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HomeMy WebLinkAboutBuilding Permit #832 - 255 MASSACHUSETTS AVENUE 6/4/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: V00 J_? IMIPORTANT: Applicant must complete all items on this page ;1016 UNT75 e- 7� 7 7P.=hntf _-A '! ��'!t tr?c t 5 F—ep —If@ q MR IYA5 Md' St t ing; - y g ur P. r 'ic WAIP19" @ 0 JD 1 o' Z ING 0_ 11.4 gj_O�Jg gig 0, -A RARG � E 11 111) QTJ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building UOne family OWNER: Name:— 0 Addition El Two or more family 0 Industrial El Alteration No. of units: 0 Commercial PfRepair, replacement El Assessory Bldg 11 Others: D Demolition El Other IN, N - a - �Cf__ 9 5, Fdfaepti f On 7 . - V-4 �$ P.,e-r,7v DESCRIPTION OF WORK TO BE PERFORMED: a, Identification Please Type or Print Clearly) OWNER: Name:— Phone: Address: I S; -z --w TERA Q e! Rbb 1) - a - �Cf__ 9 5, P.,e-r,7v fl' bb ffidl, I �46 -7 ARCHITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. ,W 'Total Project Cost: $ FEE: $ Check No.: Z04 �o 2 —Receipt No.: NOTE: Persons contracting with un is con tors do not have access to the guarantyfund ;"Si, "Otbria 'Of.. enubwo Ski, u re of c ra Plans Su bmitted Plans WaiY6 11 Certified _. Plot .. PI a n Stamped Plans El Building Department The foli�-awinj is a -list of the required forms to be filled out for the appropriate.permit to be obtained. Roofirig, 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 10TE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application L3 Certified Surveyed Plot Plan o Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Ei 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 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 Mass check Energy Compliance Report 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 app�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording rmist be subrn'Ated with the building application Doc: Doc.Building Permit Revised 2012 Plans Submitted D Plans Waived -11 Certified Plot Plan 11 Stamped Plans F1 TYPE.-OF-SEWERAGE.DISPOSAL Public Sewer TanningIMassage/Body Art ' El. -Swimming Pools Well El Tobacco Sales Food Packaging/Sales D Private (septic tank, etc, E] Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED - DATEAPPROVED PLANNING & DEVELOPMENT El T1 COMMENTS CONSERVATION COMMENTS H, H E A',' T ' COMMENTS Reviewed on Si-qnature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfrecelpt submitted yes_. - Planning Board Decision: Comments Conservation Decision: Comments Water Sewer Con necti on/Signature & Date Driveway Permit DPW To-jv;2 tugineer: Signkfire: LOcatea 6M USgooci btreet FIRE -EINT'­ Te'Ob"D'ump§ter on sit e yes ._no '�bcated at"! 24 Main Strd.et Fire Qeparfihefit.s1gii WrOldatb a COMMENfS* 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 21 A —F and G min.$100-$1000 fine Doc.Building Pennit Revised 2010 Locatio N o. Dat�-/�/�- TOWN OF NORTH ANDOVER Certificate oi Occupancy $ Building/Frame Permit Fee d Foundation Permit Fee F -b Other Permit Fee $ TOTAL $ Check 6-*� 6-4"- 26471 1 Building Inspector z r- 0 0 CD 0 —4 cc CD CD " 55, 3 = -n " a) CD ai — m w 3 0 91 -n CD CD " CD 0 0 CD 3 = -n -0 CD 0 c "D cn CD W 0 "0 CD CD -11 .O< m 0 (D 0 CD z -Ga 0 m m Enter constr - uction cost for fee cal - North Andover Fee Cakulation Construction Cost —$ 1 %000.00 m $ - $ 228.00 Plumbing Fee $ 28.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.50 Total fees collected $ 385.00 255 Mass Avenue 832-13 on 6/4/2013 New Kitchen Cabinets, Tile Kitchen and Bathroom Floor I U3 w U3 > Ln Tn r- 0 0 C) Q =� m �! M �3 0 0 a- Z 0 0 —Z 0 cn �o fn C) o r- :� C) Z— U) ni Fi. = z *o to 0 rn UD c U) a] S. (A --i Al :C;a* rn 0 V) > �o a. — Ila r- 3 00 V) cn 00 un OM m C U3 rn 1\ It\ 0 -4 0) CD 0 -4 cn m The Commonwealth ofMassachusetts Department ofIndustriqlAccidints 12 Office ofInvestigations 600 Washington Street Boston., MA 02111 vwW.mass.gov1d1a Workers' Compensation Insurance Affidavit: BufldersfContractor�[ElelctriciansfPlumbers Ap-plicant Information Please Print Ledb &)A '14 r Name (Business/Organizationlfndividual): LAkA Address: �D6;' C-PeSS -ST, Phone#: Are you an employer? Check the appropriate box: - I - D I am a employer with 4. El lam a general contractor and I employees (M and/or part-time).* 2. U11 am a sole �ropiietor or partner- ship and'have no employees working for me in any capacity. [No workers' comp. insurance required.) 3.E1 lamahomeowner-doingallwork myself. [No workers' comp. hisurance required.] t have, ned the sub-coiitraGtors listed on the attached sheet. These sub -contractors have workers, comp. insurance. 5. D 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 requiredJ Typp of project (required): 6. New OASttuction 7. Remodeling 8. E] Demolition 9-. [].Building addition 10.[] E lectrical repaks or additions 1I.ElPlumbing repairs or additions 12111 Roof repairs 13.E1 Other '�Any applicant that checks box#1 must also fill outthesectionbelow showing their workers I compensation policy information. indicating such. I Homeowners who submit this affidavit indicating they ire doing allworkand then hire outside contractors must submit a now affidavit tContractors that check this box must affached an additional sheet showing the name of the sub-contraotors and their workers' comp. policy information. lara an employer that 1sprovialng Workers'compensation insuranceformy enployeeN. Be10JP is the.POMY GnJi0b site information. Insurance Company Policy 4 or Self -ins. Lic. Expiration Date: ------------ = Job Site Address-, pity/StatelZip: Aftach a copy of the workerO comp ensation policy fleclaration page (showing the policy number and expiration dvife). Fail -are to secure coverage as requiredunder Section 25A ofMGL 0. 152 can lead to the imposition of criminal penalties of a fine up to $1,50 0.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOp. WORK ORDER and a:rma ofup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwardedto the Office of Investigations of the DIA for insurance coverage verification. I do h'erAy c ertify u n der A e F a in s an dp en a [ties ofp erju ry t7l at t7l e inform ation pro vided a b o v e is tru e an d c o rrec t Sim i)ate: C, �o a l.'a Phone 4: 2- 1 Z 7.0 Official use only. Do not tPrite in this area, to be conpletedly chY or toWil Official City or Town: Permit[License# Issuing Authority (circle one): I.Board of Health 2. Building Departnient3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Information and Instructions. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an em . ployee is defined as "...everyperson in the service of another under any contract ofhiro,. express or implied, oral or written.,, An ein ,vloydis defined as "an individual, partnership, association, corporation or other legal entity, or any two or more Of the foregoing engagedlu ajoint enterprise, and including the legal representatives of a deceased employer, or the r0ccivcr or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house, havmig not more than three apartments and who resides therein, or the occupant of the dwelling house 6f another who employs persons to do maintenance, construction or repair work on such dwelUng house or on the grounds or building appurtenant thereto shall not because of such employment be doemod 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 forany applicant who has not produced acceptable evidence of compliance with the insurance coverage requ,ired." Additionally, MGL chapter 15�, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic; work until acce lee on 0 PR nce with the insurance ptab vid c of com. a requirements of this chapter have been presented to the contracting authority." ApplicaUs Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to �our situation and, if necessary, supply sub-contractor(s) name(s), address(es) andphone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cany workers' compensation insurance. If anLLC orLLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirm�ation of insurance coverage. Also be sure to sign and date'the affidavit. The affidavit should be returned to the city or town that thic 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 aworkers' 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 printedlegibly. Tfie Department has provided a space at the bottom of the affidaWt for you to fill out in the ev6nt the Office of Investigations has to contact you regarding the applicant Please be sure to fill in & penrit/lice'nse number which will be used as a referenc.o number. la addition, anappliGant that,�Wst submit multiple pamit(liccuse applications "Many given year, need only submit one affidavit indicating current Policy information (ifnecessary) and under "Job Site Address" . the applicant should write "all locations in -(City or town)." A copy of the affidavit that has b can officially stamp ed or marked by the city or town may b a provided to the applicant as proof that a valid affidavit ii on Me -for future permits or licenses. A new affidavit must be filleLd out each year. %ere a homeowner or citizen is obtaining a license or'p-ermit not related to any business or commercial venture 0.e. a dog license orp"armit to bum leaves etc) said person is NOTrequired to complete this affidavit.' The Office ofInvestigations' would like to thank you in advance for your cooperation and should you have any questions, pleas a do not hesitfte to give us a call. The Department's address, telephone and fax number. The Cowmojawoajt� of Yas�or,-h-v Dapartraeut offadugrial Acoldonts Ofte offlimilgatiolls 60 0 Wwhingtaa Sfx��- t Bostp, MA 021 It TO, # 617-72.7,49 0 0 Qxt 4 0 6 or 1-8 77-�MAS SAFE U) CD O -Z f-11. o CD CL r- m a) 0 m = rmll o It Cl) om 2: r- m