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HomeMy WebLinkAboutBuilding Permit #460-11 - 1635 OSGOOD STREET 11/3/2010 . j 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 3 i Permit N0: p�IL Date Received Date Issued: _-3 IMPORTANT:A licant must corn -lete all items on this page LOCATION S v S o ad S7 . Print PROPERTY OWNERT-q) Cr Pyl J Y\rt,< Print cc 03 MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition l�Two or more family ❑ Industrial ❑Alteration No. of units: 3 ❑ Commercial $i Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic []`Well ❑Floodplain q OVe_tlands 0 Watershed:Districf.. 0 Water/Sewer - - - -- DESCRIPTION OF WORK TO BE PERFORMED: 1V\,00C--r, 0\, U !- 1" cv(V11C.ti,-t Identification Please Type or Print Clearly) OWNER: Name: I tf MJ h ro t Phone: Address: I �c S =r/� T �� of tl CONTRACTOR Name: K Zy;,n r -I Phone: Address: -c, T- 1 J 0 A-JJ d\/-V c,SI V J Supervisor's Construction License: 0S 3 — Exp. Date: Home Improvement License: t 0 j - V) 4 Exp. Date: 61 -Z-!� 1 L-7 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: $ D 0 0• yy FEE: $ y�• o U Check No.: 7 Receipt No.: a' NOTE: Persons contracting with unregistered contractors do not have aVcesso the guarantyfund Sgnature.of;cont'rac Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL _ Public Sewer ElTanning/Massage/Body Art ❑ Swimming'Pools' ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ISF1I Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning B( and of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning 1joard 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 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.$10041000 fine NOTES and DATA.---: For department use 1,4 I I ® Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department p ' r t d 'ssuance of Bldg Permit Addition Or Decks -� "Mold ❑ Building Permit Application o Certified S ]ot--Pl-an 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) ❑ Muss check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products QUOTE: 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 chat 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 2008mi Location,&z3-r No. (/ - Date NORTH TOWN OF NORTH ANDOVER 0 9 " Certificate of Occupancy $ sJ�cMuSE< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r� 23757 Building Inspector ORTH ToVM of Andover 0 ,..a...ra .,.4•; 1. No. 70 AKdover, Mass., � ._ � � 0 GOCMICMEWICK 7�S RATED P' � �C BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... �..... ..I.�/.�:.....I/ "�!Nl/ ....0 ......................................................... "" """""""' Foundation has permission 4o erect...... . ....:.............. .......... buildings on ...... ..�Q ....... ...... ..Q� .......`s............-............. Rough 0 � to be occupied as N v� �`t� ��vw Chimney .............. ..................................... ............................. ................................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N TARTS 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. ORTH 0q" 0 TAndover CS LAK -o do0 TO i� 0 7 wer, 1V1ass. , - COCHICHEWICK ORATED S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... ..... ..�.�............ ." � .... ....................... .............................................. Foundation IT has permission to erect...... . ....:.............. .......... buildings on ...... ..1 ....... ...... ..Q'Id.......`5.............-............. Rough /� VCS ^^ ''\� vV�- �/V Chimney to be occupied as.............. ....................................0 ........................ ............................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N TARTS 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. Massachusetts Home Imus~ovement:Sample Contra t orm satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not'include standard langdage to protect homeowners. Seek legal advi ovemce If neeessary. Any person planning home improvements should first obtain a copy of"a ; Massachusetts consumer guide to home imprent"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8797 or 1488-283-3757. Homeowner Information Contractor Information Na-meComp-my ame t Stree Address(do not use a Post Office Box address) CTriaorl Salesperson/OwnerName ' (635 'j0SSoo'y . Ser, j0 (hiss 0If(-),-' t'tJ � Itil�r City/Town State Zip Code usiness Ad0jess(must include a street address) a curd sI Daytime Phone Evening Phone 'ityrrown St(a�te- Zip Code io0 ��5� tr"ST'. o. AJow ©/ty'r ►-iM�v� tr 451 I �4 !" Mailing Address(lt different from above) Business Phone ederal Employer ID or S.S.Number e Law_res that mon hnmE tin- I Home pmvemeat eomractors have fwvera enl Conhactot Reg.Nmnber Hxpb7tion date aadR�IttCattaaaDahG I _/� �� The Contractor agrees to do the"following work for the Hameo mer. m e to a worico rap e e specr g me type,brand,and Itle 01 m Ml als to be useon / use ece Regtiired.Permits-The followin 'buiIaing permits are required Proposed Start and Completion'Schedule-The following schedule will and till 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 own permits will be excluded from,the Guaranty Fund provisions of I I U Date when contractor will begin contracted work. MGL chapter 142A.) QD bate when contracted work will be substantially completed. Total Contract Price and Payment Schedule ' The Contractor agrees'to perform the wort;,famish the material and labor specified above for the total sum of U,U� (s) Payments will be made,)abcording to the following schedule: ' 000 upon signing'contract(riot to exceed 1/3 of the'total contract price or the cost of special order items,whichever is greater) by ____/�/� or upon completion-9f S by _/_/r•or upon completion of S t00 Y 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 be paid for ordered before the contracted warl-'begins in order S to be paid for to meet the completion schedule.(**) t+ NOTES:(4)Including all finance charges(")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(h)the actual cost of any special equipment or custom madelmaterial which must be special otdered.in advance to meet the completion schedule; Exoress Watranh-Is an express warrartty being provided by Hte contractor? No Yes all terms of the warrnn 4 must Subebptractors-Thetantractor a h'ID be attached to the cnntrwcrt , grecs to be solely responsible for completion of the work described regardless of the actions of any third partylsubcontractor utilized by the contractor. The contractor further agrees to be solely'responsiblefor all payments to all subcontractors far materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has 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 fully understand it Ask questions if something is unclear. e sure the contractor h • ' 1vlAkes a valid Home Improvement Contractor R.eyistration The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Wiprovement Contractor Registration You may inquireslibout contractor I by;wridug to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617.-')27-3200 or 1:800-223-0933. Does the contractor have insurance? Check to see thatyour contractor is properly insured. Know 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 wri'ng at his/her main office or branch office b ordinary fY dine Y ry mail este 6 tele third business followin .the sr p Y gram sent or by delivery,not later than midnight of the Y g going of agreement. See the attached notice of cancellation form for an explanation of this right. g DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!.! w i tical copies of the•contractmust be completed and signed. One copy should go to,the hotneowner.The other copy should be kept by the contractor. N� of s Signature C ntractor's Signature ate Date f, Contractor Arbitration The Home Improvement 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 afforde 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 homeowper 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 apprpved.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 Iu Massachusetts General Laws,chapter 142A. H'omeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties.'to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this separately signed by the parties. section is not 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 maybe excluded from certain rights if the contractor they choose is no.t properly registered as prescribed by law, Homeowners who secure their own building permits are automatically excluded from all Guaranty.fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike meaner. Homeowners maybe endtled'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,ba the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability andfitness for a partictllar purpose; An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the term's 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 Inforxnation Hotline(listed below). Execution of Contract w The contract must be executed in du licate and should not be signed until.a copy of all exhibits and referenced documents have been.attached. Parties are.also advised not to sign the document until all'blank sections have been filled.in or marked as void, deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract,•and the three day recission period has expired. Accelerated Payments A contractor may not demand'payments in advance of the dates specified on thea' 1 . homeowner deems him/herself to be financially insecure. However,in instances where atcontractor deemcass whimere the /li elf to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,orif you wish to obtain a free copy.of f "A Cons Law,"contact: umer Guide.to the Home Improvement Contractor Consumer Information Hotline Office of Consumer Affairs and Business Regulation. •10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787`or 1-(888)2833757 't If you want to verify the registration of a contractor or if you have questions Or need a y about the contractor registration component of the Rome Improvement Contractor information specifically or Law,contact: Director of Home Improvemenf Contractor Registration Bureau of Building Regulations and Standards One-Ashburton" Place,Room.1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 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 �ry AND/OR -Better Business Bureau (508)652-4800 .(508)755-2548 (413)734-3114 i ' ,-- '� DATE(MM/DD/YYYY) �= CERTIFICATE OF LIABILITY INSURANCE 1 12/2/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER NAME: M P ROBERTS INS AGCY INC A//CC.N,Ext: 978 683-8073 (ac,Noy(978)683-3147 1060 Osgood Street AODREsssandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ZURICH INSURED TYLER MUNROE LANDSCAPE INSURER B: CONTRACTOR INC. INSURER c: ACE PROPERTY & CASUALTY 100 FOSTER STREET INSURER D: NORTH ANDOVER, MA 01845 INSURER E: 978-685-3545 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �S TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY -PREMISES(Ea occurrence) $ 300,000 ICLAIMS-MADE CI OCCUR MED UP(Any oneper.on) $ 10,000 A SCP000659757 02/28/10 02/28/11 PERSONAL&ADV INJURY $ 1f000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PEO- LOC $ AUTOMOBILE LIABILITY Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECLMVE ❑ N/A NAC C46285530 05/04/10 05/04/11 E.LEACH ACCIDENT $ 500,000 C OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1$ 500,000 If yes,desbe ESCRIIPTIONuOFeOPERATIONS below E.L DISEASE-POUCY LIMIT $ -900,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AttachACORD 101,Addibonal Remarks Schedule,if morespaceis required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER, MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REP VE 00ilitill ©1988-2010 ACORD CORPORATION.AII rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/d'ia 'workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name(Business/Organization/Individual): MUA 1' cowri�,Grw Address: (� 1—c�cTrt r a 1�'�4 City/State/Zip: N4 0 �{J� Phone#: 7 V G 3S_YJ_ —T Are you an employer?Check the appropriate box: Type of project(required): 1. ] 1 am a employer with � 4. El am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors ❑ listed on the attached sheet.? 7• Remodeling 2. I am a sole proprietor or partner- . ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers'comp.insurance. 9. 0 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 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.Fl Roof repairs insurance required.] employees.[No workers' 13F1 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 sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.M S P 0 0� to� `l � S^ / Expiration Date: (�,, Job Site Address: 3�� ©St 000, City/State/Zip: J I"l4 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 herebM1 , ins and penalties ofperjury that the information provided above is true and correct. Si afore: Date: 0 Phone#: 13 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: