HomeMy WebLinkAboutBuilding Permit #649-2011 - 186 ROSEMONT DRIVE 3/30/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: �7 �6 f� Date Received
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ANT: Applicant must complete all items on this
LOCATION / g6 �Os�mda� torl✓� '
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PROPERTY OWNER An d -PP i -i .l oye- I l t n e
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MAP NO: PARCEL: q1 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes 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
`O¢Septic +®Well 4
,Floodplam � ®Wetlands ' �
E
®WatershedD s ie5-
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly) - - -
OWNER: Name: &Ahn.V Matte III;)e Phone:
Address: r A:_.
CONTRACTOR Name: Phone: 90 3025-ba.v4
Address: ,21 6zeaYa•er. D ri-p- kA W a.r% A A/, 0-? 9� I -
Supervisor's Construction License: Exp. Date: 3�L�G2U/oL
Home Improvement License: / Da.D ? 1 Exp. Date: 13o d-6
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost:
Check No.: S-7/6 Receipt No.: 1002
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
[TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc. ❑
Tanning/Massage/Body Art ElSwimming Pools, El
Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY _.
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT ❑ -
i COMMENTS
13
DATE APPROVED
El
i
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
4
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-signature/date
CO 4MEENTS
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
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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)
❑ 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
JOT'E: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
a all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording .
lust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location 40 Sr 40f 0 -f
No. Date
x,to . 05 � T
;! I. �Z, TOWN OF NORTH ANDOVER
F
Certificate of Occupancy $
Building/Frame Permit Fee $ 1 V- —
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# 6—zzg
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Massachusetts Home Imnrovement Sample Contract
This form satisfies all bast regairemeats ofthe dlapta 142AX bat dm not include standard
lengoage to protect homeowners. Seeli legal advice if necessary. Any person planning htrm: improvements should first obtain a copy of A
Massachusetts Consumer Guide to Home 1mproven mt" before agreeing to any work on year residence. You may obtain a five copy by calling the
Office of Consumer Affiirs and Business Regulation's Consumer infonandion Hotline at 617-973-8787 or 1-8118-2113-3757 or on our website
Homeowner Information
Contractor Information
Name
1)h
Company Name
7A,
Street Address (do not on a Past Office BeX address)
Coatraaod Salapersad Owner
Name
186 Rae m tvi 0r%ver
City/fowa State Tap Code
No. AJOutc rn W8 8
Business; Addres(mustinclude asueetaddress)
X 1
Daytime Phone Evening Phone
Uly/fowa
-�—ewdl
State Tap Code
N A. 639,11
Mailing Address (it diffyrent from above)
Businessftone6a j&1q
Employa ID or S.S. Number
r.. reyo6e ant mourn..
n.mecmnaCaaee.tfimeer
E�toadeee
The Contractor agrees to do the following work for the Homeowner:
t'Desarbe in detrel the vaak to completed, specifying thetype, brand. and grade of matoaiels tb be used, one additioal aberls if rxecesarv.)
Rewv,,c br;t-k var eer 4L rn&41-e - few -are ; Zero efe >✓wOetCA ►t�el _ e
Qw;Se p�er.,t.q h�'. 2nb�a lj nos rnci*v�1-e' . Does noi- ;rijJde. 94 S'',t ep�ac�
0 r r�>TUAlcf ri r
Required Permits -The following building permits are required Proposed Start and Completion Schedule - the following schedule will
and will be secured by the ccetractor as the homeowners agent: be adhered to unless circumstances beyond the contractors control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of Bate when contractor will begin contracted worst.
MGL chapter 142A.)
Date when contacted work will be substantially completed.
t Price and Paynmt Schedule F
agrees to perform the work, fiunish the material and labor specified above for the total sum of
Payments will be made according to the following schedule
$ ' upon signing contract (not to exceed In of the total contract price si the cost of special order items, whichever is Beater)
s by or upon completion of bCiek_ iYry%&-4A + onenma int" mc..iy
S/ O_ d �± by or upon completion of (ritunLh c'Lei 1��-t9,'.
$ d upon completion of the contract (law forbids demanding full payment until oontsact is completed to both party's satisfaction)
The following material/eepripment mast be special S to be paid for
ordered before the wmractedwnk beams m order
to meet the completionseheduk(") S tobepaidfor
NOTES: Mkiclud-mg allf ranee o 9 (`h 1—requires that any deposit ordawn-peymmt required by the ommactor before work begins may
not exceed the greater of (a) mm third afdro ectal contract price or (b) the actual cast ofasy special equipment or centum rade material
which must be special ordered in advance to meet the Completion stele
EirarmWarimin ban ernress warranty beiaa oeovMed by the emtradot ❑ No Yn (all taros of the avarranty menu be attached to the contract)
Subcontractors -'rhe contractor agrees to be solely responsible for completion of the work described rcgardless of the actions of any third
party/subconhaaor uttiiad by the contractor. The contractor father agrees to be solely responsible for all payments to all subcontractors for
materials and labor underthis atmgm t -
Contract Aceqshnce - Upon signing. this document becomes a binding Contract under law Unless otlairmse noted within the &C mwk the
contract shag not imply that any lien or other socauity interest has been placed on the residence. (Review the following emotions and notices
carefidly before signing this contract.
• Don't be pressuod onto signing the contract Take time to readaid fully understand it Ask questions if something is unclear-
• Make smig the contractor has a valid Home improvement Contractor Registration. The law requires most home improvement contractors and
subconbuturs to be registered with the Detector ofHome Improvemem Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Placa, Room 5170, Boston, MA 02116 or by calling 617-973-8797 or 888-283-3757.
• Doss 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 insmarice" document '
• Know your rights and responsibilities. Read the hapmtant Information on the reverse side ofthis form and get a copy of the Consumer
Guide to the Home improvement Contractor Law.
You may tgeced this ague== if it has bew signed at a place other than the contractors normal place of business, 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
thirdbusiness day following the signing ofthis agreement Seethe aft c hednotice ofcancellation form for an explanation ofthis right
DO NOT §IGN THIS CUNTKN F IIx' THLKLr" Alm API X ISLAnM. ArAI. rW:::
copes eaonast�atbaeo�lmeddsiami 0wcopydmoldgoWdcba®owac 1b3odwcWsxm1dbel¢ptby9wcma aeroc
Homeowner' ignature s signature
Dater—'��'� Dater
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, the contractor may submit the dispute to a private arbitration firm which has been approved by
tScre7tary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
trati as provided In Massachusetts General Laws, ter 142A.
omeown s Signature Con es Signature
NOTICE: The signatures of the parties above apply only to the agreement 6f 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 duplicate 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 http:/hvtivw.mass. govJoeabr/
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 hnprovement 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 hito://xj,Nvx .mass._-ov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
httl2:Hdb.state.nia.tis/lio.iiieimj2ro%,ementJlicenseelist.asp
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/=010
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IOHNHORA
ACORD- CERTIFICATE OF LIABILITY INSURANCE
06A x,`'" o °"Y""'
PRODUCER
USI insurance Svcs of NE, Inc.
PO BOX 6360
Manchester, NH 03108-6360
603 6254100
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE MAIC #
INSURED
John Horan Construction LLC
21 EVERGREEN DR
Hampstead, NH 03841
INSURER A: Maine Mutual Group Insurance Company 15997
INSURER a: EastGuard Insurance Company 14702
INSURER C:
INSURER D:
INSURER I-
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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVt FOR THE POLICY PERIOD INDICATED. NOTWWIT ISTANDING
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 DESCRIBE) HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRM'POLTR
TYPE OF INSURANCE
POLICY NUMBER
LICY EFFE��
O EXPIRATION
�S
A
GEKERAL LIABLLRY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Q OCCUR
SC10955638-
04/01/10
04101/11
EACH OCCURRENCE $1,4100,000
DAMAGE TO RENTED $250,000
MED EXP (Any one person) $5,000
PERSONAL B ADV INJURY $1,000,000
GENERAL AGGREGATE $2.000.000
GENS. AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG $2,000,000
POLICY PRo- LOC
A
AUTOMOBILE LIAe1LITY
X ANY AUTO
KA10955638
04101/10
04/01/11
COMBINED SINGLE LIMIT $500,000
(Ea a�wd)
ALL OWNED AUTOS
BODILY INJURY $
()
SCHEDULEDAUTOS
X HIRED AUTOS
X NON4WNEDAUTOS
'
BOILINJURY $
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
ANYAUTO
AUTO ONLY: AGG $
A
pL UlIIBRIBLA LIABILITY
X1 OCCUR D CLAIMS MADE
KIJ10955638
04/01/10
04/01/11
EACH OCCURRENCE $1.000,000
AGGREGATE $1.000.000
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATIWiAND
EMPLOYERS! LIABILITY
JOWC118140
04/01/10
04101/11
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E.L.. EACH ACCIDENT $100,000
E.L DISEASE - EA EMPLO $100,000
ANY PROPRIETORIP.ARTNERIEXECUTIVE
OFFICEWMEMBER EXCLUDED?
Yes
EI DISEASE -POLICY LIMIT $500,000
IYesIAL -be
SPECPROVISIONS below
OTHER
DESCRIp-hok OF OPERAnoNs I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Excluded officer. John Horan, NH &NIA
"FOR INFORMATIONAL PURPOSES"
John Horan Construction LLC
21 Evergreen Drive
Hampstead, NH 03841
FOR INFORMATIONAL PURPOSES
LD ANY OF THE AWVE DESCRIBED POLICIES BE CANCEL r ED BEFORE THE EXPIRATION
TLBEOF, THE ISSUNIG RMMM VWU ENDPAVOR TO MAIL Ifl_ DAYS WRITTEN
NAMM TO THE LEFT, BUT FAILURE TO DO SO SHALL
OSUGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
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