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HomeMy WebLinkAboutBuilding Permit #584 - 266 MIDDLESEX STREET 4/1/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: ,—/ IMPORTANT:Applicant must complete all items on this page LOCATION S /'-?LOP e, e'-X 9 / ;Ilf Ptint PROPERTY O NER Print MAP NO: PARCEL:47 ZONING DISTRICT: Historic District yes I Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family �� Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: eP9.&r, Z0.6 dyS7—,gL1- A16 V 1-310y .t' P,G /,Daat'e.. Identification Please Type or Print Clearly) OWNER: Name: MJIR*7-#A 6clG )64'1-zS Phone: -74f Address: CONTRACTOR Name: -t'Sams. Phone: 9 ,E-eo&e-(o73",7 Address: J.g F60945�7_� A/0_.0 Al,0 Ue,� J*2 �, Supervisor's Construction License: 0214K Exp. Date: 0&11b [.Home Improvement License: /03 e Exp. Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P96IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST,BASED ON$125.00 PER S.F. Total Project Cost: $ ' /�i , �f�� y`� FEE: $ Check No.: �1 -'(� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Siignature of Agent/Owner Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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) ❑ Co ofC Contract o act ❑ 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: Doc.Building Permit Revised 2008 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/]Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales f I 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 submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FlIkE DEPARTMENT Temp Dumpster on si yes no Located at 124 Main Street :`Fire De=partment signature/date I 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 Location, gg�,0414�'x No. Date MORTM TOWN OF NORTH ANDOVER F � 9 a Certificate of Occupancy $ + a NUEta Building/Frame Permit Fee $ AC S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #,a, qq� 1 f 2 2 G 91 �---� Building Inspector Masacht1wtts - Department of public >afeO Board of Building, Re'-julation, and Standard Construction Supervisor License License: CS 22680 Restricted to: 00 x ARTHUR J WALSH JR 55 PLEASANT ST �.., N ANDOVER, MA 01845 Expiration: 61g/2010 Tr» 27002 ��iv toa�nrno�arue o 6[asa�u�ae6 Board of Building Regulatio sand Standards -/ HOME IMPROVEMENT CONTRACTOR Registration: 103358 ;a Expiration: 717/2010 Tr# 271352 Type: Private Corporation ration A.J.WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover,MA 01845 Administrator Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: / Job Name Job# Address - Job Location Date Date of Plans Phone# 6J,5-- /sem.- Fax# 7A—rclitect FWeherebysubmit specifications and estimates for:.........-..........................................._.........-- -.._......_................_.....- ----............_........... __._..._........_......_._........................_......................_----......_....._...._............._..__.._............................... �r— ..._._._._ ------���- ---- __lam_--� _ . r�_U�r�/ -----._ _.. --------__ .__-. -----------__.___.__ .....__...._._....--...__._....._.-.__.._ _%Y °' __.....-Gzr ..... G_ %''- ___--.---.--_-.--_-------_-____:...._.............-----_.____......._..__.____.__...__.._... _............_.._..................___:..- ----C ..---------c_........_.._..__._._..__._._.._..___..__._--.--..___.-.__...____._. .. �� ,� _. __._...._.........._...._._ _ .. ......e....'...... ........ _.._._..._ ---- _.....---__ ---------------------------_......_._...._..._..._... _..__..._... _.............._..........._..........._...._..._._._._...._ .._._ _ ,C-... . �1� - .. _............_...._..---......_........ 9 .............._...._..--1--l-........................................... F7propose hereby to furnish material and labor complete in accordance with the above,specificat`ions for the sum.of:. 0 -�� u-C fix/ .Gf��'� l���l �d� Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be /RespeC ully executed only upon written order, and will become an extra charge over and (%submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. 01cceptance of PeoPo at The above prices,specifications and conditions are satisfactory and are Signature w hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature The Commonwealth of 1►1assachusetts _ Department of Industrial Accidents Office of Investigations ioy 600 td'ashington Street Boston, AM 02111 ngvw.mass.g ov/dia Worhers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunibers Applicant Information Please Print Le ibl J latne. (Business.'Orgarvzation'Lidi%iLa!): 4-j W-A LSRCt Address: Pt Z46#/Pr 51,' City/State/Zip: Phone #: 197t -6-:W-11737 Are you an emploper? Check the appropriate box: � ' Type of project (required): L.�'l am a employer ,.v'ith 4. ❑ ] am a genera] contractor and I employees (full and/or pari-time).* have hired the sub-comractors 6. ❑ '`law construction 2.❑ i am a sole proprietor or partner- listed on the artache.d sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. [No workers' com insurance 5. 9 ❑ Building addition ( p. ❑ We are a corporation and its required j officers have exercised their 1.01❑ Electrical repairs or additions 3 ❑ I am a homeowner doing all work right of exemption per MGL I I ❑ PI nbing repairs or additions myself. [No workers' comp. c. 152, §l(4); and we have no 12. Roof repairs insurance.required.] t employees- [No workers' comp. insurance required.] 13.❑ Other Any applicant that checks box t;1 mus also fill out the section below showing their workers'compensation polio,information Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most it submiew affidavindicating such. on tractors that checl:this box must attached an additional sheet shoe.ing the name of the suLt e n�cgniractors and their Workers'comp.policy information. am an employer.that is providing workers'compensation insurance for n+h employees. Below i� the policy and job site rformation. \ tsurance Company Name. Y M l'7l/J�G� JMS GD :licy #or Self-ins. Lic. 11:_ 4�0/�1lodl7,0014 Expiration Date: /Ik/l/bo ,b Site Address: M1 J 0&e,-S&X 6'f Ciry/State/Zip:_ 14))9 12d,111Z Mfg' ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ie up.to 11;500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office vestigations of the DIA for insurance coverage verification. of 'o hereby cem under the pain and penalties of perjur,,that the information provided above is true and correct. mature: Date: one#: Official use only. Do not write in this-area,to be completed by ch),or town official. City or Town: Permit/License # Issuing Authority(circle one): t. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector S. Other :70niact Person: PhnnP 11- MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfids all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A) but does not inelude standard language to protect homeowners. Seek,legai advice if necessary. Any person pla tmmg home ihtaprovement9 should first obtain a-copy of"a Massachusetts.consumer guide to home•improvement"before agreeing to any work on yourresidence.You may obtains free copy by'calling the Office of Consumerhil'airs:and Business Regulation's Consumer Information Hotline at617-9734787'or 1.888+2834757.- Homeowner Information Contractor Information . Mame Street Address(do not usopk Offise 9&oxad Carltractor/ Owner Name` Cityfrown State Zip Code I hismoss Address(must'°�c��e�a street Daytime Phone Evening Phone., Atyrrown � � S Code Mailing Address(It different from above) aces Phone ederal Employer ID or S.S.Number ' Ino Mgfre,Wt man haeoei- Hoorn CamsorReg.Number mmmmmro� (j mahmammmbe I The Contractor agrees to do the following work for the Horueo nor: Q-365i- j 6yllawl RequiredPermits-:The-following building permits are required Proposed Start and Completion Schedule-The fdllowing 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 excluAedl,from.theGuarantyFuiidorovnionsof when contractor will begin contracted work. MGL chapter 142A.) to when contractbd .work will besubstantiaily..completed Total Contract Price and Payment Schedule , The Contractor.agrees to perform the work,fitmish the material and labor specified above for the total sum of: 1,4., W r • Payments will bepygde according to the following schedule: Oupoon.sig�ning�contract(not•th exceed 1/3 of the totel:contract price,gr the costmf speci`1 order items,whichever is greater) —by_// or upon completion of } /�$ by _/_/ or upon completion of e�—' " 0 t$upon completion of the contract (Law forbids demanding full payment until.wntract is completed to boot party's satisfaction) The following mater Wequipment 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:(h Including all finance charges(••)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greeter of(a)ane-third of the total contract price or(b)the actual con of any special.equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is in oxyress warranty heirs nrnvid..t by the contractoel No d tall tefmR"f the N . Subcontractors The contractor agrees to be solely responsible for completion of the workdescribed regardless of the actions ofany third Party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aerecment 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 inter est)tas been placed on the residence Review the following cautions and notices carefully before signing this contract • Don't be pressured into sighing the contract Take time to read and fully understand it Ask' * :; '%xz • 'Make sure the contractor has a valid Home Imnmvement Contractor Registration quCSres >f soniamg is dear• The law requires most home improvement contractors and. subcontractors to be registered with the Director ofHome Improvement Contractor Registration, You may inquire about.cont actor . registration by writing to the Director at One Ashburton Place,Room 1301,Boston,-MA 02108 or 617-727-3200.or . 1-800-223-0933. �' • Does the contractor have inti ance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the revetsip side of this form and get a copy of the Consumer Guide to the Home Idtprovement Contractor Law: You may cancel this agreement if it has been signed at a place other than the comractm's normal place of business,provided you notify the contractor in writing at his/her main office or branch office ordinary mail by ry posted by telegram sent or by delivery,not later than midnight of the thrid business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of.this ri ht g DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two Iderhol copies of the wormer"mat beh ted ere � dsryoed Oashould c•Pr io to the homeowner.rhe othc Dopy ahouW be kept by the contraaar. .. Homeown ' er s Si mie Contractor's Signature Date Date Contractor Arbitiai9on The Home Improgemeat Contractor Lawrovides:homeowners withtheright-to•initiate an arbitration action(as an . alternative to court action). ction)if,they ,have a;dispute with a contractor. The same rightis not automatically afforded to'a. contractor,however. .!The contractor.would 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 has been.approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation andthe consumer shall be required to bniit totesuch �arbitration as provided In.Massachusetts General Laws,chanter 142A. Homeowner's Si re Contractor's Signatu NOTICE:•The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative:dispute resolution even where this section is not separately signedby`.the patties:.' 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 responsible for completing the work as described,in a timely andworkmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees. or provides an.express warranty for:workmanship oi•materials. In addition to.guarantees or warranties provided by the contractor,all goods sold in Massachusetts cavy an implied warranty of merchantability:and fitness_fora particular purpose. An enumeration of other matters on which.the homeowner and contractor lawfully agree:maybe 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 Tgmal 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 orgy 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 that the balance of funds not yet due be placed in a joint escrow account as a prerequisite tocontinuing 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 s fi ee:copyof"A Consumer Guide to.the Home Improvement.Contractor Law,".contact: . Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,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,additions]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 (617)727-3200 ort-800-223-0933 For assistance with informal mediation-of disputes or to register formal complaints against a busmess,-call: Corisini er`Complaint'Seetion Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 TAO R T'HI Tovm of 4Andover 0 VO C, dower, Mass., v T 0 - LAKE A. COCMICKEWICK V ADRATED `s BOARD OF HEALTH Food/Kitchen PERM Septic System BUILDING INSPECTOR IT D THIS CERTIFIES THAT........./ . .... ... . / s4L /!!t .....A ... .. Foundation •has permission to erect............. ... ................... 'Idings on� ....... .��.. � .... Rough to be occupied as............... *'..... ........ . . ,Q ~........................................................................ Chimney provided that the person acceptin his permit shall i every r ect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws r ting 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 ( 46 ,* PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S ARTS Rough ... Service B ING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.