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HomeMy WebLinkAboutBuilding Permit #495-14 - 61 RUSSETT LANE 12/12/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:�h � / �� Date Received Date Issued: I IMPORTANT: Applicant must complete all items on this page LOCATION,(�t :--^ P,rint PROPERTY OWNERI'-- MAP NO+.. PARCEL: . Print ZONING DISTRICT: 00 Year Old Structure Historic District. Resid al Non- Residential ❑ New Building Machine Shop Villa ,yes n yes o e ves , 110 TYPE OF IMPROVEMENT PROPOSED USE Resid al Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District - El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Please Tyne or / r Address: �%�� -/���� /k// q , 1V11,4 o%91FIS..— CONTRACTOR Name: /Y '1�561YS Phone: 97k -6ei--- /J 7 Address: SJ`� �Sf}✓�i l��� DI�Z�` j�% Supervisor's Construction License:y Exp. Date: 1 r Home Improvement License:/ 63 Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 1000.00 OF TI TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ - / �G� © FEE: $ �O? Check No.: :?.-) Z Receipt No.: 2-1 I'l 15' NOTE: Persons contracting with unregistered contractors do not have access to to guaranty fund Signature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on 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 Driveway Permit h DPW Tow Engineer: Sign FIRE :DEPTemp Dumpster on site yes Located at -124 MainStreet Fire Department-signatureldate COMMENTS n Street 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 filo 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 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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'Ated with the building application Doc: Doc.Bui!ding Permit Revised 2012 Locationye—u l�Q "'iJ No. 1 /� Check #3'5b2- 27175 3'5b2-- 27175 Date TOWN OF NORTH ANDOVER Certificate of Occupancy - $ Building/Frame Permit Fee $ 6o? • n Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 w' Building Inspector CO) m m m m CO) mm U) .a C � n O ID c. �• U) V O v� cr M O CD 0 CD O N. C• 41D ' � v O 0Z CD 0 �- 0 X CD CD m X a TO z 0 Z ''_A vi C 00 'a -4L = -i O = - O _ = < O-0 y O >_ (D.O CD 0 O rt Q" .•a C.) z o ==� N -i O 3 y °: 'n O O •-• n m M - CD N r~ N M. N =.CDS co 2 G CD 0 � N � to rt ` • O !� WCD CD A S.�.CD- Ll �� co H .f O CD o0(A � �Cr U) > CD CL N = 0 U)�. < Q. O — vi 2. N O U) � � co � O 03 .o CD �D CA r � 0 1 #** O O sem: C CD CD cn cn C . C C) N 0 D CD CD -o'a as � O as o Ln 0 (D v N Y (D '"�' Z ° W C :3y 32 O M $ z T mT C S �^ z cn -I y N (D 0 (D � C S m m 70 y r n T D7j A C S M C W z n 0 T paj nT s :3 (D ` C S C d d o =3 C O G m 0 N 'a n LnT 3 T O \ s W > v O m x * b� Z, �O 1 " M ter: The Commonwealth ofMassachusetts >:~r' Department of Industrial Accidents Office of Investigations 600 Washington ,Street z__6 xr ` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): s s� Address: sJ—, City/State/Zip: NO MAOne #: O Areyou employer? Check the appropriate box: L 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. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ 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.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ 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 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:. /1/x'7 111617 -Wk." 6fJ Policy # or Self -ins. Lic. zoo Expiration Date: Job Site Address:% /1 �{�c��/� L.%� City/State/Zip: IY,/ 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 certiJ5�mgder the pains andpenalties ofperjury that the information provided above is true and correct. 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 C'nntnet Peron - Phone 4 - CS # 022680 HIC# 103358 = Propmal == A. J. Walsh & Sons 55 Pleasant Street .North Andover, MA 01845 # of 978-688-6737 or 1-866-AJWALS H We propose hereby to fumish material and labor — complete inVccordance with the above specifications fr f. 'the sum of: C/UZ jlo 13 Dollars ``ff with payments to be made as�follows: v v An alteration or deviation from above specifications involving extra costs will be Any p g Respectfully executed only upon written order, and will become an extra charge over and / above the estimate. All agreements contingent upon strikes, accidents, or delays submitted .. beyond our cdhtrol. Note — this proposal may be withdrawn by us if not accepted within days. �cce�taitc,e of �o�o�a� � The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature Payments will be made as outlined above. Date of Acceptance f I f• ASignature Proposal Submitted o Job Name Job # Address ' 4 Job Location Date ////O�,_ 113 T5ate of Plans Phone # f/ Architect bmit specifications and estimates for. rF. h Cl./'/,•G4�L.f� (/ �� C�I� ./w L.v `r"r/ � _ �_ G'?7�.K'.s-•��vY� t� /�_, off_ _ Or j,_�� _.Citi rr."u�C.++ �' ..�^ i�(..(H't���'b�G/ / / /�� �fh�� � //.►'"y ,,�'��fT/wnL" / We propose hereby to fumish material and labor — complete inVccordance with the above specifications fr f. 'the sum of: C/UZ jlo 13 Dollars ``ff with payments to be made as�follows: v v An alteration or deviation from above specifications involving extra costs will be Any p g Respectfully executed only upon written order, and will become an extra charge over and / above the estimate. All agreements contingent upon strikes, accidents, or delays submitted .. beyond our cdhtrol. Note — this proposal may be withdrawn by us if not accepted within days. �cce�taitc,e of �o�o�a� � The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature Payments will be made as outlined above. Date of Acceptance f I f• ASignature I. cvIJ IL. ii. i,. FIVVVViniLv 111 VV1\nl\VL IYV. LVYU F. I) cORl7® CERTIFICATE OF LIASILIT DATE(MMMDfMM Y INSURANCE 121`0412013 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS :ERTIFICATBELOW, THIS DOES FICATEFOF INSURANCERDOESANOT CVELYONSTNRJTE A CONTACT BERTWEEN THE ISSUING INSURER(S),TAU POLICIES REPRESENTATIVE OR PRODUCER., AND THE CERTIFICATE HOLDER. MPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the Pollcy(les) must be endorsed, If SUBROGATIONI IS WANED, subject to :he terms and conditions of the policy, Certain Policies may require an endorsement. A statement on this certificate does not confer rights to the :ertlflcate holder In lieu of such endorsement(s). IDUcER 00775 - 001 CT use S Jankovnkl Insurance Agency Inc 8 Maes Ave Suite 1018 Ie Eltt : (97!).682-5175 N, ; (978)794.0313 Irth Andover, MA 01845 201688. )RED thur Welsh J Walsh S Sons Pleasant Street Irth Andover, MA 01845 Mutual )VERAGE8 CERTIFICATE NUMBER: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO IDIERTIFICATENMAY BESISSUED ONG RNMAY PERTAIN. THEINSURANCEM OR N FIFORDED BY THE POL CIES XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAI 7YPEOFIN$URANCE _2190 POLICY NUMBER GENERAL LIABILITY ]�!CLAIM13,MADS MERCIAL GENERAL LIABILITY ❑ OCCUR AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY EACH OCCURRENCE ANY AUTO DAMAGE 0 ED MED EXP (Arty one peraon) I ED S U a AUT08 S AUTOS HIRED AUTOS LJ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAR CLAIM8 MADE OED RETENTION a 'may e���p�o°��pPSp'�Ctq�RT�.4E�Rr�X �FFICER/M�MBER�tcXCL�OED9ECl1TNE� NIA (MAndstory In NH) OF OPERATION$ 'n Of North Andover ) Osgood Street :h Andover, MA 01845 33758 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT wTH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, D CLAIMS, LIMITS EACH OCCURRENCE a DAMAGE 0 ED MED EXP (Arty one peraon) a a PERSONAL 6 ADV INJURY S GENERALAGOR90ATE a PRODUCTS •COMPIORAGG S BODILY INJURY (Per person) s BODILY INJURY (Per ecddent) S R PERTYDAMAGE : B EACH OCCURRENCE a AGGREGATE s s AWC-400.7014648-2013A 11/14/2013 11/14/2014 E.L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYEE S EL DISEASE. POLICY LIMIT S ACORD 101, AddWonel Remarks 8cfiedute, IT mon epeee I& re4uVed) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ORD 25 2010/05 "S 1°�°'`°19 ( ) The ACORD name and logo are registered marks of ACORD MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfics.ell basio-requiremenm of the state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard langmage to protecbhomeownera. Seek legal advice lfnecessary. Any peison•planning home irtnprovements should fust obtain a copy of "a Massachuseu consumer.goide to home,improvement" before agreeing to any work on yourresidenoe.You may obtains free copy by'calling the Office of Consumer. Affairs, and BusinessRRegulatiodi; Consumer Information Hotline at -617-9734787 or 1.888:283-375.7: ' Homeowner Information Coattactor Information 7. Name Pane_ ante Street Address (do not use.a Post Office Born addres;)trsftrt Salespersow Owner Name 1Styfrown state zip de usiness Address (mast include a street ) Daytime Phone Evening Phone ityrrown state Zip Code /7 Gid ��s"" ,yp vc( 13-7ff 0I• ' Vailine Addt— fit diff t fmm ,h, l ---_ _ x/71 � r"� •oatndcmuwa t - tgmanaa®� los The Contractor agrees to do the following work for the Homeo mer. . Itequirecl Permits - The -following building peimits sac required Proposed Start and to mpiet}on Schedule -Tae following schedule will and will besecured:by the contractor as the'homeowner's agent; be adhered ro'uriless circumstances Beyond the contractors° control arise (Owners who,secure their own permits will be excluded from.the:.Guaranty Fund :provisions of Date when contractor will begin commeW work MGL chapter 142A.) Date when contracted .work will Beaubstentiaily.completed• . Total Contract Price and Payment Schedule The Contractor.agrees to perform the work, furnishthe material arta 1.1---. ;.a .u.....