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HomeMy WebLinkAboutBuilding Permit #733-14 - 13 HARWOOD STREET 4/18/2014 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: Afi4(-q IMPORTANT: Applicant must complete all items on this page LOCATION I7,.`�%', r.7 PROPERTY OWNER � ice e ` /'nG�sG� Print 100 Year Old Structure yestno - MAP NO: PARCEL ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ACOne family [I Addition El Two or more family El Industrial [I Alteration No. of units: 11 Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11Septic ElWell ElFloodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DES. C T PTION OF WORK BE PERFORMED: �A"e Identification Please Type or Print Clearly) OWNER: Name: U9-67: Phone: Address: T� L' CONTRACTOR Name: Phone, l Address: Supervisor's Construction, License: 5-D� Exp. Date: // 6 11 Home Improvement License: —Exp. Date: Iezz 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: $ �S'� , FEE: $ �30 �- Check No.: r -� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 07 -L - Signature of Agen41� ell t/Own J Signature of contracto��_ Plans Submitted Fj Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived `❑. Certified-Plot Plan ❑ Stamped Plans ❑ :TYP OF=SEWERAC3EDiSPOSAL- Public Sewer ❑ Tanning/Massage/Body Art ❑. . ,Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ { Private(septic tank,etc._ ❑ Permanent Dnnpster on Site El THE:FOLLOWING SECTIONS FOR OFFICE USE ONLY M i, _ INTERDEPARTMENTAL SIGN OFF - U FORM 1 2__-DATE. REJECTED DATEAPPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS :CONSERVATION Reviewed on- Signature I� COMMENTS i HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: :Comments Water& Sewer Connection lS_ignature& Date Driveway Permit DPW Toga: Engineer: Signature: -- Located 384 Osgood Street [FIRE D'EPi4RTI�ENT =:Temp Dumpster on site yes no ocated-at 124,Mair., Street Fire Departure►it signatureldate"-. COMMENTS a -- -- -- — Dim-ensign Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land-area; sq. ft.; ELECTRICAL: Movement of Meter locations 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.$100-$1000:fine NOTES and DATA — (For department use i i El Notified for pickup - Date I --------------------- [ 22 Doc.Building Permit Revised 2010 - I Building Department -'rhe fol owing is'a=list of,the retluired.forms to be filled out for..:the appropriate-permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits - o. Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C-S.L Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks L3 Building Application Permit A lication u Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) u 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 Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apwr 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 I Location 4 No. �� Date r ( 4 . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $� _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ;_ , •, } Building Inspector � NORTpi Town ofndover t_ p .1 No. 3 * 01 - �ah ver, Mass, 'P coc«�c«ew�cw 1• V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT ........e>NOW ,.......VV%w C ���`C BUILDING INSPECTOR ........ .............................................. has permission to erect .... buildings on ..��....... Foundation .. Rough —As to be occupied as ........ .. ..... ... .. ........... !!.4�� .:...................... 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 T Rough Service ... ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm 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 Commonwealth of Massachusetts , Department oflndustrigl Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 -www.mass gov/rlia Workers' Compensation.Insurance Affidavit:SuiXders/Contractors/Electricians/Plumbers A. licant Worm.ation Please Print Le_ •b ), ENS O,� Name(Business/0rganization/Xudividual. i/n S Z. Address: �� 7 Ciiy/Statc[Zip: I'1'I Phone#: 7 7, 3S,—e 7 Are you an employer?Check the appropriate box: Type of project(required): 1.C] I am a employer with 4. El am a general contractor and I 6. F1 Now construction em loyees(full.and/or part-time).* have lured the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and`haveno employees These sub-contractors have 8. []Demolition worldng for me in any capacity. workers'comp.insurance. 9, E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised.their 3.E11 am a homeowner doing all work right of exemption per MGL 11.❑Plumbingrepairs or additions myself.[Nb workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurancere edemployees.