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HomeMy WebLinkAboutBuilding Permit #443-2016 - 328 FOREST STREET 10/7/2015 Q ��y•O •' �O 4 tkORT#t BUILDING PERMIT 3? e` . �» :• o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ^L`" Date Received °,w<.,-�=.�•;r " Date Issued: / / i SSwcHusE IMPORTANT:Applicant must complete all items on this page LOCATION 22 9 9—jr-g-&-7 Prin� PROPERTY OWNER i/vrint /tZt �z2 LI.&I /l ov✓S �/ P MAP NO: le/ PARCEL:��7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer (d 4. yx, :fl h,g z,,11 r,—La-_AAA / VA,1 Yo CSI C0 ?- /-f 10Gsf✓,*% Identification Please Type or Print Clearly) OWNER: Name: E'ilif 7 si ti %i fipm Ad o S Phone: t 7) ML 5 Y3 Address: CONTRACTOR Name: Address: t a 1 Tc-J Supervisor's Construction License: Exp. Date: Home Improvement License: / Exp. Date: Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$1212.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 00 Total Project Cost: $_�5 �, FEE: $ Check No.: 2fa-17-- Receipt No.: _�Y NOTE: Persons contracting with u-nxegistered contractors do not have access to the uaranty fund ignature of Agent/Owner Signature of contractor Location No. � �{ST / 7 3 Zdl Date 1617 150 �° . - TOWN OF NORTH ANDOVER 27 Certificate of Occupancy $ Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ I 22 Check#2- 2 4 8 4 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ,. Public Sewer ❑ 1 Tanningimassage/Sody 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Toning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes fulanning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature ®ate Driveway Permit DPW'r--Wn Engineer: Signature: FIRE DtPLocated 384 Osgood Street I ,AR�TIVIEN,T}} Ter_npapumpsteron,sr te rt Locatedjat1v24�Maint Street FiretDepartment1signatureldate COMMENTS. t ; Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL. Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE, Yes N® k MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (E®r department use) �I i ® Notified for pickup Call Email 3 . Date Time Contact Name Doc.Bnilding 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 OTE: 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/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 INIOTE: 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 2012 IECC Energy code 4- Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 r 1 NORTI� - _ _ . w. .. . . ve' . O -. . .... n+ No. soh ver, Mass, /0 5-- cocHic«ewIcK 1' A_ P � 1S V BOARD OF HEALTH Food/Kitchen PER . IT T D 'M Septic System THIS CERTIFIES THAT ............ ��,.:...T '00�w '04" mks........ .... . ...... BUILDING INSPECTOR .................................... -`El. f....��.G:. Foundation has permission to erect .......................... buildings on .. ...... .... s. .......��. ..... Rough to be occupied as .................... c .� .t..... ........................................................... Chimney provided that the person accepting this permif shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ......... ....... .. 'GAA ..........I.................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. National Management Team Inc. ' This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not Include standard language to protect homeowners. Seek legal advice If necessary. Any person planting 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 Consmner Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name CompanyName tMt.�✓i % /i!lC� Street Address do not use a Post O0�nice Bos address) Contractor!Salesperson/Owg et ane 00 CN City.To«n State tip Code Business dress(must inchude a street address) V-4 1U0/+rte►',17%1001a% o O/es" Daytime Phot Evening Phoue Citv'fow u State Zip Code '7)3 — a33y3 Mailing Address(It different from above) Business Phone Federal Frnployer ID or S.S.Number QHome tmpmavat"v COWWor Reg.N ber Exph"tt-drte „y Lore regn mentt teat most Aome 0104 rontrarrorsasre /� h � .orad regtgmnon"am4er N000 The Contractor agrees to do the following work for the Homeowner: ^00 tAcscn'be in deiait the work-to completed,specifying the type,brand,and grade of materials to be used, use d itional sheets if necesse cry) bn o � �/>/h�� !2�/�oot /Zltfin/ ifo�s� E f �—t CNr7iZt„i tp ..f7h��-/J /f1LU4-t. X1 W t. S Q p Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will P t t- and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond die contractor's control:rise a kg� (Owners who secure their own permits will be a� t- excluded from the Guaranty Fund provisions of 10 f Date when contractor will begin contracted work. err. % 000 MGL chapter 142A.) 04.� 00 / /v Date when contracted work will be substantially completed z � Total Contract Price and Payment Schedule ©(1 C) The Contractor agrees to perform the work,famish the material and labor specified above for dge total sum oF. (+) 0 Payments will be made according to the following schedule: id $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by / / or upon completion of $ by_! / or upon completion of $ LO upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipmeat must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(•)Including all finance charges('•)Law requires that any deposit or dowv-payment required by tie contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material wfiich must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express wnriwnh being provided by the contractor? No ]es(a11 terms of the warranty must be nnnched to the eonhactl Subcontractors-The contractor agrees to,besotely responsible for compietion of duework described regardless.of the actions of any third party/subcontractor utilized by the.contractor. The contractor firther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance Upon sign ng 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 has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • -Don't be pressured into signing:the contract.Take time to read and fully understand it.Ask questions if something is nuclear. • Make sure the contractor ins a valid Homer Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with die Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing tothe Director at 10 Park Plaza,Room 5170,Boston.MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does dre contractor have insurance?Ask the Contractor for his insurance company information so that)'On can confirm coverage,or ask to see a copy of a`proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on die reverse side of this form and get a copy of the Consumer Guide to die Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other,dlan the contractor's normal place ofbusiness,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of tie turd business day following the signing of this agreement. See dre attached notice of cmuellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE BLANK !!! Ttro idrntical Tract mar be eoatpleW and signed one copy should go to the hot anti .Tie other copy sip d be kept by a eouTracror. :2 Ile Homeowner's Signa r Con igna i ice Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the 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 rsunmer shall be required to submit it tion as provided In Massachusetts General Laws,c terkresolution Homeown 's ature ract 'NOTICE:The signatures of the parties above apply only to the a een t of th e dispute resolution initiated by the contractor. The homeowner may hmitia ernative dispeven where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. 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 GuarantyFund provisions of the Ho Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike mamier. 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 cavy an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been tilled 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. I Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of 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 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 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 Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at htto:/hvwtiv.mass eov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htti)://db.state-ma-us/lioineimproveinent/liceiiseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6524800,508-755-2548 or 413-734-3114 veniou 2.1-112212010 The Commonwealth ofMassachusetts fra Department of Industrial Accidents Office of Investigations Y 600 Washington Street Boston,MA 02III www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A licant Information • Please Print Le 'bl Name(Business/Organization/individual): �� i Address: Gcf . City/State/Zip: AJ Phone#• Awrou an employer?Check the appropriate box: 1. ama,employer with__j,0 4. ❑ I am a general contractor and I Type of project,(required): employees(full and/or part-time). have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have 0 Remodeling —_.----a 8. ❑Demolition -- working for me m any ca acit .______ emplbyee�and-have workers' - --- [No workers'comp.insurance comp.insurance. —._.-----9—E]Building-additioz--------_..... __.......... 3,❑ required,] 5, ❑ We are a.corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself'[No workers'comp• right of exemption per MGL ILEI-Plumbing repairs or additions insurance required.]t c.152,§1(4),and we have no 12 IR Roof repairs employees,[No workers' 13.❑Other comp,insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners tubo submit this affidavit indicating they are doing all work and then hue outside contractors must submit s new affidavit indicating such. ;Contractors 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. Ifthe sub-contractors have employees,they must provide their workers'comp,policy number, i I an employer that is providing workers inffoormation. 'compensation insurance for my employees th Below is epolicy and job site Insurance Company Name- ��/� (,'n/��-t,/✓L/t%�1.T ln��1' Policy#or Self-ins,Lie.#•_ /Cl � �0 1 7 • LXpiration Date- Job Zj Job Site Address- • City/State/ZiP-- /�y✓Li�`t' /Ji�/(,/I d t/,/" D i t Y 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 ' risonment,as well as civil lienalties in the form of a STOP WORD ORDER and a fine Of up to$250.00 a day against the vi r. Be advised that a copy of this statement may be forwarded to the Office of —�_... the DIA_for rn• . . coverage verificafiop.. ..... I do hereby cert under thep penalties ofperjury that the information:provided above is true and correct. Si afore: - Date: ;p I � hone#• Official use only. Do not write in this area,to be completed by city or town offrcial City or Town: Permit/License# Issuing Authority(circle one): - 1.Board of Elealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person• Phone#• NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In ac ordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 2 i h s that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Si tore of Permit Applicant ZOZ7115- Date A �® CERTIFICATE OF LIABILITY DATE(MIDDlYYY") L.....� INSURANCE 8/14/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT NAME: Circle Business Ins. Agcy, Inc PHONE 978 777_5619 FAX No. (978) 777-4898 247 Newbury Street E�aL Danvers, MA 01923 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC W INSURED INSURERA:Hartford Underwriters Ins. Co. INSURERB:Main Street America National Management Team Inc. INSURERC:TOrus National Insurance Co. 2 Austin Square Lynn, MA 01905 INSURER D:Merrimack Mutual Insurance INSURER E• INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A UBR POU EFF POLICY EXP LTR TYPEOFINSURANCE NS POLICY NUfJ®ER M/OD/Y bA11DLYYYYY UMTS B GIfJERALLIABILM Y Y MPT7965M 2/24/15 2/24/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIALGENERALLIABWTY DAMAGETORENTED CLAIMS-MADE 51OOCUR PREMISES(Ea occurrencg) s 500,000 MED EXP(Ary one person) S 10,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PE R PRODUCTS-OOMP/OPAGG $ 2.000,000 POLICY }( PRO LOC $ B AUTOMOBILE LIABILITY Y Y MPT7965M 2/24/15 2/24/16 (29,cideertSINGLEI I7 $ 1,000,000 ANY AUTO BODILY INJURY(Per person) 3 ALLOWPED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIREDAUTOS X NON-OWNED AUTOSPROPERTY DAMAGE er acciden1 3 3 C X UMBRELLA OCCUR Y Y 858241140ALI 2/26/15 2/26/16 EACH OCCURRENCE S 5,000,000 EXCrSSLIAB CLAIMS-MADE AGGREGATE 3 5,000,000 OED RETENTION S A WORKERS COMPENSATION UB2E71937-6 2/21/15 2/21/16 WCSTATU- OTH- S AND EMPLOYERS'LIABILITY YIN X OFFICE RIME ANY 9EREXCLLDED?��TIVE N , NIA E.L.EACH ACCICENr S 1,000,000 (Mandatory In Wand E.L.DISEASE-EA EMPLOYE S 1,000,000 describe under er RIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Rental Equipment cover IMCB-454-711 5/21/15 5/21/16 Limit 100,000 REPLACEMENT COST Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS IVEHICLFS (AttachACORD101,Additional Reim rl6Schedule,Itmore space Isregllred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE Janet Nichols ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone; Fax: E-Mail: •� i . • F f Massachusetts_DeparGnent dF public Safety f Board OT Building Regulations and swdaids ! Corisftucciod.¢upetvisbr License:CS 080Ag5 �{a: Q;, ! '' GEOktG VA yj a 'A 5 0638 Commissioner Expiration 1012-612015 i