- c__.,..._._, Payments will b&dc according to the following schedule: S� upon signing contract (not to exceed 1/3 of the total.contract price, gt the cost;of special order items, whichever is. greater) $ by _ _/ or upon completion of $ or upon completion of g� 0 sollOupon completion of the contract (Law forbids demandingfull e payment untilcontract is completed to both party's satisfaction) The following material/equipment must be special S be paid for ' ordered before pIttihe contracted wodc"begins inorder S be paid for to meet tlie..completion schedule.('•) NOTES: (•) including all finance charges (••) Law requires that any deposit or down -payment required by the contractor before wot)t notexceed the greater of (a) one-third of the total contract price or (b) the actual ren of as begins may which must be special ordered in advance to meet the completion schedule Y spxtel,equipmmt or custom made material Subcontractors -The contractor a • pe ° glees to be solely responsble for corupletioa of the work described regardless of the actions ofany thud patty/subcontnutor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors fol materials and Is on ih+e aaTMrtnent 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 interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into sighing the contract Take time to read and fully understand it Ask'questions ifsori3ethinb is unclear. • Make sure the contractor has a valid Home Imtrroveme-t C ontractor R 'chat 7be Viv requires most home improvement contractors and . subcontractors to be registered with .the Director ofHome Improvement Conttacta Registration. You may inquire about.connactor registration by writing to the Director at One Ashburton Place, Room 1301,. Boston MA 02108 orby calling 617-727-3200 nt 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 flus foim and get a copy of the Consumer Guide to the Home bAprovement Contractor Law: You may cancel this agreement if it has been signed at a place other, than the contractor's normal lace of business, provided contractor in writing at his/her main office or branch office P P you notify the third business writing followis the signing by ordinary marl posted, by telegram sent or by delivery, not later than midnight of the. Y g. gning of this agreement . See the attached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM o Weeded tmpies of the contract awl be completed and,Wm4 one eopy.d outd ao to the honowmc. The other copy abauW be kryt by the contractor. Homeowner Si tore Contractor's Signature Dau • , ;Date i/// aW 13 o a r d j U 1 rl CS -022680 P 41 ARTHUR JWAISHJR 159A WAVERLY-RD N ANDOVER MA 01845 06/09/2014 ?�"P/fiopmeq//X Office of Cons,umei -Affairs&Busi es-91tegulatio"n IMPROVEMENT CONTRACTOR 'w i - _-t istration: Type: ... gL 1 103358 w'j,-9xpi ration: 7/7/2014 Private Corporati(. A. i WALSH & SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover, MA 01845 Undersecretary Contractor Arbitrations.: . The Home ."yement Contractor Lawprovides homeowners with the right-to4nitiate an arbitration action (as an alternative t6 dourt action) if they, have a:dispuEe wiih.a contractor. The.same. rightis not' automatically afforded to a. contractor, however..- contractorwould have tp resolve any, dispute belshe.h 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 Consumd Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In. M�Sa sachusetts General Laws, char 142A0 _k / n Homeo er's Siga tore 1 / / Contractor's Signature NOTICVThe signatures of the artiy� dove apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor:' Thetom er.may initiate alternative:dispute resolution even where this section. is not a_afatrly cion :.hv'.t}re trarlreS:" .. . Homeowner's_ Rights A homeowner's rights under the Home1riprovement 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 I,aw. -The contractor is responsible for completing the work as described, in a timely and workmiplikemanner. 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 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 du lice a 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. thel contractor. Any modification to the griginal contract must be in writing and agreed to by both parties. Contracted v+ork 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 may 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 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:generalquestions or.need additional information about the Home Improvement Contractor Law or other consumer rights; or. if you wish to,obtain a fi ee;copy of "A Consumer Guide to.the Home.Improvement Contractor Law,"- contact: . Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1-(888) 283.3757 If you want to verify theiegistration 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 or1-800-223-0933 For assistance with informal me,diation'ofdisptttes or to register formal complaints against. a businosj'tall:'` Consiitirier`CoinplaintSeCtion Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114