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HomeMy WebLinkAboutBuilding Permit #437-11 - 1427 GREAT POND ROAD 11/22/2010 pORTy L BUILDING-PERMIT °F �t�Eo r6�tio TOWN OF NORTH ANDOVER t6 °� APPLICATION FOR PLAN EXAMINATION * _ Ococw,twvrc�y1' Permit NO: Date Received ��Arm �SSAclws Date Issued: Z IMPORTANT:Applicant must complete all items on this page -s.+ z.:a�_ Ali:[._+ _'<•-'- -''=`4- - - y Ra3i>T=• - .rrin::!I.,:..:_-....,,.rz,� :--h.,� - vW�'i�'•�:" __.:+..,•..;,,t Y- - - r4�„5J'� W�'tK•..�•�. `,`.�i. - - 'a�_•. >>z.:. :Vie. - •cr'�•.r_... -9� - .yi...... 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J—v r�:_1�:���<:Y�..,=:�, DESCRIPTION OF WORK TO BE PREFORMED., 11>6 I Zvi iv,yv w s dentification PIease Type or Print Clearly) j OWNER: Name: //6/'9 /1G-'LU/�� Phone: Address: _ 61Re1 -/ ASL lec Ltrrn§ �ei�•"�a,., =z`_-`�j �.".'�G"�3:�r`E:at}rh'�"�"`� �-�w'l:•�i�r'..H`. .� ''1'r:a ��,., .G.mLt' 1�.mL�J�`�•^�i.'E".a�r,+�^:��'�k, rx .'K;' iyr`'-,, � i � � y'. �.i' .f"�! r+"-z-."fx_s:s;Kv��'�aK�.• E c�.-s.>.J .r � ],, "". s 4. ��+. �_� ��,rr.'}� ''` ;' s'• -„q.,`�•�v2��`„q _ ";�`,_-•"'r' lr�. ':m.'..�.av:+N,. �+�:�t. - x” � 'a�j' '�:�:-£ F; �yi;.t' r�.�,�..x...-,.Y-r�J,��.....:`�- m I, . �} =zT'1t,a''t f•'"f`"+ts'h �',`yTr� 'y�S`��' v�,p�7,et,F;.F �� �r`"l�rt""+ I � '�,,''.�Y,r-'�s,��"'F.t t",;-`r'I°"i` 5 + ��•` � sr�-Srri�1�2kt tea~ A'�n _"��1 i? 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Total Project Cost: $ � �U FEE: $ 0a Check No.: Receipt No.: NOTE: Persons conte ctingwith registered contractors do no have access to the guaranty fund 921K0-1190 51K'". en YOan/n r � i _ r _.,.:fln,,r-ae Dr k s 4 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 o 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 Pian 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 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 j . NOTES and DATA— (For department use) i I ❑ Notified for pickup - Date Doe.Building Permit Revised 2010 - - rT - 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 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: Locate 384 O's o d Street ifR EiE?, ►RTaMEIl3'.-7 :r ° D,ir iter Aaaate , e _ :;, ' _: _ _ - +..}.=_:.: "12e`P Wil'!C2._Cay. - - 'zoC-:CaLe.d: 1 - .;c �- _ _ ::t• :2, 71... _ Y �•--•vr:.-•tie.-'•' _ ...Il :. , � _ c i 1 1 , � C1d::e�.date.',.:-.::r_ - ...^,...^—, -,.1+'?'c;.YS• —•.1a— � '�:r'.._]!��_'. .r-Y-v.• —_ ^.n.r.a;:r Location No. — Date 7 - � �ORTM TOWN OF NORTH ANDOVER O + Certificate of Occupancy $ L � • ��J'••°'Eta' Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2378 Building Inspector PO Box 55098 Briton,MA 02205-5098 617-951-0600 i9so5 2015 35 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: THOMAS MELVIN Property Address: 1427 GREAT POND RD,N ANDOVER, MA Policy Number: HMA 0296907 Claim Number: BOS00050491 Date of Loss: 2/19/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either.exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Connor Donovan Claim Examiner 2/23/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3298 Fax: (617) 603-4926 Email: Connorponovan@Safetylnsurance.com 1 ORTH To'" of And No. .... _ _ -0 7 dover, Mass., o LA K COC HI C HEWICK �d AERATED P'? C7 7`s BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D • BUILDING INSPECTOR �� �W THIS CERTIFIES THAT........... .. ' ....................�. ` .... .......................................... ........ ... Foundation - has permission to erect.... ................... ............ buildings on ........I.4..�. ..........II�.11T... ... .... . • Rough • gro �� Ch to be occupied as. ... ........... .. ................... ........... �...... j .............. Chimney ' e provided that the on ac piing t s permit shall every resp t 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 Final PERMIT EXPIRES IN 6 MONTHS � UNLESS CONSTRUCTI ARTS ELECTRICAL INSPECTOR 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. Office of Consumer Affairs&Business Regulation - 1M_;__HOME IMPROVEMENT CONTRACTOR Registration: 103358 Type: Expiration: 7/7/2012 Private Corporatior A.J-WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover,MA 01845 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 - Boston,NTA 02116 Not vali without sig► ture Nla..uchusett.- 1? partntrnt lit' Public 'safct� 1 Board of Building, Rc:;ulatinns ar►d standard. MY,: License: CS 22680 ARTHUR J WALSH JR 159A WAVERLY RD r" N ANDOVER, MA 01845 -- - —�- Expiration: 619/2012 ( unmi..i uu r Tr=: 29327 The Commonwealth of Massachusetts j ' Department of Industrial Accidents Office of Investigations t 600 Washington Street Nlv Boston,MA 02111 'i`` ,�'y�~t WW1v.maSS. ov/dia g Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: C.�21_ City/State/Zip: /SSC 1q-1Y0 Al Phone#: 9'4—6 td 673Z Are yo mployer?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 employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. # ❑ 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 L0.❑ 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. Other e011Y 111671/fZ­ 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 andjob site information. ` Insurance Company Name: Policy#or Self-ins. Lic.