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Home My WebLink AboutBuilding Permit #569 - 41 HAWTHORNE PLACE 4/4/2008 p10 R TF► BUILDING PERMIT of OOR TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4 ��SSA rE D Date Issued: ` 0 IMPORTANT: Applicant must complete all items on this page LOCATION �) 4auh"f- nt PROPERTY OWNER aie,r ISCt Gc>rc r/D-gra Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildingne famit Addition wo or more family Industrial Altera ' No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREF MED: S2 4Y1.PAI po CG CP Identification Ple se Type or Print Clearly) OWNER: Name: Phone: �l -�7J SYS Address: CONTRACTOR Name: &y�+ /V4>-)e6& Phone: Address: S)tny CLAW Supervisor's Construction License: aLc/�� Exp. Date: Home Improvement License: 7 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1C� FEE: $ �1 r i Check No.: a3 S Receipt No.: �)1 O 77 - NOTE: Persons contracting with unregistered contractors do not have ccess t e guaran fund Signature of Agent/Owner Signature of contractor 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 li 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 Siqnature 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 I 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 de artment use G� h'tGSs qo� ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location 7kyA41f��` No. Date �aRTN TOWN OF NORTH ANDOVER Of••No x•,'60 • i : , Certificate of Occupancy $ s�.'';,:.0'''`4• • '"ter �ssAC"us E<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # G 6 U '\ uilding Inspector D .o 1 C) CD J "ffIA, , . e a latib n of Building g ns � . hM� Boar ROOM 1301 ' ,' ' `►;`�`' shburton Place - o0 One A RDY4usetts 02108 aRDY4 Boston. Massach X10— ,.: r ., istrat><on Home Improvement Contractor Rei Repletration: 151488 Type DBA EXpiration: 6/512008 SCOTT NOVACK CONSTRUCTION �__.._._.__•_._.-.. - SCOTT NOVACK 33B STONE CLEAVE ROA _. ! BOXFORD, MA 01921 ._.._...._. ..._. Update Address and return card.Mark reason for�ost Card + Renewal ! Employmenk i Ell L I —. + CPS-CAI {'i 5D+�+`�"nF•PC6699 v r i'.�`� �,.kY .y.� �*+� 3:. 1� '� •kyr�>+'=.Y'- mai "�� ..i".� r'"" �> yz"".ti''k'�- � • ng a .;i�Q} ;��'� r't� P �a+"� � s �� ,�: vii' :,.,{; ••• �� r'� 1�e �rc �, �a� alai �C 4� �� .�4� L� � i '��;� •• ;1.- it' ,,1, 1 1. 'Y.. r " :, i` ""�' ,` '. - • 1 .1 ;1' 1. 1 ,••�� s .� p � ��° :c`'�,t a�`'a', f f i' -`� ,�r� `;+-. •J-Zw .�� 3 � .�+;,= _ •�' �. :.1,. 1 'T 9: i -..lig ;r d ',l; 6i�1' •�, •• • IND :' I • • • 4 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Nrashington Street .Boston, ALL 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Euilders/Contractors/Electricians/Plumbers Applicant Information Name (Btts7ness/Or Please Pant Le�bly pnization/Inatvidual):_ Address: `_ 6w—C,I/r- City/State/Zip: _ ( - d(�)(Phone.#: 7-- . [A6,You an employer? Check the appropriate box: IF a employer with 4. I am a'general contractor and I Type of project(required).` eoyees(full and/or part-time). have hired the sub-contractors 6 ❑New construction 2- I a:sole proprietor or partner- listed on the attached sheet.' 7. -Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8' ❑Demolition [No workers' CO insurance Co insurance.: ' 9. Buil" a mP ce -addition comp. ❑ � on , 3.❑ required,] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their ` 11.0 Plumbing repairs or additions myself (No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no I2.[]Roof repairs employees. [No workers' 13.[]Other ooh insurance required *Any applicant that checks box#1 must also fill out the section below showing their workers,compensation PohcY information. t Homeov secs who sulsmit this davit ind sting they are doing all work and the hire outsidc contractors must submit a new affidavit indicating such, +Contractors that check this box must attached an additional sheet showing the name of the sub contactors and state whether or not those entities have employees. If the sub-contactorshave employees,they must provide their work==,comp;pohcy number. ram,an employer that is providing workerscompensation insurance for my employees. Below is the poUcy.and job site information. i 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 Failure date. to secure coverage as required under Section 25A of MGL c. 152 caiming, ) pe fine an lead to-the imposition UP to$150 on of p 0.00 and/or one-year imprisonment, as well as civil penalties in the form of�a STOP WORK ORDER and a fine of es to$250.00 a day against the violator. Be advised that a copy Of this statement may be forwarded to the Office of Investisations of the DIA for insurance Coveralffe,verification. Ido hereby cerWfy under the ains.andpenalties ofperjury that the information provided av is true and correct Date: Phone Official.use only. Do not write in this area, io be completed by cuy 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-PIumbing Inspector 6.Other Contact Person: Phone#: Information asd 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." r 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,partaersbip,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three artuzents and who�g g aP h resides therein, the.occupant c enl,or o cupuurt 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 notbecause 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,tiperate-a business or to aonstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." ' Additionally,MGL chapter 1,52, §25CO)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 maybe 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 peraait or license is being requested,not the Department of Industrial Accidents. Should you have any questions regardin the law,or if you are re g y quired 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 suret.o fill in the permit/lirmse 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 thathas 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 pmmnits 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 burn 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 shou ld 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 Invetsfigati ons 600 Washin6non Street Boston,MA 02111 Tel.#617-727-49M ext.4.QM or 1-877-MASSAF_B Revised 11-22-06 Fax 4 617-727-770 727-7749 ww-Aumass.-govlciia i 2K ' q r r'll;f�hlCw?l p.�it 'rt V)A1 t(rt ! ! iz OFrIcG ` S LOSET C- NEATt? rr,4.t2,5 r i I3oai >�i`�'Trri Aid8 Construction Supervisor bpense License: CS 96154 With 6/26/1965 Expiration 612612010' Tr# 96154_ Restriction 00 SCOTT NOVACK 338 S ,ot CLEAVE BOXFORD MA 01921c Commissioner. i ill l Massachusetts Home Improvement Contract j This contract satisfies all basic requirements of the state's Home Improvemerd Contractor Lav(MGL c.142A),but does not preclude 11 parties from adding language to protect their specific interests.Seek legal advice if necessary.Before agreeing to any home improvement work on your residence you can obtain a free copy"A Consumer Guide to Home Improvemerd Contractor Lave'by calling the Office of Consumer Affairs and Business Regulation's Information Hotline at 617-973-8787. Homeowner Information Contractor Information Name:Peter and Elisa Goldber Dw er and Novack Constntction Street Address:41 Hawthorne Scott Novack 8t John er i Ci :North Andover State:MA Z Code: 33B Stonecleave Road Boxford,MA 01921 1 Daytime Phone:978-975-2581 978-887-0238&978-884-9625 Evenin Phone: License#:151498/CS 96154 ! Mailing Address(if different from above): i i a WORK TO BE PERFORMED AND MATERIALS TO BE USED ! Contractor Aarces To Do The Following Work For Homeowner: stair rail$100 Electric allowance$1600 7 cans and 9 outlets and cable and phone(plan to be finalized) Framing stock$700 ` Frame interior walls including office,bath,laundry,closets$5000 Concrete floor cutting$550 Permit allowance including drawings$250 Trash $350 Install bath/dryer vents$500 Ceiling allowance $1300 Patch concrete$400 Doors schedule attached(4 total)$1019 Install doors $900 Insulate office wall$250 Onsite management$900 Plaster$2100(skim coat over scratch coat in stairs may be extra) This does not include paint,shelving,the bath fan or plumbing fixtures. Homeowner agrees to the following conditions: Bathroom facilities must be made available for workers during the renovation,.We will need access to electrical outlets and the electrical breaker panel in the event that a breaker is tripped while running tools. i Materials Effected ToBe Used: i Plumbing components as needed(copper,PVC,or ABS),tank-less water heater,concrete etc. The following schedule will be adhered to carless circumstances beyond the contractor's control arise: Work scheduled to begin:upon obtaining permits in April Expected Date of Completion: 4 to 6 weeks after commencement (Date Contractor will begin contracted work) (Date when contracted work will be substantially completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE 111 The Contractor agrees to perform the work,furnish the material and labor specified above for the estimated SUM of:$i 5,919.00. **Extra work will be billed as time and materials,at the hourly rate of$50.00 per man hour worked. . payments will be made according to the following SCHEDULE: iter(terns whichever is ❑ $5306.00 upon signing contract(*Not to exceed U3 of the total contract price OR the cost of special o , greater* ❑ $5306.00 afire 3 weeks after first payment completion of the coact(*Lan fobids r E3 and the remainder(which maybe more or less than the estimated SUM)upon demandingfcdl payment until contract is completed to both parties'solisfaction*) **** ***Please make all checks payable to Scott Novack,or they can be made payable to John Dwyer. **Extra work is defined as work not included in the original scope of the project. This includes but is not limited to things like rot, leaks and fixing existing code violations. It may also include customer requested changes. In order to meet the completion schedule,the following material/equipment must be Purchased before the contracted work begins:all materials stated in description above.(*Law requires that any deposit or down-raynrent required by the contractor before work begins may not exceed the greater of(a)on-d ird of the total contract price or(b)the actual cost of airy special equ*=ent or the comptBion sehedule4) custom made material which must be special ordered in advance to meet R F I DO NOT SIGN THIS CONTRA THERE 9 ANY BLA SPACES Id copies n d o to the hom and the ctor. mracto s ign e omeowner's e � iD ateDate You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement See attached notice of cancellation for an explanation of this right. i NOTE:All home improvement contractors and subcontractors shall be registered and any mqurnes about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 617-727-85" Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION 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 such dispute to a private arbitration service which has been approved by the Seeretary o the Executive Office of Consumer Affairs and Business Regulations and the cons er be re hire o Sul to such on asp in QL c 142A Contractor: Homeown Date: Date NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity—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. Contractor's Financial Insecurity—In instances wheat a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet due be placed in a joint escrow account as a prerequisite to continuing work Withdrawal from said account would require the signature of both parties. THE CONTRACT MUST ALSO CONTAIN: 1) A Complete Description of any other documents which are part of the agreement; 2) A List and Description of other matters upon which the contractor and homeowner lawfully agree; III 3) Any Other Provisions otherwise required by applicable laws of the Commonwealth. Remember,the Contract must be the Complete Agreement between the contractor and the homeowner. DNC-ramourt-eontract4172007 t {