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HomeMy WebLinkAboutBuilding Permit #680 - 1532 SALEM STREET 6/9/2009 RTly BUILDING PERMIT 0* �10VIO o A TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4 ��SSACH►1S�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ' not PROPERTY OWNER Ames 90"e-1 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One fa Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacemenD Assessory Bldg Others: Demolition Other Se tic Wel Floodplain Wetlands Watershed District Water/Sewer DESC IPTION F WORK TO BE PREFORMED: Identification Please Type or Print Clearly) _ OWNER: Name: J a-vv--e,5. P o eA Phone: S6(. •L GZ-- I S 66 Address: CONTRACTOR Name:—y -c Phone: 97 Address: Supervisor's Construction License: CS . 'St3' 2 t Exp. ;Date: L -Zai - 7,0 l t Home Improvement'License: l Z- 1 'Z-3 Exp. Date: ` 1-CM 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: $_1 { 60 FEE: $ I F-0 Check No.: ' -33So Receipt No.: a a Die— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gnature of Agent/Owner . Signature`of contractor • I 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 i ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i I Addition Or Decks U 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 r. 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 'i ❑ Certified Proposed Plot Plan I ❑ 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 i j Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 I I Revised 2.2008 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/SaJrJ 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 y _ 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:.Siggiture: ': Located 384 Os ood Street FIRE DEPARTMENT :-jemp Dumpster on site yes ' no ; I& Located at 124 Maihi Street Fire Department signature/date COMMENTS Dimension Number of Stories: Z- Total square feet of floor area, based on Exterior dimensions. �zyoc� Total land area,'sq -. ft.: rti(-f ;_- - I r ELECTRICAL: Movement of Meter location, mast-or service drop requires approval of Electrical Inspector Yes No N DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA- For department use i I I� i i ❑ Notified for pickup - Date _.—.._ i Doc.Building Permit Revised 2008 i i Location/,S'-3 2 _S41ekt, S ' No. Date HpRTFTOWN OF NORTH ANDOVER F - 1 . i Certificate of Occupancy $ MUs t�' Building/Frame Permit Fee $ L�" Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / '33 22 ; 8 Building Inspector V40RTH Town o s 4Andover . No. �w.w ti-F;_ L A K E dover, Mass., L COC MIC 1'.W'C. ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System # BUILDING INSPECTOR THIS CERTIFIES THAT ........................................................................ . ............ ..... ............ ...... ............. Foundation % 1111111k,011jr 11FIM has permission to a ................. ...................... buildings on .... ........ . ........ ................. .....0....... Rough to be occupied as.... J16 Chimney provided that ......411i� ermit shall in .... in to the terms of the �?fic)6n-(otfIle 4in P the person accepting I every respect confor 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TaS Rough ...I...... Service ................................ ....................�BU156iliNZ 7INSFMCTOR 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. ✓ Cl owri i AGREEMENT FOR SERVICES This CONTRACT satisfies all basic requirements of the State's Home Improvement Contractor Law(M.G.L.c. 142A),but does not preclude parties from adding language to protect their specific interests. Seek legal advice if necessary.Before agreeing to any home improvement work on your residence you should obtain a free copy of"Consumer Guide to Home Improvement Contractor Law"by calling the Office of Consumer Affairs and Business Regulation's Information Hotline at 617-973-8787. You may cancel this Agreement if is has been signed by a party thereto at a place other than an address of K&R Contractors,Inc.,which may be its main office or branch thereof,provided you notify K &R Contractors,Inc.,in writing at its main office or branch by ordinary mail posted,by 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. "J Homeowner Information Contractor/Owner Name: Debbie Arillotta Kenneth Roy,President 1532 Salem St. Business Street Address North Andover,Ma 01845 K&R Contractors,Inc. 1 Campbell Road North Andover,MA 01845 Business Phone:978.726.5062 Federal Employer ID:000961723 Salesperson(s): Kenneth Roy,President HIC:279873 Exp.Date: 1/20/2011 MA Sup.License:CS80721 Exp.Date:4/29/2009 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Homeowner:vynil side house Work to include:strip all old siding off of house,reside with Mastic Quest(wicker),cover all