HomeMy WebLinkAboutBuilding Permit #094-2017 - 250 MIDDLESEX STREET 7/29/2016 Location
No.0 + 26 it Date
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $��
Foundation Permit Fee $
Other Permit Fee
TOTAL $
Check# f
Building Inspector
Id�l� CQ2�- , BUILDING PERMIT o No DRT'6"6 ti
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TOWN OF NORTH ANDOVER a 5� '
APPLICATION FOR PLAN EXAMINATION ~ '°
Permit No#: `1 ` �'
Date Received '!s A°Rareo�Pp`45
gSSAGHV`���
Date Issued: Z�
IMPORTANT:Applicant must complete all items on this page
LOCATION z5?� iee����'�����
Print
PROPERTY OWNER V -
Print 100 Year Structure ye On MAP ( PARCEL,5� ZONING DISTRICT: Historic District yesMachine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Buildingne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septwc; ❑7Well ❑F'FlootlplvnxWetlands : ❑ 1NatershedDistnctg;- '
ry
®1Naterl5ewe_k
DESCRIPTION OF WORK TO BE ERFOR D:
G
Identification- Please Type or Print Clearly _r
07�
OWNER: Name: Phone: `
Address:
Contractor Name: ��/ �� � Phone: QA"���6 : �6/7
Email:
Address: Z-` V
��.��/�" �
I
Supervisor's Construction License: ff,��J:6 Exp. Date: _
Home Improvement License: ILIU330 Exp. Date: 7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING*MIT.$12.00 PER$1000.00C)
100000..00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �y�i FEE: $
Check No.: pfd �Z Receipt No.: ��
NOTE: Persons contracting with unregistered contractors do not have ac ss o th guar, my fun
Sbgnature_ ,
--_d ff 'g `r a —
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
i
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/Cross Section/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 .
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
4, 2012 IECC Energy code
4- Engineering Affidavits for Engineered products
OTE: 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
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
1
I,
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 m U FORM
i
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
i
CONSERVATION Reviewed on Signature
{
COMMENTS
HEALTH Reviewed on Signature
�I
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
s'
�^ tPlanning Board Decision: Comments
Conservation Decision: Comments
Water& Sower Connection/SDriveway Permit
]DPW Town Engineer: Signature:
Located Q good Street
`L DEP RaTIV1ENT �T�emp}Dumpsteron�sife
�.
t 124 Main Street � -VAR
•fix= s;�'
R.s. +.. .,.^.^i. `�.,k-C'• s �+°.' "'�"k�)Y!��,'Yks} $'•ffi Ai t �f'
NGLs Sr # } ' ' e tt �fX l=Y .,
Fire Depar{yt�rnent�signatqure/date. =.4 � ( .fix: - , : "�;; �t
a' � ,y {�+, .Fx:- rz.c,p = i iFj�7"4�{t Wit,,;ja1•t}} �,fid*�' �.�rY=��,k��y�'�t,'t�,�,`� ��a`�:" �;i-�CI "'�tj'aE�i��aK'L�' i� �" iR�•x';,.:��`t�`:�-+ s; _.
COn .at.♦ a aF�•L dtv�.r r.1 ''.'.j•r til-+•f r*^: • � ;., r t"•M w� i Y � F � 4Yh+�+�+ 'f�'('1..♦��*.7�t
MMENTS,, $ p is, , � �, F.�, �. s F, ,_ ., , �, ; � � �,�,t�ip r ,x �-,,v
I
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 Call Email
Date Time Contact Name
.................
Doc.Building Permit Revised 2014 I
A
t%0 R T1y
Town of _ ndover
No. 094-21) [1
� i
^ h , ver, Mass, �l
COC NIC Nl WICK V
'tl.4s R�+rEo �4a��5
U BOARD OF HEALTH
Food/Kitchen
PERMT D Septic System
THIS CERTIFIES THAT I C L BUILDING INSPECTOR
.......................... .... ............... ....... .......... J
.. .................... ... ......
.. ...
. Foundation
has permission to erect .......................... buildings on ..60
. Rough
to be occupied as ..... ........ ...4.... .......................................... Chimney
provided that the pers..... ceptin his permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONS TI Rough
Service
. ........ .. . ... ....... .........
Fina
I G INSP CTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
F
_ ikopotal Page# of pages NN
CS # 022680 978-688-6737
HIC# 103358 A. J. Walsh & Sons or
159A Waverly Road 1-978-912-2853
North Andover, MA 01845
Proposal Submitted To: Job Nam�..��..,- Job#
A
Address ` Job L&atiojun
A
All'
4;Date Date of Plans
Phone# ?(/ �j,� &--7—7 7 Fax#' ,,,/ Architect
rWe hereby submit specifications and estimates for.
M
We propose hereby to furnish material and labor—complete in accordance with the above specifia tions for the sum of:
60
$ _�.-- Dollars
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs wilt be Respectfully f /�
executed only upon written order,and will become an extra cMrge over and fi f
above the estimate.AD agreements contingent trpan stnkes,accidents,or delays submitted
beyond our cdhtml. Note—this proposal may be withdrawn by us H not accepted within days.
�CCEp�BItCC O�t 0�10$�
The above prices,specifications and conditions are satisfactory and are 4-/'Signature
hereby accepted.You are authorized to do the work as specified.
Payments Wil be made as outlined above. v
Date of Acceptance Signature
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form satisfies.all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard
language to protectbomeowners. Seek legal advice itnecetisary. Any peison�plemm�g home"provements sho ild.1%j obtain a copy of"a
Massachusetts;consumer.guide to home,improvemene before agreeing to any work on yourri aideace:You m obtain,a free-
Office of Consumer;Affairs:and Business.Regulation's Consumer Information Hotline at617-9734787'or 1..888;.283-3757. copy by'ralhng the
Homeowner Information Contractor Information
Name .. PmY
Street A (do not .ost Office Box dress �\ ..
tralxor/ 0 Name
aryrr State z; case
e P usiness (mast include a street address) .
Ae.
Daytime Phone EveoingPhoae. ty?own State Zip
Mailing Address(It tlifferent from above) Susiness Phone ederal Employe ID or S.S.Numbe
I..regidm ctrl moK Intoe mr Rome tClmnt*Rea;R®be':Hxpiniion
,��� k
The Contra�cto�rf agrees to do the following work for the Horneo ner..
Do us
RequiredPermits The-following building pens Wits are required Proposed Start and Completion Schedule-The following schedule will
and will besecured;by the contractor as the'homeowner s agent be adh h)iU as$circumstances beyond the eontractoes control grist.
(Owners who;secure their own permits will be
excluded=from the:Guaranity Fund:provisions of Date when contractor will begin contracted work.
MGL chapter MIA:)
Date when contracted .work willbe substainigily completed.
Total Contract Price and Payment..
ayment Schedule ,
The Contractorto perform the wont,fdmkb-the material and labor specified above for thetotal sum of.
Paymtnits will be made according to the following schedule:
S upon signing contract(not•tb exceed 1/3 of the total.contract price ar the cost.of special order items,whichever is.greater)
b3 /4_ or upon completion of
$ by_� or upon completion of
$L�_ upon completion of the contract (law forbids demanding full payment until.contract is completed to both party's satisfactjon) ,..
no following materiaYequipmeat must be!pedal 4bo paid for
ordered before to contracted work-begins in order $ to be paid for
to meet the completion schedule.(**)
NOTES:(h Including all finance charges(••)Law requires that any deposit or down payment required by the contractor before work begins m
not exceed The greater of(a)one-third of the total contract price or(b)the actual con of as er
Y apeciel.equipmlat or custom made materia]
which must be
special ordered in advance to meet the completion ttrhedule.
Express Warranty Ice a warrsaty being orovided by thn*•..tracto!2 Noy -fad term_a pf the rvarrapri mmrt Ian tta haA M the eontraeft
Subcontractors The contractor agrees to be solely responsrble for completion of the work descnbed regardless of the actions'ofany cothitd
parry/subcontractor .utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under ih+e"ereement
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 interes0las been placed on the residence. Review the following cautions and notices
carefully before signing this contract
• Don't be pressured into signing the connect Take time to mad'a.od fully understand it Ask' ns ifsonil thing is unclear.
•
Make sure the contra has a valid Home Immovement Contractpr Rr 'c:r•n Tyle Idw requires most home improvement contractors and.
subcontractors to be registered with the Director ofHome Improvement Coutractok Re 'stration. You
gl may in abouico
registration writingto the D
Y 9 enactor
by *rector atflne Ashburton Plate,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 lnfonnetion on the reverse side of this;foim'and get a copy of the Consumer
Guide to the Home hrlprovement Contractor Law:
[third
u may cancel this agreement if it has been signed at a place other than the contractor's trormal place of business,provided you notify the
tractor in writing at his/her main off ce or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the.
business day following Ute signing of this agreement.See the-attached notice of cancellation form for an explanation o€.this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two ideadal copier of m a mart be completed and ti�cd One should oto
�DY a the heothc - .
copy rhatrW be kept by the coptractor.
Y Homeowner's Signature
;COn
tractor's »
S'> lure
Date G
Date .
i
Contractor Arbitraiion
The Home Improvement Contractor Law provides;homeowners with.henght•to initiate.an arbitration action(as an
alterna$ve to courtaction)if they;have a dispute,with ti contractor. ?he same hghtis no'automatically afforded to a
contractor,how.ever.-:Ttie contractorwould have-tp resolve any..dispute he/she.ltas 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 hag been.approved by
the Secietary of the Executive Office of Consumer'Affairs and Business Regulation arid--the consumer shall be required
to subm' o sue itrationas provided In.Massachusetts General Laws,cha 142A.
