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HomeMy WebLinkAboutBuilding Permit #250-12 - 30 HEATH ROAD 9/26/2011 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION P Permit NO.. VVV Date Received Date Issued: I RTANT:Applicant must complete all items on this page LOCATION 30 W46_+h 9-A. Print PROPERTY OWNER Ot- Ar r CL+ Unit# Print MAP NO: PARCEL:00A10 ZONINGDISTRICT: Historic District yes o it Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑A0dition ❑Two or more family ❑ Industrial —goAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: El Demolition El Other �(Sepf c 'tWell OlFloodplam ❑ UJetland's j IN 1Wdtershedbistrict `D\Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 'l-,vo ,►oma—SLA , �rs4�11 h v� n_tns� 1 ��►�,. boy ,-d aP -� Identification Please Ty o P le y OWNER: Name: . rol one: Address: 3 CONTRACTOR Name: J w6 l bAJ_r_tA-.`1r Phone. &03 ? g Address: Do'k zvy 'ap ar l a-l d AA 6,1031 Supervisor's Construction License: Zoo y'/,6 Exp. Date: - /Z Home Improvement License: / J'03 y Exp. Date: f z ARCHITECT/ENGINEER A/-4- Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �, `� FEE: $ 6 Check No.:_Q�� a Receipt No.: NOTE: Persons contracting with unregistered contractors o not have access to the guaranty fund tgnatu.reiofAg Senf/Owner 'a_Sia _._T..ntr�' I` Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL I 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 i CONSERVATION Reviewed on Signature !'-.WMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: 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 7 L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, roast 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 2011 June/mi 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 Perm 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) ❑ 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: Doc.Building Permit Revised 2008mi Location +4e444 Id No. Date NORT1y TOWN. OF NORTH ANDOVER F � s 9 Certificate of Occupancy $ s�CMUs<� Building/Frame Permit Fee $ (! i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 246'13 Building Inspector V The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �"A �-` Address: City/State/Zip: PMr �¢,� 0_0Y)Phone#: 63) T Are you an employer?Check the appropriate box: Type of project(required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2. 71 am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees ,These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 Name: ©6)•— �J+ 3 C1 J Policy#or Self ins.Lic.#: H C,d b,sw'<N _77 Ste' i e.A L, Expiration Date: Job Site Address:-3c) 6.4'k Imo- 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 DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date• 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Nomes Ana l ne p L 0 , ome CONTRACTING WINDOWS & VINYL SIDING � olei owner property 1, the undersigned, the ow r •f the p �p y located at hereby verify that 1 have authorized myHome Contracting, LLC to apply to the Building Department in the city/town of-4,20= /f�' rta act as my agent in obtaining, a building permit and /or zoning, r.equriemenets to obtain permits_ Si tlature Property Owner Date P Y HOME CONTRACTING LLC rrt , Y f. New Registered !n Diassachaserrs t 1\c�e Haim shire �, • s.. _ . _ 1 y if P.O.Box 989-`it4r-tlnien,IMA °UI b•i•�i :•°Tel-(975)G83-905? �� .• IBB . l <` P.O.Boa 14-4 Deerfield.NH ' 03057 Tel.(603)40-5898 MEMBER Toll Free C8001921-9052- Fax(603)463-8911 w nnv.mtrhomecoi irracrino.com 9 Job # INVESTMENT TOTAL FOR SPECIFIED PROJECT WE HEREBY PROPOSE TO FURNISH ALL LABOR AND MATERIALS IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS FORTHESUMOF — Deposit Payment Options Deposit $ Cash Visa MasterCard 0 Deposit Due upon Start Acct.# Exp.Date Balance Due On Completion Indicate payment method for Name as it appears on card: Balance Due On Completion —By my/our signature below,IMe agree to allow My Home Contracting,LLC to charge the above referenced credit card for the amount indicated above. Check Credit Card Finance Cardholder's Signature Date gnature of My Horn sentative: r C Authorized Signature: Date: Authorized Signature: Date: MY HONE CONTRACTING, LLC Registered in Massachusetts&New Hampshire �t rl" P.O.Box 989 uMethuen,MA 01844 Tel. (978)682-9052 MEMBER P.O.Box 144 Deerfield.NH 03037)7 Tel.(603)463-8898 Toll,Free(800)921-9052 Fax(60'))463-8911 WWNV.mvhomecontractin-,.com 4 EPS RRP'C+erffectenov�`to RRP Ititt►at�"otuse�>sngttsh) Jason.ITaberstrohiyklt g a*F 200 North,Rd, boerfiield,NH-030.37 Expire:>2/lfl%2015 �� � • °z � n y 692y10=00101 �w ,,;• i . l'exd Edu' a3 Nute"Rd^Madbury ffvMy:Q3823 (b031749- 575 f I ' �ip ss t to airs Sbsme g p{tice o ousumer CTOR HOME IMPROVEMENT CONTRA Type: Registration:.,y,14'5039 Individual Expiration: 012 fHABERScC!