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HomeMy WebLinkAboutBuilding Permit #828 - 183 FRENCH FARM ROAD 6/8/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 15 -- IMPORTANT: Applicant must complete all items on this page 1 Print MAP NO: ,57 PARCEL:5 ZONING DISTRICT: Historic District yes?no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑ Addition 11 Two or more family ❑Industrial ❑ #4eration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other . i® Sep"tic �01We11 i❑�Floodplaui ���W_ .etlands �' 'Watershed 10156t,", _ (]Water/Sewer DESURir 1 JUN UP W UK-& If\U tsr" OWNER: Address: CONTRACTOR` Name: — Address: Supervisor's Construction License: 16-5';3& Exp. Date: Home Improvement License: 1,2e? 99 3 Exp. Date: ARCHITECT/ENGINEER Phone: Phone: �' � � `� _ 5 - Address: Reg. No. FEE SCHEDULE. BULDING P RMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: FEE: $ Elf I ---- Check No.: Receipt No.: o�-`I a4,6 NOTE: Perso s contYact ith unnegi r "on", do not have access to the guaranty fund Location No. Date N0�7h TOWN OF NORTH ANDOVER 3?o',t�'e !•'ho 0 Certificate of Occupancy $ s;- C�s t� Budding/Frame Permit Fee $ Foundation Permit Fee $1 Other Permit Fee $ TOTAL $ Check # 242L6 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Commen 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.$100-$1000 fine 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 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) ❑ 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 Doe: Doc.Building permit Revised 2008mi CA m X m m CA v m v y .0 C � 'v O CD C � Z VA = O = . rmm� d = CO) O C v CD Q O Q CDCD CD CD °o av y _• o co C E v CA O 'v z CDa O CD O CCD 5 N,, F cn n O cn low! In! C O ? x m CO m y m m0 o m y m n C O cD x = O 0 co Ow C 79 = z�•C O y C2 O -COD a vi = i _ Om ' CL CD 0 CD a� mwf d yfib• go Q CL N O m I y m CO2 CD CD Cl CD C-1 ca CD T. CD my C* C' _ -0 1 C2 O ,rt _ inn CD C* ~' Co cn y v cin O �+ n. y p r C ,n y O � w tom" \T1 � td 7d w 7y 0 b n -r? n �' 7y81cn C G O O n .d r) y - O °� n O 0 0 . Nn N9 Oo H 0 0 c This lane assachOWS Home Iia. 'O'NIemend Contract satisfies all basic requirements of the state's $ome Improvement Contractor Law (MGL chapter 142A), but does not include standard to protect homeowners. Seek legal advice If necessary. An setts consumer guide to home improvement' before agreeing toy any work Person on your r Ing home improvements u may obtain first mfree corn b copy the 4onsumer Affairs and ]3us1ness Regalatian's Consumerinformation Hotline at 617-973-8707 or 1 -may obtain 11 • pY of as PY Y g ' Homeowner Information Contractor Information Required.isermIts -The followinobailding permits arc required PraQtosed 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 co (Owners who secure their own permits wfII be ntractor's control arise exellided from the Guarant3i Fund provisions- of MGL chapter 142A.) ' Yej�Date when contractor will begin contracted work. "4"'1 -=r --Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agreor to per the work, fiirnish the material and labor specified above for the total sum of O0 Paytt}enade ts will be maccording to the following schedule: (*) upon signing•contract (not to exceed III of tbe'total contract price or the cost of'special order items, whichever ise --�- - ater) . � by l�l or uponcompletionnf Aft • • ---- —_ by /_ -or upon completion of �-3�_ upon completion of the contract• • '� '• (Law forbids demanding full paymentuntil contract is completed to both party's satisfaction) The following materia]/equipment must be special ordered before the contracted worl'begias in order 5 to be paid for �L l to be paid for r to meet the completion schedule,(**) ; NOTES: (*) Including all finance charges(**) raw requires that any depositor down- a not exceed the greater of (a) one-third of the total contract ca or P yment required by the contractor before wort begins m'ay, Pri @) the actual cost of any special equipment or custom made material which must he special oYderedin advance to meet the completion schedule. 1Jx ress Ova an _ Is an a ress warm' bean rovided Hre con actor? No yes Subc6ntractors - The cotihaotor agrees to be solely responsible for completion of the work described regardless of the actions of any third all terms of the warran must bo attac ed o rho contract party%subcontractor utilized by the contractor. The contractor further hgreeS to be solely'respbnsible far all a aterials and laborunderthis-e Bement p yments to allsubcontractors for ContraeiAcceptance - Upon -signing, this documentbecames a binding contract under law. Unless otherwise noted within this document, the e re contract shall not imply that any lien or other security intcresthas been placed on the the following cautions and notices carefully before signing this contract sidence. R • Don't be pressured into signing the contract Take time to read and fully understand it, Ask questions if something is unclear, • ' kc sur a contrac or has a valid Home m rave ent Co su istration b to be registered with the Director ofHotpe I4ro relent Contractor Registration You may inquire about contractor do The law requires most home improvement contractors and registrntion by writing to the Director at One Ashburton Place Raom 1301 Boston, MA 02108 or b calling inquire ]8001223-0933. + 4 • Does the contractor have insurance? ;t Your contractor Y g 727-3200 or s properly insured. • Know your rights and responsibilities'. the Important Infornlatio nton the rove rre side Chills form and eta c Guide to the Home- Improvement Contractor Law. l g opy of the Consumer You may cancel this agreement if it has been signed at a place etiii r• than the contractor'a normal lac contractor inwriting at his/hermain office or branch a8tce by ordinary mail posted, 6 tele third business day foIlowing.the signing of this agreement See the attached notice of cancellation form for an explanationed you notify lira Y gram sent or by delidery, not later than midnight of the DO NOT SIGN THIS CONTRACT rF- T]EtEItEI ��y�°f tins righk Two identical copies of the•contr!7;be completed and signed, One ARE n' A x B pyshouldgo to thb hotneown¢ SPACES!! 1 0otherco''shouldhetb kept y thaknnsetur. Homeowner s Sign re (e7 'IV ,t, . AContractor' tgnature ' Date Date Contrhetor Arbilt at on The Dome improvement Contractor Law provides homeowners withthe right to initiate an arbitrationc, ` F alternative to.court aetion)•if they have a dispute'with a contractor. The same right isnot 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 homeowner by the Home Ianprovement Contractor Law. The contractor and the homeowner hereby mutually agree iia 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 beet a . ved.b th ecretary of the Executive Office. of Consumer Affairs and 'Business Regulation and the .consum er�hail�lpe rewired /,77t su arb' 'on.as provided In Massachusetts General Laws, chapter 142A. orneow rs Signature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the parties. to altetnative d'isput'e resolution initiated by the contractor. The homeowner may initiate, alternative dispute resolution even where this section is not separately signed by the parties. Homeowners Rights 'A homeowner's rights under the Home Improvement C.otrtractor Law (UGL chapter 142A) and other consumer protection laws' (i -e. MGL chapter 93A) may not be waived in any way, .eV6n by agreement. However; homeowners may be excluded from certain rights if the contractor they choose is nat properly registered gs prescribed by law: Homeowners who secure their own building permits are'automatically excluded from all GuarantyVund provisions of the Home Improvement Contractor Law. The contractor is msponsible for completing the work as described, in a timely and workmaulilce manner, Homeowners may be entitled'to other specific I gal 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'labbut your consum&r/homeowner rights, contact the Consumer Iriforxnatioir Hotline (listed below). Execution of Contract . The contract must be executed in du Iicate and should not; be signed . ntil•a copy of all exhibits and referenced documents havd 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 co py of the contract,. and the three day recission period has expired. Accelerated Payinents 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 firiancially insecure. 'However; in instances where a contractor deems himll erself 'to be financially insecure, the contractor may require that the balance of funds not yet due be placed tri a joint escrow account as a prei-equisite to continuing the contracted work, Withdrawal of funds from said signatures ofbottiparties. account would requite the Additional Information If you have general 'questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or•tf you wish. to obtain a free copy .of A Consumer Guide to the Home Improvement Contractor Law," contact: ' Cdnsumer Information Hotline Office of Consumer Affairs and Business 'Regulatioa .10 Park Plaza, Room 5170, Boston MA 02116 (617) 973-8787'or 1-(8'88) 2833757 "_ Ifyou want to verify the registration of a contractor or if you have questioia5 or need ti about the contractor registration component of the Home'Improvement Cdaddifiotact nfortnation specif tally ontractor da Directot of Home Improvement Contractor Registration Bureau of Building Regulations and Standards ! One•Ashburtoin Place, Room -1.301, 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 " AND/OR •BeEterBusiness Bureau (508)652-4800 .(508) 7�5-2548 (413)734-3114 HIC Registration Complaints Page 1 of 1 The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) Mass.Gov Consumer Affairs and Business Regulation Home > Consumer > Housing Information > Home Improvement Contractor Program > ............ HIC Registration Complaints Registration # 128993 Name Ray Morrissey City, State, Zip Danvers, MA, 01923 Expiration Date 6/21/2011 Status Current No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search © 2011 Commonwealth of Massachusetts http://db.state.ma.us/homeimprovement/licdetails.asp?txtSearchLN=28994 6/8/2011 The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): City/State/Zip: Phone #: 9757 ©�% / 5 Are you an employer? Check the appropriate box: 1. ❑I in a employer with 4. ❑ I am a general contractor and.1 employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 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.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. El Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box 41 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 employes that is providing workers' compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name:. Policy # or 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceAllfy under the pains 6wd penalties ofperjury that the information provided above is true and correct. 1 Official use only. Do not write in this area, to he completed by city or town official City or Town: PermitUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #::