HomeMy WebLinkAboutBuilding Permit #530 - 267 OLD CART WAY 4/9/2008Permit NO: t2 o
Date Issued: W 7 -�/ ` 0
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
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 ` `1 -611
Floodplain Wetlands
yl/a#er hed b�str.Ict
Weter/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
f .s oo 'tom
denlnfi tiopr,�lea e got_OWNER: Name: V V �i Phone: Qilt - M -17A (a
1 L,t7
Address: ato LAYZ�Typm �/� +�'' 1'r ,'�"
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: $ t , �] FEE: $
Check No.: % ! Receipt No.: 9 19 69 (o
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of .Ag
pp. 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
4
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:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
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
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
p�Workers Comp Affidavit
;Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o 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
o Certified Surveyed Plot Plan
o 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)
o 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)
o Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location
No. �;3 b
Date
i
NORM TOWN OF NORTH ANDOVER
10. 2
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L a a" Certificate of Occupancy $
Mu <� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
``,,TOTAL $
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Building inspector
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�.\ The Commonwealth of Massachusetts
.«� Department o
.f Itldustrial., , de,,&
�.. , Office o
r.i .f Investigotions
600 W
ashanaton Street
) BOSIO
n, MA 62111
,Workers,Werkersl Compensation Fnsuranee.AFivlt. g�ders/Contractors/Eiectrecians/Plumbe
QIicant Information rs
Name (Business/Organization/Individual):
Address: 91 N ti N n it < ,
City/StatelZip:_ Cj� P I- -
Are you an employer? Check the ap
1❑Ipropri— $te b��
P
Phone #: 78(- 3� � -0894 GOAL
aJ
rn a employer with 4. ❑ I am a -,nri al
2>ployees (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.]
3. ❑ I am a homeowner doing ail work
myself. [No workers' comp.
insurance required.] t
contractor and I
have hired the sub -contractors
listed cm the attached sheet I
These sub -contractors have
workers' comp. insurance.
❑ We are a corporation and its
officers have exercised.their
r' -ht of exemption per MGL
c. IS2, § 1(4), and we have no
employees. [No .workers'
comp. ins,, --
Type of project (required):
.6• ❑ New construction
?• modeling
8. ❑ Demolition
9. ❑ Building addition
10:0 Electrical repairs or additions
I I.❑ Mumbingrepairs 'oradditions
12., 11 Roof repairs
ce require LJ I 13 ❑Other
*An}+ appficettt.that checks box # 1 .must also fill our the section below showing thair workers com rtsation policy tnmrmatton.
t F-lotneowuers who submil •this agdavii indicating lite-,' atb tiutttr E?`iNC �' a
(Contractors that ehecl: this box *must attached-, '"' t'u men hirr Dicta{ cuntrarturs must submii a new a
an additional sheet showing the name of the b c-- mtiavit inci:stirtg seen.
S'`t"' uuudCtotS and their w—'v—'
—••••,•......f.avyc+ rruu rs• provuttrzg Work=( competuadon i -- --• •". "•,•"'.' unorndnr,�r,
information.. nsurance for ng' emuloyees. Below is theoli
p cy and job site
Insurance Company Name:
Policy '# or Self -.ins. Lie. #:
Expiration Date:
Job Site Address:
Attach a copy of the workers' compensation a City/State/ZtF:
Polie y declaration page (showitag the policy Dumber 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 50. S1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fin
in es to 5250.00 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. e
"`c paar[s ana penalises of periury that the information provided above is true and correct
Official use orzly. Do not write inthis area, to be completed h
J city or to wn of lciaZ
City or Town:
Issuilcg Authority (circle one):
1. Board of Health 2. Building Department
6. Other
'Contact Person;:
-�._ PermitlLicertse #
3. City/Tovvn Clerk 4. Electrical Inspector
Phone
S. Plumbing Inspector
Information c" .nd Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined. as ".. every person in the service of another under any contract ofhire,
express or implied; oral or written."
