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HomeMy WebLinkAboutBuilding Permit #338-15 - 23 GILMAN LANE 10/6/2014 ORTH BUILDING PERMIT O� �tc1%-E° TOWN OF NORTH ANDOVER . :�.�6 oL APPLICATION FOR PLAN EXAMINATION * ,� Permit No#: ' Date Received �14p°awreo °Py45 � LIS�� Date Issued: PORTANT: Applicant must complete all items on this page LOCATION 0 G rV1C� !�• yl/ci ©�`�� gnPROPERTY OWNER �e-reA� z5/cit f�Cl � I�•1 0►� Print 100 Year Structure yes no MAP /67 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 13l Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (5715C tob� Identifcation- Please Type or Print Clearly OWNER: Name: Phone: Address: � �Gt dYe pContractor Name�0 ,�+� �n : C�43-r�0 7 �"D7 TNS Address: 176 r rcj wa u �� ���ry 0,3038 Supervisor's Construction License: O 9 o'2 J o-Z-7 Exp. Date: Home Improvement:License: / 7o2 / -"7 Exp. Date: 3! a0�6 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 9. o�� FEE: $ 49y,-�5 Check No.: �ys� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the guara fu Signature A Agent/Owne ignature of contractor Location o3 �m No. 3 Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# i Building Inspector i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments " Conservation Decision: Comments Water & Skewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 O_sgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i 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) i 4 ❑ Notified for pickup Call Email Date Time Contact Name 1 Doc.Building,Pennit Revised 2014 1 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/Cross Section/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 o 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:Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 19,598.00 m $ - $ 235.18 Plumbing'Fee $ 29.40 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 29.40 Total fees collected $ 393.97 23 Gilman Lane 338-15 on 10/6/14 Basement Renovation ;I NORTH 'V , own o . � Andover 0 - .:;. 1 No. zO oh , ver, Mass, /6 COC KICNl WICK �•9 A°RAreo S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .. ..... l.s�r..-�(�l. �,l........... BUILDING INSPECTOR .... ............................................................ Foundation has permission to erect .......................... buildings on 1"ev............................ .1 � Rough ���/v c�CY/Oi to be occupied as ......... fE.rd.�lll. ..................................Y...:-........................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service ......... ...... ... ..... ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinje Rough r 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. 1 1 1 i 5 0 x t Custom Design Carpentry Homeowner Information Contractor Information Name i Company Name O `� ✓� a ire t C JSfoM eSl h �I est �e 1 ssa S � Yry Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name ` a G l Yha✓► V✓1, 176 oGrd-v4v Est City/Town' State Zip Code Business Address(must include a street address) 0 10 x Af7dader AIA 0/91/5 Aer N h/r Daytime Phone Evening Phone Citylrowm State Zip Code (? - �O67 603' 89-75 7' Mailing Address at different from above) Business Phone I Federal Employer ID or S.S.Number Home Improvement contractor Reg.Numba Esq'vatianduc Iasi requires shut mast home improvement annfrocton bare / —lid reeistrotion number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) _-Kell C4 �2t.�d������ s�� � �eCk sheej Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be /O ao���jj excluded from the Guaranty Fund provisions of �lDate when contractor will begin contracted work. MGL chapter 142A.) �*Wjl ate when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of M Payments will be made according to the following schedule: 00 $,Sopor upon signing contract(not to exceed 1/3 of thetotal contract price or the cost of special order items,whichever is greater) $'5000,00 by / /_or upon completion of \Ve010�V71-gy4i014 CO"lle.1I ed 5,55000,0° by / oruponcompletionof Drj�, IRAdily16 And /,--/o of in, COwrd/larLN Syr upon completion ofttte contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special S to be paid for ordered before the contracted work begins in order to meet the completion schedule.(") 5 to be paid for 'NOTES:(t)Including all finance charges(t'•)Lawrequires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third 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 express warranty being orot ided by the contractor? &Ko[]Yes fall 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 filly understand it. Ask questions if something is unclear. • 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 ofthis form and get a copy of the Consumer Guide to the Home hpprgvement Contractor Law. You may cancel this agree}nent if it has been signed at a place other than the contractors normal place of business,provided you notify the contractor in writing at hislher maitt 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. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE AR NY BL PA ES!!! Two identical copies of The contract must be completed and signed.One copy should go to the ho r er.lire other cope out t v the c _ gdy/w wpu Signah a Contra 's Signature L 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,ch r 142A. Homeowner's Signature Contra 's Signature NOTICE:The signatures of the parties above apply only to the agreement o t e parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http•HxN,%V%v.niass.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 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•/hvx-,2v.niass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.nia.us/hoineimproveinent/licenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/27J2010 i I Custom Design Carpentry 176 Fordway Ext. Derry, NH. 03038 603 - 289 - 7507 Melissa, Derek Slaton 9/24/2014 23 Gilman Lane N. Andover, Ma. 01845 Basement Renovation Derho: Remove drywall ceiling, nonberring wall between rooms, and Walls to open up stairs. Work out Room: Frame walls along foundation, repair crack in foundation, Install pocket door, and drywall walls and ceiling. Family Room Install New windows, Install new treads,rizors and hand rails to stairs. Builtin in closet opening. 1h" drywall to ceilings. Flooring Seal floor with dryloc, and install flooring . Cost of Project $ 19,598.25 Raymond Lirette Custom Design Carpent Derek, Melissa Slaton a51-� S�o� CK, 5$'83 VLA V/ anznra�zcuen %a Office of Cons n ner Affairs&Business Regulation # ME IMpROVEMENT CONTRACTOR Type. egistration: 172177 DBA xpiration: ,513112016 RAY LIRETTE CUSTOM DESIGN CARPENTRY r RAYMOND LIRETTE 176 FORDWAY EXT. Undersecretary f DERRY,NH 03038 ' i Massachusetts -Department of Public Safety Board of,Building Regulations and Standards F Construction Supervisor t: License: CS-092527 RAYMOND C LIITT.F. �. 176 FORDWAY EXT.ou s Derry NH 03038 Expiration Commissioner 08/20/2015 The Commonwealth of Massachusetts - - Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 u4p www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/OrganizatiorAndividual): Address: 7(o f' o l)a / K� City/State/Zip:,'Aecr��/1�� 030,39 Phone#: �nO `off 9 7J 0� Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2.® I am a sole proprietor or partner- listed on the attached sheet. �• ®Remodeling ship and'have no employees These sub-contractors have 8. El Demolition workingfor me in an capacity. workers'comp.insurance. 9 y p ty. E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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.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 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 DIA for insurance coverage verification. I do hereby cer ' under the i s penal' rjury that the information provided above is true and correct. Signature: Date: d L340/ Phone#: CO4 " L2 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. 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 employes." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall:withhold the§.suance 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Lability 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 maybe 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.ad og license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. i The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: �'he�aaxt�onwealt�Z of Massacl�vsPtts• ;- ,', :� i= . .�:��, �� i Department of Industrial.Accidents Office offnvestigations 600 Washington Street Boston,MA 02111 Tel,#61.7-727-4900 ext 406 or 1-877,7MASSA FE Revised 5-26-05 Fax#617"727-7749 www wass,govldia