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HomeMy WebLinkAboutBuilding Permit #249-15 - 12 HAMILTON ROAD 9/12/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: I Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION / , x' r �. Pr'nt. PROPERTY OWNERS d��-/ �',_ Print 100 Year Old Structure yes no MAP NO: ,PI6.PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE ResideNon- Residential ❑ New Building One family I ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic-'-El Well ❑ Floodplain El Wetlands ❑ Watershed District _11 Water/Sewer i DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: AP41e' C-�-,� 5 Phone: Address: CONTRACTOR Name: qSOt6 Phone: Address: 1331A ,144'4 L V _Rcz- /Ill 1'1U A� Supervisor's Construction License: 0 Z? Exp. Date:. g� Home Improvement License: l�,3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. / 153 ` Total Project Cost: $ `� �6®,� m � FEE: $ Check No.: `�(P.1I Receipt No.: ? -1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signatur& -Agent/Owner_ _ SigDature of coniracto w Plans Submitted [] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ . 'Plans Waived ❑. ;.-Certified Plot Plan ElStamped Plans El -TYPE-_0.F:SEWERAGEDiSPOSAL - Public Sewer ❑ Tanning/Massage/Body Art ❑. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ "Private..se c tank,etc._ Permanent Dempster.on:Site El .-THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -DATE REJECTED.--_ DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS ONSERVATION 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 ConnectionlSignature& Date Driveway Permit DPW Tows Engineer: Signature: ' Located 384 Osgood Street FIRE D�EPARTIVI;it:'iVT.:-:Temp Dump;steronsite yes no Lbcated at,124;Mair, Street "'j TM _ r • �• Fire"Departm " e►it�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..locatFon-, mast or service drop requires approval of Electrical Inspector Yes No DANGER.Z®NE LITERATURE: Yes No MGL-Chapter 166.Section 21A-F and G min.$100-$1000fine NOTES and DATA— (For department use i ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department -The wipwing-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 apn•�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 No. J Date V/zAi } ' I . - TOWN OF NORTH ANDOVER SETT D X646 Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# (01 u Building Inspector NORTH own of ndover No. 4I 4�'_.A-1 h " ver, Mass, coc"Ic"aw.cw U BOARD OF HEALTH Food/Kitchen Septic System PERMIT THIS CERTIFIES THAT .. . A 1. .. �, BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ilk......... . . +1414.......�.....s�............. Rough 1 • to be occupied as ...... .. . ........... .....� ............... y provided that the person accepting th' mit shall in every respect conform to the 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 i 63 PERMIT EXPIRES IN 6 ON HS ELECTRICAL INSPECTOR UNLESS CONSTRUC Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough i 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. I MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form,satisfies-all basic tCquiremenfs of the state's Home Improvement Contractor Lew(MGL chapter 142A),but does not Include standard language to proteet1omeowners. Seek legal advice if necessary. Any person planning home iupruvements should fust obtain a copy of"a Massachusedstconsutnes.gmiide to home'•improvement"before osier ing.to any work on yourresidenee.You may obtain-a free co Office of ConsumerAffairs:and Business Regulation's Consumer Information Hotline at-617-9734787-or or 1:888:283-3757:the Homeowner Information Contractor Information ante ;P/0pony ante �� a /��� � �v�s SaA/s Street Address(do not use a PostOffice Bnx ad ss) tractor/Sal msordOwnerName City/f State zip Code usiness• �raual include a street address) Daytime a J(, Evmin Phone p itylfowa State Zip Code Mailing Address pt different from above) 3usiness Phone lederal Employer M or S.S.Number ' lav ngwm sal am=int• Rome :rr Cmaadtr atamhtr :Hxtmaur 7 .. pov®ml eeatrecooio W.ee eYimetioo®ham /b3 - �� The Contractor agrees to do the following work for the Homeo tier. —a ME UK U1133,3110 grado or Itequired'1Permits-Tho-following building permits are required Proposed Start and'Completion Schedule-The following schedule a'U and will besecumd;by the contractor as the'homeowner s agent be adhered to unless circumstances beyond:the conttactoes'cormul wise (Owners who serine their own Permits will be excluded.from:the Guaranty Fund.provisions of )date when eont<ectorwill begin contracted work. MGL chapter 142A.) Date when eontractbd .workwill-beaubsUatiallycompleted.. Total Contract Price and Payment Schedule ��` The Contractor.agrees to perform the'work umish-the material and labor specified above for the total sum of. (s) Payments will according to the following schedule: S!I) r Vt'upon.signingcontract(not•toexceed1/3ofthetotal.contractprice.grthecost;ofspecialorderitems,whicheveris:greater) or upon completion of upon completion of upon compietionof the Contract (Law forbids demanding full payment until.contract is completed to both party's.satisfacgon) The following material/equipment must be special S to be paid for ordered before the contrscted'workbegms in order S to be paid for—�- to Meetltie:rnmpletion schedule.