An employer is defined as `pan individual, partnership; association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and includi r:g the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than .three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintznance, constriction or repair work on such dwelling hoose
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state a r local licensing avency small withhold Nue issuance or
renewal of a license or permit to operate a business or to construct bubdiags in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither -the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the cont -acting authority." .
Applicants
Please fill out the workers' compensation affidavit completely, by checking the bores that apply to yoLu situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their cerrificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carryworkers' compensation insurance. If an LLC or LLP does have
_
employees, a policy is required. Be advised. that this afficLa.vit may .be submitted to the Departrnent of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. TheafFidavitshouid
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions re'-'Bi.r-ding, th-- lam, or if you are required to obtain a workers'
compensation policy, please call the Department at the nrzjrnb--r,lised below. Self-insured ca«panies should enter their
self-insurance license number on the appropriate tine.
City or Town Officials
Please be sure that the"affidak is complete and printed legibly. The Department has provided a spare at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the appiicant.
Please be sure to fill in the permitliicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/iicense applications in arty given year, need. only submit one affidavit indicating current
policy information (if necessary) and under "Job Site AddFess" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a licenses or permit not related to any business or commercial venture
(i.e. a. dog license or permit to burnleaves etc.) said person is NOT requited to complete chis affidavit.
The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department ofL-ndustrial Accidents
Office of LavestigatiFons
600 Wasl�gton Street
Boston, MA Q2111
Tel. 4 617,727-4900 C= 406 or 1-8:-77-MASS.4FE
Revised 5-2645
Fax 4 617-7-7-7749
v^ml.mass.gov/dia
�: -- AIasssachusetts - Department of Public Safctt
Board of Buildin�a Re,ulations and Standards
Construction Supervisor License
License: CS 60898
Restricted to: 00
4 ALBERTA ALIE
21 DUNCKLEE AVE
STONEHAM, MA 02180
Expiration: 9/20/2010
( om�nisi„ner Tr=: 2183
� ,per ./it¢ i/Jp.'I11i777.Q�2lUP.Q.U�L
AA
Board
Board of Building Regulations and St lfit-rds
HOME IMPROVEMENT CONTRACTOR
Registration: 161150
Expiration:_ 9/29/2010 Tr#. 275575
Type: DBA
AL ALIE CONSTRUCTION=_
ALBERT ALIE
21 DUNCKLEE AVE. "-
STONEHAM, MA 02180 Administrator
i�
j•jnnaiacausens home im r:ovement Sam le Contract
This form satisfies ell basic mquirements of the state's Home improvement. Contractor law (MGL chapter 142A), but does not include standard
language to protect homeowners. Seek le al advice if necessa An
Massachusetts consumer guide to home improvement" before a rY yrml; F -04 planning home improvements should first obtain a copy of,,a
Office of Cnaumer Aiiairs and Business Regulation's Consvme�Informatzon Hotline t your residence.
Yoor 1.888-283,3757.
ina copy by calling the
Homeowner Information
Contractor Information
the Contractor asrees to do the
ENL Aetol`
K C t45T'A Lt; frcu ba- Doo
Required Permits The following buil
ilii .permits are required Proposed Start and Completion ScbedWe -The following schedule will
and will be secured by the contractoras the homeowner s agent be adhered to unless
.(Owners who secure•their own permits vat :be c cucumsanoes beyond the contractor's control arise
excluded from the Guaranty Fund provisions of �' � 'b l
MGL chapter 1tS2 L) —Date when contractor will begin wntmcted work
_ ib -0 o Date when contracted work will be substantial) 1
Y Completed
axed.