cn U) > 0 _0 -a m 0 0 >< Z -0 Cl) 0 CD o z m CL CI). cr z CD CD 0 z CD Cl) 0 CD z -0 CD 'It 0 W cn CO CD ;z Cl) U) 0 '0 Z CD 0 0 0 CD cl): a . -0: 0 m < 0 CD --i o: 00-0- 0 - 0 .r- 0s I Ir > M 'o, 0 c) CL C) M = !;.c X z 0 0 U) --q 0 = �L ZD-- Ln. �5- 0 0 — CL 0 i -Ti CD CD cin) m U) 0 —j CD 'V - 0 ID r.L s U) CD = 0 t CL 0 2) 0 U) Err CD CD CD -0 0 to (a 0 cn UP CD 0 = U) '0 Z CD 0 0 --s - cr !ft E. CD > 0 r .L 0 0 r. L CD C<D W CD < CD CL CD mu) CD 0 : 10 0, CD CD in CD CD A) CL Lf) 0 X, (D (D LA (D rl) z :3 (D m m M > -n 0 -n 5 3 Ln M 1 5 . r) 0 C m r- m > -n aL 0 C crq =r r— aL ::r f =3 (D < ;;o 0 C: Oro =r 0 C :3 CL cu 0 :3 w P 2 z m 'a L-) M 3 -n 0 0 CL 0 m z m 0 z (A V m 0 V rm 0 z Un M m 0 m v Lj !pr LSamiphe C This folm satis:Res all b ements of the s�ate!s Home Improvement Contractor Law (MGL . chapter 142A), but does not include standard language to protect homeowners. See] legal advice if necessary. Any person planning home improvements should Erst obtain a copy of "A Massachusetts Consumer Guide to Hojae Improvementubefore, agreeing to any work on your residence. You may obtala a free copy by callilig the Office of Consumer Affairs and Business Pcgulation!s Consumer InfolmationHotline at 617-973-8787 or 1-888-283.-3157 or on our w6bsite. Homeowner information *Contractor Imformition — StreetAddress CdO nOtUsO a �P=Officc Box address) City/Town LJ1 UtA — Mytime Phone � C / � — zo/— r state 'Zip—C—ode Mailing Address (It different from d ;Z i S—�Z ��ig —phone - L tx — I Uontractorl Salesperson/ Owner�Name T7,,e-,,oA)^- J/* J�Psmess Auctress (mast includea street address) X0 5� 6T, Cityllown State Zip Code Business 3ne Federal Employer ID or S.S. Number L -,1W requires t1i.1t raost 110me Explmfion date ImPrOWInent C ntractors have a willd registratZon nu inber c� The Contractor agrees to do thb following work for the Homeowner: (Describe in detail the worjc to Completed, sPecifYingthc tYPe, brand, and grade Of materials to be U�ed, ji-s_eadditional she ,S ,l e --C - �,-S, k� �Z- Re4uir Permits -- T'he followiig building permits are required Proposed St' art and Completion, Schedule - . The following schedule Will and will be secured by thecontractor as -the homeovmer's agent: be adhered to unless circumstances beyond the contractoes control arise (Owners who secure their Own Permits:WiR be excluded from the Guaranty Fund pro-,isions of �J' Date when contractor Will begin contracted wor1c. MGL chapter 142A.) —V—LDj—'I/--]Date when contracted work will be substantially completed. Amu' u0nixactvrice and Payment Schedule The Contractor agrees to p erfolm the wOr1c, fmnish the material and labor specffi- ed above for the total sum of. Payments will bemade according to the following schedule: -4A� �- �(*) $AX,S0—, Okupon sigriing contract (not to exceed 1/3 of tile total contract price pr the cost of special order items, or upon completion of 4-94p- $ by or upon compl�tion of e, i upoll completion Ofthe contract. (Law forbids demanding fan Paymcn5tRUZ-GG�tract is completedto both partys satisfaction) The f0llOwing material/equiPment must be special to be for ordered before the contracted work begins in order 'or to meet the completion o Xbbe paid for NOTE, S: (1) Including all finance, charges (**) Lawrequires that any deposit or down -payment required bythe contractor beforeworkb may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of my special equipment or custom megaffidesmaterial which must be special ordered in advance to meet the completion schedule. larranty being provided by the Contmetor? F, -yes 11 Subcontractors - The contractor agrees to be solely resp - MICS "Ilte soithewnrran,-Vznustb�.��� PartYlsubcontractor utilized by th onsible for Completion ofthe Work described regardless ofthe actions Ofanythird c Contractor. The c0ntraOtOr further agrees to be solely responsible for a paymentsto materials and labor 'Under this aM6em It aJl subcontractors for Contract Acceptance - Upon signing, this document becomes abinding contract -qhaU not imply that MY lien or o erse contract under laW. Unless otherwise noted within this doc lr� his contract. en placed On the residence. Pleview the f011Owing cautions and notices carefally before signing t th curitY interest has be ume the • Don!t be pressured into 0 s'guing the contract, Take time to read and fuliTtInderstand it Ask questions if something is unclear.. Make s Me—t—he colitractothas a valid Rome I IL tr gistrati mProvementCon _actorRe on. The law requires most home improvement contractors and subcontractors to be registered with the Director ofi-lome improvement Contractor Registration. You may inquire about contractor registration by writing to tha Director at 10 Par1CPlaZa, Room 5170, Boston, MA 02116 or by calling • Does the contractor have insurance? 