#: J�,�D7Yz1a,yeO 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 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 der th pains a�enalterjury that the information provided above is true and correct.' t;CGti Date: St nature: �j ate. Phone#• �A 6o/ 672 ©/'ficial 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#: MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies:all basic requirements of the state's Home 6provemem Contractor Law(MGL chapter 142A),but does not Include standard' language to protect homeowners Seek,legal advice it necessary. Any person planning hotm rhinprovements should first obtain a copy of"a Massachusetts:consumer guide to home improvement"before agreeing to any work on your-res You may obtains free copy by'calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at617-973'8787 or 1.888:283-375.7. Homeowner Information 'Contractor Information amerce _ Lmupany area Street Address(do not use a Post Office Box address) Umbactorl Sal Owner Name Gr��R� e4e- >H q U�f�GS7 City/town State Zip Code i kisiness Andreas(m' inclnde a street address) . eloe 4W7 Daytime Phone Evening Phone ity/Iown State Zip Code Mailing Address(It different from above) 3usiness Phone ede—W Employer ID or S.S.Number r•w re9ona tWtmon Lemaiar Hv CeWMC rRea.N®ber 8xptrab—dole .. ayimanmaambc I ///r The Contractor agrees to do the following work for the Homeo ner: SP grace"T� mmom /rY oW / sTi�GG r/o 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 beyond the contractor's'contrul arise (Owners who,secure their own permits will be ` r) excluded:from the.Guaranty Flund provisions of MGL chapter 142A. ate�when contractor will begin contracted work ) 1Z when contracted .work will be substantially completed. Total Contract Price and Payment Schedule , The Contractor.agreas to perform the work,furnish-thematerial and labor specified above for the total sum of: (•) ments will be according to the following schedule: ' $196-M upon signing contract(not•to exceed 1/3 of the total contract price 4I the costofapeci`1 order items,whichever is greater) $ by / / or upon completion Of by_/_/ or upon completion of V'55 3 'foupon completion of the contract (Law forbids demanding full payment until.contract is completed to both party'.s satisfaction) The following material/equipment must be special S paid for ordered before the contracted work begins in order $ to be paid for - to meet the completion schedule.(**) NOTES:(*)In exp all finance Ser(••)Law requires that an deposit or down-payment required by the contractor before work begins may greater of(a)one-third of the total contract price or(b)the actual con of any special.equipment or custom made material which must be special ordered in advance to meet the completion schedule Express Warranty-re. n express warranty bairn urovlded by fhe c ntracr+ No Vas fag terms of the warranty .t. . Subcontractors The contractor agrees to be solely responsible for complcnon of the work described regardless of the actiona to a thud Party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi 4 materials and labor under ibis aereemen[ 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 reed and - - • Make sure the contractor has a valid Home Improvement[ understand it Ask if sonlethiag is unclear. The hw requires most home improvement contractors and. subcontractors to be registered with the Director of Home Improvement Contractor Regis(ration. You may inquire about.conaactor registration by writing to the Director at.One Ashburton Place,Room 1301,.Boston MA 02108 or by calling 617-727-3200.ot 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important information on the reverse side of flus form and get a copy of the Consumer Guide to the Home Iniprovement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's'normal lace of business,provided contractor in writing at his/her maim office or branch office o Pyou nO �0 third business day following the signing of this a ordinary mail posted by telegram sent or by delivery,not later than midnight of the. agreement..See thaauached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANy BLANK SPACES!!! Two identical copies of the contract must he waylee'd and a*=&pee cagy should so to the hmneownc.The other . . copy sfasrld be kept by the contractor. Homeowner's Signature Contractor's Signature Dau •,Date � Contractor Arbitration- The Home Improvement Contractor Law provides;homeowners with the righvt.o initiate an arbitration action(as an alternative to court achda)if they have a dispute with a contractor. The same right is not automatically afforded to'a. contractor,however. The contractor,would have.tp resolve any.dispute he/she.Itaswith a homeowner in court unless both parties agree to,the optional clause provided below..This clause would give the contractor the same 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 byr the Secretary of the Executive Office of Consumer Affairs arid Business Regulation and the consumer shall be required to mit to such arbitration as provided In.Massachusetts General Laws,chapter 142A. r Homeowner's Signature Contractor's Signature NOTICE:'The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alteraative.dispute resolution even where this section is not s aratel signedfiy:the parties.: Homeowner's Rights A homeowner's rights undef the 116me'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 legal.rights if the contractor guarantees. or provides an.express warranty for workmanship or materials. In addition to guarantees-or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability:and fimess_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 consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution-of Contract The contract must be executed in d_uplicata 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 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 griginal.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,or if you wish to..obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"•contact Cctnsumer 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 a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 ort-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a bulsiness,call: Coir fieeCoinplaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114