HomeMy WebLinkAboutBuilding Permit #697-14 - 281 WAVERLY ROAD 4/10/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ' C Date Received
Date Issued:
I ORTANT: Applicant must complete all items on this age
LOCATION`S
r --�--
PROPERTY OWNER . -Q yt`I e- t, .c t2 f? `%— I --tri o
Pring 100 Year Old Structure° yes
MAP NO: �, ,PARCEL'-: ZONING 0 SaTRICT _ -_.Historic District yes
Machine,,Shop,Village yes
TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
Z -One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Z -Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
.0'Septie 0' 61F r .,'
0 Floodplain ❑ Wetlands
E!Watershed District
o -Water/Sewer.., ,
DESCRIPTION OF WORK TO BE PERFORMED:
3 e , 0c.G 'r-.� u---, \-I � U
ication Please Type or Print Clearly)
OWNER: Name: C° - 20 .c , 1� �2a'� l v� N j'i- P
ArirlrPs�•
-S?- vgg3
0
ARCHITECT/ENGINEE
Phone:
Address: Reg. No.
FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
s j
Total Project Cost: $ c i�k I FEE: $
Check No.:
Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the gua antyfund ,
Plans Submitted Plans \kaived ET ` Certified Plot Plan ❑ Stamped dans ❑
Plans Submitted ❑ 'Plans Waived ❑. :'.Certified Plot Plan ❑ Stamped Plans ❑
JXPEOF:-SEWERAGE-DiSPOSAI
Public Sewer ❑
Tanning/Massage/Body Art ❑ ...
Swimming Pools ❑
Well ❑
Tobacco.Sales E1
Food Packaging/Sales ❑
Private (septic tank, etc_. - - .
=Peririanent Diunpster on Site ❑
THE- FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
-DATE REJECTED .
PLANNING & DEVELOPMENT
DATE:APPROVED
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
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 Tow;-, Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTItfiU NT:,- Temp Dumpster on site ..yes no
Located at 124�Mair Street R cF .W,
Fire Departme►�t signature/date " 3~ x f f ,,
-Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
--Total an area; sq.
ELECTRICAL: Movement of. Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER.Z®NE LITERATURE: Yes No
MGL .Chapter 166. Section 21A -F and G min.$100-$1000:fine
NOTES and DATA — (For department use
EI Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
the fol;owing is -'a -list of the required -forms to befilled 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. And1O'r 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
o 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)
a
❑ 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
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 apn•-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building permit Revised 2012
Location
No. "" �"' Date
Check # R
27429
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Massachusetts Home Improvement Sample Contract
This form satisfies all basic requirements ofthe 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 first obtain a copy of "A
Massachusetts Constuner 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.
Homeowner Information
Contractor Information
Name
Co " y Name
ai 05,t. rv1�12(2
_
SON [o( i t4a-
Street Ad ess (donotuse a Post Offt a Box address)
C ractor/ Salesperson/ Owner Name
J
c L
75
u ,(.
City/Town State Zip Code
Business Address (must include a street address)
J ' I
0 D �f 1 0 �`1 5
e L/ Ul I/ t ✓(
Daytime Phone Evening Phone
City/Ib
State ZiF Code
7� • �0� . nt4y
3a�
Mailing Address (It different from above)
Business Phone
Federal Employer ID or S.S. Number
Homehnpmvemmt ContmctorReg.Number
Expiration date
Law require that most h—
Improvement mntmaors have
ltd mglstsnnoo number
J
3 It
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.)
(? 0 0 , J�_, cf
Required Permits - The following building permits are require Proposed Start and Completion Schedule - The following schedul ill
and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions ofDate when contractor will begin contracted work.
MGL chapter 142A.)
Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule [��jt7
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum oillr,. 13".15–, G3 (•)
Payments will be made according to the following schedule: 7
$3� S on signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$ by _//_ or upon completion of
$ —' by _/_/ or upon completion of
O. ;Rpon 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 $ y to be paid for
ordered before the contracted work begins in order
to meet the completion schedule.(**) $ to be paid for
NOTES: (*) Including all finance charges (**) Law requires that any deposit or 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 cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express Warrantv - Is an express warranty being provided by the contractor? ❑ No ❑ Yes tall 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 tinder this aereement
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 confine 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 ofthis agreement. See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical copie f the contract must be plated and signed. One copy should go to the homeowner. The other copy should be kept by the contractor.
omeow r' Signature �ontic_tore5sature
O11 !f lY
Date I I I 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.
