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HomeMy WebLinkAboutBuilding Permit #602-2016 - 21 SOUTH CROSS ROAD 11/17/2015 ScAlw'Veo 11-100 -16- %AORTH BUILDING PERMIT 0 'I"D '696 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Date Received 0 A ED Permit No#: C Date Issued: IMPORTANT: Applicant must complete all items on this page iu,0�0-AT Pint l 0, it- Of Structure s ria',Vi Y"; PARCEL --J M. do village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 0 One family 0 Industrial 0 Addition El Two or more family Ei Commercial No. of units: wAlteration [I Repair, replacement El Assessory Bldg [I Others: [I Demolition El Other 5- 7 700--;- J5 [5(Wefb t141) s' w r DESCRIPTION OF WORK TO BE PERFORMED: V-0 0 F 5" 0 Identification- Please Type or Print Clearly OWNER: Name: rv\',)ce rv-\0 C-0^J:�� Phone: 9 G<76c(- 333 '7 Address: C Name. P.Rhone.:- ContractorrNAm A tom- Address: jExk- Vote.:' Supervisor's n*r�-S,V 1,on k T 0,;L to.:- a Home p rpe nu,� Phone: ARCHITECT/ENGINEER Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $— �14 570 FEE: $ 7D .� Receipt No.: -7 -1('07 Check No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t'ractbJ J 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH ' Reviewed on Signature COMMENTS I Zon in'g Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes yI Planning Board Decision: Comments i Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ` DPW Town Engineer: Signature: Located 384 Osgood Street 1 IF FIREtDEPAR?TMENT rnp Dempster onsite eyes �Locaedaat 124�iMainStreet� ,- F r0, partment s gnatu_rbe%date __r I ,_ - _ - _A _ � COMMEIVT�S;� 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products SIOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application a Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 40TE: 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 i Doc:Building Permit Revised 2014 NORTH own of ndover 1p No. Q ��a0� +� k W,- _ � h ver, Mass, t. 17,2616 � o COCKIC141WICK 1' A°RArEo S U BOARD OF HEALTH Food/Kitchen IT T LD Septic System • fi O.N....... BUILDING INSPECTOR THIS CERTIFIES THAT .................. ..I.�.....al..... r ................ .... .. ................................. .,.. j has permission to erect .......................... buildings on `...S6116 Foundation .S�' 09f Rough tobe occupied as .... �. ...... ..� ..................................................................... Chimney provided that the person accepti�this permit shall in eve respect conform to the terms of the application g � p pp Final on file in 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 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO R Rough Service ................. ................ .......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. r � YES TA Building and Remodeling Start date 11/17/15 5 APPLETON STREET Finish date 11/25/15 NORTH ANDOVER, MA 01845 H1C Lic. 120296 Expires 11/19/15 (978) 682 2023 CSL Lic. CS 54718 Expires 6/8/16 Proposal November 14, 2015 Proposal Submitted To: Carol Moroney HOME PHONE: (978)689-3337 21 South Cross Rd North Andover, MA 01845 Job: re roof Obtain building permit Complete removal of all demolition and construction materials Generated by Testa Building and Remodeling and its subcontractors. Strip the whole roof. Remove gutters and 1x2 on the fascia. Install 6 feet of rubber and new metal drip edge. Shingle the whole roof with 30 year IKO Cambridge Charcoal Grey Architectural shingles. $ 9450 If the fascia needs to be replaced it will be an additional $2475 A finance charge of U/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $9450.00 Seventy Nine Hundred Dollars One-third to start, one-third once stripped,one-third upon completion. Authorized signature-4 A— I reserve the right to cancel this contract if not accepted in— 30_days 1 Signature 64-1�t Signature i This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home j improvements 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 ConsumerAffairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work MGL chapter 142A.) Express Warranty-Is an express warranty being provided by the contractor? W No a Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/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 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 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. e Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. •Does 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 insurance"document. •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 SPACESIII Two identical copies of the t must I,,— leted and signed.One copy should go to t omeowner.The othercopyshould be kept by the contractor. Homeowner's Si a on tor's tore �( tG Date Date 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 submit to such arbitration as provided In Massachusetts General Laws,chapter 142nL,JV�/2 Homeowner's Signature Con is 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 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 financial) insecure,the contractor may require that the balance of funds not yet due be Y Y q 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://www.mass.gov/ocabr/ 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 P g 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 http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/licenseelist.as i For assistance with informal mediation of disputes or to register formal complaints against a business,call: f Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6524800,508-755-2548 or 413-734-3114 Version 2.1-11/22/201 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Sell r],AT ress of Seller's Place of Business NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: The Commonwealth of Massq chusetts Department oflndustrialAccidents y 1 Congress Street,Suite 100 u' Boston,AM 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information 1 Please Print Legibly NaMe (Business/OrganizationdividuI et5 al): 1��'^� `rte'e 0 /In1 Address: S ►(`\top 1e-�-y 5� /tl• � �o City/State/Zip: vt r' � Phone#: a- Are you an employer?Checic the appropriate box: Type of project(required): l:❑I am a employer withemployees(full and/or part-time).