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HomeMy WebLinkAboutBuilding Permit #487-15 - 7 SULLIVAN STREET 11/19/2014Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Date Received RTANT: Applicant must LOCATION - V P FPROPERTY 0111/NER__ _ _ �C'� �r z = P MAP, PARCEL_.ZONING`D all items on this �2 y�... A 100 Year Structure yes no ICT _ _ _Historic Dist'nct ye no KAarrl ina .Henn Villaiia vac nn TYPE OF IMPROVEMENT PROPOSED USE j Residential Non- Residential ❑ New Building R6ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `rSeptic El V11ell ❑Floodplain p Wetlands' ❑ Watershed �Dstnct: 'Nater/Sewer DESCRIPTIO OF WORK TO BE PERFORMED: egcation� Please Type or Print Clearly ��� ������ OWNER: Name: orn ©eN Phone: ,f Address: St1 f 1 f /V AI Jpt4l Contractor Name:. Awa` b''r41C Ph°one:. Address: __��►� iG 0= -= S'upervisor's Construction'ILicense:.� reaTS �_°Exp. ;Date:_ r` Home Irr provement-License::-J _� : _ :Exp.; (Date ARCHITECT/ENGINEER Phone: a 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: $ FEE: $ Check No.: D'5%1 Receipt No.: NOTE: Persons contracting with unrered contractors do not have access to the guaranty fund n t �. \ n 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 PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: 1 t Comme Comm Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 'EIRE +DEPARat tTM124 Main Street ENT . i,emp iDumpster on site eyes_— __� . _ no Located l - _----�- Firevepartment - -gnatureld'ate Dimension Number of Stories Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I t5 and DA I A — (For department use ❑ Notified for pickup Call Emai 1 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 ❑ 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 a 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 �J V PC—V— No. .� Date Ch 28286 TOWN OF NORTH ANDOVER4 Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector" E 1 rA 0 O O ♦ i v 0 .Q L Q �a ® 0 � Q Y N • ate+ i 1 4 4T O r 2 h S' c Z 0L Ocn c �� ~1E L m a — dmc �; N W c N m O o � :yea �Z O W 0 o c .y oW 0 0 ACCO - _ >0 w -j _��a a.Z d m v �' L O O N a7 o 'v c c Q i i CC 'O .O _ Q. '— N F— O U) v m O co m =F, W_ O 'O O O uj LL to C O �t O LU E v� 0 O W �, v UCL 0-0 d w _ G1 *5;J N' •O 0 O w O V W CL N z CD z 0 J_ m E Z 0 .E L a as V ca a w 0 .Q i 0 cc cn rdw O0 J O O Z U W d O W y = N Z N z U LLJ LL Z d C7 Q Z a 0 z Z V W 000 N O LU _ C C LU co J W LL Nm d J W t +O TO O N Y- N co N N L z \ U i C t iU i Y O Q. 7 7 c6 UO c6 j f6 j c0 i N O LL to LL K U LL LL d' In LL d' LL m N (n 0 O O ♦ i v 0 .Q L Q �a ® 0 � Q Y N • ate+ i 1 4 4T O r 2 h S' c Z 0L Ocn c �� ~1E L m a — dmc �; N W c N m O o � :yea �Z O W 0 o c .y oW 0 0 ACCO - _ >0 w -j _��a a.Z d m v �' L O O N a7 o 'v c c Q i i CC 'O .O _ Q. '— N F— O U) v m O co m =F, W_ O 'O O O uj LL to C O �t O LU E v� 0 O W �, v UCL 0-0 d w _ G1 *5;J N' •O 0 O w O V W CL N z CD z 0 J_ m E Z 0 .E L a as V ca a w 0 .Q i 0 cc cn rdw 168 Maple Street _ Methuen, MA 01844 (978) 683-5127 FAMILY R00WAS & PAINTERS Bill To: Keen -Na rh-1' Vl Address: —7 5% 11 ivc4w) A)' • h/9• Phone: g7e- 9 75-- 3305( A -le co Iri P E- ,:5 pp1 � Board cfJ'- j � � .411 It ebrr , ALL WORKMANSHIP GUARANTEED 10 YEARS ESTIMATE � ,?00 INITIAL DEPOSIT 1ST PAYMENT 2ND PAYMENT FINAL PAYMENT �aC� James Debreceni LIC # 99685 HIC # 122385 Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home hnprovement 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 flee 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 Name a�, h Compan e - orAo n r i 1?0 Street Address (do not use a Post 0 ice Box a� drress) 4ft/V ntra or/ Salespe n/ Owner Name City/To State Zip Code Business Address must include a reet address) Daytime Phone Evening Phone ityfro S.{t[a�te Zip Code Mailing Address (It different from above) Business Phone Federal Empl yer ID or S.S. Number - Law require that most home Nome Lvprovement ConhactorReg.Number Expiration date improvementatot numb have valid registration number �ae;" /7� f — f6 !JY �A/ / 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 homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits"' be j excluded from the Guaranty Fund provisions of / Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, famish the material and labor specified above for the total stun of: Payments will be made according to the following schedule: $ upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ 0 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 parry's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES: (*) Including all finance charges (**) Jaw 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 - Js an express warranty being provided by the contractor? 11No es fall terms of the warranty must be attached to the contract) Subcontractors - The contractor ogees to be solely responsible for completion of the work described regardless of the actions of any third 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 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 ofthis 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. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed. One copy should go to the hom owner. The other copy ml be kept by the contractor. Home ner's Signature Contra or's Signature /1-15 rV /i-/ q -I 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 submit to such arbitration as provided In Massachusetts General Laws, chapter 142A. Home e�ature Con ctor's Signature NOTICE: The signatures of the parties above apply only to the agreement Vf 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 specific 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 io by both parties. Contracted work may not 'begin until'both parties 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://www.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: http://db.state.ma.us/homeimprovement/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 - 11/22/2010 The Commonwealth of Massachusettsfu 07 - -' Department of Industrigl Accidents Office of Investigations IN 600 Washington Street Boston, MA 02111 7vww.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/fndividual): a,- r o(f rh l -Address: cto G 'o'' (_V4/ City/State/Zip• / 1 Phone Are you an employer? Check the appropriate box: Type of project (required): 1. UTI am a employer with 4. El am a general contractor and I 6. E] New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and'have no employees working for me in any capacity. These sub -contractors have workers' comp. insurance. 8. ❑ Demolition 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3111 am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12, g4tUolrepairs required.] insurance . re uired employees. [No workers' 13.[i Other comp. insurance required.] 'Any applicant that checks box#I must also fill outthe section below showing their workers' compensation policy information. i -Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit anew affidavit indicating such. ?Contractors that check this boas_ must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name:. }/ Policy # or Self -ins. Lic. & /7vu 77U ' .�1� Expiration Date: Job Site Address: City/State/Zip: r O , AM Attach a copy of the workers' comp ensation-policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or ono�year imprisonment, as well as civil penalties in the form of a STOP WORD 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 herebyy fy under thpai an penalties ofperjury that the information provided above is trueand correct. .4.0 n 1 I� .-50 n A n . , . /%_ /0- L1/� Phone #: Official use only. Do not write in this area, to he 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. EIectrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,• express or implied, oral or written." An employer is defined as "an individual, partnership, 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 trustee 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 be 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) 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, apolicy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should 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 affidavit 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 burn leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone anal fak number: Tho Gommonwalth of Massachusetts Department ofIndustrial Accidents ()ffiice ofInvestigations 600 Wasbiingtou Street Boston lA 021.1.1. Tel # 61.7-727-4900 at 406 ox 1-877- tA.SSAFIB Revised 5-26-05 Fax # 617-727-7M wWW=tSS,gQ,V1d!a