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HomeMy WebLinkAboutBuilding Permit #892 - 162 GRAY STREET 6/20/2013 4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IWORTANT:Applicant must complete all items on this page kLOCAION y r - PR©PERTYOOINNERt - r - Pnnt — �i-+100�YeaO�ltl•,tS�ucturej jies� PARCEL Z©� NINGfDI,STRICT+:_ _ HistoricaDi`stnct ryes nod =� --� Macliine�Stiop;Village] yeses nor _r._. _- .. _. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ✓`�a "'C t".; -r+-n r.�� - rc ' <.',Ytr'ir:f �ti'S 9 ri. r t •➢iY c, ti,io v Septic-} OtWelll r, ❑ Floodplain} '°OiWetlands D;INatershedlDiM. stnct�, , oW_a_t_e_�/,Sewerz, ,-, _ DESCRIPTION OF WORK TO BE PERFORMED: I entifi do Please Type or Print Clearly) OWNER: Name: r Phone: Address: 16 �)o�4IIII.IIII 14?A �"_?�"4 aF,'" `[:t (y1. ;(�'•-v(♦ r'•}.:�:, � f[tS •1' a v- �r 3'. , 1Gt"r .-e j''`' �y t -r::7 ?-.:^k r ,r `,•v{a ,..•,•. t �..-. 3:'K} h � j�,r 4 }'. - r { .f � k•ci i lS �- a �' .. w ♦4 • 'l �,� �C®N�RACT}®RNamerr�� - :Phone -t rlo . _ S , 4e q �!vim'. Supery.isor''sConst'ructionJLicense .3 � r� HomeImprovementLicense' <®�, �=: �1. :f.� � " s{.. ..Exp' pater ARCHITECUENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST $125.00 PER S.F. Total Project Cost: $ FEE: $ rT Check No.: f l�1� Receipt No.: c,'— NOTE: Persons contracting ith acnregistered contractors do not have access to the guaranty fund !Sigt ature ofAgent/Owner: : = nature of'eontracto .. :_..g Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ Location ,O' No. Date / • • TOWN OF NORTH ANDOVER 8 Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#& rp Building Inspector I Plans Submitted ❑ Plans Waived-E] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF-SEWERAGE.DISPOSAL . <s Public Sewer ❑ Tanning/Massage/BodyArt ❑. . 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 1 i PLANNING & DEVELOPMENT ❑ .❑ COMMENTS I CONSERVATION Reviewed on Signature i li 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 ermit DPW To-tw! ]Engineer: Signature: � Located 384 Osgood Street- FIRE.DEPAIRTI3IiE.WT -Temp Dumpster on site yes no D .Locatea at'124 Main Strdet Fire ®epine�t sigiiaturelaate LC-' ''NTS i 1 i Pimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: movement of Neter location, mast or service drop requires approval of Electrical Inspector Yes No OAN GER ZONE LITERATURE: Yes No AGL Chapter 166 section 21A-F and G min.$10041000 fine IMOTES and DATA—(For department use I B Notified for pickup - Date f pe.Building permit Revised 2010 i Building Department The foliawing is a list of the required forms to be filled out for the appropriate.permit to be obtained. Rooting, Siding, Interior Rehabilitation Permits ❑- Building Permit Application ❑ Workers Comp Affidavit m Photo Copy Of H.I.C. And/Or C.S.L.- Licenses Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products TOTE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o 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 OTE: 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 apt)eal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subrn:-tted with the building application Doc: Doc.Building permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 369000.00 m $ - $ 432.00 Plumbing Fee $ 54.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 54.00 Total fees collected $ 640.00 162 Gray Street 892-13 on 6/20/2013 Kitchen Renovation massachimsets $ome Tm xovement Saxe le Contract This foam satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. An Massachusetts Consumer Cruide to Home Improvement"before agreeingto any ork rson on your rresideng home rce.You may obtain a free copy by covements should first obtain a copyalling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Ho eo r rnmbioln ContractorInfonmi&n Name EContra,!,torlSaloespersonl C1 ceBox address �OwnerX�=e C Ci /Town State Zi Code Zip Bpsiness Address(must include a street address) 7— S a }��-�- 2- ��rx 11/► aytime Phone Evening Phone City/Town Strom Zip Code 4Ca �d` d� -� o Mailing Address(It different from above) Business Phone Federal]inployer ID or S.S.Number Law requires tit-it most home Home ImprovementContmctorReS.Number Expirationdato improvement contractors have a valid registration number )J ^ The Contractor agrees to do the following work'for the Homeowner: -7 V (Describe in detail the worlcto completed,specifying the type,brand,and grade of materials to be used,use additional sheets ifneces ma ) L� • .. ter. • Required Permits-The following building permits are�regaired Proposed Start and Completion Schedule-The following schedule will and will be secured byte.contractor as-the homeowners agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits vWM be excluded from the Guaranty JElarlm.d provisions of Date 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 accordingto the following schedule: $ upon signing contract(not to exceed 1/3 Of the total contract price or the cost of special order items,whichever is greater) $-3 r by b / orupon completion of Y or upon completion of $J.j Qupon completion of the contract. (Law forbids demanding full payment unfit contract is completed to both party's satisfaction) . The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.0-a°) $ to be paid for NOTES:(1)Including all finance charges(°1*)Law requires that any deposit or down-payment required by the contractor before work begim 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. xxnress Warr fury-Ta an express wlrr tutu Ueine provided by the contractor? ❑No Yes(11i terms of the Warr tutu must be-44-1--ced to the contractl Subcontractors The contractor agrees to bs solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for aterials and Iabo•under this a eement Contract Acceptance-Upon signing,flus document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall pat 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. C Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear, o Make sure the contractor has a valid Home Trriprovement Contractor Registration. The law requires most home improvement contractors and . subcontractors to be registered with the Director ofI3ome Improvement Contractor Registration. You may inquire about contractor registration by writing to the-Director at 10 ParkPlaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-28actor . Does the contractor have insurance? AsIc the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. o Know your rights and responsibilities. Read the Important Information on the reverse side of this form Guide to the Ho and et a co 0 Home Improvement Contractor Law: g PY f the Consumer 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 ordinarymail posted,b third business d p d, y telegram sent or deliver ay following the signing gr Y y,not later than midnight ofthe g going oftbis agreement Seethe attached notice of cancellation form for an explanation of this right. JD®NOT'SIGN TMS CONTRACT lF THERE ARE ANY]�lLSPACESr t r Two id otic '�.