Loading...
HomeMy WebLinkAboutBuilding Permit #500-13 - 183 PLEASANT STREET 1/7/2013TOWN OF NORTH ANDOVER 3APPLICATION FOR PLAN EXAMINATION Permit NO: O _ Date Received Date Issued: / IMPORTANT: Applicant must complete all items on this page SPR®°NER� i Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition k(Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i 1919eptici Dwell; i ❑,Floodpla n� N,`W0 lands, EliWatershed=District, I nwAter/Sewer} OWNER: Name: Address: 1,6,L DESCRIPTION OF WORK TO BE PERFORMED / Please Type or Print Clearly) ,--,:2-C ,. Phone - � . - .�._ C ? lic�. a1C�ONTRACTO.R� Name:; � Ce _ Y Su{ervis"or;'sConstructibniLicense, 4 Ex,Pj Date P Nomellmp-rovement Lsicense�' l_ j l Expi Date ° 5 5 `T ARCH ITECUENGINEE 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. Total Project Cost: $ 66i C) FEE: $_ Check No.: /3 Receipt No.: D (n NOTE: Persons contracting with unregistered contractors do not have access to aran u� Signature of Agent/Owner Signature`of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan El to Plans ❑ 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 PLANNING & DEVELOPMENT COMMENT CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED El DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town- Engineer: Signature: FIRE DEPARTM Located at -124 -Main Fire. Deparitme'n COMMENTS Located 384 Osgood Street qT=-7emp;Dum ster on site yes-... no p Y signature/date Dimension Number of Stories: '2 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 B Notified for pickup - Date 1 Doe.Building Permit Revised 2010 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 Lr Building Permit Application i/ 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 (VOTE: 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 VOTE: 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) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 Location/k-� No. �-Lo C) 3 �"' Check # 26070 57 - Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 14 Building Inspector RJMc- /Management IncE 25 Decarolis Drive EIN-80*O725884 Tewksbury Mass- 01876 Mass License C5-98529 Phone- 978-852-0806 Contract and payment authorization Agreement made on this Monday January 7, 2013 by and between RJM. Management Inc. at 25 DeCarolis, Dr. Tewksbury, Massachusettes 01876 hereinafter referred to as (RJM) and Property address 181-183 Pleasant St North Andover Mass. Job Location; Same Jim Vitas ( hereinafter referred to as "You" Article 1• Nature of the work and contract price. RJM agrees to commence work on your property and coordinate matters with you and or your insurance company in order to effect repairs quickly and professionally. RJM shall supply itemized specifications to you and or your insurance company showing the work specified and its cost, and accept payment in the amount agreed by RJM. All proposed work is subject to approval by appropriate building officials and you. The total amount agreed to be paid for the work specified and the time schedule of payments is set forth in the attached payment schedule. The specifications, payments schedule, any addenda and any change orders shall become part of and incorporated into this contract. The scope of work is a follows; Remove all existing shingles and replace with thirty year architectural shingles, ice and water shield three feet from the edge of the entire roof area. 151b felt to be attached to the substraight in all the other areas of the roof. Cobra vent at the peak of the roof for proper ventilation. 8 inch drip edge aluminum on all the edge of the perimeter of the roof. Price includes labor and materials. $4,860.00 w -N i �I Z I H -� uj S OQ p m C O y O U E O N fl_ Ln 0 Vf Z 0 m C N 7 LCL W 7 O' E U LL -d' 0� � W H z c7 Z mF J d. GO O C LL a to Z Q J W w 7Z U oc O U a Z Q c7 C w 7 C U- z W cr a W W cc LL cu m v `! N Y O In W, .a C� o O U W a CL z °� a - +� c Z JE ,� o,- o U as r r ,rte E h m :A;Xw f <. W O LAO M O a f _ N GAP C •c 10 E :Le J i • > v, W �. =o = m > �--- ao0 > aN CLW cZ V QNB � ��y. Zia cn • � 3 li W cm> o c W J _ 0 C Z • as � �.• m c o tm c c _ =L L cc -a o a� CL 4) N cc W = 'a'= O y - LL •cn= O tq .Q O . Lw N O V V • W � � ami •� � H �J U GCL > Off_N J 1` 1 U) O •> _ U) .0 O O F- 0 . :z O 0 > ;v ti i `Iv Article 2; Permission to start work. You. agree to allow RJM to commence work on the above described property, to pay RJM the amount agreed to by RJM and or your insurance company for work performed by RJM. Article 3; Additional changes to work. You may, from time to time in writing, make changes in or additions to the work to be performed by RJM and RJM shall make sure such changes or additions at your sole cost and expense, at such prices as you and RJM may agree to in writing, ( Change Orders) RJM will obtain your written permission before any work not covered under this agreement or by your msurance company. Article 4• Insurance and Delays in work performance. RJM may not be liable to begin work or continue to work due to weather conditions, strikes, accidents, unavailability of material, or delays beyond RJM's control. You must carry fire, general liability, tornado, and other necessary insurance. RJM and its contractors shall provide all insurance required to fully protect RJM and its contractors. If payments are not made by you within three (3) days after the date as applicable to the payment schedule. RJM may terminate performance and cancel contract. If RJM elects to terminate performance and cancel contract,. RJM shall do so by notifying you in writing. Performance by RJM is conditioned upon payment by you. If RJM is delayed at any time in the progress of the work by and act or neglect of yours or by any employee or agent by you, or by any separate contractor employed by you or changed ordered in the work, or by labor disputes, conditions not reasonably anticipated, unavoidable casualties, or any causes beyond RJM control, or by delay authorized by you, then the contract time shall be extended by change order for the reasonable items as you and RJM determine. Article 5; Workmanshiu. RJM shall cause the work to be done in a good and workmanlike manner according to the standard practice of the trade. RJM will provide a one (1) year warranty as required by the Massachusetts State law. Article 6; Default. In the event of a default in payment or in any other manner by you, you agree to pay all cost of collection including reasonable attorney's fees, in addition to other damage incurred by RJM. You further agree to pay the maximum interest permissible by the laws of the state of Massachusettes on any sum in default. (L� Article 7; Concealed Conditions. Should RJM discover concealed conditions or unknown conditions in an existing structure different from normal conditions customarily found orunknown conditions below the ground, then the contract amount may increase by a change order upon the request of RJM or you within five days after the condition is first observed. RJM and you or your insurance representative shall agree on the work to be performed and its cost prior to the work being completed. Both parties agree that the work to be performed shall be stated in writing and signed by both parties, which shall become a part of this contract. Article 8; Binding Obligations. The obligation of this agreement binding upon RJM and its successors and assigns and upon you and your heirs, successors, executors, administrators, and assigns. Article 9; Starting and Completion Dates. Work to be commenced on or before January 7, 2013, 2013 and substantially completed on accordance with the terms of this contract on or before January 12, 2013, which may be extended for delays beyond the control of RJM. Any changes orders signed after this agreement date may affect the completion dates, in addition. It is the responsibility of RJM to obtain all necessary and applicable permits before beginning the work. In the event you secure your own permit, you will be excluded from the residential Contractors Guaranty Fund. All contractors and subcontractors must be registered by the state. Any inquires relating to RJM registration should be directed to the administrator of the board of Regulations and Standards. Your rights are set forth in M.G.I. c. 142A. You are entitled to a copy of this contract at the time you sign it. No work shall begin prior to the signing of this contract. You the buyer may cancel this transaction at any time prior to midnight of the third (3) business day after the date of this transaction. See the attached notice of the cancellation form for an explanation of this right. RJM Prin custox Date; Print; Theti vyJy Tate; Do not sign this contract if there are any blank spaces. �L Notice of Cancellation You may cancel this transaction, without penalty of obligation, within three (3) business days from the above date, provided you submit written notice to RJM within that time set forth herein. If you cancel, any property traded in, any payments made by you under the contract or sale, any negotiable instrument executed by you will be returned within ten (10) business days following receipt by RJM of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to RJM at your residence, any goods delivered to you under this contract of sale; or you may, if you wish, comply with the instructions of RJM regarding the return shipment of the goods at RJM expense and risk. If you do make the goods available to RJM and RJN does not pick them up within twenty (20) days of the date of cancellation, you may retain or dispose of the goods without further obligation. If you fail to make the goods available to RJM or if you agree to return the goods to RJM and fail to do so, then you remain liable for performance of all obligations under the contract. RJM. Management 25 DeCarolis Drive Tewksbury Mass. 01876 No later than the third(3) business day following the signing of the contract. I (We) hereby cancel this transaction. Buyers Signature; Date; Buyers I (We) hereby acknowledge receipt of a fully completed contract & payment Authorization and notice of cancellation. Buyers Signature; Date; Customer; Tim Vitas Payment Schedule Restoration; Due to remodeling of office area Total cost of services; $14,199.00 Payment #1 Due upon acceptance. $2,430.00 Two thousand and four hundred and thirty dollars and no cents. Payment #2 Due upon completion of the job. $2,430.00 Two thousand four hundred and thirty dollars and no cents. Payment #3 Payment #4 This payment schedule does not include any costs for amendments and owners extra work, these cost will be invoice separately. Total subject to change per agreed cost to the owner. Contractors signature; Acceptance of proposal; The above price, specifications and conditions are the satisfactory and are hereby accepted. You are authorized to do the work as specified, payment will be made as outlined above. All change ord-yrs, extra work, and credits will be agreed upon prior to final payment. Owners Signature; Owners w c n . , . .. mm d\ )C%l C x � 7 / � ƒ ] � \ � . 0 2 @ ; ® FIN i .: �■ d . \ /ƒ\A` tsCCO r z . J/ �. 9 2 x& 62 z � \ , E Q £ °� c z - o \ \ . c = )@ ui o ac -f5td\�72,J .!■p�.ƒ\:zz. f / § 2 #f'oil; /f\y// \ / ? �� < � , 2 < 0 < n n # % - © § $ f 3 § % , ° CL / \ . � / / . 0< \ § \ . ' 7 ƒ m / . \ . � Z . / Z w c n . , . .. mm d\ )C%l C x � 7 / � ƒ ] � \ � . 0 2 @ ; ® FIN i .: �■ d . \ /ƒ\A` tsCCO r z . J/ �. 9 2 x& 62 z � \ , E Q £ °� c z - o \ \ . c = )@ ui o ac -f5td\�72,J .!■p�.ƒ\:zz. f / § 2 #f'oil; /f\y// \ / ? �� < � , 2 < 0 < n n # % - © § $ f 3 § % , ° CL / \ . � / / . 0< \ § \ . ' 7 ƒ m / . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 M www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): City/State/Zip:l 6 lo CJ1e(� �/�'��- Phone #: q 171?' f�1,2 _04��)o. Are you an employer? Check the appr I am a employer with 6_ employees (full and/or part-time).* ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] 1 riatdbox: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no 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.KRoof repairs 13.❑ Other my applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. im an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. �— surance Company Name: 1licy # or Self -ins. Lid. #:, Expiration Date; b Site Address: rF �� i P 44-- City/State/Zip:_ZLICIA7`11 Irl I�641( :tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a LC 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ✓estigations of the DIA for insurance coverage verification. 'o hereby ced.tyun er the pains and penalties ofperhiry that the information provided above is trite and correct. G 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. PIumbing 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-contractor(s) 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 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 (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. A new 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 or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advatice for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. ## 617-7274900 ext 406 or 1.877-MASSAFE Rax * 617-727-7749