HomeMy WebLinkAboutBuilding Permit #789 - 274 CHESTNUT STREET 5/2/2012BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: r
Date Issued: r Z I�—
IMPORTANT: Appli
'.PROPERT�IC�OI/VNER+�`��•`^I.p .--�
�MAP?Nb �Q=P.ARCEL� : t.IV� ZONrIa
Date Received
it must complete all items on this page
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;DISTRICT: HistonclDistnct yes no
z Y Machine ShopVillage yes, o
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
ne family
0 Addition
0 Two or more family
11 Industrial
e'Alteration
No. of units:
0 Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑Septic❑,Well
_
`p Floodplain;, ❑.Wetlands
�1%VatershedDlstnct
zvllater/Sewer
x _
DESUKIF I IUN UI- IMUMM 1 v tsC rmr-runwicv.
Identification lease Type or Print Clearly)
OWNER: Name: 8ry,A"j no) i � S 1
Address: C>^e5`j �}
•
Phone I
►CONTRACTOR: ,Name.: 1 �� �`: ,� M �s
Ad
q '1 I
SupervisorastCoristructionzLieense: L S_ Exp= `C
:LJ:,rr;.i:IrrinrnvomCn��IFI('.PtlCP7_ _ .�
ARCHITECT/ENGINEER Phon
• 9-1'-I- 9-.�6
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT.- $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
I
Total Project Cost: $ � FEE: $ (5-9
Check No.: `{ (3 Receipt No.: L �- S
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
zSignature;of,A ent/Owner _ Si nature of contractor::
Location_
No. -7709- Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #-��"' w
25254 Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBody 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
1
C(IMMENTS
HEALTH
COMMENTS
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:
IN
anii
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
r
�FIREDEPARTMENTr Temp�Dumpster�on
Located at 1243Main. Street
FireDepartmenttsignature/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
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
40TE: 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
VOTE: 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
N 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 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 DEPARTMENTMFORM07
Revised 2.2008
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Building and Remodeling
5 APPLETON STREET
NORTH ANDOVER, MA 01845
(978) 682 2023
Proposal Submitted To:
Bryan Cindy Foulds
274 Chestnut Street
North Andover, MA 01845
Job: Remodel Kids Bath
Start date May 5th
Finish date June 9th
HIC Lic. 120296 Expires 11/19/11
CSL Lic. CS 54718 Expires 6/8/10
1Proposal
May 1 ,2012
Home Phone: (978) 974-9267
Obtain building permit
Complete removal of all demolition and construction materials
generated by Testa Building and Remodeling and its subcontractors.
DEMOLITION:
Remove all cabinets and plumbing fixtures. Total gut the walls , ceilings and floor down to
the sub floor in the Bathroom.
CONSTRUCTION:
Install new under layment on the floor.
PLUMBING:
Rough in for tub and shower, toilet and vanity. Install new tub, toilet and vanity sinks.
Note: There is no allowances for plumbing fixtures
ELECTRICAL:
Rough and wire bathroom to code. Install a new fan light combo.
Note : There is no allowances for light fixture other than the one specified .
INSULATION:
Insulate the walls and ceiling to code.
PLASTER:
Hang new blue board and plaster the ceilings and the walls.
CARPENTRY:
Install all vanity cabinets and molding as per the designers drawings. Install new trim in the
kitchen around the doors to match the existing trim in the house.
COUNTER TOPS:
Install new marble counter tops for the vanity area.
TILE:
Install tile in tub area and four feet high around the bathroom and along the back splash.
Labor and adhesive supplied Tile supplied by owner.
VENTING:
Pipe the exhaust fan. Will provide all duct work needed.
THE HOME OWNERS WILL SUPPLY CABINETS AND PLUMBING FIXTURES.
THERE IS NO ALLOWANCE FOR PAINTING OR STAINING INTERIOR OR EXTERIOR
A finance charge of V/2% month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity is required the
customer shall be responsible for all costs associated with collection, including reasonable attorney's fees.
I propose hereby to furnish material and labor complete in accordance with above specifications,
for the sum of:
$12,768.00 Twelve Thousand Seven Hundred and Sixty Eight Dollars
One- third to start, one-third after rough inspection, one- third upon completion.
