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HomeMy WebLinkAboutBuilding Permit #525 - 34 ELM STREET 2/26/2010Permit NO: 3451" - Date Issued: A TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: ADDlicant must complete all items on this nage LOCATION 3 Y 0Lm "S Print i Q W Print MAP NO: PARCEL:_ ZONING DISTRICT: Historic District Machine Shoo no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteratio No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Floodplain Wetlands Watershed District Water/Sewer • DESCRIPTION OF WORK TO BE PERFORMED: RtcPLS e'r. FroP92 sor -Sr-5 Q4,w4GC-D SS? t'�'®wnCz� Posr G,,:ere-eF-5 0,10 C,C(Ter F? C�L,6j�> e- o e -c,01/ y� S - ' S'T„G>• c..t. C o g Cr67 -r/.Aj GS F 0 g PQSIJ Identification Please Type or Print Clearly) OWNER: Name: ?,tCKa t E Phone/�7 �� 8� -aa g Address3 CONTRACTOR Name: T 0 Address: V / 4,P [ ,, C'` i4 0 INi �•A Fv0 Supervisor's Construction License: CS 41 3d o? :2 Exp. Date: I—/ I — 2 O/ / Home Improvement Licenser ARCHITECT/ENGINEER Address: Date: /— 7 -- o� O / 0 Phone: [$I FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. e Total Project Cost: $ y �' O FEE: $ © Check No.: /R Receipt No.:��� NOTE: Persons contracting. teunrZ,,gpWd contractors do not have access to the guaran fu d Signature of Agent/Own Signa re of contr or Location��•n No. Date ZY LORTN TOWN OF NORTH ANDOVER Of «•o :•1'1.0 9 Certificate of Occupancy $ S��M�S Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check # ,Z -L r L Building Inspector 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 a Zoning Board of Appeals: Variance, 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 FIRE DEPARTMENT - Temp Dumpster on site yes no, Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No 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 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: Doc.Building Permit Revised 2008 m m m 14 /m YI m m v vi C � _ O VA C" CD 0 Z y CLO 0. r C O ? C CZ y O CD CDCL O CS m CD CD 0 CDa CoC" C CDCD y� CL O y CD I � v CA O 'vCD Z o CD O CD D, cn cn O cn wo C O O z m 0 m 0 C a m m m C COV C 0 c: N cn H O C— OC " CO) = m c, G N O d C 9. =6 �dd� H ..o ^.m T CL -0.0 ^►a 0 Mn -i O m N o y .� ; -4 IECl) - a �.0 c : C o : r. MAJc Z O N C! a � CK j sW, Cc. - — m m N o m CL -4 t m N 01 N CL m Q. _ C � a C � m N IE mcd to= -- o � O CD w y3� � o~ N O � cn ED CD � CD go d� ='O a'o t C O C-1 O . O � p (n n 0 to IT1 Oc " O O r a � m n O 0 O � r� CA O O\. xCZ xCD rb >O a H 0 9 § . ƒ ) -n ƒ $ R / ¢% ( kz . eft �f r\7 . = k\( . > \ o oo _f o X g ■ _ 0 2\\\ 0 w / / \ cam§ m (D §j \ , a w # 22 ))2 - $f \ \ Homeowner Information K IC14- how e Street Address (do not use a Post Office Box 341 Ee- A- -i S T city/own State Dit nneQ� Q�� �, Day V 'Ku Mailing Address Ot different from above) Contractor Information CA 77,0 Name Address (must inciude a street moo„ Phone 3ederdl Employer ID or S S Number Lweg.res 1 on hme m I amuReg. NumbeHxpns,_ dnW.mHm pmvmreat Counselors haves ad registration amoher The Contractor agrees to do the following work for the Homeo to,/I sp mb a e, her: Matenais o us a na , r n MM RePc.,#c E' Ft,o �o t2 o" S rs 254,,7,4 R.ePt_64e0 TEAne SCA- ppcv2 OS1 S Cs��earoQ,QtTE FI c.L_ y C o r,3 / �o dT/,j 'Gs Required Permits - The following building permits are required and will be secured by the contractor as the homeowner's agent, (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) Proposed Start and Completion Schedule - The following schedule will be adhered to unless circumstances beyond the contractor's control arise J ~165), when contractor will begin contracted work gate when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, famish the material and labor specified above for the total sum of: Payments will be made according to the following schedule: $ C v pon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) or upas completi or upo ompletion of upon completion of the contract (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to 'd for / ordered before the connected work- begins m order $ ! for to meet the completion schedule.(•*) / 7 ----- NOTES: (*) Including all finance charges (•*) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. - Express Warranty -1s an a ress warranty bein rovided by the contractor? No Yes ell terms of the warranty must he attached to the contract Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest 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 unclear. • Make sure the contractor has a valid Home Imnmvement Contractor Registration The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, 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 the third business da ollowing the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right. DO OT GN IS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical tt on must be completed and signed One copy should go wner. The other copy should be kept by th/1 contreaor. Homeowner' ignature C n dors Signature Da Date - -• •• • -ib cause woulo give the contractor the same right to amttration 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 ZSecre is contract, the contractor may submit the dispute to a private arbitration firm which has been approved by tof the Ex tive O ce of Consumer Affairs and Business Regulation and the consumer shall be required tuch provided In Massachusetts General Laws pter 142A. i Homeowner's Signature ctor's Signature NOTICE: The signatures of the parties above apply only to the agr t of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative di ute resolution even 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 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 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 be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day recission period has expired Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be 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 Consumer Guide to the Home Improvement Contractor Law," contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 .(617) 973-8787 or 1-(888) 2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General (617) 727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413) 734-3114 The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations U1 .600 Washington Street Boston, MA 02111 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nnlirunf Tnfnrm m"__ i aca�c J Name (Business/Organization/Individual): AjftUAe 0 d-725 0,1d4 -1.50 Address: /I Ip p ( C 12-n City/State/Zip:_BF,( M (--I (ice_ ('�� � phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- ' listed on the attached sheet. # 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.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption MGL myself. [No workers' comp. per C. 152, §1(4), and we have no insurance required.] t employees- [No workers' comp. insurance required] 007 IF -C??9--(i) Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11 -[1 Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other `Any applicant that checks box ui must also full out the sevtion be:e•,, shoe ins ibgr wori e*s' comms=• �g�oI ! ' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 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 here under the pains apenaltie�s of perjury that the information provided above is true and correct U Date- 7_ — - 7 Y C/ 1--D Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political. subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum 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-MASSAFE Fax # 617-727-7749 Revised 5-26-05 wvmr.mass. govfdia