HomeMy WebLinkAboutBuilding Permit #882 - 360 WAVERLY ROAD 6/21/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Lif
Issued: 1�2
IMPORTANT:
Date Received
must complete all items on this
LOCATION \3 6 W 067e 2 ' Y 9 'D
Print
PROPERTY OWNER Gc
Print
MAP NO: J 1 PARCELA 0,� ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residen '
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
9 ne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Commercial
❑ Repair, replacement
❑ Demolition
0 Assessory Bldg
0 Other Y
❑ F<lood-�-�� ❑Wetlands�g�
��,.p _ �
❑ Others:
r
®�Wa,,tershgedtDist�riet
nm��eptie, ❑�W`ell
DESCRIPTION OF WORK TO BE FhEirUxlvihli:
Rooms RF /iDve-L 1A1sr,#L-L. AjeW 14kc Af14L
OWNER: Name. Gu I9
lo' Z e IZe;4 i
Ication Please Type or Print Clearly)
U L cDuC,
��92 071 i
Address: �� bo eaeR .0 � /?d - Alo 6/1/1)0 UGI'Z {i -
CONTRACTOR Name: 8 V -,ovs Phone:
Address: s`s'PL ! S 69 N%� d' T ,fid �N�Uy�lZ J`7 �4
Supervisor's Construction License:
0 ,?,-uC-Q
Exp. Date:
Home Improvement License: /d 9✓ Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
(0 /-"h z---
71711Z---
J
i7 7 !v .
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ P%01 FEE: $
Check No.: c2ff/ Receipt No.: x%6.2 1 ��
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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 ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE APPROVED
El
Reviewed on Signature
Reviewed on Signature
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:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Osgood Street
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-$1 000 fine
NOTES and DATA — For department use
El 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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o 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
o 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)
o 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
o 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)
o Copy of Contract
❑ Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
d®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
lust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
"7j
Location
No. Date
ViONTI, TOWN OF NORTH ANDOVER
Certificate of Occupancy $
MUS Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee I
TOTAL
Check #
24295
Building Inspector
Q
�A
u
o
w°
a
U)
O
w
A
GG
c
o
w°
t
,
U
w
O
w
°
w
O
W
i
w�'
cvi
m
w
d
C7
w
w
x
W
C
wQ
U))
v
Q
cn
M,
UI
O
O
O
L
_ O
O v
Z a3
C.
O y
� C
co cm
i O
L** O O
�E m m
G3 Q CD
CLI.—+=+
G3
O �
a2
coL
env o a
CL CMQ
c�
Q c
v Cc
1.�
O
CO3C Zts
O
V y
OCOD
C
U)
LLI
U)
W
W
W
U)
c o
a� c
4
c w
o `
=h
O
::g
O
ivV
O O
C
;= O
O �
N CD
Ea
CF
w
=
CD
:oQ
• `� N
J
CS, $
u os
E
CO c
CL=
ISea
m
a
vi
c
0
y
3
y
N
CT
�
a':'),
N
JS
�m
s
N O
O
now
L�
co 0
c
cm
N m
O-==
A=
lm
m
vHZ
p
ev o
Cr
=
o
mr 3
N
H
4—
O
y �
m
COD '
W
=
G
.
MD
WC3
ii
CL= =
Z
cm
C/2
CZ
vw=
m 'c
C
2
H
=
C.� m
M,
UI
O
O
O
L
_ O
O v
Z a3
C.
O y
� C
co cm
i O
L** O O
�E m m
G3 Q CD
CLI.—+=+
G3
O �
a2
coL
env o a
CL CMQ
c�
Q c
v Cc
1.�
O
CO3C Zts
O
V y
OCOD
C
U)
LLI
U)
W
W
W
U)
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form satisfies all basic requirements of the state's Home Improvement Contractor law (MGL chapter 142A), but
flo(x not include standard
language to rotetthomeowners. Seek,le al advice ifnecessary. P 8 sary: Any person plaoniog hotite improvements Should' Srsf 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' --ling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at617-973'8787 or 1+888.283-375.7.'
Homeowner Information 'Contractor Information
h tL WUL
d/o�aot usa.a Post Office Box adder—)./�
v bf/ 411,4A L
A/0 /9tyooLe°(a, i" n,
ntractor/ ow sparson/.Omer Name
oness Address (mum include a—, addregs) .
L�J�L��s�A;0� Ss!-
177�-_&S-2,- D7sk xo f%n1DCJ1;2�L ✓b";
Mailing Address (1t diffmant from above) lusiness Phone gederal Momlbyc Il
1—mp-tWtmatx tutoe ®•� Atn"e tConxngorF
aoatr�amaihnee
trginntiw®�
The Contractor agrees to do the tolloiving work for the Homeo tier. /40 31�
;PbDL fie/J�W,44 - rc W-crucdu ^S6t,ee-D
IZequired'Permita - Thefollowing building permits are required Proposed Start and" CompletionSchedale - The following schedule will
and will be secured by the contractor as the'hontcownerts agent; be adhered to `unless circumstances beyond the connactaft contra] arise
(Owners who secure their own permits will be
exclnded.:from the Guaranty Fund provisions of L Date when contractor will begin contracted work.
MGL chapter WA.)`
Date when contracted .work will be substantially'completed.
Total Contract Price and Payment Schedule ,
no c.-uuucwr. agrees m perform the worx, Lnnnjh the material and labor specified above for thetotal sum of (s)
yments will be made according to the following schedule:
neon signing contract (not to exceed 1/3 of the total.contract price. yr the cost.of special order items, whichever is greater)
S by or upon completion of
t6f(iupon
by 7Tor upon completion of completion of the contract (Law forbids demanding full payment until contract is completed to both party!s satisfaction_ )
The followiag matcaiaUequipment must be specialS be paid for
ordered before the contracted work begins in order 5 to be paid for _
to meet the completion sihadule.(••)
NOTES: (•) Including all finance charges (••) Law requires that any depositor down -payment requited by the contractor before work begins may
not exceed the greater of (a) 0110-d1 d oftbe total contract price or (b) the actual con of atiyy special. equipment or custom made material
whim must be special ordered in advance to meet the completion schedule.
Exorws Warranty - Is an ewress war nett' being-rrovfded by the ntrat tot^ No Yes (alt terms of .. warranty cue- [- a e-a[raen
Subcontractors The contractor agrees to be solely responsible for Completion of the work= regardless of the actions of any diiid
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontraetora for
materials and labor under h;s sere meet
Contract Acceptance - Upon signing, this document becomes a binding -contract under. -law. Unless otherwise noted within this document the
contract aball not imply that any lien or other security interest)tas 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 understand it Ask'
Y questions if something is unclear.
• Make sure the contractor has a valid Home ImtmovemCutContractor Re •atntt •1.110 law
subcontractors to be registered with the Director ofHome requires most home improvement contractors and .
Improvement Contractdr Registration. You may inquire ttbout.contractor
registration by writing to the Director at One Ashburton Place, Room 1301,.BostoA MA 02108 orby.,calling 61.7-727-3200.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 IaVmcment Contractor Law: ..
You may cancel this agreement if it has been signed at a placeoderthan the coactoz+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 the
third business day following the signing of this agreement . See the; attached notice of cancellation form for an explanation of.this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES►t1
-- — -• -• ............�.....�,�-npxeo, cine eopy.w oulgno to ere homeowner otJxc eopr ahouW be kept by the contractor.
w
Homeowner's Signature
Co U,.Gwr
n's Si hue
v11
nau ,Dat
Contractor Arbitration
The Home Improvement Contractor Law provides. homeowners with theright•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, how.ever...The:conttactor:would have tp resolve any.dispute helshe.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 andihe consumer shall be required
to su it to such orb' tion as provided In Massachusetts General Laws, chaptZ14.,
Homeowner's SignAturek ntractor's Sign
NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution
initiated by the contractor:: Thehomeowner may initiate altemative:dispute resolution even where this section -is not
.tenarately siened-lorthe oartres.
Homeowner's. Rights
A homeowner's rights underYhe 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 responsrble for completing the work as described, in a
timely andworkmanlike 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.guaranteea or warranties provided by the
contractor, all goods sold in Massachusetts carry an implied warranty of merchantability ;and.fitaess.for a particular
purpose. An enumeration of other matters on which -the homeowner and contractor lawfully agree** 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 du lice 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 griginal 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 ImprovementContractorLaw or other
consumer rights,.or if.you wish to.;obtain a free copy of "A Consumer Guide to the Home.Improverrent Contractor
Low,"• contact:-
Cgnsumer 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 1-800-2234933
For assistance with informal in ation of disputes -or to registerfornal complaints against a business, call;
CoiftSudi& CoiiiplainYSeetion
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114
CS # 022680
HIC# 103358
=,Vropoal ==
A. J. Walsh & Sons
55 Pleasant Street
.North Andover, MA 01845
# of
978-688-6737
or
1-866-AJWALS H
Proposal Submitted To: Job Name Job #
�. e.LeJoc
Address�..✓ �� � A,, , Job Location
/) Date �7 Date of Plans
1747
Phone # , �1 _ r 67 V Fax # Architect
�(We hereby submit specifications and estimates for. _
A
We p7ose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of:
$ 3006 d3���� Dollars
with payments to be
Tmde as follows: /
Any alteration or deviation from above specifications involving extra costs will be Respectfully '
executed only upon written order, and will become an extra charge over and submitted
above the estimate. Ali agreements contingent upon strikes, accidents, or delays
beyond our control. Note — this proposal may be withdrawn by us if not accepted within days.
Xcceptanct
of D 10 �Y
The above prices, specifications and conditions are satisfactory and are Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance W2 2 c) Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
0'r, Office of Investigations
600 Washington Street
' 111111
Boston, MA 02111
www.mass gov/rlia
Workers' Compensation Insurance Affidavit: Builders/Contractor-s/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): u% 1q 6H --e SG NS
Address: c:5, %Ge *,s J4 "/ 7- s/
City/State/Zip: /Vg /31Y ,000Cq /'-'/& Phone #:
F7e- 4W-6737
Are yo y an employer? Check the appropriate box:
1. I am a employer with l
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. 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
3. ❑ 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.]
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Pqupbing repairs or additions
12. Roof repairs
13.❑ Other
*Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors acid their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site
information. M ../
Insurance Company Name: Iq //'V)- / �/ ��L /&S CU
Policy # or Self -ins. Lic. #: _%%li�4:ed /dyb0 Expiration Date:
Job Site Address: 3�0O W (4-0&Q L)y City/State/Zip: /,yo� �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-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certif under the ppaaii�njs��and penalltti�es of perjury that the information provided above is true and correct:
Riannfiire• /" 4�+`L%{� AV Q, _ Date' &/.,7-/b/
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
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration:
103358 Type
Expiration: 7/7/2012 Private Corporatior
A. J. WALSH & SONS,INC,
Arthur Walsh,Jr
55 Pleasant St
IN Andover, MA 01845
License or registration valid for individul use only
before the expiration date. If found return to;
Off -ice of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, SIA 02116
Not v9Ii&-;vitliout sigil/Iture
1-w(twse: (;S 22680
ARTHUR J WALSH JR
159A WAVERLY RD
N ANDOVER, MA 01845
ml
619/2012
29327