old rakes and fascia board with white aluminum trim,replace old 908 wood trim with solid vynil trim w/built in "j"chanel and vynil sill,old wood soffit to be removed and replaced with fully vented vynil soffit,corner posts to be 4"vynil(white),garage door trim to be replaced with solid pvc,new plastic shutters(cust. Choice of color),new 5"white standard gutters in front and rear of house and side of porch,vynil mount blocks for spigots and vents,add tyvek house wrap and 1/2"foam foil board r2 insulation,replace kitchen window with Harvey slider bumped out,replace garage door side window with Harvey single hung,install 11 storm windows on porch and trim out in pvc trim,install custome purchased front door and storm door for porch,install customer purchased a/c unit. o All necessary permits The following schedule will be adhered to unless circumstances beyond the contractor's control arise* Work Scheduled To Begin:06/18/09 Expected Date Of Completion:07/10/09 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work,furnish the material and labor specified above for the SUM OF$15,000 Payments will be made to the following SCHEDULE: ,r $5000 upon signing contract $7000 upon start of project $2000 upon completion of 2 sides $1000 upon completion of projects 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*)No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto. OTHER IMPORTANT PROVISIONS You are dealing with a Registered Home Improvement Contractor and are entitled to certain rights under the provisions of 780 CMR R6 and M.G.L.c. 142A. Payments: If payment is not received as per the Contract,then the Owner shall be responsible for all attorneys' fees,court costs,and other costs incurred by the Contractor and enforcing Contractor's rights hereunder. Pets: Homeowner agrees to keep all pets out of the work area and take whatever steps are necessary to safeguard them from any harm that may come to them as a result of the work being performed under this Contract,including but not limited to injury on or outside the Premises or ingestion or inhalation of,or contact with,hazardous substances. Company assumes no responsibility for any harm to the pets as a result of the work performed under this Contract. Further,Homeowner shall take all steps necessary to protect Contractor,its agents,servants,contractors and employees,from any harm as a result of contact with said pets. Characteristics of wood: Wood is a hygroscopic material. Wood swells and/or shrinks in relation to the humidity,temperature and environmental conditions of its surrounding. Generally,wood flooring is expected to shrink in any conditions and expand when exposed to moist conditions. Natural wood also contains variations of graining,texture,hardness and/or knots,depending on the wood chosen.Contractor cannot be responsible for the natural features of the wood chosen. Contractor is not responsible for shrinkage,checking,swelling,or other conditions which are the normal condition of wood or the result of household or environmental humidity,heat,cold,or other conditions. Colors: You may choose colors and finishes for the parts being used in your remodeling project. It is important to remember that a color or finish you see at the store or in a showroom may not look the same in your home,especially after all of the different colors and finishes are brought together upon the completion of a project. In addition,one manufacturer's named color is not the same as another manufacturer's named color.The Contractor cannot be responsible for the appearance or lack of coverage from Homeowner/chosen paints and/or stains and finishes. Building Officials: Any additional costs incurred by Contractor as a result of decisions made by Building Officials will be the responsibility of the Homeowner.The costs of additional work will be calculated as follows:cost of materials plus an hourly rate of$45 per man hour. Liens: In the event of non justifiable non-payment,Homeowner's residence or property may be subject to a Mechanic's Lien as a consequence of signing this Contract. Utilities: The Contractor will use reasonable efforts to notify the Homeowner in advance of any interruption of utility services. However,there may be instances where the Contractor must shut down these services without advanced notice. Homeowner must arrange for emergency backup service for any utility critical equipment such as medical devices and computers. The Homeowner must also notify the Contractor at the start of the work day if you will be engaged in any utility critical activities in that the Contractor makes a notification in writing in the daily log book or otherwise. Additional work: Any additional work requested by the Homeowner which is