(**) NOTES:('h including novex� finance charges(••)I.aw requires that any deposit or down-payment required by the contractor before work begins m greater of(a)one-third of the total contract price or(b)the actual con of an er which must be Y special equipment or custom made material special ordered in advance to meet the Completion schedule. Express Ware a warraori beinQ.orovlded by MasantncM*� Ne Yes (aLterms of the warranty mast be attached to the eontraen Subcontractors The contractor agrees to be solely responsible for completion of rhe work described regardless of the actions of any tliiid party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and laborunder ih+s••»..-a,cot Contract Acceptance-Upon signing,this document becomes a bindingcontract under:law. Unless otherwise anted within this document,the contract shall not imply that any lien or other security interesNas been placed on the residence. Review the following cautions and notices carefully before signing this contract • Doul be pressured into signing the contract Take time to reed'and fully'understand it A* M;ifsons' • 'Make sure the contractor h•a".•t:t u .r M__ _ g is uaelear. subcontraetora to be registered with the Director ofHoome The taw requires most home improvement contractors and registration Improvement Contractdk Registration. You may inquire about contractor . by writing to the Director shone Ashburton Place,Room 1301,.Boston,MA 02108 or by,calling 617.727-3200 or 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 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 contractor's'normal place of business,=notifycontractor in writing at his/her mala office or branch office by ordinary mail posted by telegram sent or by deliveryht of the,thiid business day followingthe signing of this agreement.See the attached notice of cancellation form for an expl DO NOT SIGN THIS CONTRACT THERE wa idemtfeal eapics arum masa must lx ARE ANY BLANK SPACES!!! eompttxea oma siaaea,one eapy.stnutd w to the .rhe other Copy shouter be kept hr the contr ,/ eetor. 7 J'I.�.� Homeowner's Si tura / Contractor's Signa f Date 1 to Contractor ArbitiaHon The Home improvement Contractor Law provides homeowners with the-Aglivto initiate an arbitration action(as an altematrve to court achoii)if they;have a.dispute with.e contractor. The.same:nght is not automatically afforded to a. contractor,.how.ever.• contractor would have.tp resolve any,dispute helshe.has. ith a homeowner in court unless both parties agree to.the optiontl=elause 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 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 hag-been.approved by the �cretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shat]be required subrrrit to such arbitration as provided InMassachusetts General Laws,cha 142A. Homeowner's SignAture Con tot's Signaud NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor::.The:homeowner.may initiate alternative:dispute resolution even where this section:is not separately signedbyr*6 patties:: Homeowner's Rights A homeowner's rights undec'theHome'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 descried,in a timely and worktaanlike:manner. Homeowners-may be entitled to.other specific legal rights if the contractor guarantees. or provides an.express warranty•for:workmanship of materials. In addition to guarantees,or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability:and:fit ims_for A particular purpose. An enumeration of other matters on which•the homeowner and contractor lawfully agme: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 du lice 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 aad the other kept by the contractor. Any modification.to the gngmaf 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 mgy not demand payments in advance 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 "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 l-(888)2813757 If you want to verify the tegistrationof 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 Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 - For assistance with informal ift ation of disputes or to register formal complaints against a buso0s;-call 'Consumer'Courplaint`Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Page# of pages CS # 022680 j. 