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Home My WebLink AboutBuilding Permit #45 - 1634 SALEM STREET 7/8/2010 BUILDING PERMIT o` OORTH q tt�eo i6 ti TOWN OF NORTH ANDOVER 0 p APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �° X1,9 ��/ � SgACHUSE Date Issued: I IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER - ` � � PI a ms Paint MAP 210PARCEL: ZONING.DISTRICT: Historic District yes no Machine Shop Village Vires no 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 Septic Floodplain Wetlands watershed District . Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: PR t-,2 e-4 Z Identification Please Type or Print Clearly) i OWNER: Name: A/ 19 F1 /-1 S Phone: Address: CONTRACTORName: / - rr Phone: Address: a Supervisor's Construction License: Exp. Date: Home]mprovem,-ent License: Exp_ Date, 7 -y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 00 Total Project Cost: $ 90d'— FEE: $ Check No.: c;.Y--5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to guar r �Signature of Agent/Owne�. Signature-of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMIF\IENTS 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 s ood Street FIRE DEPARTMENT -Temp Dumpster on site }yes no x Located at 1.24 Main Street fire Departmerit:si+gnature/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 2010 i Building Department , IIS 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) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Location� � zz�� No. Date 17—ifOf —� TORT" TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ sACM�SE<� Building/Frame Permit Fee $ i Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check # � 230 6 Building Inspector ORTH Town of And 0 45 -,o I► -_ X _ _ _ A K E o dover, Mass., COCHICHEWICK 7�ADRATED P' '�� `SS BOARD OF HEALTH PERMI i�T T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..............61&14: .A.A&4A........ ............................ ....................... ... ` Foundation has permission to erect........................................ bwldin s on........a1.4f.... .... .. .................... Rough to be occupied asSChimney provided that the person accept g this permit shall in every respect con to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ,, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations-Voids this Permit. Rough Final ? PERMIT EXPIRES IN 6 MON UNLESS CONSTR T ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh $ Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted o: Job Name Job# Address Job Location Date Date of Plans Phone# f Ffax# x Architect We hereby submit specifications and estimates for:....._....._................----...-------.........._..._---_....__._._........_...._...._.._..-.----...__..__.._.._..........._......---...---...._..---.........-.--.---.._._._.__..._.._.._..-........................... ._....._....._._..._.._._.___----..._._._.._..._..._. 00, .__...__..--- - ______..__.._.._._...__.: .� -.-............________________ j �1_rr _ _ _ _ _ _--------_-------___ ........_.._...------ --_ ___ 1 _ _--- __._ �,w_ /_ -_ --- pzv .....................__ - -._....--........._._.._..__ ._...._. _____ - ............ - ._............................------....._...... _ _ - _--_ ___.__ __ _---- _...__........_.._.....---...------- _-.__f �_!------------- __._----- =_ _--- --------------_ __-____ _--- - - - G x �proposehereby to furnish material and labor—complete in accordance with the above specifications for the.sum of: �j^ 674/ /OZ7L . _ �% 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 submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. �Icceptancle of �ro�ogaY The above prices,specifications and conditions are satisfactory and are /Signature hereby accepted.You are authorized to do the work as specified. t `m L ents will be made as outlined above. of Acceptance Signature f �_ �Ia.. rrhtn�ti. - I)�lt lrtnnni of Nuttiir �1fc�t� Boal(I 1+1' 1Wit(IitI t2t'11tatr/,11% 111111 �'tlmf1rds License: CS 22680 Restricted to: 00 ARTHUR J WALSH JR 55 PLEASANT ST N ANDOVER, MA 01845 Expiration: 6/9/2010 n11i11� 111+.'1' Tr-; 27002 Board of Building Regulatiohs'and Standards fir'! HOME IMPROVEMENT CONTRACTOR Registration: 103358 j' Expiration: 7/7/201 . Tr# 271352 Type: Private Corporation A.J.WALSH&SONSJNC. y• Arthur Walsh,Jr. 55 Pleasant St N Andover, MA 01845 Admiuistrator The Commonwealth ofMassachusetts . Department of Industrial Accidents Office of Investigations r 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers'. Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): f7� �� PT `'✓csi Address: �Lf',/�Si� />' s✓ City/State/Zip: /i/C� A,,K,0 aeX /Wf,)-Phone#: 2e--6S FJ cp737 Are yo employer? Check the appropriate box: Type of project(required): 1. I am a employer with�_ 4. E] I am a general contractor and I, 6. F1New construction 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. ❑ Remodeling ship and have no employees These sub-contractors have g. [] Demolition working for me in any capacity. employees and have workers' 4. Buildingaddition p o workers' comp. insurance comp. insurance.1 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its �. p 3.F-1I am a homeowner doing all work officers have exercised their I LF]�oofortepairrs epairs or additions right of exemption per MGL myself. [No workers comp. 12. insurance required.] t c. 152, §1(4), and we have-no 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. 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 sheetishowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f, Insurance Company Name: /Y z Policy#or Self-ins. Lie.#: �G �� Ll,�b /d20b l b Expiration Date: / s Job Site A8dress:1431-15/9C_e/_) / City/State/Zip: i4`O /}/Y0D6)6,12 � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: LID Phone#• 9 _60� e � 7 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies all basic requirements of the state's Horne Improvement Contractor law(MGL chapter 142A) but does not include standardlangua ' Massacge a protecthomeowners.guidtoSeek,legai advice itneceasary:Any peisoaplsnniog horns gnprovements should fust obtain a copy of"a Massachusetts:consuitnerguuide'W home,improvement"before agreeing.to any work on yourresrdenct.You may obtain free copy by'caning the ' Office of Consumer.Affairs and Business-Regulation's Consumer Information Hotline at617-973v4787-or I+888=283-375.7: ' Homeowner Information 'Contractor Information ams Street A �do not use a Post Office 13o address) tractor/Salespason/.OwnaName J City?own State Zip Code -4ass Address(must include a street address) Daytime Phone Evening Phone- Atyrrown State Zip Code Mailing Address(It different from above) Business Phone ederal Employer ID or S.S.Number iay.egmro um mop taupe int- some Compmoraea:itamttr,.B>�doa�du.._'. .. coon.n.v6. / - em.4aoambv The Contractor agrees to do the following work for the Homeo ner. _ . G��cv�Te�. sh�.ec Required-permits-Thefollowing building permits are required Proposed Start and''Completion Schedule-The fdllowiiig schedule will and will besecured:bythe contractor as the'homeownet+s agent; be adhered to-unless circumstances beyond-the connaetots'control ari wse. (Owners ho.secure their own permits will be excluded:from;the:Guaranty Fundprovisions of J /ate when contractor will begin connacted work. MGL chapter 141A.): eal when contracted .work will:besubstantially.eompleted.: Total Contract Price and Payment Schedule , The Contractor.agrees to perform the work,fiunish the material and labor specified above for the total sum of (r) Payments will be made according to the following schedule: $ upon.signing contract(not to exceed 1/3 of the tota1contract price g the cost;of special order items,whichever is:greater) by or moron completion of y by /_/ or upon completion of �/Q( S oo upon completion of the contract (Isco forbids demanding fWl payment until.contract is completed to both party's.satisfaction) 71te following material/egmpment must be special S paid for ordered before the contracted wo&begins in order S to be paid for to meet the:completion s&edule.(••) NOTES:(•)Inclading all finance charges(••)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed theer a !sem of()ono-third o f the total contractpriceor @)Oe actual con of 'a) airy apes .equipment or custom made material which men be special ordered is advance to mat the completion scLedule _ Express Warranty-Is an express-warranty bein•provided by Mee ti•" No Yes (an.terms of M w4&M9t.M91ibe attached to Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions ofany flied party/subcontractor utilized by the contractor. The contractor further agrees m be solely responsible for all payments to all subcontractors for materials and labor under Mis aereement 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 interesthas 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$illy understand it Ask'gttestions ifsontt 614 is unclear. • Make aft the contractor has a valid Home Imttmvement ontrac a R t r3tl The Idw requires most home improvement contractor;and. subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about.connactor registration by writing to the Director at:One Ashburton Place,Room 1301,Boston,MA 02108 or.by 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. Read the Important Information on the reverseside 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 o posted,by telegram sent or delivery,by ordinary mail by cry,not later than midnight of the. third business day following the signing of this agreement..See the attached noticeof.cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM idmtlnl copies of the opppaet past be completed and siamd pas copy ahuuld.ao to the le _ otic Dopy ihoold be]syr by the Homeowner's Signature Contractor's Si true Dau Date e,