HomeMy WebLinkAboutBuilding Permit #518-15 - 176 CHESTNUT STREET 12/3/2014Permit No#:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Aepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
/ i2E rLA`(-E WE vel s"POW AT-
Identification - Please Type or Print Clearly
OWNER: Name: bA v') 9 PE91PW Phone: 9 79- - 6-9'(D
Address: 1'7(., C,446STOUT
Contractor Name:MEVE- Hwy- Phone: 9 7s-- ST4. - Ci t `4 *7
Address: 3 3 r e p-L.r l (?=9
Supervisor's Construction License: G5 - (3 9 S'S 3 9 Exp. Date: 1 1-) 3,- 2 o 1 S
Home Improvement License: 1 7(. 1 g Z
Date: % " Z - ZOI !�'
ARCHITECT/ENGINEER Phone:
Address:
. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.0 R S.F.
Total Project Cost: $ A o 0 L) ` FEE: $ ( (P&
Check No.: , ocf5 Receipt No.: e -1g -_S 1
NOTE: Persons contracting wit unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner 6Signature of contractor
Location 0
No. G" Date 1
Check # L
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
OF SEWERAGE DISPOSAL
[TYPE
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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on _ Signature
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/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 signatureldate
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 Call Ema
I Date Time Contact Name 3
Doc.Building Pennit Revised 2014
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
o Workers Comp Affidavit
o 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/Cross Section/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
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o 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
Doc: Building Permit Revised 2014
ALDEN WEBSTER
STRUCTURAL ENGINEERING SERVICES
113 North Street • Lexington, MA 02420-1929
(781) 861-6513
FINAL STRUCTURAL AFFIDAVIT
I hereby certify that I, Alden L. Webster, Massachusetts registration number
31028, being a registered structural engineer, prepared the structural
computations and the structural drawing for the:
Perry Residence Renovation
176 Chestnut Street
North Andover, MA
I further certify that I made a final inspection on December 11, 2014 and
found that the structural work was done in accordance with the plans and
specifications. As far as I am aware all the structural work satisfies the
structural requirements of the Massachusetts State Building Code.
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Massachusetts Home Improvement Sample Contract
This form 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. Any person planning home improvements should first obtain a copy of "A
Massachusetts Consumer Guide to Home Improvement" 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 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name
Company Name
Street Address (don t use a Post Office x address)
%-7(,
Contractor/ Salesperson/ Owner Name
714 5"f
A- !P
City ownState Zip Code
A JVee 11�A 0145"
Business Address (must include a street address)
'S3 e -t NbR- 019Lf5
Daytime Phone --venins Phone
3_ 5:0 S5- L
City/Town State Zip Code
u.4— yeti MA,
Mailing Address (It different from above)
Business Phone I Federal Employer ID or S.S. Number
Lary requires that most home
Home Improvement Contractor Reg. Number
Expiration date
haprovement contructon have
registra
a valid tion number
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.)
Required Permits -The following building permits are required Proposed Start and Completion Schedule - The following schedule will
and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of Z S- l Date when contractor will begin contracted work.
MGL chapter 142A.) 4 8r�
Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of.
Payments will be made according to the following schedule:
$ 0 _ 0 0 upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$ 50b0-00 by _!2. Ijf or upon completion of 7i�'`1�u MAI
$ OG, ' by r Z 12A IV or upon completion of e,," J C
$ upon completion ofthe 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 work begins in order n
to meet the completion schedule.(**) $2066, to be paid for L t/ ^'YK.-
NOTES: (*) Including all finance charges (**) Lawrequires 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. ul�
Express Warranty- Is an express warranty being provided by the contractor? IA=I NoEfYes fall terms of thewarranty must be attached to the contractl
Subcontractors - The contractor agrees to be solely responsible for compl on 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
materials and labor tinder ibis 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 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.
• Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757.
• Does the contractor have insurance? Ask 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.
• 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 ofbusiness, provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the
third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
T o identica pi• f the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor.
Homeowner's Signature Contractor's Signature
i1 ' I1' I I'Dtj iZ / ZOy
Date I I Date
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 afforded to a
contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute
concerning this contract, e contractor may submit the dispute to a private arbitration firm which has been approved by
the Secret of the Ex u ve Office of Consumer Affairs and Business Regulation and the consumer shall be required
to submit suc arb' 'on as provided In Massachusetts General Laws, ter 142A.