�� e al copiesofthecontractmustbecon letedandsi ed ' P gn . One cop should to the Y $o Homeowner. The outer copy sltouldbe lceptbytho c n[raetor, 2 Homeowners Signature 400ntract:6rW4SSij�gnatare l � - � Q 'Date — �3 Date Confraefor Arbifrafion The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an ,alternative to colt t action)if they have a dispute with a contractor. The same right is not automatically affordedto 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 firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to •such arbitration as provided In Massachusetts General Laws, chapter 142A.. Homeowner's Signature Contractor's Signature NOTI[C]E: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 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 P1�e contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from a71 Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worlamnlilce 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 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 eonsumer/homeowner rights,contact the Consumer information Hotline(listed below). Execution of Contract: . The contract must be executed in du licate and should not be signed until a copy of all cibits 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 vm! l boUb.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 fiends from said account would require the signatures of both parties. Additional Information ' If you have general questions or need additional information about the Horne Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consuaner Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 ParlcPlaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at 1 :11wwrv.mass;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 ParkPlaza,Room 5170,Boston,MA 02116 617-973-8787, 888283-3757 or visit the IRC website at b=://v;w,,v..inass.zov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: . htt7�://dU.state.ma.us/tio7neimt-rovem ent/licenseelist.asb For assistance with informal mediation of disputes or to regisi:er formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4.800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 NORTH Town of . s ndover No. - �oh , ver, Mass,LA coc«Ic«.WAC« �1 AERATE 0.P� S V BOARD OF HEALTH PER.MIT D Food/Kitchen Septic System • THIS CERTIFIES THAT ............��.l�w h................................ ...... ................... ............................... BUILDING INSPECTOR ..'........................... Foundation has permission to erect ..... ..... ............. bu' ings on ,,Awx......... Rough to be occupied as .l... .�i ...... Chimney ......... .. ................ .. provided that the person accepting this permit shall in every respect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TAR S a Rough Service ................ ............. ..... Final BUILDING INSPECT GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 i The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): Address:_,�j �-- City/State/Zip: _ /`�� � hone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.# E]Remodeling ship and'have no employees These sub-contractors have 8. [J Demolition working for me in any capacity. workers'comp.insurance. g, EJ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3:❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]r employees.[No workers' 13.[ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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#br Self-ins.Lic.#: 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 I do hereby cer. ' under the pains and a ie ofperjury that the information provided above is true and correct. Si ature ` a Date: OUAA-01 Phone#: _p Official use only. Do not write in this area,to be completed by city or town official. City oIr Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or loeal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit 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 rence number. In addition,an applicant that must submit multiple permit/license applications Pp man e p p pp y giv n year,need only submit one affidavit Y Y indicatingcurrent 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. Anew affidavit must t be filled out each year.Where a home owner or citizen is obtaininglicense a or permit 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 you have an questions, lease do not hesitate Y p t tog ive us a call. The Department's address,telephone and fax number: The Commonwealth ofMassachusetts Department ofl dustrlal Accidents Mice of IaVestigatlons 600 Washington Street Boston,MA,02111 Teel,#617-727-4900 oxt 406 or 1-877:MASSAF B Revised 5-26-05 Fax##617727-7749 www.mass.gov/dia q I Erasmo Da Silva 617.828 4750 5 Neilson Ave Everett, MA 02149 Date: Proposal: Mike Hurley 162 Gray st North Andover,MA Description Description Amount Kitchen to renovated. New wood floor . Kitchen labor: All the Cabinets to be taken $ 8,800.00 off,and new cabinets will be installed. The floor(old tiles)will be Cj removed and new hardwood floor will be installed. Wall repaired with v sheetrock,taped and plastering . 0 New door to be installed. t As specified, all the work to be completed in a professional manner according to standard practices. The house owner will provide all the material(to be agreed) necessary to complete the work listed above. In case of any extra labor and material not shown in these list new charges will applied accordingly. We propose hereby to furnish labor complete in accordance with above specifitions , for the some of: Dollars: $8,800.00 for the whole work. Payments : Project: Kitchen Total: $ 8,800.00 Payments/Credits: renovated Acceptance of proposal: 1"Payment: 2 nd payment: -- ----- -�-, ------------- - ----------------------- ------ ------ Erasmo DaSilva Mike Hurley i Ua7zyxAt�[u a sine��'°"e7? Office of Consumer airs i HOME IMPROVEMENT CONTRACTOR Type !4 =..Registration 4A61340 DBS ExpirationQ11 /2014 ( IIPA4,Y RgFMGJ'DA SLLVA mix` g NIEL$ON AVE.#2\ s ,l kVEROT,MA 02149 w UndersecretxfiY rk Massachusetts - Department of Public Safety -Beard of Building Regulations and Stah-s arils- ". Cuiist•ruction Supers isur License: CS-092360 bz. ERASMO B DA&VA �� 5 NIELSON AIE#2 [2 EVERETT A 02149, ' - ; x0 Expiration CdMiinissioner 07/A/2013 ' i 3