HomeMy WebLinkAboutBuilding Permit #649-2017 - 76 GREENE STREET 12/19/2016�D BUILDING PERMIT
Iz� I�'t4 v' TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: `�" Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION ao,, p
PROPERTY OWNER .1/ (/
TrA f 100 Year Structure
MAP G` PARCEL: 21� ZONING DISTRICT: Historic District
Machine Shop Village
yes no
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Resid I
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
11 Septic ❑ \Nell
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
OWNER: Name
Address: 7
DESCRIPTION OF WORK TO NtK1-KMt
/Ir� OQ
Identification - PIe e 7
Print Clearly
9i
Contractor Name: / Phone:
Address:
Supervisor's Construction License
Home Improvement License:
ARCHITECT/ENGINEER
Address:
0,24�(0C-b
Exp. Date:'
Exp. Date:
Phone:
Reg. No.
I
FEE SCHEDULE. BULDING P IT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
mom- �-
'r-
Total Project Cost: $ FEE: $
Check No.:Receipt No.: �1
NOTE: Persons contracting with unregistered contractors do not have access he gua •anty fjunnd
Signature of Agent/ -Owner Signature of contract
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 Reviewed On Signature,
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
t
F.
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
-- , Conservation Decision:
Commen
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
I
-1 n
ood 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 No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Nu i is ana UA I A — (For department use
❑ Notified for pickup Call Ema
Date Time Contact Name
Doc.Building Pennit 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
❑ 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)
D 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)
o Copy of Contract
❑ Mass check Energy Compliance Report
Li 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
No.,,/,-"— Z -O/ -7 --
Check #
j
Date 19 / 9
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee $ f
Other Permit Fee $
TOTAL $
Building Inspector
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CS # 022680
HIC#103358
= ro owd =
A. J. Walsh & Sons
159A Waverly Road
North Andover, MA 01845
# of pages
978-688-6737
or
1-978-912-2853
Proposal Submitted To: Job Name Job #
Address ` /, , Job Location z,
Date &Zn Date of Plans
Phone # 60i— Architect
We hereby submit specifications and estimates for.
U
t �In�/��i/�''1 .I f:L-.:.L/. �wf/r.�i�c�fl �Q./11�C-�..r�✓�.% Cr.�il.4GC.+C.'C./ /c_.►y�':�tn'+•l4t _ �J�l/
IV
We propose hereby to furnish material and labor -complete in a6co,/ rdance with the above specifications for the sum of:
$r .�� .ale-.�%�iJI/ Dollars
with payments to be madeas follows:
Any alteration or deviation from above specifications invotwing extra costs wUl be Respectfully
executed only"upon written order, and will become an extra charge over and submitted
above the estimate. All agreements contingent upon strikes, accidents, or delays
beyond our cohirol. Note — this proposal may be withdrawn by us H not accepted within days.
�cce�taatce of o�o�a�
The above prices, specifications and conditions are satisfactory and are /Sig tura
hereby accepted. You are authorized to do the work as specified.
!�'
Payments wfll be made as outlined above.
Date of Acceptance— 7. Signature Com`=y--
r g U
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 iLmormation
contractor information
Name
Company Name
w
Street Addr (do not use
Yolt Office Box address
Contractor/ ales n/ OwnerName
City/To
Sta Zip Code
Business Add(must include a street address)
o
/`
/&Z)
D '
P ones
Evening Phone
City/Town Mate Zip ode
Mailing Address (It different from above)
Bu tness Mone
Federal Employer iD or S.S.
limber
o
Home lmpmveromt Contmctorlty,Number
Expiration date
Lwrequim that most home
impruvemmt wrirsdora have
avaad regtrtntlon number
/ a
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed, specifying the type, brand, and gradeof� to be used, se additional sheets if necess .)
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 ��ate when contractor will begin contracted work.
MGL chapter 142A.) n_
/&te when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work, fumish the material and labor specified above for the total sum of M
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)
$ ^- by / / or upon completion of
,' / I � by / / or upon completion of
gal4$ ! W upon completion ofthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
Q The following material/equipment must be special $ paid for
ordered before the contracted work begins in order
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 warranty 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
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 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 IF THERE ARE ANY BLANK SPACES!!!
Two identical copies of the contract must be completed and signed. One copy should go to the homeo . The othXysbe kept by the contrac r.
