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Home My WebLink AboutBuilding Permit #570 - 137 MAIN STREET 3/24/2010 BUILDING PERMIT * NORTH r.7 0'6 2 yE,.,. ,..'., a p TOWN OF NORTH ANDOVER - Z. APPLICATION FOR PLAN EXAMINATIONso 5?_0Permit NO: Date Received A- Date Issued: � t�V �Ssgc►+osE� IMPORTANT: Applicant must complete all items on this page LOCATION 13 3- /teQi Print ~� / 7'� PROPERTY OWNER O/VMr z/�9 44 /IV l.Lld- 6x-W t- Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Re air, re lacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer �-y // DESCRIPTION OF WORK TO BE PREFORMED: w�e LQ(it/ S/,�l° 0;17 l 00 0/n f" on Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Mco��S 2 fov/ Phone Address: ?d4 /t-1171 s [ � rLetc / Supervisor's Construction License: ' .S �S S Exp. Date: '! Home Improvement License: f LI/ a S` Exp. Date: 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: $ /g57I FEE: $ Check No.: ZD / Receipt No.-—2_?,k.457 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 Dumpster on site yes no Located at 124 Main Street Fire Department 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 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 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:Building Permit Revised 2008 Location 1,31 No. � -�y Date �� d NORTH TOWN OF NORTH ANDOVER AL Certificate of Occupancy $ a`'JAcHu- E<� Building/Frame Permit Fee $ s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #/o 22U `i5 Building Inspector vAORTH Town of : 4Andover 0 �O LAKE dover, Mass., • ��• COCMICKEWICK 0RATED PPa�y�S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT �L. BUILDING INSPECTOR P .. ... .. ... ................................. Foundation has permission to a ct. ................................ ... buildings on ....� SIL . .....%.. .......... Rough to be occupied as.. ..... 1 ....... ..A.. a l�! .r...... Chimney provided that the person accepting this permits II in every respec onform to the terms of the application on le n this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Constructi f Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EMPIRES IN 6 MONTHS Final ' UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR Rough 49 .... .... .... .................................................... ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT [Burner treet No. SEE REVERSE SIDE J1 Smoke Det. ✓fie T�amirnoouuea� o�,��oaacfivaetla Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration.,,-;L-141257 wM Expiration 1/2712012 Tr# 292672 Type MARION CONSi.71 C�iON1 NICHOLAS MAFtJN K ' { k. 309 MT.VERNON LAWRENCE,MA 01$4'3`_y>`' Undersecretary ,_•. $at'et) Niassachusetts- Departmnt eof Public Re'vulations and Standards B(t�tConstOtt Tuction Supervisor License License: CS 85497 Restricted to: 00 NICHOLAERNON SION 309 M LAWRENCE, MA 01843 y Expiration: 811912010 Trt#: 1788 ('unuui,�i,rner t The Commonwealth of Alassachuselts Department of Industrial Accidents Office of Lnvestigations ..600 Washington Street I Ut Boston, AL4 02111 i+w►+.massgov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please ' Leaibl Name (Business/Organization/Individual): W/GLi O(� lit2/ vJ Address: -17 City/State/Zip: ZA W Lc c d/�?Phone#: Are you an employer?Check the appropriate box: 1•❑ I am a employer with 4. ❑ I am�on eneral contractor and I Type of project(required): . gavloyees(full and/orpart-time).* have ed the sub-contractors 6. ❑New construction 2 I am a sole proprietor or partner- listed the attached sheet $ 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' comp,insurance, g' ❑Demolition [No workers'comp, insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.❑ required.] officers have exercised their 10.0 Electrical repairs I am a homeowner doin all work ri t of ex additions g exemption per MGL 1.❑ Myself. [No workers'comp. c. 152,§1(4),and we have no 1Plumbing repairs or additions insurance required.] t employees_ [No workers' 12.0 Roof repairs POMP.insurance required.] I3.0 Other :A-v v -Plicant that checks box#1 must also IM out the section beioK• hoK�^•. t Homeowners who sunmit this affidavit indicating they are doing^ g `u"L Overt a s'comps s�sn pol-cy .m.sfion_ *Contractors that check this box must attached an additional sheet showing the name of thed then hire isub-contractors con �d miik� affidavit indicating such. I compensation insurance or m e poItcy tnfonnahon am an employer that is providing workers' information. f y mployees Below is the policy and job site Insurance Company Name: A14 do Giz� dh � yiS, Policy#or Self-ins.Lic.#: /Z/0,00 Expiration Date: q Sob Site Address:_ / !