HomeMy WebLinkAboutBuilding Permit #942-15 - 318 MAIN STREET 5/20/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 2, Date Received
Datelssued:�
0 o
RTANT: Applicant must complete all items on this page
A . 1, 1
t-00 W A * R-) W. t
PROPOSED USE
'W
Non- Residential
0 New Building
'*X One family
AIR,(
0 Addition
0 Two or more family
D Industrial
)< Alteration
No. -of units:
El Commercial
CA �FKMR-Q- -L
1 r1R,- lf–'- TE.
H.i§.f-E-)ri9PLV1
YES -
El Other
------
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ly
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
'*X One family
0 Addition
0 Two or more family
D Industrial
)< Alteration
No. -of units:
El Commercial
0 Repair, replacement
El Assessory Bldg
El Others:
El Demolition
El Other
------
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DESCRIPTION O� WQKK IV t:St:JFtrI-UK1V1LL)'
"'I'n I -) Gi r D ';� 1) - +n , �+
OWNER: Name: VAH6LA
Address: 31 � RA I NJ
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Please Type or Print Clearly'
A P-ne Q
[ emo-
JE
ARCH ITECT/ENGI NEER Phone,.- .
Address: Reg. No. -
FEE SCHEDULE. BULDING PERMIT.'$IZOO PER $1000.00 OF THE TOTAL ESTIMATED COST -BASED ON $125.00 PER S.F.
Total Project Cost: $ PDf -�) 2��- 11P FEE:
itted El
Plans Suh(ni
Plans Waived Ell Certified Plot Plan Stamped Plans
-rTYW—P—FULF SEWERAGE DISPO—SAL
'51i S
Plib ic ewer
Tanning/1\4assage/Body Art F1
Swill1ming Pools 'El
well
Tobacco Sales El
Food Packaging/�ales' El
Private (septic tank, etc.
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature,
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Rinnntilre
Zoning Board of Appeals: Mariance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision, Comments—
Conservation Decision: Comments
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
15,11t --.� by_,e
p
Dimension
Number of Stories: Total square feet of floor area, based on Exte imens ions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requirei-s-;�'-approvall of
Electrical Inspector Yes No -
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc -Building Pennit Revised 2014
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
Ei Building Permit Application
• Certified Surveyed Plot Plan
• Workers Comp Affidavit
Lj Photo Copy of H.I.C. And C.S.L. Licenses
u Copy Of Contract
Lj Floor/Cross Section/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
cl� 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
Doe: Building Permit Revised 2014
Location
No. Date
Check
26800
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $-
TOTAL $
Building Inspector
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Massachusetts Home Improvement Sample Contract
Ibis form smsfies all basic requirements of the stater Home hopurrvement Contractor Law (MGL chapter 142,k), but does not include standard
language to protect homeowners. Seek legal advice U necessary. Any person planning home improvements should first obtain a copy of "A
Masndmsm Consumer Guide to Home hoprovemeW before agreeing to any work on your residence. You may obtain a fice oopy by calling the
Office ofConsumerAfflairs and Business Regulation% Consamerbif==on Hodme at 617-973-9797 or 1-888-283-3757 or on our website,
tLomeowner iniormation Contractor ]Information
Name
Company Nuf
ShvdAddres�s(donatmeaPagofriceBm: dim)
?-tRI rta"I'A 11� =
cityfrown state zip Ccdc
Business Address wj# include a adchess)
5.-tt\. A" Py4A
V
DaytimaPhon . Evening Phone
cityrrown
State Zip cc&
T72—
Anwia"t,
me,3,e,
Meiling Address (TI different fivan above)
Husimss Phone
Federal Employer ID or S.S. Number
1�..ph thanodb—
nwbw
lb 75-9(=.
I
The Contractor agrees to do the following work for the Homwwuez-
(Descrt-be in detail ffieworit to campld4 specifying thttype, brand. and grade of material tobeus4 use additional shects ifnmmm)
11 e- 4�10 C4� —to s, -,w
RNui-dP—nb-lbefDUowmgbmldmgp—=—repa,ed Proposed Start and Completion Schedule - The following Scbe&dc;a
and will be secured by the contractor as the homeownces agent be adhered to unless circumstances beyond the COWMCIXIes control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of 5:�a�Dzte when contractor will begin contracted work
MGL thapte - r 142A.) 6L: �'Daft when contacted work will be sabstantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to pertma the work Amish the material and labor specified above for the total sum of C)
Payments will be made according to the f011owmin SdWMC:
$ upon sign 9 the cost ofspecid under items, whichever is greater)
in contract (not to exceed 113 ofthe total contract prim
S ;;�--=:��--poucompleftcm-f
s—L29:P'5y --L—�— or up- completion of
a -w finbids demauding full payment until contract is completed to both parVs satisfaction)
The following makrial/equipment must be special s-- _--tD be paid for
ordered before the contracted wad: begins in order
to mod the completion schadWe.(* *) S ---to be paid fbr
N0TES:(*)jndudiagaUfi— charges M) L—fequires did any deposit or derwa-payment required by the contractor befure work begins may
not meed the great= of (a) one-third ofthe total contract price or (h) the actual cost ofarry special equipment or =store made material
which must be special ordered in advance to meet the completion schedule.
Exisrest Amirranty - Is an asoress warramy beige provided by the contmctor? eN. 11 Yes (.H t� of the warranty must be attached to the contract)
Subcourtracitirs - 1he contractor agrees to be solely responsible for completia of the work descrilied regardless ofthe actions ofany third
party/subconftactorublized by the contractor. 11he contractor father agrees to be solely responsible for all payments to all subcontractors for
inaterials; and labor under this agreement
Contract Acceptance - Upon, signing, ffirs document becomes a binding contract under law. Unless otherwise noted within this document, the
coutract shall not imply that any lien or other security' been placed cm the residence, Review the following cautions and notices
careffilly bdimc signing this contract,
• Doa'tbe pressured into signing the conaaa Take thnew read and hilly understand it. Ask questions ifsomet[iingisunclear
• M*o sure the contractor has a valid Home lmw� Contractor RAzistratiom ne law requires most home improvement contractors and
subcontractors to be registered with the Director offlome Improvement Contractor Registration, You may mqmm about contractor
registration by writing to the Director at 10 Padc Plam Room S 170, Boston, MA 02116 or by calling 617-973-9797 or 8W293-3757.
• Does the contractor have finurance? Ask the Ctaftactor for his insurance company information so that you can confirm coverage, or asir to
am a copy ofa "proofofinsmanod' docurnent.
• Know your rights and responsibilities. Read the Important Inibimanon an the reverse aide ofthis firan and got a copy ofthe, Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement ifit has been signed at a place other thim the contractoes normal place, ofliusiness, provided you notify the
conha= in writing at histhermam, office or branch office by ardinarymail posted, by telegram sea or by delivery, not later tharimidniglit ofthe
t*d business day following the sigain ofthisagreement. Seethe attached notice ofcancellation, form for an exvlanation of*is right
DO NOT SIGN THIS CONTRACT ]IF THM ARE ANY
hl -AW �W- �Ird,,Lcad -.t be ennpbftd and sigue& One eM should as to fi� hw� The 4
11 1 54 MOV -11 W14 1-9
1�,
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
this contract the contractor may submit the dispute -to aprivate arbitration m1whichlipbeena
pproved by
ofthe Execffin Officebf Consumer Aflairi'imd Business R Zgulatui the co �e requ6a,
al itatio ded In Massachusetts General Laws, 4
Houicowner Wg Contfi&es ignature.
S
NOTICE: ThNe of the parties abo� apply only to the agreement of the parties to alternative dispute
regr the contractor The homeowner may initiate alternative dispute resolution evenwhere this
section is not separately signed by the parties.
Homeowner's Rights
A homeownces rights under ffe'll'o6e Iniprovement 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 fights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own budding permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is re3lo'nsible' for completing the work as describ.-A in a
timely and workmanlike manner. Homeowners may be entift to other specific legal rights if the contractor
guarantees or provides am 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 sad 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/horneowner rights, contact the Consumer Information Hotline (listed below).
Execution of -Contract
The contract must be executed in 4mlicate 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 mitil all blank sections have been
filled in or marimd as void, deleted, or not applicable. One original signed copy of the contact 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 writq
and agreed to by both parties. Contacted work may not begin until both parties have received a fiffly executed copy of
the contract, and the &-ee day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in caseswhere the
homeowner deems huntherself to be financially insecure However in instances where a contractor dectins him,/herself
to be financially insecure, the contractor may require that the balance of flinds not yet due be placed in ajoint eicrow
account as a prerequisite to continuing the contracted wodL Withdrawal of funds from said account would require the
signatures of both parties. I I
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights, �r ifyou wish to obtain a fi-ee copy of "A Massachusetts Consumer Guide to Home Improvement"
contact:
Consumer Inforr6don Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 88&283-3757 or visit the OCABR website at http://www.mass.eov/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 ��ent Contractor Law, contact*
Director of Home Impr6ement Contractor Registration
,�. 1. -,
Office of Consumer Affairs and Business Re0ation,
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the HIC website at bM://www-mass.gov/ocab
Go online to. view the status of a Home Irnprovernent Contractor's Registration:
b�p://db.state.ma.us/homeimprovement/licenseelist =
For assistance with informal mediation of disputes or to register formal complaints against a business, call:
_Consumer Complaint Section
Mee of the Attorney General
617-727-9400'
AND/OR
Better Business Bureau
A,
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
ceming this contract the contractor may submit the di'spute-to a private arbitration firm .6 een a proved by
whi. b#&,b p
the je=tary of the Execffive Offia'bf Consumer Affairs and.Business Regulation the co be riquirea -
to
to nut to such ar�itafioNas provided In Massachusetts General Laws, chapter 4
C
H er!s(3-1p_4e cto - e tu
CIO a Siggaature.
om Co
NO;47:- e es of the parties abo\ie apply only to the agreement of the parties to alternative dispute
-Ib V e contractor. The h6meowner may initiate alternative dispute resolution even where this
resolution initiate th
section is not separately signed by & parties.
Homeowner's Rights
A homeowner's'nglits under ffeHionie' lin-pr'bveiient 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 prescnbed by law.
Homeowners who secure their -own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The �ontractoris resp6i�i1bld-for completing the work as described, in a
timely and workmanlike manner. Homeowners may be entitle'd to other specific legal rights if the contractor
guarantees or provides ahexpress warranty for workmanship or materials. Inaddition-to guarantees orwarranties
provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consuiner rights. Ifyouhave -
questions about your consumer&omeowner rights, contact the Consumer Informad I on Hotline (listed below).
Execution of -Contract ' I
The contract must be executed in Lur&ate and should not be signed u I ntil 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 wheire the
homeowner deems him/herself to be financially insecure However, in instances where a contractor deems hmVherself
to be financially insecure, the contractor may require that the balance of finids not yet due be placed in ajoint e's'cr'o'w
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
rights,. I ... �
consilmer or ifyou wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement"
contact:
Consumer lnfbrj�ation 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 OCA13R website at http://www.mass.eov/ocab
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 Affhirs and Busin6s's Rci
on
10 ParkPlaza, Room 5170, Bdstoj4MA 02116
617-973-8787, 888-283-3757 or visit the HIC website at htti)://www.mass.ggv/ocabr/
Go online toyiew the status of a Home Improvement Contractor's Registration:
b.9p://db.state.ma.us/homeiml)rovement/licenseelistp
For assistance with informal mediation of disputes or to register formal complaints against a business, call:
Consumer Complaint Section
Off ' ice of the Attorney General
617-72-7-840 0-
, AND/OR
Better Business Burean
.The Commonwealth of Massachusetts
Department of IndustrialAccidenti',
I Congress Street, Suite 100
Boston, AM 02114-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FIELED WITH THE PERIVHTTING AUTHORITY.
Name (Business/Organization/Individual): ,
Address: 02LU�� 01 1 f,�
0 C�IT
City/State/Zip:
Are you an employer? Check tfie app�opriate box: Type of project required):
1.21am.aemployerwith employees (full and/or part-time).* 7. F1 New construction
2. n I am a sole proprietor or partnership and have no employees working for me in 8. M46modeling
any capacity. [No workers' comp. insurance required.]
9. F1 Demolition
3. [J I am a homeowner doing all work myself [No workers' comp. insurance required.] t
4.F] I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all contractors either have workers' compensation insurance or are sole 11. E] Electrical repairs or additions
proprietors with no employees.
12. Plumbing repairs or additions
5.FJ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. Roof repairs
Thes'e sub -contractors have employees and have workers' comp. insurance.:
6.FJ We are a corporation and its office rs have exercised their right of 'exemption per MGL c. 14. Other
152, § 1(4), and we have no emplo"yees. [No workers' comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t
I 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 6ox must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub-coniractors have employees, ibey must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurancefor my employees.' Below is thepolicy andjob site
information. i A I
Insurance Company Name:
Policy # or Self -ins. Lic. #: \A/L Vc) k ( S I k C)c) Expiration Date: Z_— t —'Z_0 k
Job Site Address: 3 19 tV,^ S6,,et h^_Anxrcity/state/zip: H=ss e!:q aq5,--
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy -of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification. 7
I do hereby certify undejAhepains a4dpe�alties ofperjury that th e 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): 'I
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical ln��ic'tor 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 e oyees.
ImPl.
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 ajoint 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 apartinents and who -resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenancd, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such empLoyment b.6 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) naine(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-in'sured 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 pohiiit/license applications in any given year, need difly submit one affidavit indicating current
policy inforrnation (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 pen -nits 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 bum leaves etc.) said person is NOT required to complete this affidavit.
The Department's adoTess,.telephone- and fax number:
The Commonwealth of Massachusiits'-
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, NIA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
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