HomeMy WebLinkAboutBuilding Permit #878 - 25 DUDLEY STREET 6/21/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: e3 - Date Received
Date Issued:_ -- 2-,/— //
IMPORTANT: Applicant must complete all items on this page
MC'ATTON 0� (\�'% so- a
MAP NO: -/ PARCEL: ZONING DISTRICT:
Historic District yes
Machine Shop Village yesno
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
®-�Cfteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
(]Septic O'Wellr
OFFloodplau D Wetlands'.51
WatersliedDstr`ct
❑ Water/Sewer
DES CRIE WWON OIy D. WORTO BE PERFORMED:
A,.0 -
CSM ce ltlre s� RI Ines j� P-UA�
OWNER: N
Address: 2�- -�) O—A
CONTRACTOR Name:
Address: 9l -7 I> (L cu
Please Type or Print Clearly)
/974-6J- �—o Yl I
.� � � D 012 9 JQ/U -,!�J Phone: 7
0-'j " A,.f4 Ik t,- M A
Supervisor's Construction License: 0 3 b�-b Exp. Date:
Home Improvement License: )( � '� r 2 Exp. Date:
ARCHITECT/ENGINEER Phone:
C)c-0L/ -f-2—
o 9 --2 (.- •-- / `2_
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. • $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ "6 !77-7, FEE: $
Check No.: G Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the gu�raV fundi
i "
f
Location ?,J— A�1--
No. e4 9 Date 1,/-;2
TOWN OF NORTH ANDOVER
Certificate
of Occupancy
$
MU
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check
#
24�51
Building
Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/MassageBody 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
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submifted yes
Planning Board -Decision:
Conservation Decision:
Comments
Commen
Water & Sewer Connection Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
r--
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
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 0 I
o Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
a Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
MOTE: 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: Doc.Building Permit Revised 2008mi
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Homeowner Information
Name:
Mrs. Ann Apkarian
Address
25 Dudley St
City/state/ zip
North Andover Ma 01845
Day Phone #
1978 685 0321
E- Mail
Cell Phone #
Contractor Information
Jones & Company
Bradley J. Jones, Proprietor
97 Druid Hill Road
Methuen, MA 01844
Tel. 978.688.7307
H.I.C. # 117359 CSL # 036263
Contract Date: 06/18/11 start Date 06/22/11 Completion Date 06/26/11
(approx): (approx.):
Required permits — permits will be secured by the contractor as the homeowner's agent. (Owners who secure their own permits will
be excluded from the Guaranty Fund provisions of MGL chapter 142A)
The contractor agrees to perform the work, furnish the material and labor specified below for the total sum of $4.777.00
Payments will be made according to the following schedule:
$1,000.00
Upon signing contract (not to exceed 1/3 of total contract price or the cost of special order items, which ever is greater)
$2,000.00
When we start
$
When the
$1,777.00
Upon the completion of the contract and final inspections.
Modifications — Any changes in the scope of work or materials outlined in the original contract will be pre -quoted on a CHANGE ORDER FORM
requiring signature and payment in full at this time.
JGOpe oI worK.
Location of work
On the side deck attached to the Carriage House
We will carefully remove 4 sections of railings from the deck cut away the 3 out side railing post and
replace them with taller pt 4x 4 support post secured to hold up the beam that will support the roof.
The three posts will be wrapped with pre primed finger jointed pine boards, the beam will be trimmed
with the same materials.
The gables will be framed with 2x4's and closed in with '/2" aspinite and the cedar siding will be blended
in on the exterior gable ends to the main house wall on the outside. The inside of those gable walls will
be covered with a vertical bead type board. Pre primed.
The ceiling (Vaulted) will be covered with a bead style board pre primed.
We will strip away some siding and install a sleeper on the house to fasten the rafters to. We will install
shed style roof rafters (2 x 8 run of 12 ft set 16"oc with hurricane ties) covered with ''/z" cxd plywood.
We will apply Grace snow & Ice shield up 3 ft unless the roof is less than a 5 pitch, then the whole roof
Overhangs will be 1 x 8 pre primed finger jointed fascia & rakes boards, with a 3 5/8 " crown molding
along the entire roof level . Soffits will be closed in with 'h" plywood and continuous soffit vent
Roofing IKO brand 25 yr White aluminum drip edge at all perimeter edges.
Snow & ice shield will be run on the roof and up the wall at that transition point.
Roofing to match as close as possible to the main roof in color and style.
Siding we will blend in the # 1 white cedar shingle back on the wall again after the roof is flashed with
aluminum flashing,
We will trim and re -install the existing railing
Includes Building Permit, Debris Removal, Materials & Labor
No painting of any kind is included
Any other task not listed in this contract will be billed separateh
Page 1 of 3
Materials Cost Review - We Reserve the right to review the cost of materials to be used in your project one
weekbefore we start, and if said materials have had any increases we will be forced to pass that cost on to
you as the end user. We are sorry to have to consider this action but the volatility of his world market due to
higher fuel cost and the fact that some products are specifically petroleum based. Thank you for your
cooperation and understanding in this matter.
Express Warranty — Labor for one year from completion will repair any defects due to workmanship.
Building materials are covered by the manufacturers' implied warranties.
Registration - All home improvement contractors and sub contractors shall be registered and that any
inquiries about a contractor or subcontractor relating to a registration should be directed to: O zce o
Consumer a ffairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston MA 02116 or call (61 7)
973-8700.
Contract Acceptance — Upon signing, this document becomes a binding contract under law. Unless
otherwise noted within this document, the contract shall not imply that any lien or other security interest
has been placed on the residence. Review the following cautions and notices carefully before signing this
contract.
• Don't be pressured into signing the contract. Take time to read and fully understand it. Ask
questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Registration (see above).
• Does the contractor have insurance? Check to see that the contractor is properly insured.
• No work shall begin prior to the signing of the contract and transmittal of a copy to the owner.
The contractor and the homeowner hereby mutually agree in advance that in the event that 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 Office of Consumer affairs and Business Regulation and t onsumer shall be required to submit to
such arbitration as provided in MGL c142A.
Homeowner's Sign re Con actor's Sign re
Notice: The sign tures of the parties above apply only to the a ementthe pa� ��t to alternate dispute resolution
initiated by the contractor. The owner may initiate alternative dispute resolutiorf�ven where the section is not signed
separately by the parties.
The homeowner's three day cancellation rights under MGL c93 s48: MGL cl40D s10 or MGL c255D s14 may be
applicable.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other!
by the contractor.
v W✓
Homeowner's ignature
-..1�_2d-il
Date
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
Page 2 of 3
responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may
be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for
workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods
sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An
enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the
terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed
below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exhibits and
referenced documents have been attached. Parties are also advised not to sign the document until all blank
sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the
contract with attachments is to be given to the owner and the other kept by the contractor. Any
modification to the original contract must be in writing and agreed to by both parties. Contracted work
may not begin until both parties have received a fully executed copy of the contract, and the three day
rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases
where the homeowner deems him/herself to be financially insecure. However, in instances where a
contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds
not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.
Withdrawal of funds from said account would require the signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law
or other consumer rights, or if you wish to obtain a free copy of "A Consumer Guide to the Home
Improvement Contractor Law," contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plazas, Room 5170, Boston, MA 02116
(617) 973-8787 or 1-(888) 2833757
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 Ash Burton Place, Room 1301, Boston, MA 02108
(617) 727-3200 or 1-800-223-0933
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
(413)734-3114
Page 3 of 3
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: 9-7 i>- (2U4,_ % 4 t U
City/State/Zip: A X41 y ?iL- ,.-
Phone #:
j 97d- 94y�6D /
Are you.an employer? Check the appropriate box:
1. UK= a employer with —3
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑
have hired the sub -contractors
I am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for mein any capacity.
workers' comp, insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ 1 am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. emodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other
-- �-rr•��� <==a� �� rz uua+rr must also nii out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. j
Insurance Company Name: 1rQ/LS p1 ��Q/L'�y (A
Policy # or Self -ins. Lie. #: �. L
Expiration Date:
Job Site Address: f
City/State/Zip: jo,
Attach a copy of the workers' compensatio 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 hereb c der tpains a d pen s of perjury that the information provided above is true and correct.
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
6. Other
Contact Person:
G
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
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 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy; please call the Department at the number listed below. Self-insured companies should enter their
,self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple pen-nit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The 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 Investigations
600 Washington Street
Boston, MA 02111
Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax ## 617-727-7749
www.mass.gov/dia
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Safety Insurance
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
Building Commissioner or
Inspector of Buildings
City Hall
NORTH ANDOVER MA 01845
Re: Insured(s):
Property Address
Policy Number:
Claim Number:
Date of Loss:
Company:
Board of Health or
Board of Selectman
City Hall
NORTH ANDOVER MA 01845
GAYLE APKARIAN & RENEE SLACK
25 DUDLEY ST, NORTH ANDOVER MA 01845
0261690
BOS00013645
01-11-2011
Safety Indemnity
Claim has been made involving loss, damage or destruction of the above -captioned property, which may either
exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass.
Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a
reference to the captioned insured, location, policy number. Date of loss and claim or file number.
Allan Leavitt, Adjuster
Safety Insurace Company
Homeowners Claims Unit
P.O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 x3213
Fax: (617)531-8891
01/11/11
CC012.001