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Home My WebLink AboutBuilding Permit #796 - 149 MIDDLESEX STREET 5/31/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IlmORTANT:Applicant must complete all items on this page i LOCATION 4/� /tli7P L---SSeX S-7 Print PROPERTYOWNER Print MAP NO: 02-o PARCEL: 000yZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside ' Non- Residential ❑ New Building O'One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other 9 p it c�'.®.3VJell� �aPl ,0 ) fOWetlandst ��';04w tershed}District 'i OFloo am i . Y DESCRIPTION OF WORK TO BE E RFORNMD. G'7//??yV4 40 /Nk7ate/S Identification Please Type or Print Clearly) OWNER: Name: �iQk��v �'� )VOR II/ Phone: � T Z�7 Address: /D/JGe s�5 X S ✓ /W;%Voav�k IVA- CONTRACTOR Name: -w�LS l� 9Phone: Address: cS.S r A/d ,91vau Supervisor's Construction License: 4-;t-LGBo Exp. Date: Home Improvement License: Date: 7 �� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMITj$12.00 PER 00.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: �D FEE: $ � �' Check No.: #-� Receipt No.: I �s NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of-A ent/O.wner.;�;::: ::: :�_. ._ • '-- - - -- ---,_._—_.—�_-- _ - - -. .... .: ....::.._..;:. �• i a ure of°:contra;� o:<. i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ FPubEc WERAGE DISPOSAL ❑ Tanning/MassageBody Art ❑ SwimmingPools❑ Tobacco Sales ❑ Food Packaging/Sales ❑c 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 E HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning DecisionJreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Lo at d 38 sgood Street FIRE DEPARTMENT - Temp Durapster 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 i 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 g DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals i fait the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording . lust be submitted with the building application i Doc: Doc.Building permit Revised 2008mi Location Zf# dz — No. TOWN OF NORTH ANDOVER AL F R 9 Certificate of Occupancy $ ---4 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24 , L6 � Building Inspector ORTF1 Town of An ove O ;,' `.p..fl` '��• ..fit . No. LAK O dover, Mass.. Nu D COCKICMEWICK 7�S RATED P'P�,`�5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR V' ��t `!. .............. ....... ... ...Q.✓ri i.............................. ................................................ Foundation has permission to erect........................................ buildings on........ 1.. .......... .� . . ... ............ ............ Rough to be occupied as........ ....�.,.� �J...........� .G - .T .........�..�.t#a—ejAxr............::............ ................... Chimney provided that the perso accepting this permit shall in every 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR Q-- UNLESS CONSTRUT TS Rough ........ . .............. 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Page# of pages NIS CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH .North Andover, MA 01845 Proposal Submitted To: Job Name r Job# Address Job Location Date ". "? Date of Plans Phone# _ 4?7�- M .3o"7 _ 4 74 Fax# ` Architect We hereby submit specifications and estimates for: D a We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ 1�� ' a`4 d a� �'''�Q Uri Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays submitted beyond our cdhtrol. Note—this proposal may be withdrawn by us R not accepted within days. Scceptance of propoof jz: The above prices,specifications and conditions are satisfactory and are Signature t I ^ + hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature 11 The Commonwealth of Massachusetts Department of Industrial Accidents j„ Office of Investigations 600 Washington Street IU1 Boston,MA 02111 .: www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Legibly --- Name (Business/Organization/Individual): S' \7 � s Address: City/State/Zip: A10 9 N DOy-60, /1}—Phone #: 97e — IzPif—(oo 737 Ar�yon mployer?Check the appropriate box: Type of project(required): 1. mployer with 4. ❑ I am a general contractor and I 6. ❑New uction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling 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 10.0 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 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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.#G �� Yed/7�� Z'� Expiration Date: Job Site Address: �7 '�/�P I(cod f Sz S 1 City/State/Zip:NP�i00bYA M A d-'8" 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 fonn 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 certif under the pains andpenalties of peijury that the information provided above is true and correct. Signature: �y Date: Phone#: Official use only. Do not write in this area,to be completed by city or town offlciaL 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 M 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-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 pen-nit 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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit 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 yod`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 ww4v.mass.gov/dia r.' __ Office of Consumer Affairs&Busin;_ess Reulation :-HOME IMPROVEMENT CONTRACTOR Registration: 103358 Type: Expiration: 7/7/2012 Private Corporatior A. J:"WALSH&SONSJNC. Arthur Walsh,Jr. 55 Pleasant Sty _ N Andover, MA 01845 l,'ndersecretar� License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Boston,MA 02116 ! •l l�,i rJ/t� !, /,'jib.