HomeMy WebLinkAboutBuilding Permit #990-2016 - 24 GILMAN LANE 3/22/2016BUILDING PERMIT
A AAM �o L�- TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
slPermit No#:Of�.O— Date Received
Date Issued: rJ t'll IV
IMPORTANT: Applicant must complete all items on t1us page
[LOCATION .94- C-rlmov-i Lou*qa-
Print
PROPERTY OWNER
yes
Print 100 Year Structure
ZON
!MAP 7 PARCEL: ING DISTRICT: Historic District yes,
Machine Shop.,Yil,!@gp yes.
or
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
X One family
El Addition
El Two or more family
0 Industrial
[I Alteration
No. of units:
0 Commercial
—
X Repair, replacement
0 Assessory Bldg
E3 Others:
[I Demolition
11 Other
rn
ij--� -Water
DESCRIPTION OF WORK TO 13t PtM1-UMMt:LJ;
1110 , UZ I
,41,40 .6 W1
Identificatio'h - Please Type or Print Clearly
OWNER: Name: 1�*A* Phone:
JM4,1— qar+� P,"ver
Address: A16r J
Contractor Name: Phone -
Email: Dear-ligr-Y) Ou 114,0 YmAi h C -,o rM
Add A."' /69:44 n A4 A -
Supervisor's Construction License: (,p Exp. Date: -
Home Improvement License: Exp. Date:
ARCH ITECT/ENGI NEER — Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT.- $JZOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
JAZ --
Total Project Cost: $ FEE:$ 17-7
Check No.: Receipt No.:
NOTE:, Persons contracting with unMis;ered contractors do not have access to the guarantyfund
Location 4 'ki 07 /11
No. Date
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
-7
.1 CHU I Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # elo
2
Building Inspector
Location C�) VIA C;
No. 9 -2 0 Date
Check# ,
.i , --% 1-1 11 �
Z; _J I
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Building Inspector
-4: 10
Plans Submitted
TYPE OF SEWERAGE
Public Sewer
well
Private (septic tank, etc.
Plans Waived Certified Plot Plan Stamped Plans F1
)SAL
Tanning/Massage[Body Art F] Swimming Pools 0
Tobacco Sales 11 Food Packaging/Sales 0
F] Pennanent Dumpster on Site 0
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PL I ANNING & DEVELOPMENT Reviewed On Signature'
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: --zoning Decision/receipt submitted yes
Planning Board Decision:
Comm
Conservation Decision:
Comments
Water & Sewer Connection/sig nature & Date Driveway Permit
DPW Town Engineer: Signature:
I i - Located 384 Osgood Street
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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.$100-$l 000 fine
No i Ls ana UA I A — wor cievartment use
U Notified for pickup Call Email
Date Contact Name
Time
Doc.Building Permit Revised 2014
Building Department
The following is a list . of the required forms to be filled out for the appropriate permit to be obtained.
I
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
"_�Floo.r Plan Or Proposed Interior Work
4 Engineering Affidavits for Engineered products
DTE: 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
4. Workers Comp Affidavit
4 Photo Copy of H.I.C. And C.S.L. Licenses
4. Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
4. Mass check Energy Compliance Report (If Applicable)
4 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)
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
2012 IECC Energy code
'Engineering Affidavits for Engineered products
10TE: 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
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LEE DEARBORN
BUILDING & REMODELING
4 Hawthorne St.
Acton, MA 01720
50M28-6441
CONTRACT
Mar. 18,2016
Clicryl Gikas
24 Gilman Ln.
North Andover, MA 01845
CONTRACT for repain to kitchen and family room due water damage from water pipe in
ceiling that froze and split at 24 Gilman Ln.
Site prCparation:- Move furniture and furnishings to a location,"id-lin the house as designated
by owner. Remove curtain rods and brackets. Cover floors in kitchen and family room with
protective drop cloths. Seal off door openings as needed to confme dust to and family room.
Labor: 2 carpenters x 4 hrs = 8 x 75. 600.
Materials: plastic, drop cloths, tape, dusk masks 62.
Demoltion: Remove two layers of blueboard from family room ceiling and dispose of in container
in driveway. Remove blueboard behind the cabinets where small sink is located. Use vacuum to
collect dust directly adjacent to blade of cutting tool. Remove and dispose of fiberglass insulatiOIL
Labor: 2 carpenters x 6 his - 12 x 75. 900.
Electrical: Remove and dispose of all (thirteen) existing recessed lights in the kitchen and family
room. Install nineteen new Halo 4 inch insulation contact recessed lights with white trims and
45 watt equivalent R20 dimniable LED bulbs. Reinstall curved low voltage ceiling fixture over
island. This may require relocating ceiling electric box. Install new 115 volt outlet behind stove.
Add 115 outlet for mi*crowave shelf in base cabinet to left the stove. Wire new range exhaust
hood. Install new electrical outlets horizontally in granite backsplash. Reinstall undercabinet
lights. Replace all other kitchen outlets and switches.
Sub -contract: Electrician 1600,
Materials: Recessed light frames, trims and bulbs 857.
Plumbing. Replace and relocate laundry drain and water connection box.
Sub -contract:- Plumber 800.
Materials: laundry connection box: piping 86.
Plaaer. Install 1/2 inch blueboard on family room ceiling and kitchen walls and ceiling. Apply
veneer coat of plaster.
Sub -contract: Plasterer 1630.
Materials: Blueboard, screws, web tape, plaster 548.
Cabinetsj appliances: Install tall utility cabinet, cabinet over the reffigerator and tall panel
to the right of the refrigerator; Install base and wall cabinets where utility sink is located;
Install saved door and drawer front panel on dishwasher; Install new hood fan vented to
outside; Install wall cabinet above new hood fan; Install crown molding at top of cabinets;
\Install cabinet kickboard; Install cabinet hardware; fill nail holes
Labor: 2 carpenters x 12 his = 24 x 75. .1800.
Casings and crown molding: Re -install. casings at kitchen window, sliding door and cased opening;
Install paint grade crown molding on kitchen and fainily room ceiling.
Note: crown molding will not cover stone on fireplace
Labor: 2 carpenters x 6 hrs = 12 x 75 900.
Materials: 3 1/2inch primed cxown molding 332.
Supervision: On site supervision of all work performed
Labor. I supervisor 30 hrs x 75 2250.
Total 12,365.
Payment schedule: $4,000. upon signing of contract.
$4,000. upon installation of plaster board
$4,365. upon completion
GL/Vm�d'
Owner/
i- )a - 16.
, Date
Contractor
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 142A.
Homeowner's Signature Contractor'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 homeownees 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 hqp://www.mass.povlocabr/
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 hU://www.mass.wv/Qcabr/
Go online to view the status of a Home Improvement Contractor's Registration:
hg://db.state.ma.us/homeimr)mvement/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
508-6524800, 508-755-2548 or 413-734-3114
Vemion 2.1 - I I /=010
mwmm�
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 T14E 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 CANCELLED.
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 DESPOSE 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 TFUS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE, OR SEND A TELEGRAM TO [Name of Seellerl, AT [Address of Seller's Place
of Business] NOT LATER THAN MIDNIGHT OF. (date).
I HEREBY CANCEL THIS TRANSACTION.
Date: Buyer's Signature:
Booth Electrical Services
16 Proctor Rd.
Chelmsford, MA
Woodbury Home Solutions (plumber)
45 Ossamequin Rd.
Billerica, MA,
Millbrook Plaster
26 Chestnut Ave.
Braintree, MA
The Commonwealth of Massachusetts
Department ofIndustrialAccidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
wwwmass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE, FILED WITH THE PEPJMTTING AUTHORITY.
Applicant Information Please Print Leeib
Name Q3usiness/Organization/Individual): L6e 'Daarbocti
Address: -4- 4aw+6 rn e, 4,+-
City/State/Zip: Ac+oo 1; M)+ 01
Are you an employer? Check &e appropriate box:
Phone #: S-08 -3 Z-8 - 44+1
I.F-1 I am a employer with - .,, : P111ployees (M and/or part-time).*
2.1-11 am asolepro rietoror partnership and have no employees working formein
� p
any capacity. [No workers' comp. insurance required.]
3. n I am a homeowner doingall work myself [No workers' comp. insurance required.] t
4.FJ 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
proprietors with no employees.
5.;jo I am, a general contractor and I have hired the sub -contractors listed on the attac hed sheet.
Thesle si�ib-contracto6lia4e' en�ployee's and have workers' comp. insuranceJ
. i . I .
6.FJ We are a corporati ' on and its ' offic.ers * have exercised their right of 'exemption per MGL C.
152, §1(4), and Nye have noke loyegs. [No workers' comp. insurance required.]
Type of project (Tequirbd):
7. F1 New construction
8. Remodeling
El Demolition
10 Building addition
11. Electrical repairs or additions
12. Plumbing repairs or additions
13. F1 Roof repairs
14. VMW Other UJM4?-Y-
,. _MPAAr_!�,
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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-co'n"tractiors �a� e e'mp'l I oyees, &y must provide their workeis' comp. policy number.'
I am an employer th at is piovidhig workers' compensation insuran cefor my employees.' Below is th e policy andjob 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 MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year impris6mment, 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 certify under the pains and penalties ofperjuyy that the information provided above is true and correct.
Si ature: Date:
Phone#: OS -Ozb -IP441
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/�own 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 eqiployees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract 6hire,
expres's 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 OLLP) 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 Depattment of Industrial
Accidents fbi confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city gr 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 requ�red to obtain a workers'
compensatioii'policy, please call the Department at the number listed below. Self-iiisur6d companies sh.ould'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 bum 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
I 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
Massachusefts Department of Public Safety
Board of Building Regulations and Standards
License: CS -006235
Construction Supervisor
LEE H DEARBORN
4 HAWTHORNE ST
ACTON MA 01720
Expiration:
Commissioner 0211912018
��_Office of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR
egistration: 136431 Type:
-X;piration: 7124=16 Individual
LEE DEARBORN
LEE DEARBORN
4 HAWTHORNE ST.
ACTON, MA 01726 Undersecretary