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HomeMy WebLinkAboutBuilding Permit #694 - 272 MASSACHUSETTS AVENUE 6/15/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 4 Date Received Date Issued: I IviacnmeM--,)nop viiiage yes/ no 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 WORE( TO BE PREFORMED: . Sliptle -If Identificatioon Please Type or Print Clearly) Y OWNER: Name: ] % 0 lz� Phone: Address: CONTRACTOR Name: A Ir\ G - Phone: `I -' 7 f77 Address: t� T � /� jet -c..� 5-e,vn Supervisor's Construction L""icense:L Exp. Date Home Improvement License: 1 % J '� EXp. Date: a 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: C) FEE: $ Check No.: t)- (T� Receipt No.: NOTE: Persons contracting wi ;unregistered contractors do not have access to the guaranty fund ger Signature of contractor_ 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) L3 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 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature a COMMENTS 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: Located 384 Osgood Street FIRE DEPARTMENT -'Temp. Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 '137— lM SS's' f44 -.e--' No. Date �aRT� TOWN OF NORTH ANDOVER AL F 9 Certificate of Occupancy $ --__ Building/Frame Permit Fee $ s�CNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22) 14 , Building Inspector massaehusetts Home Im �'ovement Sam le Contract F4n satisfies all basic requirements of the state's Home Improv, fie o protect homeowner's. Seek legal advice If necessary. An Contractor Law (MGL chapter 142A), bat does not in standard arts consumer guide tohomeimprovement" before s airs to person planning home impericrovements shotild friar obtain a copy of "a may ra onsumer Affairs and Business Regulation's Conswner Inf nna on HotlinanyWork e t 61You7-97re your x8787 or 885-283-375 tee copy by calling the Romeowner Information 5 I o j Contractor Information ame mpany setan .� Street Address (do not use a Post Office Boy, s) Ail `� % �'-*I6 ' l� - /I /1 Cantrr/ 5e]espersoa/ pwaer Name _ CiryffowaState Zip Code usiness Address (must incl ude a street addresa) Daytime Phone4 Evening Phone ty/Town State Zip Code iviaiiing Address (h different from above} T usiness Phone ede al fimplover ID or S.S. Number. • lau•re9uirosthat most Lnmc ml. Home tmprovemmtCaompm vel conoeame levee .) '>kR'• NomMi I Exrrinnon dere The Contractor agrees m do the following work for the Romeo ne tsa nonmmtber I n) sn ! �/ ✓� U J/V/G V P m • e yp^y rax , o e e r ee r TtZpp (?t- a00r, F ired Permits -The following building permits are required Propped Start and Completion Schedule - The following schedule will. ill be secured by the contractor as the homeowner's agent, be adhered to unless circ ners who The o recur • ire ande thea own permtta will be Y the contractor's control arse ded from the Guaran r. Funic .tj provisions ofDate whencontractor will,eL dhapter 142A.) gin contracted worts �4-14 Date when contracted work will be substantially completed. __j Total Contract Price and Payment Schedule The Contractor agrees to perform the work, furnish the material and labor specified above for the total stmt of: Y 00 t 0 (') Payments will be. made according to the following schedule:. - $ upon signing fining contract (nor to exceed 1/3 of the tocol bonta act price or the cost of special order items, whichever is greater) b3' _/_/ or upon completion of y� _ _/ or upon compienon of �-upon completion of the contractdemon ' Law forbids ( ding full payment until contract is completed to. P both party's satisfaction following materiel/ tri eat must ) The e9 Pm be special S � to be paid for ordered before thargntracted work begins in order .$ to meet the completion schedule.("•) �--- to paid for NOTES: (•) Including a0 Horace charges ,'(""Maw textures that any deposit y the ceatraaor before work begins may not exceed the greater off(a)(a) oncrtlurd of the total centtactor dova-payment required b .price or (b) the acetal cost of say special equipment or custom made maraca! which must be special ordered in advance to meet the completion schedule: E ress�WarrahtH- .Ison ress:warranrvbei rhvided.hv.the.covtrsaor. Subcontractors The contractor agrees to be sole]y responsible for co • Nn Yes all terms of the warrantv.must be attached to the contract early/subcontractor utilized by the contractor. The contractor further amplevon of the work described regardless of the actions of any third renals and labor tinder this a ement grees to be solely responsible for all payments to all subcontractors for 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 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 full • Make ore the c ntre egg es a valid oma 1 rovement.Contract r Re istmiioersnnd it. Ask The law r questions. es S� home mpro e�irlte�trt contractors and subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may cmc ireabout contractor registration by writing to the Directorat One Ashburton Place, Room 1301, Boston, MA. tr do . by calling G17-727.3200 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 Information on the reverse -side of this form and get a copy of the Consumer Guide to the Home improvement Contractor Iaw. ,Ilur�d omay cease! oris agreement If' f it bas been signed at a place other than the contracmYs normal place of business, provided you notify the onnector in writing athis/her main office ar,ranch office by ordinary mail business day following the signing ofthis a Poste by telegram sent or delivery, not later than midnight of'the greement See the attached notice of cancellation form for an. explanation of this right DO NOT SIGN THIS CONTRACT IF T Two idrntirsl copies Of the canvaa.must bccompleted and signed. T HERE ARE ANY BLANK SPACESM WPY Should go m the homrm,•rnz. The othc copy should bt leap by the conheaor. Homeowner s Signature i a :C:ont-]ractorIs SigamDat/D e Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate anarbitration action (as an altemative 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 the dispute 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. General Laws, chapter 142A. Homeowner's Signature Contractor's Signature NOTICE: The signatures of the pa ties 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 signed by the parties. 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 fromcertain 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 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 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 consumerlhomeowner rights, contact the Consumer Information Hotline (fisted below). Execution of Contract The contract must be executed in durilicate 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 beet 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 original contract must be in writing and agreed to by bot parties, Contracted work may not begin until both parties have received a fully executed copy of the contact, and the three day recission period has expired, Accelerated Payments A contractor may not demand payments in advance of The dates specified on the paymentsebedule 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 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- ights, 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 1-(888) 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 of Building 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, call: . Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/Olt Better Business Bureau (508) 652-4800 (508) 755-2548 (413) 734-3114 =K*-rz=u-Ar= fW I IAAH ITY 11MISAMA MCF *M Aoidovei MA 0184) joHN LANZAFAME 0" ALL UNDER ONE RWI- 50 TEMPLE OR METHUF_N. 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Di tlelollS IE CA*C&tt W JK t0fll' 1n1, f emumm VAULi, ramANLA nD Sam,, to "*VCR TO no C—MATF PmLam WAMD To rw ( /-t rA I .1' 11 r f-, I fy)- -;7 1 / - , n ('$ 1. Strip all shingles from entire roof 2. Re– nail any loose plywood or boards 3. Any compromised plywood or boards will be., placed ere- placed at an additional cost of $50.00 per sheet or $2,25.00 per linear foot of roof boards. 4. Install heavy gauge 8" aluminum drip edge to all eaves and rakes. 5. Install 6" ice and water shield along all eaves and top to bottom in the valleys for winter protection. MA state code. Extra will be used on front low pitch area. 6. Install all new pipe boots. 7. Above the ice and water, install heavy 301b felt base sheet to the ridge. 8. Install IKO Cambridge style 30 year architectural shingles to entire roof. 9. Cut and install GAF Cobra ridge vent to improve attic ventilation. ( MA state code) 10. Counter -flash and seal chimney with black tar. 11. Building permit included. 12. Removal of all work related debris. 13. Shingles are covered by the manufacturer up to 30yrs. Pro -rated after 5 years. 14. Contractor workmanship warranty –10 years un- der normal conditions. 15. Install one mitered gutter comer if possible. If new gutter is needed. There will be an additional cost of 250:00 to install. ptance of Proposal—The above prices, specifics d. You are authorized o do the work as specified. of Acceptance:_ '`� t Total cost$ 8,800.00 -Chimney Options: Option 1- Cut and install all new lead flashing, same as when chimney was built. = $350.00 Option 2- Existing mortar joints on chimney are very compromised. We will cut or grind out all mortar joints about 3/8" and then install all new mortar to every joint, re -storing structural integrity. Also, in- stall new cement crown on top. = $450.00 Balance due upon completion Referrals available upon request Highly rated member of the BBB Thank you! *Very important note* OSHA regulations have become extremely strict this year. Contractors and homeowners are being fined daily in Mer- rimack valley. Our entire crew will be fully harnessed and tied off properly with ridge lines throughout the job. Also, we run an in-house crew meaning that these are our guys that have been with us a long time . No sub -contractors! We try to do everything in our power to make your project as safe and cost effective as possible. and conditions are satisfactory and are herby ac- nent will be made as outlined above. k� )i saN°t ' .