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HomeMy WebLinkAboutBuilding Permit #3 - 4 CHRISTIAN WAY 7/1/2009 BUILDING PERMIT of pORTH q t�tLeo ,6• ti0 TOWN OF NORTH ANDOVER o? APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ^0 Argo r� �SSACHUSE� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION /"t (,t/ P " PROPERTY OWNER Mr. /J'�T`�. 1J.¢ t Print MAP NO: '04D PARCEL: f 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 DESCRIPT N OF WORK O BE PREFORMED- Ieem#a-4- ce'i a ..I entification Please Type or Print Clearly) OWNER: Name: !� 3 Phone: �e96— 0z-' Address: rsT/ 4-t4 CONTRACTOR Name: r"" %'"V I , �d�1 Phone: i 66 -7e r✓ __11/ Address: n,�d �lL� d4dpvel4^/ - Supervisor's Construction License: Exp. Date: Home Improvement License: /Y V2 Exp. Date: 102 0 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: $ l.�y�/a, FEE: $ Check No.: 7 / Receipt No.: NOTE: Persons contracting with regi ter contractors do not have access to.the aran f d Signature of Agent/Owner Signature of contractor Location No. Date — v �aRTM TOWN OF NORTH ANDOVER 0 9 Certificate of Occupancy $ ��s''• Eta Building/Frame Permit Fee $ AC NUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22 , ! .� 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 Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 or, 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:INSPECTIONAL SERVICES DEPARTMENT:111'FORM07 Revised 2.2008 J � �e T�anzrnzoozeuea�i o��/l�cQ�d�+�a� • ' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 108511 Expiration':8/19/2010 Tr# 275023 ..''Type: DBA SMITH CONSTRUCTIQN CO.' + ' Kevin Smith 63 INGLEWOOD ST-,.,'1. N Andover,MA b1845[. Administrator M1iassachusetts - Dep:a-tment of Public Sateh rf Board of Buildin ,. Regulations and Standards Construction Supervisor License License: CS 102589 Restricted to: 00 KEVIN SMITH 63 INGLEWOOD STREET NORTH ANDOVER, MA 01845 Expiration: 3/5/2013 ('unmrisiuner• Tr#: 102589 NORTH Town of 4 L Over 0 No. 3 1`y ;_ E dover, Mass., n T L K �. COC MICMEWICK V ORATED PPP` �G> `S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System • BUILDING INSPECTOR THISCERTIFIES THAT.........:. .........A." s ............................................................................. Foundation has permission to erect ... uildings on ........ �.r�1 w!K .............. Rough to be occupied as...... '+..T Chimney provided that the person accepting this permit shall in eve respect conform to the ter sr�T of the application on file in P P P g P every P PP 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 v Final I�b PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough .................. . .......... ..................... .......................................... Service B TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE j Smoke Det. The Commonwealth of Massachusetts =~j !! Department of Industrial Accidents ! Qjfcce of Investigations SI SSU '• 't 600 iashington Street � N �NlJ soBoston, MA 02111 www_massgov/dia . Workers' Compensation Insurance Affidavit: Builders/ContractorsMiectricians/Piambers A Iicant Information Please Print Leaibl Name(Business/OrguizatiorAin idual): Address: C�wvO� Citystete/ ZiF. ✓�/i ,� 0� t Phone#: . Are you an employer?Check-the appropriate box: 1.❑ I am a employer with 4, F[]�Rmnodelmig ject(required): ❑ I am a genera!contractor and I /employe-•s(fun and/or part-time).* have hired the sub-contractors construction [TQC Pte- )2. I am.asole proprietor.or partner_ listed on the attached sheet. ship and have no employees These suls-contractors have . Qemolition working for me in any capacity. workers' comp.insurance. [No workers'comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition required.) officers have exercised their I0•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.1] PIumbing repairs or additions myself[No•workers'comp. C. 152, §I(4),and-we have no . repairsinsurance required.]t m to ees.[No workers' 12.[]Roof comp. insurance required.] 13.❑.Other t`f►ny eppiic suit filet tdrecks bon!{ utt I malso fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they ars doing all work and then him outside contraetots must submit a new affidavit indicaf*such ;Catttractots chat cheolc this box muata an additionalshev,Showing.the name of the su1;-mss and their worlmrs'ceu•,••sig r rte•7 infnm stion. OWLD.yet that&pro Vi&ng:workerscompensation insurawe for m1'employees: Below is the inforntapolicy and job sure tfom Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State2ip: Attach a copy of the workers' eompenmtion 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 50.$1,500a d and/or one-year imprisonment'as well as civic 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 c and the p a p aloes of perjury tkat the information provided ove is a and correct Si tore: /_ A �� Phone#: — d O,f.1ciat use only. Do not write in this area,to be comple'zed by city or town of rxat City or Town; Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector5. Plumbing Inspector 6.Otber Contact Person. Phone#: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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 Ito entity,or any two or more of the1breping engaged in a joint enterprise,and includirig the legal representatives of a deceased employer,or the receiver or trmstm 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 ficensing agency shallwithhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealtb for any applicant who has not produced acceptable evidencezi7 compliance with the insurance coverage required." Additionally, MOL 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-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are;not mquiredto carry workers'coy rnpensation 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 regar-diing 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-licensc 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. When 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 affidaviL MrOffice 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 Bosfon, MA 02111 TeL#617-727-4900 eat 406 or 1-8.77-MA.SSAFE Fax#617-727-7749 Revised 5-26-QS www.mass.govldia CONTRACT Date: 6/30/2009 Homeowner: Mr. &Mrs. Dale Merski 4 Christian Way North Andover,MA 01845 (978)688-6432 Contractor: Kevin Smith 63 Inglewood Street North Andover,MA 01845 (978)687-7064 Home Improvement Contractor Lic.# 108511 Construction Supervisor Lic.# 102589 The contractor agrees to do the following for the Homeowner: All work performed in the basement Game Room: Remove existing ceiling,wall paneling, interior doors, carpeting. Furnish and install new ceiling,wall sheetrock, interior doors,baseboard, carpeting. Box lally columns,paint walls and woodwork. Furnish and install recessed lights and electric heat. Clean up and debris removal. The following permits are required and will be secured by the contractor as the homeowner's agent Building Permit Electrical Permit Start Date: 7/6/2009 Completion Date: 7/31/2009 Contract Price: $ 15,476.00 r ' Payment Schedule: 50%upon completion of sheetrock installation 25 %upon completion of painting 15%upon completion of carpeting 10%upon completion of contract Subcontractors: The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third parry/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for material and labor under this agreement. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 (617)727-3200 ext. 25239 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. 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 main 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 4 .-A- 4j zo� Homeowner�s Sign t rea � • Contract Signature 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 belshe 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 Contractor3.aw. 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 apgoved by the S of the Executive Office of Consumer Affairs and Business Re lation and a consum ball required to sub to sub do ided assach etas G eneral Laws,ch 142 Homed s Stgna re � �/Cj�1(tC&W1kfiAS_SiJWW NOTICE:The signatures of a parties above apply only,to the agreement of the p es 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 parties. Homeowner's Right 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 rigbts 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 Iong 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 dunIicate 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 bei 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 fire dates specified on the naymem schedule in cases where the homeowner deems him/haself to be financialiv insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not vet 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 consumeriights,or if you wish to obtain a free copy of"A Consumer Guide.to the Home Improvement Contractor Law,"contacts Consumer Infomration 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 Rome 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 wills informal mediation of disputer 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 gem Ce, t4� 4r 44 k 1 Yo 161&4 4 � R144 Wt-7 �� 10 to Y. Co CAI 7) AA 1/15 $4� -1 1.C�-