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HomeMy WebLinkAboutBuilding Permit #686 - 250 MAIN STREET 6/10/2009BUILDING PERMIT 00 M ­,q TOWN OF NORTH ANDOVER =' ' APPLICATION FOR PLAN EXAMINATIONoo ( Permit NO: Date Received 79Q°Awrao �' (y �SSACHUS�� Date Issued: =/O y I POR plicant ust c all items on this page LOCATION . ?,// /II aN '�ruRCF PROPERTY OWNER_, S /17(f, Print �(/ Print MAP NO: `E PARCEL:a d00} ONING DISTRICT:, Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: R e__R © O)r (:: �_? /fie /4'G-- �. Cole '19 /M Identification Please Type r Print Clearly) OWNER: Name: /,L�' I N f%!�� /f}iy N)lY-C,6 �y2cl hone• Address: /tel 404 Sr /YG Akvouf/a lV7/1– CONTRACTOR Name: 4":V IV44 S H -1 4a/'S Phone: i�'cf -�i73 7 Address: S � a-esi r � 7— /YO lW,�0t)ee_. /U71q_ ,S Supervisor's Construction License: 4 2,2-4Exp. Date: –...& 1 9 1 Home Improvement License: /w335�r ARCHITECT/ENGINEER Phone: Address: Reg. N "7 /7 //b FEE SCHEDULE: BULDING PERRMMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_ / `�/,��, FEE: $ �0 Check No.: % L/ �'% Receipt No.:�� NOTE: Persons contracting with unregistered contractors do not have access to a gu ranty fund ignature of Agent/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 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: Comments Conservation Decision: . Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Street FIRE DEPARTMENT - Temp Durnpster on site Located at 124 Main Street Fire Department signature/date COMMENTS 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 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: Building Permit Application Revised 2.2008 Location No. Date HORTM TOWN OF NORTH ANDOVER OL �? _ i • Certificate of Occupancy $ MU tt� Building/Frame Permit Fee $ ACS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22�� Building Inspector 4Oft "*A 6 z 1 0� xrn O O x O w v cn U "a o as p w O rx , � r. C U co G x w a c7 p w cc C w fY, w w p r� y cn ci Q X O r C7 O o: co C w a rs: w � cn v Q 0 U) a o m C O N o C C Q V : CL= cc :t C O Cc N = E Q i O .�+ y :moo m V : c BE$ m c ca R ' CDm -m H A H CD Amo Q o•CJ H m � c O Q dCcm.0 (ml ycc O Z C.2 oao CD a:o m •y 'a= O C � .� Ci cm Vm •— CL. oho {p m N O CL E a H Z coi VJ O cm m O7 32C m 0 cm c N m r O Z O s_ O fli I Ccm C 0.— CO) Q CO2 O O 'g m m co 0 CD CL ~ y=-+ CD O � 3� O G O CDCaL a a CO2 r o c ev M CL C3 CD C CD C3 CL V CO) O C c c C. is LU cl U) W W W U) �fte �0777/lY1.O�IZffIP.CI.tCIL Q ,�ia�:sacizuaetla Board of Building Regulatioks and Standards wl= HOME IMPROVEMENT CONTRACTOR ,y Registration: 103358 Expiration: 7/7/2010 Tr# 271352 Type: Private Corporation A. J. WALSH & SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover, MA 01845 Administrator Nlas%achu%ett. - Dehartnuvnt of puhiic '-'afet% AM Board of Building-, Re-uidatiuns and Standard, NW Construction Supervisor License License: CS 22680 .... . ....__.. . Restricted to: 00 ARTHUR J WALSH JR 55 PLEASANT ST N ANDOVER, MA 01845 �-- -� Expiration: 6/9/2010 ( Huai i iu r Tr--: 27002 The Commonwealth of Massachusetts Department of Industrial Accidents OR Office of investigations (• �a 600 Washington Street Boston, MA 02111 miJYv.ntass.gav/dig Wo'rkers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers imlicant Information Please Print Leyibll allle (Business/nrganization/Individual):_ _7K1// ! �� ! (�j 0 ✓t1�r d C� i%y/�C, adress: ty/State/Zip: A10 I NWQOrJel-e— /1I Phone.#=: �/ 7t�f —4,' you an employer? Check the appy I am a employer ,,arith employees (full and/or part-time). I am a sole proprietor or partner- ship and have no employees Working for me in any capacity. [No workers' comp, insurance required.] j I am a homeowner doing all wort: myself. [No workers' comp. insurance required,] 4. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance,'- 5.17 nsurance.=5.17 We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reouired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling E. Demolition 9. .7 Building. addition 10.❑ ElectricaI repairs or additions 11.17 Pl ' g repairs or additions I').ZRoof repairs 13.