OW
Homeowner's Signature Con ctor s Signature
17-( 111 11R &
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, chap
�;r1j42A
Homl;owner's SigUture Contractor's Signature
NOTICE: The signatures of the parties above apply only to the agreement 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 sinned by the
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 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 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 bim/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 hM://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 hn://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
hLtp:Hdb.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 2.1-11/21/2010
The Commonwealth of:llass(rehusetts
Department of Industrial Accidents
,�;r - Q ice o f Investi, afions
k 600 fV(tshin-fon Street
Boston, 1114 02111
-`"' -� �; tvtvtv.rttuss.,ot�/dia
Workers' Compensation Insurance Affidavit: Buildel-s/Contractors/Electricians/Plumbers
Applicant IIIforIllation
��illle (Busine» C)rganization`indiyidual):
!address:
City/State/Ziw"
4: /i
phone ff4,:
.Are you an employer? Check the . ppropriate box:
I .i am a employer with
4. ❑Ij 1 1111 a gencral 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 ille 111 ally capacity.
employees and have workers
[:to workers' comp. insurance
comp. insurance. -
required.]
3. ❑ 1 am a homeowner doing all work
myself. \o workers' comp,
insurance required]
❑ We are a cotporation and its
officers have exercised their
right of exemption per MGLc �l 52. § 1(4), and we have no
employees. [\o workers'
C01111). insurance required.]
Le6ibly
Type of project (required):
6. ❑ \ew construction
7. ❑ Remodeling
S. ❑ Demolition
9. ❑ Buildings addition
10.❑ Electrical repairs or additions
1 L❑ Plumbing repairs or additions
1?.oofrepaiI's
13.0 Other— —_—
"Ane applicant that checks hos =1 nmst also rill out the section belo\y sho\\'ing their \\orkers* cmttpensation paliey inform cion. —
Honteo\yners \vho submit this affidavit indicating they are doing all \cork and then hire outside contractors must submit a ne\\affidavit Indicating such.
'Contractors that check this box must attached an additional sheet sho\\ ing the name of the sub-conu'actor and state \yhether or tu>t (hose entities have
employees. If the sub -contractors have employees. they must provide their \\'orkers' comp. policy number.
I am an employer th(tt is providin workers' compensation in.surolleefor rrrt e'nrpinrees. Beloit, the /)OIiCr anll joh site
information.
insurance Company Name: _ �A%y'/ 1 �17 Z/041141S--Y^
Policy or Self -ins. Lic. Expiration Date: %Y117__
lob Site Address: 7� C,—L=e—ly e-- S / City'Statc'Lip: 3./C/_ / /�%/-
Attach a coPy of the workers' compensation police declaration page (showing the police number and expiration date).
Failure to secure coverage as required under Section 25A of' \'iGL c. 152 call lead to the imposition of cl-111111111 penalties of -a
fine up to 51.500.00 and/or one-year imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a coPv of this statement may be for yarded to rile Off -ice of
investigations of the DIA for instuYance coveraee verification.
l do herehr certif rrtc'r tlr' pains and penlrlties of perjurl, that the infornwtion provided above is tale on'd correct
Sillnature: t !l" % / 1 %/%t`
Phone :=: G� -�7.3 7
OJficial u.ce only, Do not write in this area. to he completed bl, citr or tow/ official.
Cite or Town:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. C itv/"town Clerk 4. Electrical Inspector 5. Pluntbiug Ilispectol•
6. Other
Contact Person:
Phone #:
AJWALSH-01 JONE
ACO�Q`
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)11117/2016
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 have ADDITIONAL INSURED provisions or 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 NAiAE:
Durso & Jankowski Insurance Agency
11 Saunders Street iAHIc°°, No, Ext): (978) 688-7000 j
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS -022680
Construction Supervisor
ARTHUR J WALSH JR M1
159A WAVERLY RD
N ANDOVER MA 01845
Expiration:
Commissioner 06/09/2018
rJXrrrriiiiirr.rrricrr�/� r/G?/�lv rir�ri r•/J.
�= Office of Consumer Affairs & Business Regulation
,Y+ : r HOME IMPROVEMENT CONTRACTOR
1-_--_ 1egistration:
�{ 1 R 103358 Type:
Expiration: °= 7/7/2018 Private Corporation
A. J. WALSH & SONS jN- C.
Arthur Walsh
55 Pleasant St
N Andover, MA 01845 ~~ —
Undersecretary