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Home My WebLink AboutBuilding Permit #417 - 134 COACHMANS LANE 12/1/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued:I'L IMPORTANT: Applicant must complete all items on this page LOCATION �� n R _ _ Print PROPERTY OWNER_ t d ck Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No.. of units: Commercial eair a lacem Assessory Bldg Others: Demolition Other Septic WeII Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 11 JI Identification Please Type or Print Clearly) OWNER: Name: NL Pho 66 7 " 88 Address: CONTRACTOR dame: Phone: C2 17---AA,--/q 7/ Address: IL Supervisor's Construction License: (/'. xp. Dater p Home Improvement License: 1 81�9 Exp. Date: Sb �Zr 1/ 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. Total Project Cost: $ �o 1,eE FEE: Check No.: �� 7 Receipt No.: 2 NOTE: Persons contracting with unregistered contractors do not have access to the ar ty nd Signature of Agent/Owner Signature of„contractor C Location 1 7 ( o eIZ 4"nNo. �l Date �pR,M TOWN OF NORTH ANDOVER Oita.•° .•,h0 f w n ° Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22663 "Uilding Inspector 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 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -.Temp Dumpstero site yes no treed at 1:24-tMain Streets, z Fire DepaArnent signaturefdate LL t t , , COMMENTS Y 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 - Date Doc:.Building Permit Revised 2008 Building Department The following 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 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: Doc.Building Permit Revised 2008 NORTH own of 4 over No. &4 /, t _ - dover, Mass., T Q LA E COCMICMEWICK V 7�SQRATED PPG �5 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .........P..!rr'.!.KN V.�/.°..�..1 ..�! ... . .. ............................��...��...................av Foundation has permission to erect........................................ buildin gs on �I.��...7........ ........!�............l -S.........:.. Rough �_— Chimney to be occupied as.. ....r l.!'t ........................ !!�''t .L�T3`-.......511 ��!.. .....t. .�h''�►..'"'.................. provided that the person accepting this permit shall in every respect conform to the tes 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 3&0 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ON STARTS Rough Service r.......................................................................... BUILDING INSPECTOR Final Occupancy Permit Required to Oc ipy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ~ pp�� License or registration valid for individul use only <L Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: I HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation I "' l0 Park Plaza-Suite 5170 Registration 138697 Expiration 5/6/2011 Tr# 700215 Boston,MA 0211'es TYPe C.STEPHEN COOK CONSTRUCTION STEPHEN COOK� "= i PO BOX 357 � � , r', — I RAYNHAM,MA 02768 , ^� Undersecretary of va id ithout signature 1, Ii i I, f This foam satisfies all basic requirements of the state's Home lmprovernexxt.Contract.,Law language•to protect homeowners. Seek hegal advice tf necessa (MQL�ptc142A),but does not include standard Massachusettsconsumer guide m.hourc improvement"befatc Y. Any P—on'planning home improvements should first obtain a c Office of consumer Affairs and Business Re ece work on your,residence.You copy or-,a gelation s Consumer info msS' 83-.3n•e free copy by calling the rraataan Hotiincat617 973.87$7 or 7.885-283-3757. Somt:owner Information 4—Contractor Information �mm Ne Part EiptN y e SOIAddr=(do not use a Post Off,Box.addreas) `� C:0 V / /'Gj Contractor!Sal 3 7 L ..City �'1 tS �,v. - ��a� . Sam Zip Code i+sia ess address fmttst iadade a strct address Daytmte,Phoae Eve Phone J �A tQd P/1 / �'� j �►�nith Sna, /Ny//�/��Ztpcode hds�limg address(11 different from above) C 6 VU / usiaess Phone ederal FzaployerID erS.S:NuuI The Contractor agrees to do the followhngwork for the 13omeo mer 4% fags : • Pl->l,s. Required Permits-The following 6tniditre•,permits are required Pro end will be secured by the contractpras the homeowper s agent, iuc►sed Start and Completion SDitetlnle-The flowing ac (Ownees who serrata thtiiu own be aclhere8 m unless cusums®nces }«a"I.will. pt t mfta WM-he beyond the conasetoes control arise e'dutled'from the Gum my Rum provisions of jy�`�O 1VIGL ahapber'141A:) Date whet comraemr