�d c The Conv wnwealth of Massachusetts Department of ,industrial Accidents Office of Investigations 600 TT ashington Street Boston, MA 02111 I www_mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Piumbers aoiicant Inforexatinn Name (Business/orgwization/tndividual) /q(f l� Address: City/state/zip: Phone #:. Fes/ ._7 Are I 3. ❑ RN employer? Chec� appropriate box: I am a employer with �_ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors I am.a.sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity, [No workers' comp, insurance . workers' comp. insurance. 5. ❑ We aro a corporation and its required.) officershave exercised their I am a homeowner doing all work right of exemption per MOL Myself [No•workers' comp, c, 152, § 1(4),'and we have no insurance required.) t .employees. [No workers' ' cornp. insurance required.) Type of prefect (require: 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11 -11 Plumbing repairs or additions 12.0 Roof repairs I3.7Other 'Any eppiicartt tient checks bot;' f� 1 must also fill out the section below showin their workers' bom I t liomeowaer; who submit this affidavit indicatin th are iioin ail work B pensatron Poircy mformahon. ;Contractors that check this box rnusr 8 and then hire outside contmctats must submit a new affidavit iadiaz* such. atteh*d an additional sheet showing the name of the sub -contractors and their workers' com- . ^li• r P�j iefmmation. or am an employer th& is1ProtvW1ng:workers' cornpensatron insurance information. H7 m1' employees: Below h Po&Y andjob site Insurance Company Name: ' AV�1-1 Policy # or Self -ins. Lic. # Lnf . G b O q Vo 20 Expiration e: l CDt Job Site Address:_ City/state/Z" Attach a copy of the workers' compensation policy declar-ation pale (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 weii as civil penalties in the form of a STOP WQRK ORDER and 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 he cern nd a paints penalties of perjury that the informationprovided ove islirme and correct Si tore: Date: cc) Phone #: ficial ase nnfy. Do riot write in [his area, to be co let�d b or town o mP y rdtJ' fficia[ City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information a nd Instructions `^ Massachusetts General Laws chapter 152 requires all emp 3 oyers to provide workers' compensation for their employees. Pursuant to this statute, an eVloyee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." )' An employer is defined as "an individual, partnership, assodiation, corporation or other legal entity, or any two or more of the'foreping engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, associatioin 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 maintenance, construction or repair work on such dwelling house 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 ur 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 for any applicant who has not produced acceptable evidence -of compliance with the insurance coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither Ube commonwealth nor any of its political subdivisions shall enter into any contract for the pm fornnanee of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(ea); and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members orpartners, are not requiredito carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage., Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the .app.Iieation for.the permit or license is being requested, notthe Department of Industrial Accidents. Should you have any .questions regarding the law or if you are required to obtain a workers' compensation policy, please can the Department at the numberlisted below, Self. -insured companies should enter their self-insurance"Iicense number on the•appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which w-ilI be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy in.formation (if necessary) and under "Job Site Address" 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 fut= permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT.required to complete this affidaviL The Office of Investiptions 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 of Industrial Accidents Office of Investiisations 600 Washington Sheet Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.govldia N m m m C m m CA y m C= H CA CD d C � � d 'v O C2 Z Cn O. 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Mark rear,on Tnx' changc. Address Renewal Employment L.asi C aria Lweuae or ilWWW"GO wand for iadividal mw oah beforit, ttx cxpitstboo date, if hm:d txsara to: and Standardsdine A P12ft RM 1301 Boston. NIL 02M R LV4E RO(w IN LANZAFAME A WERRMACK ST -19 A` �� VA of l�� ����. 6taHaka , aiiitila.,achu.ctt. - Urlaualnacrtt of Public safcti 19 Board of Btiildiw, Ronikition% and Stand;iifis - Construction Supervisor License License: CS 139120 Restricted to. 00 JOHN W LANZAFAME 30 TEMPLE DR �. METHUEN, MA 01844 m Expiration: 4/3f20t1 f •uuui d nrc,' Tru: 1344.9 Nlw,�Nxwhu.c•to, - Delf ti•iniciat 101 Paibtac ti tfet� t3iuii t! .,f' 8uittliaa Rc�,;ui,ttittn. ante �t.anil:ii sl. Construction Supervisor License License: CS 69120 Restricted to: 00