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 159A Waverly Road 1-978-912-2853 North Andover, MA 01845 Proposal Submitt Job Name Job# Awl � Address ` f Job Location ,, Date � / Date of Plans "t "# AL Architect We hereby submit specificati'ondw� estimate for. ddAO �r v We propose hereby to furnish material and labor—complete in accordance with the above spec ns for the sum q/ of: / IlVd Dollars with paymefits to be made as follows: Any alteration or deviation from above spedfications involving extra costs will be Respectfully executed only'upon written order,and will become an extra charge over and Submitted- above the estiinate.PJ agreements contingent upon strikes,accidents,or delays beyond our cdhtrol. Note—this proposal may be withdrawn by us if not accepted within days. �CCP�Jtd1tCl2 !OL D�?0$� The above prices,specifications and conditions are satisfactory and are Ze Signature ZeN e q- hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature i i The Commonwealth of Massachusetts =p Department of Industrial Accidents Office of Investigations Y r }arta 600 Washington Street AD` s = sy Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ?/ Please Print Lie ibl Name (Business/Organization/Individual): xalt Address: /�'U�if'L' All City/State/Zip: N' d #A10&1_e_A 1-"7 phone #: ���''—1� 737 Are yo employer?Check the appropriate box: Type of project(required): I. 1 am a employer with _ 4. M 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, F1 Demolition working for me in any capacity. employees and have workers' 9 Buildingaddition [No workers coin comp.insurance p• insurance.t required.] 5. We are a corporation and its 10.❑ Ele ical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ umbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'Airy applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy,and job site information. Insurance Company Name:. 6 y Policy#or Self-ins.Lie.#: /da.p/y! Expiration Date: Job Site Address: /4114 hlol City/State/Zip: �W V ,domed Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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. I do hereby certi nder t e pains/andel p�en�0erjury that the information provided above is true and correct. Si nature: Datf& Phone#: .. ;72 7 - - - 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 l+,...a,.,.a D........... Dl,......4. I DATE(MMlDDfYYYY) ACO1?C!® CERTIFICATE OF LIABILITY INSURANCE 12/04/2013 TH�RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CpNTACT IRODUCER 00775-001 NAME: PH NE S78 582-5175 A%.r;o,: (978)794-0313 Durso&Jankowski Insurance Agency Inc Ali.IJo.Ext: ( ) 198 Mass Ave Suite 101B EMAIL ADDRESS: North Andover,MA 01845I #E F DIN CO E E INSURER A• A.I.M.Mutual Insurance Company 33758 INSURED INSURER B Arthur Walsh INSURER A J Walsh&Sons 55 Pleasant Street INSURER Q North Andover,MA 01845 IN REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING NREQUIREMENT, TERM OR CONDITION DESCRIBED DOCUMENT RESPECT TO HEI CH THIS ED ORMPERTA E INSURANCE BY THE POLICES HEEIN IS SUBJECT TO ALL TERMS, CERTIFICATEMAY BESSUY gEXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE AINSR W I POLICY NUMBER MMIDDnEYYY MMIDDnYYY LIMITS EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY P c e CLAIMS-MADE OCCUR MED FRCP(Any one person) $ PERSONAL&ADV INJURY $ EIVE $ GG S EN'L AGGREGATE LIMIT APPLIES PER: ___]POLICY RO OC uECT T $ AUTOMOBILE LIABILITY t ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED e accident) $ AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS MADE AGGREGATEpp KKDEDggR�ETENNTIIONN $ y�C ST ji ANLgEMPL�YOfMRS LIABILITY X TORY LIMyy .p EE77pp{R� ISqARTNERE E.L.EACH ACC1 OO,OOO.00A A PRRMRjgMBERPEXCLUDE/D7 ECUTIVE N/A AWC-400-7014648 2013A 1111412013 11!1412014(ManICEdatory in NH) ��I—IVV�J E.L.DISEASE- 100,000.00 If YQsdes��ffibe�LrLderE.L.DISEASE-POLI500,000.00 DtSCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town Of North Andover 1600 Osgood Street SHOULD ANY THE ABOVE NOTICE POLICIES WILL CANCELLED DELI DELIVERED BEFORE IN THE EXPIRATION DATE THEREOF North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. w 11THOR115D RCPG FRGNTATIVE &-oa ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-022680 FIS ARTHUR J WALS,S3 159A WAVERLYRD"I'' s N ANDOVER MSF 01845 Expiration Commissioner 06/09/2016 ��c epo•�uneanuc�r,//�o�G��ilir:uac•�uJcG/� � . ffepistr'iation: Office of Consumer Affairs&Business RegulationLicense or registration valid for individul use only ME MPROVEMENT CONTRACTOR before the expiration date. If found return to: 103358 Type: Office of Consumer Affairs and Business Regulation iraton: VM016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 A.J.WALSH&SONS,INC. i Arthur Walsh 55 Pleasant St a�v G(N Andover,MA 01845Undersecretary Nalid with t signature I 1