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HomeMy WebLinkAboutBuilding Permit #786-13 - 534 SOUTH BRADFORD STREET 5/17/2013Permit NO: 1 � ` ` I -3 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: f ' IMPORTANT: Applicant must complete all items on this page LOCATION S - QRg Sr PROPERTY OWNER \ QE. ()_Ci Q f� MAP NO: n_PARCEL:416O Print ZONING DISTRICT: 100 Year Old Structure Historic District yes yes` :Fno ❑ Addition Machine, Shop Village yes, TYPE OF IMPROVEMENT PROPOSED USE Residen ' I Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial N.At%ration No. of units: ❑ Commercial D Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic: ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District' . Ej Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMtU: ^loo y�� ties c%"A 7-c � 12p-acor f— Identification Please Type or Print Clearly) OWNER: Name:. .>r>c 'taz>t c%iso Phone: IR -71D boy, U( -7q Address: 1;34 S i3Rq�C-c.2n Si'. DJ CONTRACTOR Name: Phone: �1-1�j � L9 13W(o Address: Q u C3 ox 13 Z I last DU,►t't' �-(� Supervisor's Construction License: C) 2'� [ _Exp:, Date: Home Improvement'License; 1 T7 5 �5 Exp. Date: 111 s i ly- ARCHITECT/ENGINEER Qbl, 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 T�c�Lo FEE: $ Check No.: Receipt No.: �- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature,.of Agent/Owner Signafure of contractor Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ x Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools Ell. 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 PLANNING & DEVELOPMENT ❑ COMMEN DATE APPROVED El 0 CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature 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 'Tow ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMEW Temp Dumpster on site yes no Lto oca e at 124 Main Street Fire Departme`r�t signature/date" COMMENTS t 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 s El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fohowing 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 o 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 app: al 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.Building Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculai7O11 Construction Cost 6,826.00 m $ - $ 81.91 Plumbing Fee $ 10.24 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 10.24 Total fees collected $ 202.39 534 South Bradford Street 786-13 on 5/17/2013 New Kitchen Cabinets and Countertops Repair Floor and walls M v Fac. Lf. O c .O cC• U > O .0 :a O Z E :ta C O .. z ♦+ O O CL E Q Z �,�CD ti �— .�, E cm _ O 'a 4 `m ° V a� 0 cn �c :a�_ : •��.� t> U ti aar �>5oN Otn 4� .V a Z QCL OO W o2 ;MM U)Z �Q U) c, Cf) y •� W cacc rn •> o _c W J v V —J ~a. Z Z �O. O d CL t CL 0 m� d •\ �: Com' L O CL ca c -ac = O Q L � •� = m . Q. 6= 0:4:+ m i W G •C 4a O O W iCL v m C L N d Colo m -0> J . FE w o n o c� > O O~ O J W w = Z Z Z CL N Q Q Z D Z W m Q J Q W u C7 mC E m J J LL O d u+' C p yJ ` Y Lna) Z bo C Lpp Y U) OC t1D O 7 v Y O O N O O L O C O N p p C p LL to LL M U LL LL OC In LL d' . LL m N N Fac. Lf. O c .O cC• U > O .0 :a O Z E :ta C O .. z ♦+ O O CL E Q Z �,�CD ti �— .�, E cm _ O 'a 4 `m ° V a� 0 cn �c :a�_ : •��.� t> U ti aar �>5oN Otn 4� .V a Z QCL OO W o2 ;MM U)Z �Q U) c, Cf) y •� W cacc rn •> o _c W J v V —J ~a. Z Z �O. O d CL t CL 0 m� d •\ �: Com' L O CL ca c -ac = O Q L � •� = m . Q. 6= 0:4:+ m i W G •C 4a O O W iCL v m C L N d Colo m -0> J . FE w o n o c� > f_. ­oa"O."zi au oasic requirements oft -he state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seely IegaI 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 c Office of Consumer Affairs and Business Regulation's Consumeralling the lnfOnnationHotline at 617-971-RlIA7 Homeowner hnformataon , )oi.= UgQIV)G_0 Street Address (do notuse aPost Office Box addrdss) Contractor Information Contractor/ Salesperson/ 0wnerName rown State Zip Code BpsinessAddress (must include astreet address) AripmT Hcj 6 t ((3 4-5' time Phone Evening Phone City/Tom State 1� C. xlp LjU__ ` Zip Code Ling Address 2t different from above) Business Phone I'ederall;mployer ID orS.S. taw requires Iiome Improvement contmctorReg. Number ' tarot most Isome • ImProvemcntcontractorsbavc n valid registration number The Contractor agrees to do the following worIt for the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets ifnecessarv.) MtL, J K i t -c hoo C q 6 i nt G j G^ d mp S; b-2 pc? i t i.j R i j FLWO- Required Permits - The following building permits are required and will be secured by the .contractor as -the homeowner's agent: (Owners who secure their ownn permits vWW be excluded from the Guaranty Fund provisions of MGL chapter 142A.) ]Proposed Start and Completion ScheduIe -'The following schedule will be adhered to unless circumstances beyond the contractor's control arise S 11-A 13 Date when contractor will begin contracted work. 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. ti Payments will be made according to the following schedule: upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ by __L_L_ or upon completion of ' $ by or upon completion of $ 0 5Z (.0 upon completion of the contract. (Law forbids demanding full payment until contract is completed to both 's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contractedworlc begins in order to meet the completion schedule.(*"-') $ to be paid for NOTES: (-') Including all finance charges (°t°°i°) Law requires that any depositor 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. Exnress Warranty - is nn express warranty being provided by the !contractor? ❑ No ❑Yes (11i terms of the wgrninfy must be pinched to the coniractl Subcontractors The contractor agrees to be solely responsible%r completion of the work described regardless of the actions of any third Party/subcontractor utilized by the contractor. T materials and labor under he contractor further agrees to be solely responsible for all payments to all subcontractors for erials chis a cement Contract Acceptance - Upon signing, this document becomes abinding contract under law. Unless otherwise noted within this document, the contt'act 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. o Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear, o 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 ofITome Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Parialaza, Room 5170, Boston, MA 021.16 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company to coverage, or as information so that you can confirmasksee a copy o£a "proof of insurance" document o ICIn ow 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'SZGN TMS CONTRACT ]F THERE ART ANS' BLANK SJP.A.CESM mdcal copies of the contract must be completed and signed. one copy should go to the homeovmer. The other copy shotdd be ]cept by the contractor. om owner's Signature Con act 'sSignature Date 5 I� Date C'ontraetor Arbitration The Home Ilnpiovement Contractor Law provides homeowners with the right to initiate an arbitration action (as an 'alternati've to court action) if they have a dispute with a contractor. The same right is not automatically affordedto 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 fi17n which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as -provided In Massachusetts General Laws, chapter 142A.. homeowner's Signattiue Contractor's Signature NOTICE: The -signatures of the parties above apply only -to the agreement of the patties 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 patties. 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 to contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically exclude dfrom 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,specif'ic legal rights if the contractor guarantees or provides an express warranty for worlananship 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 fife 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 I-lotline (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 j oint escrow account as a prerequisite to continuing the contracted work. Withdrawal of Hinds from said -acco-a t would require the signatures of both parties. Additional Information .Hyou 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 Impiovement" 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 btp-://v^-v,,v.Tnass..gov/oc-,Lbl•/ 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 Cons-amer Affairs and -Business Regulation 16 ParkPlaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the IRC website at bttp://ww,,v.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: bt1p://db. state.ma.us/itomeimprovern ent/I icenseelis= For assistance with informal mediation of disputes or to register formal complaints against a business, can: 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 Version 2.1-11/22/2010 j.4J r A A y(1jbdT ((( 61THINSURANCE Jia 7:57:31 Ate?. 8935 Q 02/02 CESM!9F�CC 6 E OF LIAMI TSF S r �, e001/001 GATE ft. rstonn^'-ry ) 03109/2053 rdaW Aa H� a IYtrdT-FZ-R OF INGORMA T1ON ONLY AND CONFERS P1@ RI(3ft q UPON C�R59FFC�?e D®I:S Fd6S QPPI+:Mr;ilV(?LY 6R iVEGA9iVELY ARSEfiID, laliFE=ND. 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THE POLICY -PERIOD INDICATED_ NOTWTHSTANDIKG ANY REBUIREkhENT, TERM OR CONOITIO,4 OF ANY CONTRACT OR OTHER, DOCUMENT 1AITH RESPECT TO VMICM THIS CERTIFICATE MAY DE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES D_SCRISED HEREIN IS SUBJECT TO ALL THE TERIVTS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL411�S. 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'io5 0E1iv1?©?d The Commonwealth of Massachusetts Department of IndustriqlAccidints office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lease Print Legibly Applicant Information Name (Business/Organization/lndividual): lUpt Address: QO 0-j6X f 32 Ir— City/State/Zip: 10. %ODS �4C . 01 Phone #: 0(iv 860c, q(okl Are yo employer? Check the appropriate box: 1. a employer with, 1_3_ 4• ❑ I am a general contractor and I am employees (full and/or part-time).* have Hired the sub -contractors listed on the attached sheet. # 2. El I am a sole proprietor or partner- -These sub -contractors have ship and have no employees working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. t c. 152, §1(4), and we have no employees. [No workers' insurance required.] comp. insurance required.] Type of project (required): 6. ❑ New construction '7, �odeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. A 104 Policy # or Self -ins. Lic. #: A ,v G % z7 -?—U_7 � i �Z Expiration Date: /I 1 � City/State/Zip: � ever �� Job Site Address: '-� 3 S ��` �Zd�srr' Attach a copy of the workers' compensation 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 $1,500.00 and/or one-year 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido herebyti under the pains and penalties of perjury that the information provided above is true and correct. 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 Person: Phone Information and 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." 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 cant' workers' compensation 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 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 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. 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 bum 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. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston., MA 02111 TeX, # 617-727-4900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 Fax 4 617-727-7749 www.znass.govaa LO V' co C O •O 'O 'O •O � 'O 'O N N N Y T o' m v v v v v v v 3 3 3 r >` 6T d �' 0 0 0 6I1' c c c c c c c _..>w •Q Y 3> U N O .. O 0 0 o N U') 60 ER 64 O O O O Cl O c6 c6 O c0 co N N N 61% 6% 60 673 673 67> 613, U). 6H to W7 EA 6% 673 O O i C:i O N 60-6fl 6A K3 69 60 6f3 6A 6A 63 6A Pt> 67> Vf3 O O O O N 61% Eli E!3 E9 6n 673 6n 6!3 61). 6fl 60 613, Wi 60 619, 69, 631 673 H3 6fl 60 619,60 60 6fl 60 6A 673 6A EH 6A 613 6R 67> 61) O O O O coC6 06 co N N 6n 69 67> 6,% 673 673 v> N> 6.1, 679. efl 6A 673 6fl 619, 69 H3 6A 67> V% EA 6A 6A 60. 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