• Not vali(Vivithout sigtattire ila,Sarhtlsot, - Deltartrncnt of Public "afc! }Dart fit, Bilildin:; iZc-ulilt imt+ ;tial ,t:ut(iar6 License CS 22680 ARTHUR J WALSH JR 159A WAVERLY RD N ANDOVER, MA 01845 F,<1)11attun. 6/9/2012 t ;,jinni i n r Tr= 29327 MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form.satisfiesap basic requirements of the state's Home lmpmvemert Contractor law(MGL chapter 142A)I but does not include standard language to protect homeowners. Seek,legal advice if necessary. Any person planning home}tnprovtmtents should first obtain a copy of"a Massachusetts;consumer guide to home•improvement"beforo agreeing to any work on yourresidenoc.You may obtains free copy by'calling the Office of Consumer:Affairs and Business Regulation's Consumer Information Hotline at617-973'8787 or 1.8884283-3757, Homeowner Information Contractor Information Name -QUIPany Name Street A (do not use a Post Office Box address) tractor/Sal's esptsaon/Owner Name .. Ci tyfrown state Zip Code ess Address(must include a street address) . Daytime Phone Evening Phone •tyrrowa State Zip Code Mailing Address(It different from above) 3usiness Phone Haderal Employer M or S.S.Number 1•v nq• tnnmopnomei, Rome ConncWr Reg;N= _a"imatim�drte ' ' ewoactm6nea m{Imatic.aambe ��33J-'ji The Contractor agrees to do the following work for the Homeo stir: 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 comrol arise (Owners who secure their own permits will be excluded!rom the Guaranty Fundprovisions of /&lien coiitractorwill begin contracted work. MGL chapter 141A.) /Irate when contracted .work will-be-listamiaily completed.. Total Contract Price and Payment Schedule , The Contractor.agmes to perform the work,furnish the material and labor specified above for the total sum of: (r) Pfgents will be made according to the following schedule: ' $ � upon signing contract(not_tb exceed 1/3 of the totalcontract price.2r the cost.of sped fI order items,whichever is greater) $ by___ or upon completion of0. p $ by =J-='7=�or upon completion of upon completion of the contract (Law forbids demanding full payment until.contract is completed to both party's,satisfaction) U The following material/equipmeat must be special Sebe paid for ordered before the contracted work begins in order S� to be paid for W meet the completion schedule.(**) NOTES:(•)incladiog all(mane charges(••)Law requires that any deposit or down-payment required by the contractor before work not exceed the () price or(b)the actual cost of bigots may greater of a one-third ce to total contract any special er custom made material which moat be apodal ordered in advance to meet the completion schedule. _ Exvress Warravty.Is av axvresswarranty beLn4 otovided by the contractor? No Yes (all ter•.. of the *.+S1fed tothe covtliintn Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actionaofany dcn 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 Gen or other security interest)ias 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 folie understand it Asltquestions ifsomething is unclear. • Make sure the contractor "r a valid Home Improvement Contractor.Registration Tyre 91ti;requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about.contra ctor registration by writing to the Director at.One Ashburton Place,Room 1301,Boston,MA 02108 orby 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 and responsibilities. Reed the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not hater than midnight of the, thud 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 IF THERE ARE ANY BLANK SPACES!!! o ideotiral copies of the contract moat be wmplard and sigued.Ow copy.d ould so to the otic eopy sbouW au . ,/ ke pt the contractor. .. L% Homeowner's Signature 7 Co. is Si tore DatSli /aoi� ,Date t. Contractor Arbitration - The Home Improvement-Contractor Law provides,homeowners with the righVto-initiate an arbitration action(as an alternative to courtaction)if they have a dispute with a contractor. The same.rightis not automatically afforded to.'a. contractor,however. he contractor would have tp resolve any dispute helshe.has.with a homeowner in court unless both parties agree to the options&.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 by 4 the Secretary of the Executive Office of Consumer Affairs and Business Regulation andthe consumer shall be required W baht to such arbitration as p led In.Massachusetts General Laws,ch 142 w rr Homeowner's SignAtureContractot's Signa 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 alternative:dispute resolution even where this section is not separately signed*-the 'es:' Homeowner's Rights A homeowner's rights under the Home'Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Le.MGL chapte.f 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 cavy an implied warranty of merchantability:and fitness.for:, particular purpose. An enumeration of other matters on which•the homeowner and contractor lawfully agree:maybe 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 duplicate 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 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,or if you wish to.obtain a free.copy of"A Consumer Guide to the.Home Improvement Contractor Law,"•contact Cgnsumer 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,questiims 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 s (617)727-3200 or1-800-223-0933 For assistance with informal tr ediatron'of disputes or to register formal complaints against a business,call: ConstiYuerComplaint'Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114