOtJTRAG7 OR OTHER DOCUMENT WffSURED NAMED `H ftESPEGT Oft THE��PERIOD
INDICATED DESCMEED
oERT1FI DNS by BEI SUED OR MAy OF SUCH PO TAJN.THE LIMITS N SuRAmCE SHOWN
MAY HAVE BEEN REDUCED BY ClAIM3. HEREIN Is SUB IECT TO Ali THE TE
CL ONS NDIneeR � WYMTe
T TYPE OP I)IBURANCE EACH OCCURRENCE E 1,000,00
GENERAL UAMLiTY10/Z8l2013 10/2812014 n» S 500,
A X COMMERCIAL GENERAL LIABILITY BOA5122764 16
MED EXD one rem) $
CWMS•M OE Q OCCUR PERgpNAL8ADV INJURY 8 1,000,00
GENERAL gGGREGATE E 2000,000
PRODUCTS•COMP IOPAGG 8 0001000
GEN'LAGGREO,ATELIMITAPPLIES PCR E
FOUCY ¢ LOC CO SIN EU S 1,000,OOc
AUTOMIookE LIAVILIW8
OA5122784 1012812013 'IOr2812014 BO(NL'rINJURY(PaPermn)
A ANY AUTO 9001LY INJURY(P61 w0dont) S
ALL OOwNEp A�SULED RTY i
P
X HIREDAUTOS X AUTO $ i
EACHOCCURRENCE _
UuantLAUA0 OCCUR AGOREGATF-
i
EXCESSLu6 CWMS�IADE _
OEO RETE X wC'SrATU• OTH-
WORKERS COMPENSATION 50O 00
AND 90PWTiR9 LAAeN.ITY v/N 05122768500100
10428/2014 EL EACH ACCIDENT _
A ANY PROPRIETOWAR FRIEXECUTIYE n K)A F-L.DISEJI.,"£•EAE OYEE i 600,00
Of'reERNEMBER E xCLUDHD7 t � i Mac
(mwHWwy in NN) E.L.D POLICY LRr9T
If YYee6,�desgibe under
oESCRIPnON OF OPE N ow
V=RIPTION OF OPlRATlON3I LOCATiDNb I YiTIICLES(AMxAAaORD 101,AEdi11eM1 R Re lScl�pet�II mot+ePw°►� "�)
Ken periguy & paul Pallerin have elected to be wwludled £rem Workers
Cc1penaation coverage
8r0eot. tSary Crate 100 >Adatua Avenue, North Andover, NA
CERTIFICATE IR CANCE TI N
TOWNNOA
SHOULD ANY OF TFIE ABOVE pE8CRI8ED POLICIES BE CANCELLI BEFORE
THE EVIRATION DATE ?HEREOF, NOTICE WILL BE DELIV MD 0
ACCORDAWA YIRnI THE POLICY PROV151IONS.
Town of North Andover
1600 Osgood Sta'eet AumoRMEORWR@&M'rAMS
North Andover,NIA 01845
®l888 2010 ACORD CORPORATION. All rights reserved. �
ACORD 26(2010105) The ACORD name and logo are registered memos of ACORD
I
MThe Commonwealth of Massachusetts
Department of Industrigl Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
V
Name(B g I(?,r► 10 f� SI
usiness/Or alnization/Individual)•
Address: 5S%izN , r cod -0
City/State/Zip: S� Iy l" C ( Phone#: ho-S gq d o2
Are ypu an employer?Check t e appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. workers'comp.insurance.
Y p tY• 9. E]Building addition
[No workers'comp.insurance 5. El We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I 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.]t employees.[No workers'
131i Other
comp.insurance required.]
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
7'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 cheek this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that isrovidin workers'com enation insurance or m employees. Below is the olic andjob site
IP g P .f myP y .1
information.
Insurance Company Name:. l `t
Policy#or Self-ins.Lic.#: �y s)a� �O� ExpirationDate: a 1 7
Job Site Address: /0(5 City/State/Zip: A Ando �
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 o. 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 ofthe DIA for insurance coverage verification.
I do hereby under thepns a 1ferjury tliat the information providedf a ove i trueand correctt
Si ature: � -
Phone#•
� Fq
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.PIumbing Inspector
6.Other - - -
Contact Person: Phone th
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 of hire,•
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)andphone 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
be 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.
City 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. Anew affidavit must be filled out each
year.'Where a homeowner or citizen is obtaining a license or'-permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
i
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:
Tho CoiumoaweaMofMassa..clhuseutts -
Depa imoiat of l dusftiai.A.ccidonts
I
Of-ace of Investigat io.m I
600 Wash raglan Street
Boston,MA.02111
Tei,#617.727-4900 W 406 or 1-877 MA.SSAFE
Revised 5-26-05 Fax#617"727-7749
www.mass,govMa
NORTH
Town of ; 2 . 1Andover
- �
No. -�- . - *
soh .� ver,, Mass, IWIAJV 1 2A14
COC NICKl WICK y1.
�.I RgTED k"P��,(5
U BOARD OF HEALTH
PERMIT T LD Food/Kitchen
Septic System
Cry BUILDING INSPECTOR
THIS CERTIFIES THAT ............... .................................A.4.W.S%
................ ................................
has permission to erect ...... buildings on ..166... . Foundation
Rough
tobe occupied as .....4�....��........�...... R.Qd!W.......................................................................... Chimney
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUC ST S Rough
Service
\% 7
............ . 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.
Smoke Det.
SEE REVERSE SIDE
Massachusetts -Department of Public c Safety
Board'of Building Regulations and Standards
Construction Supeni,or
License: CS-037603
KENNETH W PE13tG
5 MCGRATH ST.
SALEM NH 03079 ' I
w )! 4411'1 1
Expiration
Commissioner 04/17/2014
it
— r
Off ice!dfOiPP4Alflt �8$6iI License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration. 100286 Type- Office of Consumer Affairs and Business Regulation
Expiration: 671512014 Private Corporation` 10 Park Plaza-Suite 5170
4, Boston,MA 02116
IN VINYL SIIlIN0
Kenneth Perigny
354 N.Broadway ��
Salem,NH 03079
Undersecretary Not valid without signature
Visit Our Showroom At: P'LL
RIN Famous Brand Names
354 N.Broadway " •Certainteed
Salem, NH 03079 Mastic
Mon.thru Fri. 9am-5pm VINYL ��®��G
Alcoa
Most Saturdays 9am-12pm , A dersen
or by Appointment Inc. •Harvey
Tel. 603
� )898-2259 •Therma-Tru
----
;Proposal - Agreement-
PROPOSAL SUBMITTED TO PHONE (jj,,57J DATE &113
STREET JOB NAME
CITY,STATE&,ZIP CODE JOB LOCATION
--)j4i , ,A1,4k,&/5gt4
We hereby propose to furnish all materials and labor necessary for the completion of the following products in accordance with the
specifications and drawings
✓��`F'`� E�i[N`�/ '� '0u0-'( 40,S �a'C' c`! a Ae -.',4-e— tt't.Gt✓el��)
&3� cfG 6>16i 1 ce tt w A4,t fid.
(jYll.ne ` De-cl-
A.-Aeees
LeI
b' ..0'.'
Total contract price is: ✓ dollars
PAYMENTS TO BE MADE
RAS/FOLLOWS:
ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED. ALL WORK TO BE COMPLETED IN A AUTHORIZED
WORKMANLIKE MANNER ACCORDING TO SPECIFICATIONS PER STANDARD PRACTICES.
ANY ALTERATION OR DEVIATION-FROM ABOVE SPECIFICATIONS INVOLVING EXTRA
SIGNATURE-
WORKMANLIKE
COST WILL BE EXECUTED ONLY UPON WRITTEN ORDERS AND WILL BECOME AN EXTRA
CHARGE OVER AND ABOVE THE ESTIMATE.
ACCEPTANCE OF PROPOSAL-THE ABOVE PRICES,SPECIFICATIONSAND CONDITIONS
ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE
WORK AS SPECIFIED. PAYMENTS WILL BE MADE AS OUTLINED ABOVE. SIGNATURE
CUSTOMER HAS THE RIGHT TO CANCEL THIS CONTRACT UP TO THREE(3)DAYS AFTER
DATE OF ACCEPTANCE.
f J
Required Contract Terms Page 1 of 2
The Official website of the Office of CarramerAfidrs&Business Regulation(OCABR)
Consumer Affairs and Business j
Regulation
i
Home Consumer Home improvement Contracting Required Contract Terms
Required Contract Terms
iContract Content&Paymmtt
Contracts-a0 contracts over$1,000(One Thousand Dollars)mast be in writing. Term
The law requires the following FOURTEEN Items to be included in any contract between a homeowner and a registered
home mtpnovement contractor for home improvement work Subject to MGL c.142A: Performance of tate Contract
1.The complete agreement between the contractor and the owner and a clear description of any other documents which
are part of the agreement.
