HomeMy WebLinkAboutBuilding Permit #509 - 733 TURNPIKE STREET 3/31/2009TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial-
n strial._Alteration
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
ers:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK Tq BE REFORMED: / /�
4arx-- J/Ck/ �l i% v'1(�' uQ-7—
Type or Print Clearly)
OWNER: Name:
Address:
3317- PJ0
CONTRACTOR Name: Ale ek %-41 Phone: b2l—)&f r C,�?
Address: ? "�2t rG�l r
Supervisor's Construction License: C-! ' Q �l�Q Exp. Date: /&A a
Home Improvement'License:�.. Exp. Date: r o c
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.
o c_
Total Project Cost: $ � _ %�G FEE: $ � �f
Check No.: ��� Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guara and
L ignature of Agent/Owner Signature of contractor
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
tl
HEALTH Reviewed on Siqnature
C
d
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
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
COMMENTS
uocatea 3i54 usg000 street
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
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
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: INSPECTIONAL SERVICES DEPARTMENTMFORM07
Revised 2.2008
Le
33
Location T�lnv,,4
No. Date
,40RTol TOWN OF NORTH ANDOVER
O: .•o ,1hO0
9
` Certificate of Occupancy $
y� s'••'°' Etn Building/Frame Permit Fee $
�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # Q 1`t
21b96
Building Inspector
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.
Wmeovyyr(.i�p o �/ �ntract �nformation
�Uhrl,�'i ff�/ 0°e
Name
7
-
Lorripany ame —
- I
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/
G r.C--
Street Addres's (do not us a Post Office Box address)
me/ -
ontractor/ Salesperson/ Owner Name
//�z Vii(
provisions of
Date when contractor will begin contracted work.
6�C' /fo State Zip Code
?�J-
usiness Address (mu t include a street address)
33 - W
Daytim hone Evening Phone I
ity/Town State Zip Code
�> ),-- T—(- 2'I/ a.3
Mailing Address (It different from above)
Business Phone ederal Employer ID or S.S. Number
The Contractor agrees to do the following work for the Homeo
Ing .-gauss that most homem-
pNl'emem eeanama h" o
'lid reaistratioa mmrbcr
mer:
Home rp--1 CouuactorRq. Number E%'ptrsti. &tc
e e tr) detpgtlie woro go�ttp a ,sped mg a pe, oran
�i/4jtfu l�L�/ai%htls°t fyjC64/
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 will be
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, furnish the material and labor specified above for the total sum of: �✓ (*)
Pay, e�ncsjwill be made according to the following schedule:
G
$ " upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$ by
_/_/ r upon completion o
$ by /_ or upon completion of _
$ upon completion of the contract. (Law forbids demanding full payment l/t`il 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 $ to be paid for
4.
to meet the completion schedule.(**)
NOTES:(*) Including all finance charges (* *) Law requires that any depositor 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.
.. r n - is a e: r s w rr n me provided by the contrador? No Yea tall terms of the warranty must be attached to thecontract!
Subcontractors -The contractor agrees 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 aoreement
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 One Ashburton Place, Room 1301, Boston, MA 02108 or by 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 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.
Lv INvi 01"I'm 1nla ULK IKAU1 It 1 1ERE ARE ANY BLANK SPACES!!!
,! Two identical copies of the contract must be completed and signed. One copy should go to the homeo oth by the contractor.
Homeowne ' ignature Contractor's Si
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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 sho be required
to submit;to suc bi ation as provided In Massachusetts General Laws, chap4
Ho �eg) er's Si tyre Contractor's
Nd�fCE: The signatures of the parties above apply only to the agreement of the paraeto 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. hi addition to guarantees or warranties provided by the
contractor, all goods sold in Massachusetts cant' 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 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 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 Consumer Guide to the Home Improvement Contractor
Law," contact:
Consumer 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 ort -800-223-0933
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
(413)734-3114
Contract
733 Turnpike LLC
Doug Locke March 18, 2009
RE: Jasmine Plaza, North Andover; continue snow skirt around front of building to end of
Dunkin Donuts drive thru
*Strip shingles up 6', strip sidewalls as well, remove trim on large gable end
*Remove any rotted wood and replace with new @ $3.00 per foot
*Install 2 courses of ice/water barrier
*Install drip edge
*Install 20"x4' aluminum (.040 Hartford Green) panels to roof, caulking between panels
*Install 18" of ice/water, 9" on panels and 9" on roof
*Tie in shingles and metal with new 30 -year Architectural shingle
*Finish valleys and sidewalls flashing with same materials
*Cap two hips with aluminum, one with shingles
*Install roof to wall flashing at transition
Labor & Material: $ 14,745
C en
*Install new clapboard and corner boards on sidewalls
*Install new trim and 8' of fascia on each side of large gable end
Clean and remove all debris
Labor & Material: $ 985
Total Labor & Material: $15,730
1/Z payment due prior to start of job, remainder due at completion
ho'ugTocke Eddie O'Keefe
Fax sent by : 7817294468 SHIELDS & ASSOC. INS 03--38-89 87:54 Pg: 1/1
ACORD CERTIFICATE OF LIABILITY INSURANCE
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EXPIRATION DATE THEREOF, THE ISSUING MURER WILL ENDEAVOR TO MAIL 10 VAYS
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DESCRIPTION OF OPERA71Of1SILOCATKW&PVEHICLESIEXCLUSFONS ADDED 13Y ENDORSEMENT] SPECIAL PROVISIONS
A"mu Zs pw1 ) COffflkoto 0 4248 (b ACORD CORPORATION 1888
SHOULC ANY OF THE ABOVE DEWJW..D POLICES BE CANCELLED BEFORE THE
733 TURNPIKE, LLC
JASMINE PLAZA
EXPIRATION DATE THEREOF, THE ISSUING MURER WILL ENDEAVOR TO MAIL 10 VAYS
WRITTEN NOTICE T4 THE CERTIFICATE HOLDER NAMED TO THE LEFT, PUT FAILURE
TO CO 60 SHALL IMPOSE NO O&JW. ION OR ;°M UTY OF ANY 11,1NL: UPON THE MURER,
733 TURNPIKE STREET
ITS AGENTS OR REPRESENTATWS.