Will begin coatrricted work 3��Data W"M conttaeted work will be Total Camract Mce and Payment Scbednle substaatiiliY completed The Contractor agrees mpetform the work,furnish the material and labor specified above for the total sumo. •�e� �a ®� Payments wM-bb made acct ° (*) rdirtg m the following schediile: - s /0 ..upon signing Contact(not to exceed 1/3 of the total cera tract price or the coat of special order items,whichever is great= ) or upon completion of / r upon completion of s A ®o upon completion of the contract (Law forbids d c:mI frill paymeat until cotrtract is coarplemd'm.both The following ma__U,,1mpmam must be speriw S. party's_smdsfaction) ordeeil before tbemnnacted wotk'beP in order .s— to be paid for to meet the.—platiaa rxhedWri(•'t) - to be paid far NOTES:(•)lncbidiag all Hm_ e11217M`ry'IBw reneirrs that not exceed the. foto° dowu-payment remmeil by the coauacmr before work b*as may Eerier of m ten adva cat o total he comt.tm�rxenor(b)the acetal tori of any special eyitipmmtor rantdm made mateaa] which must lee spedal mdaeil m advante m meet the coaap schedule: . �xprear.Warranry.lsarrrsnrsay�'vvart•aritvb' nv7dedirvlhacoatrameYi . .. c b tr2c[orb' The Contractor$gr=to be stile r tart terms M N.e wartvnry �+ party/subcontractor utilized the con roapnasible for comp) n of the work descnbai m COm so the n acts tit' 7O0mOTR agrees m be sole) re gardless of the actions of any fiord sad ' or.underih . t Y responsible for rill payments to all subcontractors for Contract Aceeptance-Upon signing,this document becomes a.binding contract shall not imply that any lien or others connect under lay'• Lhiless otherwise noted within this document the carefully before signing thus contract`interest has beta P>eced on the residence. Review the following cautious and notices Dont bePressured into sighing the contract Tike time to read and f U • sub–b reontracrof has a valie d H Y it is Ask questions if something andicar• lmmm subcontractors to be registered with the DuectorofHomp verrterlt nnfmimpren r... R no The law requires most home improvement ooattactors and registration by writing to'the Director at One Aslibarmn Place Roomeat Goatractor Registration You may inquire,about contractor Does 223-0933. 13D1,Boston Ma.021108 or by calling 627-727.3200 or Does tine�om co"r have inmas ? Cheek to see tharyottr conuactor is PtoPer13'itisureii Know year rights wad respoasrbilities. Read the-lmpartantIriformatio3o Guideon the revetse•aide of this form and get a .to the Home bnPmv=cw Contractor Taw. copy ofthe Consumer You may Cancel this agreement if it has been signed-at a phtce other than the co oenaactar m writing.st hisThermam Office or branch office ordi ntraetoYs normal plate of business, video 'thud business day following the si i of this a OOty mail Piuted ter P" You notify the ga ag gmemeat Sec$e menthe' telegran sent or by doiivery,not later tba idnight of the DO N4DT S'1'GN THIS CO d aotite of cancellation f for an.expl on right Two itlmti at NTRACT TF T•F3ERE wpis of Ibe mtmad.must tie mmpletr�and signd..Core . n. L I r 1 SPY°hoWdgoro fat ' tby thematraavr. f . Homeowner's Signature Contractor's Signature z 7- I Cf Date �� 0, Da¢ Contractor A,16itratio6 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 i not -ally afforded to a eormactor,however. The contractor would have to resolve any depute he/she has with a'homeowner in courrunless 'both parties agree to the optional chute provided below. 'I leis clause would give the contractor the same right to arbit mfion as is afforded to the homeownerby the Home Improvement Contiactor'Law. The contractor and the homeowner hereby mutually agree in advance that in the event the co conceturactorhas a dispute concerning this contract the contractor may submit the dispav-te•to a private arbitration firm which has been approved by The Secretary of the Executive Office of Consumer Affairs and Business Regulation d the shall be required to submit to such arbitration as vided In Massachusetts•Caeneral Laws,chap mewes Signature - Con r s SignatureNOTCr:Tie•sgnte of the parties ab a apply onlyxo 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 separately.signed by the parties. not Homeowner's Rigyrts_. . A homeownei"s right ander the Home Improvement CoMEactor Law(MGL chapter 142A)and other consumer protection law i e.MOL chapter 93A)ma 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. ROmeowners-who secure their own building permits are automatically excluded from all Guaranty Fund provisions of • the Home Improvement Contraetar'Law: The contiaetor is respa�rble for completing the woiic as described,in;p' timely and watiananhke 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 contractor,all.goods sold in Massachusetts carry an implied w guarantees or warranties provided by the warranty of mernhantability and fitness_fora 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 mot restrict a homeovvner's basic consurn rights. If you have questions about your consumer&Meowner rights,contact the Consumer•Information Hotline(listed below)., E=ecgfion of Canhacf The contract must be executed in duoIicate 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- fihie in or marked as void,deleted;.or not applicable. One original signed copy of the contract with attachments is w be given to the owner and the other kept by the contractor. Amy modification to the original contract must be in writing . and agreed to by both parties.Contacted work may not begin until both parties have received a fully executed copy of the contract,and the three day recission period has expired. Ameierabed-Psyments A contractor may not demand payments in advance of the dates specified on the paymentscbedule in cases where the homeowner deems him/herself w be frnaocially.insecrae. Howeverja instances where a contractor deems him/herself to be financially isrsectue the contactor may requite that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal signatures ofboth.parkes. of funds from said account would.require the Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer-nights,.or if you wish to•obtain a free copy of "A Consumer Craide.to the Home Improveroca-Contractor Law,"contact; Consumer 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 s contractor or if yon have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact Director of Home Improvement Contactor Registration Bureau of Building Regulations and Standards - One Ashburton Place,Room 1301,Bostoa,.MA 02108 (617)727-3200 or 1=800=223-0933 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/OB Better Business Bureau (508)652-4800 (508)753-2548 .(413)734-3114 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: -7o � , City/State/Zip: 9_4N t a Phone#: 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. ❑New construction loyees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.El 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.❑Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-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 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 unp7onront,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day ag�fofuXr //erage advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA verification. I do hereby certify un a he i and penalties of perjury that the information provided above is t true and correct. Si afore: - `—�/- Date: Z,///D / Phone#: Ll 0—1Y/1 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 Contact Person: Phone#: 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"...eve person in the service of another under an contract of hire "...every Y 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-contractor(s)name(s),address(es)and phone 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. A new affidavit must be filled out each year.Where a home owner 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. 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111. Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia The d.o-m onwaalth of aS achuse tS Department of Fire Services Office of the State Fire-Marshal P.Q.Box 1025 State Road,Stow,MA 01775 PERMIT Date: North Andover permit No _ (City of Town) (If Applicable) =Date In accordance with the provisions of M G Ll 4$.Chaptcr_J_Q_asprovided in section_ 5?7 C:MR 34 I. This Ptnnit is granted to:. „p it'A c/ ,�j��f `/� sa��s�L Full name of person,Finn or Corporation Permissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be , 25 ' from structure if unable to lace with re aired Restrictions:clearance dumpster must be covered with 1 wood or tar end of work -day at (Give location by street and no.,or describe in such manner as to provie equate identiFication of location) Fee Paid s 50.00 ' ?. Fire Chief This Permit will expire /// O�i (Signature of o tea granting permit) Wffic'al��gr"aGgp,�,uit (Title)