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HomeMy WebLinkAboutBuilding Permit #418-11 - 28 STAGE COACH ROAD 11/16/2010 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ' Permit NO: / I Date Received l/ bwo Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Pr t _ PROPERTY OWNER o�1� S�e PC_rciyw� Print - - MAP NO: PARCEL: 6 ZZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside ial Non- Residential , ❑ New Building N-6ne family ❑Addition Ij Two or more family ❑ Industrial -1.,•^ z ❑AlteKation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: _ ❑ Demolition ❑ Other plate 7LUMls� Ufld.Watershedl Dist DESCRIPTION OF WORK TO BE PERFORMED: M X is ��.z�; o�^a �( 1 -���i 4, - /Ucx-.> v Identificationease Type or Print Clearly) . OWNER: Name: o/1,, t :Ss,c r� C-1 ve-1 Phone: 7 97� f Y2 Address: Z4s S' ��c l vas. A XJ CONTRACTOR Name: �,� T �tZc e�^o Phone: -�Z'.Y-Z Y 9,)— Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ''/ A 3 //O- ARCH ITECT/ENGI NEER /OARCHITECT/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: $ 000 m " FEE: $ oZ Check No.: D 2— Receipt No.: �3 �-- NOTE: Persons contracting with un istered botitractors do not have access to the guaranty fund Signature�ofsAg_e;nt/Qwner �;. �.. � _ ignature:of�contractor� :Y� • ._..� .:<� .R..- . . . - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL j 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 _ DATE REJECTED DATE APPROVED - PLANNING & DEVELOPMENT ❑ ❑ { COMMENTS" CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature ti COMMENTS E t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer:'Sigiiature: Located 384 Osgood Street FIRE DEPARTMENT. -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS I I Dimension i 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.$10041000 fine NOTES and DATA— For department artment usel ® Notified for pickup - Date Doc:.Building Permit Revised 2008 I y I 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 i 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 i '13 4Floor/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 F ❑ 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 I'I Hydraulic CalculationsIf Applicable) ( pp able) ❑ Copy of Contract It ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products I� MOTE: 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 I f Doc: Doc.Building Permit Revised 2008mi Location No. Date `v MO^T►, TOWN OF NORTH ANDOVER O 9 • : " , Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 10 Mus 9 � s, E Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23702 %Building Inspector 2010/11/15 15 :46:18 3 /4 ACORi® t CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) �...�` 11/15/2010 PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Easterr- Insurance Group LLC - Main ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 0-760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Arbella Protection Ins. Co. 41360 Mark T Emero 56 Cordis Street INSURER B: Wakefield MA 01880 INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ALDDT POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS L NSR TYPE OF INSURANCE DATE MMIDDNW DATE MMIDDNYY A GENERAL LIABILITY 8500002391 3/27/2010 3/27/201_ EACH OCCURRBICE $500,000 X COMMERCIALGENERAL UABILFY DAMAGE 0 RENTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE FOOCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $500,000 GENERAL AGGREGATE $1 000, 000 GEN L AGGREGA-E LIMIT APPLIES PER. PRCDUCTS-COMP/OP AGG $1 000,000 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS B014LY INJURY SCHEDULEDAUTOS (Perperson) $ HIR.EC ALTOS BOCdLYINJURY $ NON-OWNED AUTCS (Per accident) PRCPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAWS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCSTATU- I OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR./PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICEPIMEMBER EXCLUDED, (Mandatory In NH) E.L.DI SEA:3E-EA EMPLOYEE $ II yyes,describe under SPEDAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATICN DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TC MAIL 30 DAYS WRITTEN NOTICE ^_0 THE Town of north Andover CERTIFICATE HOLLER NAMED TO THE LEFT, BUT FAILURE TO DO SO Building Departlr.ent SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN`_' KIND U?ON 1600 Osgood Avenue THE INSURER, ITS AGENTS OR REPRESENTATIVES. North Ancove_ MA 01845 AUTHORIZED REPRESENTATIVE �r Gam+ "i ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.nnass.gov1dia 'workers' Compensation Insurance davit: Builders/Contractors/FlectriciansfPlulnbers Applicant Information ]Please Print Legibly NaME)(B.usiness/Organization/Individual): Address: C rJ l S City/State/Zip: C 1 F Fo Phone#: 9 F l-? Z q—Z q Vy Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction _ Spiployees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet.1 7. modeling . ship and have no employees These sub-contractors have 8. []Demolition workingfor me in an capacity. workers'comp.insurance. Y p tY 9. EJ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its ' officers have exercised their 10.0 Electrical repairs or additions required.] o 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E]Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.] ? employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. 7 Homcm niers who submit this affidavit indicating they are 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. I am an employes that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or SeIf-ins.Lic.#: Expiration Date: 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 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 well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be'advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. X do hereby certify under the pains andpenaldes ofperjury that the information provided above is true and correct. Signature•�A.� Date• 111)5f)0 Phone#: C - �1 Z Y— Z y YJ F[Oth only. Do not write in this area,to be completed by city or town offlelal. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: 1'lassachusetts - oepartment m ruui« .7--« Board of`Building Regulations and Standards �I� Construction Supervisor License License: C5 67334 Restricted to: 00 MARKT EMERO 56 CORDIS ST WAKEFIELD, MA 01880 Expiration: 11/8/2011 ('ummi.ciuncr Tr#: 8388 92. { --� , Office.of con suriia '`� HOME IMPROVE Affaire 11 guess Regulafion A. Regttr MENT CONTFtgCTOR ? Expiration: 122144 ��-i/2012 TYi?e: MA K EMEROIndiwdual MARK EMERO 1 V Y i! 56 CORDIS S7REE� WAKEFIELD,MA 0180 Undersecretary "t 1 ORTM 0 of over No. j�. - �,o -o dover, Mass., COCKICHEWICK ��. ORATED BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR ............................................................. THIS CERTIFIES THAT........... .. .............4146.........................