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HomeMy WebLinkAboutBuilding Permit #511 - 24 WEST BRADSTREET ROAD 12/30/2011Permit NO. 5 -0 - Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ANT: Applicant must complete all items on this LOCATION Print PROPERTY OWNER %lid lel G/©cP ®A/-,yc�'/�G D fiy iSoiy Print- MAP rint-MAP NO: PARCEL: ZONING DISTRICT: Historic District yesr110) o Machine Shop Village yes TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial [I Alteration No. of units: ❑ Commercial- ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `i®Flo plaui' ®iW� eland ®'Wa erg sliedlD strict` `��� '- t®,IWater/Sewers,,,.- �_ F =�,� _ _ ��.•- - � �<�. - --y� _.�� �l _ �,a��. _ oc] r— PTION OF WORK TO F i o v4(- 1�-e, r Identification Please Type or Print Clearly 5*5 Address: ::R1 `/ Glie`Sr 864Q-5 'A,,,: ied-' 1 CONTRACTOR Name: So.S/S Phone: 9;5" -6dP-0737 Address: :�r Supervisor's Construction License: Exp. Date: Home Improvement License: /03n Sr Exp. Date: ARCHITECT/ENGINEER Ph M/4- .® /kv�'> . Address: Reg. No 0 Z/ FEE SCHEDULE. BULDINGPgUff. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. eo p Total Project Cost: $ / L��® FEE: $ f �� Check No.: U Receipt No.: o NOTE: Persons contracting with unr egrstered contractors do not have access % the guaranty fund ��nnatiirP of Aaent/Owner ::: _ Signature-of:contractor Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY - INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS E r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: ments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locate_ d 384 Osgood Street FIRE DEPARTMENT - Te ftip Dumpste on site ' yes Located at 124 Main Street •- Fire Department signature/ ate COMMENTS - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ff.: 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 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) ❑ Muss 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit u all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over.. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording . lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location IV lZiLf J -Z 7— No. ` Date NORTIy TOWN OF NORTH ANDOVER 3 FR 9 !: } �a Certificate of Occupancy $ �N�s <�' Building/Frame Permit Fee $1— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # G 2 3 24920 Building Inspector q O U O U W O W U H W A O w aQi cn or O w O w U as C X O r2 C w w p C2 cn cz C w" 0 w C u. v w i cn 0 cn :.CIS G CD °._ : G � O N O O C3 V CL G A W G co 14IMPV. :. N �' E Q 1 CD :SCD O C. y N CD CD O .� cm (D = C c E ®m�4!: d N go M� 3. N «' Of m co) • cm � ._ N G G N O O ®' 4 : Ego L- CD Om N m ' Z = O CI C cS �dCt -c m p� m v N O. L- C.I m O cm cO O Q m c m c o a � ..C:, Nmol- m WB�1 C=m.. .y m a C Z LU ,c 'E CJ'O �'N o COD CZ O. O.0 z 0 w w 0 '3 co O E co O v CD 0. O CO) CO vm Ip� CO)CD G3 O O m m t O � O O w � � e -v o a C 0 C Ccc CO2 ts C CD CL V y C C C _c 0. COD U) ceW W ce W p �� Y/ CS # 022680 HIC# 103358 A. J. Walsh & Sons 55 Pleasant Street .North Andover, MA 01845 # of pages 978-688-6737 or 1-866-AJWALSH Proposal Submitted To: / f/a r? C V yd% / 601 Job Name����i� Job # - `/ Address L / p Job Location u Date Date of Plans Phone # , , r �, Fax If Architect rrWe hereby submit specifications and estimates for: �il.���� �^.��.�. _ .�.�� ,GJri .fes/� � ��.�,�•� .- r/ U` r We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: $ jw aP Dollars with payments to be made as follows:-- u Any alterexecuted only*up eviction from above specifications involving extra charge ovts er be respectfully executed onl u on written order, and will become an extra char a over and submitted ((( above the estimate. All agreements contingent upon strikes, accidents, or delays r beyond our cohtrol. Note — this proposal may be withdrawn by us H not accepted within days. ZftttptRnCt 4UopOd The above prices, specifications and conditions are satisfactory and are Signature-'%+�rd��1 hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above z"re.—./- Date of Acceptance ��? _ /S�/l/ Signat The Commonwealth of -Massachusetts .Department of Industrial Accidents lPh� Pa { ; i 4 �c: ;'� Office of Investigations 600 Washington Street Boston, MA 02111 livivm mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual Address: S )VG rt5l­ At T_ \51 City/State/Zip: k/O aq-ty,Dd "'4 P /✓JAhone#: g7k- 4-C_ 7 --37 Are you employer? Check the appropriate box: 1. I ama employer with l 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ± ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. e. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New. construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. oof repairs 13.❑ Other, *Any applicant that checks box #I 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 a»d their workers' comp. policy information. l ani an eilzployer that is pi'ovitlitzg ►vorkers' compensatiozz insurance for zzzy ettiployees. Below is the policy and job site information.