NO. ANDOVER, MA 01846
8TS-745-7101
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The Commonwealth of Massachusetts
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600 W¢shinocqon Street
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Boston, MA 02111
Workers' CoWWK,.M=S.gov/dia
Compensation Ins uranee.Affidavit: guildersontractors/Electricia,ns/Plu
olicanf Iaforlaation /Cmb„rs
Name (Business/Organization/individual):
Address: 3
City/State/Zip:_:Ya�4/,L
3��
Phone #:
Are
eyoouu an empioyer7 Check the appropriate box:
�,- t am a empioyer With 4. ❑ i am a tr
=enera.l contractor and.1
2. ❑employees (full and/or part-time).* have hired the sub -contractors
1 am a sole proprietor or partner- Iisted ozi the attached sheet $
ship and have no employees These sub
working for me in any capacity.
No workers' comp. insurance
required.]
3. ❑ 1 am a homeowner doing all work
myself. [No. workers' comp.
insurance required -1 t
-contractors have
workers' comp. insurance.
❑ 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. insu
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Type of project (required):
-6• ❑ New construction
7• ❑ Reemodeiing .
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
i 1.❑
Plumbing repairs or additions
�::�u ^wi Fepairs
ranee required.] I 13 ❑Other
*Any appii ant.that checks box # 1 .must also fill our the section below showing their workers' compensation policy tnmrtnatton.
+ o meo rs th Who submit .this a U.St at indl(:etinL L`iey ere eiulfi� e::'4l;et;; ;�yu Ihen him outsidb auntracior6' 111,3( submit a new aRlUavtt tnai
zConttactota Ilial check. this boa'mttst attached an additional sheet showing the name.of the s v;o ,sactots and (heir wor
�ttng ion.
I am ar, employer that is providing workers' co ensadorz kers' romp, po}icy infatmation.
informationurefor ml' employees. Below is the policy and joh site
Insurance Company Name: Atv ,�,� �•� I,/ /I'— - , _ .0-/
Policy # or Self -.ins. Lic. #:/('. `7 f^�, •
Expiration Date:
Job Site Address: )33
Attach a copy of the workers' compeasatioa oils tiecia City/Stat✓/Zip
Policy . ration page (showictg the policy number and expiration date).
Failure to secure coverage as required under Section 25A of
fine up to 51,500.00 and/or one-year imprisonment as well MGL 152 can lead to the imposition of criminal penahies of a
of up to 5250.00 a day against the violator. Be advised that a co penalties sste the form of a STOP WORK ORDER and a fine
Investigations of the DIA for insurance coverage ve copy of this statement may be forwarded to the Office of
g.. rification_
I do herehv
21- 1r -
of perjury tizat the information provided above is true and correct
Official use onip. Do not write inthis area, to be cnnrpleted h3, cit], or town nciaL
City or Town:
Permit/License #
Issuiag Authority (circle one):
L Board of Health 2. Building Department 3. CitY7OWjn Clerk 4. Electrical Inspector S. 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 "..wer-y person in the service of another under any contract of hire,
express or implied, oral or written."
An ernpinyer is defined as "an individual, partriership; 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,orthe
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 ap-wtments 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 empioyer."
MGL chapter 152, §25C(6) also states that "every state a r local licensing agency shall withhold the issuance or
renewal of a license or permit,to operate a bnsiness or to construct buildings in the commonwealth for -any
applicant who has not produced acceptable evidence cb-T compleance 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 worl< 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 compZ•etely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone numbers) 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 carryworkers' compensation insurance. if an LLC or LLP does have ..
employees, a policy is required_ Be advised that this affidavit maybe submitted to the Department of. lndustrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affiidavitshould
be returned to the city or town that the application for the permit or license is being requested, trot the Department of
Industrial Accidents, Should you have, any" tion regrL'rding the.laW or if you are required to obtain a workers'
compensation policy; please call the Department at the nmrnber:iisted below. Self insured co„sanies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that theaffidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit foryou to fill out in the event the Office of' nvestigations has to contact you regarding the applicant.
Please be sure to fill in the pe-nnit/license number which will be used as a reference number. in addition, an applicant
that must submit multiple pennittlicense applications in arty 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 citi=n is obtaining a licenser 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,
pleasedonot hesitate to give us a cail.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Dopar =nt of Lridustrial Accidents
Office of fnvesfigatior a
600 Washington Street
Boston, MA (12111
Tel. 4 617-727-45100. eft 406 or 1-877 MASSAFE
Revised 5-26=05
Fax 4 617-7227-7749
wvmmass.gov/dia