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HomeMy WebLinkAboutBuilding Permit #137 - 20 MIDDLESEX STREET 8/14/2009 T ORNh BUILDING PERMIT O OR 11 TOWN OF NORTH ANDOVER °� APPLICATION FOR PLAN EXAMINATION Permit NO: J Date Received �SSACHUS Date Issued: e l� IMPORTANT:Applicant must complete all items on this page LOCATION 0 }f. -G S 4 g PROPERTY OWNER c d4'/2 U,xf Print MAP NOc,) �0 PARCEL: 03 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resident; 1 Non- Residential New Building ne family Add�i 'on Two or more family Industrial teration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WOR TO BE PREFORMED: ►ADO f� 1�s°.�I Uy�-�.. -- l�� ,,Ids fication Please ype or Print Clearly) OWNER: Name: 0 Phone: Address: °l /1O� /!JD L.�S'e �(� 1�1�/,�Ov e/�z_ /V ra- CONTRACTOR Name: Phone: ` : � 7�7 r _ Address: $ FCC -4s N:g/1 �; NO */V, 1004-R Supervisor's Construction License: OZ121 Exp. Date: Home:Improvement License: S cr- Exp. Date: 7Z7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE T;$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 410 Total Project Cost: $ l��d FEE: $ �� Check No.: 022/ Receipt No.: 122.32 NOTE: Persons contracting with unregistered contractors do not have access tohe guaranty fund gnature of Agent/Owner Signature of contractorat,/�- dl&vq 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 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 sit 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 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Ll 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 stampthe 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 co and roof of recording PY P ding must be submitted with the building application Doc:Building Permit Application Revised 2.2008 Location ���i �I- No. 87 Date �,P9 OHORTM TOWN OF NORTH ANDOVER 3? �t•`•o ,•,hO O � s 9 i y Certificate of Occupancy $ CMUs<� Building/Frame Permit Fee $ 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2- 226 %-44 226 :, 4 wilding Inspector e1ORTH Town ,of �r� 4Andover . 0 No. /3 7 * - NRI _ Odover, Mass., T � HIC COCNICHE ME WICK �t ADRATED PPS\ -`C2 `S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �c BUILDING INSP CTOR THISCERTIFIES THAT............... 4................�..�............... t`. .................................. ........................... ......................... Foundation has permission to erect........................................ buildings on .....V.. ?.... �` �`''Ye S6� �� ...................................................................... Rough to be occupied as........................... !?�. ..�'� - �?. <> ,1 ..'... F... . . . . .. . .. . . Chimney . . . . ................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ................... ... Service DING 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 Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. ���0��� Pae# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh A Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: Job Name j � Job# Address Job Location'j Date iooDate of Plans y Phone# Fax# Architect rWe hereby submit specifications and estimates for: �� -1' _._ � fin. : _ ) �c� " �� ✓.. _ .�G__ /1 r We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: 4 d $ �QQ Dollars with payments to be made as follows: Any alteration or deviation from above will specifications involving extra harpcosts will be Respectfully � ��%�L�`� �✓!/���`y 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 � beyond our control. Note—this proposal may be withdr wn by us if not accepted within days. acceptance of J31ropont The above prices,specifications and conditions are satisfactory and are ;� 0 kll { CY L- Signature hereby accepted.You are authorized to do the work as specified. - Payments will be made as outlined above. Date of Acceptance Signature Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Impmvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home opmvements should first obtain a copy of"a Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757. Homeowner Information Contractor Information Name PAY ame S Address(do"not use a Post Office Box address) tractor/S erson/Owner Name Cityrrown State Zip Code usiness Address m1A de a street address) . Daytime Phone Evening Phone ity/Town State Zip Code D � oliqY Mailing Address(It different from above) Business Phone ederal Employer ID or S.S.Number law tequira nut mop Dome an- I Home ptov®mt Coatramor Reg.Number{Expiration date Powomt eoatracton hew:e I ;lid"'.1 oa m®hc D/3 �G37� The Contractor agrees to do the following work for the Homeo her. wescrioe in Main me Inc type; a,- Required Permits-The following buildin7provisions ed Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the ; be adhered tounless circumstances beyond the contractor's'control arise (Owners who secure their own pe // excluded from the Guaranty FunI7 ate when contractor will begin contracted work. MGL chapter 142A.) pp J'a/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 total sura of: (s) Payments will be made according to the following schedule: ' 0 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by=7 T=or upon completion of Q. $ 60Y ___ or upon completion of $ 3 upon completion of the contract (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order $ to be paid for to meet the completion schedule.(**) NOTES:(•)Including all finance charges(s*)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)onothird of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-is an e: ress warranty being Provided by the contractor^ No Yes (all terms of the warranty must e a ched[o the contractl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third parry/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for !materials and labor under this a anent 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 interest has 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 fully understand it Ask questions if something is unclear. -Make sure the contracr has a valid Home Improvement Contrary P '•ration. The law requires most 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 it 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 and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's 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 this 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 identical copies of the contract must be completed and signed.One copy should go to the ho a.The other copy should be kept by the contractor. Ho er's Signature Contractor's Signature Date ��CY/o 9 Date h. 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 ltas 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 submit to such afbitpVion as provided In.Massachusetts General Laws,chapNr 142A. Ho owner's Signature Contractors Signatdre NO ICE:`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 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 cavy 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 delicate 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 griginal contract must be in writing and agreed to by both parties.Contracted mvork 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 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 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 l-(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 ort-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 Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 i _ ,�Plr= i!:(.'iliJii<%i7!ncgtl Cl�tt , i•�fl;flt'f1!liC�✓i Board of Building Regutatios and Standurds `f" HOME IMPROVEMENT CONTRACTOR Registration: 103358 Expiration, 7/7/2010 Tr# 271352 Type: Private Corporation A.J.WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant Stew, „ �• N Andover,MA 01845 Administrator Nh"N chosmN - IDt,I)m-tmcnt lit Puhlir Bilard of t1uiltiin�4 Re.-ulatinn" itild "tanil:u-[I" License- CS 22680 Restricted to: 00 ARTHUR J WALSH JR 55 PLEASANT ST ' N ANDOVER, MA 01845 '<mr„lmw 6/9/2010 27002 The Commonwealth of Massacharsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, .MA 02111 ;v)v)v.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep_ibly Name (Dusiness/Organization/Individual): c Address: \6 ,5 City/State/Zip: 4kd Phone #: —r A;rp employer? Check the appropriate box: Type of project(required): I :.1-n a employer with l 4. ❑ I am a general contractor and [ employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.[JI am a sole proprietor or partner- listed on the attached sheet. t F1 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition Workingfor me in an capacity. workers' comp. insurance. y9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I.❑ Plumbin epairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12. oof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box Hl must also fill out the section below showing their workers'cotnpensalion policy information: t Homeowners who suunnit this affidavit indicating they are doing all work and then hire outside contractors tnu_ct subrnil a new affidavit indicating such, tContraclors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for►ny employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-his. Lic. #: Expiration Date: Job Site Address: a LGA 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. 152 caul 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. 1 do hereby certif j nyder the pains and penalties of perjury that the information provided above is true and correct Si fore: --�a— Date: Ell_411,6 _ Phone#: Oficial use only. Do not write in this area,to be completed by cit),or toren official City or Town: Perinit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. Cityrrown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: _ Phone#: