HomeMy WebLinkAboutBuilding Permit #542-13 - 30 WRIGHT AVENUE 1/29/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: l Date Received
Date Issued:
IM RTANT: Applicant must complete all items on this page
k /4U e--
OPERTj("QWNER� �a (�,� + � �mil - - -
Print 100+Year.0ltl'St�ucture yes.. nos.
! MAFiNO r (PARCEL � ZQNING�DISTRI -T: IHistonctDistrict yes: no
MachinwShop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Resid ial
Non- Residential
❑ New Building
One family
itio
❑=;tqen
11 Two or more family
❑ Industrial.
tion
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
Septic 'Elwell
❑Floodplain, p.Vlletlands
` .� W_atersfied Distnctl'
_.....
oVVater/Sewer.. _
-Ali
10 �}
OWNER: N
At4t4r000•
DESCRIPTION OF
A-- �; /,� f
BE PER F ORMED:
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se Type or Print Clearly)
&-n
ne: 1'6/7- $;1— )�91
:CONTRACTOR Name. Tr"i�4.ic �PSic�I._ C•h»�`P-,hone: �l?8. �4�L3
t q,2
w
Address::' 0 l q 3.
Supervisors.Construction0bense:._0 6Q S j 3 .Exp ;Date:,
Hbmettnprovemeht L•idense; y 3 2.� EXp Date: v �3-
ARCH ITECT/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: $ 40 000 FEE:
Check No.: `(�� �� Receipt No.: (O
NOTE: Persons contracting with unregistered contractors do not have access to the gu anty fund
Signature `of A(ient/Ovvher Signature of contracto'r'...
Plans Submitted Plans Waived ❑ Certified Plot Pla Stamped Plans ❑
0
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE APPROVED
El
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
f#
C
Conservation Decision:
Comments
Comments
Water & Seaver Connection/SicLnature &Date Driveway Permit
DPW Tower Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes. no
Located at_,l24 MainStreet . .
Fire Dep2i�triment signaturelaate
-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, roast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G m1n.$100-$1000 fine
NOTES and DATA — (For department use
B Notified for pickup - Date
Doo.Building Permit Revised 2010
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
DOTE: 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
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 subm,tted with the building application
Doc: Doc.Building Permit Revised 2012
Location gO W 1Ll C,* 7—
No.
No.'24Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $�1lyU,�`�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #0 C)
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Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
$ 80,000.00
m
$ -
$
960.00
Plumbing Fee
$
120.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
120.00
Total fees collected
$
1,300.00
30 Wright Avenue
542-13 on 1/29/13
Kitchen Remodel, move kitchen into
sunroom, close in existing sliders
ATLANTIC DESIGN 1ae/13
Phone: 978-423-9920 Fax: 978-312-1446
To: Aaron Allen
1 Wright Rd
N.Andover, Ma
CSL # 69513 HIC# 143213
Location: 1 Wright Rd
N. Andover, Ma.
: FIXED PRICE CONTRACT:
Kitchen Remodel:
►Demo & dispose of existing floor, walls & ceiling throughout sunroom area
Poo- Demo existing floor in dining rm area
Poo- Demo & dispose of existing kitchen
►Remove existing sliders to accommodate new layout
► Frame kitchen/dining room wall to accept new kitchen layout
► Frame in new kitchen window
► Patch in exterior siding as needed to finish
►Rough in all recessed lighting, electrical outlets & appliance feeds per plan & to code
No- Move existing thermostat to central location
►Provide under cabinet lights feeds
► Rough in pendants over island
►Rough in plumbing & vent to new sink & refrigerator location
► Run gas line to new cook top location
►Install R-15 Kraft face insulation to all exterior walls
►Install 1/2' blueboard to all wall & ceiling surfaces
►Apply skim coat plaster finish to all walls & ceiling
► Install new 2 '/a' pre -finished flooring throughout kitchen/dining area
►Install customer- supplied kitchen cabinets per Moynihan plans
► Coordinate installation of granite counter tops
► Install all interior trim to match existing
► Install all finish plumbing
► Install all finish electrical
► Install all customer -supplied appliances
• Price includes $4.50 per sq. ft. hardwood flooring
• Electrical includes recessed lights, devices & under cab lights (fixtures by customer)
• Price includes all building requirements and permits
• Scope of work is limited to this contract, any work above and beyond this contract will
be priced on site at an additional cost
Payment schedule as follows:
1/3 to start
1/3 upon rough inspections
1/3 upon completion
• All work subject to town approvals
• Price includes all building requirements and permits
• It shall be the obligation of contractor to obtain such permits as the owner's agent
• Owners who obtain their own permits or deal with unregistered contractors shall be
excluded from access to the guarantee fund
TOTAL LABOR & MATERIAL $34,909
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Jason Wilcox/Atlantic Design Aaron Allen
713
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ATLANTIC DESIGN
Phone: 978-423-9920 Fax: 978-312-1446
Homeowner Information
e/7
Street Address (do not use a Post Office Box address)
I w c1- 4 A -v E—
es CU5+6� ,
tractor/ Salesperson/ Owner Nim
!G90 W, \ ca -c
Cily/Towo State zip codeuaiaess Address (must include areas address)
over M� 2u /�J e U7 cy 1�_ L
.
