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HomeMy WebLinkAboutBuilding Permit #525 - 313 SUMMER STREET 4/7/2009BUILDING PERMIT o� X67 �•� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION S Permit NO: Date ReceivedArao " 9qo ` ��SSACHUS � Date Issued: -�r 0 f IMPORTANT: Applicant must complete all items on this page LOCATION = 5 )' M �Evz- Print PROPERTY OWNER Cr14A-- .Q a N MI Lt,L Print MAP NO -U �;C— PARCEL:4rf ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family 1/ Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement 1/ Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 2� =fit C5JV Sir's N 6 1 G -Q-,- 12 X, t (o - I,j T it-- ly GtO =co " r2R-0y C)4 rQ0 O2 F'P-ohJ _3 -Sc��f-J iar" ffY ./g0/,J fir, Lx,--,,u,- Identification x.` ,L, -Identification Please Type or Print Clearly) OWNER: Name:_ TZiC,t1, 2�"1. ml LLA- Phone: GE51- VW4% Address: '-,V3 SOil rmc& 91-- l`I, /-21-1DOvs-4 N CONTRACTOR Name:'Pp1Ll ONJ-����' �-- Phone: 1)78 -- 470 -1 qL3 Address:6(o P.Q, P144 0/810 Supervisor's Construction License: poo Z6 f Exp. Date: ,3 /A3 )a Home Improvement License: /S�� 1 S Exo. Date: 29/15'/ZGr-> ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125 PER S.F. Total Project Cost: $ 9 C3 FEE: Check No.: 7,6 Receipt No.: OQI��— NOTE: Persons cont acting w4 ii#registeredcontractors do not have access to the guaranty fund ire of Agent/OwnerSignature of c 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 DATE APPROVED PLANNING & DEVELOPMENT 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: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: t_ocatea 364 us ooa ,street FIRE DEPARTMENT" Temp Dumpster on site yes no Located at 1:24 Main Street Fire Department.signature/date . COMME!NTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 No IM 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 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 �' Location Jul � n� 4-,%- 1 NoDate ,. TOWN OF NORTH ANDOVER 3 . G A Certificate of Occupancy $ JACHUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ L TOTAL $ Check # r r i 2962 Building Inspector a qk� 0 q O � O �•m C F- lz O C7 ~ m 4 0 5 a w I c h O C OAor. t� u o V)v U a O C co b x a -� a �1, c� co w U w ►-� m V) _ w T U 0 O v W O � '116MC i CL voc CD �•m C F- O p r0a*- + GO 4DCOD ~ m 4 0 5 I c h O C i.+ c cc 0 O C y: 0•_" •E ca o .yLU L- Z o c Cc 1p C V COD O � CO) = m R M CD ci 7 A 0 a .. ES .rc oc M C.2w a MEMO: ts cm I M m e E CD a C y N m 4 N •• m s • H O O CD 0 cm ` y O m O cm w° � U) m O CA O �Z 0 o o T U 0 O v W � '116MC i CL voc CD CM c c F- O p r0a*- + GO 4DCOD ~ m o0..~ c" .y C O C 0•_" •E ca o .yLU L- Z o OCL V COD C O�JOD � C '� O = m R M A T U 0 O v W O CD ■ L �+ O v v Z o. CD y 1 I CO CCM O•— yCA 'O •ff m �3 CD 0 CD CD o cc o a M a C C3 Cc� ■j C. o *-a Co Z CJ C CD CL V y c C C _c C. CO2 0 U) 19 W 19 Iww Y/ W a w A a ° y w z Q w° � U) a°' O CD ■ L �+ O v v Z o. CD y 1 I CO CCM O•— yCA 'O •ff m �3 CD 0 CD CD o cc o a M a C C3 Cc� ■j C. o *-a Co Z CJ C CD CL V y c C C _c C. CO2 0 U) 19 W 19 Iww Y/ CONTRACTOR'S AGREEMENT BRIAN LAWLER F.I.D. #04-2960346 GENERAL CONTRACTOR Registration # ¢ (v I I * 66 Wildwood Road Mass Builder's License #000261 Andover, MA 01810 (978) 470-1983 Date: "179 CUSTOMER INFORMATION Name and Address: %8 Home Telephone: 667 - 96�8 Si 09113 MC t -LC/- ' 1; -SUM nI U--ttS' 1 : %1C, Oy Work Telephone: CONTRACT TERMS IN CONSIDERATION OF THE PROMISES AND AGREEMENTS SET FORTH IN THIS CONTRACT, LAWLER AND THE CUSTOMER AGREES AS FOLLOWS - 1) Services: The Customer hereby requests, contracts with and authorized Lawler to provide the work and the materials described below: 2) Date of installation: The work under this contract is scheduled to begin on 5-/-//W and to be completed on ,- . This time period may, however, be reasonably extended by Lawler in thb event of inclement weather which precludes the installation or other circumstances beyond Lawler's control. The Customer acknowledges that he/she has been informed of, and consents to, this time for completion. 3) Cost to Customer and Payment Terms: The total cost of the services and materials to be provided by Lawler is $ 9,Sb U. . This customer cost shall be paid as follows: a) $ 3 '79; �" (33 1/3%) shall be paid upon execution of this Agreement. b) $ ] (66 2/3%) shall be paid upon completion of the work. 4) Customer Cooperation: On the date for installation set forth in paragraph (2) above, as such may be extended the Customer shall allow Lawler and his agents reasonable access to the premises at reasonable times. 5) Warranty: Lawler hereby warrants that its installation shall be performed in a good and workmanlike manner in accordance with accepted industry standards and further warrants the installation against defects in workmanship for a period of one year from the date of installation. Lawler, however, is not the manufacturer of the materials used in the installation and has not made and does not make any representation, warranty or covenant with respect to the condition, quality, suitability or merchantability of the materials in any respect or any other representation, warranty or covenant, express or implied. Lawler will, however, take any steps reasonably within its power to make available to the Customer any manufacturer's or similar warranty applicable to the materials. Lawler shall not be liable to the Customer for any liability, loss or damage caused or alleged to be caused, directly or indirectly, by the materials, by any inadequacy thereof or deficiency or deficit therein. 6) Arbitration THE CONTRACTOR (Lawler) AND THE HOMEOWNER (Customer) HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THAT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT, THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER (Customer) SHALL BE REQUIRED TOS MIT TO ARBITRATION AS PROVIDED IN M.G.L. c. 142A. ian Lawler Customer NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY THE CONTRACTOR. THE OWNER MAYINITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. 7) RIGHT OF RESCISSION YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER (Lawler), WHICH MAY BE ITS MAIN OFFICE OR BRANCH THEREOF PROVIDED YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. 8) Acknowledgment of Rip'hts The Customer hereby acknowledges that he/she has been informed that he/she has legal rights related hereto under the provisions of M.G.L. c. 142 A. and 780 CMR -6. Pursuant to M.G.L. c. 142A and 780 CMR all home improvement contractors and subcontractors shall be registered by the director. Any inquiries about a contractor or subcontractor relating to registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108, (617) 727-8598. 9) Necessary Permits The construction -related permits which are required for installation are as follows: 4 '2N1 kQ 111(1'f r� si +2 c�"ICa+y RG 24"1 j It shall be the obligation of Lawler to obtain such permits, if any, as the Customer's agent. Customers who secure their own construction -related permits or deal with unregistered contractors will be excluded from the guaranty fund provisions of M.G.L. c. 142A. 10) Miscellaneous This Agreement is made and executed in the Commonwealth of Massachusetts and shall be construed in accordance with the laws of that state. In the event that for any reason any provisions of this Agreement shall be declared invalid or unenforceable, it shall not affect the validity or enforceability of the remaining provisions. This Agreement sets forth the entire contract between the parties and it may be modified or amended only by a written instrument executed both by Lawler and the Customer. THE CUSTOMER HERE:BYACKNOWLEDGES THAT HE/SHE HAS FULLY READ AND FULLY UNDERSTANDS THE TERMS OF THIS CONTRACT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SIGNED UNDER SEAL THIS -77-"� DAY OFi'i2�L Customer: e'�(LVA ) C' fL Printed name: Brian Lawler ACKNOWLEDGMENT AND RECEIPT OF COPY The Customer hereby acknowledges that he/she has received a copy of this contract signed by both the Customer and Brian Lawler. )V&j Cust8mer The:Commonwealth o 1Vlasschusetts Department of IndustHat Accidents Off ce:of.Investigations 600 .Washington .Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu'eYs ApOicant:Infor nation ._Please:pr Name (Business/Organization/Individual):j� I� jj��� 4 ^LoLG - 6V -36/w Address: L& 2i, City/State/Zip: ^moa v� � Q` 1 Q Phone #: 978-470 ` 4 Z3 Are you an employer? Check the appropriate box: Type of project.(required)::.. 1. ®"I am a employer with 1 4. Fj I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. T. [Remodeling ship and have no employees These sub -contractors have g. [j Demolition working for me in any capacity. employees and have workers' 9 O Building addition [No workers' comp. insurance comp. insurance.# 5. Fj We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other .employees. [No workers' coma. insurance recluired.l 'Any applicant that checks box #I 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. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. . Insurance Company Name: -r At -M L M c1' J U QM- /Al Sy 94N e F CJS M 9R^J5/ Policy # or Self -ins. Lic. #: W LY a 6 q7Z 82.0 J Expiration Date: Job Site Address: 313 SV''i'iM G� 31, City/State/Zip: 1% /�PJiO G VC--.. M1q 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 and penalties of perjury that the information provided above is true and correct. Signature: Date: /7�G� Phone #: 97v-47® -113-3 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 #: 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 -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 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 ort own`Off1cif 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 perrmt/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. townAcopy-of the affidavit that has been officially stamped or marked by the city or town may be provided,to the,; applicantnas�pFoo€: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•ox.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. Ihe.Department's address; telephone and fax number: The Commonwealth of Massachusetts L�gPartm nt of Industrial Accidents .:Office of Investigations 600 Washington Street Boston, MA 02111 :Tel.-#` 617-727-4900 ext 406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 4-24-07 :. wwvv.mass.gov/dia WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 0_415 J (Ed. 7-1-87) Atlantic Charter Insurance Company VDAC POLICY INFORMATION PAGE ENDORSEMENT Endorsement No. 1 Endorsement Effective 11/06/2008 Policy Number WCV00478205 Location Number 1 Insured Brian A Lawler General Contractor Policy Period 11/6/2008 To 11/6/2009 Item 4. * Class, Rate, Other is changed to read: NCCI Co. No 29211 Atlantic Charter Insurance Company VDAC Policy Rating Period 11/6/2008 To 11/6/2009 Classifications Code No. ! Premium Basis Total Estimated Annual Remuneration Rate Per $100 of Remuneration Estimated Annual Premium Masonry-noc 5022 If any 11.62 ! 0 Plumbing-noc & Drivers ; 5183 i 13,220 3.88 513 Electrical Wiring -within Buildings j 5190 ( 19,300 3.17 612 Carpentry-noc ! 5403 i If any 11.92 0 Painting Or Paper` 5474 If any I 5.01 j 0 Carpentry -detached Private 15645 I 30,774 i 7.50 f 2,308 Carpentry -dwellings -3 Stories Or ! 5651 I If any 7.50 0 Excavation & Drivers 6217 I If any 4.17 ! 0 Manual Premium Increased Employers Liability 0% Subject Premium Merit Modifier 1.00 Merit Adjustment -5% Modified Premium Standard Premium Normal Premium Expense Constant Terrorism Act Surcharge Total Estimated Premium DIA Assessment Total Premium and Surcharge(s) All other terms and conditions of this policy remain unchanged. 3,433 0 3,433 0 (172) 3,261 3,261 3,261 338 19 3,618 205 $3,823 Issue Date 03/16/2009 Page 1 of Last (c) 1987 National Council on Compensation Insurance. Form: 1091t /yam ✓fie �ommzorwiea.�i o�✓�iaaaaciivaei�d Board of* Building Regulations and Standards s HOME IMPROVEMENT CONTRACTOR Registration: 156915 Expiration: 8/15/2009 Tr# 257'965 I Type: DBA w . BRAIN LAWLER-GENERAL CONTRACTOR BRIAN LAWLER ' 66 WILDWOOD RD.�Q^' ANDOVER, MA 01810 Administrator '-' - .J1JC i�I0977r7JJ6'ItfIJGlL��� /)�../!-`(.Ct':1�CffllC �Gui Board of Building Regulations and Standards Construction Supervisor License �j License: CS 261 Expiation: 3/23/2010 Tr# 20087 lRestriction: 00 BRIAN A LAWLER 66 WILDWOOD RD., ANDOVER, MA 01810 Commissioner f /yam ✓fie �ommzorwiea.�i o�✓�iaaaaciivaei�d Board of* Building Regulations and Standards s HOME IMPROVEMENT CONTRACTOR Registration: 156915 Expiration: 8/15/2009 Tr# 257'965 I Type: DBA w . BRAIN LAWLER-GENERAL CONTRACTOR BRIAN LAWLER ' 66 WILDWOOD RD.�Q^' ANDOVER, MA 01810 Administrator '-' - .J1JC i�I0977r7JJ6'ItfIJGlL��� /)�../!-`(.Ct':1�CffllC �Gui Board of Building Regulations and Standards Construction Supervisor License �j License: CS 261 Expiation: 3/23/2010 Tr# 20087 lRestriction: 00 BRIAN A LAWLER 66 WILDWOOD RD., ANDOVER, MA 01810 Commissioner THAT 'A a m IWBUILDING W1131" MIND APAA'A&- 0164MIM CN C IRV A TH ARY. Ampo! Nb AV FIT 46 QN p P D'FQR MOP r (15- - IMILTS CWA APE RENT LAN AN I $wow IAN. M IAWS. AND: F M. AOFA4IM&,- .Man Rp Iva lKj..t 4w I pup popmm" -11,>1. a t -A 3 [3 v.f 12b 04� .$U*V THAT 'A a m IWBUILDING W1131" MIND APAA'A&- 0164MIM CN C IRV A TH ARY. Ampo! Nb AV FIT 46 QN p P D'FQR MOP r (15- - IMILTS CWA APE RENT LAN AN I $wow IAN. M IAWS. AND: F M. AOFA4IM&,- .Man Rp Iva lKj..t I pup popmm"