�/ Insurance Company Name: �T �J /%' C p 6b I Z_ Expiration Date: Policy # or Self -ins. Lic. #: p Job Site Address: z_/�vanrqp hp sy— 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. - - - - -' -' ----. _-4 ---0 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 #: Office of, collslilliel. Affairs & Btiiilless Itefamliatioll .;..HOME IMPROVEMENT CONTRACTOR Registration: 103356 Type: Expiration: 7/7120'12 Private Corporation - A. J. IJJALSH & SONSjNC, Arihm, 55 Pleasant St N Andover, MA 01845 License or registration valid fol' ilidil'iffill use 011IN before the expiration date, If found 1,0111,11 to: Office of Consumer Affairs and Business Regulation 10 PRl'1( Plaza - Suite 5170 Boston. ;STA 02116 ?got vali&Witllollt siallilture 0 22680 ARTHUR J WALSH JR 159A WAVERLY RD N ANDOVER, MA 01845 619/2012 29327 MASSACHUSETTS ROME IMPROVEMENT CONTRACT This form. satisfies all basicr"itiremetts of the state's Home Improvement Contractor Law (MGL chapter 142A) but does not include standard language to protectbomeowners. Seek legal advice if necessary.- Any person planning hodhe tnpmv 'm uts should.firsf obfain a copy of"a tts'> Massachuseeonsumer guide 20 home,improvement" before agreeing to any work on yourresrdenct. You may obtain >a fitie copy by'calling the Office of Consumer. -Affairs and BusinessRegulation's Consumer Information Hotline at617-971+8787 or 1.4888:283-375.7. Homeowner Informtipn Contractor Information Name/P'a 17C Iii' PmY N4 mr Street Address (do not use.a.PostOfficeBox address), tractor/SalespersoordOwner NName ,t dnW n ��O S Zip de ��W ave i�J o trainees A must include a atrxt address) . f, Da a PhEv g Phone.. 7k �� ��S ity?own State Zip Code .11yd wpope4' A- o r� � Mailing Address (It different from above) lusiness Phone ederal Employer ID or S.S. Number ' ' . The Contractor agrees to do the following work for the Homeowner- Lvragauea Whmoa lxuoe im• R•wmeamatr+ctmthne� ber Aoma iC®aadorReaNmie"a ':aslmatim _ / j v / /. Required =Perbtits- The -following building permits are required and will be secured:by the contractor as the'homeowheris agent; (Owners who;secure their own permits will he excludedifrom;the Gnaranty Fund'provisions of MGL chapter 142A.) Price and Payment Schedule Proposed Start arid` Completion Schedule - The fdllowing schedule will be adhered to unless circumstances beyond:the connector's control arise Date when contractor will begin contracted work. Date when conttacted .work will be substantiailycompletrA . .,.� • uuNacwr.ag[cca w perrorm rqe worx lnml$h the material and labor specified above for the total sum of. % Wo r) Payments will be grade according to the following schedule: $ �� ryupon signing contract (not_to exceed 1/3 of the total.contract price. 2r the cost,of;pet ial order items, whichever is -greater) $ �_/ / or upon completion of q r-$ el by orupon completion of ' 0 f�— o l gpy�o pon completion of the contract (Law forbids demandingfull a ' payment until .contract is completed to both party's satisfaction) The following matedal/equipment must be special S to d for uttered before the contracted work begins inorder $ to be paid for to meet the..cthmpIttion schedule,(**) NOTES: (•) including all finance charges (••) Law requires that any deposit or down-Paymcmt required by the contractor before work begins may not exceod the greater of (a) one-third of the total contract price or (b) the actual con of any special equipment or custom made mataW which must be special ordered in advance to meet the completion schedule. �soreas warreary . s ser e:oress warrsaty brinInrovided by the contractor? No Yes fa0 * of die warranter m�.'r.. ». h A ro the eoatroeft Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions`ofany thrid party/subcontractor utilized by the'contraetor. The contractor further agrees to be Solely responsible for all payments to all subcontractors for materials and labor under iiia aereement Contract Acceptance Upon signing this document becomes a binding contract underlaw. 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 reed'aad fully understand it Ask'questimis itmolething is unclear. • Make sure the contractor ties s valid Home Imorovement ContractorAzdamd211. The Iger: requires most home improvement contractors and . subcontractors to be registered with the Director ofHoute Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director arone Ashburton Place, Room 13Q1,.Boston, MA 02108 or.by.,calling 617-727-3200.or 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the Guide to the Home Improvement Contractor Law: reverses' de of tris foim'aad get a copy of the Consumer You may cancel this agreement if it has been signed at a place other. than the contractors 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 fora for an explanation of.this right DO NOT si(2N Tmg r'nlvTn Arm n-r•r�,r� .,,.. . Two identical copies of the connect - - -- — tooted m W .-aa":, gat. i DLA1V 11 ACAI.:'Lr,'A' 111 - d siIDbd One copy should go to the 1. he otic should be kept by the omwwner's Signature Dau ... t onttactor's S' true /�� Date Contractor Arbitration The Home Improvement Contractor Lawprovtdes; homeowners with the right:to4nitiate an arbitration action (as an alterna&eto coprt achop) if they have a.dispute with.a contractor. The same fthtis not automatically afforded to a. contractor, however. -,The contractor would have;.Ap resolve any, dispute he/she.ftai.with a homeowner in court unless ... . both parties agree to, the optional, clause provided below., This clause would.give the contractor thesame. right to ' arbitration as is afforded to thehomeowner.by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor h'as a dispute concerning this contract, the contractor may submit the dispute to a.private arbitration firm which has .been. approved by th tary of the Executive Office of Consumet Affairs and Business Regulation and -the consumer shall be required /srrb t to such arbitration as provi assachusetts General Laws, chapt 42A omeowner's Signature Contractor's Signa NOTICE:'The signaturesof the parties above apply only to the agreement of the parties to alternative4ute resolution initiated by the contractor Thetomeowner.may initiate alternative:. dispute resolution even where this section:is not eeKft"*, lv Vi'onPliifd'.tlre iigttiesr ' _ Homeowner's Rights A homeowner's rights un dt r -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;w.orkmanlike 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 .guarantee's or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and frtness_for-a particular purpose. An enumeration of other matters on which•the homeowner and contractor lawf illyagme: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/hameowner rights, contact the Consumer Information Hotline (listed Below). Execution of Contract The contract must be executed in di lice a 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 4 - 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 anginal contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties havereceiveda fully executed copy of the contract, and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.. However, in instances where a. contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to. continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or.need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish toobtain a free copy of "A Consumer Guide to the Home.Improvement Contractor Law, contact.. . Cgnsumer Information Hotline Office of Consumer affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1{888) 283.3757 . If you want to verify the -registration of a contractor or if you have questions or need .additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place, Room 1301, Boston, MA 02108 (617)727-3200 or 1-800-223-0933 For assistance with informal Mediation of d4sptitesor to register formal complaints against abiisiness, call `C+onsuYner'Corirplsint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (548)652-4800 (508)755-2548 (413)734-3114 CERTIFICATE OF LIABILITY INSURANCE DATE 12(IvIIvU /2 11 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 Durso & Jankowski Insurance CONTACT Nom` PNONE FAX (A/C. No. Ext): (A/C. No): Agency Inc E-19IL 198 Mass Ave Suite 101B ADDRESS: PRODUCER CUSTOMER ID#. North Andover, MA 01845 INSURED(S) AFFORDING COVERAGE NAIC / INSURED Arthur Walsh INSURER A: A.I.M. Mutual Insurance CO 33758 INSURER R: dba A J Walsh & Sons INSURER C: 55 Pleasant Street INSURER D: INSURER E: North Andover, MA 01845 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. y�rr TYPE OF INSURANCE POLICY NUMBER POLICY EFF IMH/OD/YYYY) POLICY EXP (NH/DD/YYYYI LIMITS GENERAL LIABILITY EACH occGRANCE 9 ❑COMMERCIAL GENERAL LIABILITY ❑CLAIMS MADE OCCUR OGEE TOERENTEDrsence) $ MED EXP (Any one person) $ PERSONAL i ADV INJURY $ ❑ T. AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES ER: PRODUCTS - COMP/OP AGG $ POLICY PROJECT nL.0 $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT (ea accident) $ ❑ANY AUTO BODILY INJURY (Per Parson) $ ALL OWNED AUTOS BODILY INJURY(per accident) $ ❑SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (per accident) $ ❑NON -OWNED AUTOS $ n 9 ❑UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ [:]EXCESS LIAB ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ ❑ RETENTION $ $ WORKERS COMPENSATION '=Ta OTH- AND EMPLOYEES LIABILITY roar LxxxrER ® I E.L. EACH ACCIDENT $ 100,000 THE PROPRIETOR/PARTNERS/ A EXECUTIVE OFFICERS ARE incl ® eXCl 701464801201111/14/2011 11/14/2012 E.L. DISEASE -POLICY LIMIT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 COMMENTS / DESCRIPTION OF OPERATIONS OR LOCATIONS: ARTHUR WALSH IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 1600 OSGOOD STREET POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATI'G