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Home My WebLink AboutBuilding Permit #413 - 137 MAIN STREET 12/1/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 1.3 In S 7 / / PROPERTY OWNER+f SPrint ��°U IU Z9I6 Print MAP NO: 31) PARCEL: 2— 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: om rcia �eplacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORM��fj D: 14,lyz do I= t' i n On f� Ide tification Please Type or Print Clearly) OWNER: Name: / lllZvsTL Phone: Address: IgG In S CONTRACTOR Name: AAC�o I GAS H4 v2/ar Phone: t` - - �" - G•�S" Address: 301 /Ll - J,"Vlekl v,-� J7L �r vrz�vt !�4 a/e Supervisor's Construction License: Exp. Date: 91/?1p�6/O Home Improvement License:--/q t P 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: $ FEE: $ 20 e Check No.: c)-3 (,.- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor`—e<�-�- 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 t 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 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 zr Building Permit Application 6 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/Elevatjon 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 Location 13q RC1/k S No. Date MORTM TOWN OF NORTH ANDOVER; Certificate of Occupancy $ s''••°'E<� Building/Frame Permit Fee $ M SA us Foundation Permit Fee $ Other Permit Fee $ nn TOTAL $ Check # D 265, o Building Inspector NORTH Town of Andover . No. F 0!) LA dover, Mass.,-I?, COC NIC ME 0 K 0, C) RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... .......... ...........V........ ................................................ Foundation has permission to erect buildings an .... .......44�w ................................ Rough Chimney ......... ... ............ to be occupied as.......... i� �Vk.......... lc�.......•........................................................ provided that the person accepting this permit respect conform to the terms 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 20 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUT AR S 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 REV I ERSE SIDE Smoke Det. �/ee Panmaouue�ci o��/�q� fucaetia Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistratlQi, 141257 IEvPirAt#on: 1127/2010 Tr# 264695 Ir �w MARION CONSTRUCTION NICHOLAS MARIpNti 309 MT. ERNON ST LAWRENCE,MA 01843 Administrator : DeR��u'lat on t.Pn I Stan� felN Nlassachusetts dar d, Board of Bttil(Itn� ervisor License Construction Sup License: CS 85497 Restricted to: 00 - NICHOLAS T MARION _ 309 MT VERNON ST 3 LAWRENCE, Expiration: 811912010 7r#: 1788 (lnuiui��iuner �larzQn _ Construction JlMUM Date: November 23,2009 Homeowner Information: Olympia Realty Trust 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 1/27/2010 WORK TO BE PERFORMED AND MATERIALS USED Contractor agrees to do the following work for homeowners: See attached proposal# 1383 Anything else is excluded Materials expected to be used: Grace Ice and water shield, 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$1,250.00 Payments*will be made according to the following schedule: *Please make checks payable to Marion Construction $250.00 Deposit to be paid upon signing ` $500.00 upon start of project - - $500.00 upon completion of project DO NOT SIGN THIS CONTRACT IF THERE ARE ANY LANK SPACES Please make sure to sign all three documents�- �.. *****Homeowner's signature Date ///1 V C Contractor's signature Date 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 - NO 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 arbitrati provided in MGL c. 142A Contractor ri.. Homeowner Date 3// Date NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPL ONLY 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. VW--an( n Construct -on NOTICE OF CANCELLATION November 23,2009 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 November 26,2009 Cancellation of the contract can and will be subiect to a fee of$250 00 Any& all hours rendered due to individual citv/town complications(permits)are billable hours. *****Customer Si nature Date��_ �- artOn� 978-725-3625 ZWD CO,IZ�St`1"ZLCt'�jQfZt1 978-361-6668 Marion Construction 309 Mt Vernon St -Lawrence Ma. 01843 EStlrillte Marionconstruction@comcast.net Estimate # 1383 Date: 11/17/2009 Salesperson: . "Bill To: Olympia Realty Trust Re: 137 Main St. No.Andover Ma. Attn:Jay or Steve #1 Remove existing siding from front of building ` #2 nstall ice and water shield #3 nstall new aluminium flashing sealed to the existing rubber roof with geo seal clear rubber roofing patch and seal #4 Install existing vinyl siding back to the original misc. 1 debris will be removed upon completion misc. Any/all rott/water damage is an additional cost to this invoice misc. Does not include paint misc. Does not come with warranty due to being a repair (band aid) _Page I of 2 1.00$1,250.00 $1,250.00 \ Please contact us if you need any assistance. 978-725-3625 Total $1,250.00 Page 2 of 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 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): 0145-S l0,17 Address:-?0 Cl de-K a 0n1 51 City/State/Zip: 14AX- Z_W C!e 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 _ �gloyees(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 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.❑ 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.[1 Other comp.insurance required.] *Any applicant that chis box 1:1 must also fill out the section below showing their worker'compensation policy information. t Homeowner 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-contractor and their worker'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: NC-tt� �_/p,?g Policy#or Self-ins.Lic.#: /1"/ P� Q �p Expiration Date: l 610 Job Site Address: 1 hz 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 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 and h pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 0 S 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"...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 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-contractors)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 permitor 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 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 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wwvv.mass.gov{dia