2.The full names,federal I.D.number(If applicable),addresses(NOT P.O.Box numbers),of the parties,the contractors
registration number,the names)of the selesperson(s)involved,if any and the date the contract was executed by the
parties.
3.The date on which the work is scheduled to begin and the date the work is scheduled to be substantially completed.
4.A detailed description of the work to be done and the materials to be used.
5.The total amount agreed to be paid for the work to be performed under the contract.
6.A time schedule of payments to be made under the contract and the amount of each payment stated in dollars,including
any finance charges.Any deposit required to be paid in advance of the start of the work SHALL NOT exceed one-third of
the total Contract price or the actual cost of any material or equipment of a special order or custom made nature,which
must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment
shall be demanded until the contract is completed to the satisfaction of all parties.
7.All parties must sign the contract.
8.A clear and conspicuous notice stating:
a.That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor
or subcontractor relating to a registration should be directed to:
Ofitcs of Consumer Affairs and Suelness Regulation
Ten Park Plaza,Sults 5170
Boston,MA 02116
Phone:(617)9738700
I
b.The contractor's registration number must be on the first page of the contract
c.The homeowner's three day cancellation rights under MGL c 93 s 48;MGL c 140D s 10 or MOL 0 255D s 14 as may be �
applicable.
d.All warranties on the owner's rights under the provisions of and MGL C.142A.
e.In ten point bold type or larger,directly above the space provided for the signature,the foNowing statement:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
f.Whether any lien or security interest is on the residence as a consequence of the Contract.
9.An enumeration of such other matters upon which the owner and contractor may larrOolty agree.
I
10.Any other provisions otherwise required by the applicable laws of the Commonwealth.
11.Permit Notice:Every contract shall contain a clause informing the owner of the following:
a.any and all necessary construction-related permits;
b.that it shall be the obligation of the contractor to obtain such permits.
c,that owners who secure their over construction-related permits or deal with unregistered contractors shall be excluded
from access to the Guarantee Fund.
12.Acceleration of payment:No contract shall contain an acceleration clause under which any part or all of the balance not
yet due may be declared due and payable because the holder deems himself to be insecure.However,where the
contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds
http://www.mass.gov/ocabr/Consumerlhome-improvement-contract/required-contract-terms.... 1/6/2014
Required Contract Terms Page 2 of 2
yrs �
due under the Contract,which are in possession of the owner,shall be placed in a joint escrow account requiring the
signatures of the home Improvement contractor and the owner for withdrawal.
13.No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract.
14.Arbitration:If the contractor determines that in the event of a dispute,the contractor wishes the dispute to be settled by
arbitration,this fact must be signified on the contract and both the contractor and owner shall sign this clause separately.
The following format is acceptable(in 10 point type or larger);
I
"The contractor and the homeowner hereby mutually agree In advance that in the event that the contractor has a
dispute concerning this contract;the contractor may submit such dispute to a prfvete arbitration service which
has been approved by the Office of ConsumerRftairs and Business Regulation and the consumershey be
required to submit to such arbitradon as provided In MGL c 442A.
I
Owner:
,r se,J a I
Contractor: - ' CTL>v�t P l&,t t, AJC cam_
NOTICE.,The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution
initiated by the contractor.The owner may tnttiate alternative dispute resolution even where this section is not sioned
seharafely by the narties."
®2014 Comronweafth of Massadwsens.
Site Policies Contact US
Mass.CoA Is a m0aered service matt of the Commonweaf h of Messetlwwtts.
