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Home My WebLink AboutBuilding Permit #93-15 - 58 LINDEN AVENUE 5/8/2015 i _ h NORTy (W BUILDING PERMIT OF�tL�°,6;�tio TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �NU Cl s�� Date Issued: —12 IMPORTANT:Applicant must complete all items on this page LOCATION rint PROPERTY OWNER Print - 100 Year Structure yes no. V MAP eyPARCEL:M2-0 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential [INew Building 1 'One family ❑Addition ❑Two or more family ❑ Industrial 'Alteration No. of units: ❑ Commercial ❑ Rep replacement lacement ElAssessory Bldg ElOthers: ❑ Demolition ❑ Other __ra Q Septic ❑1Nell, Floodplain Wetlands ❑ Watershed Distract 0 Water savve. DES RIPTION/OF WORK Tq BE PE FORME : J (' OG 7 }tet r r rw .7 3// /� id tification- Please Type or Print Clearly le�� `�ll i�w1l Phone: g �A Zo N33 OWNER: Name: en Address: Contractor Name: J Phone: Z B Email:_ C� Address: AJ a 'Exp., 0/7Supervisor's Construction License: C S Home Improvement License: /D .y'/1 Exp. Date: ( IIAZ,0� 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: 37 !r CIO FEE: $ Check No.: / Receipt No.: 0'7 Id NOTE: Persons contracting with unregistered contractors do not have access to the "aranty f d 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 its require sign off from Fire Department prior to issuance of Bldg Permit OTE: All dumpster perm q g f 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/Cross Section/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 OTE: 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 .4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Copy of Contract 4 2012 IECC Energy code 4 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance ors special permit was required the Town Clerks office must stamp the decision from the Board of Appeals p 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:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ,, TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tannin Swimming Tanning/Massage/Body Art ❑ g pools ❑ Well ❑ Tobacco Sales ❑ ❑ Food packaging/Sales ❑ Private(septic tank,etc. permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 1 i tom` i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments ',mater& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: - Located 384 Osgood Street FIRE DEPARaTMENT Temp Dempster oh sife eyes Located at 1+24 Main Streets ' rt ry Fire Department si rj i< E gn fere/date �' .�:. � � ;`• • ,t .E ` d '� C'OIVIM 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) I i i i ❑ Notified for pickup Call Email Date Time Contact Name I Doc.Building Permit Revised 2014 NORTI.i Town of Andover O fA No. 3 ' �� - _'.4' - Kver, Mass, coc"Ic«ewicK ��S R�TEO r`PP�,�S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System �e-, BUILDING INSPECTOR THIS CERTIFIES THAT .......... �.<3/..,�:�r.............................................................................................. • . has permission to erect .......................... buildings on .�.�nC/..1'?.0�N....44Ne.................................... Foundation Rough to be occupied as6...... tel�: Pr<. ??c.!:x.......................:............................. Chimney .................................. provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN S MONTHS ELECTRICAL INSPECTOR .UNLESS CONSTRUCTION VARTS Rough ............................. Service ................ ..... . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts Home Improvement�Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary.Any personplanning home improvements should fast obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a fine copy by calling the Office ofConsumer Affairs and Business Regulatloa's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name _ CompanyNNaame 4 Street Address(do not use �JaPost Office Box address) Contract / espetsonlOwnerName � e✓ f , rL City/TownState Zip Code Business Address(m�inclu a street addr DaytimePhane Evening Phone Citylfo State Zip Code Tq ing Address(B different from abovel BusinessPhone lFederal EmployerlD or S.S.Number }rorb Tmpmvcmmt Coatruforxeg ATma6er t>acariondzie I I,R=quit=that most home tQt ha wildm-istrtkn-pbr .0 V The Contractor agrees to do the following workfor the Homeowner. (Des car m detail the work to completed,specifying the typ brand,and grade of materials to be used,use additional sheets ifn ) 4 std l 'i t fid ?d 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 beyond the contractors control arise (Owners who secure their own permits will bett�� excluded from the Guaranty Fund provisionsofDtewhencontactorwillbegincontractedwork.MGL chapter 142A.) 15�ate when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of ® i Payments will be made according to the following schedule: r r1/ om� $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by 1 / or upon completion of $ by / ! or upon comp�I an of $ upon i�rpletion o the contract (Law farbids demanding fimll payment antl contract is compiet�to bath party s satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(")Izverequires 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. Express warranty Is an express ivam.ntv being provided by the cont".ctory ❑No❑Yes tall terms of the warranty must be attached to the contrnet) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless ofthe actions of any third party/subcontractor utilized by the contactor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement ContractAceeptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any flea or other security interest has been placed on the residence.Review the following cautions and notices carefiilly before signing this contract e Don't be pressured into signing the contract Take time to read and fully understand it Ask questions if something is unclear. • Make store the contractor has a valid Home Improvement 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"proofof 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 hoprovement Contractor Law. You may cancel this agreement ifit has been signed at a place other than the contractees normal place ofbnsmess,provided you notify the contactor in writing at his/her main office or blanch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing ofthis agreement See the attached notice ofcancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY B PACES!!! Tao- txf=cfthacm*aetmttstbeeamp--4edattdsigaed.0neeoppsheamdgotothe rnpysh be- drecontraaer. omeownei's Signature ctor's Date Date �- I 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 contractor 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 Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to subm4 to TY arbitration as provided In Massachusetts General LawsLCI ter 1 A. homeowners Signature or' 'gnature NOTICE:The signatures of the parties above apply only to the agreement of arties to alternative dispute resolution initiated by the contractor. The homeownermay initiate alternative fdispute 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 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 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 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://www.mass.gov/ocabr/ 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.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http•//db state.nia.us/homeimprovementtlicenseelist.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 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 The Commonwealth of Massachusetts Department of Industrial Accidents a d 1 Congress Street,Suite 100 Boston,MA 02114-2017 •�` www mass.gov/dia • i� SV•V Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl L�l�drmz Name (Business/Organization/Individual): ✓i Address: d City/State/Zip: N 01. Lo Phone#: q z& Are you an employer?Check the appropriate box: Type of project(required): 1.F1 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2I am a sole proprietor or partnership and have no employees working for me in 8. ,remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.,0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.Q Other, 6.Q 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.] *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 are doing all work and then hire outside contactors 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I 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 required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert'y under t re pai and enalties of perjury that the information provided a ove is true and correct. Si nature: Date: Phone# Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# [I.Board g Authority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector er ct 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." j 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 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: i The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia II O.1 ............................................................... .............. .................................... Massachusetts_ Board of' Department of Public �uridrn Regulations Safety and standards Jt!7C!Y 1.\'Q j License: CS-102589 63INGLEW f' North Andover jWA of ,94 -- 3 NO >rrea AIX Commissioner Expiration 03/05/2017 i I U oa�r��can,cuea a�C��uJJrc��tc e173,:. �_ Office of-Consumer Affairs&Business Rr-,,, ;. DME IMPROVEMENT CONTRACTOR,. gistration y08511 - , Type:, xpiration: 819.916-6 DBA f SMITH.CONSTRUCfLON b � Kea;h S ., mith 63 INGLEWOOD ST "? N Andover,MA 01845 _:; � — ! t Undersecretary