- A, s 14 / Attach a copy of the workers'compensation policy declaration ane(showing QUO A/�c/UliL�l2 � F b ( wing 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 certify un r e pains and penalties of perjury that the information provided above is true and correct Si atwe: Date; Phone#: R-�-V— Official use only. Do not write in this area, to be completed bj1 city or town off ciaL City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: 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 apartazents 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 emplbyer." 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 applicafion for the permit or license is being reques*.ed,not the r eparanent.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 permiits 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 bum 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 Washmggton Street Boston,MA 021.11. Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax #617-72.7-7749 v vrw.mass-zovfdia. JV�anon Construction Date: March 22,2010 Homeowner Information: Olympia Realty Trust Steve P. 137 Main St. No.Andover Ma. Contractor Information: Marion Construction Nicholas Marion 309 Mt.Vernon St. Lawrence Ma. 01843 978-725-3625 Salesperson:Nick Marion Construction Supervisor#085497 Exp 8/19/2010 Home Improvement Contractor Registration#141257 Exp 1/27/2012 WORK TO BE PERFORMED AND MATERIALS USED Contractor agrees to do the following work for homeowners: See attached proposal# 1414 Anything else is excluded Materials expected to be used: K.D. framing lumber,roll asphalt roofing The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work schedule to begin: Expected date of completion: TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE: The contractor agrees to perform the work, furnish the material and labor specified above for the Sum of$1,950.00 Payments*will be made according to the following schedule: *Please make checks Payable to Marion Construction $1,400.00 Deposit to be paid upon signing $0.00 upon start of project $550.00 upon completion of project DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Please make sure to sign all three documents *****Homeowner's signature Date Z O Contractor's signature_ - � _Date-3/22/1 0 r i You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. REQUIRED PERMITS The following building permits are required.It is the obligation of the contractor to secure such permits as the homeowner's agent. 1. PERMIT TO BUILD - YES 2. ELECTRICIAL PERMIT- NO 3. PLUMBING PERMIT— NO NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from Guaranty Fund provisions of MGL c. 142A NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,Ma. 02108 617-727-8598 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The homeowner hereby mutually agree in advance that the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitrations as provided in MGL c. 142A Contractor *****Homeowner Date 3/22/10 Date NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS IS NOT SEPERATLY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity: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. Contractor's Financial Insecurity: In instances where a contractor deems him/herself to be financially insecure,the contractor may require the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signature of both parties. �IV1arzQn Construction NOTICE OF CANCELLATION March 22,2010 YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER,S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER,AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION.IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAILTO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO MARION CONSTRUCTION AT 309 MT. VERNON ST.LAWRENCE MA.01843 NOT LATER THAN MIDNIGHT OF March 25,2010 Cancellation of the contract can and will be subject to a fee of$250.00 Any& all hours rendered due to individual city/town complications(permits)are billable hours. *****Customer Signature Date Maf'Zn 978-725-3625 ' Cc3nstruct�o 978-361-6668 Marion Construction 309 Mt Vernon St Lawrence Ma. 01843 Estimate Estimate # 1414 Marionconstruction@comcast.net [Date: 2/26/2010 Salesperson: Bill To: Olympia Realty Trust 137 Main St No Andover Ma. 1#1 Construct new roof frame to create shed roof to pitch to street #2 "x 6"framing with 1/2"plywood #3 Install new ice and water shield (grace) on the entire new frame #4 Install new alluminium dripedge on new roof frame #5 Install low slope asphalt roll roofing to entire new roof #6 Install new(brown)gutter on the front of new roof with two downspouts o drain to the sides of the building #7 Install new trim metal to all three window sills misc. All debris will be removed upon completion misc. Does not include paint misc. Any/all rott/water damage is an additional cost to this invoice Page 1 of 2 7 1.00$1,950.00 $1,950.00 Please contact us if you need any assistance. 978-725-3625 Total $1,950.00 Page 2 of 2