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HomeMy WebLinkAboutBuilding Permit #673 - 54 HEATH ROAD 4/16/2013Permit NO: Date Issued: LOCATION PROPERTY O NEI MAP NO: © P TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION EXTANT: Applicant must r An c Date Received mplete all items on this page �C �Prinf- Y Print 100 Year Qltl Structure yes nQ ZONING DISTRICT: _ _- Historic, District yes no Machine -.Shop Village yes no_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ®One family El Addition El Two or more family 11 Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain: ❑ Wetlands ❑ Watershed District, El Water/Sewer OWNER: Namfe:_t r�)O Address:�r >T KIP, 4UN Ur VIIUKtX i U Cir- rr-mrvnmr-v. ioq, Please Type or Print Clearly) b ►� CONTRACTOR Name: ' ��C f Phone:Wf-&.�T Address: 16f 114 J 5_ Supervisor'sConstruction License: tp�� - Exp. Date: Home Improvement License: 4 )- � Exp. Date: 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: $ ��� FEE: $ Check No.: 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne; Signature oli-f contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 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 DATE REJECTED FI DATE APPROVED CONSERVATION Reviewed on I Signature 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 Water & Sewer Connection/Signature Date Drivewav Permit DPW Towp- Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departme'rt-signature/date COMMENTS 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 DATER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NU I Lb ana UA I A — ([-or clepartment use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foliowing 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 o 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 subm":¢ted with the building application Doc: Doc.Bui?,ding Permit Revised 2012 Location k« '044, No.— V Date10 yr 'r Check 1--+ • ii TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 7ri Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4:�De-a� Building Inspector A s w s LL Q O m v v Y -0 O LL0 OE1 v+ N Y fl. cu N O a H z 0 J m O O O L.LL -C bD O w O E L U (0 C LL N z z m J d t 7 O � O LL LLI z Q V Fes- v J W t 7 O cr V ' "Cu N C LL w O U aW. z Q C9 L 3 O O' LL z F- W O LLJ OC W v E m, O Z v v �+ N N O Y O E N n y 4) ["c2u r_ >O W O acn cc. � z cu ~ OZ VQ . N O cn 0 _ O o N �,. Q m dE h •cam Z~' V a�cc��Q' ��L 0� v im LLI 0 " y z O O CD L N L m N uj U) WDC O �+ > W 04-- �OO c �_� o� vC 0 > CF) ��a N a Z Q. W masa 0 CL c WQ a hoc a I --V �� W � W �• U)g0 �W y ��c c WJ V t�J� a' o F- G- Z .= O .d+ ..a .� Z 0 r -00O Q. L v V doomca o •y V O V O C = . Q L ea -a c .� •+ Ho cn N ' w c 0 c Q. cn c � H to •��-+�,, 0 Zuj N O • W •E . v y .� V QO 'O d N J �j0 am N N .•0�C O * �1 ti A8190NOCINOI A M 3 VNVi Z V �j E) dx3 ji d80:uO!18. :edfti 21o10".LN0.0 1. N3W3AOH.dWl3WOH CLOZ/goav'. Jauolsslwwoo U01 Lip 0 M. Nv)waaf)vmvjL Z ,ibjajaukaaf Sawvf 999660-ISS3 :9-sua?i-1 kjjm.i,idS.jmi,%.j,)dnS uoipnjjsuoj. spiepuelS pue §uoijejn6ag Buipf!nq jo Oleoe .KlajeS oilqnd ;o . 4uawlir:da(] - s)4asnqc)rssej, �. Massachusetts Rome Improvement SaContract This form satisfies all basic requirements of the slate's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seek Iegal 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 calling the Office of Consumer Affairs and Business Regulation's Consumer information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. .muuneuwner .uuormauon Contractor Information Name Company Name Street Address (dd not use aP k Office Box address) Contractor/ S sperson/ OvmerNa6e City/Town State Zip Code Bplsinessss Address (m/u/st include a street address) Daytime Phone Evening Phone City/Town State Zip Code Mailing Address (It different from above) Business Phone , f%Cl jZederal Employer ID or S' S. Number Law requires that most home Rome rmprovementContractorReg:Number Expiration date improvement contn umb havc a valid registration number The Contractor agrees to do the following work for the Homeowner: (Describe in detailthe workto completed, specityingthe type, brand, and grade of materials to be used, use additional sheets if necessarv.) - Required Permits - The following building permits are required Proposed Start and Completion Schedule -'The following schedule will and will be secured by the contractor as -the homeowner's agent: be adhered to unless circumstances bevond the contractor's control Price (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A..) ,_Date when contractor will begin contracted work. fJ Date when contracted work will be substantially completed. .cvuuA vvaa..a NH4A llt.{i Ue14 .4 itJ'�11.G114 VL:11 V"LL LL1G // 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: $ upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ P by / >> or upcm completion of $ d by / / or upon completion of $!500 upon completion ofthe contract. (Law forbids demanding full paymentuntil contract is completed to both party's satisfaction) The following material/equipment must be special $ allto be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTE, S; (*) Including all finance charges ('"'i') Law requires that any deposit or down -payment required by the contractor before workbegins 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. . nub wast UC 711Li1C11CU 10 IRC COnrrac 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 0 subcontractors for materials and labor under this a Bement 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. o Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear.. o lylalce 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 ofHome 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. o Does the contractor have insurance? Aslc the Contractor for his insurance company information so that you can confirm coverage, or asIc to see a copy of a "proof of insurance" document. o 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 T'BIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be Icept by the contractor. 2=40wne' igna e 'Date 4COcptor's Signature Date Contractor Arbitridion 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 world give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Conic actor 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 firlu 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 142 H�meown r' i' retractor's Signature• NOTICE: The si ires of the parties above 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 the parties. 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 the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically exchided'from all Guaranty Pu d provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and worlananlike 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 cavy au implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which lite 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. Hyou 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. Pai des 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 i.s 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 a ct begin-. ial bom parries have received a. fi11-Iy 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 joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiends from said -account would require the signatures of both parties. ;Uditional 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 OCA13Rwebsite at bitp://ww,,v.mass.gov/oc,-Lbri If you want to verify the registration of a contractor or Lryou 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 16 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the IAC website at bM://wwtiv.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: 11ti.1)://db.state.ma.us/li.oineimurovei-n ent/Iicenseelist.asb For assistance with informal mediation of disputes or to register formal complaints against a business, calx: 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 The Commonwealth of Massachusetts Department of Industrial Accidents fn Office of Investigations 600 Washington Street Boston, MA 02111 UV www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 14,f 9 City/State/Zip: PA. IV14 Phone #:6�)" / kre yo employer? Check the appropriate box: I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c.152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.❑ Plumbing re airs or additions 12. repairs 13.❑ Other iy applicant that checks box # 1 must also fill'out the section below showing their workers' compensation policy information. :)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. ,n an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site 9rmation. prance Company Name: icy # or Self -ins. Lid. #: -7'�0001c;20ia— Expiration Date: 43 Site _ 43 Site Address: ! / `tel / City/State/Zip: of, /W ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 tp to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. hereby ce ' acnder t z in andpenalties ofperjury that the information provided/above is true and correct. iature: Date: ne 4: 97Y-- )ffrcial use only. Do not write in this area, to be completed by city or town official. ;ity or Town: Permit/License # ssuing Authority (circle one): . Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Other '.nnfarf Parenn• PhnnP #- 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 -contractors) 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 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, Tease do not hesitate to give us a call. 'he Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. ## 617-727-4900 ext 406 or 1-877-MASSAFE Rax :# F,17-7? 7-'174.9 168 Maple Street Methuen, MA 01844 (978)683-5127 Bili To: bvr6 Address: r �y 4e. a� Phone: �` FMILY ROOFERS & PAIMBS ALL WORKMANSHIP GUARANTEED 10 YEARS ESTIMATE C1C INITIAL DEPOSIT IST PAYMENT 2ND PAYMENT _ FINAL PAYMENT L le.-/'s James Debreceni LIC # 99685 HIC # 122385