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HomeMy WebLinkAboutBuilding Permit #174-16 - 261 MIDDLESEX STREET 8/7/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION s Permit N0: — l Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LQCATION I . -� r b �t`' Tit/• 1 ! C.. r f PROPERTY OiNNER _- ____ C/MAP, NO CJ. _ 10o Year Old Structure yesn- PrintPARCEL;��� ZONfNGDISTR[CT _. .Historic District ye Machine Shop Village ye TYPE OF IMPROVEMENT. PROPOSED USE Re ' ntial Non- Residential ❑ New Building One family ❑Addition Wfwo or more family ❑ Industrial ❑Alteration i n No. of units: 11Commercial [I/Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑-Septic ❑Vllell ❑ Floodplain, E Wetlands 0 Watershed District ❑',Water(Sewer a DESCRIPTION OF WORK TO BE PERFORMED: i e Identification Please Type or Print Clearly) s ) OWNER: Name: Phone: `�7 Y Address: 1cc 5+ /VI A rich f /q/4 - 76 - CONTRACTOR Name- t'y2..e 1��rfC_Ctlf ;Phone:. Address: cm ,r Late a nd�� o. ,Supervisor's'Q,Qn,,trU AiOn License: (, .- :Exp Date.. ? _. Home Improvement License �. r� j _ _ _ Exp Date �'��1_ - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �U® FEE: $ y Check No.: Receipt No.: 9fZ7 NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund -)-04-c-Ga- Si natureof*A ent/Owner_, _ Signature of contractor,; Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department :--The foi,'awing'"i9�'a=list of,the required forms to befilled outfor.:theappropriate.permit to.be obtained. RoofiFag, Siding, Interior Rehabilitation Permits ❑ ' Building Permit Application j o Workers Comp Affidavit Ll Photo Copy Of H.I.C. And/Or-C.S.L Licenses o Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dum pster..permits require sign off from Fire -Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses I� o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) _o_ Engineering_Affidavits for Engneered_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 o 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 Li Mass check Energy Compliance Report i o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casts if a variance or special permit was required the Town Clerks office must stamp the'decision from the Board of Appeals that the apnoal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:tted with the building application Doc: Doc.Buiiding Permit Revised 2012 i i Plans-Submitted❑ - Plans Vllaived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TYPE QF SEWERAGEDISP.OSAL ` Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales 0 •Food Packaging/Sales ❑ . . . Private(septic tank,etc_. permanent Dempster on Site El �- THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM _:._-DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS :CONSERVATION Reviewed on Signature I, COMMENTS HEALTH Reviewed on Signature . COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planing Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW To`r;-, Engineer: Signature: Located 384 Osgood Street FI RE DLPARTiI� Il9T.-:Temp Dumpster on site yes no Fire.D x ff �' s_ epartme►�tsignature/date COMMENTS Dim rasion Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land-area, sq. ft.: ELECTRICAL: Movement of Meter location, rust-or service drop requires approval of Electrical Inspector Yes No DANGERZONE LITERATURE: Yes No MGL-Chapter-166.Section 21A.--F and G min.$10041000..fne NOTES and DATA— (For department use El Notified for pickup - Date (E 1 I Doc.Building Permit Revised 2010 II - Location No. 17LI— 16 Date , 7 it • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ g Buildin /Frame Permit Fee $ ., . � Foundation Permit Fee $ A* Other Permit Fee . TED '. a TOTAL $ Check# b 6 � C. Bdildidg Inspector NORTH Town Of 2 t E ndover 0% I_ 14�1 _n No. _ - = - s Z h ver, Mass, O� V COC MIG C"t hl WICK � �d""ATE O S BOARD OF HEALTH U LD Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ...... ..... .. `? ✓... ..................................................... .. ....................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. ..:. �o..: .... .�<. 1.�. .�:x...<.�.. Rough F to be occupied as .... :Rg.�..................................................................... Chimney ...... . . ......:��p..... .... provided that the person accepting this 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 CONSTRUCTIO RTS Rough Service ............ ...... .... ............................ Final BUILDING INSPECTOR 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. 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 home 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 or on our website. Homeowner Information Contractor Information Name Compan ame p•� c Street Addres (do not use a Post Office Box addres Contractor/Salesp on/OwnerName City/1'ovm StateZip Code Business Address(must include a street address) - ar • r&!� " fe 5 Da me Phone Evenin-Phone Ciwr vm State Zip Code 7 _&? 7- -7 Re uc n 0,4 , v la's{ Mailing Address(It different from above) Business Phone I Federal EmployerlD or S.S.Number Home rue t hamasthome �rmpavem�mt C�mtmctorReg.Nmba ^Eapha hcndate finprorm. 116ava11dreg@amnioaaumbr !! The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary) S+r y-s- enoo_3 Lei Q C. Required Permits-The following building permits are required Proposed Start and Completion Schedule-Ile 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 excluded from the Guaranty Fund provisions of ���ewhen contractor will begin contracted work. MGL chapter 142A.) ate when contracted work will be substantially completed Total Contract Price and Payment Schedule �•� The Contractor agrees to perform the work,fiunish the material and labor specified above for the total sum of! Payments will be made according to the following schedule: $ (J upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $0 by / / or upon completion of $ 0 by / / or upon completion of $ 1 000 upon completion of the contract. (Law forbids demanding Rill payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any depositor doom-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the 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. Express warranty-Is an express warranty being provided by the contractor? ❑No 19 Yes(all terms of the warranty 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 fiuther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this a¢reement ContractAcceptance-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. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document • 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 contractor's 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 form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be co eted and signed.One copy should go to the homeowner.The otheruld ba kept by the contractor. e HomedV5 Signature Con tor's Signature Date Date DATE(MMIDDIYYYY) AC",F�'f> CERTIFICATE OF LIABILITY INSURANCE 05/2112015 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 02025-001 NAME CT Degnan Insurance Agency Inc Ac°ONro.Ext: (978)688-4474 Alc.No.: (978)327-6558 85 Salem Street EMAIL Lawrence,MA 01843 ADDRESS: INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: James Debrecini Family Roofing & Painting INSURER C- 2 Tanager Way INSURER D Londonderry, NH 03053 INSURER E 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. INSR TYPE OF INSURANCEDDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDIYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAM MISESS EAGE ( RENTED $ a occurrence CLAIMS-MADE r—]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY F_TER,0T- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Fa accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS Per accident r $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ M N A ION O STgTU- OT WORKERS CO PE S BTLITY X TORY LIMITS E AND EMPLOY S' IA 1 E.L.EACH ACCIDENT $ 100 000.00 A o� Ic��PM MMBEA%�ETOJUB�&ECUTIVE Ya NIA AWC-400-7025900-2015A 5/11/2015 5/11/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The workers compensation policy does not provide coverage for James Debrecini CERTIFICATE HOLDER CANCELLATION Andover Town Offices 36 Bartlett Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover,MA 01810 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety- ' Board of-¢uildirig Regulations and St an - dards Construction Supenisof Specialty E� License: CSSL-099685 �. JDEB AMES J - i'TANAGER WAsY si ` CONDO0305- r f Expiration •. Commissioner 12/06/2015 '?• - ��e�oo�vnzaTzcuea�t�a��a�acc'c�ucaaG�J, !I _C�\ Office of Consumer Affairs&Business Regulation . ME 1110P.120VEMENT CONTRACTOR ill egistration: 1.22385 Type: ' zpiration: 8/26/2016 DBA I J&D WEATHERSEAL.. JAMES-DEBRECENI t� 2 TANAGER WAY LONDONDERRY,NH 03053 r Undersecretary ; I