HomeMy WebLinkAboutBuilding Permit #750-13 - 54 BRADSTREET ROAD 5/13/2013� L�
Permit NO: ()�
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this base
Print
PROPERTY OWNER Z,�e,(_ -6;kd Unit #_
Print
MAP NO: 044 PARCEL: ZONING DISTRICT: Historic District yes � Ao
Machine Shop Village yes ! no
100 year-old structure yes 11�0
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
KRepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
Septic El . ..
�� ❑Foo playWatershed�District
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DESCRIPTION OF WORK. To BE PERFORMED:
(fo5e rAJ Sky'
1'%G'` G /J &
CONTRACTOR
Address: �� 6f_6&- i-�Ik. ��U�% �-O 61,ra4
5 �-0
Supervisor's Construction License: Exp. Date: L' v
Home Improvement License: Exp. Date:/ 3
ARCHITECT/ENGINEER Phone:
Address:
Reg. No
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $/ �'7 FEE: $ I
Check No.: ge _�_ Receipt No.:—Q &
NOTE: Persons contracting with unrgytered contractors do not have access to the guaranifund
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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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed onSignature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wafer & 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
Dimension
Number of Stories: Total square feet of floor area, based on u,,,,%,
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 t5 and UA 1 A —(1 -or department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
o 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 Pel
Addition or Decks
❑ Building Permit Application
o 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 Pern
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 .Perr
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 recordin
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 12,385.00
m
$ -
$
148.62
Plumbing Fee
$
18.58
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
18.58
Total fees collected
$
285.78
54 Bradstreet Road
750-13 on 5/13/2013
Close in 5x5 Exisiting Porch
NUMBER F -
543021433
/EXP ,.t. --DOB -. p�'�'�...^�„�'t
`01-31=2014 01.31-1966
CiASS 'REST R6T SEX t t-., ,r'':. �+ j x,
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GOBEIL
DANIEL L
16 CARLIDA ROAD
GROVELAND,MA.
01834 a
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Super%isor
License: CS -063220
DANIEL L. U,
16 CARLIDARD
Groveland MA 01834
i
r' v
Expiration
Commissioner 01!31/2014
Office of-LWIOIm 1f l rs- n5ines�tio
HOME IMPROVEMENT CONTRACTOR `
Registration, .,132182 Type:
Expiration: X1'1440/,2014 DBA
D GOBEIL CONTRRC� 313VG=.rrr
6 -ARLIDNIEL OA RDL
GROVE -LAND, MA 01'834--X,,'0' Undersecretary
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Dan Gobeff Home Improvement LLC
16 Carlida Road
Grodeland, lea 01 834
(508) 451-0493
C.5. 063220 CONTRACT REG. 132182
CUSTOMER: Lee Bluemel DATE: April, 17th 2013
54 Bradstreet Road
North Andover, Ma
PIAN: Remodel Back foyer area
THE JOB WILL INCLUDE THE FOLLOWING:
PRICE
DEMO:
• Remove existing deck and stairs and cut out opening for entry door.
• Relocate electrical feed for existing exterior light.
• Dia footing for 12" big foot footing 4 feet below grade. Fill with 2000 PSI concrete.
• Build 2X10 deck, 2X6 walls, stairs and rails.
• Hang new simulated 4- divided light Therma-Tru Smooth Star door. Apply any applicable
trim. Apply siding with red cedar shingles.
• Insulate exterior walls with R-19 and deck with R-3 S.
• Apply skirting to underside of deck wood lattice with pre -primed wood trim.
• Sheet rock, mud, tape, sand and paint inside and out.
• Apply floor tile to foyer area. �R _ 54.00 a square foot allowance
• Reapply existing storm door.
• Install switches outlets and lights to code.
• PAYMENT SCHEDULE: 1/3 at contract signing 1/3 half complete and remaining
when complete.
• MATERIAL:
52,675.00
• LABOR:
$7,470.00
• ELECTRICAL ESTIMATE:
$550.00
• PAINT:
$950.00
• DISPOSAL PEES:
5250.00
• PERMIT FEES:
5190.00
• Anvthing above and beyond said work will be done on a time and material basis @ a rate
of $50.00 an hour.
• Clean and remove all related debris.
TOTALMATERIAL, AND LABOR
512.355.00
ACCEPTED & AGREED T BY:
4'j5nie416G--
Lee Bluemel obeil
DATE: DATE: G1 ��
T �3 0
`►, 30
4 LV I I A
The Commonwealth of Massachusetts
Department of lndustrialAccldints
Office ofInvestigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeWbly
Name (Business/Organization/Individual):
Address: IL
Phone # 0 -.IS,/ - D-fq 5
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with - 4. ❑ I am a general contractor and I
employees (full and/or part-time)
2 I am a sole proprietor or partner-
ship and'have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet.
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.]
Typo of project (required):
6. ❑ New construction
7. Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
!Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information.
7 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.
X am an employer that is providing workers' compensation insurance for my employees. Below is the,policy and job site
information.
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 date).
Failure to secure coverage as requiredunder 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 /zereby c i y under thepai ndpe hies ofperjury that the information provided above is true and correct.
Signature_ nstw —1 5/ / j 25
Phone #:
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. CityiTown 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 employeiis 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 permit/license applications in any given year, need only submit one affidavit indicating current
policy information (ifnecessary) 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. Anew 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 MassochusPtts
Department of Industrial Accidents
Office of Investigations
604 Wuhington. Street
Boston} MA 02111
Tol, # 617-727-4900 ext 406 or 1-877�,MASSAFB
Revised 5-26-05 Bax # 617-727;7749
XVUnV_mace CrAv/14;a
Dan Gobeil Home Improvement LLC
1.6 Carlida Road Groveland, Ma 0183
508-451-0493
C.S. 063220 CONTRACT REG. 132182
Ynfnrmnt:n
ee
'- '" "utractor inlormatlon
Name Q ee Company Name / /
g 1J rA S �'rw,'i o adl Q& 1 G (1l°/VI.
Street Address (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Nam
ovA AJv v AAA. p I r�
City/Town State Zip Code Business Address (must include a str t address)
7r- 9 W-S51vS- 1r- g1- 1944
Daytime Phone Evening Phone City/Town State
Zip Code
Mailing Address (It different from above)0
usiness Phone &j 6( at Employer ID or S.S. Number
Lmv requires that most home Home Improvement Contractor Reg. Number Expiration date
improvement contractors have
n valid registration number !/ �Q4A hA_/
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.)
C �o t5/e,, �� '5 ' s jI,/e_�Cie. g��� f oue ChC, r 4 Fyic�or 5 �
514e
+ �'S 4 6 COdf- +0 _,6 e �
Required Permits - The following building permits are required
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.)
Proposed Start and Completion Schedule - The following schedule will
be adhered to unless circumstances beyond the contractor's control arise
Date when contractor will begin contracted work.
Date when contracted work will be substantially completed.
Total Conti act Price and Payment Schedule
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of:
Payments will be made according to the following schedule: (*)
�,,
(� .N $_—�q �O pon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
4( $ by / / i or upon completion of(ec v. YDC51//
$by/�13 or upon completion of V
41d)6# $A upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special
ordered before the contracted work begins in order
to meet the completion schedule.(**)
$ to be paid for
$ 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 Warran - Is an ex ress warran beina provided by the contractor? ❑ 1'To
❑ 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 a eement
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. Take time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Irrl rovement 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 SPACES!!!
Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy ould be kept b the contractor.
i 1y�
Homeowner's Signature
Con actor's Signature
Date
bate
LN
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 contracfor 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 ExeciAve,CSffide' of.Consumer. Affairs �ndBusiness Regulation and the tonsuine'r'sliall be required
to submit to such arbitration as prodded In Massachusetts General Laws,.chapter 142A.
Homeowner's Signature - Contxactpr's Signature • -%- - . i`'
NOTICE: The signatures of the parties Bove 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 thelparties.: - d "' i
Homeowner's Rights (.`r f, �'
A homeowner's, rights under the_Hbme 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, �gludedafrom-all Guaranty Fund provisions of
the Hoine hnprovelne>1t Contraotor'L' aw. The contractor i,responsible for completing the work as described, in a
tiiiieely,and`wbrkmanlike' maiinei. Romeowners fi at' be•entitled t6'other spec'ific legalhrights if the contractor
guarantees or provides an express warranty for workmanship or materials: Ih additior ,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 tlie'ownenand 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. c ;�.. , -� ; • —
Accelerated Payments •' I� �' �� �• s ; - C'M ,—
A"cantractor may not demand payments in advance of the dates specified on the payment schedule in cases wliere the `
homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems hzm/herself(--,.. #. 1
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 http://wwvv.niass.gov/ocabi-
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 http://www.inass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
http://db.state,ma.us/hot-neimprovement/licenseelist.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
L 508=652-4800, 508-755-2548 or 413-734-3114
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Version 2.1 -11/22/2010