beyond the scope of the work to be performed as set forth in this Agreement,shall be the subject of a separate agreement,and/or if not,subject to the same terms and conditions as set forth in this Agreement and billed on a time plus cost of materials basis at Contractor's normal hourly rate. Contractor's normal hourly rate per man hour is$45. In the event that additional work is to be performed on an hourly plus cost of materials basis,the Homeowner shall be required to execute a Change Order which shall include Contractor's best estimate as to the time required,together with the cost of labor as well as the type and cost of materials necessary. Delays: Contractor is not responsible for delays attributable to Homeowner initiated modifications or additions,or for delays incurred due to the actions or inactions of city/town officials,strikes,acts of God,unfulfilled customer obligations,vendor delays,interference by other tradespersons,customer supplied items or other delays beyond Contractor's reasonable control. Contractor will use reasonable efforts to stay on each job until substantial completion by allotting specific time periods to each Homeowner to complete each job in as timely a manner as possible. In the event that Homeowner does not allow Contractor and/or his employees or sub-contractors access to the residence or property so as to allow Contractor to perform his obligations and/or to complete the scope of work in as timely a manner as possible,other than for reasons of safety or other reasons mutually agreed to between Homeowner and Contractor,then the Homeowner shall be responsible to pay Contractor the sum of $500.00 per day,on a pro rata basis,to cover the costs of delay. Contractor reserves the right to suspend work and/or delivery of materials in the event of unjustified non-payment. In such event,the Contractor shall have no liability to the Homeowner for alleged delays or damages due to said suspension. Punch-list Items: The Homeowner agrees that routine"punch-list"or repair items after substantial completion are outside the agreed scope of services,and covered by Contractor's warranty obligation and will be completed as soon as practicable and according to Contractor's and Homeowner's mutual availability. Homeowner agrees that it shall use his/her best efforts to make himself/herself available to observe and/or sign off on the completion of any such punch-list Items,and that the approval of one Homeowner regarding the completion of any such punch-list items,as well as change orders shall be binding upon all Homeowners. Unforeseen Conditions/Circumstances: Contractor shall not be responsible for any changes at the request of the Building Inspector. Contractor shall also not be responsible for any unforeseen bedrock/ledge or latent defects such as structural and/or dry rot or insect damage to the existing structure,or for preexisting faulty or inadequate wiring or plumbing. Contractor shall also not be responsible for any pre-existing code violations or responsible for correcting contiguous work completed by others not under the Contractor's authority. Insurance: Homeowner agrees to carry fire,theft,vandalism,liability and all other necessary insurances to protect their personal property while construction is in progress. Contractor will carry all required and necessary insurances including worker's compensation insurance. Contractor will ensure that all personnel including sub-contractors will be covered by all required and necessary insurance including worker's compensation insurance. Homeowner's Cancellation Rights: In addition to the rights the Homeowner has,as set forth in the attached Notice of Cancellation,the Homeowner may have rights under other Massachusetts Statutes, including M.G.L.c.93 §48,M.G.L.c. 140D, § 10 and M.G.L.c.255D§ 14. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contractor. Homeowner's Signature: Contractor's ignature K& C actors,Inc.: q Date: © l By: Kenneth Roy Its: President 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,by 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. NO WORK WILL BEGIN UNTIL BOTH PARTIES SIGN THE CONTRACT AND THE OWNER RECEIVES A COPY REQUIRED PERMITS The following building permits are required.It is the obligation of the contractor to secure such as the homeowners agent: Electrical rough and finish Plumbing rough and finish Insulation Framing insp. Finish and occupancy NOTE:Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. EXPRESS WARRANTY All workmanship and materials to be free of material defect for a period of one(1)year. During the Warranty period,the Company may,at its option,either repair or replace products or workmanship which prove to be defective. This Warranty shall not apply to defects or damage arising from improper or inadequate maintenance by the customer,customer's applied products,unauthorized modification or misuse,damage incurred as a result of acts of God or civil strife,or normal characteristics of the materials such as wood shrinking,expanding and otherwise reacting to moisture or environmental conditions. The Company's liability is limited to the repair or replacement,at its option,set forth herein and Company shall not be liable for any consequential,sequential,incidental or other damages not set forth herein.The Warranty set forth herein is exclusive,and no other Warranty,whether written or oral,is expressed or implied. Company specifically disclaims the implied Warranties of Merchantability and Fitness for a Particular Purpose, NOTE:All home improvement contractors and subcontractors shall be registered and any inquires about a contractor subcontractor relating to a registration should he 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 contractor and the homeowner hereby mutually agree in advance that in the even the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has b4the d by the Secre of the Executive Office of Consumer Affairs and Business Regulationsumer sha required to submit to such arbitration as provided in M,G,L.c.142A. Contractor: Date: L( , ©t HomeowneDate: © NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETFLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOTSEPARATELY 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 hint/herself to be financially insecure. Contractor's Financial Insecurity-In instances where a contractor deems himself/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 from said account would require the signatures of both parties. Homeowner agrees to allow reasonable access to allow Contractor to reasonably attempt to remedy any outstanding uncompleted,disputed or non-satisfactory item. If you have general questions or need additional information about The Home Improvement Contractor Law,contact: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170 Boston,MA 02116 617-973-8787 If you have questions about Contractor Registration,contact: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Room 1301 Boston,MA 02108 617-727-3700,x25205 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION,WITHIN THREE (3)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(10)BUSINESS DAYS FOLLOWING RECEIPT BY THE CONTRACTOR OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE CONTRACTOR AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT;OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE CONTRACTOR REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE CONTRACTOR AND THE CONTRACTOR DOES NOT PICK THEM UP WITHIN TWENTY(20)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 CONTRACTOR AND FAIL TO 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 K&R Contractors,Inc. 1 Campbell Road,North Andover,MA 01845 NOT LATER THAN MIDNIGHT OF TBD. I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: Received: ✓fze 1�aomvmamu�ea��i a�./GZaoruu.�ut�a t Board of Building Regulations and Standards -- HOME IMPROVEMENT CONTRACTOR Registration:,162123 - Expiration 1/-20[2011. Tr# 279873 Type Pndate Corporation K&R CONTRACTORS:-INC KENNETH ROY 1 CAMPBELL RD. N.ANDOVER,MA 01&45.. Administrs tol 1l as achu�ett5- Department of Public Safetx Board of Bniltlin-Re-utations and Standards' p Construction S oerviser License License: CS 80721 Restricted to: 00 KENNETH R ROY r .1 CAMPBELL RD N ANDOVER, MA 01845` Y �%- ——d Expiration: 4/29/2011 . Commissioner TrT: 13310 i The Commonwealth of Massachusetts l! Department of Industrial Accidents •. ! O,ffice of Investigations 600 Mashing ton Street Boston, MA 02111 www massgov/dia Workers' Compensation Ince nwce Affidavit-. Builders/Contractors/Eieatriciaas/pinmbers Applicant Information. Please Print LeQibl Name (Business/orpoiza6on4ndividual); .•. Address: I � City/State/Zip: -K-Phone #: . Q11 Are you an employer?Cheek.the appropriate box: I.Q I am a e Type of ro•ect r employer er with 4. project( egnir�: P Y ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub- ctors 6. Q New construction 2.0 I am -sole proprietor or partner_ listed on the�.Ee et I 7. -�Remodeling ship and have no employees' These subcveworkin for me in an aci workers' courance. 8. Q Dem°ith°n r Y� 9. Q Building addition [Aro workers'comp,iasttrattce 5. We are a corporation and its required.] officers have exercised their 10 0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions insurance-required.] o wo�� t comp. r 15 , §I(4),and-we have no 12.