�D1 -- JASON HABERS, ' 200 NORTH RD `� r Under secretary DEERFIELD,NH _a; l chi is�tt. Dc iM-611cnt 1.4 Puhlic�S!1177 Bim"d of Building„ Rc�ulati(m, and_St,tntl;trd. Construction Supervisor Specialty License I , License: CS SL 100416 Restricted to: WS JASON HABERSTROH '� -..225.RAYM OND ROAD , tDEERFIELD, NH 03037 Expiration: 2/13/2012 T r#: 100410 ' (,unni„incr r NORTH 0 0 _. over . 0 o , �`0 Mover, IVlass., O LAKE COCHICHEWICK %S RATED p'? C-1 U BOARD OF HEALTH Food/Kitchen PEMMIT T U Septic System (A34-4-,t BUILDING INSPECTOR THISCERTIFIES THAT......... c- ��.. . ........... ............. ......... ... ..................... ....................... Foundation Lhas permission to erect...... .... buildings on .�b............ .....�i�. ...... .. �............... Rough to be occupied as..............1'1�.�.�......V:th. �,. .1 i�1!. .. . chimn y e provided that the person accepting this permitlhall in every respect c form to the 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 Lthe Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MOhMiS a�� • ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST �' .. . . TA . Rough ... ....... .. 09L ....... ......... 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. i Massae. usetts Home Improvement Sample Cont I U tact 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 first 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. . Homeowner Information Contractor Information Name I Company Name -M _w .Street Address(do not use a Post Office Box address) Contrac /Salesperson/Owner Name d He TU W City/Town State Zip Code Business Address(must include a street address) 7S 0 Daytime Phone Evening Phone - City/Town State Zip Code Fill 9 Y 571 Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home Improvement Contractor Reg,Number Expiration date Law inquires that most home improvement rationcontractors umbeinvc /(L��� S 0 ��/� n unlit)registration number 7 1% / 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.) ISIAill Gloss{ cs�,4d° n vlefha7 GK ►(,� Vin y� J Required Permits-The followingibuilding pemiits are required Proposed Start and Completion Schedule-The following schedule will 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.) L Date when contracted work will be substantially completed. . i Total Contract Price and Paymefif Schedule The Contractor agrees to perform the work,fiunish the material and labor specified above for the total sum of: (*) Payments will be made according to;the following schedule: $ G upon 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 upon completion bfthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ 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 1(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 warranty-Is an express warranty being provided by the contractors ❑No ❑Yes(•Ill terms oFthe 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 a eerrient 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 lienor other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract! l ' • 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 alvalid Home Im rovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may in about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-ire o t888-283-3757. • 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. i You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you no the contractor in writing at his/her mainloffice or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the sigrimg 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 SPACES!!! Two identical copies oft e c ct must be co p1 d and signed. One copy should go to the homeowner. The other copy should be kept by the contactor. (Ho owne Signature ACctor'!s Signature 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 contri�ctor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. i 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.i 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 iwork 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. j 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 fluids not yet duel be placed in a j oint 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 j 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.nnass.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,ciontact: 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: hn:Hdb.state.ma.us/homeimprovementilicenseelist.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 j Version 2.1-11/22/2010 I �