HomeMy WebLinkAboutBuilding Permit #287 - 19 WAVERLY ROAD 10/7/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: • "' Date Received
Date Issued: O�
I PORTANT:Applicant must complete all items on this page
LOCATION G - / net /Sf 4, P� l t713t1lZ.,
PROPERTY OWNER �-' - P ,-�
�
Print -
MAP NO: "` PARCEL: ' `/&*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
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Roo r= J?e A ooh ue t'Gr 30 f2-
e,4L - 0 - p7,})
Identification Please Type or Print Clearly)
OWNER: Name: S.IS A 11 L-e-0.> / S Phone:
Address: /1'2 /41#iiy r,ll? L :r m D/`l I /V A/ 03d&/'1
CONTRACTOR Name: Ot,3 P q Phone:
Address: ) Iv)/3-
Supervisor's Construction :License: 0,'z-�"G��i-� Exp. Date:
C- /(7
Home Improvement License: f� sdExp. Date:—
ARCH ITECT/ENG IN EER
ate: .ARCHITECT/ENGINEER Phone: ,
Address: Reg. No.
FEE SCHEDULE:BOLDING PWT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ v2 FEE: $
Check No.: 2-2 Receipt No.: ZZ�S k
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor w
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools a �
d �y
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 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:
r,, Located sgood Street
FIRE DEPARTMENT Temp Dumpster onsite yes ' C no
Located at 124`Mairr3tr6e# fw r L
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
❑ 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 prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
Li 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
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: Doc.Building Permit Revised 2008
I
I
Location
No. Date
MORTN TOWN OF NORTH ANDOVER
f - 9
' Certificate of Occupancy $
�'�s''••°•Eco Building/Frame Permit Fee $
s^CMUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # _?�7
225 2
��Buflding In ctor
NORTH
ONM 00
_
4 over
err• .4. .r
LAKE dower, Mass., "d�----
COCHICHEWICK ,,
'9S°Rq re o PP �� BOARD OF HEALTH
Food/Kitchen
Septic System
PERM IBUILDING INSPECTOR
THIS CERTIFIES THAT....... 51 '\r...... C. .1.�51.......................................................................................... Foundation
..... ...
has permission to erect........................................ buildings on ......... ..................... Rough
............. ........
Chimney
to be occupied as....�'�': .. .. •f2a••
provided that the person accepting this permit shall in a ry respect conform to the terms of the app ieation on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
PLUMBING INSPECTOR
Buildings in the Town of North Andover.
VIOLATION of the Zoning or Building Regulations Voids this Permit. Fi ugh
Fnal
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUC TS 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.
S
EE REVERSE SIDE Smoke Det.
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form,satisfic"11 basic Mifirements of the state's Home Improvement Contractor law(MGI:chapter 142A) but does sot include standard
language to pro tect Seek legal advice if necessary, Any person'planuieg home improvements should'first obtain a,copy of ea
Massachusetts consumer:guide to home,improvement"before agreeing to any work on yourresidence:You may obtain-a free copy by calling the
Office of Consumer hffairs and Business.Regulation's Consumer Information Hotline st617-9738787 or 14889483475.7.
Homeowner Information Contractor Information
Na—me paoy Name
Street Add=(do not use.a Post Office Box address). tractor/Salesperson/Owns Name
I MIR
Cityffowa State Zip Code lusiness Address(mast include a street address) .
pZ
Daytime Phone Eveaiog Phone tty/Town State Zip Code'
Mailing Address(It different from abovey usiness'Phone ederal Employer ID or S.S.Numbs
• law heq®nlLnmafthomeim•I Acme f.onOaGOl aeg:riomher'8spitsdwdsu�._. . ..
' amtramathevhi■ -
malmahfmmmh6e ® 1336P374
Q _ -
The Contractor agrees o do the following work for the H/o�meo rich. y '
Required-Permits-The-following building'permits she required Proposed Start and Completion Schedule-The fbilowing schedule will
and will bcsecured by me contractor as the'homeowner s agent be adhered tovnlesa circumstances beyond':the contractor's control arise
(Owners who,;secure their own permits WM be
ezeludedfrom the Guaranty Fundprovisions of Date when contractor will begincnntratitd work.
MGL chapter 142A.)
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 vital sum of.. (+)
i
ymcuts willb&0ade according to the following schedule:
Sy Q aponsigning contract(nota excad 1/3 of.the wtal.contract price.91 the costof speciail order items,whichever is greater)
S by or upon completion of '}
S 1'-�by__r__/ or upon completion of
$ 66upon completion of the contract (law forbids demanding frill payment until contract is completed to both part
y's.satisfaction).
The following mater al/equipment must be special S I to be paid for —
ordered before the contracted work"begins in order $ to be paid for —'
to meet the:completion sihedu1c.(••)
NOTES:(h inti"aU finance charges I—requires that any deposit or down-payment-pared by the contractor before work begins may
not exceed the greater of(a)ono third of the total contract price or(b)the actual con of any&pedal.egnipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express Warranty-Is ere exoress warranty beta arovided by theeontroeMr^ No Yes
—jalawsofthewu k
vin
Subcontractors-The contractor agrees o be solely responsible for completion of the work described regardless of the actions ofany tlihnd ."
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all sub
wntractoss fol
materials and Is 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 interw)ms 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 :. .=j
fully understand it Aslr'gaestions ifsoiiietl»ng requires most
unclear.
• Make sure the contractor hp a valid Home Im �
erovem nt Contractor Rechation The bri,requiresmost home improvement contractors and.
subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at.One Ashburton Place,Room 1301,Boston,MA 02108 or by.calling 617-727-3200.or
1-800-223-0933.
• Does the contractor have insurance? Check to see that your contractor is properly insured.
• Know your rights and responsibilities. Read the Important Information on the reverse side of this form end get a copy of the Consumer
Guide o the Home improvement Contractor Law. ..
You may cancel this agreement if it has been signed at a place other than theecustme eIa 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
third business day following the signing of Oris agreement-See the attached notice of cancellation form for an explanation of.this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
./ Two idmtiul copies of the contract must be wmpleW and signed the copy shwld so to the homeowner.The other ropy shonm be kept M the coatraaar. ._ .. .
N' `rr/f K
omeowner's Signature Contracor's Si lure ��
Dat
Dat
Contractor Arbitration -
The Home improvement Contractor Law provides;homeowners with.the.nght to-initiate an arbitration action(as an
alternative to court action)ifthey haveiiiisput'with.a,contractor. The.same nghtis not automatically afforded to'a
contractor,how.ever....The:contractor.would have rp resolve any,dispute hcVshe.has with a homeowner in court unless
both parties agree to-the optiongl 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
the secretary of the Executive Office of Consumet Affairs and Business Regulation art dthe consumer shall be required
to su alit to such arbitration as provided In Massachusetts General Laws,chapter 142A.
omeowner's Sign$ture Contractor's SignatuW
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 section.is not
s arately signed-by the ` es. ".
Homeowner's Rights
A homeowner's rights under-the Nbnie'Improvement Contractor Law(MGL chapter 142A)and other consumer
protection laws(Le.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 responsrble for completing the work as descnb4 in a
timely and werkmanli e,msnner. Flomeowners may be entitled to other specific legal rights if the contractor guarantees
or provides.an.express warranty for:workmanship oi•materials. In addition to.guarantees br warranties provided by the
contractor,all goods sold in Massachusetts carry an implied warranty of merchantability.and:fitness,:for:aporticular
purpose. An enumeration of other matters on which the homeowner and contractor lawl'ullyagree: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 duica a and should not be signed until a copy of al}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 the payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However,in instances where:&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 ImprovementContractorLaw or other
consum-er rights,or if you wish to.;obtain a flee copy of"A Consumer Guide to the Home Improvement Contractor
Law,".contact
Cgnsumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
(617)973-8787 or 1-(888)2833757 .
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
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 tmediatron ofdsput�or to register formal complaints against a business,call:'
CodumerCoinplaint'Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114
Page# of pages
CS # 022680 978-688-6737
HIC# 103358 A. J. Walsh & Sons or
55 Pleasant Street 1-866-AJWALSH
.North Andover, MA 01845
Proposal Submitted To: Job Namee� Job#
i
Address w CCl.+v Job Locat�7—,—;/t Dateq date of Plans
?Xg
Phone# v Fax# Architect
r hereby submit specifications and estimates for:........_._........................-.----..._.....__......__._.__..............._.....---._._....._............_...._......_..._..._.___..__..___........._...—.---.-.-.--..._____.._.........._._..__.._..__.._........
__..__.._......_...._..---._-.
.- 4.46 _----
...._...._..
-------------------- --C...... __ . .. ', -_ ... _._.....-------__,
----..............._.._--................
�.._.._._JG
t
—_.._.......... -._...._.. _._.._._.._..---......_......._.....--..............................,.:J_..........._............----._._........._...__.... .---.._......._................ ..._.._........_..............__.._.._........._... _ .....--- ------.._...__-
t'
------.._......_......._............._._.__ .._........................._..._....._................ --._.._................--._........__..._..--- ._....._.. .... ._......._.._......__._. __.....--- --.....-._..-------.....__.._._.....-...................-----..._....... –
We propose hereby to furnish material and labor—complete in accordance With the above specifications for the sum of:
$ �-40d Dollars
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs will be Respectfully
executed only upon written order, and will become an extra charge over and submitted
above the estimate.All agreements contingent upon strikes,accidents,or delays ` y
beyond our control. Note—this proposal may be withdrawn by us 9 not accepted within days.
jIlt'�ki-, 1L of Pop ar _
} The above prices,specifications and conditioware satisfactory and are /(/Je%�Y�
._ .f , f � l/Signature
hereby accepted.You are authorizedrtoido,theAvork as specified. / if
Payments will be made as outlined above. y
Date of Acceptance g r Signature
f /
.�• ♦lar.achu.cttr - Ul'ilHt'trtll'nt of I'uhlir �+�tfch
Br�arrI fit. BuiltlSn� Rei triatirrns antl �t.urriardr
construction Supervisor License
License: CS 22680
Restricted to: 00
ARTHUR J WALSH JR
55 PLEASANT ST
N ANDOVER, MA 01845
Expiration: 6/9/2010
( „mmi.•i•,nr Trz: 27002
-\ Board of building Regulatiohs and Standards
- HOME IMPROVEMENT CONTRACTOR
— Registration: 103358
Expiration: 7/7/2010 Tr# 271352
Type: Private Corporation
A.J.WALSH&SONSJNC.
Arthur Walsh,Jr.
55 Pleasant St
N Andover,MA 01845
Administrator
The Commonwealth of Massachusetts
'Department of Iidusit al Accidents
�5 Office of Investigations
600 Washington Street
Boston,MA 02.111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leldbly
Name(Business/organizatiom4ndividual):
Address:—,\ �L L°A o+ n S
Ciiy/State/Zip: d !Y !�Ve i2 J�Phane#: 5'-��� —&7-3-7
Are yo n employer? Check the appropriate box: Type of project(required):
1.6;1-am a employer with � _ 4. (] I am a general contractor and I
employees(full and/or part-time),
* have hired the sub-contractors 6. F1 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have g, []Demolition
worldng for me in any capacity. employees and have workers' 9 Building addition
[No workers'comp.insurance comp.insurance.1
g
required.] 5. [] We are a corporation and its 10.[]Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑plata ' g repairs or additions
myself.[No workers' camp. right of exemption per MGL 12.61&--ofPlumbipairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.❑Other
comp.insurance required.]
•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 WZdavit indicating such.
tcantractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. irthe sub-contractors have employees,they must provide their workers'comp,policy number.
I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site
information: / l
Insurance Company Name: /T PI q f&/ ,7 �� d
Policy#or Self-ins.Lic.#:_ / 0 t)d 7 Expiration Date:
Job Site Address.,_/ 1�' �/�G L /\ City/state/zip �d /�„
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. I52 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 hereby certiA,under thepains andpenalltie�os ofperjury drat the infor madonprovided above is true and'correct.
Signature: Date: ✓d to
Phone#: 99d — 7,-3 /
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.Plumbing Inspector
G.Other
Contact Person_ Phone#: