HomeMy WebLinkAboutBuilding Permit #725 - 24 WEST BRADSTREET ROAD 6/24/2009BUILDING PERMIT o� t�ac
TOWN OF NORTH ANDOVER �4,y,.,'..'_'
APPLICATION FOR PLAN EXAMINATIONso
Permit NO: 2,_ Date Received �a"°R1C P <y
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One fami
Addition
wo or more family
Industrial
Alteration
No. of units:
Commercial
Repair, eplacemen
Assessory Bldg
Others:
Demolition
Other
Se tic Well
Floodplain Wetlands
Watershed District ;
ator%Sewer
�
� „�
UE5GRIPT ON OF WORK TO BE PREF RME
e�L��u w i ►'S N C,t, �+� S ��
L� �.9 iVlALav��
Identification Pleape Type or Print Clearly)
OWNER: Name: iu A-/.► C)t ( u!, Phone:
ARCHITECT/ENGINEER Phone:
Address:
Reg. No
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �7 FEE: $(�
Check No.: 5 Receipt No.: a `f
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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
COMMENTS
CONSERVATION
COMMENTS
HEALTH
-COMMENTS
DATE REJECTED
DATE APPROVED
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
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-$1 000 fine
NOTES and DATA — (For department use
❑ Notified for pickup - Date
.................. . . ..... . . ... . .................. . . . . . .......... . ....... ............ . ................................................................ . ...... . . ............................................................................................... . ........... . . .................................................................. . ............... . . . . ................................................
Doc.Building Permit Revised 2008
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo.Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location of 6veS T -
No. ls� Date -- —v�
MORTM TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $-
s�cHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # / 3 5 L
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AGREEMENT FOR SERVICES
This CONTRACT satisfies all basic requirements of the State's Home Improvement Contractor
Law (M.G.L.c. 142A), but does not preclude parties from adding language to protect their specific interests.
Seek legal advice if necessary. Before agreeing to any home improvement work on your residence you
should obtain a free copy of "Consumer Guide to Home Improvement Contractor Law" by calling the
Office of Consumer Affairs and Business Regulation's Information Hotline at 617-973-8787.
You may cancel this Agreement if is has been signed by a party thereto at a place other than an
address of K & R Contractors, Inc., which may be its main office or branch thereof, provided you notify K
& R Contractors, Inc., in writing at its main office or branch by ordinary mail posted, by Telegram sent or
by delivery, not later than midnight of the third business day following the signing of the Agreement.
See Attached Notice Of Cancellation For An Explanation Of This Right.
Homeowner Information
Jeannette Davidson &Nancy Houghton
West Bradstreet Rd.
North Andover, ma 01845
Contractor/Owner Name:
Kenneth Roy, President
Business Street Address
K & R Contractors, Inc.
1 Campbell Road
North Andover, MA 01845
Business Phone: 978. 726.5062
Federal Employer ID: 000961723
Salesperson(s): Kenneth Roy, President
HIC: 279873 Exp. Date: 1/20/2011
MA Sup. License: CS80721 Exp. Date: 4/29/2009
WORK TO BE PERFORMED AND MATERIALS TO BE USED
Contractor Agrees To Do The Following Work For Homeowner:Install vynil replacement windows
throughout main living area of house
Work to include: replace old windows with new vynil replacement windows (Harvey Slimline series), 5/8"
grills in glass, lowE/argon filled (except 2 garage windows),federal incentive package, side lights for front
door will not be replaced. Andrerson window will be reglazed with new crank outs and hasp.
o As described above
o All necessary permits
The following schedule will be adhered to unless circumstances beyond the contractor's control arise*
Work Scheduled To Begin: 06/10/09
Expected Date Of Completion: 06/30/09
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to perform the work, furnish the material and labor specified above for the
SUM OF $7,750
Payments will be made to the following SCHEDULE:
$5000 upon signing contract
$2750 due upon completion of this project
Law requires 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* ) No final payment shall be demanded until the contract is
completed to the satisfaction of the parties thereto.
OTHER E"ORTANT PROVISIONS
You are dealing with a Registered Home Improvement Contractor and are entitled to certain rights under
the provisions of 780 CMR R6 and M.G.L.c.
142A.
Payments: If payment is not received as per the Contract, then the Owner shall be responsible for all
attorneys' fees, court costs, and other costs incurred by the Contractor and enforcing Contractor's rights
hereunder.
Pets: Homeowner agrees to keep all pets out of the work area and take whatever steps are necessary to
safeguard them from any harm that may come to them as a result of the work being performed under this
Contract, including but not limited to injury on or outside the Premises or ingestion or inhalation of, or
contact with, hazardous substances. Company assumes no responsibility for any harm to the pets as a result
of the work performed under this Contract. Further, Homeowner shall take all steps necessary to protect
Contractor, its agents, servants, contractors and employees, from any harm as a result of contact with said
pets.
Characteristics of wood: Wood is a hygroscopic material. Wood swells and/or shrinks in relation to the
humidity, temperature and environmental conditions of its surrounding. Generally, wood flooring is
expected to shrink in any conditions and expand when exposed to moist conditions.
Natural wood also contains variations of graining, texture, hardness and/or knots, depending on the wood
chosen. Contractor cannot be responsible for the natural features of the wood chosen. Contractor is not
responsible for shrinkage, checking, swelling, or other conditions which are the normal condition of wood
or the result of household or environmental humidity, heat, cold, or other conditions.
Colors: You may choose colors and finishes for the parts being used in
your remodeling project. It is important to remember that a color or finish you see at the store or in a
showroom may not look the same in your home, especially after all of the different colors and finishes are
brought together upon the completion of a project. In addition, one manufacturer's named color is not the
same as another manufacturer's named color. The Contractor cannot be responsible for the appearance or
lack of coverage from Homeowner/chosen paints and/or stains and finishes.
Building Officials: Any additional costs incurred by Contractor as a result of decisions made by Building
Officials will be the responsibility of the Homeowner. The costs of additional work will be calculated as
follows: cost of materials plus an hourly rate of $45 per man hour.
Liens: In the event of non justifiable non-payment, Homeowner's residence or property may be subject to
a Mechanic's Lien as a consequence of signing this Contract.
Utilities: The Contractor will use reasonable efforts to notify the Homeowner in advance of any
interruption of utility services. However, there may be instances where the Contractor must shut down
these services without advanced notice. Homeowner must arrange for emergency backup service for any
utility critical equipment such as medical devices and computers. The Homeowner must also notify the
Contractor at the start of the work day if you will be engaged in any utility critical activities in that the
Contractor makes a notification in writing in the daily log book or otherwise.
Additional work: Any additional work requested by the Homeowner which is beyond the scope of the
work to be performed as set forth in this Agreement, shall be the subject of a separate agreement, and/or if
not, subject to the same terms and conditions as set forth in this Agreement and billed on a time plus cost of
materials basis at Contractor's normal hourly rate.
Contractor's normal hourly rate per man hour is $45.
In the event that additional work is to be performed on an hourly plus cost of materials basis, the
Homeowner shall be required to execute a Change Order which shall include Contractor's best estimate as
to the time required, together with the cost of labor as well as the type and cost of materials necessary.
Delays: Contractor is not responsible for delays attributable to
Homeowner initiated modifications or additions, or for delays incurred due to the actions or inactions of
city/town officials, strikes, acts of God, unfulfilled customer obligations, vendor delays, interference by
other tradespersons, customer supplied items or other delays beyond Contractor's reasonable control.
Contractor will use reasonable efforts to stay on each job until substantial completion by allotting specific
time periods to each Homeowner to complete each job in as timely a manner as possible. In the event that
Homeowner does not allow Contractor and/or his employees or sub -contractors access to the residence or
property so as to allow Contractor to perform his obligations and/or to complete the scope of work in as
timely a manner as possible, other than for reasons of safety or other reasons mutually agreed to between
Homeowner and Contractor, then the Homeowner shall be responsible to pay Contractor the sum of
$500.00 per day, on a pro rata basis, to cover the costs of delay. Contractor reserves the right to suspend
work and/or delivery of materials in the event of unjustified non-payment. In such event, the Contractor
shall have no liability to the Homeowner for alleged delays or damages due to said suspension.
Punch -list Items: The Homeowner agrees that routine "punch -list" or repair items after substantial
completion are outside the agreed scope of services, and covered by Contractor's warranty obligation and
will be completed as soon as practicable and according to Contractor's and Homeowner's mutual
availability. Homeowner agrees that it shall use his/her best efforts to make himself/herself available to
observe and/or sign off on the completion of any such punch -list Items, and that the approval of one
Homeowner regarding the completion of any such punch -list items, as well as change orders shall be
binding upon all Homeowners.
Unforeseen Conditions/Circumstances: Contractor shall not be responsible for any changes at the request
of the Building Inspector. Contractor shall also not be responsible for any unforeseen bedrock/ledge or
latent defects such as structural and/or dry rot or insect damage to the existing structure, or for preexisting
faulty or inadequate wiring or plumbing.
Contractor shall also not be responsible for any pre-existing code violations or responsible for correcting
contiguous work completed by others not under the Contractor's authority.
Insurance: Homeowner agrees to carry fire, theft, vandalism, liability and all other necessary insurances to
protect their personal property while construction is in progress. Contractor will carry all required and
necessary insurances including worker's compensation insurance. Contractor will ensure that all personnel
including sub -contractors will be covered by all required and necessary insurance including worker's
compensation insurance.
Homeowner's Cancellation Rights: In addition to the rights the Homeowner has, as set forth in the
attached Notice of Cancellation, the Homeowner may have rights under other Massachusetts Statutes,
including M.G.L. c. 93 § 48, M.G.L. c. 140D, § 10 and M.G.L. c. 255D § 14.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the
contract should go to the homeowner and the conntrraactor.
Homeowner's Signature: ����) Date: 04�_d%
Contractor's Signaturdf. & R Contractors, Inc.:
Date: Icy
By: K nneth Roy
Its: President
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of
the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his
main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of
the third business day following the signing of the agreement.
See attached notice of cancellation for an explanation of this right.
NO WORK WILL BEGIN UNTIL BOTH PARTIES SIGN THE CONTRACT AND THE OWNER
RECEIVES A COPY
REQUIRED PERMITS
The following building permits are required. It is the obligation of the contractor to secure such as the
homeowners agent:
Electrical rough and finish
Plumbing rough and finish
Insulation
Framing insp.
Finish and occupancy
NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the
Guaranty Fund provisions of MGL c. 142A.
EXPRESS WARRANTY
All workmanship and materials to be free of material defect for a period of one (1) year. During the
Warranty period, the Company may, at its option, either repair or replace products or workmanship which
prove to be defective. This Warranty shall not apply to defects or damage arising from improper or
inadequate maintenance by the customer, customer's applied products, unauthorized modification or
misuse, damage incurred as a result of acts of God or civil strife, or normal characteristics of the materials
such as wood shrinking, expanding and otherwise reacting to moisture or environmental conditions. The
Company's liability is limited to the repair or replacement, at its option, set forth herein and Company shall
not be liable for any consequential, sequential, incidental or other damages not set forth herein. The
Warranty set forth herein is exclusive, and no other Warranty, whether written or oral, is expressed or
implied. Company specifically disclaims the implied Warranties of Merchantability and Fitness for a
Particular Purpose.
NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a
contractor subcontractor relating to a registration should he directed to:
Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA
02108
617-727-8598
Unless otherwise noted within this document, the contract shall not imply that any lien or other security
interest has been placed on the residence,
ARBITRATION
The contractor and the homeowner hereby mutually agree in advance that in the even the contractor has a
dispute concerning this contract, the contractor may submit such dispute to a private arbitration service
which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business
Regulations and the consumer shall he required to submit to such arbitration as provided in M,G,L. c. 142A.
THE INSTRUCTIONS OF THE CONTRACTOR REGARDING THE RETURN SHIPMENT OF THE
GOODS AT THE SELLER'S EXPENSE AND RISK.
IF YOU DO MAKE THE GOODS AVAILABLE TO THE CONTRACTOR AND THE CONTRACTOR
DOES NOT PICK THEM UP WITHIN TWENTY (20) 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 CONTRACTOR 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
K & R Contractors, Inc.
1 Campbell Road, North Andover, MA 01845
NOT LATER THAN MIDNIGHT OF TBD.
I HEREBY CANCEL THIS TRANSACTION.
Date:
Buyer's Signature:
Received:
The Commonwealth of Massachusetts
kj 1! Department of Industrial Accidents
t ! Office of Investigations
ii`h91 600 ff lashing ton Street
Boston MA 02111
www_ n 2=s gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers
ADpIicant Information
Please Print Legibly
Name (Business/organization/individual):
Address:-
City/<State/Zip:_%U Phone #:. 7 `� ' 7 2� • sz)
Are you an employer? Cheek the appropriate box:
1. ❑ 14111 a employer with 4. F7.
ject (required):
❑ I am a general contractor and I
employees (full and/or part-time).* have hared the sub-coritractors construction
Pte' )
2. I am .$.sole proprietor or partner- listed on the attached sheet odeling
ship and have no employees These suh-contractors have lition
working for me in any capacity, workers' comp. insurance.[No worers' con iasi>rance 5. ing addition
p ❑ We are a corporation and itsreqm1ed� officers have exercised their rical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL .uming repairs or additions
myself, [No -workers' comp. c. 152, § 1(4), andwe have no
required.] .employees. [No workers'
insurance uired. t 12.[]Roof repairs
`
comp. insurance required_] I3.[].Other
Homeown
`Airy applicant tient checks bo)e # I must also fill out the section below showing their worker:' compensation policy information.
t ers who submit this affidavit indicating they ars doing all work end then hire outside contractors rarest submit s.new affidavit indieatiag such
;Corttraetors that check this box must aff cb*d an additional shes showi-rg• the name of the sub -contractors and their wortoxs' comp. poli�J ;{tenon.
I
am-
or nratinn. arter layer that isprovirirrr
infarg:workers' compensation insurance for nr employe= Below is thepolicy andjob site . .
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Expiration Bale:
Job Site Address: City/StateJZip:
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 e. 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 againstthe 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 nder the et penalties of Perjury that the information provided above is true andcarred
Si Lure: Date: G 1 Z Y- O?
Phone #: cl ' 7 2 ` •
!29 61 Z
Official use only. Do not write in this arra, to be completed by city or town officio[
City or Town;: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Cierk 4. Electrical Inspector 6. Otb&r-5. Plumbing Inspector
6.Otber
i Contact Person• Phone #:
Information a nd Instructions ^
Massachusetts General Laws chapter 1 S2 requires all emp Ioyers 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 includirng 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 *o construct buildings in the commonwealth for any
applicant who has not produced acceptable evidencevr compliance with the insurance' coverage required"
Additionally, MGL chapter 152, §25C(7) states "Neither ti ie 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 cor&ac mg authority." ,
Applicants
Please fill out the workers'.compensation. affidavit compiertely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) mind phone number(s) along with their certificates) of
insurance. Limited Liability Companies (LLC) or. Limited Liability Partnerships (LLP) with no errrployew other than the
members or partners, are not rcquired'to carry workers' cornpensafion insurance. If -an LLC or UP 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, notthe 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 nur. nber listed below. Self-insured companies should enter their
self insuiance'license number on the'appropiiate Tine.
City or Town Officials
Please be sure that the affidavit is complete and printed iegibiy. The Department has provided a space at the bottom
of the affidavit for yon 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 siairrped 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. When 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 etre.) said person is NOT.required to complete this affidavit
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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesfiscions
600 Washington Street
Bosfon, 1vIA 02111
TeL # 617-7274900 6= 406 or 1-5.77-MASSAFE
Fax # 617-727-7741
Revised 5-26-Q5 wwwmem.gov/dia