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HomeMy WebLinkAboutBuilding Permit #946-14 - 107 OLD FARM ROAD 6/30/2014 BUILDING PERMIT o�"�oT"�ti 02 �6 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '" Permit No#. 1 Date Received 3 �gSSgcHus���y Date Issued: L MP RTANT: Applicant must complete all items on this page LOCATION f LJQ P Pq Paint PROPERTY OWNER tl� L %J/Ur4pe—:L �^ Print 100 Year Structure yes ' no MAP ,S � PARCEL: _ZONING DISTRICT: Historic District yes no I 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: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO B PERFORMED: 5 �r Identification- Please Type or Print Clearl OWNER: Name: C' �- e IS 7-1�� tom- �1 �/Z L7- Phone: ? 7 5' 7-2J Address: / (6� CAR-OL-1wW L--L Contractor �, �� Y, , „ „—, ,Phone: �7. `7 7 / �� 1 '00 Address: -/ C 0 ydAZi Supervisor's Construction License: 6-4107 Exp. Date: q"Ikly Home Improvement License: 17 7 V3 2- Exp. Date: &/44 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.: r� Receipt No.: NOTE: Persons contrac angMn recl contractors do not have acce he guaranty fuignature of Agent/OwnerSignature of contract Plans Submitted ❑ Plans 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS r OjEALTH 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/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 ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract D Floor Plan Or Proposed Interior Work L3 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 . o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o 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) ❑ Copy of Contract o 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location /v 7 No. Date tP . - TOWN OF NORTH ANDOVER • P Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � � '� Building Inspector c10RTH Town of Andover O i No. h ver, Mass, COC N'C N(W IC. 7,4 RATeo ►P S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..................... . .....✓..�..)..................... .... .......... ........ .................. BUILDING INSPECTOR has permission to erect .......................... buildi s on ... .Q. ok&.. .. �r .• Foundation .. �, Rough to be occupied as .......... ........ ................... ... .... chimney ... t. .. �'. 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 an Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T S 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. Smoke Det. The commonweaXth of Massachusetts ` Deparbu ntoflndustriglAceldnts Office of Investigations 640 Washington Street Foston,MA 02111 vmmass govId a Wo rke:r$,Compensation Jf murance A�idavif:Bui der s/Cont°actorsfFIectx ciansfriii)kP M Applicant Information Please Ledb Name(Businessioxgmizationllnsd%vidt Address: CitylStatel7 p: F'�,�'� c) s°� rl Phone#: !� 7 Are you an employer?Check the appropriate box: Type of project(required): 1.[� i am a employer with 4• ❑ I am a general contractor and I 6. EJ New constriction f employees(fall and/or part-time).* have nod the sub-contractors 2.E] 1 am a sola proprietor or partner listed on the attached sheet:I `7• El Remodeling ship and`have na employees Thes sub-contractors have 8. ElDemolition working forme in any capacity. rkers'comp.insurance, g, ❑Building addition [No workers'comp.h sarance 5, We are a corporation audits 10.E]Electricalrepairs or additions requixed.� officers have exercised.their xi ht of exemption per MGL 11•[[Plumbingrepairs or additions 3.El am.a homeowner doing all work 1 an dwehave no myself Mo workers comp. c 52, ( ), 12.p Roofrepairs insurancerequired.] employees.[No workers' 1311 Other comp.insurance required,] xAuy applicantthat checks box#I must also fiU out the section below shovtingtheir workers'compensationpolicy information. i Homeowners who submittbis affidavit indicatingthey 2ce doing allworkand then hire outside contractors must submit a new affidavit indicating such. TContractors that checktbis boy must attached au,additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I=an employer that is•providing workeYs'comperasation iusurane,f"My ernproyees BetO'w isthepoliCy andjObsite information. Insurance Company Name: Policy#or Selz ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach,a copy of the workers'compensation-policy declaration page(showing the policy number and expirationt date). Failure to secure coverage as requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a fma 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 fie of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. ,l do hereby a' e Z enalties ofperjury Mat tlZe in Ormation lYOVided ali0ve ZS tYll6 and CoiY6et - Si afore• ` Dafe• Phone#: l Offreial use 0111y. Do not wa'ite in glis a.