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 consumerihomeowner 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 the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights, or if you wish to obtain 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.gov/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://Nvww.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
http://db.state.ma.us/homeimprovement/licenseelist.asp
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 or 413-734-3114
Version 2.1 - 11/22/2010
Quote: 1514
H Ben Fontaine 14a Mercury Lane Pelham NH 03076 (603) 635-3499
Cell # (603) 661-7429
Job Name: Amy Grose & Cherry Bennett
281 Waverly Rd
N. Andover Mass 01845
Job location: Same
Description:
Date: 2\26\14
Type: Roofing
Replace shingles on the front part of the roof, and siding on each side of the dormers
Will install six feet of ice & water shield at the edge of the roof, three feet in all the
valleys, three feet on each side of the dormer 18" on the wall 18" on the roof, new
flashing at both windows and dormers
Will install new cedar clad board and corners and paint,, Paine not icy E:.ided
Material & Labor ...............$ 5,987.97 �� Cb
*All shingles will 30 years architectural, color to be Owner choice, all debris will be
remove from the job site All work is guarantee for one year
Acknowledge & Agreed: U
Contractor �-� Date
Pleas gn & Retur one copy)
*Price can only be held for ten days*
Massachusetts -.Department of Public
Safety
P, Star
''Card
-,,a' -As
Glmtructjon Super -N km-
nse: CS -058817
BENFONTAINE
14A MERCURY LN
PELHAMNH 03076
07/23/2014
Office of Consumer Altairs & Bti§ji'i'e , ss Regulation
OME IMPROVEMENT CONTRACTOR
egistration: 1.63654 Type:
Expiration7/8/2015 Individual,
BEN FONTAINE
BEN FONTAINE
14 A MERCURY LANE,:,
PELHAq 03076
Uq#,crsecretary
The Commonwealth of Massachusetts -
Department ofIndustrialAccWnts
Office of Investigations
600 Washington Street
.Boston, MA 02111
www.massgov/clia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Prim Legibly
Name (Business/Organi'zationftdividual): 0� //1 POO � Q l V1 C_
Address: (q A !IM,t t? e_c)t2J Lo a ,aA N VA a a-7
City/State/Zip: Phone #: 6-O 3 , 6 1 ( 0,1
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/or part-time).*
have hired the sub -contractors
2. am a sole proprietor or partner-
listed on the attached sheet.
ship aud'have no employees
These sub -contractors have
working forme in any capacity.
workers' comp. insurance.
[No workors' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ 1 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] i
employees. [Nb workers'
comp. insurance required.]
Type of project (required):
6. EJ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
I L E ] Plumbing repairs or additions
12.❑ Roofrepairs
13.❑ Other
*Any applicantthat checks box91 must also fill outthe section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they 2 -re 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 employer that is providing workers' compensation insurance for my employees Below is the policy and'job site
information.
Insurance Company
Policy # or Self -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 requiredunder Section 25A ofMGL o. 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 maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
I d0 hereby C2Yt ilep thepains a wnaltie)rofperjury tliat the inforinationprovided a%JOVP�iS tYlle and COYY2et
Phone #• v
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. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector
6. Other - - -
Contact Person:
Phone #:
Information and 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 "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 shall not because of such employment be deemed to be an employes."
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 consiruct 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 of its 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' compensaiion affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) 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 or partners, are not required to carry workers' compensation insurance. If au LL C or LLP does have
employees, a policy is required. Be advised that this affidavit maybe 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 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 requited to obtain a)orkers'
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. 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 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:
Tho CommonweaM of M -a ssa chvsetts
M,pax`imant ofZndustdal .Accidents
Qfilce Qflimstigatiom
600 Washington ftoeet
Boston,, MA 4.2111
TQL # 617-7-274900 at 406 ox 1-877 M'AMAFB
Revised 5-26-05 Fax # 617-727-7749
wwvc mass,govAa
Quote: 714
H Ben Fontaine 14a Mercury Lane Pelham NH 03076 (603) 635-3499
Cell # (603) 661-7429
E mail- pinaxllayahoo.com
Date: 1/9/14
Job Name: Amy Grose & Chery Bennett
281 Waverly Rd
N. Andover Mass 01845
Job location: Same
Type: Tile
Description:
Replace tile over the counter top and behind the range even with the counter top
Work include removing the file repair and tape drywall prime wall install transition strip
between counter and tile and install tile (tile not included)
Material & Labor ............... $ 1,761.00
Overlay tile around fire place (tile not included)
Material & Labor .......:....
Acknowledge & Agreed:
Cna-i rµctor
Please Sign & Return (one copy)
*Price can only be held for ten days*
Date�Z--S �
Date �Z
Quote: 1514
39 Ben Fontaine 14a Mercury Lane Pelham NH 03076 (603) 635-3499
Cell # (603) 661-7429
Job Name: Amy Grose & Cherry Bennett
281 Waverly Rd
N. Andover Mass 01845
Job location: Same
Description:
k• eY'4 �� k�5e F�t�z Fa i„`r,Es :n""s `�fh..„ ...,�, �.�.�'..
Date: 2\26\14
Type: Roofing
Replace shingles on the front part of the roof, and siding on each side of the dormers
Will install six feet of ice & water shield at the edge of the roof, three feet in all the
valleys, three feet on each side of the dormer 18" on the wall 18" on the roof, new
flashing at both windows and dormers
Will install new cedar clad board and corners and paint , Pains: �rM� inluded
Material & Labor ...............$ 5,987.97 �� Cb
*All shingles will 30 years architectural, color to be Owner choice, all debris will be
remove from the job site All work is guarantee for one year
Acknowledge & Agreed: Date
Contractor G� DateZIV
Pleas gn & Retur one copy)
*Price can only be held for ten days*
Quote: 114
H Ben Fontaine 14a Mercury Lane Pelham, NH 03076 (603)635-3499,
Lela # (603) 661.-7429 .3
E mail- Vinaxl.lcawyahoo.com.
Date: 1\2\14
Job Name: Amy Gross & Cherry Bennett
281 Waverly Rd
N Anrinvar 1Viacc 01 Rd5
Job location: Same
Description:
Type: Windows
Windows:
NVhite Classic D.H. half ge.revn by ( Har pv 1 T .mv F Arann fillarl FnPrg
Star foam filled Half grill
Interior casing:
34/2 stafford painted white two coats
Exterior trim:
\�ThitP
Com nnciVZ;
Material & Labor ............... $ 2,076.66
All work is guarantee for one year
Acknowledge & Agreed: : Date L
ai V
Co tractar Date. �//V
Please Sign & Return (one copy)
*Price can only be held for ten days*