❑ Other pplicant that cheeks box #1 must also fill out the section below showing their woricers' compensation policy information, ;ovmcrs who submit this affidm it indicating they are doing all work: and then hir: outsid,. contractors must submit a new affidavit indicating such. actors that check: this box must attached an additional sheet showing the name of the sub•concactors and s ate :v-.1eth.—. or notthose entities have ccs. If the sub -contractors have employees, they must provide their workers' comp, policy number, tit employer that is providing worlcers' compensation insurance for net} emplovees. Belou- is the policp and job site dation. nce Company Name: Cv rr or Self -ins. Lic, #: 7 A/—�W Expiration Date: to Address % /lI]' J/ City/State/Zip: t a copy of the workers' compensation policy declaration page (shoving the police number and expiration date). to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of'a STOP WORK ORDER and a fine o 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nations of the DLA for insurance_co_ veraae. verification. :reliv cert1 ,, under the pains and penalties ofMgrjurkI that the information provided above is true and correct, u e: 0, kris U-G—J(7 Date: T. T. cia/ use only. Do not write in this area, to be completed by city or town official. or Town: PermittLicense 9 ng Authority (circle one): —-y )ard of Health 2. Building Department 3. Cit}/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 'her. :act Person: Phone #: V = Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A). but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning (tome improvements should first obtain a copy of"a Massachusetts consumer guide to home improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757. Homeowner Information Contractor Information Name coH Zompany Name 77� S# � SG.�s Street Address (do not use a Post Office Box address) N ontranor/ Salesperson) Owner Name City/Town State Zip Code lusiness, Address (must include a street address) D b�- M fi— A o✓ mon4_3 /vm- 6 O -q Daytime Phone Evening Phone "ityrrown State Zip Code Mailing Address (It different from above) Business Phone jederal Employer ID or S.S. Number for Homeo I.— regJnC51ni1 R_oSl hn.9e h1N pmsrneet conoannrs has�z a •olid repistrtian number aeme'.N�"t•[nitttt.enCa[ICi Rep. N-11r�tixpnatien dos 9i D 3a Y The Contractor agrees to do the following work the Mescrine in Wall ulewom to comuietetL s t g lite 1M. WIMIU. W, U MUC her: a UNW,_ s. Required Permits - Tire following building permits are required Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be Q excluded from the Guaranty Fund provisions of I 0 ate when contractor will begin contracted work. MGL chapter 142A.) 6, / 12, _✓Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: Pavments will be made according to the following schedule: 5 upon signing contract (not to exceed 1/� of the total contract price or the cost of special order items. whichever is greater) S by mor—upon completion of / or upon completion of *---/j—�' — — 5 0 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special S to be paid for _ ordered before the contracted work begins in order S to.be paid for _ to meet the completion schedule,(•'") NOTES: (•) Including all friance charges (••) 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 ibe 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. Extures; Warrants -Is an express warranty befoe provided by the contractor? No Yes tall terms of the warrant' must be attached to the contract/ Subcontractors , The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor farther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing. this document becomes a binding contract under law. finless otherwise noted within this document tine 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 Improvemem.Contractor Registration. The late requires most home improvement contractors and subcontractors to be registered with the Director ofHome improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place. Room 1301, 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 reverse side of this form and get a copy, of the Consumer Guide to the Home Improvement Contractor Law. 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. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! *mebwner's identical copies of tet must be eompieled and signed One copy should go to the homeowner. 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