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Home My WebLink AboutBuilding Permit #248 - 7 SOUTH CROSS ROAD 10/2/2006 pE NORT"141 p TOWN OF NORTH ANDOVER •' APPLICATION FOR PLAN EXAMINATION � -Oreo rr`g9 9SSAC HU`�Et Permit NO: Date Received: Date Issued: U Z,-0 IMPORTANT: Applicant must complete all items on this page LOCATION 7 Print f PROPERTY OWNER �APr_rf _ � � �- XICLI E. Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ?'One family ❑Addition ❑ Two or more family ❑ Industrial ?'Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED `` n,o o rtir 64 36-, V 1,J o u w+ ij�� 14svnc �i ems,-IL�t�X� �,��i� �f�TfJ• Identification Please Type or Print Clearly) OWNER: Name: /[A-,r- rr f-c Phone: q-V-6h, Address: '7 &,-7w cledSS CONTRACTOR Name: a rJL- "iC-f—de Phone:9 7oo-397- 90'2�C u Address: _ R Supervisor's Construction License: 414-S 6 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ S!5&6 x10.00=FEE:$ ezqq . ,00 Check No.: 5�-� - Receipt No.:� Page I of 4 i TYPE OF SEWARGE DISPOSAL Swimming Pools 11F1Tanning/Massage/Body Art ❑ Public Sewer Well lvvfjw Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. Q� Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �� Signature of Contra Plans Submitted F Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED ' HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signat re&date Temp Dumpster on site yes no_ Fire Department signature/date � "" r�y 0� Building Permit Approved and Issued by: Page 2 of 4 Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.Jan.2006 i Building Department f 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 4 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 j 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 t v4ORTH Town of No. 2 �gN. = A- dover, Mass.,Ih ' 2 • O 4i COC MICMEWICK �^ ADRATED oP�\ �� S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......PAW1....... G.. . . .................................................................................................... Foundation has permission to erect........................................ buildings on .... ..... ......... . ��............................. Rough �.. to be occupied as.. 01A. ....�w.i .........:..... lrlA!�!�.�Zlpf�y!!�..... �. .•............ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 7- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS Rough .............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner _ Street No. SEE REVERSE SIDE Smoke Det. �Ecz•T'i�(E� �oV U QaTt o u �_ L,occa-r+=.cam A t..� tilotZT'1-1 A �no.rr�� MASS � 82,00 I L,-r- 1 1. 1{s1= 1?Z.o 2.1'AVK� 171.'y? .3 4.D,b, l'•T(. os �•b.ra . t'1o.6 7. Epp t7o.` S B•r•.+..+D 170.6 + .o q•„3,S tLo S.F. � 0 soc C- T 2 >q / 2 S AIR -Aa O gg ®00 AT o P F'S�TS +-low - T HC-7_ C-_= 7E!>U�L.D t�G Z u S PEC'Trj • :^t�-"'. di J•'��, i m o s H - -N E ZAv D Pay L. \,j S F C.o F o �' -o by tri Cy I \ r•�t lT Y o cl N E til vO�TF.P \T y HC , ti E r" CONTRACT This Agreement is made this l day of S l— , 200 ;by and between Wayne Hinckley (the "Contractor") and lk�c r t ("Owner'). WHEREAS, Owner has asked HINCKLEY to provide certain materials and services at Owner's property located in k "Le -- , 44aie; and MASS WHEREAS, HINCKLEY has agreed to do such work; NOW, THEREFORE, HINCKLEY and Owner, for good and valuable consideration, hereby agree as follows: I. CONTRACT DOCUMENTS. The Contract Documents consist of_1' pages including this Agreement and all addenda issued prior to and all written modifications issued after execution of this Agreement including written change orders. 2. SCOPE OF WORK, ESTIMATED WORK DATES, ACCESS. HINCKLEY agrees to provide all labor and materials necessary to complete the work described on Exhibit A (hereinafter the "Project"). The estimated date of commencement of the Project is Uc.-tZ 1 , 2004, and the estimated date when the Project will be substantially completed is 7t)e c. 30_, 200(. Owner agrees that HINCKLEY shall have complete use of and access to the property where it is undertaking Project location during regular business hours, upon reasonable advance notice to Owner. Unless otherwise provided in Exhibit A, Owner shall remove all obstacles such as furniture, carpeting, personal property and appliances from the work area and Owner shall provide all heat, lighting, access to sanitary facilities and water for HINCKLEY during the time HINCKLEY is performing Project. During the Project, HINCKLEY shall properly dispose of remnants or scrap material relating to the Project. HINCKLEY is not responsible for the discovery or removal of asbestos or other hazardous or toxic substances or materials, and HINCKLEY reserves the right to discontinue work on the Project upon discovery of such materials pending the proper removal thereof by properly qualified firms at Owner's expense. If HINCKLEY does dispose of material, it shall be at the Owners expense and shall be in addition to the estimate or contract price. 3. STATUS OF HINCKLEY. It is expressly understood by the parties that neither HINCKLEY nor any of HINCKLEY's employees or agents are licensed architects or professional engineers. 4. BUILDING PERMITS. Any building permits required by State or local authorities shall be obtained by fir. El`,rNcKj� 5. SUBCONTRACTS. HINCKLEY may retain qualified subcontractors to perform installation, HINCKLEY,being responsible for the management of the Project, shall have full responsibility for the performance of such subcontracts. J 6. CHANGE ORDERS. Any alteration or deviation from the above contractual specifications that results in a revision of the contract price will be executed only upon the parties entering into a written change order. Each change order shall become a part of and is in conformance with this contract. All work shall be performed under the same terms and conditions as specified herein unless otherwise stipulated. The change order must detail all changes to this contract that result in a revision of the contract price. The original contact price and the revised price shall both be stated. Both parties must sign the change order. 7. CONTRACT PRICE. As consideration for HINCKLEY's performance of this Agreement, Owner agrees to pay either (a) A Fixed amount equal to the sum of$�� (coo . Unless otherwise mutually agreed upon between the parties hereto by virtue of a written change order pursuant to paragraph 6, above. In addition. Owner shall pay all federal, state, and local sales, use,property, excise or other taxes imposed on or with respect to the Project, except taxes levied on HINCKLEY's net income. (b) Time and materials with an hourly rate of$ HINCKLEY's good faith estimate of the cost of time and materials is attached hereto as Exhibit B. {OPTIONAL, BUT USEFUL--If HINCKLEY believes that the estimate is under the actual cost or projected cost by more than twenty percent (20%), HINCKLEY will so advise the Owner in writing within two business after HINCKLEY makes such determination.} 8. METHOD OF PAYMENT. The method of payment of the contact price set forth in paragraph 7, above (the initial Down payment being no more than kh3'of the total contact price) shall be as follows: //Z_ 5 00o a s�f lid.✓ u All payments shall be due within two business days after Owner's receipt of invoice or five days after mailing of any invoice. Owner shall indemnify and reimburse HINCKLEY for all reasonable costs of collection associated with law payment or nonpayment, including but not limited to reasonable attorneys fees. In addition, a late charge of 1-1/2%per month shall be added to all overdue balances (nominal annual percentage rate of 18%) 9. DELAYS. HINCKLEY shall not be held liable for any loss, damage or delay in connection with this Agreement due to delays in transportation of materials, weather, inability to access the premises, accidents, theft, fire, labor disputes, insurrection, acts of God, or any other cause beyond HINCKLEY's control. 10. OWNERSHIP AND USE OF CONTRACT DOCUMENTS. All Contract Documents are and shall remain HINCKLEY's property. With the exception of one set of CANct Documents for each party to the Agreement, such documents are to be returned or suitably accounted for to HINCKLEY on request at the completion of the Project. i l 5. This contract shall be governed under Maine law and venue for all proceeding shall be in the Courts of the State of Maine or Arbitrators sitting in Portland, Maine. I In Witness Whereof, the parties hereto have executed this Agreement the day and year first above written. � 1=FNESS- oW--,2 : Owner�,yz�� l<��> l� � t�e Address: 'Tourw 6Z+SS Phone: 79- (Qg(,— JY&( WAYNE HINCKLEY FACLIENTS\hinckley Wayne\Construction Contract.doc The Commonwealth of Massachuselts Department of Industrial,accidents ,a /,l i, Office of Investigations 600 Washington Street "1 12,i'i Boston, ,V14 02111 www.ntass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ;Vault:'. (l3usinessr(h•ganiialitmiln�livi�lual►: '� �C ;address: lP—� /y 6k —5 b2 t _ City,'State,lipPhone:4: 978-387 - 90 Are you an employer?Check the appropriate box: Type of project(required): I.❑ 1 am a employer with 4. F1 am a general contractor and 1 6. ❑ New construction employees(full and,'or part-time).* have hired the sub-contractors 2.( 1 am a sole proprietor or partner- listed on the attached sheet. ' ? Remodeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. workers' comp. insurance. y. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL i I.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,31(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] \ny applicant that checks box,4 I must also lilt out the section below showing their workers compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating:aich. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurancefor r my emphgyees. Below is the policy and job site information. Insurance Company Name:—_-_-- -, ------- _._--- --- --- Policy '-'or Self-ins. Lic. ''k: --.--_ _ 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 Section 25A of MGL c. 153 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 tiX ORK ORDER and a tine 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 the pains anpe aloes of perjury that the information provided above is true and correct. Si natttr [late: 9 P6� !Yjich d use w dy. Da,tut rorile in this!trerh,to hccn,nplctcd by crl) nr tmvn,,Jficiul. City or Tnwn: 1'et xttit/License# _ issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 3. Plumbing inspector 6.Other C oritact Per,;ow Phone#:. -- -------- - - BOARD OF BUILDING REGULATIONS s License: CONSTRUCTION SUPERVISOR ! ! i 1 Number: CS 032970 t Birthdate: 01/01/1961 Expires: 01/01/2008 Tr.no: 15522 ' ! Restricted: 00 WAYNE E HINCKLEY 49 NORTHERN OAKS DR 4 RAYMOND, ME 04071 Commissioner Board of Building Regula (ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 116361 Type: Individual Expiration: 6/8/2006 WAYNE HINCKLEY WAYNE HINCKLEY 49 NORTH OAKS DRIVE RAYMOND, ME 04071 Update Address and return card.Mark rea Address ❑ Renewal [j Employmen T� �oma�ywoi,�.uecz� �r��.-![�iJracfu6e�fG �- :--. Board of Building Regulationsulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 116361 Board of Building Regulations and Standards Expiration: 6/8/2006 One Ashburton Place Rm 1301 �•^-•' Type: Individual Boston,Ma.02108 WAYNE HINCKLEY WAYNE HINCKLEY 49 NORTHERN OAKS DRIVE RAYMOND, ME 04071 ti — - Administrator of i witho to e P• "' � Location r No. ty Date 10 -71-6 MpR,� TOWN OF NORTH ANDOVER p:t . e , 1qp 41014 1 s s i, � • Certificate of Occupancy $ ,3• � °•,a«�..r�"� • �� 8 Building/Frame Permit Fee $ •��' • ,SS,emust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # — 19636 l Building Inspector 1`