HomeMy WebLinkAboutBuilding Permit #515-13 - 32 MAY STREET 1/15/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIOIN
Permit NO: �� Date Received
1
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION zJ 0", — /'f&X _ _ ,5"?',
PROPERTY OWNER_ zj�,y
PROPOSED USE
MAP NO: PARCEL: �b�
Print
ZONING DISTRICT:
100 Year Old Structure
Historic District
yes
yes
❑ Addition
Machine Shop Village
yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
9-erl family
❑ Addition
❑ Two or more family
❑ Industrial
V,Atferation
No. of units:
❑ Commercial
CSP- epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
mater/Sewer
DESCRIPTION OF WORK TO BE PEKFUMmtu:
70
4 04�re�_ 7T.1 T —4 /19/1; ^ �t �fJ1-�� A l? Iq
•�ya��d'� /RS �'o i�TT/G � -f �6T�yv ��� L ,bou�� ,si��.�S
Identification Please Type or Print Clearly)
OWNER: Name: �, Lf�stl �. uSC��,�¢- Phone:
Address:
CONTRACTOR Name
Address:
�T
r ,r'
Supervisor's -Construction License: C-5 Czsoo Exp. Date: 3p
Home Improvement License: (7 O �j Exp. Date:
ARCHITECT/ENGINEER Phone:
Address:
Reg. No
FEE SCHEDULE: BULDING PERMIT. $1Z00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED O $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: (0 YO Receipt No.: i a --
NOTE: Persons contracting with unregistered contractors do not have access to he -guarantyfund
,SlgnatureKof3Agent/Owner' Signature of contractor
Plans Submitted 11 Plans Waived 11 Certified Plot Plan ❑ Stamped Plans 11
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 ❑
DATE APPROVED
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMAS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
14
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW 'Tow, Engineer: Signature:
Located 384 Osqood Street
HKE DEPARTMENT - Temp Dumpster on site yes no
Located at'124 MainStreet
Fire Department siignature/date
COMMENTS x
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 crop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For de
® Notified for pickup - Date
Doc.Building Permit Revised 2010
ent use
No
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)
o 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 submAted with the building application
Doc: Doc.Building Permit Revised 2012
Location-32M4L4
No. Date .i
Check # (a( 0
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
4
Foundation Permit Fee $.
Other Permit Fee $
TOTAL $
26092 Building Inspector
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
I' 1; I
Permit NO: _ Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
i
L.00ATiIONi_
PROPERTY OWNER '
PROPOSED USE
MAP`NO` o_-_�PARCEL•: bb( _
Print
ZONI.NG DISTRICT:
100 Yea bld1$fhjgture,
Historic:District,
yes, ,
yes.
❑ Addition
MachinelSlop Village
yeso
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
9.611�e family
❑ Addition
❑ Two or more family
❑ Industrial
VAferation
No. of units:
❑ Commercial
9 -impair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septici ❑ Well
0 Floodplain ❑ Wetlands
❑ WatershedDistrict"
&W—Water/Sewer,
_ _ DESCRIPTION OF WORK TO BE PERFORMED: _
Identification Please Type or Print Clearly)
OWNER: Name: 4& 4n*A r Phone:
Address: hay-,
CON TRACTOR Name: e -%Sly
Address:
NT
Supervisor's.Construction'L'icense:'_r �_.Z� 3� Exp: Date:_
Home, Improvement1icense:. 7 g b Exp,. _Date::
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASEDO $125.00 PE
Total Project Cost: $ ba FEE: $
Check No.: (8— / 0 Receipt No.: }
NOTE: Persons contracting with unregistered contractors do not have access to. he ara..
SI nature of A ent/Owne Si nattare'of'eontractor
.__g_.__._.. _ _. 9...___. ._-. _. _-. _-.
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
North Andover Board of Assessors Public Access
Click Seal To Return
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Summary
Residence
Detached Structure
Condo
Commercial
Page 1 of 1
roperty Record Card
tion: 32 MAY STREET
er Name: WALDIE, TIM
C/O BANK OF NEW YORK MELLON
ier BAC HOME LOANS SERVICING,LP7105 CORPORATE
ress: DRIVE
City: PLANO State: TX Zip: 75024-3632
Aborhood: 4 - 4 Land Area: 0.11 acres
Code: 101-SNGL-FAM-RES Total Finished Area: 1440 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 241,900 237,000
Building Value: 122,900 105,700
Land Value: 119,000 131,300
Market Land Value: 119,000
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkId=2250438&town=NandoverPubAcc 2/26/2013
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a
e Improvement SamiDle C
This foim satisfies all basic requirements oft -he state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard
language to protect homeowners. Seek Iegal 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 Informamon
Contractor Information
"i Cf k 9'�
Street Add ess (do not use a Post Office Box ad ss) Contractor/ Salesperson/ Owner Name
City/Town State Zip Code Business Address (must include a street address)
1 vat' vii U�►� l �(G� D �y� ka� e
Daytime Phone Evening Phone City/Town Stat
Zip Code
Mailing Address (It different from above) 4_Ll�Phone
llI —(b'�.� Federal Employer ID or S.S. Number p
Law requires that most Homc Home Improvement contractorReg: Number Expiration date
•
improvement contractors Iiavc
a m
�' 13
valid registration �mbcr [/ (,/./ �O/D�/
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the woricto completed, specifying the type, brand, and grade of materials to be used, use additional sheets ifnecessarv.)
` REAkewt S QirW� irV� 4o abw,-✓ S-41irS 4e, 0�i'zJ 0 q
X &t4 o,\) URejoleve n&r-j C., -✓d SAIrS _0 3�VS• /( lad, 'rf t4,✓e1.�
�„► �of��� iew,ave:�ei�er�1 .Zc.lo;,�eas a,�lcl I�v5 11 /tleW �h,Ve�s� %
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 affordedto 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 adispute
concerning this contract; the contractor may submit the dispute to a private arbitration filo. which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shallbe 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 patties above apply only -to the agreement of the patties 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 patties.
E[omeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer
protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excludedfrom all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor, all goods sold•in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below).
Execution of Contract , .3 , .
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
begiven 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 patties have received a fully executed copy of
the contract, and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the.payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself
to be financially insecure, the contractor may require That the balauce of =ands not yet due be placed In aiolnt escrow
account as a prerequisite to continuing the contracted work. Withdrawal of fi=nds :From said account would require the
signatures of both parties.
Additional Information '
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement"
contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the OCABRwebsite at hM://www.mass.g ocabr/
If you want to verify the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law, contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and3usiness Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the BIC website at bM://www.tnass.gov/oeabr/
Go online to view the status of a Home Improvement Contractor's Registration: .
httto•//db.state.ma.us/homeiLnprovety ent/l icenseelist.as'D
For assistance with informal mediation of disputes or to register formal complaints against a business, calx:
Consumer Complaint Section.
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
508-652-4800, 508-755-2548 or 413-734-3114
Version 2.1-1L22/2010
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Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 26,500.00
m
$ -
$
318.00
Plumbing Fee
$
39.75
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
39.75
Total fees collected
$
497.50
32 May Street
515-13 on 1/15/2013
add 1/2 bath on first floor, remodel
kitchen, remove stairs to attic
Page 1 of 1
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HOME IMPROVEMENT CON t KAU I UK
A=• M issachusetts - Department of Public Safetc
9ConsBoard of Building Regulations and Standards
truction Supervisor License
- Registration: ,;1.40876 Type: .
. � Expiration: �12J,1/2013 Individual
K � GRASSO �_
KEVIN GRA5S0'��}
29 KRISTINE LN
HAVERHILL, MA 0183=2..} =��;� Undersecretary
License: CS 83845
KEVIN J GRASSO '� # •� •_
29 KRISTINE LN
HAVERHILL, MA 01832 •�
Expiration: 111
30/2012
� ('onnnissiuncr
Tr#: 6003 �
r
30/2012
� ('onnnissiuncr
Tr#: 6003 �
Failure to possess a current edition of the
' Massachusetts State Building Code
is cause for revocation of this license.
Refer to: WWW.Mass.Gov/DPS
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The Commonwealth of Massachusetts
�f Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
h ,Y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual): VeAJ i ri
Address: 3
City/State/Zip: 49dk.A 1,)eY_&Y<Phone #:
Are you an employer? Check the appropriate box:
. ❑ I a employer with,
4. ❑ I am a general contractor and I
mployees (full and/or part-time).*
have hired the sub -contractors
I am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. construction
7. �Eglw
modeling
8. ❑ Demolition
9. ❑ Building addition
10. El Electrical repairs or additions
11. F1 Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
my applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
im an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
formation.
surance Company Name:
dicy # or Self -ins. Lid. #:
Expiration Date:
b Site Address: City/State/Zip:
:tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
Le 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
up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
✓estigations of the DIA for insurance coverage verification.
'o hereby c rten he pains and penalties of perjury that the information provided above is true and correct.
,nature: Date: r
one I /)2 ow)
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-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 confnrnation 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.. # 617-727-4900 ext 406 or 1.877-AMSSAFE
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Fax # 617-727-7749