HomeMy WebLinkAboutBuilding Permit #079-13 - 42 BAY STATE ROAD 7/31/2012 BUILDING PERMIT o`�t``° '6"�0
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Date Received
Permit NO: 07q—/.,,;.
�((A Ri �d °RA*•°SSACHUS��
Date issued: `Y
I ORTANT Applicant must complete all items on this page
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M'AP;NO � P4lCELONiN 1315 IiRI� t nHistoric l�istrct,t r � yesd 4
TYPE OF IMPRO_VEMENT PROPOSED USE
Residential Non- Residential
❑New Building ❑ One mily
El Addition wo or more family . ❑ Industrial
❑AI tion No. of units: Q Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic Welt r LrEIoTt�dAplam' `b�llVetfands} <W rs ed
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DESCRIPTION OF W RK TO BE PR;EFORMED:
Identification Please Te or Print Clearly)
OWNER: Name: 1�' 1`J� 7—i�` Ae /Y/A(C, Phone: g�
Address ��� �j �} .S!���- /�� jY� /'�✓S'��Ui°1L
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CONTRACTOR Name Phone
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T
;A;�ddress
i
S:upervisor's ConstroCoonl.�cens �Xp Date
,
'o a,1r 1 ror ement icetase _,'.
E `Date -
ARCHITECT/ENGINEER Phone:
Address: Reg. No. Y
FEE SCHEDULE:BOLDING PER $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ // FEE:
Check No.: 9 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to guaranty fund
- Si nature of'contractor '� .t
Slynature of
r
AgentjOwne
r
Location
No. 79— Date
�, • • TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
g
Other Permit Fee $
TOTAL $
Check# �
25561 3uilding Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ S"i"ing 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
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
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 Drivewav Permit
Located at 384 Osgood Street
FIR� DEPAf�TMENT =Temp D rnpster on slte'Eyes :: -
Located
Fare Departmeint slgnature�date `� '
�OMME�iTS 1
_ t s
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.$1o0-s1000 fine
NOTES and DATA—(For department use)
t
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
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
o 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 2.2007
NORTH
:own of z 6Andover
0
No. 07q _ _
h ver Mass �/,3///
z
COCN.0 HI W.Cw ��.
�.9 ADR�ITED PPp�.�S
S V
BOARD OF HEALTH
Food/Kitchen
PERM IT T LD_ Septic System
THIS CERTIFIES THAT ...........� �. lt...r ...j�•e/Ve BUILDING INSPECTOR
........ .......................... ...........................
has permission to erect .... buildings on . v'-a F,4� Foundation
Rough
to be occupied as // .... ��77 ......................................... ...................
p� ..................... 5.:... Y... ... ...............: Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
Service
........ ..... "��• --+`:+-............................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
Smoke Det.
SEE REVERSE SIDE
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form satisfies all basic rrquirements of the state's Home]mpmvemem Contractor Law(MCL chapter 142A),but does not Include standard
language to protect homeowners. Seek legal advice if neceasary. Any peison'planning home tnptOvtanents should fir.. obtain a copy o.
Massachusetts':consumerguide to homo,impmvement"befdre agreeing.to any work on yourrestdenod.You may obtain-a froe co
Office of Consumer:Affairs:and Business Regulation's Consumer Information Hotline at617-973,8787 or 1.888.283-3757. PY calling the
Homeowner Information Contractor Information
ame .
��°4-1�I�S X14�1�S ,�✓ . ek
ey
Street�(do not tae.aPo�� Js � tractor/Salespeson/pruner Name '
Vi/4l4SW
atyrrown state Zi Code usin—Addreas(most=tude a meee addrem) .
'NO AA66"k
Daytime�4e Evening Phone i /town.
Ir fat �l�® Avv y v la v%tz zip
n
Mailing Address(It different from above) usineas Phone ederal Employer ID err S.S.Number
4v nquao�prrauM aoep ierl Rome tCoatrarrm aea3Thxeber':Rwpeatim rax' ..
eeeo�don h•wa '
'agi,mdw aombv
The Co^ntractor agrees to do the following work for the Horst ner:
Aequired'TertrtlU-The-following building pe wits are repaired Proposed Start arid'Completion Schedule-The fnllowitig schedule will
and will be secured.by the contactor as the homeowner's agent; be adhered to'unless circumstances beyond-the contractor's cont of arise
(Owners who;secure their own permits will be
excluded from UreGaarantYFnnd:provisionsof 'r/'� whelfcontractorwillbegin comraetedwork.
MGL chapter I42A.) � �f�y �
o / L�H'ate when contracted .work will be substantially completed..
Total Contract Price and Payment Schedule
The Contwctor.agrees W perform the work,fmn4h the material and labor specified above for the Wtal sum of. (+j
—_Oaymcnts will be Edo according to the following schedule:
$vLG upon signing contract(not tb exceed 113 of the total:contract price,gr the cost.of
special order items,whichercr is:greater)
$ by / or upon completion Of
- or upon completion of
i m1
upon completion of the contract (Law forbids demanding fill payment until.contract is completed to both partlit y's.ssdsfaetionj. . .
ordered
contracted work
-bc ins in rd S be paid for
ordered bcforo the contracted cootie begins inorderS io be paid for .
to mad tha,completion schedule.(••)
NOTES:(•)inelntw all fmaace charges(••)Iaw requires that any deposit or down-payment required by the eoatraaor before work begins m ;
not=ceed the greater of(a)one-third afthe total contract price or(b)the actual cost of ry
which must be mY special m custom material
special ordered in advance to meet the completion erhedala
Exores Wamnfv-Is an exoro�varrtoty beineyrovided by ebevantmw • No Y fag t� �a eah affiKpdto theeonMetl
Subcontractors The contractor agrees to be solely respots able for completion of the work described re
party/subcontractor utilized by the contractor. The contractor farther a an pa as en t toa all
sub contra thrid
grecs to be solely responsible for all payments to all subcoatraetots for
materials and labor underthisaere nen[
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'fake time to read and fully understand it.Ask'quesfioos if souiethieg is unclear.
• Make sure the contractor has a valid Home Immnvement contra r R n
The hiw requires most home improvement contractors and.
subcontractors to be registered with the Director ofHome Improvement Contractot Registration. You may inquire.
registration by writing to the Director it:One Ashburton y -7 7-32 contractor. .
Place,Room 1301,Boston MA 02108 orby,calliag 617-727-3200 or .
1-800.223-0933. .,.
• Does the contractor have insurance? Check m see that your contractor is properly insured
• Know your rights and responstbilities. Reed the Important Information on therm of this fdim'md get a copy of the Consumer
Guide to the Home fprovement Contractor law;
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business.providedu notify the
branch office by ordinary mail posted,by tele Y
connector in writing at his/her mein offide or Yo
third business da followin the si 8r�sunt or by delivery,not later than midnight of the,B. going of this agreement See the attached notice o£cancellation form foram explanation of-this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPA be enmpletedaada*ed.OaecepYAWd ao b the hanr:oww.T .. -
// 4wow ropy shwW be kept by ria:contractor.
HOmeo er's Sign
Contractor's Signa
Date
Date
Contractor Arbitration
The Home ImprovementContmetorLaw provides homeowners withjhenght•to.tnitiate.an arbitration action(as an
altemaiie io cou[t action)i€.they,have a.dtspuft with.a contractor.
The.same r'ightis not automatically afforded to s.
contractor,however.-;rhe contractor would have.(p resolve any..dispute'6/slie.lias with a homeowner in court unless ...
both parties agree to,the optimal clause provided below..This clause would,give the contractor the.same.right to
arbitration as is afforded to the bomeownenby the Rome 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 hasbeen.approved by
the.Secietary of the Executive Office of Consumet Affairs and Business Regulation andthe consumer shall be required
nut to such arbi tion ded In.Massachusetts General Laws,chapt 2A.
Homeowners Si Contractor's SignaturxV
NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution
initiated by the contractor:,T ie:homeowner.may initiate alternativedispute resolution even where this section;is not
separately signeddiy-:the 'es: '
Homeowner's Rights
A homeowners rights and *e 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 war'r'anty for-workmanship of 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
l
purpose. An enumeration of other matters on which the homeowner and contractorawfully 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 du lice a 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
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 keptby 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
r
Accelerated Payments
A contractor mgy not demand payments inadvance.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 bim/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 too 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 Consumer Guide to She Home ImprovemContractor
ent.
Law,"contact
Cgnsumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
(617)973-8787 or]-(888)2833757
If you want to verify the registrationof 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:or1-800-223-0933
For assistant;with informal mediation of disputes or to register formal complaints against a business call
C+offe er`Coiirplaint'Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114
i
Propool
Page# of pages
CS # 022680 978-688-6737
HIC# 103358 A. J. Walsh & Sons or
55 Pleasant Street 1-866-AJWALSH
North Andover, MA 01845
Proposal Subm' To Job Name Job#
Address L ` /r // Job Location
&& Date �// Date of Plans
Phone# / `r�Gl Fax# Architect
We hereby submit specifications and estimates f r:
U
, d&0,4,,1t
U
� � ,,..tom=r-fYi!`,c.� ' �G-�,��rt,.l�2,c�G•-- ,,�i Ghti (ll��,�,%G�t..t�
We prop hereby to furnish material and labor—complete in accordance with the above specifications for the sum of:
CIO
$ Dollars
with payments to be made as follows: cC �"k'.
Any utte only
or deviation from above will become
involving extra costs r be Respectfully
executed only upon written order,and xn'g become an extra charge over and submitted
above the estimate.A!I agreements contingent upon strikes,accidents,or delays r
beyond our cohtrol. Note—this proposal may be withdrawn by us R not accepted wlthin days.
�cce�tartce of o�,o�a�i
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. G/
Date of Acceptance Signature
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Super%isur
License: CS-022680 t
\ a
ARTHUR J WALSA JR
159A WAVERMRD � 'r
N ANDOVER MA 01845.'r,
txprration
C ummi s si o n e c 06/09/2014
_ Office of Consumer Affairs&Busi ess R�gulaton ff
S-'.
+M ,1OME IMPROVEMENT CONTRACTOR
keg istration: 103358
r;E`xpirati011: 717/2014 Private Corporatic,
A.J.WALSH&SONS,INC.
Arthur Walsh,Jr.
55 Pleasant St
N Andover,MA 01845 g =r�—
Undersecretary
CERTIFICATE OF LIABILITY INSURANCE DATE 2/12/2 11
1'2l12/20I 1
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 DOE§ 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).
PRODUCER
CONTACT
Durso & Jankowski Insurance
PHONE FAX
Agency Inc (A/C.He. Ext): (A/C. No):
E-MAIL
198 Mass Ave Suite 1011B ADDRESS:
North Andover, MA 01845 PRODUCER
CUSTOMER IDy.
I)ISURED INSUREDS) AFFORDING COVERAGE MAIC q
Arthur Walsh INSURER A: A.I.M. Mutual Insurance Co 33758
dba A J Walsh & Sons INSURER B:
INSURER C:
55 Pleasant Street INSURER D:
North Andover, MA 01845 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
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS
aM/no"M (H nw....
GENERAL LIABILITY
$
COMMERCIAL GE)J EACH OCCURANCE ERAL LIABILITY DAMAGE
NTED
❑CLAIM$MADE �OCCU0. PREMISES(EaE-rence)
$
❑ t4:0 EXP (Any o e person) $
❑ PERSONAL E ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES ER: GENERAL AGGREGATE $
11 POLICY ❑PROJECT❑IAC PRODUCTS-COMP/OP AGO $
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
❑ANY AUTO (ea accident) $
❑ALL 0:9NED AUTOS BODILY INJURY (per person) $
❑SCHEDULED AUTOS BODILY INJURY(per a Ldent) $
I.E.AUTOS PROPERTY DAMAGE
O (per accideot) S NON-OFNED AVTOS �
$
$
EIUHBRELLR LIAB ❑ OCCUR EACH OCCURRENCE $
OEY.CES$LIAR ❑ CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
ORETENTION $ - S
WORKERS COMPENSATION oxx-
AND EMPLOYEES LIABILITY ® roaxsLxxa pA
THE PROPRIETOR/PARTNERS/
EXECUTIVE OFFICERS ARE E.L. EACH ACCIDENT $ 100,ODO
El incl ® eXcl 7014648012011 11/14/2011 11/14/2012 E.L. DISEABE-POLICY LIMIT $ 500,000
E.L. OTSEABE-EA EMPLOYEE $ 100,000
COMMENTS/DESCRIPTION OF OPERATIONS CR LOCATIONS:
ARTHUR WALSH IS NOT COVERED BY THE WORKERSTCOMPENSATION POLICY.
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
1600 OSGOOD STREET EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
NORTH ANDOVER, MA 01845 AUTHORIEED REPAEBENTATI