Authorized signature cm'�
I reserve the right to cancel this contract if not accepted in 30_ days
Signature 1
Signature.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
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 fust
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.
(Owners who secure their own permits will beAk
excluded from the Guaranty Fund provisions ofDate when contractor will begin contracted work.
MGL chapter 142A.)
Ess Warranty - Is an express warranty being provided by the contractor?
Ef
No
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 further agrees to be solely responsible for all payments to all
subcontractors for materials and labor under this agreement.
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 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 completed and signed. One copy should go to the,161mowner. The other copy should be kept by the contractor
Homeowner's Signature Contractor's Signature /
s � �
Date 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 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. `
W&J
Homeowner's Signature Contractor's Signature
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 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 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 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 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 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 rescission 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 of funds from
said account would require thesignatures 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 a free copy of "A Massachusetts Consumer Guide to Home
Improvement"
contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the OCABR website at http://www.mass.goy/ocabr/
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
Office of Consumer Affairs and Business Regulation
10 Park Plaza., Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
http://db.state.ma.us/homeiMprovement/licenseelist.asi)
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/OR
Better Business Bureau
508-6524800, 508-755-2548 or 413-734-3114
Version 2.1-11/22/201
NOTICE OF CANCELLATION
YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR
OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.
IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE
BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE
INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN
BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU
CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF
THE TRANSACTION WILL BE CANCELLED.
IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT
YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN
RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR
SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF
THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE
SELLER'S EXPENSE AND RISK.
IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE
SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF
CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT
ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE
TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER
AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL
OBLIGATIONS UNDER THE CONTRACT.
TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND
DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE, OR SEND A TELEGRAM TO [Name of Seller), [Address of Seller's Place
of Business] NOT LATER THAN MIDNIGHT OF 6') Y (date).
I HEREBY CANCEL THIS TRANSACTION.
Date: Buyer's Signature:
The Commonwealth ofMassachusetts
Department oflndustrialAccidents
Office oflnvestigations
600 Washington Street
.Foston, MA 02111
www.massgov/d'ia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lep-i
Name (Business/Organization/Individual): P_ V1,
Address:
City/State/Zip: Ai J C� (3 v tT Phone #:
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/orpart-time) * have hired the sub -contractors
_
2. I am a sole proprietor or partner- listed on the attached sheet. t
ship and'have no employees
working forme in any capacity.
[No workers' comp. insurance
required.]
3. [] 1 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] ;
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and wehave no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. [1 Remodeling
8. ❑ Demolition
9. ❑ Building addition
ME] Electrical repairs or additions
11.0 Plumbing repairs or additions
12.❑ Roofrepairs
13.❑ Other
'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
X am an employer that is providing workers' compensation insurance for my employees Below is thepolicy and job site
information.
Insurance Company
Policy# or Self ins. Lic. #: ExpirationDate:
Job Site Address: ,City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder 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 well as civil penalties in the form of a STOP WORK 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.
Ido hereby cert er the pains and pnSlties ofperjury that the informrction provided above is true anti correcf.
11>1� Date: 5 Z a -Z/ _�—
Phone #:
Official use only. Do not write in this area, to be completed by city or town official
City or Town:. Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk d. Electrical Inspector 5. Plumbing Inspector
6.Other - - -
Contact Person: Phone #:
Information and Instruction*8
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 "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including 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 maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shallnot because of such employment be deemed 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 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 ofits political subdivisions shall
enter into any contract for the performance ofpublic 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-contractor(s) name(s), address(es) and phone number(s) along with their certifica
insurance. Limited Liability Comptes) of
anies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. 7f an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents fox 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 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 a workers'
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 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 will 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 information (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 :future permits or licenses. Anew affidavit must be filled out each
year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license orpermit to burn leaves etc) said person is NOT required to complete this 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 anal fax number:
Tho Commonwoalth o;F fassachvsPits
Dap.ariment ofIndustrial Acoldon:
ONCe of estigatiou
600 Washinpa Street
Boston, MA, 02111
TO, # 617-727,4900 PA 406 or 1-877 UASSMB
Revised 5-26-05 Fax # 617;,727-7749
www.J;><;<ass,govMa
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