-ea,to be completed by city or town official. City or Town: Permif/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - bx,-- Information and Instrutxons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statate,an employee is defined as"...evezypexson k the service of another under any contract of h7xe,• express orimplied,oral oxwxitten:' An employd:ls defined as"an individual,partnership,association,corporation or other legal entity,or anytwo oxoxe of the foregoing engaged in a joint enterprise,and including the legalrepresentatives of a•deceased em to ex.or the xn xeceivex ortrustee of an iudividuat partnership,association or other legal entity,employing employee s Iii Wever the owner of a dwelling househavingnotmore than three apartments andwho resides therein,or the occupant of Me dwelling house of another who employs persons to do maintenance,construction ox 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." MOL 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,MOL chapter 152,§25C(7)states'Weither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been.presentedto the contracting authority.." Applicants Please 1717 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if nocessaxy,supply sub-contractor(s)name(s),addresses)andphonenumber(s)along with their certificate(s)of Insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members ox partners,are notrequired to carry workers'compensation insurance. If an LLC orLLP does have employees,apoIicyisxequired. Be advised thatthisaffidavit maybe submitted tothe Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be rettunedto the city or town that the application for thepermit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are xeq*ed to obtain"a*oxkers' 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 andprinted legibly. The Department has provided a space atthe 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 fdl in the permit/license number which will be used as a reference number, In addition,an applicant thatmust submitrrtultiple.permitflicense applications in any givenyear,need only submit one affidavit indicating current policy information(if necessary)and under"lob Site Address"the applicantshouldwrite"all locations in (city or towu):'A copy of tho 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 ltome owner or citizen is obtaining a license ox permit not related to any business or commercial venture 0.e.a dog license or permit to burn 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 , please do not hesitate to give us a call. Testions The Department's address,telephone aiid faxnumber: °l.,:he CQ Moll-W. Of M-0 - Dep"at(MeUt Q-fkJU*ia1.AAcoldenta t. fte ofTn•VeWlgaaQM NAP, 02111 Tel RM-2Z,49,0 0 PA 406 QT 1-87MASSAFE Revised 5-26-05 FQX#617-727-7749 ' wt�4vzxfa�,s,gQ.v�c1�a . Massachusetts Home 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 Name C4tt5-n Al 1� E-Zo�5 Street Address(do not use a Post Office Box a ress) Contractor/Salesperson/OwnerN e City/Town State Zip Code Business Address(must include a street address) &) (e /Afkwo�� 014 / C, -� Daytime Phone Evening Phone City/Town I State Zip Code Z �5 Mailing Address(It different from above) Business Phone Federa mployer IDor S.S.Number Home Improvement Contmcmr Reg.Nwnter E#,uion dale I.mv requires[hat most home t avolid ghtntiatnumb Kase valid mgistsation number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of rpaterials to be used,use additional sheets if necess .) viv 1G,�1 S C�CcU 6CC0 l 7T0 1 S U)4j V( i�G `O 1,A L is 0 k' LC I K K ►-1 S Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: 4aher to finless circumstances beyond the contractor's control arise (Owners who secure their own permits will beexcluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) (Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,fumish the material and labor specified above for the total sum of (*) Payments will be made according to the following schedule: $ 166 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by / / or upon completion of $ by /_/_or upon completion of $ a yn v upon 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 $ 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 down-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 Warranty-is an express warranty being 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 sore 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 contr ctor s normaAafc f business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail post d,by telegram by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached not ce of cancellatifor explanation of this right. DO NOT SIGN THIS CONTRACT IF THE E AR B K SP CES!!! Two identical copies of the contract must be completed and signed.One copy should go to meowne Th o py should be pt by the contractor. 0 Homeowner's Signature Co or's Signature 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 isnot 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 advaYthment the contractor has a dispute concerning this contract,the contractor may submit the dispute to tion firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Bun and the consumer shall be required to submit to such arbitration as provided In Massachusetts Genera142 Homeowner's Signature ontractor's Signature NOTICE:The signatures of the parties above apply only to the Bement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may itiate 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 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 http://www.mass.pov/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 BIC website at http://www.mass.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 Version 2.1-11/22/2010 wa Massachusetts r D Ppartm�rjf-4p RtiEil� ::"5 Board of Buildinafety g Regulatiot3 i$ac3.St`aiicl rds Construction Supe n� - License: Cs-007$$4?;.,1, GERARD E WEL PO BOX 248 elt N ANDOVER Mk 018 5 Commissioner Expi ration 04/18/2016 ale �P��vnaoazcuca�L�a/(�/aCcraJac�ca elJd Office of Consumer Affairs&-Business Regulation ME IMPROVEMENT CONTRACTOR _ ,egistration: IY7832 xpiration; :_2/12/2b16. Type: y Individual GERARD WELCH GERARD'WELCH` I 19 COUNTY RD L ANDOVER, MA 01810 - (-,•� Undersecretary