HomeMy WebLinkAboutBuilding Permit #744 - 51 WEST WOODBRIDGE ROAD 4/18/2012BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: I Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
VOne family
0 Addition
0 Two or more family.
❑ Industrial
[/Alteration
No. of uriits:
is Commercial
0 Repair, replacement
❑ Assessory Bldg
0 Others:
0 Demolition
❑ Other
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OWNER: Name:
DESUKIP I IUN Ul- VVUKM i u mr- rmtrummau.
Please Type or Print Clearly)%
..k Phone:1/") 6S6 -J 7&
A.
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: $ 0 FEE: $
Check No.: 1/4 w Z Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
0
DATE REJECTED
DATE APPROVED
❑■
s
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 COrinection/Signature & Date Driveway Permit
Located at 384 Osgood Street
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
NU I LS and DATA — (For department use
0 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
o 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 2.2007
LocationL�/ 4%t
No. A- Date
40- �y
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
r -
Foundation Permit Fee $
Other Permit Fee $_
TOTAL $
Check #I
25197 Building Inspector
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168 Maple Street James Debreceni
Methuen, MA 01844 LIC # 99685
(978) 683-5127 FAMILY HIC # 122385
AROOFERS 1 PAINTERS
�/-3-1�-
BiII To: ' �ewe'
Address: ) Zde-A b r 1 5
Phone:
-5-�A76
/V& ij PCSeoos
Ila L)14�y
5 Aq I I OF Per,,
115+4)) l�p . 6j % m A -o .7et 1V
540 i )5/,6 reff lqlper- 1457� 6�r lor06_
-IT-51411 004-r
Se Vel
ALL WORKMANSHIP GUARANTEED 10 YEARS
ESTIMATE
/-5-00
INITIAL DEPOSITo�Gj�
1ST PAYMENT
2ND PAYMENT
FINAL 2PAYMENT �r �G (�
Contractor Arbitration
Tile 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/site has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the satire 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 -drat in the event the contractor has a dispute
concerning this contract, the contractor may submit the dispute to a private arbit..::un firm which_ has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
imeowner's
mit to su h arbitration as provided In Massachusetts General Laws, chapter 142
SignatureC tractor's Signature
CE: The signatures of the parties above apply only to the agreement of the partes 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 outer consumer
protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners
may be excluded from certa►n 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 du icate 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 copyof 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 recission 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'tf you wish to obtain a free copy of "A Consum
Law," contact: er Guide to the Home -Improvement Contractor
Consumer Information 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 Home Improvement .Contractor Registration
. Bureau of Building. Regulations and Standards
One-Asltburton Place, Room. 1301, Boston, MA 02108
(6171 7)7_1100 — 1 _uno n,, nn r-,
I
ompnny Name
StreetAddress (do not use a to Office Box address)
/ We5,14 /c -r 0-
co awl Sal spersonnn/ Owjner Na
�D'►lt°S.
Cily/Town Slate Zip Core
W,&dl
_ JL�,�t°��CC®T f}
lusiness Address (rnus( include a street address)
Daytimephone�j��'�jj^ Evening Phone
'ityflloown
%� gState Zip Code
Mailing Address (II different from above)
Busi2ess Phone al Employer ID or S.S. Ntunber
The Controclor
hw requires aul mad home im- name t mvemear Caan actor see. Nmaher Expoalion dile -
pro—=l eonhnclorr have a
aad mplmalioa amnlw,�y '
1`0815
agrees to do the following work for the Ilorneor
mer:
j1783i3i n n Ir e y ❑g e,
e it r t wroo ge i e
rot ge r,f oe
Required Permits - The following building permits are required Proposed Start and Completion Schedule - Tie following schedule will
and will 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
excluded front the Guaranty Fund provisions of. .7--pia'Dalc when contractor will begin contracted work.
MGL chapter 142A.)
®l Dale when contracted work will Ire substantially completed.
Total Contract Price and Pavnsanl Srl o.l..l•
Tire Contractor agrees to perform We work, furnish the material and labor specified above for the total siren of: 6,1! 1
Payments will be trade according to the following schedule:
S 4 _ upon signing contract (riot to exceed 1/3 of the total contract'.price or the cost of special order items; whichever is greeter)
by _// or upon completion of
S by _// or upon completion of
$_ � ✓� D upon completion of the conimet. (Law forbids demanding full payment untii contract is completed to both party's satisfaction)
The following material/equipment must be special S _ to be paid for
ordered before the contracted work begins in order S • to be paid for
to meet the completion schedule.(**) `— f
NOTES: (') Including all finance charges (**) Law requires that any deposit ordown-payment required by the contractor before work begins may
not exceed the greater of (a) one-third of the total contract price (it (b) the actual cost of any special equipment or custom made material'.
which must be special ordered in advance to meet the completion schedule.
Gxarrss varreuly belle nrnvided by the toutEasq9A No Yes (all terms artbe warrimIx
ust be attached f rise c -
Subconh'aclnrs - Tfie�onlreclor agrees to be solely responsible forcompletion of the work described regardless of the actions 0f any;'-thirdd
party/subcontractor utilized by (he contractor. The contractor findier agrees to be solely responsible for all payments to Ali sultan, for
IIldJetitll�e[.ld ltlirllr II 1 ellI is ggseerneut
Contract Acceptance - t'po❑ signing, this document becomes a binding conlrnet under Inw, unless otherwise noted within this document, the
contract shall not imply thnl any lien or other security interest hos been placed o❑ the residence.. Review the following cautions and notices
carefully before signing this conlrnct.
Don4 be pressured into signing the contract. Take time to read still fully understand it. Ask questions if someUning is unclear.
• Make sure the contractor bps a valid Home hnroveUtent Conitac(or e i t'ot . The law requires`rnost bona improvement oveent contractors`smd
registration by writing to the Dir
subconUactors to be registered with We Director of Home llnprovclnent Contractor.Registration. You may inquire about contractor
1-B00-223-0933. ector at One or
Place, Room 1301, Boston; MA .02,108 or by calling 617-727=32(10 or
• Does the contractor Its ve insurance? Check to see that your contractor is properly insured.
• Know your rights and responsibilities. Read the important Information on the reverse side of 0,i-. form rima get a copy of the Consumer
Guide (o the Home loipr+.)vement Contractor Law.
You may critical this sgre-:-ro tit if it has been signed at a place oilier than lire contractor's normal place o�f business, provided you notify the
contractor in writing at hi s/hcr nrnin office or branch office by ordinary mail posted, by telegram sent or L+y delivery, not later than midnight of the
Third business day following. (Ile signing of this agreement- See the attached notice of cancellation fonn for an explanation of this right.
DO N,'OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SP'ACESI-!!
T ideal ical c (,pier, of rhe contract mus( he cnnlp feted and signed. ,One nilly should go to the ho rneewnco- The olha —py should be kepi,by the cunhacmr.
t
1101 wner's Signnhlre �4 -� — —C
of
rac![it S Signattue --
-L 3 =�a_
jr
Dote ---- — —Y— 3, /A
Date `---T
HIS CERTIFICATE 18188UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
ERTIFICATE HOLDER. THIS; CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
HE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER,
IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION
IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and"endorsement. A statement
n this certificate does not confer ri hts to the certificate holder in lieu of such endorsement.
PRODUCER
Degnan Insurance Agency
65 Sal®m 5t - - -
Lawrence, MA 01843
COMPANIES AFFORDING INSURANCE
COMPANY A GRANITE STATE INSURANCE COMPANY
INSURED
James Debrecenl
Dbe Family Roofing And Painting
2 Tanager Way
Londonderry, NH 03053-0000
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
THE POLICY PERIOD INDICATED, NOT WITHSTANDING 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 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.
CO
LTR
TYPE Or INSURANCE
POLICY NUMBER
PCUCYEPFEVMPATE
POLICY EXPIRATWNDATE
A
WORKERS COMPENSATION
AELOY@NLnY
LIMITS
E PROPRIETOR!
PARTNERSIEXECUTIVE
OFFICERS ARE:
Ila-orxCLp
_2453365`. -_
5!1'112011.
_., 51.11/2012
sTATUTORr�IMrrs__
OTHcR
Cwwega Appl lw to MA Opwallana ONy.
CN ACCIDENT $ 1 00100
ISEASEPOLICY LAdIT $ $00100
ISEASE•EACH EMPLOYEE .10000
DESCRIPTION OF OPERATION&VEHICLIWOPECIAL ITEMS
RE: THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAMES DEBRECENI.
CERTIFICATE HOLDER
CANCELLATION
COTE S FOSTER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
21 AEGEAN DR
WIHTETNEPOLICY PROVISIONS.
METHUEN, MA 01844
AUTHORIZED REPRESENTATIVE
The Commonwealth of Massachusetts
Department oflndustriglAccidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information Please Print Legibly
NaMO (Business/Organization/Individual): V� d�'I C� bete-e-c(f P1. t
Address:
Phone #:�-
Are you an employer? Check the appropriate box:
1. [1I am a employer with 4• ❑ T am a general contractor and T
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
ship and'have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3111 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet. x
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. El Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. Rgoofrepairs
13.❑ Other
'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
Aram an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company
Policy # or Self -ins. Lic. #: a? 34 Expiration Date:
Job Site Address; __N F City/State/Zip: ave "Y?G1 I q_
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or oneyear 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 DTA for insurance coverage verification.
Xdo hereby ce t fy under t Ins gndpenaliles ofperjury that the information provided above is true and correct.
Phone #: / %,79"&aOl `S12 7
Official use only. Do not write in this area, to be 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other - - -
Contact
Phone #:
Information and Instruction --s
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."
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, 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 licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required"
Additionally, MGL 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-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 permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding 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 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 sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permithicense 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. Where a home owner or citizen is obtaining a license or pemrit 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 should you have any questions,
please do not hesitate to give us a call. i
The Department's address, telephone and fax number:
Tho Commonwealth of Massachusetts
Doparirnent of Industrial .A.ccxdonts
Office of Investigations
600 Wa.sW gton Stroet
Boston, MA 0211.1
Tel # 617-7274900 at 406 or 1-877:MASSAFB
Revised 5-26-05 Bax # 617-727-7749
www-mass.govfdla