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HomeMy WebLinkAboutBuilding Permit #764 - 136 SALEM STREET 6/1/2010 NORTH BUILDING PERMIT 01*J-( *D ,6;sti- TOWN OF NORTH ANDOVER or h' °�, APPLICATION FOR PLAN EXAMINATION '" 7D n Permit NO: Date Received �q DgATfD�Pp��S SAC us Date Issued: d IMPORTANT: Applicant must complete all items on this page LOCATION ct`!E't'X" �" /�✓_? � . /� ,„ PROPERTY OW., R Print MAP t $210 PARCEL ZONING D1s7 -Historic'Distnct yes o .77777 :Machrne Shop Village yes o ` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial jRepair, replacement ✓ Assessory Bldg Others: Demolition Other Septic ' Well 1=loodplain 1Netlands WatersFied District Ua/ater��Seuve.r; F DE RIPTION 9F WORK TO BE PREF ORMED: Identification Please Type or Print Clearly) o OWNER: Name: C�n'1�'a%I �`a �v,—,cy-,-k Phone: Address: &>� CONTRACTOR= Name ftil'°�'tJi C? Cp� 1 y Phone.. 1, Adtlress, Ak v �^ Su ervJsor's Construction L=acense (�,� J Exp Date . Horne Itn ;rovenaent,License exp . Dae., r . . .. i 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: $�, DQ FEE: $ I Check No.:1(� �o Receipt No.: 6'13220 NOTE: Persons contracting with unregistered contractors do not have access to the gu nty_fund Signature of Agent/Ovvner 1�rignature of contractor 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 j ❑ 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 2008 I I 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 r DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature CCY°AMENTS .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'_Durnpster on site Lgcatecf at 124 MamStreet '`� , Ir�re:Department slgnat6 1date. COMMENTS i 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 2010 Location 1241 cS�/� .�� No. Date O: N0R7M TOWN OF NORTH ANDOVER } 9 Certificate of Occupancy $ ~f_ Building/Frame Permit Fee $ A sACMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Q 232 �. C# Building Inspector ORT#q TO" of Andover 0 No. dower, Mass. O �= LAK 1 1 COC MICMEMC.K AERATED i'V C:) `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......... 1? /.�-..:. .......Cr'1....097................................................................................. Foundation has permission to erect........................................ buildings on ....,340.... t.... T-...................... ..... Rough S. Chimney to be occupied as................... .��v . ......."!--....... ....... . ..................................................— . --................. he person acce tiermit shall in eve res ec conform to the terms of the application on file in Final provided that t p p p �i p Fa 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 S 6 — PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough ........... ............................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. The Commonwealth of Massachuse&s Department o f Industrial Accidents Office of Investigations 600 RlashinaWn Street Boston, M4 02,11 , www mass.gov/dia Workers' Compensation )<nS Applicant Information urance Affidavit: Builders/Contractors/Electricians/Plumbers --; PIease Print Legibly Name(Business/Organization/individual): (J Address: r le:z� City/State/Zip: L,D n��o✓- /u Phone#: Are an employer?Check appropriate box: I•I vJ i am a employer with 4. ❑ I am a and I Type of project(required): employees(full and/or part-time).* have hired subcon-contractors 6• Neu,construction 2.❑ I am a.sole Proprietor or partner- listed on the attached sheet t �• ❑Remodeling ship and have no employees These ub-contractors have working for me in any capacity. workers' com . ' 8. ❑Demolition [No workers' P Insurance. comp: insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3•❑ required] officers have exercised their 10 ❑Electrical r I am a homeowner doing all work rit of ex epairs or additions emption per MGL 11.❑Plumbing repairs or additions myself [No workers'comp. c. 152,§I(4) and we have no insurance required_] t em to ees. 12.Z<oof repairs *-av sp?Iic ut that x box=: a,usc r�sc, Pomp.Insurance required] 13.[] Other 1^Yll(Sn[the EC' Q^_h�'QP.':.aQY.'L^c i..^.eL 0.'Ort:er5'eomP-..X---:QQ i:...: Iiomeowaers who submit this affidavit indicating they a.e acing all work and �c Qa 'Contractors that check this box must attached an additional sheet showmP the me hire outside contractors muss'submit s ne-N affidavit inaiating such. name of the sub-contractors and their.workers'comp. I am an employer that is providing workers'compensation insurance or m employ policy information. information- f Y employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie. Expiration Date: --/f Job Sit--Address: S City/State/Zip: �o j,j< , �Alh, Attach a copy of the workers'comp ensati n policy declara�on page(showialb the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL C. 152 can lead to the im osition of fine up to$1,500.00 and/or one-year imprisonment, as well as czv�Penalties in the form of a STOP WORK ORDER and a fine P criminal penalties of a 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 certify under th and penalties o er u r fP j rJ Sicat the information provided above is true and correct. Si�ature: Phone#: F[th only. Do not write in this area, to be completed hil cam,or town of ciaL n: Permit/License# hority(circle one): Health 2.Building Department 3. Ci /Town p Clerk 4. Electrical Inspector 5.Plumbing Inspector son: Phone#.- Information an- d 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"...every person in the service of another under any contract of hire, 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 maintsxrance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be cause 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 c--onstr-uct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co3mpliance 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 ua 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-contractors)name(s),addresses) 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' comp ration 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 swire to sign and date the affidavit. The affidavit should be:turned to the city or tern that the application for the perryait or ice-se is being requestzd,not the Department.of Industrial Accidents. Should you have any questions regardirag the law or if you arerequired to obtain a workers' compensation policy,please call the Department at the.numbs=listed below. Self-insured companies.should enter their self-iw=ce 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 pemiit/lice,we 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 peru►its 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 Ifice to than 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.faxnumber:.__... . The Commonwealth of Ma,ssa.chusetts. Department of Industrial Accidents Office of I> resifgatfons 600 Washington Street Boston,ILA 02111 Tel. # 617-72.7-4900 eat 406 or 1-877-MASSAFE Revised 5-26-05 Fax #617-72.7-7749 u rurw.mass._mov/dia. ,.wr FOURNIER Family Roofers & Painters JAMES DEBRECENI' MAPLE ST. EXTERIOR PAINTING - CARPENTRY - ROOFING HUEN, MA 01844 FREE ESTIMATES _ 978-683-5127 S� r P, trip C-ck@ ep4i�-,f VA Ile is s�41/ Ue iI-r Rhe �l ise lea .� � TOTAL ✓I J Da ON ACCEPTANCE e � WHEN STARTED I ! `I CO✓ c/` TG���J HALF COMPLETE BALANCE WHEN COMPLETE l ALL CHECKS TO ALBERT FOURNIER OR JAMES DEBRECENI - tv �I .77 r •. oil „ 5 .16 s r =ouRIv1ER Family Roofers & Painters JAMES DEBRECENI= ' EXTERIOR PAINTING - CARPENTRY - ROOFING L MAPLE S �o 3 / T. i S HUEN, MA 01844 FREE ESTIMATES I`I IC• roo 978-683-5127 - ____:_ ....mtun Hotline at 617,9 i3-8787 or 1=888-283-3757. Homeowner Information Contractor Information Name ompany Name Street Address(do not use a Post Office Box address) Contractor/Sal sperson/Owner lrame 136 Sal��l Sf J�ti►-1�s �e,6 r@ c e� City/rown State Zip Code usiness Address(must include a street address) it/orfI A.tcl�e r /t�9. !d I? /t1�p le /�I�f`i � o/y Daytime Phone Evening Phone :iryrrown State Zip Code Mailing Address(Il different from above) Business Phone jederal Employer ID or S.S,Number Law reVims that mon home int- Home pmvemeat CnmraClnr Reg.Nmnber Expiration date pmvemmt contractors have a aaer.. tration ainober ' �I� Q.� ( Q's The Contractor agrees to do file following work for the omeo neC:. nalitneworKlocomp e ng e,Drand,and graa-e-b1-bjATFnjIgT0--DFWe ce Pie r003 Al Avs'� Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will slid will be secured by the contractor as the homeowner's agent, be adlhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of 4__;'!0 Date when contractor will begin contracted work. MCL chapter 142A.) Date when contracted work will be substantially completed. 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 will be[Wade according to the following schedule: $ © upon signing contract(not to exceed 1/3 of the total contractrice or the p _ cost of special order items whichever is greater) ) byJ_ or or upon completion by _/ / or upon completion of s7/000 upon,completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) I The following material/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 completion schedule.(**) 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 Warreoh-1s an exor warranty beiao by the contraMaT? _No Yes fall terms of the warranty must be attached to the contractl Subcontractors-Thecontractor 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. • M aka sure.the contractor has a valid Home Improvement Contrac(.oLRegistratioft 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 One 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 find-responsibilities. Read the important Information on the reverse side of this form and get a copy of the Consumer Guide to rte Nome-Improvement Contractor Law. You may cancel dhis agreement if it has been signed at a place other than rte contractor's normal place of business,provided you notify file , 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 of the third business day following.the signing of this agreement See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IIS THERE ARE ANY BLANK SPACESI!I Two identical espies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor. f i i nleowner's Signature Con actor's Signature l� 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 is not 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 sanle 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 has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. Q)��0A.9e1%k omeowner's Signature C ntractoes Signature NOTICE: The signatures of the parties above apply only to the agreement of the partes to alternative dispute resolution initiated by the contractor. The homeowner•may initiate 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 1jegal rights if the contractor guarantees or provides an express warranty for workmanship or in 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 consumerlhomeowner 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 havee b en.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 recission 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,or1f you wish to obtain a free copy of "A Consumer Guide.to the Home:Improvement 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 l-(888)2833757 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: t Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,NIA 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/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114