�..�............................... .. Foundation has permission to erec ...................... buildings on .. 13. ....... ........I�.! !i ....�............ Rough lk�- . 6 1Chimney tobe occupied as....................................................QKA.......... ... ...$�........ . ..... ►............................... provided that the person accepting this permit shall in every respect conform to he terms of the application on file in Final 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 CONSTRUTS Rough .......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. Massachusetts Honie Int_ provement. Sample Contract This Form satisfies all basic requirements of the state's Home improvement`Contractor Law(MOL chapter 142A),but does not Include standard -gage to protect homeowners. Seek legal advice If necessary. Any person planning home improvements should first obtain a copy of"s ; Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtalin a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8797 or 1-888-283-3757. -� Homeow r Information toniractor Information J 9- Sve_ c_r-c1i� " ameCompany Name _1'1`1 oA T-" mart Street Address(do of use a Post Office Box address) Contractor/Salesperson/Owner Name City/Town State Zip Code lusiness Address(must include a street address) Daytime Phone Evening Phone ,ity/fawn 1 State Zip Code Mailing Address(It different from above) usiness Phone')z•(LV r Zsl9 ederal Em to er II]or S.S.Number o'- P y S 3 So GJ6 Law requires that mast home ba-. Home provwentContnctor seg.Nmnbet Hxpoatton date . provrmmt eonactors have a • ` sad reghorstion m=ba ' The Contractor agrees to do the following work for the Homeo ner: ) i cZ ) I(bes co e ur oetall me woric to complete sped g e e, ran a grace o m n s o e e on my lYtDAC_I QX-041-t� Reg6ired.1'ermits-The foliowin�huilding permits are required Proposed Start and Completion Schedule-Tlie following schedule will and vyill be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the IontractoYs control arise (owners who secure their own permits will be excluded from the Guarant3i Fund provisions-of J J 1/c Date when contractor will begin contracted work MGL chapter 142A.)' . !-C Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of ,D 0Z.1 Paynjents will be made according to the following schedule: upon signing contract(riot to exceed 1/1 of theIrital contract price or the cost of'special order items,whichever is greater) `dao by it�`/Z�//o or upon completionrof S 4a by JD 110 .*or upon completion of upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special 5--^ �o�e paid for ordered before the contracted wari'begins in order S to be paid fpr to meet the completion schedule.(**) NOTES:(*)Including all finance charges(**)Law requires that any depositor down-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 cast of any special equipment or custom made material which must be special ofderedin advance to meet the completion schedule. Express Warrantt—Is an express warranty beioprovided by the coptracto- No Yes loll terms of Etre warrapty ttaht Subcontractorst -Theontractnr agrees to be solely responsible for completion of tho the contruan e work described regardlmust be aced ess of the actions of any third paitylsubcontractor utilized by the contractor. The contractor further a�TeeS to be solely responsible for all payments to all subcontractors materials and labor under this a for agreement Contract Acceptance-Upon•signing,this document becomes abinding t antractunder law. Unless otherwise noted(within this document,the contract shall not imply that any lien or other security into resthas 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 somethi g is unclear. • ' Make auto the contractor hes a valid Home Improvement Contractor R.egilltration subcontractors tThe law requires most home iirtpravement contractors and o be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by-writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 6 H-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 Guide to the Home.Improvement Contractor Law. copy of the Consumer You may cancel this agreement if it has been signed ata place other than file 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 delidery,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 MERE ARE ANY BLANK SPACES!!! • Two ides' I copies o£the•comnctmust be completed and signed. One copy should go tq tfrb homeowner.The other copy should be kept by the connector. 1 c eo n g er Contractor's Signature Date Date Contractor Arbitration : The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action as an . alkernative to.court action)�if they have a dispute"with a contractor. The same right is not automatically affordeq 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 anis 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 Secreta .of th xecutive Office-of Consumer Affairs and'Business Regulation and the consumer shall.be required to su it t such rLtra�c n provided In Massachusetts General Laws,chapter 142A. Ho a wnees St attire �-*� r Contractor's Signature N CE: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 regal rights:if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees orwarranties 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 adde8 to the term's 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 luforxnation Hotline(listed below). Execution of Contract v The contract must be executed in dulicate and should not be signed until.a copy of all exhibits and referenced documents leave been.attached. Parties are-also advised not to sign the document until all'blauk sections have been filled.in or marked as'void, deleted,or not applicable. One original signed copy of the contract with ts is to be given to the owner and the other kept attachmen 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 co the contract;and the three day recission period has expired. py of 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/l erself 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 info consumer rights, rmation about the Home Improvement Contractor Law or.other Law,"contact: or*tf you wish to obtain a free copy..of Consumer f "A Guide_to the Home Improvement Contrwor • Consumer Information Hotline Office of Consuruer Affairs and Business•Regulation 10 Park Plaza,Room 5170,Bostonx 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 addi about the contractor registration component of.the Home'Improvement Contractor La ' honal information specifically, - w,contact: Director of Home Improvement'Contractor Registration Bureau of Building Regulations and Statidards One-Ashburton" Place,Roorn.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/OR -Better Business Bureau (508)652-4800 .(508)755-2548 (413)734-3114