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HomeMy WebLinkAboutBuilding Permit #624 - 41 FERNCROFT CIRCLE 3/26/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received v Date Issued: ' IMPORTANT: Applicant must complete all items on this page LOCATION .Print. -- PROPERTY OWNER int 100 Year Old Structure yes r30 MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building jOne family ❑ Addition ❑ Two or more family ❑ Industrial ((Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition El Other ❑ Septic ❑ Well El Floodplain ❑ Wetlands El Watershed District ❑ Water/Sewer RIPTIIN Ur• VVUKr-. I u or_ rcmrurxrnr=v. Y17 P0S�szeJt v-c�� i V\� YvOvw\, , 1-A �, Inowe,✓ � view � � Y. � ���� l .e � `c �. ���`� v\ o.y�2-�^-i � ���� � c� , C e: l � v`a Identificatipn Please Typg or Print Clearly) OWNER: Name. ':Sc�v�w��A Phone i7�'S6:� Y6� Address: Ltll k-eyry\ cvak A V,�' 1A nyQ\0yw ✓ CONTRACTOR Name: koY- U n 19 Phone: Phone: % O Address: Y�e.r Z_-7 e �`,�� MA V Supervisor's Construction License: Exp. Date: 46119 Home Improvement License: ARCHITECT/ENGINEER Phone: Address: Reg. No W—MyaffLi 1 FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 91 g _FEE: $ (7 Check No.: 16�3 Receipt No.: Q C, 0 NOTE: Persons contracting with unregistered contractors do not have access4dIans ty fun Signature of Agent/Owne.r Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St ❑ LocatioA No. Date3 JL'j)-S Check # 26229 TOWN OF NORTH ANDOVER Certificate of.Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED Q DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes u - Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connectionlsignature & Date Driveway Permit DPW Towo ]Engineer: Signature: FIRE DEPARTMENT !- =Temp Dumpster on site yes Located at'124 Main Street Fire Departiner t,pignatdre/date COMMENTS Located 384 Osgood Street - no 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 U Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folowing 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 submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee CakWation Construction Cost $ 81480.00 m $ - $ 101.76 Plumbing Fee $ 12.72 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 12.72 Total fees collected $ 227.20 Foundation 100 41 Ferncroft Circle Permit 624-13 on 3/26/2013 Install new walk in shower, new sink, toilet, ceiling fan, window and tile floor. Remove some sheetrock The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cj V\S ly,-L&L�\ 'G(6kUU. \/IJVPJC Address: 1 � C p Y �� S�— City/State/Zip:_a`�� k�� Phone #: 7 5 t��Uo4 i re u an employer? Check the appropriate box: VLJ I am a employer with _� 4. El am a general contractor and I employees (full and/or part-time).* ❑ have hired the sub -contractors 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.] ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp, c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance reouired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 Q Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other iy applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. Fn an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site brmation. urance Company Name: V, 6\ Ut S r tiV,o\V\C,(_? icy # or Self -ins. Lid. #: i nn Expiration Date: Site Address:_ `-(� -�� �c+'c� r City/State/Zip: D W -,V- YV l A :ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 tp to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. eV_ � i hereby certlo th i and peva ' ofperjury that the information provided above is trite and correct. nature: /5 175 / f me #: / ' 6%7- Sa/ 6 6D y official ttse only. Do not write in this area, to be completed by city or town official. �ity or Town: Permit/License ]ssuing Authority (circle one): . Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector i. Other 'nn4art pnrenn Phnna #f E� N S QyVA ui LL O m cc O Z z m Ix O LM Z Z d m O W Z v LU(� W � w Z a G Z F- a W LL O LLL1 j N '0 a LL 7 0 2' T cu U F, LL t :3 o LL t10 O �' u In r6 C Il 0 CC. C LL cu L m O v Z v O N N C = O O cl M 0 ^•; •F+ C V .Z: n a - c N E Q O, C�. as Lcn (� ) O E- 0 O tL oz. " 3 . � J Lm W J. > = L O = Gs > U) O Q S=E c 'Q am N z Q = O �.r V% O .0 . o0 L w � Q CL .y _ O v O c Q L L F- O CL ... d Vco m .LULU C d O O LL w_ P: N �M O W E _ v d o.'0 CL �C CL0U 1.f.. 0 V W Z z o m C F- Z 0 cul)E CL Z U N W 0 U) X Z C0 U) c W J a. Z m O C .O N N O z 0 a J 0 w E LL O O v Z O I � � C A, O N •E co W IL O �+ v D O L CL CL � Q OM v_ J � •CL O Z 0 CL V � U) G o� /v�aaaoac�zude( License or.registrat on valid for jlidividul use only �A Office of Consamer Affairs. Bfis►ness Regulation before the expiration date, If found return to: — _ 'HOME IMPROY9ENT CONTRACTOR Type. Office of Consumer and Business Regulation Registration,._1- 66624 10 Park Plaza - Suite 5170 Expiration: 6/2/1014 DBA Boston, MA 02116 C„ 'CONSTRUCTICsPi t SLAVA DOROGOPUfi Ka ._ . 1 PORTER ST HAVERHILL, MA 01832.1Undersecretary. No . ali without signature - Mase,tchusetts - Department of Public Safeth Beard ul' Building Regi lutiiins and Standards Construction $upgrvisor License License: CS 105071 Mr SLAVA DOROGOPULKO ' 1 PORTER ST HAVERHILL, MA 01832 l Expiration: 6/16/2013 ('Smaui. i+iur , Tr#:' 1Q5071 I 03/25/2013 12:30 9783739321 JAMES PAGE INSURANCE PAGE 01/01 A�ORa' CERTIFICATE OF LIABILITY INSUR SLAVA-1 OP ID: D! THIS CERTIFICgTE IS ISSUED ANCE DATE(MM/DD/YYYY) A3 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND 03LDER. T 9ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; i} the certificate holder Is an Aonlrtntuei THE ISSUING INSURER($), AUTHORIZED the t= ___..-.- ect to t on this certificate does not confer Drights jto the THIS IS TO CERTIFY THAT ��RI IrwgL� NUMBER: T THE POLICIES OF INSURANCE LIgTEp BELOW HAVE_ DEEN ISSUED Tp THE INSURED NAMED ABOVE FOR THE POLICY -PERIOD INDICATED. If"' ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEREVISIONT NUMBER; EXCLUSIONS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED eY THE POLICIES DESCRIBED HEREIN IS SUB �O�ENEXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED CI PAID SCRIMS. WITH RESPECT TO WHICH THIS rRRAL TYPE Or INSURANCe JEST TO ALL THE TERMS, IABILITY POLICY NUMBER ICY EF_ _ POLIS DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attaeh ACORD 101, Addltlonnl Remarks schedule, Irmorn Bpaeo Is ►aqulrod) Town of North Andover 1600 Osgood St, 81920 Ste2-36 North Andover, MA 01845 B SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL ACCORDANCE WITH THE POLICY PROVISIONS. BE DELIVERED IN AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) The ACORD name and logo are reglatered marks of ACORD ACORD10 CORPORATION. All rights reserved. COMMERCIAL GENERAL LIABILITY CLAIMS -MARE 1�1 OCCUR —• GE L. AGGREGATE LIMIT APPLIES PER; POLICY DPRO- " TTY LIMITS EACH OCCURRENC[ EMIS (FeR2LM nge) MED EXP (Any one eraon) PERSONAL g ADV INJURY GENERAL AGGREGATE 8 $ S $ LOG AUTOu1oBILE LIABILITY PRODUCTS-COMP/OPAGO $ ANY AUTO ALLO rFD SCHEDULED COMBINED SIN GL : LIMIT Eeaee nr10�`_ S AUTOS AUTO AUTOS BODILY INJURY(Pnrpermn) HIRED AUTOS NON -OWNED AUTOS ©DOILY INJURY (Per eecldnrnl $ UMt)RELLA lJAO PR Pr d9 DA GE R OCCUR EXCESS LIAR It CLAIMS.MADE EACH OCCURRENCE T D D F.TENTION WORKERS COMPENSATION AGGREGATE 9 A AND EMPLOYERS, UABILITY ANY PROPRIETOR/PARTNER/ Y OFFlCEMIVE EXCLUDED XOTH- IHUB7-12 .71T- w a naIn NNu vvn' rry._ A 012 0/19/2013 .LI(Mand E I FnnJ - DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attaeh ACORD 101, Addltlonnl Remarks schedule, Irmorn Bpaeo Is ►aqulrod) Town of North Andover 1600 Osgood St, 81920 Ste2-36 North Andover, MA 01845 B SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL ACCORDANCE WITH THE POLICY PROVISIONS. BE DELIVERED IN AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) The ACORD name and logo are reglatered marks of ACORD ACORD10 CORPORATION. All rights reserved. *law morogopulko 617-501-0604 MASSACHUSETTS HOME WROVEMENTS CONTRACT lireugeb & Xneureb 61auabor 1@pahoo.rom 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 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 Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Name ff Street Address (do not use a Post Office Box address) 4 1 'Ire ,,-V\C rd!�-E Ci /Town State Zip Code N Daytime Phone Evening Phone 9-79-56.9- q6��f Mailing Address at different from above) Contractor Information Company Name CMD Construction Contractor/ Salesperson/ Owner Name Slava Dorogopulko Business Address (must include a street address) 11 Porter Street City/Town State Zip Code Haverhill, MA 01832 Business Phone Federal Employer ID or S.S. Number 617-501-0604 46-137-1026 Construction Supervisor License. Number CS 105071 Home Improvement Contractor Reg. Number 166624 Expiration date 6-21-14 The Contractor agrees to do the following work for the Homeowner: • In the 1St floor hall bathroom, remove the existing cabinets and floor/wall tile. • Repair and finish new sheetrock as needed. • Install new walk-in shower, pedestal sink and toilet. • Install new tile on the floor. • Replace the existing window with a Harvey new construction window. • Install a new ceiling fan. • Replace the door with a bifold door. • Install all new pre -primed trim inside the bathroom, around the door, the window, and the baseboard. • Repaint bathroom. Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following 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.) schedule will be adhered to unless circumstances beyond the contractor's control arise. 3 k5115 Date when contractor will begin contracted work. YjjZ,jtS Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: $ q 90, DO O Payments will be made according to the following schedule: $ Z Z -D upon signing contract (not to exceed 113 of the total contract price or the cos7�1 f special order items, whichever is greater) $�20 by I_l or upon completion of b-1, v\ ��Y ` C-OIX $ y1 2t0 upon completion of the contract. (Law forbids demanding full paymeneuntif contract is completed to both party's satisfaction) The following material/equipment must be special $ 5 Z Z p to be paid for b cd vvi� ordered before the contracted work begins in order to meet the completion schedule.(* *)I to be paid for 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 warranty being provided by the contractor? ONo 0 Yes (all terms of the warranty must be 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. s 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 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 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you 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 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 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 SPACESM Two id tical opiesIf the contract must be completed and signed. One copy sho to e homeowner. The other copy should be kept by the r.con � � ✓1 . � e , .,� / /���! Hkj!,e�d r na* I I �6hc tor' ag e �lDate �1 � 1 � Date V, U 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 %ulation and the consumer shall be required to submit to such arbitratiorMs provided In Massachusetts General Laws, NOTICE: The signaturVof the parties above apply only to the agreement of the parties 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 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 rescission 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 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 hap://www.mass.gov/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 hq://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovementAicenseelist.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 508-652-4800, 508-755-2548 or 413-734.3114