Homeowner's Signe Con tot's Signature
NOTICE:"The si res of the parties above apply only to the agreement of the parties to alternative dispute resolution
initiated by the contractor.'.I'he<homeowner:may initiate alternative dispute resolution even where this section is not
Sep
stately signedby:the parties::
Homeowner's Rights
A homeowner's rights uncle-the;FIoale'.Improvement Contractor Law(MGL chapter'l-42A)and other consumer
"protection laws(i.e.MGL chapter 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.
Homeownetq;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 wotkmanlike.manner. Homeowners-may be entitled w.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 f rocas fora 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 attaclimeats is to
be given to the owner and the other kept by,the contractor. Any modification.to the Iriginal 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 recission period has expired
Accelerated Payments
A contractor ropy not demand payments inadvance.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 thatthe.balance of funds not yet due be placed in'i joiat escrow
account as a prerequisite to.continuing the contracted work. Withdrawal of funds from said account would require the
signatures ofboth parties.
Additional Information
If you have general questions or.need additional information about the Home Improvement Contractor Law or other
consumer rights,or i.you wish to obtaiaa free copy of. A Consumer.Guide to.the Home.Improvenient.Contractor
Law,"•contact: .
Can=nier Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
(617)973-8787 or 1-(888)281.3757
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 .
T (617)727-3200 or1-800-223-0933
For assistance with informal mediation of disputes or to register formal complaints against a bitstrtess;call
Consiisiier`CD*mplaint'Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114
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:_ 3 �,xlee ZZ Act-
City/State/Zip: hW4 e N/JPhone#: �117k ...6eV�--X737
Arc you an employer?Check th appropriate box:
L E��/ ' Type of project(required):
1 am• °-;mployer with 4. ❑ I am a general contractor and I
empl `'.-,es(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am 1, 'le proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship ai ave no employees These sub-contractors have g. ❑ Demolition
workiri" r me in any capacity. employees and have workers'
[No wo s' comp. insurance comp.insurance.X 9- E] Building addition
required 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am"a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL
t c. 152 ) 12. Roof repairs
insurance required.] ,§1(4 ,and we have no
employees. [No workers' 13.❑Other
comp.insurance required.] 4.
'Any applicant that checks box#1 must also fill out the section below showing
their workers'compensation mpensa policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside
. g e contractors must submit anew affidavit indicating
tContractors thatg such.
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-contractors have employees,they roust provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:_ / ,
Policy#or Self-ins.Lic. Expiration Date:
Job Site Address: City/State/Zip. /T!'1' /��•�
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`4nd 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 hereby certi der t pains and penalties of perjury that the information provided above is true and correct
Si ature: Date:
Phone#: . �,�
Oficial use only. Do not write in this area,to be completed by city or town offkiaL
City or Town:_ _ Permit/License#
Issuing Authority(circle onell:
I.Board of Health 2 adding Departmet .City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person - --' Phone#• ° ` '" %_4
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 26158
POLICY NO. AWC-400-7014648-2015A
PRIOR NO. AWC-400-7014648-2014A
ITEM
1. The Insured: Arthur Walsh
DBA: A J Walsh&Sons
Mailing address: 159A Waverly Road FEIN:**-***6792
North Andover, MA 01845
Legal Entity Type: Sole Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 11/14/2015 to 11/14/2016 12:01 a.m, standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
I
i
INTRA 40579 i
INTERSEELCLASS CODE SCHEDU E
Minimum Premium $500 Total Estimated Annual Premium $500
I GOV I GOV Deposit Premium $500
STATEICLASS
MA 1 5403 + State Assessments/Surcharges
$.00 x 5.7500% $
�8 ,, � �
This policy, including all endorsements,is hereby countersigned by 11/05/2015
Authorized Signature Date
Service Office: Durso&Jankowski Insurance Agency LLC
54 Third Avenue 11 Saunders Street
Burlington MA 01803 North Andover, MA 01845
WC 00 00 01 A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with Its permission.
y Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-022680
Construction Supervisor ' .,k
ARTHUR J WALSH JR
159A WAVERLY RD
N ANDOVER MA 01845
'�_/►`"'� `�`-- Expiration:
Commissioner 06/09/2018
1
n. ta�:rr�za�nue�r/�ajC�/��r��cr.�ar�e6
Office of Consumer Affairs&Business Regulation
�i , HOME IMPROVEMENT CONTRACTOR
t" ?�
Registration: 103358 Type:
}
Expiration /71201 7/7/201:8 Private Corporation
A.J.WALSH&SONS',-C-
Arthur Walsh =
55 Pleasant St
N Andover,MA 01845
Undersecretary
I