* 7. 0New construction 2�I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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 state whether or not.those entities have employees. If the sub-contractors fiave employees,' iey must provide their workers'comp.policy number. I am an employer that is pioviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c a y der the pains andpenalties of perjury that the information provided above is true and correct. Si nature: G��-✓� Date: / Phone 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 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 1 '...F 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia mice of Cops ME1M u�erAff, xAirstration•OV 20ENT CQN --9,AessRegala tl��• ;.. x'96 RACTO/2 1 ll1 TESTA B(1�LD�NG& � 15' F IRE TYRe: .TAMES ��ECI_NG; SBA t' 5 4 TESTq . - It".-�, APPLET i i NAIypOVER STREET MA 01845 ✓ (JAC e Massachusetts -Department of Public Safety I •Board of.Building Regulations and Standards Construction Supervisor License:•CS-054718 JAMES M TESTA= ""' f'�• APPLETON.STf N ANDOVER MA'0145 .. o )1 19'`' Expiration 06/08/2016 ' Commissioner Location No. 2 —�ZC��� Date . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ 7.` ti g Building/Frame Permit Fee $ Mt Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � 29678 Building Inspector BUILDING PERMIT %aoRTa� " o��yfLED tb�•y� TOWN OF NO ANDOVER O }� APPLICATION FOR PLAN EXAMINATION 4E Permit No#: �G Date Received �'�s RATED s 'CHus Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 4�j �v�� &C-5_5 10A '0 Print PROPERTY OWNER � JealyeV Print 100 Year Structure yes On MAP PARCELDS ZONING DISTRICT: Historic District yes Machine Shop Village yes no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family ❑ Industrial .alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �_. ❑ - _ r- Septic; 01Nell o � _ p 'Wetl n s i❑1�UVatershed ®istrict� ® Floodplai,ri� m� 4 I �s UV•ate�/Sew,err DESCRIPTI N OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: //c-/g- .1vz"tirl� Phone: 9�Z � 3� Address: Contractor Name: Z41 Phone: �0 Email: e_7v�l ti Address: o?.a ? G i�• r�3"P S i /VVx�-,� Supervisor's Construction License: O Exp. Date: Home Improvement License: /��� � Exp. Date: a ARCHITECT/ENGINEER Phone: Reg. No. Address: ,T FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /�� FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to,,4. e uar n and -'F�- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ S`r'i"�"�ing 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I 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 e Conservation Decision: Comments WAter& Sewer Connection/Signature& Bute Driveway Permit DVW Town Engineer: Signature: FIRS®EPART _ Located 384 Osgood Street ,� , ti IId1EN,T' Tem Dumpster o s e , ;"• : ,ter. :_ p� ., n it ,y"es ;��,. �a.c �,�i #Fife�no �._ LocateW t 124�4Main{Street ' :r ; r�' Et•�,..� D . a.�. �''`-.�—`...,. � L.,.`..`�r r t 1,i y'4 ,(fir r+. `ti @7, f •f , rFire.� e artmentsignature cS' r F �,� �� V 5 .tT Wi 17, sy L i COMMENTS' ,�Cf r� 4 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I 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 4� Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4� Mass check Ener Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4 Building Permit Application 47 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 of recording recorded at the Registry of Deeds. One copy and proof g that the appeal period is over. The applicant must then get this r g Y must be submitted with the building application Doc:Building Permit Revised 2014 I i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 19150.00 m $ - $ 229.80 Plumbing Fee $ 28.73 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.73 Total fees collected $ 387.25 21 South Cross Street 1061-2016 on 4/11/16 Kitchen remodel NORTH own of _ Andover 0 1061- 2,6( nO R�L.* h ver, Mass, COCMICNl �qs RATED V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..........!:��.. .. ...............................�... has permission to erect buildings on /,Sc�U "�....l�Ta ..�:L fie.. .. Foundation .......................... .. ........ .... ................. Rough to be occupied as ,1., v i ....................��...�. . 1...�% /..... . ....................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final I on file in 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 I VIOLATION of the Zoning or Building Regulations Voids-this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS Rough .............. Service .............. ::...... �.�-:;:r.::�....