HomeMy WebLinkAboutBuilding Permit #607 - 194 OLYMPIC LANE 5/12/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: -7O Date Received
Date Issued: Z
MPORTANT: Applicant must complete all items on this
LOCATION 1 Oi� o f YpAPI L. LA E r\1
PROPERTY OWNER .SRKIA E!C— �-
nni
0
MAP NO PARCEL}/ ZONING DISTRICT: Historic District
Machine Shop
1 9 \
.x670
za..:'�'• �L
o
�a p�Awreo ^pP
yes no
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 PREFORMED:
Q 6 W 60 rJ v-tr
Identification Please Type or Print Clearly)
OWNER: Name: -�PQ,A U6a�
v �
Address: P4 a 1 L4 r� Pic l ay\ -t- N. AlJov e>^
CONTRACTOR Name:-S1� �AUUL 4A Phone: (009 —5(00 - 092600
Address: 243 % Ui: c, -e Q
Supervisor's Construction License: C S 912- Exp, Date:
Horne Imo
ARCH ITECT/ENGINEE
Date /- /I - 2411.
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: $ 300. 0 0 FEE: $ T
Check No.: _ 19W Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
re of Aaent/Owner
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
t 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 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 2 1 A —F and G min.$100-$1000 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
❑ 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
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location
No. (2 C)2 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check#
220k2
EG'Iding Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
,l ._ Office of Investigations
' 91 600 Washington Street
Boston, MA 02111
e www.massgov/dia -
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant. Information Please Print Legibly
Name (Business/Organization/Individual): _�&—AfQ . �' )0L.:V aIq�
' 4
Address: 25 S h£PA9Z_A_W,n U-
City/State/Zip: M CS011 Phone #:�L&O�)
Are you an employer? Check the appropriate box:
Type of project (required):
1. ❑ 1 tam a employer with
4. ❑ i am a general contractor and 1
6. ❑ New construction
nployees (full and/or part-time).*
'
have hired the sub -contractors
7• ❑ Remodeling
2.3 I am a sole proprietor or partner-
listed on the attached sheet. x
ship and have no employees
These sub -contractors have
8. (] Demolition
working for me in any capacity.
[No workers' comp. insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
q, n Building addition
required.]
officers have exercised their
10 [1 Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work
right of exemption per MGL
11.[] P umbing repairs or additions
myself. [No -workers' comp.
c. 152, § 10), and we have no
12.NTRRoof repairs
insurance required.] t
.employees. [No workers'
13.❑ Other
comp. insurance required]
'Any applicant that checks bort # I 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.
am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job 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 of this statement may be forwarded to the Office of
Investigations of the DTA for insurance coverage verification.
I do hereby rte nde t thMand penalties of perjury that the information provided above is true and correct
Phone #: Cc 0 3 - S (PO 013 ?
O j?ciat use only. Do not write in this area, to be completed by city or town offrclal
City or Town:
Permit/License #
-//ea
issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector
6. Other
Contact Person:
Phone #•
D&S Construction Home Improvement Contract
Tbis form satisfics all basic requircmaats of the scat's Home Improvement Contractor Law (MOL 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 consumes guide to home improvemam' biota agnoamg to my work onyour residence. You may obtain a Sea copy by csllmg the
Office of Consumer Affairs and Business Regulation's Consumer lnfmntedon Hotline at 617-973-8787 or i-888-283-3757.
Homeowner information cxntractor iniormanon
Strut Address (do cot use a Post Office Bear address) Contractod Sdespasod Owner Name
\°1dC 0 \ k (, Upw\-Q . Rte N\) Mr A,r\
City/Town x I State Zip Cade I lusiness Address (met include a street address)
t-\' a ver fnA (31164S 7-5 She.PA2 RVc/\L)e,
Daytime Phone Evening Phone I ityfroum State Trp Code
"1 q)-- OZ- b ";Ru4 n OST it 0307
u-nr..sAAA- rtr.alih aa•■ -1 Phone Padual EmoloverIDorSS.Number
The Contractor agrees to do the fonowhagwort for the H - I l / l!/ 7 vV v Zai l
9,Mf vv% Go (3\A(-
Required
ver
Required Permits - The following bolding permits too required
and will be seemed by the contractor as the homeownces agem,
(Owners who secure their own permits wID be
excluded from the Guaranty Fund provisions of
MGL chapter 142A.)
Tat' Contract Price and Pavment
Proposed start and Compledon Scbedule -The following schedule WM
be adhered to unless euamsmmees beyond the eoatractoes control arise
—� O Dste when contractor will begin coutracted work.
when connoted watt will be sabstaatiaQy completed.
The Cqunwor agrees to perform the wodr, famsb the material and labor specified above for the tote) sum of. (1P D W V " U U (')
Payments will be made according to the following schedule-.
$17,00-60 upon signing counact (not to atceed 1r3 of tba total goontmct prix or the cost
�of special order items, whichever is greater)
S Zl D Q • 00 by � / t3 /09
or completion of I �Z iJ' ab+
S IjZ0d' W by S L(j/ 1 orupoaoontpletionof W hOIg— 2.00; Cr1m01t�� 0(�
S, f— upon completionofthe contract. (Law forbids demanding fullpaymentnndi connect is completed to both party's satisfaction)
The following mataioUquipmem mut be special Sm be paid far _
adm
dcmdbetheconnectedwakbeginsinmder S Ltobepaid for
to mat the completion whedule(•h
NOTES- (q Imduditg all lin—charges P9 Law regimes dint soy depotitgrgbwa payment ttaudred by the caaaaetarbefine wgrk begins may
not,"', the gmater of (a) ate -third of the toted eeaaut prig a (b) the acmai em ofsey special equipment a emmm made material
which mins be special meleted is advance to meat *a eomphaieo scimdnle.
Emma warranty- h an te<ores wa-_ m• bebta orovided ten contractor? No Ye (atl nems of the warramv meat be McW m the eontraet)
Subcontracton - The comactot agrees to be solely responsible for completion ofdw Wolk downbed ttguillexs ofthe actions of any thud
party/subcoabacor antiaed by the ommapon Tho coonacta fmtbaapees to be sciely responsible for all payments to all sobcoo actors for
Contract Acceptance - Upon signing, this document
oontractshall not imply diet any lien or otherseemity
carefany before signing this comet.
act under law. Unless otherwise noted within this dotament, the
on the residence. Review the fonowiug cautious and notices
• Donkbe pressured mm signing the contract. Taloa time to read and Eddy understand it Ask questions if sonrahmg is uaclear.
• subcontractors to be regi. with the Director ofH�e The lawman.requires mast home improvement about
, taonmhcmrs and
Imptov� Color Registratigm. You may irgeme abtmt gwotracocr
registration by writing to the Director at One Ashbur mn place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or
i-800-223-0933.
• Does the contractor have insurance? Check to see dwyour ommaaoris property insured.
• Know you'rigins and raponalflites. Red the Important laf mdm on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
YOU may ancel this agramem if is has been signed at aplace other than the coatmomfs normal place ofbeine s, provided you notify the
contractor in writing at hisThamein office orbA office by aadmery nun Posted. by War= seat or by delivmy, not hutertbea midnight ofthe
thud business day fonowitg the signing of this agreement Seethe attached nota of anrxngtion form furan ehglmuion ofthis right _
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
ideadatgagma[rhesaamrtbeamperodaodrigoad.omoopyahaaWaraothe'[he hehpttrytbaaoaaaea.
Hotneowrher's Sigtteture s Sigamare
Date Me ! I` r V 1
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
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
to submi to such arbitration as provided In Massachusetts General L spier
Homeo s Signature Co s Signature
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
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 descaibed, 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 wilting
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 hmVberself to befinancially mseem 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 fimds 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 Consumer Guide to the Home Improvement Contractor
Law," contact:
Consumer 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 mediation of disputes or to register formai complaints against a business, call:
Consumer Complaint Section
Office of the Attorney General
(617) 727-8400
AND/OR
Better Business Bureau
(508) 6524800
(508) 755-2548
(413) 734-3114
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LICENSE TYPE BUSINESS NAME CONTACT NAME LICENSE RESTRICTION ADDRESS STATUS
Construction Supervisor N/A Houlihan, Sean P 184262 100 Salem, NH 030791 Expired
http://db.state.ma.us/dps/licenseelist.asp 5/11/200 . 9
40.
Sara Keogh
194 Olympic Lane
N. Andover MA 01845
MATERIALS
D�mS
-CONSTRUCTION`
IKO CAMBRIDGE 30 ARCHITECTURAL SHINGLES, EARTHTONE CEDAR
15 SQUARE
8" X' 1" ALUMINUM DRIP EDGE, MILL FINISH
20 PCs.
f' COBRA RIDGE VENT
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