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Home My WebLink AboutBuilding Permit #615 - 11 FRANCIS STREET 3/4/2014 TOWN OF NORTH ANDOVER r`` APPLICATION FOR PLAN EXAMINATION Permit NO: 1 ✓ I Date Received Date Issued: �J V/I —� P RTANT:Applicant must complete all items on this page LOCATION Print PROPERTY O NER /t�/l�� /�C%�/� 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 a 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 O BE PERFORMED: Lx/ Identification Please Ty a or Print Clearly) OWNER: Name: /�/L�� C_ 2cc, K Phone: Address: CONTRACTOR Name: J S </ �/,S6/YS Phone: Address: /:`///y A; /Y!/tiYUi4 Cls? ""I-)/ Supervisor's Construction License: Exp. Date: C V/ `/ Home Improvement License: i'� -3 ' Exp. Date: // ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �/�C�D� FEE: $ Check No.: �� Receipt No.:_ .� NOTE: Persons contracting with unregistered contractors do not have access to t guarantyfund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. Date v . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $` Other Permit Fee $ • ;:v TOTAL $ Check#) t J Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TOF`-SEWERAGE DISPOSAL YPE Public Sewer ❑ Tanning/Massage/BodyArt ❑ 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 ❑ ❑ COMMENTS 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 ood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair Street Fire Department signatureldate 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 LI Notified for pickup - Date Doe.Building Permit Revised 2010 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 ❑ 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 cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apt)%-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.+.ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 -- Town of Andover O ti. 1r No. h ver, Mass, A- COC KICH(WICK �' 7a�ADR4TED 7S U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT .........NA.jlCer......�_p�,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR has permission to erect .......... buildings on 11......... Foundation 1 _ . Rough to be occupied as .......`. ......... ....... ..✓1 l........v-1.'.4�.t:(!.!!� ...�T...........I............................. 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT S ARTS Rough Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Buildens/Contractors/Electricians/Plutnbers plicant Information Please Print Legibly rle (Business/Organization/Individual): 4V4 cress: /State/Zip: . G ry Phone#0YM?"--6 727 yot n employer? Check the appropriate box: Type of project(required): am a employer with l 4• ❑ I am a general contractor and I employees (Rill and/or part-time).* have hired the sub-contractors 6. ❑New struction I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have- g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I am a homeowner-doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] i c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] 11 1 Aicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. «niers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tors that check this box must attached an additional sheet showing the name of the sub-contractors*and state whether or not those entities have :s. If the sub-contractors have employees,they must provide their workers'comp.policy number. i employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Wiwi. ce Company Name: f 0& or Self-ins.Lie.#: �O/y(,o y /app/y Expiration Date: l% // / Address: /,� ��2 1Gll�. �/�T City/State/Zip: ��G��z1j}-- a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a to$1,500.00 and/or one-year imprisonment, as well ascivil penalties in the form of a STOP WORK ORDER and a fine $250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of rations of the DIA for insurance coverage verification. ,eby certify unde•the pains and penalties of.perjury that the information provided above is true and correct. re: ,t! iLl�v �G� �1` Date: 3 y 441 use only. Do not write in this area,to be completed by city or town official or Town: Permit/License# ng Authority (circle one): ►ard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector :her ort lPercntn' Phone#: I MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfiesall basic requirements of the state's Home Improvement Contractor Law(MGI:chapter 142A),but does not include standard' language to protect homeowners. Seek legal advice If necessary. Any person planning home irtaprovern.nts should iiiii obtain a copy of"a Massachusettr consumergaide to homeimprovement"before agreeing to any work on yourresidence.You may obtaira flee-copy by'calling the Office of Consumer.Affairs-god Business Regulation!a Consumer Information Hotline at617-973'8787 or 1..888:283-3757. Homeowner Information Contractor Information Name prey SaketA (do not :.a Post Office Box address) tractor/ or Name City/Town State ZipCode usla m de street A17A �L/ ` Wyl9tPhone EveningPbtfne ityrlown State Zip Code %179 Mailing Address N different from ve) iui Phone ederal Employer ID or S.S.Numbs LstegWtn lWtmml Bomaim. name tcWftCWaeg Nrbv Em.Wan-slit .. aoatmetm Ervie / The Contractor agrees to do the following work for t ��be I he Homeo mer: ! ' Mi me Won Id adrapicrea,specuymg me 15,350 g,103 Required Permits-The-following building permits are required Proposed Start and Completion Schedtile-The following schedule will and will be secured the contractor as the'homeownet+s agen( be adhered to unless circumstances beyond the coatrutots'sortie!mise (Owners who;secure their own permits will be excluded.from the Guaranty Furid`provisionsof ISatewhen contractor will begin contracted work MGL chapter 14A.) L ate when contracted .work will-bexubstandally_completrA Total Contract Price and.Payment Schedule , The Contractor.agrees to perform the work,furnish the material and labor specified above for the total sum of. (■) Payments wi1Lbe made according to the following schedule: Z)00 6J upon.signing contract(notab exceed 1/3 of the totalkontract price.gr the costof special order items,whichever is greater) S -�1 by//or upon completion of $ ��by_� or upon completion of de upon completion of the contract (Law forbids demanding full payment until.contract is completed to bout patty's satisfaction) (! The following matenal/equipment must be special S to be paid for ordered before the contracted work'begins in order S to be paid for to meet the:corapletion schedule.(**) NOTES:(•)Including all(mance charges(••)Lw requires that any deposit or dowmpaymem required by the contractor before work not exceed the begins may greater of(a)coo-tthird of the total contract prize or(b)the actual cost of any special equipment or custom made maturel which must be special ordered in advance to meet the completion schedule Express warranty Is an exec es.wamety beim¢provided by theeontnebr• No Yes (n .of tb wamety mn•f h• had to the cotrtnetl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions'ofany tbiid party/subcontractor utilized by the contractor. The contractor further agrees to be sole lyresponsible for ell payments to all subcontractors for materials and labor under thisattreement Contract Acceptance Upon sigrring 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 intemst)ms been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into sighing the contract Take time to reed and fully understand it Ask'questions ifaoti3t thing is unclear. • Make sure the contractor has a valid Home Imnrovtanent(ontrac� Retrictrati The law requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contractee Registration. You may inquire about.contiactor registration by writing to the Director it-One Ashburton Place,Room 13Q1,Boston,MA 02108 orby.Calling 617-727-3200 of 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the teverseside of this foim'and gets copy of the Consumer Guide to the Home hi)provement Contractor Law; You may cancel this agreement if it has been signed at a place other than thecantraetrifs normal place of business,pro=yo'contractor in writing at his/her main o1£ce or branch office by ordinary mail posted,by tele sent or delivthird business day following the signin of thisa J3� by cry,n ,g greem-L.See theattached notice o£cancellation form for an explana DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM T-0 ideatiral copies"rhe,contract mart be eonpleted and signed oee eopy.shvWd so m the hmnwwna.The odd .. . coPY sh•uW be kept by the omtractor. Homeo er'sno re Contractor's Signature Date 1Z ,Date Contractor Arbitrsiion The Home Improvement Contractor Law provides.homeowners with the nghtu initiate an arbitration action(as an alternative to courtaction)if they.have a,dispute with.a.contractor. The same right is riot automatically afforded to a contractor,how.ever--,'. 'lie:contractor;would have:tp resolve any,dispute helshe.lias.with a homeowner in courtunless both parties agree to the optional elause provided below:.This clause would give the contractor the same right to arbitration is is afforded to the-homeowner by the Home Improvement Contractor Law. . . The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been.approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation andthe consumer shall be required submit to uch itration as provided Massachusetts General Laws,ch 142A. Ho own is SignAture Contractor's Signature NOTICE:`The signatures of the parties a ve apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The<homeowner may initiate alternative,d spute resolution even where this section.is not separately signeddn+',the.: 'es:' Homeowner's Rights A•homeowner's rights und, Iboc,116me'Improvement Contractor Law(MGL chapter I42A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement: However,homeowner$ may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowner, 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:woil®anlilce manner. Homeowners.maybe entitled to other specific legal:rights if the contractor guarantees or provides an.express warranty for workmanship oi•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:apsrticular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree:maybe 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_d0licare 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 griginal 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 recission period has expired Accelerated Payments A contractor mpy 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'i 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 genend:questions or.need additional information about the Home ImprovementContractorLaw or other consumer rights,or if you wish<to.obtain s free:copy of"A Consumer Guide to the Home.Improvement Contractor Law,"•contact Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the-registration of a contractor or if you have.questions or need:additional information specifiaally about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 ort-800-223-0933 For assistance witli informal mediation of dispttttes or to register formal complaints against a business,-call: Coiisuriier`Complaint`S6ction Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 I. I.V , J ,L ii, 1IVVVVI,I, LV InUVl%nnVL IIV. [VYU F. I) c CERTIFICATE OF LIASILITY INSURANCE DATE(MMDD/YYy) 12104/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS MIRTIFICATBELOW, THIS CERTIFICATEFOF INSURANCE DOES NOT CONSTINTJTE EXTEND OR BETWE N T IEE ISGSUIAFFORDED G NSURER(S)AUTHOR ZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT:If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATIONI IS WANED,subject to :he terms and conditions of the policy.Certain policies may require an endorsement. A statement on this certificate does not confer rights to the :ertificate holder in lieu of such endorsemant(s). IDUcER 00775-001T WC Ars*&Jankowski insurance Agency Inc 8 Mass Ave Suite 1018 e,exti!_(978)682-5175 ,,R (978)784.0315 Irth Andover,MA 01845 � 6'�Esa: )RED A.I.M.Mutual Insurance Company 33759 Thur Walah INSURER a! J Walsh&Sons Pleasant Street Irth Andover,MA 01845 )VERAGES CERTIFICATE NUMBER: REVISION NUMBLR: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TME INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOFINSURANCE i t� P40LICYNUMBPR � � UNITS LtABINTY EACH OCCURRENCE a COMMERCIAL GENERAL LIABILITY DAMAGE ISFS0CFA ED = PRFM CLAIMS MADE OCCUR MED EXP(Arty one person) _ PERSONAL b ADV INJURY s GENERALAGOREGATE : EML AGGRIWATE LIMIT APPLIES PER: PRODUCTS•COMPIORAQG $ OUCY RO. OC AUTOMOBILE LIABILITY COMBINED LE LIMIT S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Par person) S AUTOS AUTOS BODILY INJURY(Per acment) I HIRED AUTOS NON-OWNED AUTOS R PERTY DAMAGE : uMaRELLA uAe occuR e EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE AGGREGATE s WQ�NNO(eb pp RE��TpENN��TIIO��N S — AND EMPLOCYERP3'LIABILITY X O S {{��IIyyyy ggppppRR��ggTTaaqq ppRRTTNNER�X 1� MIS ��" vFFICERJINEMBER�tJtCLU❑ED►ECUTNEI NIA AWC-400.7014648.2013A 11/14/2013 11/14/2014 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory In NH) EL DISEASE-EA EMPLOYEE S 100,000.00 URI OFpP RATIONSbelow EL DISEASE-POLICY LIMIT b 500,000.00 :RIPTION OF OPERATIONS I LOCATIONS/VEHICLES iAnaeh ACORD fat,Add(Roeal Remarke Schedule,If mom*pate A NquVed) MFICATE HOLDER CANCELLATION In Of North Andover )Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE :h Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IRD 25 2010!05 0 80-2010 RD CORPORATION.All rights reserved. ( ) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs -Busi(�ess Regulation - MOME IMPROVEMENT CONTRACTOR f,4 -4=- Registration: 103358 Type: 'Expiration: -7/7/2014 Private Corporatic A. J.WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St _ N Andover, MA 01845 4 � — Undersecretary i vlassachUSetts - of?ubhr. Safety Board Of BUIlding Regulations and Standards License: CS-022680 ARTHUR J WALSji JR 159A WAVERLY_RD N ANDOVER MA 01845 06/09/2014 Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submlt : �J / Job Name i/ Job# ,lil/✓'� Address r '.-- Job Location ate /J Date of Plans Phone# / Fax# Architect We hereby submit,specifications and stimates for. We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: 00 $ -'1 000 t VQ`� L � � 6 Dollars with payments to be made as follows: � ti Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and SUbmltted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our cohtrol. Note—this proposal may be withdrawn by us if not accepted within days. The above prices,specifications an editions are satisfactory and are Signature ---- hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. / Date of Acceptance Signature