I
I I
hq://www.mass.gov/ocabr/consumer/home-improvement-contract/required-contract-terms.... 1/6/2014
i f NORTi1
� 0 4ae,e4yQ
o
NORTH ANDOVER BUILDING DEPARTMENT
4no400 Osgood Street
ssCHus
Tel: 978-688-9545 -
Fax: 978-688-9542
BUSINESS FORM FOR TOWN CLERK
DATE:
NAME: �p_i C R c 0.c
ADDRESS:
ZONING DISTRICT:
TYPE OF BUSINESS:
BUILDING LAYOUT PROVIDED: YES &0
AVAILABLE PARKING SPACES: mu L
ZONING BY LAW USAGE: S ) NO
BUILDING INSPECTOR SIGNATURE
Revised 11.5.04
BLSWESS FORM FOR TOWN CLERK
Location A c�a S Acl-e-
No.
e� Date G a q9
NORTH TOWN OF NORTH ANDOVERa�
0
?0�,�z'p,•,�0n
Certificate of Occupancy $
s
Building/Frame Permit Fee $ —
CN�s<t' Foundation Permit Fee $
t
Other Permit Fee $
_ Sewer Connection Fee $
Water Connection Fee $
4
TOTAL $
Building Inspector
i 3 � 1�f
Div. Public Works
PERMIT NO.NO. Q?�1� APPLICATION FOR PERMIT TO I3UILD********NORT1-1 ANDOVER, 1v1A
11APNo . LO'f NO. � 2. RECORD oFo\\'NFRSIIIP DATE HOOK PAGE
LONE: Still DIV. LOT No.
LOCA ZION GCj J %' 4 ` 'llitl'OSE OF BUILDING n
OWNER'SNAME �1L. / ' NO.oF s-TORIES SIZE
O\1'NER'S:1nDRE;SS BASENE:NTORSLAII
ARCIIITECI'S NAME .1. 2ND 31in
slzE of FLOOR rinrnelts 1
BUILDER'S NANIE � SPAN
msTANCETONEAR S-111 ,DIN / DIMENSIONSOFSILLS
DISTANCE FROM STREET DIN!Ei 1SIONS OF POSTS
DIST'ANCEFROM LOTLINES-SIDES REAR DIMENSIONS OF GIRDERS
AItEA OF LOT FRONTAGE TIE cwroF FOUNDATION THICKNESS
IS 1111ILDING NEW SIZE OF FOOTING k
IS BUILDING ADDITION MATERIAL.OF CHIMNEY
IS 131IILDIN6 ALTERATION IS BUILDING ON SOLID OR FILLED LAND
\PILI.BUILDING CONFORM TO REQUIREMEN 1'S OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSrUCTIONS 3. PROPERTY INFORMATION LAND COST
EST. BLDG.COST
PAGE I FILL OUT SECTIONS 1-3 EST.BLDG.COST PER S . FT. /
EST. BLDG.COST PER ROON1
EI.Ef-TRIC METERS NIUST 11F ON OUTSIDE OF BUILDING SEPTIC PERMrr NO.
Al-1'ACIIFI1 GARAGES MUSK CONFORM TO S'IATE FIRE REGULATIONS 4. APPROVED BY* �+
t A5"�Zlx
PLANS NIUST DE FlLED)AND APPROVED 111'BUILDING INSPECTOR BIJILDING INSPECI'011
DATE_FILED /
01VNERSTEL>V
CONTR.TELH
coNTIt.LIcr�
SIGN:\"1l ltE: OF O\\'NEB OR AUl'IIOIZIZED AGENT' //—
EE. $ ( , II.I.C.# / a ��o? (�
I
PERNIrrGI IN TED //--
C� _2 19
iie\'ised S/5199 .iP1
NORTFj
'own of
Andover
p zr� r^
0�A�o�:„,C y dover, Mass., 9P or
D'%ATED
S H E
BOARD OF HEALTH
PttimlT T D Food/Kitchen
Septic System
® � �� - BUILDING INSPECTOR
THIS CERTIFIES THAT.......... �.........Y......... Foundation
..........
has permission to erect... �.... .. .o............ buildings on ....../P ...... ,..., ., .,,,,,,., ,v Rough
to he occupied as.......... ............... ............................................................... y
Chimne
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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. I PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
M W S' F PERMIT EXPIRES IN b MONTHS
Ott% 3UNLESS CONSTRUCTI N S ART ELECTRICAL INSPECTOR
CRough
� V ........ ....................................................................................................
1K ,AvpService
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE smoke Det.
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BE
PARIVENT
FUR S �.
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5CS
120 WtYBOSSETT ST
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