[No workers' �' .] 1311 Other comp.insurance required.] ?Any applicantthat checks box#1 must also fill outthe section bef(V showingtheir workers'compensationpolicy information. ?'Homeowners who submit this affidavit indicatingthey sre doing allwork and then hire outside contractors must submit a new affidavit indicating such, tContractors that checkthis box must attached an additional sheetshowingthe name ofthe sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and jolt site information. Insurance Company Name: Policy##or Self-ins.Lic.#: ©6 lAl)� Expiration Date: Job Site Address: 1 3 iS�i9il�o d c5 City%State/Zip; /- � �--- Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as reguiredunder Section 25A ofMGL 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 of the DIA for insurance coverage verification. X do hereby certgy under the p/ain's and penalties ofperjury that the information provided above is true and correct. - Si afar • T Date:Phone#: Official use only. -Do not write in this area,to be completed by city or town official. City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.C41T- own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Persom Phone 9: ,�o�rrvnga,Zuse��ltlz,a����cC.?suc/u�e�; Office of Consumer nffairs.&c Busir'1ess ftegut�.�F°n .. . ME IMPROV€MENT CONTRACTOR — Type- oEgistration= 161420` Inaividu�l 1012p12_014, xp►ratio�' - , ST EV EN'F..C I ARAMAG U A STEVEN CIARAMAGJJA'I_ 127 WAVERLY ST .; EVE.REl T,MA 02149 Underseciretaxy t Massae lysetts -�_-a.Irtment of Public i Spord 0f.@ua- -1119{2ec�u(i,iions�nd Stern =s Construction Supers iso r. Licensed CS-097762' 1j STEVENT CtARAWMAGI.LAr�r 127 WAVERLY -T ' EVF�RE•TT NSA 02149 Expiation 11/1612014 -,I Cor^missioner 'I I This form satisfies all basic requirements ofthe 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 o£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 CompanyName Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 13 t/�Igwoad QST- cqec�Qov/ -- J-4— City/Town State Zip Code Business Address(must include a street address) Daytime Phone Evening Phone Cityrrown State Zip Code di-e 910 Mailing Address(It different from above) Business Phone IFederal Employer ID or S.S.Numrber W72- cwt.to Reg.Numbc Expiration&te tht omst homeavadrstratl snuuab ave 0a valid reelelslrntton a�her 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 materials to be used,use additional sheets if pMssary_) 2P�clime����i�o'�`" � Gc�/'►�/�o�f 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: be adhered to unless circumstances mstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of y' 9'' Date when contractor will begin contracted work. MGL chapter 142A.) 26 �7 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule �. The Contractor agrees to perform the work,firmish the material and labor specifed above for the total sum of 7 S D (*) Payments will be made according to the fullowing schedule: $ Z S��upon signing contract(not to exceed 1/3 ofthe total contract price or the cost o€special order items,whichever is greater) $ Z.S� by�/ L or upon completion of 3 fid✓"t/d0 t1l s �rG`� $ Z >� by�126'l�or upon completion of 7ji /i✓ 4w-de u-Y Si $ upon completion ofthe contract. (Law forbids demanding fall payment until contract is completed to both party's satisfaction) The following matenal/equipment must be special S 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 ofthe 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 scheduI Ex rens Warranty-Is an express warranty beine provided by the cqntmctor.U No❑Yes W terms ofthe womanty mast be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion work described regardless offi a 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 aweement 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 contmct_ • Don't be pressured into signing the contract Take time to read and fully understand it Ask questions if sa rnething is unclear. • Make sure 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 confian coverage,or ask to sere a copy of a`proof of insurance"document • Know your rights and responsibilities. Read the Important Information on the reverse side oftliis foam and get a copy ofthe Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing ofthis agreement. See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM TIM ideutical copies ewatract must be completed and sigwd.One copy should go to the honuowner.The other copy should be kept by the contractor. .f/ Flo�neown Signature Contractor's Signature