Daytime Phone Evening Phone .ityrfown State Zip Code
1-0-7 - (93*�; 0131
a � k k
Mailing Address at different from above) usio Pbone 8 if1g4 lex ederal Em layer ID or S.S. Number Q_-7 • 27
lace tagiure■ llrt ■wee stole is Haar C.aatoeat Res. McAn Sx* ' h
prvata� eaatr■aat Vvs■ p ,.3 —Z\
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The Contractor do yr: �
agrees to the following work for the Howes see I J 2 1 L
11-puffloe 1A Plain
me won G
CIO
Required permits - The following.building permits are required
and will be secured by the contractor as the homeowners agent,
Proposed Start and ComplSden Schedule - The following schedule will
be adhered to edeas
(Owners who secure their own permits will be -
circumstances beyond the contractor's control &rise
excluded from. the Guaranty Fund provisions of
2-,&[) 3 Date when contractor will begin contracted work.
MGL chapter 142A.)
Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule I q
The Contractor agrees to perform the work-, famish the materiel and labor specified above foflu total sum of!
Payments will be made according to the following schedule:
s.13 1
1mf 1 b 3 upon signing contact (riot to exceed 1/3 of the'total contract price gF the cost of special order i(eou, whichever it greater)
t 1 7 O by `/ / or upon comple ionvf
S 0 by / / or u coon ledon of i
— — — upon P
$ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both parry's satisfaction)
The following material4quipment meat be special S to be paid for
ordered before the contracted work begins in order f to be paid for
to meat the Completion schedule.(**)
NOTES: (0) Including all finance charges (06) 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 fatal contract price or (b) the actual cost of any special equipment or custom made material
mutt be special ordered in Edvance to meet the temptation schedule,
Exurets Warranty - Is eco e*liress wam itv bdaa srmided by the eaatratxert No Yeschad to the contracti
fad term■ et thus �..,.... .. t
Subcontractors T iemon'tractor agrees to be solely responsible for completion of the work described regardless of the acdons of any third
party/subcontractor utilized by the contactor. The contractor fiutharagroes to be solely responsible for all payments to all subcontractors for
Contract Acceptance Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the
contract shall not imply that any lien or other security interest las been placed an the residence. Raview the following cautions and notices
carefully before: signing this contact
• 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 contrctnr has a valid Home Imsrovemeat ntractar Remi■variriw Tito law requires most home improvement contractor and
subcontractors to be registered with the Director of Home improvement C.outract& Registration. You may inquire about contractor
registration by :wridng to die Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or
1-800-223-0933.
• Does the contactor have insurance? Check to am that your contractor is properly insured.
• Know your rights and asponsibilities. Read the Important Inforatadon on the reyeae side of this form and gets copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has bees signed at a piece other than the contractor's normal place of business, provided you notify the
contactor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not lata than midnight of die
third business day following. the signing of this agreameot. See the attached notice of caacellados form for an explanation of this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical epics of the coobact ant be cowlth red and ■iamd one mpy doold eco to the bei000alaer. Tho other
copy a6ouW be lupi by the rnotranor.
Homeowner's Signature Contractor's Signature-to-
2
ignature
2-`�
le
Data
31
6`lly30
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action
alternative to court action) if they have a dispute with a contractor. The same right is npJ automatically afforde� 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 su it to such arbitration as provided In Massachusetts General Laws, chapter 142A.
. t
Homeowner's Signature ntractoes Signature
NOTICE: The signatures of the parties above apply only to greement of the parties to alternative dispute resolution
initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this stiction is not
separately signed by the parties.
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law (MaL chapter 142A) and otter consumer
protection laws (i.e. MOL 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,
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 duolicgte 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 recission 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 financiallyinsecure. However, in instances where a contractor deems him/Irerself
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 Gee copy of "A Consum
Law," contact: er Guide to the Home Improvement Contractor
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
(617) 973-8787 or 1-(888) 2833757
If you want to verify the registration of a contractor or if you have questions or need additional i11f0tmation specifically
about the contractor registration component of the Home Improvement Contractor Law, contact:
Director of Home Improvemerif Contractor Registration
Bureau of Building Regulations and Standards
One- Ashburton Place, Room 1301, Boston, MA 02108
(6l 7) 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
uqP- www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leg><bly
Name (Business/Organization/Individual):
Address: '2- ew
City/State/Zip: i 1147,+ Phone #:_ 9 DF
Are y an employer? Check the appropriate box:
1. I am a employer with % 4. ❑ I am a general contractor and I
employees (full and/or partti
-me).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I
ship and have no employees These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
workers' comp. insurance.
❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
C. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance reauired.l
Type of project (required):
6. ❑�Newc�jelruction
7. emo
g
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
"Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
kContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
assurance Company Name: �f Gt/t i �� 5
'olicy # or Self -ins. Lic. #: Cr ( LIZ C oo Expiration Date: 43 2
ob Site Address: ;G w City/State/Zip:No k A„ Jw e�—
ittach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
svestigations of the DIA for insurance coverage verification.
do hereby certify under ains and�penaldes ofperjury that the information provided above is true and correct.
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
6. Other
Contact Person:
1/2-q
4. Electrical Inspector 5. Plumbing Inspector
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 of hire,
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 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 of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) 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 an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the 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. 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:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 61.7-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05
www.mass.gov/dna
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