❑ Roof repairs � I. .employees. [No workers' COMP. insurance required_] e 13.Q.Other ;Any eppiicatrt that checks bozo must also Till out thsection below showing their workew bompensstion poiicy information. Homeowners who submit this affr'davit indicating they are during an worts and then hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must ranched an additioma)sheet showing.Me m mw of Sm sub• contractors and their work=,carr. :: r p0..q.fiTDmladon. I a►-an eawtoyer Mw is pr,?vid ng:workers'compensation insurance or informafiort } mJ'employees: Below is the policy anti.job site Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/Stateizip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date] Failure to secure coverage as g required under Section 25A of MGL c. 152 can lead tothe imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well Ms 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 nder theP�' attics o e .I P dory Mat the i-formation provided above is bice and correct Si tore: . ® Date: `f 6 Phone#: 1 �' (9V 2 4f j``cial use nd1y. Do not write iii!iris area,to he ca 1. by cid' f idd mp eted or town a n City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2 Soilding Department 3.City/Town Clerk 4. Electrical Inspector S. PlumDElugpetor 6.Other Contact Person• Phone#: j r Information a nd I494ructions `^ Massachusetts General Laws chapter 152 requires all emp Ioyers 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 emplayer is defined as"an individual,partnership,association,corporation or other legal entity,or airy two ormore of the'foregoing engaged in a joint enterprise,and includirig the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,associatioin or other legal entity,employing employees.'However the owner of a dwelling house having not more than three apaa-tments 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 building in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance'coverage required" Additionally, MOL chapter 152,§25C(7)states"Neither tihe commonwealth nor any of its political subdivisions shall enter into any contract for the perfarmarLce of public work Lentil 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 complertely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),ad.dress(es):acrd phone number(s)along with their certificates)of insurance. Limitrd Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'ccsrnpensation 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.. Aiso'Ese sure to sign and date the affidavit The affidavit should be returned to the city or town that the.application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are requimA to obtain,a workers' aoMperttsation policy,please call the Department at the nurarberlisted below. Self-insured companies should enter their self insurance-Iicense number on the'appropriate fine. 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/Iicense 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 Investibations 600 Washington Street Boston, IIIA 02111 TeL#617-7274900 ext 406 or I-8.77-MASSAFE Fax##617-727-7744 Revised 5-26-QS www.mass.gov/dia I ' '/ "J 'S\ N- 2676 Date.......... \ NORTH OL TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SS^cMUSE� This certifies that .....:......................................... has permission to perform''...c.<�...... .......... -�... ................................. wiring in the building of...:- 1: .—t „--................................................. ............ � at../ ... .. ...: --...-.:r...�................... .North Andover,Mass. if Fee..�,'.n......... Lic.No --:-p ....... ..........:' .... .::.............. / ELECTRICAL INSPECTOR Check #� �dG �/�/, / WHITE: Applicant CANARY: Building Dept. PINK:Treasurer UAPPUCATIONFORPERWTO THE00MMONW 4LTHOFMA&,"C�IUSL'77S Offuse only.DEPARTMENTOFPUBLICS4= Permit No. BOARD OFFWPMEIVMONRWMTIONS527CMR1200 Occupancy&Fees Checked PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 153 ,,w �y/gym �� � /�i✓alpvrn wne r Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No L 11 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /OG Amps/20aVolts Overhead UndergroundED No.of Meters +� Nei=Service '76,0 AmpsA7o' !21/0 Volts ,-Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained i Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal o Other ED Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER J Ir>ciparreCa�aage RffsMttothemp=CnlsofMasM&05ftG01eaLam ItmeaanetLmxkh,&aa=Pobgnx dWCaT#&L- Comag cresskstwtfialegivalat YES NO LJd/ IhmesubmittedvalidpoofofsatrretotheOldoe YES M NoF-1 Ifjuuhmcdia*WYES,piww dc*thetype(,fwyuaWbydtacimgthe bcvc INSURANCE M BONDr—I allfR ftmSpeafy) (� E im Date �o Estirrg"Value&7edncalwak$ j vv WakiDStatt /b d–Ud InspecrirnDateRowested RD# Fecal Signed uixla,&R3nities ofpetjuiy. FIRM NAME Lim_&eNa Lioalsae ��2 7 t� s►g , . � ����2 G / BisitMTdNa 1,17-0;7P AjTeLNa C G OWNER'SINSURANCEWANER;IammmethattheLi asedtiesuatt etheir>=axam%p abUtie ap%alauasr q=WbyMasadasemCcnn alLaws "dratmyWutm,mftpe ntWpficMmwai mWmnat - (Please check one) Owner IED" Agent Telephone No. PERMIT FEE$ I i :::. 2iLi :L: i::;iF:'.:•.:g-F:::::?;i :;::iy;:;i=`ilii;'::i;':�::::����2�''c`i':'• =';?�:2};:..�r ,,ppi(gg ifti$fi =:::.'_'�:,+f'� :i:;a;%.;:i ..............................:........ -- -- :rfiFl::c•s �.'2......:> .::.iii::•;i:yi. ...... Date......................... ...... '' f p°RT" ° "``°:•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACNus� This certifies that .. .. `-�-'J--- ...............:..... .................................................................... -As permission to perform ......'�°",.....:......?.. —+''s /. .....� ?�....... ...., wan ng in the building of...,�. i ., ................................................... at.Z........ - " ......::......:............................`.............. ,North Andover,Mass. Fee��n.... �� Lic.No.............. ...........:................................................... VELECTRICAL INSPECTOR Check # �� Z" 487 ? Official Use Only / Permit No. £ tnZd7ZLv�r��' d� A ssLS�7`7s � -) Dr�fra art o�pu6lie Sa�Cty Occupancy&Fee C� ecked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL.WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 � }p Date (Please Print in ink or type all information) I f To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number �tpg br Tenant J!RIZ?C.S �C Owner's Address /✓�� ,���r®'7 5 �� Is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Box) Purpose of Building nn//��,,�r Utility Authorization No. Existing Service i�fW Amps za0 .� yG Volts 'Overhead 0 Undgrnd 0 No.of Meters New Service GU Amps I'FG WVoits Overhead 0 Undgmd 0 No.of Meters_ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and y No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices Nol of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wirin No.Hydro Massage Tuds No.of Motors Total HP A OTHER' INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws t I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO have submitted valid proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of.Electrical Work3 Work to Start Inspection Date.Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC.NO. _ Licensee Signature LIC.NO. Bus.Tel No. Address Aft Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusel Gen al Laws.And that my signat n this pe - pplication waives this requirement. Owner Agent (Please Check one) Telephone No. `77�' Gfl/X752{ERMIT FEE (Signature of Owner or Agent) The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Q a / V Workers'Compensation Insurance Affidavit Name Please Print Name: e- Location: ®'`e- S T City Phone I am a homeowner performing all work myself. 1 am a sole proprietor and have no one vmridng in any capacity 1 am an employer providing workers'compensation for my employees working on this job. Company name. Address Cif p11one#- Insurance Co. Policv# Comparn name: Address. Insurance.Co. Policy.# Falkwe to secure coverage asred:under Sedbon 2M or IV6GL 152 can teed tache m4W.. R4pcs7ion of crannat perms:cf arfet�e iipr't and/or one yeaw bnprisormentAs_weN_as 7 Renalties��he farm�fa 73 1�elif j tl�OD)�1taY a9 understand that a copy d this statement may be forwarded to the Office of irnrstigabons of the drA for cvuerage verification. !do hereby rertdy under dos pates and penalties of perjury bast the aobr»radaa provided above is true and correct Signature Date Print name_ Phone Official use only do not write in this area to be completed by city or town official' City of Town Perrcensirg BWfflng []Check ii`ate response is regured baensin El S%ctrn contact persom. Phone#: � Health C Ei Other Location /y -3 c>l ' -r-� S71 No. Date NpRTM TOWN OF NORTH ANDOVER 3? � _•BOG Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ YCheck # 'T 15103 Building InspU TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING x�K v i•�-r,-�.� � ��. p•„s.,3* `.,a2 -.5,? z � *:`) 8 :c*.F ''.�a, 4, _ r ,t4 _ This Section for Oficial Use Onl BUILDING PERMIT NUMBER: DATE ISSUED: T SIGNATURE: '"� ` Building Commissioner) or of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1 DO Of 9 �✓.�.tp�a L P/C �i� tom/�y S.� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 0 Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS(ft) m Front Yard Side Yard Rear Yard \. Required Provide Required Provided Required Provided Q { 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomntion: 1.8 Sewerage Disposal System: Public ❑ Private Zone Outside Flood Zone Municipal On Site Disposal System 2.1 Owner of Record r c- 13. ,2 Name(Print) Address for Service: - 6zi/� r m Signature Telephone 2.2 Authorized Agent Name Print Address for Service: z O Signature Telephone z 90m 3.1 Licensed Construction Supervisor Not Applicable Q' V ' Address License Number O Licensed Construction Supervisor:pervt Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable v' Com Name'.