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Home My WebLink AboutBuilding Permit #195 - 15 SAWYER ROAD 9/10/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: C� Date Received Date Issued: I IL f� IMPORTANT:Applicant must complete all items on this page LOCATION —r Print. PROPERTY OWNERS-< �i�-� Print 100 Year Old Structure yesrno MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 4-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: _ 77- Address: r T 1s -73d-3 CONTRACTOR Name: GSC , Phone: I Address: L& �•t �,�f/vim�`I a /-0-4-vwI' Supervisor's Construction License: C f Qq g :14:F _ Exp. Date: Zzz z Y Home Improvement License: G `��U 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: $ �dy FEE: $ 430 Check No.: Z Receipt No.: � /� NOTE: Persons contracting with unregistered contractors do not have access to the rantyfun ;Signature of Agent/Ovvner Signature of contrac r _ _ _.. _ _ Plans Submitted ❑ Plans Waived 0 Certified Plot Plan to p Pla s 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 Sionature h COMMENTS a 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 i Dimension i 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 foto DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) j ® Notified for pickup - Date Doe.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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks L3 Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) Li Building Permit Application o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract a Mass check Energy Compliance Report o 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 2012 Location Date • TOWN OF NORTH ANDOVER , y Certificate of Occupancy $ Building/Frame Permit Fee � Foundation Permit Fee $ " Other Permit Fee $ i . TOTAL $ Check 7 25692 Building Inspector { NOH RT T' own of aAndover 0 No. O�Ah ver, Mass, A_ coc"ICHIWICK I. - s � BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT 4:..40.1. .. BUILDING INSPECTOR has permission to erect .......................... buildings on ....... . ........... ..Iawwww.... %a Foundation Rough g to be occupied as Aa ...... ....... ...... .............................................n.............. Chimney provided that the person accep g this permit shall in every resp conform to the terms of the application Final on file in 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 D PERMIT EXPIRESCANARTS HS ELECTRICAL INSPECTOR UNLESS CONST R Rough Service• ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE _ Office 0fC0Hs umer/,"'—"s&Business ME IMPROVEMENT CONTRACTOR RACTOR on - ,egistration: "160504 N= xpiration: 815/2014 Type: Ltd Liability Corpc. PkNDOVER CHIMNEYS;LLC Ci.,VID HAWKINS S 00 SOUTH UNION ST LAWRENCE, MA 01843 -- Undersecretary } Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-099718 DAVID A HAWKU�S j 247 NORTH MAIN STREET s ANDOVER MA 61810 �— `-i•�•-� vw " j5� Expiration Commissioner 06/08/2014 I �_ : ACORDDAT CERTIFICATE OF LIABILITY INSURANCE 08/28/2012 TM. PRODUCER Phone: (978)475.0400 Fax: (978)4752171 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION THE HOWE INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 PUNCHARD AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ANDOVER MA 01810 ALTER RAGE INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: A I M Mutual Insurance Company DAVID HAWKINS INSURER B: National Grange DBA ANDOVER CHIMNEYS INSURER C: 640 SO UNION ST LAWRENCE MA 01843 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'LPOLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MIDD DATE MMIDD - LIMITS GENERAL LIABILITY MPJ02179 05/01/12 05/01/13 EACH OCCURRENCE $ 600,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 PREMISES Ee occurence) CLAIMS MADE OCCUR MED.EXP(Any one person) $ 10,000 B PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000 POLICY PRO LOC JECT .AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ Per accident) GARAGE LIABILITY $ AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ri EXCESS f UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F�CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION$ $ WORKERS COMPENSATION AND we sTATu- oTNER EMPLOYERS'LIABILITY AWC7027029 0$/06/12 08/06113 TORY LIMITS _ E.L.EACH ACCIDENT $ 100 000 A ANY PROPRIETORIPARTNERIEXECUTIVE r OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 M yet,describe under tvituL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS DAVID HAWKINS IS EXCLUDED FROM THE WORKERS COMP. CERTIFICATE HOLDER CANCELLATION MARGARETSULLNAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE 77 CORBET STREET EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO ANDOVER MA 01810 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: - Ji Christine 4J. range ACORD 25(2001/08) Certificate# 9161 0 ACORD CORPORATION 1988 Contraetor Arbitration The Home Impiovement 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 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 fn-m which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regt4P,Uqn and the const e shall req ' ed to s bmii to such arbitration as provided In Massachusetts General Laws, c Ater 42A.. �Omeowner's Signature Coctor's Sl aturYtelve ®TICE:The signatures of the parties above apply only-to the agreemen of the parties to 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 Fluid 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 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 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 ovmer 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 rescission 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 j oint 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 Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the OCABRwebsite at hjtP_://www.Tnass.gov/ocabr/ 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 Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the H[C website at ligp://www.tnass.aov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: . h.V://db.state.ma.us/holneimprovem eni/l icenseelist.asp 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 or 413-734-3114 Version 2.1-11/22/2010 Massachusetts Home Imn:rovement Sample Contract This form satisfies all basic requirements of the s'tate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. An y person Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You mag home improvements y obtain,a free ould first co a by calling the Office of Consumer Affairs and Business Regulation's Consumer information Hotline at 617-973-8787 or 1-888-283.3 157 or on our website. Homeowner Information Contractor Information Name Compo Name iuu ' ►it Street Address(do not use aPost Office Bo�cdijddress) � C tor/Salesperson/0 erName City• own State Code Bp nes Address( ust inc ude a street address) at -- G Rol�_ N. Myfte Phone Evening Phone City/Town State I ip ode Mailing Address(It different fromWoveBusiness Phone 'Federal Employer ID or S.S.Number Law requires tLat most]some Home Improvement Contractor Reg:Number Expiration date improvement contractors] / y / a valid registration n"mGer / G /f�({J G�r v Y The Contractor agrees to do the following work for the Homeowner: J (Describe in detail the workto completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) 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 control arise (Owners who secure their oven permits will be excluded from the Guaranty Fund provisions of ate when contractor will begin contracted work. MGL 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 made according to the following schedule: $ upon signing contract(not to exceed 113 of the-total contract price —Or the cost of special order items,whichever is greater) $ by / / or upon completion of $ by / / or upon completion of $ 6 u upon 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 $ to beaid for ordered before the contracted work begins in order p to meet the completion schedule.(**) $ to be paid for NOTE,S:(*)Including all finance charges(°i*)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 Warranty-Is an express wlr-ants being provided by the contractor? ❑No❑•Yes(1ll terms of the warrinty mast Subcontractors be attached to the contract) The contractor 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 fru ther agrees to be solely responsible for all payments e all subcontractors for materials and labor under this a Bement 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. o Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear, • Mal—cc sure the contractor has a valid Horne Ira rovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. o Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can conf m coverage,or ask to see a copy of a"proof of insurance"document. o Kmow your rights and responsibilities. Read 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 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'S GN CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical 'es a cont! must be ompleted and signed. One copy should go to the homeowner. The other copy slioitld be kept by the contractor. jintractor" weer s Sign tore 'Date 7 / -- ' Date