Total Contract Price an' tl Payment Schedule
The Contractor agrees to perform the work, furnish the material and labor
specified above for the total sum of: 7C�O
Payments will -bb made according to the following schedule: (*�
S KSbU upon signing contract (not to exceed 1/3 of the total con
tract price Q the cost of special older items, wlvebever is greater)
by ---/ or upon completion of Fg 4vin i N
S 60 a by ^/ /_ or upon completion of "15 C
'2'P� i y
upon cdmpletion of the contract
(Law forbids demanding full payment until contract is co
mp}ettd to both party's. satisfaction
. The following material/egrripment must .bespecial S. .. )
ordered before the contracted work to be paid for
to meet the completion scheddle.("•)ias in order S to be paid for
NOTES: (•j Including all finavce charges ("•) I.aw req— that any deposit or down.payment requvsd� by the contra
not exceed the 6�seter of (a) oo t ttird of the total coot= price or (b) the actual cost of before
ore work begins custom made n�may
. which must be special ordered n advance to meet the completion schedule: any special equipmctor may
Subcontractors - The contractor c w —aor7. No Yes all sof a werremvmvstbe attached to he contract
agrees to be adlely responsible for completion of the work described
partylsubcdntractor utilized by the contractor. The contractor further a regatitless of the actions of any third
is and r.0 der 's t Sys to be adlely responsible for all payments to all subcontractors for
Contract Acceptance - Upon signing, this document becomes a binding co
ntract under w.
contract shall not imply that any lien or other security interest has been placed on the iadenRe�dtew the Ou=wse noted within cautions � c�ec the
carefully before signing this contract rss
• Dont be pressured into signing the contract Take time to read and fitli
• MAke sure_. the c actor has a valid Home t Vca1e„r Y understand it Ask questions if something is unclear.
St+b°°ntractors to be registered with the Director ofHomc improvement C ntractor Registration. requires most home improvement connectors and
registration by writing to Directorat One Aslibimon Place, Room 1301, Bosto Mg�non. You may thquireabout contractor
1=800-223-0933. n 02108 or by calling 61-7_727.3200 or
• Does the contractor have insurance? Checkm ace that your contractor is properiy insured.
• Know your rights and responsibilities. Read the. bnportaat 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 been signed st a place other than the contraetoYs normal lace of bus'
contractor in writing. at his/hermai office or bmneb office by ordinary mail. p provided you notify the
third business day follvw;vo n„ f posted, by telegram sent or by deli
Signature
r
gnmg o this agreement See the snatched notice of cancellation form for eo explanatiovery, notn of this w than midnight ofthc
IGN THIS CONTRACT IF TE MRF, ARE
—anka-Must be cmwlaed and signed. one ANY BLANK SPACESM
SPY rhoWd go �'Z thethe other
Qdt by she tovtratta.
Contractors Signature
Date
Contractor.Arbitration .
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an
alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor, 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 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 thedisptute to a private arbitration firm which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
to submit to such arbitration as provided In Massachusetts G eneral Laves, chapter 142A.
Homeowners Signature Contractor's Signature
NOTICE: Thesignatures of the parties .above apply only to the agreement of the parties to alternative dispute resolution
initiated by the contractor. The homeowner mai' initiate alternative dispute resolution even where this section.is not
.separately signed by the parties.
Homeowner's Rights.
A homeowners rights tinder 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
maybe 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 Improvemept-Contractor Law; The contractor is responsible for completing the work as described,. m..a
timely .and workmanlike manner. Homeowners may be entitled to 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 fitness- for a particular
purpose. An enumeration of othermatt= on which the -homeowner and contractor lawfully agree may be added to the
terns 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 originalsigned copy of the contract with attachments is to
be given to the owner and the other, kept by the contractor. Any modification to the original 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 may not demand payments in advance 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 to continuing the contracted work Withdrawal
signatures of both parties. of funds from said account would require the
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumeriights, or if you wish to obtain a free copy of "A Consumer Guide.to the Home Improvement Contractor
Law," contact:
. Consumer Information Hotline.
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
(617) 973-8787 or 14888) 2833757
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 ofBuiiding Regulations and Standards
One Ashburton Place., Room 1301, Boston, MA 02108
(617) 727-3200 or 1-800-223-0933
For assistance with informal mediation,of disputes or to register formal complaints against a business, rail: .
Consumer Complaint Section
Office of the Attorney General
(617) 727-8400
AND/OR
Better Business Bureau
(508) 652-4.800
(508) 755-2548
(413) 734-3114