„ Registration Number m _ r Address r Expiration Date /z Signature Telephone /'1 0 r �. -- -x e. 1. I, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my 66wledge and belief. Signed under the pains and penalties of perjury � ej Print Name i 4 - Signature of Owner/Agent Date Item Estimated Cost(Dollars)to be h 111 ' L`asE 4zs" - ' k iia AAs Com leted b t applicant, Y Y a P y1e� at .rYa. 1. Building D®� - (a) Building Permit Fee // p Multi lier K� 2 Electrical (b) Estimated Total Cost of �/ y i ol Construction from(6) / L 3 Plumbing t Building Permit fee (a)X(h) 4 I Mechanical(HVAC) 5 I Fire Protection 6 I Total (1+2+3+4+5) Check Number h "ask a$z vs §b,.rr 5 ,£ ,y�.Y, ..UL i .i �. .' S�S I,f . yj}''.,v 79yy .`,?F7 "a, .. ^ `„'^., ,'',. Eyf a�`, r {�ri�4W �.�" 3�� .v>.��,4. Sp)ii t f5, d'•', �J FU;e,k n,+ 1 ��, 2J a z �'`: ''�' :-a ?:•i. .,t.die pryIt \ zt t rz gr•, a y k{,.,t i £I..S/XS i�. r:,5r 2 t,Ivw..". r s, {v1` '7 i}Yq! �➢ M � 7,�. ¢���y5 �. � lqb 4 'd; > �C Y'/ Mfih fSk L'�+�T � -`4 S�" '1 �� .UyF{�C t,Jt 't' aSf{ '' 3d v�a�.�5 3,�,.. '� ��ur,t� �'..w•}' A,� ^w,.�", s'?v:�a�'?�„Y k r'��u.§Y,, si Y,��•t. '�, '�, f�Y r� �'� .t£s.ir. ', 22��•v; �e h. ,1���, t,P Sir'�`+ £i.Hidi„�,$t"'��,4trar; NO.OF STORIES .;'SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST. 21{o 3m SPAN DEMENSIONS OF SILLS i DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS _ HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBRANEY IS BUILDING ON SOLID OR FILLED LAND y IS BUILDING CONNECTED TO NATURAL GAS LINE I - e:.tp,' R.Fy+ts7,.d' a� f-r.:. ,,k r -•+> zw ,Y j ,,f h�r - .r e SEC ION 4 +>t}RRS ENSAQ6.I + 1E5�_ Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......❑ No...... SEC TION 5 'PRGI1(+'$SSI©1AI.Di�SIt C3NSIRiIC1`ISte '` CON TR1r7C ItD$T CY?1 RU)E P[ 3 1 TO 780 5.1 Registered Architect: Name: I Address Signature Telephone . Rcg s�ered Profe�si M-!Va i Area of Responsibility Name: Address: Registration Number Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature�► Telephone Expiration Date it Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Not Applicable C� Company Name: Responsible in Charge of Construction New Construction ❑ Existing Building V Repair(s) ❑ J Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other 0 Specify Brief Description of Proposed Work: 01119 P �e vl QUI ✓� IS� 000, `� �1�,. �app►��"I¢'R�'., s ,;r �� USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-I ❑ A-2 ❑ A-3 ❑ IA ❑ A4 ❑ A-5 ❑ IB 0 B Business 0 2A ❑ C Educational ❑ 2B 0 F Factory ❑ F-I ❑ F-2 ❑ 2C ❑ H High Hazard 0 3A ❑ IInstitutional ❑ -I-1 ❑ I-2 0 I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential IV R-I ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 0 5B ❑ U Utility ❑ Specify: M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: • BUILDING AREA y EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floors Total Area s Total Height 11 Independent Structural Engineering Structural Peer Review RequireA Yes ❑ No ❑ SECTION I0a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> ,as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application i Signature of Owner Date FORM U .- LOT RELEASE FORM Ft 4.0 v4 Q3 Ase.Wv—A--4 INSTRUCTIONS: This form is used to verify that all necessaryapprovals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT Zyti`�'S 1vC��" PHONE LOCATION: Assessor's Map Number NO PARCEL O t SUBDIVISION LOT S STREET ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS IIS - e FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED v ii DATE REJECTED COMMENTS C 1`+v�l.j-, IL I PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97)'M NORTH Town of over No. dover, Mass., 6 00 RATED H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System .T....... s. 'VoBUILDING INSPECTOR THISCERTIFIESTHAT.......... a.M.r. .............. ........................................................................... Foundation dw ....... buildings on .... ...... ........3..+- has permission to er .................... ............ Rough to be occupied as..... !?...... ........ Chimney provided that the person accepting t is 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, Iteration and Construction of Buildings in the Town of North Andover. /019psaxpr avow PLUMBING INSPECTOR 6A i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS 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.