Homeowners Signa e Contractor's Signature
NOTICE: The si 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 the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below).
Execution of Contract
The contract must be executed in plicate 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 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 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, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement"
contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the OCABR website at httn://www.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 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
http://db.state.ma.us/homeiinprovement/licenseelist.gM
For assistance with informal mediation of disputes or to register formal complaints against a business, call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
508-652-4800, 508-755-2548 or 413-734-3114
Version 2.1 - 11/22/2010
4
4'
Stephen Silk
Renovation & Restoration
North Andover, MA. 01845
MA License # CS -098533 HIC # 176182
978-886-0447
Contract:
To: David Perry
Date: Dec. 1, 2014
Re: 176 Chestnut St.
N. Andover, Ma 01845
SCOPE OF SERVICES:
General description of discussed work.
Administrative:
• Construction Supervision
• Coordination with subs
• Pull necessary permits
• Construction listed below
• Keep job safe, on schedule, clean at all times, and running smoothly
Description of work:
• Remove all kitchen cabinets/disposal
• Remove all trim@ kitchen area
• Remove drywall & dispose
• Install new Pella window (window by owner)
• Install kitchen cabinets per plan
• Install new trim in kitchen area as needed
Terms and Conditions
• Contractor agrees to furnish all necessary labor, tools, equipment and
materials to complete the work outlined in the scope of services.
• Contractor shall provide copies of a valid builder's license and proof of
liability and worker's compensation insurance prior to commencement of any
work.
• Contractor agrees to complete the Scope of Services in a timely and
professional manner in accordance with the specifications set forth by the
architect and engineers, and in compliance with state and local building
regulations.
• Contractor agrees to clean all debris from construction only and to keep the
job site in a clean and workable condition at all times.
• Any materials, products or labor not specifically mentioned in scope of
services is not covered under contract and will be paid for out of allowance
fund or billed to homeowner (monies denoted in bold next to categories are
included in overall price and will be drawn from to pay for materials and
installations)
• Homeowner (not lender) is ultimately responsible for payment upon
completion of services and receipt of invoices.
• Anything not specifically mentioned in above scope of services will be billed
at $65 per hour, plus materials.
• All materials/labor supplied by Silk Renovation/Restoration are warrantee for
lyear from date of completion.
Total Construction Cost:
$6,800.00
The Commonwealth of Massachusetts , -
- Department o, f'IndustdglAceWc is
Office ofInvestigations
600 Washington Street
Roston, MA 02111
www mass gov1d1a
WQrkers' Compensation Insurance Affidavit: Builders/ContractorsIBlectrieians/Plumbers
ApplicantInformation Please Print LCWMV
Name (Business/Organizationlfndividual):
Address: 33
City/Stale/Zip: d� 0 . r{ o� Phone #: � ? Sl -
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. 0 I am a general contractor and I
ployees(fan and/or parttime)•*
have hired the sub -contractors
listed on the attached sheet.
2. I am a sole proprietor or Partner-
ship an.d'have no employees
These sub -contractors have
working .forme in any capacity.
workers' comp. insurance.
5. ❑ We are a corporation and its
[No workers' comp. insurance
officers have exercised their
required.]
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.]
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. Remodeling
8. [[ Demolition
9. ❑ Building addition
10.[] Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
*Any applicant that checks box Of must also fill out the section below showing their workers' compensation policy information.
i (Homeowners who submit this affidavit indicating they hre doing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractors that cheek 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 N
Policy # or Self ins. Lie. #: 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 requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or onet-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 maybe forwarded to the Office- of
Investigations of the DIA for insurance coverage verification.
I do Hereby certirp under filepaid penarties ofperjury that the information provided above is true and correct.
Simature: C, Date: Df a- —
e44. ol -I -s- - S -i( - 0y�� 1
Offtcial 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
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 local 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, apolicy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents fbT 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 Departmenthas 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 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 (ifnecessary) and under "Job Site Addtess" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by ih.e 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 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 orpermit to burn leaves etc) said person is NOTrequired 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 anal fax number:
Tho CQnuAonwoaTtbL of Vl;assarhvsetts
Deftmt ofhldusWal ,Aroldenta
Qmce of 11XVe0gatzon's
6QQ Waft&a Stet
B oston, MA, 02111
TeJ, 4 617-727-4900 QA 406 ox Z-$77-:MASSAFF,
Revised 5-26-05 Fax # 617"727-7749
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