617-973-8787 or 888-283-3757. Ask the Contractor for his insurance company information so that you cau confirm coverage, or asic to see a copy of a "Proof of Insurance' document aOw Your lights and responsibilities. 1�ead the Important Information oil the reverse side Of this form and get a copy of the Consumer Guide to the Rome Improvemml Contractor Law. Youmay cancel this agreement if ithas been signed at aplace other than the contractor's normal place of business, provided younotifythe contractor in writing at his/her main OfF, cc or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midmight Ofthe third business day follo wing the signing ofthis agreement See the attached notice Of cancellation form for an explanation ofthis right DO NOTSIGN TMIS (UONTRACT IF THERE ARE ANY IMAM< SPACE SM Two identical copies ofthe contract must be completed and signed. One COPY should go to the homeovmr. The other COPY Should be kept by the contractor. Homeowner's Si ature Uontractor's Signatare 'Date Date Confracior Arbifxifion The Home Impiovement Contractor Law provides homeowners with the riglit to initiate an arbitration action (as an. 'alternative to court action) if they have a dispute with a contractor. The same right is not automaticpUy affordedto a conttactor, however. The contractor would have to resolve any dispute he/she has 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 azf�orded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby �nutually 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 ffim which has been approved by the SecretaT of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitra�qz asprovided In Massachusetts General Laws, chapter 142A.. Contractof s Sigriatare . . di R61-C(3�vnees Sipatw NOTICE: The SignatL Kes-of the 'parties above apply only -to the agreement of the parties to alternative sp to resolution initiated by the contractor, The homeowner may initiate alternative dispute resolution even where t1ais section is not separately signed by the parties. Homeowner's Rights A homeowtier's rights under the Home Improvement Contractor Law (MOL 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 prpperly registered as prescribed by law. Homeowners who secure their own building permits are automatically excludedfrom all. Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as ' describecL in a timely and workmanMce manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmatiship or materials. In addition to gaarantees or warranties provided by the contractor, all goods sold -in Massachusetts carry an impliedwarrauty of merchantability and fitness for a particular purpose. An enumeration of other matters on -which ffe homeowner and contractor lawfally agree may �e 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�our . 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 e-Aibits and referenced documents have been attached. Parties axe also advised not to sign the document un -til all blank sections have been ffiled in or marked as void, deleted, or not applicable. One original signed co-py of the contract with attachm6nts -is to be gi7en to the owner and the other kept by the contractor. Any modification:�-o the. original contract must be in writing and agreed to by both parties. Contracted work may not be J -=tilbothpardes have received afu�y Z=,Lted Qopy of 9111 the contract, and the three day rescission period has expired. Accelerated Payments A contractor may not demand PaYments in advance ofthe dates specified on the.payment scliedule 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 ftds not yet due be placed in ajoint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fimdp from said account would require the signatures of both parties. AAditional Wormation In th If you. have general questions or need additional intbrmation about the Home iprovement Contractor Law or o er consumer rights, or if you. wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Impiovement" contact: Consumer In ormation Hotline Office of Consumer Affairs and Business Regulation 10 Paric Plaza, Room 5 170, Boston, MA 02116 . 617-973-8787, 8 88-283-3757 or visit the OCABR website at liZ://wv�Nv-.mmL.,90—v/oc,-Lbr/ If you want to verify the registration of a contractor or if you have questions or need additional irdormatim specifically ab out the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration office of Consumer Affairs and3usiness Regulation 16 ParkPlaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the I -11C website at b=-//Evnv,.inass.gov/oc r/ Go online to view the status of a Home Improvement Contractor's Registration: Wi)-//db.state.rn,,i.tis�iol-neum 3rovel-ne-nt/lice-nseelist.,:qsl) F or assistance wiffi informal mediation of disputes or to re isier formal complaints against a business, call: 91 Consumer Complaint Section Officp of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114. Version 2.1 - 11/22/2010