HomeMy WebLinkAboutBuilding Permit #999-2016 - 588 OSGOOD STREET 3/24/2016M g&jl � 1'� BUILDING PERMIT
-4PI TOWN OF NORTH ANDOVER
APPI IrATION FOR PLAN EXAMINATION
Permit No#: �q�- Z-6 I �
Date Issued:
LOCATION
PROPERTY OWNER,
MAP PARC
Date Received
TANT: Applicant must complete all items on this pag
6,14,
,�
Pripd
Print 100 Year btructure
ZONING DISTRICT: Historic District
Machine Shop Village
t%ORT)Li
-9
0
F -
yes no
yes no
0
yes nno
TYPE OF IMPROVEMff-N-T
PROPOSED USE
Resid e pjip I
Non- Residential
El New Building
a-(5'n;e- family
El Addition
El Two or more family
El Industrial
0 Alteration
No. of units:
El Commercial
0 Repair, replacement
El Assessory Bldg
El Others:
El Demolition
El Other
-@ptic 0 Well;
0, Flo oqplain
El Watershed Qi8triZt
OWNER: Name:
Address:
Contractor Name:
Email:
Address: /<Jo 'V -
UhbUKIF I 1UN Ur' VVumrx I U OF- r- r-rxu- tx
Please Type or Print Clearly
Phone:
Supervisor's Construction License: —Exp. Date:
Home Improvement License:
Exp. Date:
ARCHITECT/ENGI NEER — Phone:
Address: Reg. No.
72-1
FEE SCHEDULE. BULDING PER
pff.- $1 - PER �57UUUXU Ul- IM: IUIAL =0111VIAICU UVOI 0140=u L/iVP1"-vv v-
-xx 00 FEE: $
Total Project Cost: s—
Check No.: Receipt No.: ::�?6 1 SIt
NOTE: Persons contracting with unregistered contractors do not have ac" to the guar�nt
yAnd
Plans Submitted 11 Plans Waived 11 Certified Plot Plan 11 Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanuing/Massage/Body Art
Swimming Pools 11
well
Tobacco Sales
Food Packaging/Sales 0
Private (septic tank, etc.
Permanent Dumpster on Site F1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature -
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS,
Reviewed on Signature
Zoning Board of Appeals., Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connectionisic
gnature & Date DrivewaV Permit
]DPW Town Engineer: Signature:
—E--
Located 384 Osgood Street
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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.$10041000 fine
NOTES and DATA — (For department use)
L3 Notified for pickup Call Email
Date Time
Contact Name
Doc.Building Permit Revised 2014
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
4. Building Permit Application
4, 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
OTE: 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
,6 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
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
IOTE: 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 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
Location
No. Date
C
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $2
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form, satisfie�all basic ri��ems of the state's Home improvement contractor Law (MGL chapter 142A), but doii hit iodude s6ndaYd
language to pr.otect%bomeowners. Seek. . leg . al advice if necessarry. Any . person,pland . ing home'
oProvem'eints should� tobiainaccipyof'"a
Massachusetta,consumer.guide to homic,improwiftent" befdre agreeing to any'work on yourrtsidince, you may obtain-& free copy by'caffing the
Office ofConsumer. Affairs and Business:RegulationiS Consumer Infbrmation Hotline at -617-973,9787 or 6888483-3.751.
Homeowner Information Contractor Information
Name
Street AM= (do not use.& Post Oflft 115-f2dreo) Contraddl-11al
VW.
Naut;c
cityfrown Zip Code hisiness Adareas (must include a sow address)
ZI-1k) �& 'J'5r//'5;t
Daylime P)forre EveningPlionie 'Ityll own 7 g4 Code
c17C��-_—ZZI_-eZ723 - 57
Maildg Addr& (It diff6rent from above) azh;�� 14"1
Less 4V 16daWMmpIOyerl1DorS.S.Nuniber
A 23 The Contractor agrees to. do the following work for -the Homeoi ner:
MEMO materfais w Be Ubcu�wl; allaILIOnU If JLeWSExYj
Ikequired Perinits - 7he-f6ilawing building Permits am required Proposed Staft and Completion Schedule - Tbe fd1lowing Schedule will
and will be secured -by the contractor as the homeowneris isgcn� be adhered tou , filess circumstances bcYond:the contractor'stcormcil arise
(Owners who',secure their own permits Will he
excluded-fromAhe Guaranty Funid'provisions of
MGL . chapter 1,42 —Date when contractor will begin contracted work
A.)
2
Date when contract6d -work will:be substantially completed.
Total Contract Price and Pay= — 11 1
en�Schedule
Ile Contractonsigrees to perform the work fismish-the material and labor specified above for thetotal of-.
M
Payments will be side according to the fbIlowmg schedule:
$_90V9Q_ upon,signing c 'contract price 2r the costof 41 Ord
Putizet (not to exceed 1/3 of the total, Spec er iter�, whichever is greater)
_by --
or upon cozn�lefiosi Of
or upon completion of
uponcompletioncifthecontract. (Law forbids demanding full payment until.contract is completed to both
party!s satisfaction)
-me following Mat=iayequipment must be special to : paid for
ordered before the contracted *workbegins in order ���t. b paid for
to meet ilia completion schedule.(**)
NOTFS: (0) Inciu(iing all finatic. charges (--) Ia. requires that any deposit or down-psyment required by the contractor before wodc begins may
not'excecd the greeter Of (a) On& -third of the total contract price or (b) the actual cost of any special equipment or custain made material
which must be special ordered in advance to meet the completion wkedWa,
Express Warranty - Is an e zoress warranty being urovided try the contractorl q No
Arm ed to
agree -=!!e acti!ns;ofxtubV1 I= "c
Subcontractors Tle contractor s to be solely responsible for completion of the work desonjed ilifid
parly/subcoriftictDr utilZod by the contractor. The contractor further agrees to be solely responsible for all p
matcriAlsandla rund IsYments to all subrontraitors-f6i
Contract Acceptance - Upon signing, this document becomes a binding contract under. -law. Unless otherwise noted within this document the
contract WWI not imply that any lien or other security intcl-t)- been Placed on the residence. Review the following cautious and notices
carefully before signing this contract
Doul be pressured into signing the contma Take time to read and fully understand k Ask'"Ofis' itsonj is unclear.
Make surd the contra Wo as a valid Home Im . . . Ile requ
Subcontractors to be registered widithe Director of ome improvement COmsacW Regg'� ircs most home improvement contractors and
registration by writing to the lstmtion. you may inquire about contractor
1-800-223-0933. Director it One Ashburton Place, knout 1301.,.Boswn, -MA 02 108 orby,calling 617-727-3200 or
Does the contractor have insuranct? Check to See that yourcontractor is propprly insurc&
Know your rights and responsibilities. Reid ft Important Infun nation an the reverse side ofthis f6i
Guide to the Home lu�iprovcmcnt Contractm Law. rm and get a copy of the consumer
You may —91 this agreement if it has been signed at a p othe . r th . an the 00ttr8ctdfs normal place ofliusiness, provided you notify the
contractor in writing at his/her main offiBe or branch office by ordinary mail postr4 by telegram sent or by delivery, not later than midnight oftho.
third business day following.the signing ofthis agreement, See the -attached notice ofcancellation form for an explanation of.this right
DO NOT SIGN TMR rnNTR A CIT 1Trr Ir V A 111" A — — I .— .
TwOi ticlIODPies/�!1h i ct must ki� comiftW =4 SiPcd OW COW sliculd go to the home.=. Odw OW thouhl be kept by The contractor.
HOme-Ow. 'S Signs Si..
Con gnature
Date
te
Contractor Arbittdii�am
7be Home Improyement-Contractor Law-provides,-homeown withjthe.-pghvto�initiatean arbitration action (as an
ers,
ey. have fth4contradOL 7be same.�ghiis M�fautomatically afford6d tola
alterriati.�6to�'66urt-actigh if th A
with a homeowner in court u .1
contractor, owever-�j7he. contractor would have:tp resolve any Aispui beVshe.has. 11 e.ss
liothaus..
. parties agree to the optional, &I e provided below., 7bis clause wouldgive the contractor-the.same. right to
arbit�ation a� is afforded to the-homeowner-.�y the Rome Iniprovement 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 hag. been. approved by
the Se�ietary of the Executive Office of Consumet Affairsind Business Regulation arid -the consumer shall �e required
b . it such a7on as provided In.Massachusetts Gen,
m't a" . A7,
Ho wrices I
NO CV'The=ipnUw= of the parties above apply only to the agreement of the parties to alternative dispute resolutim
initiated by the contractor.jhehomev!Amer may initiate alternativetisoute resolution even where this section.is not
Homeowner's Rights
A homeownees rights undef1he Home'Improvement Contractor Law (MGL chapter 142A) and other consumer
protection laws (i.e. MGL chapt& 93A) may not be waived in any way, evin by agreement However, homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeownei� who secure their.own building perniii are automatically excluded from all Guaranty Fund provisions of
ible -for completing the work as described, in a -
the Home Iniprovement Contractor Law. The contractor is responsi
timely and-,workmaplike marmLir. Horneowners.may be entitled toother specific legal. rights if thecontractor guarantees
or providesan. express* war;mnty for workmanship oir 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:,% particular
purpose. An enumeration of other. matters on whiclithe homeowner and contractor lawfully agreern be added to the.
ay
tefins; of the contract as long as they do not restrict a homeowner's basic consumer rights. If you hive questions. about
your consumer/homeDwner rights, contact the Consumer Information Hotline (listed Selow).
Execution- of Contract
The contract must be executed in ftlicate 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 th6 contract with attachments is to
be given to the owner and the other kept b�. the�contractor. Any modification. to the ITiginal . co . ntract 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 recission period has expired.
Accelerated Payments
A contractor mjiy 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 whem.a. contractor deems him/herself
to be financially insecure, the contractor may require that-thebalance of finds not yet due be placed in ajohit 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
4you have general questions ormeedadditional information about the Home Improvement Contractor Law or other
consumer fijbts, of.'if yoti"wisb to- 6 afreecopyof "A Consumer. Guide tothe HorneImprovement Contractor
Law,�contact:
Cqnsumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
-(888) 2833757
(617) 973-8787 or I
If you want to verify tho:Tegistration of a contractor or if you have.questi6ns or need;additional information VeGifidahy
about the contractor registration . component o . f the Home Improvement Contractor Law, contact:
Director of Home Improvement Contractor Registration
Bureau of Building Regulations and Standards
One Ashburton Place, Room 1301, Boston, MA 02108
(617) 727-3200 or 4-800-223-0933
For assistance With informal ifte&afib fi Of di -, jites -or to regi ter formal complaints against a.#" 9i
sp
Office of the Attorney General
(6 * 17) 727-8400
:AND/OR
Be= Business Bureau
(508) 652-4800
(508) 755-2548
(413) t4-3114
CS # 022680
HIC# 103358
=,prope5al ==
A. J. Walsh & Sons
159A Waverly Road
North Andover, MA 01845
Proposal Subq#ted To: - Job Name Job #
I jw, &Z L4,,� 1 1
'I -- I Job Location I
Address -41 ',1 .4 1
Date
of _ pages
978-688-6737
or
1-978-912-2853
Date of Plans
IV hone # '?W--771 --272q,� I Fax 0 f I I Ardiftect i
We proppse hereby to fumish material and labor — complete in accordance with the above specifications for the sum of: 0 b
/-OV Dollars
I/ a - V
with payments to be made as follows: �U ;(�, �
Respectfully
submitted
Note — tWs proposal may be withdraw by us H not accepted within days.
Any alteration or deviation from above speciftcatioris Involving extra costs VAII be
executed only'upon written order, and will become an extra charge over and
above the estimate. Allegreements contingent upon strikes, accidents, of delays
beyond our o6hirol.
amptMut Of Pr Azal
The above prices, specifications and conditions are satisfactory and are =ignature (2,.g
hereby accepted. You are authorized to do the work as specified.
Payments Wil be made as outlined above
Date of Acceptance 3 7-�, J/ (, - Signature
The Commonwealth of Massachusetts
Department ofIndustrialAccidents
1 Congress Street, Suite 100
Boston, 3M 02114-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Ell�ctricians/Plumbers-
TO BE FILED WITH TIJE PERNUTTING AUTHORITY.
Narne (Business/Organization/Individual):
Address:
City/State/Zip;
Phone #: 9;7g1_ 64(P-6 713
Are y u a mployer? Check th - e,appropriate box: Type of project (Tequired):
ou
1.E�l M.a employer with employees (full and/or part -til 7. New construction
2.FJ I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity. [No workers' comp. insurance required.] 9. F1 Demolition
3.. F] I am a homeowner doing all work myself. [No workers' comp. insurance required.]
4.F_J I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill 10E] Building addition
ensure that all contractors either have workers' compensation insurance or are sole 1l.E] Electrical repairs or additions
proprietors with no employees. 1�. E] Plumbin :epairs or additions
-contractors listed on the attached s heet.
5. n I am a general contractor and I have hired the sub Z—of rei3aii
13. E;14 oof repairs
Thes'e si�b-contractors have en�ployec's and have workers' comp. insurance.:
14. Other
6. F1 We are a corporation and its officqrs have exercised their right of 'exemption per MGL C.
152, § 1(4), and we have nQeyipIoyee,s. [No, workers' comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their -workers' compensation policy information.
Homeowners who submif INs af�davit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such.
tContractors 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-contraci6rs have employ . ces, ificy m uit provide their workers' comp. policy number.
I am an employer thatispr'oviding workers' compensation insurancefor my empl6yees.' Below is thepolicy andjob site
information. 0
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Job Site Address: �� n el
Attach a copy of the workers'
Date:
11 �, City/State/Zip:
policy declaration page (showing the policy i
er and expiration date
'-d-under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
Failure to secure coverage as require
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 h ereby ce!�,�k un de�, th e pains an dpenalties ofpeiYuiy th at th e information provided above is tru e an d correct
4� -hirp. i,�V(W_) Date:
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License 9.
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact
Phone
ct_,�
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their em-plovees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract oh
expres's or implied, oral or written." I
An employer is defined as "an individual, partnersWp, 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 tru�tee 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 b6 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 (LLQ 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 Depailment of Mdustrial
Accidents fbi 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 Accident ' s. Should you have any questions regarding the law or if you'are re'quired to obtain a workers'
compensatioii'policy, please call the Department. at the number listed below. Self-insur6d companies sliould'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 aflidavit 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 Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-A/TASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 26158
POLICY NO. I AWC-400-7014648-2015AI
PRIOR NO. I AWC-400-7014648-2014AI
ITEM
1. The Insured: Arthur Walsh
DBA: A J Walsh & Sons
Mailing address: 159A Waverly Road FEIN: **-***6792
North Andover, MA 01845
Legal Entity Type: Sole Proprietor
Other workplaces not shown above: See Location
2. The policy period is from 11/1412015 to 11/14/2016 2:01 a.m. standard time at the insured's mailing address.
3. A. Workers CompensatiqoEE.Z�n�eo PeDOI!cy applies to the Workers Compensation Law of the
states listed here: A
B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code
Estimated
Per $100
Estimated
No.
Total Annual
Of
Annual
Remuneration
Remuneration
Premium
INTRA 40579
INTER SEE
CLASS CODE SCHEDU
-E
GOV
GOV I
STATE
CLASSI
MA
5403 1
State Assessments/Surcharges
$.00 x 5.7500% $
This policy, including all endorsements, is hereby countersigned by fi,-- LI 11/05/2015
Authorized Signature Date
Service Office:
54 Third Avenue
Burlington MA 01803
WC 00 00 01 A (7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with Its permission.
Durso & Jankowski Insurance Agency LLC
11 Saunders Street
North Andover, MA 0 1845
1W. massachusetts -!")Ppartment oi Put)ilr Safet�.'
Board of Building Rcqulations and -Stanu—
Construction super�i�or
License: CS -022680
ARTHUR J WAL40 JR
159AWAVERILYRD
N ANDOVER MR 01845
Expirltic,"'
Commissioner 0610912016
office of consumer Affairs & Business Regulation
�.AMZ'W0r,ME IMPROVEMENT CONTRACTOR
'egistration: 103358 Type:
'tgVEX
MMY .� xpiration: 717/2016 Private Corporatio�
A. J. WALSH . & SONSJNC.
Arthur Walsh
55 Pleasant St
N Andover, MA 01845 Undersecretary