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HomeMy WebLinkAboutBuilding Permit #419-11 - 37 BRENTWOOD CIRCLE 11/16/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �l Date Received Date Issued: fly/ IMPORTANT:Applicant must complete all items on this page LOCATION !- � � e xc . Print PROPERTY OWNER JA.-A4- Print MAP NO: Ok o PARCEL:00 30 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Q,One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial OLRepair, replacement ❑Assessory Bldg cI Others: ❑ Demolition ❑ Other " � a Floodla� i�wetland`sF 4 , M �glo Wa ershed " .D Septic r ®RWell 4 .= p hev Districts,, .� ❑Water/Sewer �� r s , : f -,... '.-�,� gDESICRIPTION OF/WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name:�,�A ., C i-r-m <t-i � lC C',�cxz.�..� Phone: `i'ar Address: CONTRACTOR Name: t� 4t11�5 � ,,,,,�, Phone: 97J--'79'q-,66&0 Address: X24-54L,- /LoQ- 03o6 S Supervisor's Construction License: 'N616 Exp. Date: /2---OZ-- 14) Home Improvement License: Exp. Date: 4) le-3M ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ iins,. Go FEE: $� �— Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of A ent/Ovvner <Si nature ofxcontractor x. Location3a a No. �15 � Date �✓ TOWN OF NORTH ANDOVER f 1 Certificate of Occupancy $ s'ACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL "' $ Check # 2 3 7 6 4 Building Inspector F 3 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ FTYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools El 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 b i 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: FIRE DEPARTMENT -Temp Dumpster on site yes Located 384 Osgood Streetno 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 o 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 Permi 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 Permil 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 2008mi ORTH TO" of 0 Andover . T` Q �-_- LAKE dower, Mass., COCKICKE WICK �t ��AD RATED `ss BOARD OF HEALTH Food/Kitchen . PERMIT T. D Septic System 1 �•'a N BUILDING INSPECTOR THISCERTIFIES THAT......... .......................:............... ...................... .......................................... ............ Foundation has permission to erect........%*,*,,*,**,*,**............... uildings on ....... . ....... . .�!..!.�.. ... .......r....0 r` Rough to be occupied as......... '�" Chimney Pi��il . . . . . . . ..... .............................................. provided that the person accepis permit shall in every res ct conform to the terms of the application on file in Final 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 _ UNLESS CONS TRU O �.I.,S ELECTRICAL INSPECTOR e� Rough ...... ......................................................................:................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the 7 Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,.MA 02111 qu- www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name(Business/Organization/Individual): S Address: /ZIs— City/State/Zip: .AS V c,•_ ,L J. n63 Phone Are you an employer?Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I '1, am a employer with g Now construction 6. N w employees full and/orpart-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.r 7• ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g• n Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I1.0 Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.XRoofrepairs insurance -required.] employees.[No workers' 13.0 Other2� aac comp.insurance required.] *Any applicant that checks box#1 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 6J V -S)S 8_0 Zy Z-01 Expiration Date: /O-Z�-- lob Site Address: J7 15GZew]_i, aL4 6k/s 1e-. —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-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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ter 'y tier thepains an dy en q1ties ofperjury that the information pro vided ab o ve is true and correct. signafore: Date: Phone#: d 7 t7 - 7 " fl d6© . Official use only. Do not write in this area,to he 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i I I ' Massa' chus' etts Rome Improvement Sample Contr`a'ct 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 planning home improvements should first obtain a copy of"a ; Massachusetts consumer guide to home impravement"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 617-973-8797 or 1=888-283-3757. Homeowner Information Contractor Information Name —ampany arae Street Address(do not use a Pot Office 13 x address) Contractor/ esperson/OwnerNime 1'eL - CitylTowa State Zip Code J_,osines. (must include a street address) r 4 •,q Daytime Phone Evening Phone ,ityfrown State Zip Code %9-6y6� Mailing Address(lt different from above) Business Phone ederal Employer ID or S.S.Number law re7.rr-that mast home ha- Homo provementcowntter aer.Nmobet• ------lion dne pmvcmeot contactors have a •I slid-epicoratioo mvnba I The Contractor agrees to do the following work for the Homeo ner: cn e m a r e,completea,sped g ine e, ran , or o in 1jefials o e ilseon ece S Srn,PcF Required,llermits-The followin�:buildiiig permits are required Proposed Start and Completion'Schedule-The following schedule will and v(ill be secured by.the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be exchided from.the Guaranty Fund provisions of //,/1 Z /d Date when contractor will begin contracted work. MGL chapter 142.&.)' Date 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: ��G («) Payments will be made according to the following schedule: S upon signing•contract(fiat to exceed 1/3 of the'total contract price or the cost of special order items,whichever is greater) S by /�/� or upon completionnf by _/_/�•or upon completion of ayt41'e w, ✓ W. 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 S to be paid for ordered before the contracted worl'begins in order S to be paid for to meet the completion scbedule.(**) 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-Is an express warrapty being provided by the contractor.' No Yes fall terms of the warranty must be attached to the contract) Subcontractors-Thecoritractor 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 laborunder 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 Improvement Contractor R.eaistration The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Itnprovement Contractor Registration. You may inquire about contractor registration by-writing to the Director at One Ashburton Place,Raom 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 Inforination 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 olfier 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 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!!! Two identical copies of the•contract must be completed and signed. One copy should go tq t1tE homeown .'The other copy should be kept by the.contractor. 44— Home vaer's Signature Contractor's Signature . �/-�%.1f�j� ' ' . //�iv � ie, • Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with'the right to initiat an arbitration action as an . alternative to .court action)if they have a dispute with a contractor. The same right is not automatically affordeq 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. • . or and the homeowner hereby mutually agree advance that' in'the evcut cut The contract in e contractor has a dispute concerning this-contract, the contractor may submit the dispute to'a private arbitration flim which has been approved,by the Secretary.6fthe-Executive Office.of Consumer Affairs and Business Regulation and the consumer shall.be required to submit to such arbitration a§provided In Massachusetts General Laws, chapter 142A. Homeowner's Signature t Contractor's Signat6re NOTICE:The signatures of the parties above apply only to the agreement of the parties.t�alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution evefn where this section is not separately signed by the parties. Homeowner's Rights ; A homeowner's rights under the Home Improvement M' protection laws(i.e.MGL chapter 93A)m ay not be waived in any way eG II by chana other pter A aHowever;homeowners may be excluded from certain rights if the contractor they choose is not properly register4 as prescribed by law, 'Homeowner's who secure their own building permits are automatically excluded from all Guarantynand provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the Mork as described,in a timely and workmanlike manner. Homeowners may be entitled'to other specific legal rightt:if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees orl�.w� arranties pro vided,by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability anal fitness for a particular Purpose,' An enumeration of other matters on which the homeowner and contractor lawfull�y,l 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 Consumers•Infauxuatioil Hotline(listed below) Execution of Contract The contract must be executed in dudun�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'yoid, deleted,or not applicable. One original signed copy of the contrah with attachments n to tie given to the owner°and the other kept by the contractor. Any modification to the orig]na] lontract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a full executed the contract,.and the three day recission period has expired. Y copy of j Accelerated Payments A contractor may not demand-payments in advance of the dates specified on the payment schen ale in cases where the homeowner deems him/herself to be financially insecure. 'However,in instances where a contractor deems a o financially insecure, the contractor may require that,lie balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted worlc Withdrawal of funds from said ac o luin.scrP elf signatures of both parties. ant would require the Additional Information If you have general questions or need additional information about the Home Improvement consumer rights,or1f you wish to obtain a free co of. A Consumer Guide the Home'elm vement Con actor Law or ogler Law, contact: PY_' prowement Contractor Consumer Information Hotline Office of Consumer Affairs and Business•Regulation .10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787'ar 1-(8.88)2833757 't If you want to verify the registration of a contractor or if you haVe questionsor about the contractor registration component of the Home'Improvement r need additional in Ormation specifically Contractor Law,contact; Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One•Ashburtoii 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 Attorni ey General (617)727-8400 AND/OR -Better Business Bureau (508)652-4800 .(508)755-2548 (413)734-3114 d OP ID: MR ACC7RO" DATE(MMIDDJYYYY) .... CERTIFICATE OF LIABILITY INSURANCE 11108110 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(ies)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 - - - -- CONTACT PRODUCER 781-641-3002 NAME: CHARLES MCMAKIN TYG Insurance Agency,Inc. 781-641-3009 PHONE r=0:978-994-6660 � Np --- - - 68 Freeman Street EMAIL ne ro erties live.com Arlington,MA 02A74-Ei614 PRO�CER P P - cusToMERID#.MCMACH1 INSURER(S)AFFORDING COVERAGE NAtC i INSURED Charles McMakin INSURERA:Liberty Mutual General Contracting INSURER B: - - P.O.Box 1062 INSURER C: Lowell,MA 01853 INSURER D 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. TSR TYPE OF INSURANCE POLICY NUMBER MMADIYYYY MMIDD� LIMITS GENERAL LIABILITY - - EACH OCCURRENCE $DAMAGE ToRENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE FlOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO-JECT LOC $ AUTOMOBILE 1-1ABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY MJURY(Per person) $ ALLOWNEDAUTOS - - (Per -- - BODILY INJURY(Per acpdent) SCHEDULED AUTOS PROPERTY DAMAGE $ H IR ED AUTO S (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ VYDRKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N X 70RY LIMITS ER -- A ANY PROPRIETOR/PARTNER/EXECUTIVE WC1-31 S-380202-010 10/28110 10128/11 E.L EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? ❑ N!A (Mandatory In NH) E.L.DISEASE EA EMPLOYEE $ 100,00 It yes,describe under —- - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) CERTIFICATE HOLDER CANCELLATION - TOWNAND - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN TOWN OF ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 36 BARTLET STREET - ANDOVER,MA 01810 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. " X , / .� Jte ornihyo�uvea�i,^ ����tiu�aa�c< '` " BOARD OF BUILDI G RE.GULATIONS49u License`'CONSTRUCTION SUpERViSOR � ' Numbe CS -d9 66 E ' 'Birthdate 51 W,1964; Aires 12r�0 ar n4 94896 ' ) r �3 -ict Jy 3x CHAR EL R.-,,;MCM/',If1N �R <f >` a 20 BRIDGE REET_ ST �• �, � tk 07 .01 » _ Reg►strat oq '556 °ENT' 8 Expaioh 2 a. 23/21)11 '31R, CAMBRIDGE CO! IeA 285066 Nj r .i1IS vim- 0: HARLES MCMgx GTIQ 1T y 4 y f. 80 OpOGE$T KIN , r't r • r z« 1 Y,� Y