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. a4A*A QJkQa PROPOSAL Rev.3 Mike&Carol Moroney 21 South Cross Road North Andover,MA 01845 (H)978-689-3337 (C)Carol 978-835-1705 c.moroney@comcast.net Kitchen Remodel April 11,2016 Work to be completed includes: • Building Permit • Electrical—Install new trims on existing recessed lights. Install new switches and receptacles.Install new under cabinet lighting. • Repair ceiling over table area. Replace 9-Light door with new Fiberglass 9-Light. • Install base and wall cabinets.Install crown moulding around cabinets. • Repair exterior of Kitchen window. • Install new vanity in bathroom. • Plumbing-Install new kitchen faucet,tie in dishwasher,install new garbage disposal Install new faucet in bathroom. • Refinish oak floor,sand&apply 3 coats of poly. • Install Granite counter tops. • Install tile backsplash. • Install all appliances.(New Fridge to be installed by others.) • Install new interior trim where required. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 18,650.00 Terms: $6,200.00 to start $6,200.00 after plastering $6250.00 when complete Note:This quote does not include the cost of Cabinets,tile,plumbing fixtures,pendants,or appliances. Painting is also not included. Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-794-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel:617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as tl' d abov Date // le Signature _. `` Date y / Signature K)A 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 Secre of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required t ub t to such itZt as provided in Massachusetts Gener Laws,Chapter 42 j s Homeowner's SignatureoEC ntr c or'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 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 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(888)283-3757 The Commonwealth of Massachusetts Department of Industrial Accidents 4 fit' Office of Investigations ~- it 600 Washington Street • Boston,MA 02111 •wMmass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Legibly Name(Businessrorganinfion/lndividuat): Address: 0 7 City/Statelip:,/ Ur-. -WA10 r 1416<, . /Y•011K Phone 4: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I 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 S. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp. incnrance.: 4. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13T1 Other comp.insurance required.] *Any applicaut that checks box 41 must also fill out the section below showing theewotkers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the ane of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site information. _ Insurance Company Name: 816 11 : ��'�/ 1�./4 e.._ Policy#or Self-ins.Lic.#: 0,` ',� A Expiration Date: f Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the poky number and expiration date). Failure to secure coverage as required under Section 25A ofMGL 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 DIA for insurance coverage verification. I do hereby certify under�ydte pg#ns penalties of perjury that the information provided ab ve is true and correct Gam " S' e• �' fr'� Date: Phone#: _<Zs- -X�" Official use only. Do not write in this area,to he completed by city or town onicial 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 . 6.Other Contact Person: Phone#: OP ID: OUJA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2015 Y) 09/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Macdonald&Pangione Insurance Phone:978-688-6921 NAME: Jane Jane Ouellette FAX N P.O.Box 428 Fax:978-688-5350 (A/C,No Ext:978-688-6921 C./C,No): 978-688-5350 104 Main Street E-MAIL North Andover, MA 01845 ADDRESS:jane@mpins.net PRODUCER CHRIS-5 Michael Pangione CUSTOMER ID#: INSURERS)AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURER A:Preferred Mutual Ins Co 115024 207 Winter St. INSURER B: 1 North Andover, MA 01845 INSURER C INSURER D: 1 ,-INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1 ADDL SUBRI POLICY NUMBER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE MMIDD/YYYY MM/DD/YYYY LIMITS 1 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A I_X1 COMMERCIAL GENERAL LIABILITY BOP 0100719749 09/26/2015 09/26/2016 DAMAGE TO RENTED 1 100,000 PREMISES(Ea occurrence) $ CLAIMS-MADE L^I OCCUR I i MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE 1$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X 1 POLICY n JECT PRO- X-1 RO n LOC ( I 1$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ J ANY AUTO (Ea accident) _ BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS I PROPERTY DAMAGE HIREDAUTOS (Per accident) $ 1 NON-OWNED AUTOS I ! $ I ($ UMBRELLA LIAB OCCUR 1 S)t I EACH OCCURRENCE $ EXCESS LIAB , CLAIMS-MADE t 1 i AGGREGATE �$ DEDUCTIBLE $ RETENTION S 1$ WORKERS COMPENSATION 1 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I I ER 1 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1$ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEEI$ - , DESCRIPTION OF OPERATIONS below L 1-E.L.DISEASE-POLICY LIMIT I $ r � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts-OepartrTle;st Of r`''ub1iC Safe,y Bout!of Suilding Regulations a;; Standard3 ••-' f:nr<tPitetil3;l'Superr;sf,,— . . License: CS-072173 CHRISTOPHER — F.t 207 WEMR ST: - N ANDOVEk MA 01145 l t, . Expiration Ccmm;ssioner 0610212016 !��r. �n»cma�rcacn//�o�nllcrt�i��cisc/G Office of Consumer Affairs&Business Regulation HOME 11MMOVEMENT CONTRACTOR Registration: .139962 Type: � _ - Expiration: 9/8/2017 Individual CHRISTOPHER F_RIVET - CHRISTOPHER RIVET_ 207 WINTER ST. _ N.ANDOVER,MA 01845 Undersecretary Location No. �.'' j Date u . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ --2 w Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector