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HomeMy WebLinkAboutBuilding Permit #890 - 57 STAGE COACH ROAD 6/22/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: g4� 0 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page Print // Print MAP NO: If Z ZONING DISTRICT: Historic District yesno Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE - - Residential Non- Residential ' ❑ New Building pkOne family ❑ Addition ❑ Two or more family ❑ Industrial - ❑ Alteration No. of units: ❑ Commercial )<Repair, replacement ❑ Assessory Bldg ❑ Others:- - 0 Demolition ❑ Other - a®S'epticrtIW�elll ' ®Floocylplam® Wetlandsh0.Wa �.. e_rshed.D strict ®WatVr/SeW� r� �. � a •2��5 �`���d Y �3fik'5'mCre�b+� � 1 �:.a4T+^4 ~ �eti4 ..f..i.�.F._..xw��dwr �j' ---.., �+n.a.-.� _ _- _ DESCRIPTION OF WORK TO BE PEE-FOKM D: p X-4, 1A9.%.A1-1-,0Ws rA-� a tl5nP2 tp nA -,- DVG S,� <tAc �yc Wim- braA--- c-T� lxoyLS2- ,,L 51 "e 'A -PA d`Pi�l�Lt U1 OtiN e- ��ctic� c,1\ ls-A9 e fay /-es J AeW Aislc Identification Please Type or Print Clearly) OWNER: Name: CJA v S Wk-AaXaj Phone: Address: 'Sq SVaA' oa:c. ' , N +A v\I o)e4- � ►Nils CONTRACTOR Name: Phone:`l9 9 SSt _ �%(o Address: Supervisor's Construction License: 9dss b Exp. Date: Home Improvement License: 13 qCi S -G Exp. Date: ARCHITECT/ENGINEER Phone: 3 a9L13 ;bu C Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: =00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $, FEE., Check No.: ?d (0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tolhe guaranty fund ---- --7 rifAnPrfi/Owns"r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ` Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY f INTERDEPARTMENTAL SIGN OFF - IJ FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED 11 DATE APPROVED ri CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature !,OMMENTS .1 i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Waiter & 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 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, Doc:.Building Permit Revised 2008 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 �l Building Permit Application ❑ Workers Comp Affidavit --t-& ❑ 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Flo or/Crossection/E levation 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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Tin all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals t1hat 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: Doc.Building permit Revised 2008mi - 57::� - P.1,1 .4 . I Location /7, No. el Date TOWN OF NORTH ANDOVER +--.q Certificate of Occupancy $ MU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 9 0 (,A- 24-507 Building Inspector a t ° I. u. cn co w w cG v u. COO a w w w wcz w y cn w O V `� rx w" w v c� z cn Q co • a R b O 01 Ong I Com_ CA p 'C c A C �E m m CL }r co CD � � o _R O d CL CM Q c .o Q Cc v EL C2 CD .�. CD 0 CL C.3 V� c C C _c �. CO) I 0 N uj U) W W ce W cc Massachusetts 13onie Ing, rovement Sample ContrAct This form satisfies all sic requirements of the state's I•Iome itnprovement'Contractor Law (MGL chapter 142A), but does not 'include standard language to protect homeowners. Seek legal advice if necessary. An Y Person lviusMchosetts consumer guide to home improvement" before agreeing to any work on your ring e ici nceoyou may vements sobtain hould n�free copy by calling the PY in a i Office of Consumer Affairs and Business Regulatinn's ConsumerInfamnrtion Hotline at 617-973-87$7 or 1=888-283-3757. RomeownerInformation. ; 7Vam 'VII` ,Contractor Information t v-1�V) Streel;Address (d not use a Post Office Sox address) contractor/ aalespers,Qu/ 0wne10N i o Ciiylfown State Zi Code P usiness Ad ess ( it include a street address) DaytitaePhone Z� Evening Phone ;ityflown State Zip Code Mailidg dress (!t different from above) Ad _ U(oG Business Phone ederal Employer ID or S.S. Number Law "AL7rrea that mon Name hn- Home laovemenl Caah ' PTO cut connectors ba"ajalld =l 'I The Contractor agrees fo do tile 'folloWing warp for the Homeo• ner taraanau aarobcr, cn e mM11 i a `r o camp e e speer g e ran 4t -6e' I H i�3 ►V� O VJ S D e o m n s e e on (� a t i �;,•� at.11 t,� cmc a� C l .�v L . t • . _W5r j • las 9w�1,� �� • •. Required.lbermits -The followin '.building permits are required Proposed Start and Completion Schedule - The following schedule will and ��yyil► be secured by the contractor as the homeowner's agent, be adhe ed to unless circumstances beyo»d the co (; ners who secure their own permits will be ntractor's control arise exclpded from, the Guaral Fund provisions- Of MGL chapter 142A.) ' k—=---- -Date when contractor will begin contracted work. t D l ( Date when contracted work will be substantially completed. Total Contract Price 'a ad Payment Schedule The Connector agrees• to perform the work, furnish the material and labor specified above for the total sum of Payrrieirts will be etude according to the following schedule: �y��e'total-cjonh�ctprieeror-tlre-cos[t�f=spesia}•order-i#eius;whiehevor-is•greateFj--• . - -Ct.- by l�l or upon compie' all C� ''tPQ/ CiQ k S - Cb by—_//� or upon completion of upon completion of the contract. (Law forbids demanding ` !, full payment until contract is completed to botha p riy's satisfaction) Tho following material/equipmeat must be special S. ordered before the coahacted worl'begins in order a to be paid for jv to meet the completion schedule.(**) to be paid for NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins ma must y 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 be special otdered.in advance to meet the completion schedule, Express Warranty - IS an exnresc warrYl7t� beau rovided h Subebntractors 3 he contractor agrees to be solely respo sible for oinple ' ' n of t6c work deseri6ed regardlese on artar? `10 yes nil terms al ewarrnu s of the a tions of any third et pasty%subcontractor utilized by the contractor, The contractor further blii to be solely'resphnsiblefnr all a materials and laborunderthis a cement payments to all subcontractors for Canttact Acceptance - Upon, signing, this documentbecmlies aliinding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interesthas been placed on the residence, Review the carefully before signing this contract following cautions and notices • Don't be pressured into signing tire contract, Take time to read and e sure the ,tractor fully understand it Ask questions if something is unclear. • ' IvSakhas a valid Home ret nt subcoration y to be registered with the Drrcctor 01 i'l le ItitprovCol Gontractor Registration you may inquire sbout contractor c cror etrislratfon The law requires most home improvement contractors and registration by.writingto the Directorat One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-72bou or 1800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured, • Know yourrights and responsibilities'. P Read theImportant Infotit Guide to the Iiome•Improvement Contractor Is laficla on the reyerae side of this form and get a copy of the Consumer w. You may cancel this agreement if it has been signed at n place o}Iii r• than the contractor's normal lace ofbusiness, contractor in writing at his/her main office or branch oiiice by ordinary maieposted, t third business day foIlowing,thc signing of this agreement See the attar ,I notice of cancellation form for an explanationeof tiusd you nri notify the 110 NOT SIGN TRIS CONTRACT I)H' le + ice . a F telegram sent or an ex la not later than midnight of the ANY T right. Two identical copies of tho•contractmust be completed and signed. One copy should o to the ha • V BL SPACES!!! t I g mcowner. rhe other co ACES... '% � py should be kept by the contractor. Home ner's Signature ontractor' Signa re Date ' M l/ • Date ' Contrktor Arbitration The Dome Improvement Contractor Law provides homeowners with'thd 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 affordeq to a' contractor, however. The contractor would have to resolve any dispute h6/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 h6meowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree iii• advance that in'the event the contractor has a dispute concerning this- contract, the contractor may submit the dispute to a private arbitration firm which has been apprpved.by the Secretary. ofthe•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. H'omeowner's Signature Contractor's Signature NOTICE: The signatures 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. Homeowners Rights 'A homeowner's rights vender the Home Improvement Contractor Law (M(jL chapter 142A) and other consumer protection laws' (i.e. MGL chapter 93A) may not be waived in anyway, .even by agreement: However; homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by laws Homeowners who secure their own building permits are automatically excluded from all Guaranty•Purid 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 specilc 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 andfitness for a partiedlar purpose; An enumeration of other matters -on which the homeowner and contractor lawfully agree may be added to the term§ of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions! ab6ut Your c6nsumer/homeowner rights, contact the Consumer Itnforuiation Hotline (listed below). Execution of Contract u „ The contract must be executed in duliedte and should not. be signed until•a copy of all exhibits and referenced documents have-been.attached. Parties are.alsv 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 ownerland the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Coiitracted work may not begin until both parties have received a fully executed c6py of the contract,, and the three day recission period has expired. Accelerated Payments { J 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 fuiancially insecure. However, in instances where a contractor deems liim/lierself 'to be financially insecure, the contractor may require that the balance of funds not yet due be placed iri a joint escrow account as a prerequisite to continuing the contracted worlr.• Withdrawal of fftmds from said account would require the signatures ofbothpardes. Additional Information If you have general 'questions or need additional information about the Home Improvement Contractor Law or• other consumer rights, or'ff you wish to obtain a free copy .of A Consumer Guide•to the Home lmprovement Contractor Law," contact: • Cdnsumer Information Hotline Office of Consumer Affairs and Business'$egulation .10 Park PIaza, Room 5170, Boston,; MA 02116 (617) 973-8787'or 1•(888) 2833757 ._ Ifyou want to vdrify the registration of a contractor or if u M t about the contractor registration component of the Home you C nt<ac geed additional information specifically Law, contact: Director of Home Improvemenf Contractor Registration Bureau of Building Regulations and Standards One•Ashburton Place, Room -1301, Boston, MA 02108 (617) 727-3200 or 1-800-223-0933. 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 (508) 65.2-4.800 (508) 7�5-2548 (413) 734-3114 I s I A it r. da airs O AtceAn �Onsu HOME IMpROVEMENt, Regj,ttratio"1,39956 -Trg 289700 WAYNE FRI--I I WAYNE FREITAG� —�-, s 35 TA1,'AGLEWOOV9\ TEWKSBU inOividtil Use for or License or registration rifto. before t!he,e,ijrjter Affairsidn Oate. land B& in t.�fouiid-r6u ess Rigx�tatio'�., pace C. sutn on .Suite 5170 10 Park Plaza i,,MA02116 Bosto o,4t sioatu" t�l:tssachusetts - Dep.0 tmcnt rrt' Puhtic Safch j ,Loped ut' Buildim= Regr �tilations aild. Sta:nd:trds j Construction Supervisor License License:j CS 92588 'I3,RIAN P FREITAG 33 TANGLEWOOD AVE TEWKSBURY, MA Oi876 o II1101s510p01' Expiration: 3/29/2013 Tr#: 13745 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): NmccA be6)A Address: 33 1 12�4m,ewooc� PAPe- - City/State/Zip 9 e xJ c sbmay, MA D L TI (o Phone #: 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).* have hired the sub -contractors 2.X I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have S 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 3. ❑ 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.❑ Electrical repairs or additions 11.0 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. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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. lam an employer• that is providing workers' compensation insurance. or my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Job Site Expiration Date: 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 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under the pains andpenaldes ofperlury that the information provided above is true and correct. Phone #: f 1 D` S S 1 L) (3 (D (O Official use only..Do not write in this area, to he completed by city or town official City or Town: Permit(License # X Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: