HomeMy WebLinkAboutBuilding Permit #746-2011 - 61 PLEASANT STREET 5/6/2011 (2)Permit NO.
791b
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Date Issued: 6
TOWN OF NORTH ANDOVER.
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: Applicant must complete all items on this naye ----I
e-Ic9S
Print
_PROPERTY OWNER -J U f` I PIC <<( �5
Print
MAP Ne- J'_31_0 . PARCEL: r�'�'ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Residential
❑ New Building
❑ On gamily
❑ Addition
TNon-
9 -Two or more family
Industrial
❑ Alteration
No. of units:
Commercial
❑ Repair, replacement
❑ Assessory Bldg
Others:
❑ Demolition
❑ Other
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DESCRIPTION
OF WORK TO RF PF.RFORMFn-
R e Roo G, D i/' L 0 6-
Identification Please Type or Print Clearly)
OWNER: Name: �U k rl (Ft G k- Lb c15
Address: Com; PLe- i4 ►otj ► t i Aljd fl/)' Lbl/&tr� �'YIYt—
CONTRACTOR Name: P01 UJ P LS Y-4 S G M S Phone:
Address: v53' JC_e 4__�W I I_ .'S`7' /4/,,) �y7Gs�
Supervisor's Construction License: 026.96 Exp. Date:
Home Improvement License: 1 �3� Exp. Date: 7yl�
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERw . $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925,00 PER S F.
Total Project Bost: $ FEE:
rt
Check No.: Receipt No.: 7
NOTE: Persons contracting with unregistered contractors do not have access to the zuaranty fund
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN 'E=XAMINATION
Permit NO: /
Date Issued:
IMPORTANT:
X
Date Received
must complete all items on this
yv v ----- Print
PROPERTY OWNER -1J U � 1' l PIC K111--5
Print
MAP NO: JAS PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
❑ 09e family
P -Two or more family
No. of units:
❑ Industrial
❑ Commercial
❑ Repair, replacement
❑ Demolition
ept c�; D Welly P=
❑ Assessory Bldg
❑ Other
❑ Others:
t Flo, odpl � ®Wetlands
Water
®sliedlD street � I
._�7�t..�::
DESCRIPTION f
®6 t— '
OWNER: Name: J O
DKK TO BE PERFORMED:
pe- DR11D
Please Type or Print Clearly)
iGKLe,S
Address: (,,-3 -PLe- la M T � % - Ille P/Y1OUet-,� /"I)+ -
CONTRACTOR Name: Lb A LS (4 y S G 7 l S Phone: 7 -037
Address: V? -r 1�1,&-e, A/VT .sT Alzd'}/YtDo6ee IV714-
Supervisor's Construction License: 0)--2(o,96 Exp. Date: 9 1 v
Home Improvement License: 163 Exp. Date: 7 % /Z
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE. BULDING PERw : $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: -0—
Check
Check No.: ReceiptNo.:
NOTE: Persons contracting with unregistered contractors do not have access to theguaranty fund
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
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
❑ 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
40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
lust be submitted with the building application
Doc: Doc.Building permit Revised 2008mi
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
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on - Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comm
1Conservation Decision: Com
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Loca 4 Osgood Street
yes no '
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
® Notified for pickup - Date
Doc:.Building Permit Revised 2008
Location67
No. 7 4� " 1 a Date
i
Check #
ar
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 12—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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CS # 022680
HIC# 103358
` I`". 'all i 1
A. J. Walsh & Sons
55 Pleasant Street
.North Andover, MA 01845
# of pag
978-688-6737
or
1-866-AJWALS H
Proposal Submitted To: < j, Job Name Job #
1r :�d•1..-'. Erb/✓t���� ,.y�'��c_k....,..
Address %'j Job Location
j r
Date Date of Plans
tArchitect
We hereby submit specifications and estimates for.
We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of:
_-.A' td 0
$ � �� ` '0 Dollars
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs will be Respectfully '
executed only upon written order, and will become an extra charge over and:
above the estimate. AD agreements contingent upon strikes, accidents, or delays 4
beyond our control. Note — this proposal may be withdrawn by us if not accepted within days.
�CCE�ItAIYCC Of D,pO��
The above prices, specifications and conditions are satisfactory and are
�'" Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Signature
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
�r
Name (Business/Organization/Individual):
Address: Vr6 L-2 -S4 >`/ f
City/State/Zip: /OAPhone
Are u an employer? Check the appropriate box:
1.Z I am a employer with
The Commonwealth of Massachusetts
'
I
Department of Industrial Accidents
listed on the attached sheet. t
Jk
Office of Investigations
working for me in any capacity.
workers' comp. insurance.
600 Washington Street
•
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
�r
Name (Business/Organization/Individual):
Address: Vr6 L-2 -S4 >`/ f
City/State/Zip: /OAPhone
Are u an employer? Check the appropriate box:
1.Z 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. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
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
3. ❑ 1 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
). ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. �oof repairs
13.❑ Other /��,61 AD
*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.
TContractors that check this box must attached an additional sheet showing the name of the sub -contractors acid their workers' comp. policy information.
I am an employer that is provitling wo►•kers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: /H//41
Expiration
Policy # or Self -ins. Lic. #: 77�Affl1�!d H. Date:
Job Site Address: 62
121 :o /s !e;�7' Sr City/State/Zip: lY,,) 17,0 �
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 of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify undgr the pains and penalties of perjury that the information provided above is true and correct.
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. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
Chis form satisfies'all basic retpihements of the state's Home improvement Contractor Law (MGL chapter 142A) lint does not include standard
anguage to protect homeowners. Seek legal advice if necessary." Any person planning home gnprovements should first obtain a copy of"a
dassachusetts>consumer guide to honic•improvement" before agreeing to any work on yourresidence. You may obtain free copy by'calling The '
Men of Consumer:<Affaa irs and Business Regulation's Consumer Information Hotline at 617-973,8787 or 1+888:283-3757.
aauwwrruw auaua wauvu -
Name
Strect Address (do not use.a Post Office Box address)
QtAf/tSt_1v sj
Ci0froVA State Zip Code
Wo 9NPn�p
Daytime PhoneEvening Phone -
9W_ _619r5 -,5765--
Mailing Address (It different from above)'
The Contractor agrees. to do the following work for the t
40cr c
uonuracmr intormauon
.ompany Name
Gt '017
.ontractor/ Salesperson/ Owner Name
AU
uaness address (must include a street address) .
tryfrown State Zip Code
/10N1yW49,412 X1/3-6� r
�usinew Phone 46dcrW Employer ID or S.S. Number
taw tegai,m nul erica hum im•I Aomn ICo"traelmaealhmbc l:EigmatimdaC
mrmmt 000vawan Wwa 1
Ikequired'Permits - The following building permits are required
Proposed Start and' Completion Schedule - The fdllowing schedule will
and will besecumd:by the contractor as the 'homeowner's agent
be adhered to `unless circumstances beyouri the contractor's' control arise
(Owners whoseeare their own permits will be
excluded from the Guaranty Fund provisions ofDace
-_
when coiitraetor will begin contracted work
MGL chapter 142A.)
Date when comraeted .work will beaubstantially.completed ;
Total Contract Price and Payment Schedule ,
wnuacwr.agrees m penorm me wore, 11117M. the material and labor specified above for the fatal sum of: - - - N
Payments will be made according to the following schedule:
$ uponaigning contract (not -to exceed 1/3 of the total:contract price 2r the cost:of special order items, whichever is greater)
S by or upon completion of
A.
$�by _or upon completion of
$ fzx upon completion of the contract (Law forbids demanding full payment until .contract is completed to both party's satisfaction)
The following matesial/equipment must be special S to be paid for
ordered before the coshacted work begins in order S paid for
to meet the completion sehedule.('s)
NOTES: (s) including all finance charges (n*) Law requires that Roy deposit or down -payment required by the contractor before coo* begins may
not exceed the greater of (a) one-third of the total contract price or (b) the actual con of any spedal.etpiipan®t or custom made material
whim must be special ordered in advance to meet the completion schedule
Express Warranty - Is an express warranty being provided by the contratbr+ No Yess( of fb �yarranh r--
Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of auy tumid .
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 aereement
Contract Acceptance -Upon signing this document becomes a bindingcontract under.law. Unless otherwise noted within this document, the
contract shall not imply that any lien or other security intenest'hes been placed on the residence. Review the following cautions and notices
carefully before signing this contract-
.
ontract• Don't bea;
pressured tato signing the contract Take time to read and fully understand it. Ask questions ifsornething is unclear.
• Make sure the contractor has a valid Home I rovement Contractor Reaicnati
101` The Isw requires most home improvement contractors and .
subcontractors to be registered with. the Director ofHome Improvement Contractor Registration. You may-imprim about. contractor
registration by writing to the Director at:Onc Ashburton Place, Room 1301, Boston, MA 02108 orby,calling 617-727-3200.or
1-800-223-0933.
Does the contractor have insurance? Check to see that your contractor is properly insured.
• 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 Iniprovemcot 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
:ontractor 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 tht
hied business day following the signing of this agreement .. See the attached notice of cancellation form for an explanation of.this right
nn Atn r car, mrTr0
�va1 aa�v a err 1sarescr, AICL AINY BLANK SPACESM
coo idm6al ropier ofthe ,L et be completed add maned. One cgry should so to the homeowner. The other should be
� owY Rept M the oann,etor.
Hom wner's Siare Contractor's i
g%6�U�� S
Date d T Date
0
Contractor Arbitraihou ' -
The Home Improvement Contractor Law provides homeowners with themghtv4nitiate an arbitration action (as an
alteriafive to,conrtaction) if they, have a.dispute with.a contractor. The same right is sof automatically afforded w'a.
contractor, however. -.The contractor would havetp 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. contractorthe 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 anal Business Regulation and -the consumer shall be requireii
to to s�,uc� arbi on rovided In. Massachusetts General Laws, chs m 142A.
Qk_,�el V_—V
Homeowner's Sign6ture Contractor's Signa
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 alterative -dispute resolution even where this section is not
CP.nAMYP.IV '.CiQfledj]V .the tSal'nes:'"... �. .. - .
Homeowner's Rights
A homeowner's rights under -the Home -Improvement Contractor Law (MGL chapter 142A) and other consumer
protection laws (i.e. MGL chapte"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 of materials. In addition to guarantees or waianties 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 lawfidlyagree :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 dul2licat and should not be signed until a copy of all'exbibits 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 griginal.contract must be in writing
and agreed to by both parties. Contracted vrork 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 mgy not demand payments inadvance.of the dates specified on the payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However, in instances wherea contractor deems him/herself
to be financially insecure, the contractor may require that the balance of fiords not yet due be placed in a joint escrow
account as a prerequisite tocontinuing 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 ImprovementContractorLawor other
consumer rights,. or if you wish to. obtain a free copy of "A Consumer. Guide to the Home Improvement Contractor
Law,"• contact: .
Cqnsumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
(617) 973-8787 or 1-(888) 2833757
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
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 ofdisputes or to register formal complaints against a buscall;
Coiistiri er'Complaint Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508) 652-4800
(508)755-2548
(413) 734-3114
Office of Consumer :�ffaits fi Rosiness lie�nlatian
_..HOME IMPROVEMENT CONTRACTOR
Registration: 103358 Type:
= Expiration: 7/7/2012 Private Corporatior
A. J. tWALSH & SONS.INC.
Atlhur Walsb,Jr.
55 Pleasant St Vic_
N Andover, iViA 01845 t ndcrsecretar�
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
i 10 Park Plaza - Suite 5170
Boston, NIA 02116
Not vafi&Evithotjt sigrture
�I,t�1:u:ltau:tt�. - Ucit;trtnt��nt ul 1'ithli� '�al��f�,
�'c. � lin,trtl ��f i>niitiin��, itc�;tti;tri�ut� ;tnti '�t;ntclarcia
}
Ln t%!,isa C3 22680
ARTHUR J WALSH JR
159A WAVERLY RD
N ANDOVER, MA 01845
;xr,rti+. 6/9/2012
29327