Loading...
HomeMy WebLinkAboutBuilding Permit #391-16 - 691 WAVERLY ROAD 9/28/2015 JC#,V,VED Vh-6/4'r BUILDING PERMIT NORTH �a TOWN OF NORTH ANDOVER 02,ye'tI♦696 O� APPLICATION FOR PLAN EXAMINATION '" 7D ? ee^ M � o Permit No#: Date Received �QA6QA7FD 0rc5* gSSACH�1S�� Date Issued: I TANT: Applicant must complete all items on this page j LOCATION CP_[/ Print PROPERTY OWNER 'VA 001,01 e the Print 16Q Year Structure yes no MAPPARCELZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 06ne family 0 Addition ❑Two or more family ❑ Industrial �<Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: r1 ot Identification- Please Type or Print Clearly OWNER: Name: &rre l be Phone:2/0' Address: 60 %ler wild, /a - i Contractor Name:, 5 bAr&Cd?( Phone: 7� J Email: _t II Address: ►�'� ,� a Supervisor's Construction License: CL1 2 Exp. Date:... Home Improvement License: �T 7 _ _ Exp. Date:R 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: $_ �t FEE: $_ :�2a / Check No.: ;'7 Receipt No.: NOTE: Persons contracting withunregistered contractgrs do not have access to the guaranty fund Signature of Agent/O" T tore of contractor I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 1 I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS a 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 DPW Town Engineer: Signature: Located 384 Osgood Street - r:� _ FIRE DEPARTMENT = Temp. Dumpster ontsite; yes. _ _ no n -� , Located of 124 Main.Street Fire Department signature/date COMMENTS i 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I 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/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 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 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 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 Alid 1 Vt 1 No. ✓ / Date 4;>) I Cry . - TOWN OF NORTH ANDOVER, �$ Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $_ Other Permit Fee $ TOTAL $ Check# 2 ..4- 420 ing Inspector NORTH Town of �.. � EAndover No. 1, 2,61a ,� oh ver, Mass, �,� C OCNICMl WICK y1• A°R.,TEo ►�Pp,��cy S V BOARD OF HEALTH PER T Food/Kitchen r Jle Septic System THIS CERTIFIES THAT .. ..... .. . /�/..I/�.........C �..l..j.. BUILDING INSPECTOR ..... .... ..................... has permission to erect // " 1,._ Foundation .......................... buildings on ............ 1.....���.. . Rough tobe occupied as .......................5... .. ........ ...........�2e-1.11(4.p...... .. .. ............................................ Chimney provided that the person accepting this p it shall in every respect conform 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 Rough T LD VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR � UNLESS CONSTRUCT N S TS Rough Service .............. .. ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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 Sample 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 person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Namei Company Name ai-a 4>irr,el GMt 1 t Street Address(do not use a Post Office ox add Contractor/Salespers OwnerName yyam�,, 16k AMP City/To State Zip Code Busrnes Ad s(m t include a street ad ess) Ail& ` w Da 'me Phone Evening Phone City/Town State Zip Code Mailing Address(Itdifferentfromabove) Business hone Federal Employer ID or S.S.Number Homelmprovement ConlmctorReg.Number Eapimtion date In,requires tbat most home :/ /� y.� improt•emeet tin..tors have �ea ?G/—' v/��1 nvettd registmtian number V17VS.—./1 U The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) 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 homeownef s agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of b1, to when contractor will begin contracted work MGL chapter 142A.) ate when contracted work will be substantially completed Total Contract Price and Payment Schedule q�� The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of (/�,J (*) Payments will be made according to the following schedule: $ zo upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by / / or upon completion of $ by / / or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $_ to be paid for ordered before the contracted work begins in order Grp) to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins 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 warrantv being provided by the contractor? ❑No Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third parry/subcontractor utilized by the contractor. The contractor ftuther agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract 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 signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure 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"proof of 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 Improvement 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 contractor 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 the third business day following the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT II'THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be completed and signed.One copy should go to ate h�Tltho - t by ate contractor. t 1 � H owners afore Contra is Signature x- --15 9 Date Date 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 s t to4' gmnature bitration as provided In Massachusetts General Laws Ater 142A. Homeowne actors Slgnature 1 NOTICE:The signatures of the parties above apply only.to the agreeme t of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. 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 speck 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 bothparties 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://wivw.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 ham://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: bnp://db.state.ma.us/homeiinDrovement/licenseelist.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 2.1-11/2212010 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 02025-001 NAME CT Degnan Insurance Agency Inc AC No.Ext: (978)688-9474 AIC.No.: (978)327-6558 85 Salem Street EMAIL Lawrence,MA 01843 ADDRESS: INSU ERS FORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: James Debrecini Family Roofing & Painting INSURER C: 2 Tanager Way INSURER D: Londonderry, NH 03053 INSURER E: I INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMI ETORENTED $ PREMISES Ea occurrence CLAIMS-MADE [_�OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ __]POLICY ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ �/pRKDEED OM RETENTION $ H $ AINJyD ERMR OOCYEE7R�3R��LIgARBIIN_IETRY EE X TORY LIMITS OER A OFFICER/MEMBER/EXCLUDE/D�ECUTIVE Y I N E.L.EACH ACCIDENT $ 100,000.00 N/A AWC-400-7025900-2016A 5/11/2015 5/11/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 Ms describe under E.L.DISEASE-POLICY LIMIT $ 500,000.00 SG`RIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The workers compensation policy does not provide coverage for James Debrecini CERTIFICATE HOLDER CANCELLATION Andover Town Offices 36 Bartlett Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover,MA 01810 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of¢wilding Regulations and Standards Construction Supervisor Specialty License: CSSL-099.685 JAMES J DEBRE 2 TANAGER WAY LONDONDERRY � , �je� , `�r741 Expiration 14 Commissioner 12/06/2015 a /ua - ---r•-d �aac ulation _ %� t Ivrzrz,n�2rnecr� z Businn ess Reg License or registration.valid for individul use only CTOR �a Office of Consumer Affairs& before the expiration date. If found return to: c i;�E1tOVEMENT CONTRA Type: Office of Consumer Affairs and Business Regulation i. vegistration: 122385 DBA 10 Park Plaza-Suite 5170 Xpiration: 812612016 Boston,MA 02116 >` WEATHERSEAL ,;AWES DEBRECENI � e 2 TANAGER WAY Undersecretary LONDONDERRY,NH 03053 Not validtavithout signature -. ::